EDUCATIONAL ORGANIZATIONS
The Nordic Federation for Medical Education J 0 R G E N NYSTRUP
Med Teach Downloaded from informahealthcare.com by University of Otago on 12/30/14 For personal use only.
Jnrgen Nystrup, C A N D . MED., is Consultant in Psychiatry, 18 Tagensvej, DK-2200, Denmark.
The Nordic Federation for Medical Education (NFME) has the general task of improving medical education in the Nordic countries: Denmark, Finland, Iceland, Norway and Sweden. T h e basic idea behind our method is to allow medical teachers to meet and exchange views. With increasing experience these meetings have become fully structured and have focussed on specific areas, such as teaching methods, problems in evaluation, and teacher training programmes. As well as encouraging the pooling of educational knowledge and skill, N F M E has an obligation to encourage research in medical education. T h e frame of reference has gradually shifted from the undergraduate to the postgraduate sector in line with the general trend towards diversified and high quality postgraduate programmes. Today the Board of N F M E is concerned equally with problems in undergraduate programmes and in specialist education and training, and to a lesser degree with problems of continuing education.
Figure 1. The 19 medical schools in the Nordic countfes. Copenhagen, Aarhus, and Odense in Denmark; Helsindors, Abo, Ulea'borg, Kuopio, and Tammerfon in Finland; Reykjavik in Iceland; Oslo, Bergen, Tromsr, and Trondheim in N o w a y ; Uppsala, Stockholm, Lund, Cothenburg, Umei, and Linkoping in Sweden.
A Historical Sketch There are 19 medical schools in Denmark, Finland, Iceland, Norway and Sweden (Figure 1). T h e schools in Trondheim in Norway and Linkoping in Sweden do not teach the preclinical sciences. They receive at the end of their preclinical education students from Bergen and Uppsala respectively and provide the clinical part of the course. The University of Uppsala, Sweden, was founded in 1477, and the University of Copenhagen in 1479. From the beginning there has been an intimate relationship between these institutions. In 1843 a Scandinavian society was established, and students from all over the Nordic countries gathered in Uppsala to listen to enthusiastic speeches and songs about the 'common Nordic heritage and the prospect of a unified Nordic country. The movement was too idealistic to last and did not have any real political impact. However, after the First World War the governments began to encourage practical cooperation between the countries. Numerous bilateral or even pentilateral collaborating bodies have developed
Medical Teacher Vol 5 No 4 1983
149
Med Teach Downloaded from informahealthcare.com by University of Otago on 12/30/14 For personal use only.
throughout this century. The most important of these is the Nordic Council which consists of members of parliament from each country, and which makes recommendations to the respective national parliaments. ’ At the university level formal cooperation in the 1920s resulted in a Nordic series of lectures and courses. In the 1930s there were several committees initiated by the Ministries of Education at which the possibilities for common Nordic studies were discussed. Due to these committees several Nordic medical textbooks appeared. T h e medical faculties met sporadically in the 1950s to discuss major curriculum revisions. This led a small group of medical educators to become convinced of the value of a forum for regular meetings to discuss problems and innovations in medical education. No permanent platform for such discussions existed. Scientific Nordic medical meetings flourished, but educational issues were given low priority. T h e fact that political discussions regarding the creation of a common Nordic labour market were taking place provided an important spur for the preparatory work to launch the idea for a Nordic Federation for Medical Education. A common Nordic labour market was generally accepted in 1954, but medical doctors were not included until 1966. This common labour market for physicians necessitated collaboration between the governmental health authorities and thus had many important consequences for medical educators. In 1966 the N F M E was established formally at a meeting in Gothenburg. The meeting was presided over by the Chancellor of the University of Gothenburg and it was the first time all parties involved in medical education had met: representatives from the Ministries of Health
and National Health boards, deputees from Ministries of Education, delegates from medical doctors’ associations, and student representatives were present. T h e conference passed a unanimous decision to create a Scandinavian Federation for medical education. T h e conference also approved one statement on systematic instruction in specialist training and one on training in medical research. According to the constitution “the Federation shall promote and stimulate medical education at all levels throughout the Nordic countries. ” T o fulfil this the Federation will: 0 arrange seminars a n d conferences relating to educational problems of general Nordic interest especially those for which collaboration may aid solution; 0 stimulate experiments and research concerning medical education; 0 establish international contacts; contribute to the organization of joint Nordic teaching; take other appropriate initiatives which promote medical education.
