1. Working Group 2: Development of teaching staff training curriculum compatible with European standards ROME TOR VERGATA UNIVERSITY ITALY Prof. Stefano Elia, Department of Surgery, Italy Tempus Coordinator Prof. Claudio Cortese, Department of Internal Medicine Prof. Angela Spinelli, Department of Literature and Phylosophy Prof. A. Volterrani, Department of Sociology Project TEMPUS IV 159328 – 1 – 2009 – FR – TEMPUS - SMHES Life Long Learning Framework for Medical Teaching Staff

2. Part 1 Present context in Italy

3. Italian System of Education High School Bachelor Degree 3 years Master of Science 2 years PhD programs One-cycle courses (5 or 6 years) Architecture/Law/Medicine

4. Italian University System First Reform: 1999 Law n.509 AUTONOMY Teaching By-laws and rules Financial Organizational

5. TEACHING AUTONOMY 1.1st cycle: Degree Courses (goal: to ensure appropriate empowerment of general scientific methods and contents and acquisition of specific professional knowledge) 2. 2nd cycle: Postgraduate Courses and 1° level Master (goal: provide an advanced level of education to perform high quality activity in a specific environment) 3. 3rd cycle: a)Postgraduate Courses and 2°nd level Master (goal: provide knowledge and capability for functions required by peculiar professional activities) b) Ph.D. Courses (goal: acquisition of a correct research methodology)

6. Medical Faculty is an exception in that it is articulated in a unique cycle of 6 years

7. Study Classes (Law 270) Courses of the same level that share goals and qualifying educational activities University Education Credits (Crediti Formativi Universitari - CFU) One credit = 25 working hours (comprehensive of lesson, individual study, lab, verification, etc.). Medical School 340 CFU divided by 6 years

8. Teaching and research autonomy > Art. 33 of Italian Constitution

9. Best Evidence Medical Education Evidence based Medicine plus Evidence based Education Opportunities International and experimental trials Introduction of humanities in the medical professional repertoire Attention to pedagogic role of medical profession Critical issues Research methodology and quantitative evaluation Exclusively emprical epistemiological presuppositions

10. BEME guidelines for medical education  Structure by problems;  Central role of clinical education;  Investigation of emerging problems, with reference and verifcation of scientific literature (aiming at searching for evidence proofs);  Evaluation of evidence proofs (accessibility, reliability, relevance, pertinence);  Analysis of transferability of evidence into an actual clinical case;  Self-evaluation in terms of self-learning of the work being done.

11. Main reasons for resistance to change  Sluggishness that pushes to defend your own action  Recognition of clinical committments as prioritary compared to teaching tasks  Non acceptance of education as a science with its principles  Ignoring fundamental elements of the educational process  Poor interest and minor care for educational activities  Complaining for lack of services and support for educational activities

12. Part 2 Life-Long Learning Framework for Medical University Teaching Staff

13. Life Long Learning Goals: 1. Professional update >> all medical doctors 2. Educational pedagogic update >> only for those physicians who play an educational role Transversal tools: a. Guidelines; b. Of scientific literature (and meta-analysis); c. Network of experts. Ability to read and correctly and constantly interpret the reviews. Itis a type of self-learning that has to be taught within the basic education of the medical doctor in order to build a mental dress oriented to constant education (and self-education). undergraduate (to include into core curriculum) postgraduate

14. Pedagogics and medicine Epistemological specificity: The object of the study is a subject, the human being, that can never be reduced to an object; It is not applied in a neutral context but in a world of values. Clinical VS Experimental Method

15. Pedagogics and Education in Medical School 1 Pedagogics Education Last goals of education. It elaborates on the values included and pursued by educational action. Educational goals Means and strategies to be used to achieve educational objectives Docimology: it assesses if, how and how much the established objectives have been achieved.

16. Therefore the educational process is made of three dimensions on which to work: Planning >> pedagogics Implementing >> education Evaluating >> docimology Core curriculum Teaching function Educational management Pedagogics and Education in Medical School 2

17. Core curriculum Undergraduate Implementation of clinical activity Implementation of humanities: phylosophy, sociology, history of medicine, psychology Postgraduate for medical doctors/teachers Pedagogics (education – educational technology) Docimology (experimental pedagogics)

18. They include psycho-antropological, ethical, epistemological aspects Dimension a: project Dimension b: implementation Dimension c: evaluation Pedagogics and Education in Medical School 3

19. Psycho-antropological aspects Who is the pupil? Individual educational needs Medical core curriculum Professional curriculum Style, ways and times of learning

20. Ethical aspects Which are the reference values of the learning subject ? Which criteria he has to use in decisional processes that involve ethical aspects ? Which responsibilities? How to harmonize ethics and deontology?

