Maarten Frens, vice-dean of Education, suggests having our conversation in the Erasmus MC Education Centre. Around us is the murmur of students who are studying or just catching up with each other. Frens has always liked coming here, but after the attack late last September he likes it even better. “It’s wonderful seeing all students come together here”, he says, walking past the large art canvas he officially opened last week. It covers the part of the Education Centre where the fire raged.
What prompted you to change the curriculum drastically?
“Do you ever still walk into a bank branch? You do all your banking online and digitally, don’t you? At first, people found this very impersonal and it felt unsafe. Yet this is exactly what healthcare is going to be like. It’s going to change enormously in the coming decades due to an ageing population, population growth, technological innovations and staff shortages. This calls for different care, different physicians and, therefore, a different programme.
“We embarked on this because all of us are really convinced that the profession of physician will look completely different ten years from now. And we asked ourselves: what will it be like to be a physician then?”
I read in the educational vision for the new programme that in 2017 the visitation committee found the programme a bit traditional.
“It’s funny; it’s the first-mover disadvantage at work. We were the first programme where scientists and clinicians worked together as early as the bachelor phase. What was missing then, though, and what we’re adding now, is more and better interprofessional cooperation – that is, between disciplines – and greater social responsibility among physicians. In addition, we have to pay more attention to technological developments. Since ChatGPT, this has suddenly become very obvious, but what we’d already seen coming is that many technological developments, such as artificial intelligence, will have a huge effect on medicine in the coming years. The current curriculum paid far too little attention to this, but every future physician will have to be able to relate to this properly.”
What is the biggest change to the programme?
“It starts with testing, really. We’re going to implement programmatic testing. This means no longer having students run form one examination to the next, taking a hurdle each time to progress a little.
“The new way of testing means we define clear competencies in advance that we want students to develop sufficiently in. Students do take knowledge tests, but they can use a dashboard to keep track of their progress in each knowledge domain. At the moment, they still get a mark for their overall knowledge, but this will become more specific. Rather than failing a test, you can see how you are doing in a given domain – think knowledge domains such as anatomy and physiology – and competencies such as cooperation and clinical reasoning. Of course, things do become very tricky when there’s no progress in a particular domain for a long time.
“By the way, we’ll only really be able to start programmatically testing everything in a few years. The full programme will be ready then and we’ll be able to see in which knowledge domains students need the most extra help. Until then, we’ll keep testing knowledge in the more traditional way. In September, however, we’ll already be able to start the programmatic testing of soft skills, or durable skills, as I prefer to call them.”
Durable skills?
“Yes, those are skills one no longer unlearns, such as good cooperation. Unlike some knowledge, this doesn’t age. Among these skills I count academic reasoning, taking responsibility, giving and receiving feedback – this sort of things.”
And the teaching itself, will it be different?
“For a very large part, we’re only going to offer small-scale teaching in the form of case-based learning. Case-based learning fits very nicely with medicine studies, because you look at a concrete case to discover what underlying knowledge is needed to solve the case properly.
Case-based learning is related to problem-based learning (PBL, as taught, for example, at ESSB and ESL – Ed.). The difference is that in PBL the lecturer is more of a coach, while in case-based learning the lecturer does contribute expertise and must have biomedical knowledge.”
What does this require from lecturers?
“Firstly, the lecturer pool will be reduced. About a thousand members of staff are currently involved in teaching at Erasmus MC. This means there is enormous fragmentation. I think everyone sees the training of students as a core task of Erasmus MC, but it’s hard to give it a prominent place in the hectic everyday life of acute care and ongoing research.
“Students have also told us this. They see different faces all the time, and there wasn’t always good coordination on what students should or shouldn’t already know and be able to do. Now we’ll be working in fixed groups of students with a fixed group of lecturers who are rotated every six months.
“We are currently hiring. I’d like the lecturer pool to be as diverse as possible: in terms of age and experience, but also in terms of background, as fits a city like Rotterdam.”
What kind of doctor will be at our bedside from 2030 on?
“It will be a doctor who works in a very different healthcare landscape. When you read that we’re headed for a healthcare stroke and one in three or four people will soon have to work in healthcare to meet demand, it’s time to restructure the field and keep care outside the walls of care institutions for as long as possible.
“We need to train students for the entire healthcare chain, not just to be medical specialists in hospital but emphatically also GPs, nursing home physicians and mental health physicians. “Technology will help with that. Papers in The Lancet are already saying that algorithms can make better diagnoses than physicians. This was already the case with diagnostic medical imaging.
So one’s role as physician will involve taking patients on board in this development.
“Students should learn to solve problems where the right answer isn’t on the back of a sheet, but where you really have to think about innovative solutions. We want to encourage such academic, creative thinking more. Not that we currently have a dumb programme, mind you. Wherever possible, the current programme will offer everything we are learning.”
Then comes the moment to discuss it: the attack at Erasmus MC last September that left a lecturer and colleague dead, while fire was set to the Education Centre where we’re sitting now. Sitting on a chesterfield in the Education Centre, Frens was relaxed as he spoke about innovations in the programme. Now he chooses his words carefully.
How did the attack affect the process and the development of the new programme?
“The loss of our colleague was devastating. We lost an important linchpin in the programme’s development. Then another close colleague who was running the project dropped out, which made things much worse still. So it’s definitely had an impact. Of course, the attack affected Erasmus MC as a whole, but definitely also the education sector. We are somewhat behind schedule, but we’re still Erasmus MC: we’re putting our shoulders to the wheel and moving forward.”
Did you know the suspected student, Fouad L.?
“I knew his file. That’s it.”
Did the event change your outlook on the programme?
“Yes and no. We have a number of students who everyone except they themselves can see aren’t suitable for the profession of physician. We only have very limited tools for letting such students go. This discussion has been going on for some time. In March last year, the Council of State ruled in our favour in another case: a student had rightly been expelled from the programme. Normally, you have to show that patient safety has been directly compromised, but we’re a good programme so we never let it get to that. It was clear for all to see, though, that this would have been the case had this student become a physician. The judge sided with us on that. We hope this verdict will help us in the future.”
