Does the three-cycle structure facilitate the free movement of doctors?
There is no persuasive evidence that the three cycle structure currently facilitates the free movement of doctors. This is partly a result of a significant number of countries having an integrated degree in medicine and not a three-cycle structure. The perceived benefits of the Bologna cycles for Medicine relate to the value in being able to recognise the learning of
students who do not complete the full master or integrated cycle qualification. This is a significant issue in some countries, but stakeholders are unanimous in saying that this benefit is explicitly guided towards supporting medical students to access the labour market for professions other than doctor. It is therefore relatively inconsequential to the free
movement of doctors.
However, there is also evidence to suggest that the introduction of the Bologna cycles is not or should not be problematic to the existing education and training of doctors:
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if implementation of the Bologna cycles is not aimed at creating an artificial split between the theoretical and clinical elements to training; and▪
if the introduction of the bachelor and master for Medicine does not equate to a change in the basis on which medical students enter training (i.e. students still „sign up‟ for the two cycle programme as this is the entry point to the profession).10.2.2 Calculating the duration of training for doctors
Does calculating the duration of training using ECTS facilitate the free movement of doctors?
There is a sufficient degree of awareness of ECTS to envisage using this system in the recognition of professional qualifications. A clear majority of competent authorities saw ECTS as adding value. However, concerns have been raised about the inconsistent use of ECTS across countries and a lack of consensus about the fundamental role ECTS should play (i.e. as a slightly refined measure of duration or as the cornerstone of an approach to recognition based on knowledge, skills and competence). The countries taking part in the Bologna process have agreed that ECTS shall be the common credit structure, or shall be related to the ECTS-scale. This means that its introduction could be, in the short-term at least, potentially confusing and lead to different interpretations at national level.
It is much more straightforward to suggest that there is added value in including ECTS as an additional element to the existing duration measures. How ECTS might be incorporated in this context depends on the interpretation of the current duration criteria (of at least six years‟ study or 5,550 training hours) as being separate options or cumulatively applied. Under the Commission‟s latter interpretation, numerous stakeholders saw ECTS as a potential replacement for hours alongside the six-year requirement. Replacing the taught hours by credit would enable more flexibility in the design of programmes, as ECTS takes into account all forms of learning. However, it is not clear that this would substantially support the free movement of doctors given that the six-year requirement remains. ECTS is based on the principle that one year of full-time studies is equivalent to 60 credits, so it could be used instead of number of years – meaning that the requirement would be formulated as 360 credits.
The argument for ECTS additionally supporting free movement of doctors is clearer if it replaces the existing duration criteria (hours and years), by enabling more flexible delivery of medical training. This has been noted as an issue in the context of other sectoral professions (e.g. nurses); however it appears to have little traction with doctors‟ stakeholders and is unworkable for two reasons:
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There is consensus on the need for clear minimum requirements related to duration. Proponents of the Bologna reforms in the context of Medicine agree that that educational reform does not replace this basic need for a measure of duration.▪
Even though, ECTS retains a link to duration through the process of credit allocation there is currently an understandable lack of confidence in this process at institutional level (partly because ECTS is a new system in some areas and partly because the process of credit allocation does vary). If ECTS were the main measure of volume of input into study, this would undoubtedly become a major concern for competent authorities and unlikely to work in practice.Ultimately, it is highly-debatable whether ECTS offers concrete advantages over the current system in the context of the free movement of doctors. In contrast with other professions regulated under the general system (where ECTS is seen by some as providing a potential
platform for a more confident comparison of qualifications – and therefore arguably better recognition), the consensus among doctors‟ stakeholders appears to be that automatic recognition is a simple system for qualified professionals (because under automatic recognition, competent authorities do not assess the content of the qualification).Not all stakeholders agree that ECTS provides sufficient confidence in the quality and
appropriateness of training for doctors, but this is a much wider point about the system of automatic recognition. ECTS is neutral to that debate – except to note that some
stakeholders see the Bologna reforms generally, and ECTS specifically, as making more detailed comparison of training possible and therein exposing substantial differences in approaches to medical training that are not apparent through qualification title and minimum training conditions. In this context, there is an argument for considering ECTS in relation to any future updating of the requirements for training contents for doctors.
10.2.3 Methods to better-guarantee automatic recognition for doctors
Does recognition based on learning outcomes without taking duration into account better-guarantee automatic recognition for doctors?
The current system of recognition based on minimum harmonised content and duration is a better guarantee of automatic recognition than recognition based on learning outcomes without taking duration into account. Duration is a key element of the recognition of doctors‟