Clinical training in the clinical electives year in the medical curricula in Switzerland - considerations regarding content and structure.

With their publication on quality management of clinical-practical instruction for Practical Year medical students in Germany and the preparation of a catalogue of criteria, Raes et al. tackle questions, both in terms of content and structural framework, in a current and relevant subject area [1]. The following commentary provides an additional outline of the current situation of clinical-practical instruction during the so-called "clinical electives year" in Switzerland, which broadly corresponds to the Practical Year in Germany.

Commentary

In Switzerland, the so-called “clinical electives year” is integrated into the three-year Masters study programme as part of the altogether six-year medical studies course in the Faculties of Medicine of Bern, Basel, Geneva and Zürich, as well as the Faculty of Biology and Medicine in Lausanne. During this year, the emphasis is on the clinical instruction of students.

In principle, courses of study in medicine, dentistry, veterinary medicine, pharmacy and chiropractic are regulated by law at the federal level under the Swiss Federal Law on Medical Professions [2]. Here, the statutory text defines general learning objectives valid for all courses of study, as well as specific learning objectives for the study of medicine. In addition to this, the Swiss Catalogue of Learning Objectives for Undergraduate Medical Training (SCLO) describes the profile required to enter postgraduate training in terms of competences, learning objectives and learning content [3]. The second edition is mentioned in the Swiss Federal Examination Regulations for Swiss Federal Licensing Examination for Human Medicine, and is thus applied to the faculties in significantly more binding form. Furthermore, in the second half of 2014 a federal working group from the Federal Office of Public Health (BAG) and the faculties – mandated via the Swiss Medical Inter Faculty Commission (SMIFK) was set up to develop the third edition of the learning objectives catalogue by early 2017.

Depending on the different faculties, there are differences, and sometimes considerable ones, between the content and structural framework of the “clinical electives” year. Regarding content, all faculties largely reference the competences and learning objectives outlined in the SCLO. Nevertheless, there are differences between faculties, for example with respect to guidelines on the choice of clinical disciplines, or the proportion of clinical rotations completed in medical practices, research groups or health care institutions. With regard to the structural aspects, significant differences are also to be found. For example, the location of the “clinical electives year” within the study programme varies depending on the faculty (2nd, 2nd - 3rd or 3rd year of the Masters programme), as does the duration (a total of 7-10 months) [4].

Regarding the perspective of the quality development of instruction during the “clinical electives year”, in addition to the difference in content and structural aspects, two main categories can also be highlighted: firstly, the guidelines available to individual students on how to construct their “clinical electives year”, and secondly, the basic criteria for hospitals, clinics, medical practices and other institutions in which medical students complete their different clinical rotations.

Especially in view of the second category, the work of Raes et. al. proposes a substantial and comprehensive catalogue of criteria, which includes criteria for process and structure as well as results. From the Swiss perspective, a similar approach seems reasonable and feasible in principle, particularly due to the high mobility of Swiss national students during their “clinical electives year”. This high mobility – amongst other things - results in the application of different basic criteria from different faculties to students on the same course of instruction. In addition, the guidelines for individual students should basically have a uniform structure, although adapted to the variable duration of clinical rotations in the same clinical discipline which is possible in all faculties. With regard to the structuring of content, and based above all on the competences which must be taught, all faculties have introduced a portfolio or logbook for the “clinical electives year”. As a rule, these are based on the SCLO in terms of competences and roles, learning objectives in the field of clinical skills, and the chapter “Problems as starting points for training”.

With regard to the future quality development of the “clinical electives year” in Switzerland, above all it would appear to be essential that all faculties work together to further develop structural and content guidelines for students and institutions. In addition, the objective should be, where possible, to implement and use the same tools to structure content (logbook, portfolio) and for formative and summative assessment (for example, workplace-based assessment). Ideally this would also be the case in postgraduate medical training [5]. Not least, emphasis must also be placed on the crucial importance of student participation in the context of systematic feedback on the “clinical electives year” and its further development.

Competing interests

The author declares that he has no competing interests.