COHRICE - Challenges of human reproductive medicine in a changing Europe: an innovative professional curriculum for graduate medical education

Background:

Since the population in European countries is either constant or slightly declining, reproduction is in the forefront of social and health policies with the aim to maintain or turn over reproductive rates. Recognising the complexity of this challenge, European countries try to address the problem in different ways ranging from socio-political steps to health-related measures. Concurrently, trends related to (post-)modern lifestyles and recent challenges (obesity, COVID-19) as well as to less “traditional” patient groups (e.g. 40+ pregnancies, pregnancies after egg donation, pregnant patients with autoimmune diseases, etc.) and challenges related to infertility or multiculturalism are increasingly prevalent. As a result, contemporary reproductive medicine needs to deal with complex situations, which often requires an interdisciplinary approach and the active engagement of allied healthcare professionals, such as psychologists and social workers. Also, the circulation of medical staff has become a norm, resulting in the fact that medical staff often works in realities that are culturally and socially completely different compared to the place of their studies or countries of origin.

Still, the graduate and resident medical teaching programme fails to put obstetrics and reproductive medicine in the context of social and cultural challenges, as the teaching material focuses on physiological and pathophysiological processes. This leads to the fact that obstetrics and gynecology specialists often face challenges they are not prepared for. To effectively address such situations, both graduate and resident medical doctor training programmes should become more specialised, broadened and inclusive and help students and medical teaching staff develop respective skills to overcome national peculiarities, and to expand the knowledge beside the standardised EU guidelines on medical training in obstetrics and gynecology.

Therefore, three higher education institutions from Central Europe, the University of Pécs as a lead

partner from Hungary, together with the Medical University of Vienna, Austria and the George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureş, Romania as well as the Hungarian Society of Obstetrics and Gynecology as an associated partner joined forced with the aim to address these complex issues in their project titled “Challenges of human reproductive medicine in a changing Europe: an innovative professional curriculum for graduate medical education” (COHRICE) by developing a set of innovative e-learning materials for the next generation of medical students and medical teaching staff.

In this sense, COHRICE will educate the state-of-the-art medical knowledge on key aspects of obstetrics and gynecology in the context of changing societies in Europe and provide an innovative tool into the medical specialisation programs for resident medical doctors working in the field of human reproduction, while also providing expanded learning opportunity for graduate medical students in obstetrics and gynecology. To achieve this goal, the following project results will be developed:

1. Graduate level learning material about the challenges of human reproductive medicine in a changing Europe

2. Advanced level learning material for resident doctors in the topic of relevant challenges of reproductive medicine in a changing Europe for Obstetrics and Gynecology residents

3. Teachers' Guide for facilitating the application of the graduate and advanced e-learning courses

4. E-learning platform for the graduate and advanced level e-learning courses

Objectives:

The framework of the training requirements in Obstetrics and Gynecology (hereinafter: Ob/Gyn) for resident medical doctors is provided by the so-called PACT document

(Project for Achieving Consensus in Training) developed by the European Board of College Obstetrics and Gynecology (EBCOG) with the aim to promote the standardisation of teaching and learning for OB/GYN residents in Europe. The PACT proposes a standardised core and elective curriculum for residents to harmonise OB/GYN education in Europe, with the aim to increase the standard of teaching and to support mobility. We intend to promote PACT suggestions and implement a course for resident medical doctors with an additional focus on socio-cultural trends influencing reproductive issues in our changing Europe. This part of the project would fill the gap in the education of OB/GYN residents concerning medical knowledge.

COHRICE aims to make a relevant input to the curriculum of medical students to put their knowledge in context and awaken their interest not only for physical processes but to open their eyes to how changes in societies impact health and health care strategies. This kind of knowledge makes students more innovative, curious and motivated. The project team of COHRICE believes that medical students can only become innovative, problem-oriented thinkers, if their education is interdisciplinary and is embedded in the context of culture and society. This aspect challenges the limits of the conventional approaches to medical education that is unfortunately still very much present at many universities.

Through our project results, we wish to contribute to generating an attitude-change towards sensitive issues of human reproduction. We wish to put reproductive problems in a social and cultural context and sensitise the next generation of doctors to engage them in a holistic approach towards reproductive problems. We aim to make aware medical professionals of new perspectives in therapies and diagnostic methods in human reproduction. With our three dimensional approach of education (through disseminating our products among medical students and residents/ teaching staff/  and allied professionals), we wish to improve the preparedness of medical professionals and through that decrease the public resistance toward artificial human reproduction, and motivate meaningful  lifestyle changes by addressing public health issues.

