BULGARIAN PRE-CLINICAL MEDICAL EDUCATION University of Sofia

Contact: Prof. I. Krushkov, Department of Pharmacology and Toxicology, Medical Faculty, Medical University of Sofia, 1431 Sofia, Bulgaria. tel.35-92590052; fax +35-92594049; email krushkov@medfac.acad.bg

Pre-clinical medical education of Anatomy, Physiology, Biochemistry and Pharmacology started with the foundation of Faculty of Medicine to the University of Sofia in 1918-1919. At that time the structure of the educational program was according to the model of German and Russian universities, because the first professors were graduates from these institutions. Throughout the following decades pre-clinical medical education was been continuously modernised without substantial change of its basic structure.

With the current project we aimed to become acquainted and to evaluate educational programs of leading European universities, as well as a new trends in Pre-clinical Medical Education before putting proposals to the directory boards of Bulgarian Medical Universities and Ministries (Ministry of Health and Ministry of Education and Science).

From the educational programs of Vienna Faculty of Medicine we have found that medical education was composed in three main units:

1.Theoretical unit (medical physics, medical chemistry, medical biology, anatomy, medical biochemistry and medical physiology);

 2.Theoretical-clinical unit (medical psychology, general pathology, functional pathology, functional pathology, radiology, hygiene and microbiology, pharmacology and toxicology);

 3.Clinical unit.

It became evident, that this kind of structure is very similar to the Pre-clinical Medical Education in Bulgaria. Thus, for example, the teaching of Pharmacology in our country has been included in the third year, where there are not just theoretical but also clinical disciplines as well. During the discussions with the Dean of Vienna Medical Faculty and heads of Departments of Anatomy, Physiology and Pharmacology it has become clear that the Credit Educational System is going to be introduced in Vienna, while the Module System is still at a preliminary stage of discussion. The received materials about the contents of education in pre-clinical disciplines and the shared experience for the introduction of the Credit System appeared to be very profitable for us, since medical faculties here in Bulgaria are still at the very initial stages of modernisation.

In Great Britain we became familiar with study programs of Pre-clinical Medical Education in the University College and Royal College of London, and Universities of Cambridge, as well as in Ireland (University of Dublin). Awarding the scientific degree BSc in Anatomy, Biochemistry, Physiology, Pharmacology, Microbiology, etc., has already been introduced in these institutions. After the first two educational years (after year 3) some students are enrolled in the additional third (“intercalated”) year for acquiring a BSc degree, while the rest continue their education in the clinical disciplines. Another significant feature is a substantial input of clinical teaching into pre-clinical teaching, but the real integrated process of teaching (modules) has been made only to the following pre-clinical disciplines: chemistry with biochemistry, biochemistry with molecular genetics, biochemistry with physiology, physiology with pharmacology, etc. Lectures still are the dominant form of education, while the role of practical exercises, obligatory consultations, seminars, discussions of particular problems, Computer-aided education and self-preparation has been increasing.

The course in the University of Dublin possesses the features of pre-clinical education of the English universities. It gives the impression that the teaching of Pharmacology has been connected with the teaching of Therapeutics and is being distributed in the three educational years, meanwhile including also the Clinical Pharmacology.

In the University of Ulm we were given very detailed educational programs concerning pre-clinical disciplines. One feature is that in the end of the third semester a general examination has to be taken which comprises a material from Anatomy, Physiology and Biochemistry. The initial stages of integrated education have been accomplished. For example, in joint delivery of seminars by teachers from Departments of Anatomy and Physiology. Consideration the programs of Physiology, it appears they are similar to those of our Medical University, while in some sections our education includes an additional information, which was not being provided in the Ulm University programs. Such kind of differences have been evident in the study programs of Pharmacology and Toxicology, too, where some sections are studied more widely (e.g., Pharmacology of the blood-glucose metabolism - 5 hours), while others (Pharmacology of drugs, influencing Central Nervous System and Cardio-Vascular System) are covered with less details.

In the Technical University of Munich we become acquainted with programs of Pre-clinical disciplines. We concluded that they are quite similar to the structure and content to these of Ulm University. On comparing the program of Pharmacology from the Technical University of Munich with that of Sofia Medical University, we determine almost complete coincidence in volume of content, including the way colloquiums are provided at the end of every section.

Medical Pre-clinical Education in the Universities of Maastricht, Amsterdam and Leiden is characterised by a well developed Module Educational System (problem-based-learning) in distinction from the Universities of Vienna, London, Dublin, Munich and Ulm. The Dutch Ministry of Health has organised the  publication of a review book with information materials for all other universities concerning the Module System of Education. Still in the very first year of study the education has been integrated in the following modules: Introduction to Medical Research; Metabolism; Interaction and Regulations; Attack and Defence; Inter-cell Communications, etc. A few subjects simultaneously take part in the education concerning every module. For example, the education concerning the problem “Interaction and Regulations” comprises Departments of Anatomy and Embryology, Biochemistry, Molecular and Cell Biology with Genetics, Pharmacology, Pathology, Neurology, Medical Psychology, Internal Diseases.

After introduction of this type of Module Education it occurs an integration of pre-clinical with clinical disciplines along the course of the whole medical education. Future years may demonstrate if this very type of integrated (Module, Problem-based) education in medicine will bring better results and the domination of future educational programs of medical faculties.

 After being introduced to and become acquainted with Pre-clinical Education of some European universities, we published a book with collected materials, which we will present to the directory boards of the Bulgarian Medical Faculties and Departments responsible for the Pre-clinical Medical Education.

It summarises a round-table discussion concerning modern forms of Pre-clinical Medical Education during the VII-Th congress of the Bulgarian Society of Physiological Sciences. Reports on Module System of Education and System of Credits Exchange were presented.

 In the newly created Greece Medical Faculty of Larissa we presented our information about Module and Credit Systems of Pre-clinical Medical Education.

The preparation for introduction of some modules has been started, including teaching of important problems of Anatomy, Physiology and Pharmacology, which we will implement in the next semester.

We are prepared to send to the directory boards of Medical Faculties and Pre-clinical Departments to the Medical Universities of Bulgaria concrete proposals, which are described in the published book “Pre-clinical Medical Education - Status and Perspectives (Tempus Phare Contract No CME-03609-97)”.