Organization NFME has a unique structure which links government authorities, medical doctors’ associations and medical student associations. Figure 2 outlines the basis of the organization. There are no individual members of N F M E , but all individual members of the medical community, currently
Figure 2. The organization of the NFME.
150
Medical Teacher Vol 5 No I 1983
numbering 17,000 medical students and approximately 4,500 medical teachers, are represented through the member organizations of N F M E . These member organizations, represented from each country, are:
Med Teach Downloaded from informahealthcare.com by University of Otago on 12/30/14 For personal use only.
T h e government health authorities T h e ministries of education All medical faculties T h e medical doctors’ associations T h e young doctors’ associations T h e medical students’ associations
of
1FME. The future training of specialists. Gothenburg, Sweden, 1966 Teacher training in medicine. Stockholm, Sweden, 1969
Selection of medical students. Oslo, Norway, 1971 Comprehensive training of health professionals. Aalborg, Denmark, 1973 The relation of medical school training to general practice. Tampere, Finland, 1975 The problem orientated record in medical education. Akureyri, Iceland, 1978 Curriculum planning in medical education. Economical aspects of medical education. Linkeping, Sweden, 1980
Implementing sufficient technological know-how in medical education. Trondheim, Norway, 1982
Medical Teacher Vol 5 No 4 1983
Activities
Conferences
Depending on the particular structure of each country the channels of communication to NFME may pass through special branches, offices or subdivisions of the basic member organizations. Today many issues of particular interest for the medical faculties are handled through the curriculum committee. The Federation is made up of 58 authorities, organizations and institutions. No membership fee is collected. NFME is funded by the Nordic cultural budget provided for by the individual parliaments through the Nordic Council. T h e budget for 1983 is 540,000 Danish crowns. Every other year the 58 member organizations are summoned to the General Assembly. A Nordic medical education meeting is arranged to run concurrently, covering aspects which are thought to be attractive to the delegates (administrators, preclinical teachers, clinicians, medical educators, and medical students). Figure 3 shows the topics that have been selected so far. The formal task of the General Assembly is to discuss and decide the future policy of N F M E , to evaluate the past activities and to elect an executive board. T h e executive board is composed of one senior person from each country who represents that country’s member organizations. T h e exception to this is the representation for the medical students’ associations, two medical students representing all the medical student associations in the Nordic countries. T h u s there are seven representatives in total. T h e executive board employs a Secretary General to head the small office of NFME. This board
Figure 3 . Topics selected f o r the General Assembly
meets at least twice a year, and is responsible for planning the activities between the general assemblies.
the
Since the formal inception in 1966, N F M E has arranged 82 conferences on medical education. A sample of titles is shown in Figure 4. T h e number of participants in each meeting varies between 40 and 150. It is exceptional for a conference fee to be required, participation being free on the condition that travel, board and lodging are financed by the institution or organization which the participant is representing. T h e strength of N F M E lies in its provision of opportunities for medical teachers and students to discuss teaching under conditions which enable them to momentarily forget research and clinical services. As N F M E is publically funded it does not have special interests like private firms and organizations offering continuing education. T h e major conclusions from each meeting are distributed to each faculty and curriculum committee allowing igure 4. Sample
of titles of NFME
meetings.
Use of audiovisual resources in medical education. Stockholm, 1968 Administration of medical faculties. Abo, 1969 Workshop on evaluation of learning. Uppsala, 1969 Objectives in medical education. Helsingfors, 1970 Sociology in medical education. Stockholm, 1971 The preclinical sciences in medical education. Kungdv, 1971
Room for nutrition in medical education? Oslo, 1972 Evaluation of educational achievements in medicine. Kuopio, 1973 Specialist education in medicine, surgery. Abo, 1974 Clinical immunology-teaching aspects. Arhus, 1974 Workshop on written clinical simulation-the construction of patient management problems. Bergen, 1975 The teaching of interpersonal skills. Oslo, 1976 Mental retardation. New teaching strategies. Nyborg, 1976
The education of nursing +d medical students for health. Helsingfon, 1977 Postgraduate Nordic course in paediatric pharmacology. Kungiilv, 1977 Clinical pharmacology in medical teaching. New objectives. Bergen, 1978 Shifting objectives in the teaching of anatomy. Odense, 1979
How well is medical education adapted to the needs of the society? Experiences from Tromse. Tromse, 1980 Health disease and ageing. Gothenburg, 1981 New methods in teacher training and staff development in medical schools. Copenhagen, 1981 Chemistry in medical education. Um& 1982 The shaping of Nordic postgraduate education. Hijfn, 1982
151
them to include the latest progress with each field in their local curriculum planning.
