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The majority of case study interviewees relating to the doctors’ profession (58%) thought that the current system of recognition based on harmonised minimum training content provided greater confidence than a system based on learning outcomes without taking duration into account.

Table 8.3 below shows that the results were similar for competent authorities specifically and for all interviewees. Similar responses were also found for ministries specifically and for professional bodies. There was no particular country pattern to responses – so the result is also not a simple reflection on the national familiarity with learning outcomes.

Table 8.3 The current Directive bases automatic recognition on the harmonisation of minimum training content and duration. Does such approach inspire more confidence than a system of recognition based on learning outcomes only (without taking duration into account)?

Competent authorities All interviewees Number of responses % of responses Number of responses % of responses Yes 9 60% 19 58% No 5 27% 10 30% Don‟t know 2 13% 4 12% Total 16 100% 33 100%

Source: case studies

8.3.2 The rationale for learning outcomes to provide more confidence as a system of recognition While the majority of case study interviewees thought that the current system was

preferable, it is superficially surprising that as many as 30% of respondents thought that learning outcomes inspire more confidence – given that this approach is without taking duration into account. It is important to note, though, that no interviewees suggested that the recognition of doctors’ qualifications should ideally take place without

reference to duration. Many thought that setting harmonised content/duration against learning outcomes with no reference to duration was „a false opposition‟.

In practice, interviewees took a more nuanced view of the question and many of those suggesting that a learning outcomes-based approach provided more confidence thought that the expression of the achievement of learning outcomes had to inevitably make reference to the volume of learning (e.g. through ECTS). The debate according to one medical education stakeholder ran as follows:

“You don‟t get any certainty from hours [spent training]. You need [a measure of] duration, but its not mutually exclusive. The key test is when medical student finishes, are they fit the practice? This is a competence question, not a curriculum question.”

Among the competent authorities in five countries that felt that learning outcomes inspired more confidence, in two cases this was simply an acknowledgement of the importance of learning outcomes for the specific purpose of building confidence in the system. In two cases, more specific examples were provided:

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Pragmatic response: One competent authority described itself as being „in theory‟ in favour of the learning outcomes approach. The increasing number of undergraduate medical programmes in the country and the general move towards a competence-based approach is making it „increasingly difficult to co-ordinate content in these cases - and the standards approach is more appropriate‟. It was acknowledged that „duration is an issue‟, and there was clearly a minimal requirement, but the preference for learning outcomes here was in part a response to a perceived over-emphasis on the minimum number of years‟ study that has a detrimental effect on moves to focus on what is

important from a recognition perspective (the competences developed through training rather than the time spent studying per se).

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Principled response: Another competent authority described the concern in terms of whether the existing system is able to effectively identify competence. If learning

outcomes provide a more accurate assessment of a doctor‟s fitness to practice then this should be used even if it complicates the assessment: „There are examples of applicants that have come to us with all the necessary qualifications and therefore we could not have refused the application. However, in reality the person was not suitable to be a doctor, they might be a microbiologist, and may not have the right attitude to deal with patients. A learning outcomes based system would mean that the applicant would prove that they could do the job - the practical side of things, not just ace some theoretical exams. It would inspire more confidence‟.

8.3.3 The rationale for the current system (content / duration)

Interviewees who were more confident in the current system of harmonised minimum content and duration predominantly held this position because of the widely-held view that a measure of duration is crucial to the recognition process. Other factors were influential as well:

▪

Some interviewees believed that there was not yet sufficient experience of the use of learning outcomes to provide a definitive view on how workable the approach was. There was an underlying scepticism that medical training across Europe was sufficiently

reformed along Bologna lines to make the use of learning outcomes feasible.

▪

Along similar lines, others questioned how feasible it would be to develop a common

outcomes measure for doctors that was sufficiently detailed to be useful and yet commonly agreed across Member States.

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The stakeholders who were most opposed to the use of learning outcomes feared that it would dilute the theoretical underpinning of medical degrees based on the logic that it could mean that certain subject areas, such as anatomy, which are argued to require a minimum input duration (in study hours, months or years) may no longer be safeguarded in terms of the depth of learning. This type of reaction may indicate a misunderstanding of the concept of learning outcomes among competent authorities for qualification recognition. Theoretical knowledge is also a learning outcome and the use of learning outcomes is not in opposition with learning of theoretical knowledge. When using learning outcomes, universities can design education programmes so that they contain courses/course components that refer to theoretical knowledge and that they define the learning outcomes (i.e. the knowledge) that learners achieve upon completion of the course.

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Although not explicitly articulated by many interviewees, it was clear that the views of stakeholders were to some extent determined by the medical training system in their own country.

However out the 19 doctors‟ interviewees preferring the current system (harmonised minimum content and duration), 12 of these interviewees said that they would have more confidence in if, in addition to learning outcomes, the system of recognition was based on harmonised minimum training duration defined in years and ECTS credits. This shows that the reluctance to incorporate learning outcomes among the medical profession is to a significant part based around the concern that the input measure of duration is lost.

Overview of the strengths and weakness of the two approaches

according to medical stakeholders

Harmonised content/duration:

Strengths:

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It is a „consolidated system‟ and largely effective (it supports mobility in the first instance)

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It has been effective – and more effective than any other approach – in promoting a degree of harmonisation at European level.

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People are familiar with the system

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There is always going to be a minimum duration to learning the knowledge, skills etc. Weaknesses:

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Training and education systems have to evolve (and are evolving) - there is no mechanism within the existing system for updating.

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Duration is too crude a measure – there needs to be a demonstration of competence.

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Duration is an inflexible measure.

Learning outcomes:

Strengths:

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More attuned to public expectations (patients would expect doctors to have particular competencies – interpersonal skills etc)

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Could impact on perception of training – what it should encompass.

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Would lead to a harmonised mentality for the profession (ethics, attitudes to health etc). Weaknesses:

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Only a current weakness, but it depends of having equivalent outcomes between Member States.

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Provides less confidence because it is less tangible than looking at the training content itself. Source: case studies

8.4

How learning outcomes should be incorporated

In document Hacienda el chocolate : practicas dirigidas (página 84-92)