6 The three-cycle structure and doctors
7.3 Perspectives on the potential added value from using ECTS rather than teaching hours
7.3.1 Extent to which ECTS adds value
Around half of doctors‟ stakeholders (47%) interviewed during the case studies saw potential added value in automatic recognition based on ECTS credits rather than using teaching hours. Many of these interviewees supported the approach in principle, because they felt that the current focus on teaching hours is a limited measure – in that it says nothing about the competence of doctors. The interpretation of ECTS in this context was therefore based on having ECTS linked to learning outcomes, which is not yet always the case.
A number of respondents were sceptical about how easy it would be to build consensus on the definition of minimum standards (or training requirements) in the context of ECTS. It was also noted, though, that ECTS is already widely used by medical schools in some countries at least.
7.3.1.1 Necessary conditions for ECTS to add value
The following comments were noted with respect to the necessary conditions for ECTS to add value:
▪
One health ministry interviewee noted the need to first address issues relating to credit accumulation – relating to the standardisation of what a credit means in each country.▪
According to another health ministry interviewee, the importance of equitability ofassessment and quality assurance, especially in the context of observational assessment of practice was felt to be an area in which trust was lacking.
▪
Its effective use implies and requires „a better competence system‟ according to one professional body. This was suggested as being a common system across Member States, but that is certainly not a majority view across the case study interviewees (this issue is discussed more fully in the context of learning outcomes in Chapter 8).▪
The extent to which ECTS provides an advantage for doctors‟ stakeholders depends on how the scope of learning is defined. The problem is that interviewees had different perspectives on what constitutes an ideal solution here. It „should only be based on hours under the supervision of the university‟, according to one ministry interviewee, while others saw the added value of ECTS in being able to incorporate the full range of settings in which doctors train.Table 7.2 Would the free movement of doctors be facilitated by having automatic recognition based on duration of study defined in terms of ECTS credits rather than teaching hours (the current system)?
Number of responses % of responses
Yes 7 22%
It depends on other factors (i.e. „yes, if...‟) 8 25%
No 13 41%
Don't Know 4 13%
Total 32 100%
Source: Case studies
7.3.1.2 ECTS to augment not replace existing duration measures with the Directive
Although there is not widespread support for using ECTS as an alternative measure to duration (years / hours) in the context of automatic recognition, there is support for its inclusion as an additional element. Table 7.3 below shows that two-thirds of doctors‟ authorities responding to the online survey agree or strongly agree that ECTS would strengthen the existing system.
The experience reports for doctors show that significant importance is placed on the calculation of duration in terms of teaching hours/years. Where reference was made to the duration of studies, this was often to support the approach (for example, in the reports of Finland, Bulgaria, Germany and Spain). A number of countries made no comment on the duration of studies. However, there are also references to a desire for more information about skills, knowledge and competencies required of trained doctors in other Member States. This could create a potential advantage of ECTS if it is assumed that a credit-based approach is the most effective means of measuring learning outcomes (given that the Bologna reforms explicitly link credit and learning outcomes).
There was some debate among interviewees about whether the current Directive
requirements should be interpreted as requiring studies of a minimum duration in years and hours – as opposed to years or hours. In the context of the former interpretation, a number of case study interviewees described ECTS as adding value to replace the existing measure of hours, alongside minimum study duration in terms of years. There is, of course, a direct link between ECTS and the calculation of duration in years, which would mean that the use of ECTS in tandem with number of years is quite straightforward – in theory, at least. ECTS is based on the principle that one year of full-time studies is equivalent to 60 ECTS. Applying this logic, six years of full time medical training are equivalent to the workload that
Users‟ Guide147
: „Qualifications which have formal programmes lasting three fulltime academic years are allocated 180 ECTS credits‟. In countries where all bachelor degrees have the same duration and so do all master degrees it is not unusual for countries to define a-priori that all Bachelor degrees are, for example 180 ECTS, and all Masters degrees are, for example, 120 ECTS, or to define that a Bachelor degree is a minimum of 180 ECTS148. For example in France, the requirements state that students must obtain 180 ECTS to gain a Licence degree (bachelor) and to gain a master‟s degree they have to gain 120ECTS (after having achieved a Licence)149.
Table 7.3 Do you agree that the existing system should be strengthened by explicitly mentioning the minimum volume of ECTS credit per qualification in the Directive? (number and % of respondents)
Doctors Architects Total
Strongly disagree 0 2 (14%) 2 (7%) Disagree 3 (17%) 3 (21%) 6 (20%) No opinion 3 (17%) 2 (14%) 5 (17%) Agree 9 (50%) 3 (21%) 12 (40%) Strongly agree 3 (17%) 4 (29%) 5 (17%) Total150 18 (100%) 14 (100%) 30 (100%)
Source: Online survey of competent authorities
7.3.2 Elements of ECTS that support or are a barrier to the free movement of doctors
According to case study interviewees, it is the entire package of ECTS that could add value rather than specific elements. Figure 7.1 below shows where interviewees identified particular elements of ECTS as supporting the free movement of doctors in the context of automatic recognition.
Around a third of total interviewees identified benefits in the fact that it is based on workload rather than teaching time, the way that it includes non teaching elements as part of an overall assessment of workload and the way in which it is linked to learning outcomes. Slightly fewer respondents also thought that there was a benefit in being able to look at workload at the level of specific learning modules. These elements are inter-connected, so the result is not surprising.
It is clear, though, that far fewer doctors‟ stakeholders thought that specific elements of ECTS were a barrier to free movement of doctors in the context of automatic recognition. A significant number of interviewees thought that ECTS would have a neutral impact
considering that a system of automatic recognition is in place, and it was a minority of interviewees that had view either way.
Many of those who thought that ECTS supports the free movement of doctors did so
because measuring workload and linking credit to the achievement of competencies was felt to provide a more meaningful comparison of fitness to practice. The implicit assumption for some interviewees here was that the current model of automatic recognition is unsustainable because it was felt not to reflect the quality of training.
This assumption is rooted in the wider concerns voiced by some doctors‟ stakeholders (competent authorities and other stakeholders) that the current system might not provide sufficient safeguards to ensure public protection. It should be noted, though, that it is difficult to unpick the extent to which these concerns relate to ensuring doctors are generally
competent to practice in the host country, as opposed to specific concerns – beyond the scope of this study – relating to ensuring language competence.
147
P.17 http://ec.europa.eu/education/lifelong-learning-policy/doc/ects/guide_en.pdf
148 See Eurydice National Education Systems descriptions – section 6 on tertiary education 149
P.166-167
http://eacea.ec.europa.eu/education/eurydice/documents/eurybase/eurybase_full_reports/FR_EN.pdf
150
NOTE: The profession totals do not correspond to the overall total for both professions because 2 respondents reported their response as applying to both doctors and architects.
Alternatively, some respondents saw the link to workload as providing a „less precise‟ measure of the qualification, which could lead to ambiguity in the recognition process. One interviewee questioned whether national systems having different credit allocations would be an obstacle to free movement. The link to learning outcomes was problematic for some because it implied a „lower level of theoretical knowledge is acquired by the student‟. Figure 7.1 ECTS elements that support or a barrier to the free movement of doctors under
the harmonised system based on automatic recognition
Source: case studies