Med Teach Downloaded from informahealthcare.com by University of Otago on 12/30/14 For personal use only.
Special Working G T O U ~ S
Special working groups are sometimes instituted to collect appropriate data and make recommendations to NFME. These working groups often need to consult respective authorities in each country. Thus in the very process of solving their tasks such working groups become in themselves a stimulus for educational development; discussing and comparing educational approaches from country to country, and confronting the authorities with questions about rationale and about their willingness to adapt the system to improve Nordic collaboration. A working group has just finished drafting a set of recommendations on methods for evaluating teacher competence. These recommendations will be published in a small leaflet with appropriate documentation, including a Nordic survey on the present situation, and international references. As a consequence of the activities of NFME some 102 reports and articles have been produced. Other Courses and Publications
In order to stimulate joint Nordic postgraduate courses, NFME organized a series of postgraduate model courses. Such efforts highlight some of the administrative barriers between nations: barriers which result in underutilization of medical teaching manpower in the Nordic countries. NFME does not have any permanent responsibility to organize teacher training courses, but teacher training is obviously of prime interest to NFME. New ways are tried out and conferences to evaluate the programmes are often held. NFME would like to stimulate more teaching centres to offer teacher training sessions. A comparative description of all the curricula of the Nordic medical schools was published in 1976’ and updated in 1981.’ The language chosen for the conferences and the publications is usually one of the Scandinavian languages other than Finnish or Icelandic. However, English is quite often chosen and some of our Finnish colleagues prefer English as a standard language. When international medical educators participate in our meetings the conference language is always English.
Disseminating Information to Medical Teachers Although no individual membership of NFME is possible it is important that individual participants in conferences and general assemblies function as contacts and tell their colleagues about the role of NFME as an agency encompassing all those concerned with medical education in the Nordic region. Information on current activitied is accessible for all physicians in the Journal of Nordic Medicine (published by the Medical Doctors’ Associations in collaboration with NFME). With the approval of each individual we file the names and addresses of participants 152
igure 5 . The N F M E logo: the interrelated reception an distribution of information about medical education among f i v e countries.
in o u r conferences. Many participants revisit NFME meetings, building a core group of medical teachers linking NFME to the large peripheral network of medical teachers. At each conference possibilities exist for microteaching demonstrations and feedback between senior colleagues regarding new teaching programmes, and each conference provides ample opportunity for exchanging teaching materials or promoting textbooks. NFME works in collaboration with many other international organizations. Despite different constitutions and different target groups the main goals in medical education are similar. Investment in common projects is an effective method of reaching our goals, and one which is often used. Excellent collaboration takes place with the Regional Office for Europe of the W H O , with AMEE (Association for Medical Education in Europe) and with AAMC (Association of American Medical Colleges). The NFME logo (Figure 5) illustrates the most highly valued function of NFME: to receive and then distribute information on medical education to the medical community. New ideas are often contagious, information in itself often facilitates educational development, and above all shared knowledge provides a strong impetus towards high quality medical training. Ultimately that is what NFME is all about. References
‘Wendt F. Nordisk Rid 1952-1978. Stockholm: Nordiska Rltdet. 1979. ‘Nystrup J. Karlsson Y . De medicinsba studieplanerna i Norden-en oversikt. Nordisk Mcdicin 1976; 5 : 149-152. ’Nystrup J , Oldinger E. De medicinske studieplaner i Norden-en ovcrsikt. Nordisk Mcdtcin 1981; 5 : I-VIII.
