Dresden educators work to sustain progress while navigating complex environment

Since 1996, the Carl Gustav Carus Faculty of Medicine has been working with HMI to institute significant curricular reforms at the Technical University of Dresden (TUD). Their efforts were driven in part by the demands of both faculty and students for more active learning opportunities, and the need to integrate the basic science and clinical years of medical school. The government in Germany, too, played a key role in driving medical education reform by enacting legislation to shape medical curricula.

Today the fruits of TUD’s efforts are in place in the form of a new medical school curriculum. Curriculum reform and faculty development efforts continue at TUD, but today leaders in academic medicine must contend with other regulations that will impact the relationship between universities and academic medical centers. In April, a contingent of academic, clinical, and administrative leaders from Dresden came to Boston for a week of discussions aimed at clarifying TUD’s major challenges and determining how the university will pursue its mission going forward.

Michael Albrecht: “The areas of conflict between the institutions of the medical faculty and the hospitals will increase over the next few years as funding mechanisms change.”

Dr. Michael Albrecht helped set the stage for the week’s discussions by outlining the major issues facing TUD. He divided the challenges into three interrelated areas: quality management, medical education (including both clinical and research education), and governance. Albrecht raised a question that would be a common thread throughout the week: “What do we want Dresden to be, what will Dresden produce, and how will that be different from what other medical schools in Germany are creating?”

Prior to the German group’s arrival, HMI organized the Dresden team into four working groups, each of which focused on a particular concept: clinical education, research education, governance, and quality management. HMI also assembled a team of experts—from Harvard Medical School and other institutions—with experience in these areas and insight into how different models might be used by TUD.

“The program provided a safe laboratory environment for the exchange of ideas and allowed the Dresden team to think through the complex issues and work towards an action plan,” said Tom Aretz, MD, HMI vice president for education.

New governance structure asks school, hospital to strike a balance
In 1999, the government of the State of Saxony, where TUD is located, legislated the separation of the medical school at TUD and its hospital affiliate. The main feature of the new structure is a “cooperation model” between the medical faculty and the university hospital. The university hospital has been made an independent not-for-profit public (semi-private) institution with its own governance and fiscal responsibility. The medical faculty retains all rights, funds, and personnel for research and teaching, and academic and clinical responsibilities are shared by personnel in both institutions.

Since the law went into effect, TUD’s leadership have been working to understand how to define metrics of success under the new governance structure. They are well aware that the new structure will challenge them to manage and prioritize the three main elements of the medical school’s mission: medical education, research, and clinical care. How they define success in each of these areas will influence, among other things, how funding will be allocated and what incentives will be created for faculty and clinicians.

While hospital leaders may want to apply a business approach to the hospital, there remains an obligation to provide medical education. Albrecht said, “The areas of conflict between the institutions of the medical faculty and the hospitals will increase over the next few years as funding mechanisms change.”

Evolving the medical education mission
The career paths available to a medical school graduate include not only clinical medicine, but also academia, industry, and advisory/governmental roles. Academic leaders at TUD, therefore, must take heed and address the other career paths.

One particular area of student interest that TUD is actively exploring is research. Around the world, physician investigators are becoming an endangered species. Research exposure during medical school is rare, mentors in this area are in short supply, and academic positions pay less than private practice.

Lindsey Henson, MD, PhD of the Cleveland Clinic Lerner College of Medicine, presented various education models from top United States universities— including innovative programs at Duke and Stanford—that have different approaches to required research during medical school. She pointed out that the theory behind research education is that doctors become better doctors if they have learned to think critically and engage with the literature.

Peter Dieter: “We have to find out what exactly [our faculty] are capable of and what they want to do.”

Peter Dieter, PhD, dean of students at the faculty at TUD, hopes that the school can develop a structured MD program that would require a strong research component, as well as a parallel PhD program that would encourage students to pursue research, and provide them with more career flexibility when they complete medical school. Crucial to this effort, he said, is the need to recruit young researchers to the faculty. TUD must also motivate faculty members who are already on board and may want to participate in more research initiatives. “We have to find out what exactly they are capable of and what they want to do,” he said.

Back, always, to basics
Gordon Moore, MD, PhD, Harvard Medical School professor of ambulatory care and prevention, has been involved in HMI’s German medical education alliances, including the one with Dresden, from the very beginning, so he has seen the challenges facing the Dresden faculty evolve. Moore, who played the role of planner and facilitator for this most recent series of discussions, stressed that regardless of what Dresden has achieved during its period of reform, it is important to keep the big questions—“Who are we?” “What do we want to accomplish?”—in the foreground. “This group of faculty and organizational leaders is starting by raising fundamental questions about their future, including putting on the table many of their fundamental assumptions,” he said. “They view their environment in Germany and Europe as changing rapidly, and they know they will be challenged to change. To do so, they are willing to examine altering institutional elements as fundamental as governance and structure, and to reconsider how they relate to their institutional partners and their patients.”

Gordon Moore: “This group of faculty and organizational leaders is starting by raising fundamental questions about their future, including putting on the table many of their fundamental assumptions.”

HMI World welcomes comments from readers. Please write to let us know what you think of this article.