EDUCATION. In autumn of 2021 Sweden’s new Medical Program begins. It will be one semester longer than today’s program and lead to a medical license upon successful completion. Last Thursday the Swedish government decided to amend the Swedish Higher Education Ordinance. Sahlgrenska Academy’s Medical Program Committee is already working on a program syllabus and hopes to present a preliminary proposal within a few months.
Agneta Ekman, chair of the Medical Program Committee at Sahlgrenska Academy, welcomes the decision after many years of uncertainty about when the program would start:
“For several years the Medical Program has been considering ideas about a new program, and a working committee is now developing a preliminary proposal for a program syllabus that we hope will be ready before the summer.”
Many challenges
The sweeping change in medical training affects the entire program, from the first semester to completion as a specialist. Medical training has not seen so much change since the end of the 1960s. Beginning in autumn of 2021, all universities that are to train physicians need to apply for new degree-awarding powers, which are assessed by the Swedish Higher Education Authority (UKÄ).
Agneta Ekman believes that this change entails many challenges and that all current courses can expect to see changes:
“The longer clinical internships must be accommodated in both the program and in health care system, where the situation already is difficult within certain disciplines at this point. There will be greater focus in the new training on outpatient and primary care, for which we need to develop a good organization. Another issue we need to work on is transitional rules between the old and the new program,” Ekman says.
According to the government decision, medical students who have started their training before July 1, 2021 are to complete their training under the old rules, with the provision that they obtain their degrees no later than December 2029.
Integrating foundational sciences with clinical subjects
The new program will mean greater integration between foundational sciences and clinical subjects, and the clinical subjects will be introduced earlier. For the major clinical subjects, students will have fewer but longer internships within various departments. This means the courses need to rethink internships with practical training.
“We hope this will be facilitated by semester courses, which will allow us to achieve a smoother and better distribution of students in the region,” says Ekman, who thinks that collaboration among the academy and health care organizations needs to be strengthened regarding supervisor training and communication.
“Students’ clinical expertise will be assessed on an ongoing basis to ensure that national targets are met and that the fully trained doctors will perform well in the health care system.”
More student-activated teaching
The new Medical Program includes a new qualitative target, medical decision-making, which has not previously been assessed to the extent it will be now.
“We need to keep an eye on the content of basic residential training so that we properly track our students’ progression in their next phase of training. At the same time, it’s important that the targets regarding a scientific and scholarly approach are met so that our students are adequately prepared to continue with doctoral studies,” says Ekman.
Teaching methods for training of physicians also will be developed because Sahlgrenska Academy is moving toward more student-activating teaching, which will require changes for the courses. Among other things, the new training will provide an opportunity for elective courses for individual advancement, and the Medical Program Committee also hopes to bring about a larger clinical examination at the end of the training.
Long-term study of the issue
An enquiry into modernizing medical education in Sweden has been ongoing since 2010, and Stefan Lindgren presented the first proposals in 2013. The Swedish government now assumes full responsibility for training leading up to medical licensing, and the training will be extended so that it corresponds to a total of six years of study.
“People should always have access to good care, no matter who you are or where you live. For that reason we need to establish new medical training that prepares future physicians with the tools, knowledge and expertise that will offer patients faster care, better safety and essentially more uniform health,” Minister for Higher Education and Research Matilda Ernkrans comments in the government’s press release.
AT replaced by BT
The modernized program will prepare the prospective physician for the health care and medical services of the future and emphasizes targets such as patient safety, quality and prioritizing, treatment of patients and those close to them, and approaches that promote health. It also stresses ethical principles and their application to health care and medical services. In December 2018 the Swedish Parliament decided that “AT” general residential training would be phased out and replaced by “BT” basic residential training beginning in 2020, which is one of the prerequisites for introducing the six-year Medical Program. In the first stage foreign-trained physicians will complete basic residential training, and of the physicians trained in Sweden, the first cohort will begin basic residential training in 2027 at the earliest.
The change in the Swedish Higher Education Ordinance takes effect on July 1, 2019, and the regulations will be applied to training that starts after June 30, 2021. This means that the new medical training will be able to start no sooner than the autumn semester of 2021.
TEXT: ELIN LINDSTRÖM CLAESSEN