Medical Teacher Vol 5 N o I 1983
The Nordic Federation for Medical Education J 0 R G E N NYSTRUP
Med Teach Downloaded from informahealthcare.com by University of Otago on 12/30/14 For personal use only.
Jnrgen Nystrup, C A N D . MED., is Consultant in Psychiatry, 18 Tagensvej, DK-2200, Denmark.
The Nordic Federation for Medical Education (NFME) has the general task of improving medical education in the Nordic countries: Denmark, Finland, Iceland, Norway and Sweden. T h e basic idea behind our method is to allow medical teachers to meet and exchange views. With increasing experience these meetings have become fully structured and have focussed on specific areas, such as teaching methods, problems in evaluation, and teacher training programmes. As well as encouraging the pooling of educational knowledge and skill, N F M E has an obligation to encourage research in medical education. T h e frame of reference has gradually shifted from the undergraduate to the postgraduate sector in line with the general trend towards diversified and high quality postgraduate programmes. Today the Board of N F M E is concerned equally with problems in undergraduate programmes and in specialist education and training, and to a lesser degree with problems of continuing education.
Figure 1. The 19 medical schools in the Nordic countfes. Copenhagen, Aarhus, and Odense in Denmark; Helsindors, Abo, Ulea'borg, Kuopio, and Tammerfon in Finland; Reykjavik in Iceland; Oslo, Bergen, Tromsr, and Trondheim in N o w a y ; Uppsala, Stockholm, Lund, Cothenburg, Umei, and Linkoping in Sweden.
A Historical Sketch There are 19 medical schools in Denmark, Finland, Iceland, Norway and Sweden (Figure 1). T h e schools in Trondheim in Norway and Linkoping in Sweden do not teach the preclinical sciences. They receive at the end of their preclinical education students from Bergen and Uppsala respectively and provide the clinical part of the course. The University of Uppsala, Sweden, was founded in 1477, and the University of Copenhagen in 1479. From the beginning there has been an intimate relationship between these institutions. In 1843 a Scandinavian society was established, and students from all over the Nordic countries gathered in Uppsala to listen to enthusiastic speeches and songs about the 'common Nordic heritage and the prospect of a unified Nordic country. The movement was too idealistic to last and did not have any real political impact. However, after the First World War the governments began to encourage practical cooperation between the countries. Numerous bilateral or even pentilateral collaborating bodies have developed
Medical Teacher Vol 5 No 4 1983
149
Med Teach Downloaded from informahealthcare.com by University of Otago on 12/30/14 For personal use only.
throughout this century. The most important of these is the Nordic Council which consists of members of parliament from each country, and which makes recommendations to the respective national parliaments. ’ At the university level formal cooperation in the 1920s resulted in a Nordic series of lectures and courses. In the 1930s there were several committees initiated by the Ministries of Education at which the possibilities for common Nordic studies were discussed. Due to these committees several Nordic medical textbooks appeared. T h e medical faculties met sporadically in the 1950s to discuss major curriculum revisions. This led a small group of medical educators to become convinced of the value of a forum for regular meetings to discuss problems and innovations in medical education. No permanent platform for such discussions existed. Scientific Nordic medical meetings flourished, but educational issues were given low priority. T h e fact that political discussions regarding the creation of a common Nordic labour market were taking place provided an important spur for the preparatory work to launch the idea for a Nordic Federation for Medical Education. A common Nordic labour market was generally accepted in 1954, but medical doctors were not included until 1966. This common labour market for physicians necessitated collaboration between the governmental health authorities and thus had many important consequences for medical educators. In 1966 the N F M E was established formally at a meeting in Gothenburg. The meeting was presided over by the Chancellor of the University of Gothenburg and it was the first time all parties involved in medical education had met: representatives from the Ministries of Health
and National Health boards, deputees from Ministries of Education, delegates from medical doctors’ associations, and student representatives were present. T h e conference passed a unanimous decision to create a Scandinavian Federation for medical education. T h e conference also approved one statement on systematic instruction in specialist training and one on training in medical research. According to the constitution “the Federation shall promote and stimulate medical education at all levels throughout the Nordic countries. ” T o fulfil this the Federation will: 0 arrange seminars a n d conferences relating to educational problems of general Nordic interest especially those for which collaboration may aid solution; 0 stimulate experiments and research concerning medical education; 0 establish international contacts; contribute to the organization of joint Nordic teaching; take other appropriate initiatives which promote medical education.
