Herman Van Rossum - MD, PhD Emeritus Professor in Medical Education (University of Amsterdam, the Netherlands), Head of the Center of Innovations in Medical Education (TMA).
Joke Denekens - MD, PhD. Professor in General Practice/Family Medicine and Medical Education, Past Vice-Rector (University of Antwerp, Belgium), Head of the Center of Innovations in Medical Education (TMA).
The Center for Innovations in Medical Education (CIMED) was established in TMA in 2021. CIMED is chaired by the University of Antwerp (Belgium) Professors of Medical Education- Joke Denekens and Herman Van Rossum, who visited TMA on a business trip in June 2022. The center’s purpose is to introduce innovative teaching-learning strategies while updating the educational programs of TMA; Implementation of self-directed learning and ensure integration between basic and clinical training courses.
1. How would you summarize your visit to TMA?
Joke: In one word it was very exciting. The staff is working very hard and is always excited to work together with us in one direction. It was very challenging to combine basic science teachers and clinical teachers because when we go further on with innovations in the next few years, teachers have to work “integrated” to teach the students. The most important thing I remember was that we had very good encounters with the teachers, students, and administrative staff. TMA team is working on a new curriculum, through constructive dialogue, sharing authentic problems and experiences. It’s the best audience we have in time, that’s the way TMA is working for the moment, I think.
Herman: It was my first-time visiting TMA. I was surprised when we entered the building, there were students around, and looking at us thinking “wow what these people are going to do here?” Looking back to the first day, we were asked to let teachers work together, and that’s coloring my memories of the first visit. We organized workshops for the clinical and basic science teachers together, and a clinical reasoning workshop for the students. It was exciting and rewarding because of the enthusiasm of the team.
2. What distinguishes TMA from other universities and what made you decide to cooperate with us in the long term?
Joke : The first time I came to TMA was in 2008, as the chair of the authorisation commission. I remember my entrance into the building. It was very special. There were students everywhere, talking, discussing, and laughing. When the Rector came into the building, they were so close to her that I had not seen this kind of friendly relationship before. I think the style of leadership is very different in TMA; in other universities, and also in our countries, rectors are not so close with the students. Your rector is a natural leader, she is not acting as a leader but she makes everybody enthusiastic and she cares about teachers, students, and administrative staff. She knows where she’s going because she is very visionary. In other universities, you have more individual lecturers and teachers and they are not so cooperative, and in TMA you can see the team. They form a real learning organization.
Herman: The atmosphere in the TMA Building is everywhere, students are zooming around, in the hall, the lecture rooms, in the elevators; everywhere you feel the spirit of teaching.
3. Could you briefly tell us about CIMED’s goals? How would you evaluate the progress of innovations implemented by CIMED?
Joke : I think the goals of CIMED are challenging. We aim to create the best medical doctors, and that’s a big goal. Doctors should be outstanding in clinical reasoning in the context of a bio-psycho-social encounter because a good doctor has to make good diagnoses and has to communicate with patients in a way, that he/she understands the patient in a holistic way patient can understand the doctor. We strive for doctors with “competence with compassion”., it’s very important.
Patients search for doctors who can make good clinical decisions and can take care of their patients in a biopsychosocial context. In any curriculum in the world or any healthcare system, we are not yet working on biopsychosocial content. We are working biologically and a little bit psychologically, but not biopsychosocial. So that’s a big endeavor for the CIMED. We also count on the competencies of CanMeds, and the role of the reflector, especially in the project Portfolio, where we teach students’ self-esteem and self-realization to build their personalities in a professional way and become good doctors.
We are working on a more patient-oriented curriculum, with real patients in the lectures. Also, student-centered, meaning that we activate students more, so they learn on the higher levels of intellectual functioning and not only learning by heart. We are also going to integrate a lot between basic and clinical practice. We have started small biopsychosocial, clinical reasoning, integration, and portfolio projects. I may not forget that we are going to install “Learn to learn”, a very important project in the first semester of the first-year students. This project is very important especially in the first semester because first-year students will be able to work better with a huge amount of information and the pages they must study. I think it will be one of the special things in TMA, caring for the students to learn on the higher levels of intellectual functioning and to reflect on the way how learning is taken place.
Herman: Joke was a principal advisor at TMA. Along the way, the Rector asked me to become part of TMA as an external advisor in CIMED. This was a very good decision to have a unit inside the TMA from where you can organize easier the small, but beautiful, projects we are conducting. We started with three small projects, mainly focused on the creation of interactive patient cases suited for clinical reasoning exercises with the students. Now we have developed a prototype for this format in which the actual patient case is analyzed step by step, following the usual medical problem-solving process of history taking, physical examination, differential diagnosis, prognosis, intervention, and reflection on the case. Until now we cooperated with clinical teachers who provided us the data of the real patient scripts; basic science teachers are constructing questions for these specific cases to let students explore in depth the pathophysiology of the diseases that are considered in the differential diagnosis and that are the basis for prognosis and intervention.
