EDITORIAL

Bologna: excellence and ASPIRE

Bolonia: la excelencia y ASPIRE

Arcadi Gual, Jordi Palés-Argullós, Felipe Rodríguez de Castro, Albert Oriol-Bosch

Facultad de Medicina; Universitat de Barcelona (A. Gual, J. Palés-Argullós). Facultad de Medicina; Universidad de Las Palmas de Gran Canaria (F. Rodríguez de Castro). Fundación Educación Médica, FEM (A. Gual, J. Palés-Argullós, F. Rodríguez de Castro, A. Oriol-Bosch). Barcelona, España.

Correspondence

In previous editorials we have reflected on excellence and the quality of the university that we would like to have [1,2]. On the subject of excellence, we said it was a wish, a path and an effort, since as a goal, just like the horizon, it is something that is always beyond our reach. With respect to improving quality, we said that there are methodologies for putting the complexity of the process into order and we also pointed out that it required the participation of all the agents from within the university itself, together with that of all the relevant external ones. The improvement of quality and the pursuit of teaching excellence are two key elements in the DNA of the Bologna process [3].

We now wish to highlight an external element that may turn out to be a powerful system of leverage that can give a boost to the movement for excellence in faculties of medicine. We are referring to what is known as the ASPIRE project, which will be launched by the Association for Medical Education in Europe (AMEE) next year. Although in this issue we have included the presentation of the project (see pages 127-128), we would like to highlight some of its most significant points.

The ASPIRE project is the first attempt to achieve 'international recognition of excellence in medical education'. It has a number of distinct features and is not just another way of accrediting educational programmes or centres. Rather than focusing on the processes of accreditation and quality assurance, ASPIRE is intended to act as a stimulus encouraging permanent educational improvement. It is based on three principles: 1) the assessment of the effort made to attain educational improvement must be carried out among peers, education professionals; 2) it has to be evaluated according to pre-established criteria; and 3) it requires that the particular circumstances of the setting be taken into account.

ASPIRE is confident that one day it will be possible to conduct a global assessment of the educational excellence of faculties of medicine, but meanwhile three areas that are considered to be of special importance have been selected:

- Assessment of students.

- Students' commitment and their participation in the curriculum and activities offered by the faculty.

- Social responsibility and institutional accountability.

It seems reasonable to ask why these three areas were chosen, as they might appear to be somewhat marginal aspects of life in our faculties nowadays. From the Fundación Educación Médica (FEM) we wish to speak out in favour of the choice made by ASPIRE and we want to do so by relating it with the challenge imposed by the Bologna process.

Two years ago we published an editorial devoted to what we see as the greatest challenge arising from the Bologna process, that is, the evaluation of competencies [4]. Our considerations were focused on the complexity of the process and on how poorly prepared the institutions are to deal with it. No expert in education has any doubts about the fact that the educational process is guided by assessment. Assessment is the reality that those who are learning must face up to; it puts the institutional mission into practice with greater force than can be achieved through speeches. If the educational goals are not aligned with the assessment process, regardless of what the institution aims to accomplish, students will put all their learning efforts into succeeding in passing the evaluations they are required to do. In order to improve the assessment processes in the quest for teaching excellence, it is necessary to fulfil the following criteria formulated by ASPIRE:

- The evidence to justify excellence in assessment must include the following points: it should promote learning with the aim of achieving the educational objectives established at the outset; it must be a fair way of evaluating students' achievements; it must reassure patients that they are in safe hands by ensuring that only competent individuals can graduate; and it must foster permanent improvement in the assessment of competencies.

- The five criteria defined for this area are: a) the assessment programme must serve and reinforce the institutional mission and the educational objectives as a whole in order to improve the health of individuals and populations; b) assessment reinforces, enhances and creates learning opportunities; c) assessment ensures students' competence throughout their degree studies; d) the assessment programme is submitted to a strict, continuous process of quality control; and e) it is committed to innovation and academic rigour.

For each of these criteria, ASPIRE has defined between two and six elements that must be taken into account.