Organization NFME has a unique structure which links government authorities, medical doctors’ associations and medical student associations. Figure 2 outlines the basis of the organization. There are no individual members of N F M E , but all individual members of the medical community, currently
Figure 2. The organization of the NFME.
150
Medical Teacher Vol 5 No I 1983
numbering 17,000 medical students and approximately 4,500 medical teachers, are represented through the member organizations of N F M E . These member organizations, represented from each country, are:
Med Teach Downloaded from informahealthcare.com by University of Otago on 12/30/14 For personal use only.
T h e government health authorities T h e ministries of education All medical faculties T h e medical doctors’ associations T h e young doctors’ associations T h e medical students’ associations
of
1FME. The future training of specialists. Gothenburg, Sweden, 1966 Teacher training in medicine. Stockholm, Sweden, 1969
Selection of medical students. Oslo, Norway, 1971 Comprehensive training of health professionals. Aalborg, Denmark, 1973 The relation of medical school training to general practice. Tampere, Finland, 1975 The problem orientated record in medical education. Akureyri, Iceland, 1978 Curriculum planning in medical education. Economical aspects of medical education. Linkeping, Sweden, 1980
Implementing sufficient technological know-how in medical education. Trondheim, Norway, 1982
Medical Teacher Vol 5 No 4 1983
Activities
Conferences
Depending on the particular structure of each country the channels of communication to NFME may pass through special branches, offices or subdivisions of the basic member organizations. Today many issues of particular interest for the medical faculties are handled through the curriculum committee. The Federation is made up of 58 authorities, organizations and institutions. No membership fee is collected. NFME is funded by the Nordic cultural budget provided for by the individual parliaments through the Nordic Council. T h e budget for 1983 is 540,000 Danish crowns. Every other year the 58 member organizations are summoned to the General Assembly. A Nordic medical education meeting is arranged to run concurrently, covering aspects which are thought to be attractive to the delegates (administrators, preclinical teachers, clinicians, medical educators, and medical students). Figure 3 shows the topics that have been selected so far. The formal task of the General Assembly is to discuss and decide the future policy of N F M E , to evaluate the past activities and to elect an executive board. T h e executive board is composed of one senior person from each country who represents that country’s member organizations. T h e exception to this is the representation for the medical students’ associations, two medical students representing all the medical student associations in the Nordic countries. T h u s there are seven representatives in total. T h e executive board employs a Secretary General to head the small office of NFME. This board
Figure 3 . Topics selected f o r the General Assembly
meets at least twice a year, and is responsible for planning the activities between the general assemblies.
the
Since the formal inception in 1966, N F M E has arranged 82 conferences on medical education. A sample of titles is shown in Figure 4. T h e number of participants in each meeting varies between 40 and 150. It is exceptional for a conference fee to be required, participation being free on the condition that travel, board and lodging are financed by the institution or organization which the participant is representing. T h e strength of N F M E lies in its provision of opportunities for medical teachers and students to discuss teaching under conditions which enable them to momentarily forget research and clinical services. As N F M E is publically funded it does not have special interests like private firms and organizations offering continuing education. T h e major conclusions from each meeting are distributed to each faculty and curriculum committee allowing igure 4. Sample
of titles of NFME
meetings.
Use of audiovisual resources in medical education. Stockholm, 1968 Administration of medical faculties. Abo, 1969 Workshop on evaluation of learning. Uppsala, 1969 Objectives in medical education. Helsingfors, 1970 Sociology in medical education. Stockholm, 1971 The preclinical sciences in medical education. Kungdv, 1971
Room for nutrition in medical education? Oslo, 1972 Evaluation of educational achievements in medicine. Kuopio, 1973 Specialist education in medicine, surgery. Abo, 1974 Clinical immunology-teaching aspects. Arhus, 1974 Workshop on written clinical simulation-the construction of patient management problems. Bergen, 1975 The teaching of interpersonal skills. Oslo, 1976 Mental retardation. New teaching strategies. Nyborg, 1976
The education of nursing +d medical students for health. Helsingfon, 1977 Postgraduate Nordic course in paediatric pharmacology. Kungiilv, 1977 Clinical pharmacology in medical teaching. New objectives. Bergen, 1978 Shifting objectives in the teaching of anatomy. Odense, 1979
How well is medical education adapted to the needs of the society? Experiences from Tromse. Tromse, 1980 Health disease and ageing. Gothenburg, 1981 New methods in teacher training and staff development in medical schools. Copenhagen, 1981 Chemistry in medical education. Um& 1982 The shaping of Nordic postgraduate education. Hijfn, 1982
151
them to include the latest progress with each field in their local curriculum planning.
