On the quality of education, not only at WUM

What is the medical professions’ training process based on today? 

To answer this question half jokingly, it should be based on the usual. On committed students who are aware of their proactive role in the education process, on teachers dedicated to their profession, and on a friendly environment that offers the right atmosphere for learning. These three pillars have to be strong.

However, if you want me to answer from a methodological perspective, education should be based on well defined targets. These should be followed by syllabuses tailored to these targets, and ultimately based on well matched methods. 
If we are talking about advanced education, we are observing a certain paradigm shift today. It is happening across the entire spectrum of university training, not limited to medical training. We are withdrawing from a role of the university which is focused on professional training only. According to the recommendations of the European University Association (EUA), “The higher education learning experience will nurture and enable the development of learners as creative and critical thinkers, problem solvers and active and responsible citizens equipped for lifelong learning.” 
Obviously, WUM is an occupational school and as such it will mainly prepare students for pursuing their profession. At the same time, however, we are paying more attention to the development of the competences mentioned by EUA.

What should be the top priority: theory, practice, team work?

Everything matters. It would be difficult to run practical training without theory, or engage in practical applications without team work. 

Then what should be changed about training at medical schools?

It is difficult to give a general answer to that question because just within the framework of its pre-graduation courses, the WUM Medical University of Warsaw offers studies in 16 faculties in Polish and 3 in English, each of them with its unique characteristics, not to mention the frequently special features of every subject taught at these faculties. As an example, let me refer to clinical practice at the Faculty of Medicine, with the largest number of students at our University. 
Within the scope of clinical training, the main teaching methods are based on seminars and practical courses. For the latter, we use methods involving direct work with patients. We may be discussing usefulness of specific techniques at specific stages of education, yet the most important matter is to provide the time and space for such training.

University teachers who work at hospital departments are doctors and researchers at the same time. They work under a lot of pressure. Hospitals tend to press them for proper patient care, performance of procedures, whereas the school requires them to do research work. The number of students, particularly at the Faculty of Medicine, keeps growing all the time, with a relatively stable number of university teachers, and the teachers often have to overcome a lot of problems to give their students time and space for practical training in the right environment, with the right access to patients.

 
As regards seminars, it would be good if these cease to be mini-lectures and to become actual seminar courses instead. The dictionary definition says that a seminar is a teaching method based on active participation of students who will independently work on at least some of the matters covered at the seminar and present their findings afterwards, in the form of a presentation or speech. This teaching format can be an opportunity for analysis and discussion. It also promotes student activity, thus not only ensuring higher retention of the learning contents but also showing students how to independently gather and organize verifiable knowledge and giving them foundations for effective lifelong learning. With academic knowledge being so extensively available today, the concept of a university teacher having the primary role of delivering knowledge is now obsolete. 

The main challenge faced by university teachers today is to engage students, to motivate them to study, to make them participate in the education process proactively. Moreover, students have to be taught how to sort and classify the knowledge they are surrounded with. They need to be shown what is important and what is not.

About the methods? Which ones are working today?

I would like to point out right here that new does not always equal good and old is not always bad. I am a strong believer in and practitioner of evidence-based medicine. There is also evidence-based education, employing methods which are effective, well matched to the learning goal, tailored to the student. The best option is to simply combine the different methods, without giving one preference over the others.

 
The formats which are both effective and relatively easy to promote at our school include case based learning and flipped classroom. 
Case based learning consists of resolving realistic clinical cases. Students review them, identify problems and take the right decisions. It teaches them critical thinking and a problem-based approach.
In the flipped classroom method, on the other hand, students acquire the theoretical background themselves before the class. This is usually done on-line, in the form of a lecture or a text piece. During the class, they focus on the practical aspects, i.e. on reviewing clinical cases, this applying their pre-existing knowledge in practice. 
I have to say these methods are highly satisfactory, both for the university teacher and for the student. They are also among the best remedies for the ‘seminar syndrome’, with students being bored with seminars that are still often being offered as lectures with presentation of slides.

Could we suspect that students will not be interested in a method requiring them to do extra work and to prepare before class?

Last year, at the Department of Pediatrics, we introduced the flipped classroom model at a 6th year course and we were worried that the students would protest, claiming it’s not feasible, they have no time to prepare, etc. However, we got almost 100% positive feedback after these classes. They were attended by approx. 200 students and most of them were strongly committed. I heard the same from the fellow teachers who would often extend the duration of these classes because there was so much to say and to discuss. By the way, I know from my discussions with university teachers applying so-called proactive teaching methods at other schools that such classes are appreciated very highly by students and teachers. In my opinion, we tend to underappreciate the students and their engagement. 

What else is working in the field of education?