At present, education must be considered (from the constructivist perspective in which learning is contemplated) a process of self-construction of the area of knowledge and of psychomotor capabilities, as well as - and perhaps most importantly - a process of secondary acculturation [5]. By taking on the responsibility for learning, an active subject will be better prepared to deploy creativity and responsibility later on in life. It will be difficult to attain the capacities required to act freely in an educational model that seems more like a well-regulated prison ('it is Wednesday, eleven o'clock: time to listen to the lesson on beta-blockers') than an exploration of the unknown. Although it is true that organisations, including educational ones, need to organise themselves, such a process of organisation can in itself be conceived as a learning task in which those who are learning also participate. To learn to be responsible, that is, to learn to act with creative freedom, it is good for the educational setting to leave room for learners to act freely and responsibly. The second area of excellence can be justified by a logic that, although not conventional, nonetheless needs to be acknowledged in order to facilitate its incorporation into teaching institutions.

The recognition of excellence in students' involvement can be stated in twelve criteria that range from the development of an institutional vision and mission to the processes of accreditation, and include: teaching activities, development of curricula and assessments, community and extracurricular activities, scientific activities, leadership and management roles, and student support activities.

In societies with a democratic culture the institutions are expected to perform the duties and roles they are entrusted with in a correct manner, which entails accounting for the use of the resources that have been allocated to them by society. Universities - secular social institutions - are not exempt from this obligation and must abandon the golden isolation they enjoy within their ivory towers by offering a suitable response to the expectations of society. And faculties of medicine are no exception [6]. Bologna, in the process of creating the European Higher Education Area, acknowledges this to be the case [7]. Charles Boelen, who professed this social evidence from the World Health Organisation back in the last decade of the last millennium, has recently set it down in writing in a consensus document that was referred to in an earlier issue of this journal [8]. It should not therefore come as a surprise to find that ASPIRE took up this tendency as the third area in which to assess the efforts made to improve teaching.

The acknowledgement of excellence in social responsibility of faculties of medicine is grounded on four criteria:

- Institutional function and organisation, which includes both the raison d'être of the faculty and its mission and its management, the standards that are required and their accreditation.

- The educational processes, ranging from the admission of the students to the contents and the opportunities for personal development of the educational programmes and the contribution in post-graduate professional training and continuous professional development.

- Research activities and the training of researchers.

- The contribution made by institutions to the healthcare services in terms of both the direct provision of services and, above all, the production of quality and the type of doctors needed to render the services.

We are confident that the ASPIRE project will be welcomed by those faculties of medicine that are aware that not only are they obliged to provide the best answer to society's expectations, but also that it is in their interest to take the initiative without waiting for someone to impose coercive measures upon them. ASPIRE is an instrument that has arisen from the expertise of medical educators and not as a result of bureaucratic rules and regulations. It's been a long time coming!

Correspondence:
Arcadi Gual Sala
Departamento de Ciencias Fisiológicas I
Facultad de Medicina.
Universitat de Barcelona
Casanova, 143.
E-08036 Barcelona
E-mail: agual@ub.edu

Conflict of interests: None declared

References

1. Gual A. La universidad que queremos (I): la excelencia no se compra, se persigue. Educ Med 2011; 14: 195-7.         [ Links ]

2. Gual A. La universidad que queremos (II): la búsqueda de una mejora continuada. Educ Med 2012; 15: 1-3.         [ Links ]

3. Palés-Argullós J. Evaluación de los programas. Educ Med 2010; 13 (Supl 1): S61-5.         [ Links ]

4. Oriol-Bosch A. El reto de Bolonia: la evaluación de las competencias. Educ Med 2010; 13: 123-5.         [ Links ]

5. Oriol-Bosch A. Bolonia y la aculturación profesional. Educ Med 2011; 14: 71-2.         [ Links ]

6. Gual A. Responsabilidad social en la formación de los médicos. Educ Med 2011; 14: 133-5.         [ Links ]

7. Oriol-Bosch A. Responsabilidad social y Bolonia. Educ Med 2011; 14: 1-3.         [ Links ]

8. Boelen C, Woollard R. Consenso global sobre la responsabilidad social de las facultades de medicina. Educ Med 2011; 14: 7-14.         [ Links ]