Academic time went by quickly for all of them. Teresa Valido was the one who ended up mentioning how, 4 years ago, the structuring of the long project begun. Its idea had been going on for over a decade.

Over four terms of office, the presidents made the Clinical Education Reform their ultimate goal, in the most responsible and committed way,.

So it made sense for us to listen to Teresa Valido, Andreia Daniel, José Rodrigues and António Velha. All of them have been Presidents of the Faculty of Medicine Students' Association and advocate of major structural changes.

Convinced that medical education needed to be updated in line with the times, they became involved with their working groups and made important contributions, together with a group of professors of the Faculty of Medicine.

Having completed their terms of office, today we are not talking to Teresa, Andreia, Zé and António as individuals. We shall reflect on their year-long mandates with regard to the New Reform that will begin in September, and ask for their opinions.

The plans they made and the legacy left by each of the last four Presidents of the AAFML is what we give you here.

 

The FMUL Clinical Education Reform was perhaps one of the most challenging “projects” of my mandate as President of the AEFML, which actively participated in the entire process.

 

When I took office, the AEFML had just presented and approved at the General Meeting of Students, at the end of the 2016/2017 term, the document containing the Students’ Recommendations regarding the Reform of the Clinical Years. This document was the result of the work carried out by the SA, the students of the School Council and the students of the Pedagogical Council, in 2015, when the new board of the FMUL created the Clinical Education Evaluation Committee (CAEC), with the objective of proposing the reform that had been talked about at the Faculty since 2011.

At the beginning of my term, the CAEC finally presented the document “A new curriculum for the Clinical Cycle at the FMUL: Meeting the needs of future doctors. Improving medical care”, which conceptualized this reform and created the bases for its implementation. Subsequently, the Committee for the Implementation of the Clinical Education Reform (CIREC) was created, which I joined as President of the AEFML, and this was the first time that the Students’ Association was part of the Faculty's working groups within the scope of the education reform.

Thus, it was in the 2017/2018 mandate that the way in which the basic ideals of this reform would be implemented was worked out, starting with the challenge of integrating the medical and surgical components, as well as the need for curriculum mapping, the organization of semesters, the division of ECTS for the modules and also the reformulation and innovation of teaching and assessment methods. Furthermore, bureaucratic issues were initiated in our mandate, namely the submission of the proposed new syllabus to the A3ES. I also emphasize the importance of building the Foundation Skills module, which represented one of the main innovations of this syllabus, in which we sought to integrate soft skills and transversal skills in a programme that until then was just scientific and clinical.

Many were the obstacles found along the way, and I believe that this first year of the Reform Implementation Committee was essential to understand the problems that had to be overcome so that the reform was as successful as possible, as well as laying the foundations for its start. The articulation between the various groups of students was extremely important. The AEFML, on the one hand, and the students representing the Faculty's management bodies, through the maintenance of the Clinical Years Working Group (GTAC), coordinated by the Students’ Association, and in which all the views subsequently conveyed by me at CIREC were agreed, ensuring that the voice of the students was heard in a Committee where I was their sole representative.

Having said that, I must express my satisfaction at seeing this reform finally implemented, 10 years after it began to be discussed by the Students and 4 years after its structuring began. For me and for the 2017/2018 Management, it was undoubtedly a great pleasure and pride to be part of this process, which I consider to be one of FMUL’s major achievements in the last decade.

 

Since the beginning of my journey at the AEFML, the syllabus reform had been a constant presence. Even while attending the early years at the FMUL, groups of students belonging to the clinical years met periodically to discuss the change the clinical syllabus to meet the needs of today's medical education. After joining these groups, I became even more aware of the importance of changing the syllabus for those who are the doctors of the Future.

 

During the year 2018/2019, the work previously started in previous terms of the AEFML Board in conjunction with the FMUL was continued. Assuming that the last syllabus reform had taken place during the implementation of the Bologna process and that, since then, the evolution of medicine and the expectations placed on medical practice had changed, several questions were raised about how the syllabus worked. During this reflection process, several ways to improve it were identified, namely, the lack of integration of content between subject areas, the overlapping and repetition of topics, excessive load of theoretical classes and assessment and a high student/tutor ratio, which in many classes exceeded the recommended balance to ensure adequate learning.

Starting with the problems identified, an enormous effort was made so that, interconnecting the health system and the education system, a solid project could be created that would allow students to learn more practical, dynamic topics focused on current challenges. In my perspective, the main points that marked the work of CIREC during the year 2018/2019 were the finalization of the first proposal of curricular objectives and the completion of a syllabus mapping validated by an expert in Medical Education. These were fundamental steps for the construction of the document “A new curriculum for the Clinical Cycle at the FMUL: Meeting the needs of future doctors. Improving medical care”, which contained not only information about the main changes in each subject area, but also the design of an innovative syllabus evaluation model.