In doing so, graduate students and resident medical doctors will receive a structured, practical, and up-to-date knowledge on specific, relevant, however less discussed elements of the challenging field of human reproduction. The problem-oriented e-learning materials will contribute to developing their medical skills and the quality of their training, which will allow them to become better trained Ob/Gyn specialists. Also, the medical teaching staff and senior supervisors of the residents will benefit from the COHRICE outputs, as they will receive a free, easily accessible and applicable online training tool discussing complex issues in a diverse and interactive way that they can use and integrate in their teaching practice and courses. The project also aims to raise awareness among allied professionals about certain trends in societies which an effect on reproductive health, as these healthcare professionals are in the frontline of medical service and thus have a significant influence on making high-impact changes.

Implementation:

The project results to be developed are the following:

PR 1 Graduate level learning material about the challenges of human reproductive medicine in a changing Europe coordinated by the University of Pécs

PR 2 Advanced level learning material for resident doctors about relevant challenges of reproductive medicine in a changing Europe for Obstetrics and Gynecology residents coordinated by the George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureş

PR 3 Teachers' Guide for facilitating the application of the graduate and advanced e-learning courses coordinated by the Medical University of Vienna

PR 4 E-learning platform for the graduate and advanced level e-learning courses coordinated by the University of Pécs

The aim of the curriculum development is to optimise the structure of the e-learning curriculum and its full compliance with academic requirements. Curricula will be developed at two levels, one for graduate students  who have already taken the standard curriculum for obstetrics and gynecology (PR 1), and the other to complement the training for resident medical doctors in obstetrics and gynecology (PR 2). Both will consist of interactive e-learning materials and complementary syllabuses.

In the early phase of the project, we will assess the knowledge gaps and needs of medical students and resident doctors by an international survey, which will directly feed into PR 1 and PR 2. Parallel to this activity, a background research will be conducted. These steps will enable us to engage in a transnational discussion about Ob/Gyn training in Central Europe and to produce a targeted first draft of the e-learning materials consisting of 14 modules dedicated to separate topics in Ob/Gyn.

A detailed description of the syllabuses related to graduate and advanced training, the different and modularized topics with single lectures, the learning outcomes will be created. These project results aim at developing detailed syllabuses for establishing the structure of the e-learning materials and embedding them into the programs of human reproductive medicine in graduate and advanced education. Syllabuses will be prepared only in English, while the study materials and documents (e-learning materials) will be prepared all languages of the partnership. The graduate e-learning material will be provided as an optional for-credit course. The courses will be offered by the participating universities in all their teaching languages, thus it will be available not only for domestic students but also for international ones.

The courses will be piloted at each partner university to gather feedback from graduate students as well as Ob/Gyn residents. The developed material will go under a quality control process from the participating universities, the project’s Advisory Board as well as the associated partner, the Hungarian Society of Obstetrics and Gynecology. This step will result in quality-controlled teaching materials at graduate and advanced levels as well as syllabuses, which are standardised for the three participating countries. Courses will be custom-tailored for the training rules of the given university. All activities will be conducted in a collaborative way among partners.

A Teachers’ Guide (PR 3) will be developed to facilitate the application of the e-learning courses. The methodological teaching materials will be developed including distance learning guidance for educators. Following the structure of PR 1 and PR 2, 14 topics will be created and translated in four languages.

To make project results available, a Moodle-based e-learning platform will be developed (PR 4). The platform will be installed and all produced materials will be added.

To reach the widest audience possible, dissemination activities will be continuous throughout the project. All the participants will organize a multiplier event in their home location with a special focus on their own led PRs.

Results:

In COHRICE, we will create a complex, novel training material consisting of e-learning courses, syllabuses and a teachers’ guide in four languages that will be available on a Moodle-based platform.

The e-learning materials and curricula are expected to meet the needs of resident medical doctors practicing in the field of obstetrics and gynecology providing them with unique and socially useful knowledge via an innovative online, work-based, multi-disciplinary learning model. COHRICE will also provide useful insights for graduate medical students and prepare them for the challenges of modern perinatal medicine. The project will contribute to finding solutions to real-world problems (treating high-risk pregnant women, taking care of patients of certain ethnic groups, dealing with post-modern challenges, e.g. diabetes, infertility, etc.) by increasing the efficiency of medical care and the quality of reproductive health-care services.

The presented project will provide open education and innovative practices in a digital area by making the e-learning material available for the next generation resident medical doctors and graduate students. This will contribute to improve the quality of education, in particular support for the use of digital technologies and online education in order to develop pedagogical and evaluation methods.

The project will also support higher education institutions and research institutes to contribute to innovation through developing, implementing and testing the effectiveness of e-learning materials in the field of obstetrics and gynecology; and to ensure the reinforcement of education and research, including through partnerships, inter- and transdisciplinary approaches, and strengthening the role of higher education institutions and research institutes in the local, regional and international environment.