Simulation methods are gaining importance. We have been using them at our school for a few years. That’s why we are so satisfied with our new large Medical Simulation Center to be opened soon at the Banacha Campus. We will have a lot of space there for high fidelity simulation classes: there will be an operating room, labor room, intensive treatment, emergency, to be followed with an air ambulance (helicopter and aeroplane) soon.
The simulation method is very engaging for students. Not only intellectually but also emotionally. It teaches them to think in action, to react quickly, to critically assess the situation. Students really enjoy it, and so do the teachers. Medical simulation is gaining importance as an opportunity for teaching hard procedures in a manner which is safe for everyone. Importantly, soft skills such as communication can also be learned in a simulation environment.

 
You mentioned evidence based education. What is the evidence of the methods we are now discussing being more successful than the traditional ones?

Most education methods used to be measured according to memorization rates. With case based learning, we not only memorize knowledge but at the same time we learn to use it in practice. And the latter is not often measured. Still, there is evidence to prove that while the differences between case based learning or flipped classroom and traditional learning are not significant in terms of memorizing knowledge, measured by exam passing rates, the newer methods work better than the conventional ones in terms of practical application of knowledge.
Naturally, case based learning and flipped classroom are just examples. There are more methods as advanced as these. Their use not only depends on their performance but also on the teacher and student preference.

The claim to give up lectures and seminars altogether is raised more and more often. Some U.S. universities are even boasting of lectures being a thing of the past in their organization. What are your thoughts on that?

Right now I am neutral about that trend. I am following it, curious about what emerges from it. We have to say it openly that lectures are effective in conveying knowledge. Please note that all scientific conferences are still being held as series of lectures. This has not yet been given up. In my opinion, lectures still have their place in teaching, although they should not be too long and they should be skillfully engaging for the audiences. They are often a good starting point for applying other methods of acquiring new knowledge and skills.

 
What are the limitations for introducing innovative teaching methods at medical schools, and what are the sources of these limitations? 

Of course there are many reasons. The need to combine multiple roles does not leave university teachers much time for the reflection they need on their present teaching methods and their adaptation to the students’ current needs. Another thing is us being accustomed to the traditional teaching methods. We tend to teach others the way we were taught once, and we still believe in the idea of ‘conveying knowledge’ as the teacher’s primary mission, which determines our consistency in pursuing the old teaching methods.

 
In order to introduce a new method, you need to leave your comfort zone, get rid of your own habits, apply that method and convince others to do the same. Nothing is more difficult than innovation, particularly whereas not every innovation is a success. Fortunately, there are many verified methods in medical educations that are available for use.
Finally, we have to remember that we are bound by certain organizational restraints. These require the school to comply to strict standards and certification requirements. On one hand, this is a good thing, yet on the other hand it may sometimes impair innovation. What matters most in teaching is flexibility, ability to adapt your methodology to the syllabus, to your goals and, naturally, to your own ability.

How do you deal with such limitations? 

This is not a question to me but to the entire academic community and the so-called third parties responsible for funding the education system, and the funding is inadequate. From my perspective, one of the most urgent needs is teacher education in methodology, i.e. organization of teacher training. Such courses are of course offered at WUM, yet there are still too few of them. In our present financial situation, we need support with grants for education, which we continuously strive to get.

Good quality of education at medical universities not only involves learning methods but also certain areas of knowledge, previously not appreciated enough; what I mean here is, for example, opening new courses in communication. Why is this area so important?

Good communication improves patient relations, which plays an essential role in treatment. In addition, it lets the medic get a full view of the patient’s condition, and that in turn translates into better decisions as to diagnosis and treatment. Finally, it offers emotional support so that the patient is able to deal with their disease more successfully. There is certain research demonstrating that good communication between medical professionals and patients is important for the former, as it prevents some medical errors and professional burnout.
At our school, communication courses are held at the Medical Communication College. These courses take place in various formats: as lectures, practice with simulated patients, case based method. They are held at very many faculties. Not only at the Faculty of Medicine, Medical Dentistry, Nursing and Obstetrics, but also at Audiophonology, Physiotherapy, Public Health, and Pharmacy. And this is just the first step because introduction of an even broader range of formal communication courses into the clinical course units is intended.

What is the education quality assurance system at WUM?

The education quality assurance documents contain one very important sentence: “All members of the academic community at the University are responsible for the quality of education, including the University authorities, teachers, administrative workers, students, PhD students and post-graduate students, through their attitudes and actions.” It implies that we are all actually responsible. 
From the formal viewpoint, our structure serves the purpose of learning quality assurance, evaluates the quality and inspires pro-quality undertakings. The structure consists of faculty-specific education quality workgroups (employing teachers and students), working directly with the dean level authorities. The Education Quality Workgroup at the University level inspires and supervises the operations of faculty-specific quality workgroups; the central Workgroup is composed of representatives of faculty workgroups, students, and administrative staff. We also have our Competence Development Bureau, supporting these workgroups in administrative terms. All those are overseen by Vice-Rector for Student Affairs and Training. Let us still remember that without building a learning quality culture, no workgroups are able to succeed. By culture, I mean the right attitudes and actions by all members of the academic community.

Interviewer: Iwona Kołakowska
Photo by Michał Teperek
University Communication and Promotion Office