Despite the enormous enthusiasm inherent in building such a promising proposal, there were several underlying concerns. I highlight the difficulty in the operationalization of the proposal due to the demand in human and material resources and the educational particularities where the proposal should be correctly articulated, namely, in the case of Erasmus students and students attending transition years between the two models. Not forgetting the importance that students and lecturers have throughout this process, sessions were held during the year to present the reform, allowing not only a constant update of the parties involved, but also the gathering of very useful ideas for the review of documents by the working group.

Although a change of this magnitude generates some controversy and fear, students have always been very active throughout this process, not only integrating the various working committees that have existed since 2015 but also promoting various changes that would allow for a better learning process in the future.

Fortunately, today we are facing a more current, more dynamic and more integrative syllabus. If a change always leaves room for a new change, this new syllabus must have sufficient flexibility to provide an adequate response to the successive challenges of the evolution of Medicine in the scientific, clinical and technological dimensions.

 

Since the launch of the process that will culminate in the implementation of the Clinical Education Reform, for some years now, no AEFML Board has been able to take stock of the work carried out during its mandate without mentioning this issue. The centrality of this reform for the students that the AEFML represents demands it.

 

In the 2019/2020 term, the role of AEFML in CIREC was assumed in a committed manner. At the time of our taking office, in mid-June 2019, we were convinced that the work was moving fast towards its completion and that the Reform would be implemented from the 2020/2021 academic year onwards. In this sense, based on the guiding philosophy of the Reform that has long been defined and guided by the work conducted in previous years regarding the structuring of this new educational model, the AEFML actively, critically and constructively participated in the organization of the different semesters and in the discussion related to the need to hire new professors, among other issues. In addition, it sought to give the students’ perspective on the decisions taken and it was a fundamental link between the student community and CIREC members, either through the clarification session held on 8 January 2020, or through the informal clarifications it provided upon request.

 

It was in this spirit that we were fine tuning the implementation of the Reform.

However, the unexpected happened. And if no man is an island, a reform of clinical education that depends on the coordinated work of a large team of people is much less so. In this sense, like the world around us, this reform also had to adapt to the circumstances brought about by the COVID-19 pandemic. Thus, it is likely that the most important moment in my work at CIREC was the difficult but inevitable decision to postpone its implementation by one year.

Now, more than a year after that moment, it is with great satisfaction that I see that this Reform will finally come into force, the result of an enormous shared and very fruitful work between lecturers and students.

From the outside, I look forward to the practical implementation of this education model designed for the training of doctors of the future. I am certain that it will be a milestone in the history of the FMUL that will have repercussions in healthcare over the next decades, which the doctors trained in our Institution will provide to the citizens of Portugal and the world.

 

I caught the process of implementing the clinical education reform in its final stage, and its analysis and construction took place over the last decade. During the last academic year, work was mainly done to recover from what was the abrupt postponement of the reform to the 2021/2022 academic year. It had to take into account the impact that the pandemic had on our faculty, as well as assist the Reform Implementation Committee in completing the theoretical and practical lesson plans, assessment, application of pedagogical innovation and organization of pedagogical spaces, given that the entire philosophical current and the changes to be implemented had been defined in previous years. There was also a focus on communicating the reform to the Faculty lecturers and students, especially from the 18-24 degree, who will be the first to experience it.

From now on, work will be carried out to monitor the changes that the reform will bring and complete its implementation at year 5 level. Many of these changes have been talked about for a long time and are widely needed – the integration of contents, the reorganization and rebalancing of semester contents, the increase in practical contact at the expense of theoretical components, and independent learning, among others. Other changes may be a little more controversial, given that it will be a very different organization from what we are used to.

All the changes that will be introduced are based on a set of medical education principles and evidence in this area, but they are not dogmatic. Thus, the next academic year will be decisive for us to understand what works better or worse and determine the impact it will have on students, so that we can learn and improve at every step. To this end, we will all have a role to play, giving our feedback in a clear and constructive way to try to optimize teaching and promote mental health for all of us, maintaining the guiding and structural principles of the reform. The integration of content, outcome based education, WFME good evaluation criteria, among others. There will be consultation channels, both direct and via the representatives of students from CC 18-24, CP, CE and AEFML, so that the feedback reaches the Committee for Monitoring the Implementation of the Reform and all considerations and perspectives of the students can be conveyed.

Joana Sousa
Editorial Team