Med Teach Downloaded from informahealthcare.com by University of Otago on 12/30/14 For personal use only.
Special Working G T O U ~ S
Special working groups are sometimes instituted to collect appropriate data and make recommendations to NFME. These working groups often need to consult respective authorities in each country. Thus in the very process of solving their tasks such working groups become in themselves a stimulus for educational development; discussing and comparing educational approaches from country to country, and confronting the authorities with questions about rationale and about their willingness to adapt the system to improve Nordic collaboration. A working group has just finished drafting a set of recommendations on methods for evaluating teacher competence. These recommendations will be published in a small leaflet with appropriate documentation, including a Nordic survey on the present situation, and international references. As a consequence of the activities of NFME some 102 reports and articles have been produced. Other Courses and Publications
In order to stimulate joint Nordic postgraduate courses, NFME organized a series of postgraduate model courses. Such efforts highlight some of the administrative barriers between nations: barriers which result in underutilization of medical teaching manpower in the Nordic countries. NFME does not have any permanent responsibility to organize teacher training courses, but teacher training is obviously of prime interest to NFME. New ways are tried out and conferences to evaluate the programmes are often held. NFME would like to stimulate more teaching centres to offer teacher training sessions. A comparative description of all the curricula of the Nordic medical schools was published in 1976’ and updated in 1981.’ The language chosen for the conferences and the publications is usually one of the Scandinavian languages other than Finnish or Icelandic. However, English is quite often chosen and some of our Finnish colleagues prefer English as a standard language. When international medical educators participate in our meetings the conference language is always English.
Disseminating Information to Medical Teachers Although no individual membership of NFME is possible it is important that individual participants in conferences and general assemblies function as contacts and tell their colleagues about the role of NFME as an agency encompassing all those concerned with medical education in the Nordic region. Information on current activitied is accessible for all physicians in the Journal of Nordic Medicine (published by the Medical Doctors’ Associations in collaboration with NFME). With the approval of each individual we file the names and addresses of participants 152
igure 5 . The N F M E logo: the interrelated reception an distribution of information about medical education among f i v e countries.
in o u r conferences. Many participants revisit NFME meetings, building a core group of medical teachers linking NFME to the large peripheral network of medical teachers. At each conference possibilities exist for microteaching demonstrations and feedback between senior colleagues regarding new teaching programmes, and each conference provides ample opportunity for exchanging teaching materials or promoting textbooks. NFME works in collaboration with many other international organizations. Despite different constitutions and different target groups the main goals in medical education are similar. Investment in common projects is an effective method of reaching our goals, and one which is often used. Excellent collaboration takes place with the Regional Office for Europe of the W H O , with AMEE (Association for Medical Education in Europe) and with AAMC (Association of American Medical Colleges). The NFME logo (Figure 5) illustrates the most highly valued function of NFME: to receive and then distribute information on medical education to the medical community. New ideas are often contagious, information in itself often facilitates educational development, and above all shared knowledge provides a strong impetus towards high quality medical training. Ultimately that is what NFME is all about. References
‘Wendt F. Nordisk Rid 1952-1978. Stockholm: Nordiska Rltdet. 1979. ‘Nystrup J. Karlsson Y . De medicinsba studieplanerna i Norden-en oversikt. Nordisk Mcdicin 1976; 5 : 149-152. ’Nystrup J , Oldinger E. De medicinske studieplaner i Norden-en ovcrsikt. Nordisk Mcdtcin 1981; 5 : I-VIII.
Medical Teacher Vol 5 N o I 1983