21. Epistemological aspects What is the scientific culture of contemporary medicine ? How research models and methodological presumptions are applied? Which competences for continuous updating ? Clinical Biomedical

22. Educational Management Academic institutions devoted to education Administrative, legal, logistic ties Plays the role of putting into relationship each other The management acts besides institutions and teachers in macro- planning and cooperates in the evaluation of the entire course. Some transversal work settings may be: 1)Study curriculum; 2)Courses and lessons such as: “history of medicine”; 3)Contextualize humanities that live within biomedical and clinical knowledge; 4)Recognize and implement research methodologies; 5)Reconstruct the formation of fudamental concepts for professional practice such as health/disease”

23. Part 3 Qualification requirements for medical university teaching staff developed (Teaching skills)

24. Pedagogics Normative NOT Describing Science The following hypothesis is a proposal of competence NOT a picture of the existing

25. Lesson Planning competences Planning Micro and macro planning Implementing Development Evaluation Management competencesCommunication competencesRelational competences

26. Management competences  Frontal lesson (mimics, voice management, space occupation…)  Cooperative didactics (organization of working groups for more complex goals than simple memorization such as decision making and problem solving)  Management of groups (for the analysis fof conflicts and ability to negotiate)  Simulation and role playing (active and participating didactic sto elicit transformation of knowledge into competence and to create situations which are similar to professionale ones)  Technique of case-study (decision making and individual problem solving).

27. Relational competences  Physical Setting (spaces, times, disposition of participants)  Psychological Setting (space of relation: care is not given to “removed” psychological aspects but to conditions that may be necessary to achieve different specific goals. E.g.: leadership type, definition of roles Communication competences  Verbal/paraverbal (oral exposition: times, ways, organization, clearness)  Written (needed to transfer the experience)  Tecnifor didactic communication (e.g. ppt, audiovisuals, electronic blackboard, videorecorded simulations, up to e- learning and teleconference or online working/study groups) Communication: content and exposition Site of power exerting on a single individual concerning the management of knowledge

28. Evaluation competences  Times/ways of evaluation (ex ante - in itinere - ex post)  Quantitative Methodologies (test creation)  Qualitative Methodologies (creation and interpretation) Metareflexive Competences  Observation  Analysis  Euristics Planning competences

29. Lab and tutorial activity Metareflexive competencesManaging competencesEvaluation competences  Definition of methodoloigcal premises  Research methodology  Logic of discovery  Tutoring  Scaffolding  Planning of significant working setting Observation:  Of practical and tehnical procedures  Of strong communications signals  Of weak communication signals  Of communication abilities  Of relational ailities  Of team working abilities

30. Didactic evaluation: 1)Teachers’ performance 2) Students’ performance 3) Course performance The evaluation may be quantitative (tests, questionnaires, multiple choice and filling answering, standard interview) and qualitative (non standard interview, participated observation, etnographic method) Medical didactic goals have to be related to the need for care. Therefore the overall evaluation of a Medical School/Faculty has to include the analysis of the relationship between medical personnel education and long term changes produced as an answer to individual needs.

31. How to put this model into practice? 1.Need for an appropriate normative 2.Need for “education for educators” undergraduate postgraduate 3. Evaluation system

32. 1.Normative For undergraduate path Include into curricula human sciences which are required by Degree Class (similar and integrating activities) BIO/08 - Antropology M-DEA/01 – Demoetnoantropologic sciences M-PED/03 - Didactic and pedagogics M-PSI/05 – Social Psychology MED/02 – History of medicine SPS/07 – General Sociology Pedagogic knowledge and humanistic vision widen relational competences even for those physicians who will not play a teaching role but will exert an educational role towards patients (e.g. therapeutic education)

33. Postgraduate education path for physicians with a teaching role A pedagogic-didactic proposal (5 CFU)

34. Pedagogics and Andragogics : 6 h Educatonal relation Specificity - Empowerment2 Ehtics and education responsibility Educational Deontology Knowledge ad power Euristics 4 Didactics: 14 h + 18 h PlanningCourses - Modules – Didactic Units Learning goals (knowledge and competences) 4 EvaluationQuantitative and qualitative evaluation ex ante/in itinere/ex post Statistic model and phenomenological model 10 Presential and distance practical activity: 18 h Didactic technologies: 34 h + 5 h3 Organizing and managing the setting Times - Spaces- Modes - Stuff4 CommunicationVerbal paraverbal – Writing for education - Technologies for presential and distance computer assisted communication with educational goals 10 Presential and distance practical activity: 20 h Management of relation The educational treaty – Management of learning groups - Animation of groups and management of conflicts - Cooperative learning – Active and cooperative didactic – Teaching “inter pares” and learning community – Didactic by poblems Communication pragmatics 18 Presential and distance practical activity: 20 h Monitoring and control Observation – Reflexion and metareflexion – The features of reflexive professional2 Presential practical activity: 18 h