Now we are exploring the possibilities of using the patient library of over several hundreds of cases that are stored in the anatomical table. Several cases are already under construction. Teachers can use these cases immediately for instance in the 5th semester. The goal is to construct a TMA library of well-designed patient cases that teachers can use in their teaching.
4. In modern medicine, how important is it to apply an innovative teaching approach during the teaching process?
Joke: I think we are continuously working on innovations because the content, society, and science is changing. We are going to create teaching formats that are aligned with the needs of society, healthcare, and new technologies. I can give you two examples: first, most doctors in hospitals are working in teams, and in the first line more and more teams are becoming interprofessional. We are not doing enough in teaching interprofessional behavior and second, we need much more public health in the basic curriculum for medical doctors and care for individuals and society.
Herman: I want to add one point from the educational point of view. If you look at the world of education for the last 30 to 40 years, there was a big change in the approach to teaching-learning. TMA has a program in which teaching still predominates. Students have to hear and listen to their teachers and respond by studying and doing the exams. I think the best part of innovation is that students’ study first guided by teachers' assignments. After they have prepared their assignments, they should verbalize their answers. Then teachers will be far more effective by listening, correcting, and helping the students in understanding. I think that’s the main basic change in approach. We are moving from teacher-centered education to student-centered education.
5. From this perspective, how would you describe the situation in the European countries - where can we find the best practices in innovation, and where does TMA stand in this regard?
Joke: I think TMA is in the middle of the way of innovations in comparison with some Western universities. You are already working on an international level very well! We need more and more sessions where students are actively working with information to make it real “knowledge” that is easily accessible to the “doctor”. Students have to learn to make the networks in their brains well elaborated, to become good problem solvers.
Overall the world in this way of learning is not yet well installed in the programs. We all know we have to change the approach, but doing it is difficult. Especially in groups where there are too many students, it's very difficult to work in a student-centered way. I think it’s also an advantage of TMA that the groups are not too big. We can guarantee a personalized way of learning and teaching for each student, more than in universities where there are hundreds of students.
Herman: I think TMA needs a new program to change the balance between learning and teaching. Let’s transform a teacher into a guide for learning, a coach and feedback deliverer, and who is giving lectures that are focused on the points students find difficult to understand. Our experiments will be helpful in that direction. This transition in roles will take several years.
Another thing I noticed is that staff and teachers are very curious and participate in the international fora. They keep up with the newest developments and bring innovative ideas back to TMA and also bring their own experiences with innovation to the international platform for feedback.
6. How important it is to build the capacity of the academic and the administrative staff for achieving the goals set by TMA? How does TMA accomplish this?
Joke: I think teambuilding is very good at TMA, especially when we compare it to other universities, where teachers are trying to work together to make integrated courses. I think the most important thing, for now, is to build a capacity with administrative staff. There should be a good team of teachers and administrative staff, who will be responsible for ongoing projects, and supporting students, together with the teachers.
When students enter the first semester, it will be hard, not for all, but some, but after the first semester they will know how to study and how to follow. And will have much better grades. We are going to work in this way with duo or trio groups of students so they can help each other, and get also more integration between international and Georgian students. In this way, international students can learn more easily Georgian language. In times of Covid, students felt very alone, and we need small groups of students to learn from each other and build their capacity.
Herman: I just have one remark, there is a reservoir of intellectual power you should use more for your curriculum development, we like to stimulate its use. Students should be seen as partners in developing the new learning and teaching methods, so they can bring back to teachers what they learned in the later clinical years and so become part of the development of the integrative aspects of the program.
7. As CIMED leaders, what is your vision, and what are the plans for TMA?
Joke: One big challenge in my opinion is to go to more primary care courses. I hope that our patient clinic will be ready in a few years. I think we can build capacity outside TMA, with the first line in Tbilisi, but also in the small villages around Tbilisi. But that’s a very long-term project and in the meantime today we have to create very good medical doctors, to make them not only good specialists but especially very good general practitioners, and family doctors so they can build strong first-line care in Georgia. Georgia needs also a system with continuous education to stay as good doctors and be fit for purpose not only at the moment of graduation but for their career. They have to work for at least 40 years, so they have to study continuously. And that’s the system I would love to be installed in TMA. Another plan is also the installation of the program of public health, I think it’s necessary to work more on public plans, and the Ph.D. program. So, there is a lot to do.
Herman: Maybe I can talk about my dreams about the ideal curriculum, that has an in-built motor for renewal. At the moment we construct clinical patient cases for clinical reasoning in a small working group. We have installed a prototype, and once this prototype is there, we can raise the production of fresh cases. In the beginning, clinical teachers will deliver the scripts for the cases themselves. But ultimately the students in their last clinical years could write these cases about patients they have encountered, as proof, that they have mastered the complete analysis of a patient case in the bio-psycho-social model. Teachers should supervise the students and evaluate this process of writing such ‘clinical lessons. And then … students in the earlier years can use these patient cases for their study. Then the circle for developing updated cases can be closed. So, it is a dream, but I think it might become a reality in TMA soon.