Medical education program restructuring according to the PUIGEP (prevalence, urgency, possible intervention, gravity, exemplarity, prevention) system | BMC Medical Education

One ECTS credit generally corresponds to 25 to 30 h of work; however, there are variations in the way different educational institutions allocate these credits in their study programs [6]. A fixed number of hours can easily be applied to a Bachelor’s degree or BS, where the majority of courses have almost the same workload for students. Thus, despite harmonization efforts under the Bologna process, significant heterogeneity exists between different disciplines in terms of content and credit allocation [8]. To our knowledge, no prior work has been done, in the literature, to weight or allocate credits in MC, which previously had no fixed number of credits. This essential effort enabled us to weight the courses and, subsequently, the various modules. This was achieved by objectively considering their importance for GPs and by taking into account the load and difficulty of the chapters as perceived by students.

Initially, this work enabled us to lighten the load on the Master’s or MC courses, by cancelling or transferring 8% of the courses in this cycle to the BS. Semiology courses had initially been transferred from BS to MC in the early 2000s, during the introduction of the new ECTS system, following the cancellation of semiology courses in the License. These courses were transferred back to the BS, with dedicated courses in the third year of the cycle. Several other courses were eliminated, as the evaluators considered them to be of little relevance to GPs (e.g. TAVI courses in cardiology).

This study has enabled us to put a clear figure on the workload between a lecture and a Interactive Learning course. Admittedly, an IL will have a 1.7 times heavier workload than a lecture in terms of preparation and assimilation. This can be explained by the fact that the student needs time to prepare for the IL, to participate in the session and finally to review the notes from these sessions to fully assimilate the IL, whereas for a lecture the first stage is absent, hence this difference in workload. Nevertheless, the workload for ILs is not double that of lecture (assuming that preparation time and assimilation time are equal). This can be explained by the advantages inherent in ILs in terms of decontextualization and recontextualization, which would make the assimilation of concepts after the IL much faster.

In addition, this work showed the presence of a disparity between the fourth and fifth years of medical school. Although these two years have a similar number of light-load courses (~ 20%), there is a big difference in heavy-load courses (17% in 4th year and 2% in 5th). This can be explained by the fact that the 4th year contains mainly clinical application courses with generally difficult concepts (neurology, endocrinology, cardiology, nephrology, pneumology) whereas the 5th year consisted mainly of relatively easier pathologies and paramedical science courses such as ethics, public health or even some easy modules such as plastic surgery. Another explanation for this perception of heaviness and difficulty is that 5th year students have “matured” compared to 4th year students. This was recently confirmed in a study by Aboregela et al., who showed that the degree of difficulty of the same new course decreases as it progresses from 3rd to 5th year [9].

All this work has made it possible to weight the modules by giving them a number of credits. This distribution of credits is in line with the distribution found in the literature. Termette et al., for example, found that geriatrics and gerontology accounted for 2.3% of master’s credits, compared with 2.5% in our distribution [10]. In theory, we can divide the subjects into those with a low number of credits (≤ 2 credits), a medium number (3, 4 credits) and those with a high number of credits (≥ 5). The first group consists of plastic surgery, ethics, bioethics, legal medicine, neurosurgery, public health, occupational medicine and radiology. The second group includes modules in digestive and pediatric surgery, geriatrics, ophthalmology, rheumatology, intensive care anesthesia, thoracic and cardiovascular surgery, gastroenterology, otorhinolaryngology, hematology, oncology, infectious diseases and psychiatry. The final group comprises modules in urology, neurology, orthopedics, gynecology, internal medicine, endocrinology, nephrology, pneumology, cardiology, dermatology and pediatrics. The last group now corresponds to primary medicine, the second to secondary or tertiary medicine and the first to bioethics and public health sciences [11]. In other words, this distribution of credits is in line with the training of a GP, focusing on primary medicine essentially for future practice [12].

In addition, this work has enabled a better distribution of modules over the different years. Several distributions were proposed. The version adopted, although not perfect, divided the modules into four semesters: Abdomen in S1, Thorax and hemodynamics in S2, head and limbs in S3 and holosystemic modules in S4. This approach enabled credits to be distributed almost evenly across the different semesters. Finally, this module weighting has enabled students’ grades to be weighted in the final training grade called: Program average.

Strengths and limitations

This study has several strengths: firstly, it is the first study to have attempted to weight courses in medicine by considering objective factors for the evaluation of student workload, as well as the relevance of concepts for a future GP. This made it possible to distribute the modules more evenly over the semesters. However, there are several limitations. Firstly, the relevance and load scores, although objective, have not been validated, and one may argue about the objectivity of the scale used to measure workload. The validity of these scores can be postulated, given the lack of difference in relevance scores between specialists and general practitioners. In addition, the number of participants is too small, the way the participants were chosen is not based on strict criteria, and only two doctors participated in the rating process. The time allocated per module was not considered. However, even if a module is cumbersome, this burden will be alleviated if it is spread over several weeks. Finally, this study did not take into account the implementation of “optional” credits in MC, a key value in the ECTS system [13].