Six-year Program Research Articles

Pharmacy School and Pharm.D. Program in the United States of America

Pharmacy schools in Japan started to offer the 6-year undergraduate program in 2006. Currently, students are eligible for the national licensing examination to become a pharmacist only after completing the six-year program and receiving a bachelor's degree. Meanwhile, pharmacy schools offer the four-year graduate program in the United States of America (U.S.A.). In addition to the length of the program, there are several significant differences between pharmacy schools in Japan and the U.S.A. In the U.S., students receive a professional doctoral degree in pharmacy, doctor of pharmacy (Pharm.D.), after completion of the program. Fourth-year pharmacy students in the U.S. spend 1600 h in their clinical rotations, which is considerably longer than those in Japanese programs. It is also unique that pharmacists and pharmacy students are authorized to administer vaccines in the U.S. upon completion of immunization training. This symposium review aims to introduce the pharmaceutical education and the Pharm.D. program offered in the U.S.

Toward Educating the New Generations of Pharmacist-Scientist Based on the New Six-Year System

Based on its founding spirit of "Strong, Correct and Clear" Gifu Pharmaceutical University (hereinafter referred to as "the University") has adopted the human and environmentally friendly Pharmacy (Green Pharmacy) as its basic philosophy. As the University fulfills its social mission to enrich and strengthen education, research, and social activities, it faces many challenges. These include incorporation, fostering academia-industry-government collaboration, life-science center development and expanding the role of the affiliated pharmacy. The University will continually strive to recognize trends in the social environment and make the effort to respond to challenges when they arise. This effort will allow the University faculty and staff to maintain a sustainable institution that can respond to social challenges while continuing to share the benefits of education, research, and drug discovery/development with the community. The University is committed to train world class Pharmacist-Scientist. This review explains the rationale for the University's transition to a single six-year program. It also gives an update on the current status of education, research, and the mobile pharmacy (MP) since its introduction. Furthermore, it highlights advancements in academic-industry-government collaboration.

Medical students' perspective of the motivations and limitations of studying medicine: a cross-sectional study from the United Arab Emirates

BackgroundIncentives and disincentives to study medicine are complex concepts and may involve a dynamic balancing act between financial, personal, and social reasons. These processes have not been adequately explored in the Middle East. This study explores students' thoughts and feelings about studying medicine at the United Arab Emirates University, Al-Ain. This descriptive cross-sectional study was conducted between April and August 2019. An online, self-administered questionnaire consisting of 22 questions was distributed to the students enrolled at the College of Medicine and Health Sciences, United Arab Emirates University. The survey questions focused on motivations to study medicine and limitations that prevent choosing medicine as a field of study.ResultsTwo hundred and five (33%) of 621 students in the six-year program completed the questionnaire. Forty-three percent of the responders were from the first two years of medical school. The decision to study medicine was reported as their own by 92%. Eighty-eight percent of the students did not consider gender a limitation for studying medicine, and 62% had a defined medical specialty to pursue. One-third considered quitting medicine, mainly during the first two years. Reported difficulties included mental health problems (stress, anxiety, and depression), social isolation ('having no life,' 'being lonely'), curriculum content (overwhelming workload), college condition/rules (poor condition of the hostels, lack of support, scant passion, and strict rules), and rational thinking (inadequate high-school preparation).ConclusionsThese results justify implementing an effective counseling program, especially during the early academic years. The quality of high-school education requires careful thoughtfulness from the department of education with input from our medical schools. Other modifiable factors include the methods of assessment, available supportive resources, and extracurricular activities.

Comparing achievements of medical graduates in an alternative unique pre-medical track vs regular medical track.

To evaluate the association between the achievements of medical students and whether they were admitted via the pre-medical track or the regular direct track. We performed a comparative retrospective data study using data from a three-year experimental cohort in a six-year medical school. We analyzed the academic achievements of all students admitted at one Israeli medical school between 2013-2015, either directly to the six-year program or via a pre-medical track. We compared averages of both yearly final grades and final medical examinations grades between the two groups. Descriptive statistics were calculated and differences between groups were evaluated using multivariate analysis. Of the 324 students included in the study, 65 (20.1%) were enrolled in all three cohorts of the pre-medical track. Age and Gender distribution were nearly similar for both tracks. For the first two cohorts, the average final grades of year one of pre-medical students were significantly higher than those of regular direct track (F=(3,167) 6.10, p=0.001), but the opposite was true for the third cohort (F=(3,110)2.38, p=0.073). No further statistically significant differences were found neither between the groups in their final exams grades nor between choosing a MD/PhD optional track and admission pathway. Our results suggest promising achievements with the pre-medical admission pathway. This should encourage further discussion about the significant potential human resources lost by current admission processes and may question the effectiveness of six-year programs in medical schools.

Investigating the risk factors for academic difficulties in the medical programme at a South African university

BackgroundThe National Benchmark Test (NBT) that determines academic readiness is widely used by Faculties as an additional measure to select students for the study of medicine. Despite this, many students continue to experience academic challenges that culminate in delayed graduation and sometimes academic exclusion or discontinuation of studies.AimThis study aimed to understand academic and non-academic variables linked with academic difficulties in the first three years of medical education.MethodsThe study sample consisted of six cohorts of medical students for the period 2011 to 2016 (n = 1392). Only the first three of the six-year medical programme were selected for analysis. Survival analysis and Cox Proportional Hazard (CPH) was used to identify academic and non-academic variables associated with academic difficulties.ResultsA total of 475 students (34%) experienced academic difficulty; 221 (16%) in the first year of study, 192 (14%) in the second year and 62 (5%) in the third year of study. The results show that Intermediate Upper, Lower and Basic levels for all NBT domains, living in university residence, rurality and male gender were risk factors for academic difficulty.ConclusionIn mitigating these factors, the NBT must inform the type of support programmes to augment the students' skills and promote academic success. Additionally, existing support programmes should be evaluated to ascertain if they reach students at risk and whether participating in these programmes yield positive academic outcomes.

Exploration of changes in pharmacy students\u2019 perceptions of and attitudes towards professionalism: outcome of a community pharmacy experiential learning programme in Taiwan

BackgroundA powerful way to nurture and strengthen professionalism is by accruing practice-based experiences. However, few studies in Taiwan have evaluated the impacts of experiential learning programmes on pharmacy students’ views on professionalism − the core of quality healthcare practices and services. This study aimed to measure changes in perceptions of and attitudes towards professionalism among third-year pharmacy students following an introductory-intermediate experiential learning course.MethodsA single-group pre- and postcourse comparative study using a self-administered survey was conducted in 2017. Pharmacy students in their third year of a six-year programme were eligible to participate in this study. We used a 28-item questionnaire with a 10-point Likert-type scale to assess students’ professionalism. Among them, 10 items were employed to assess students’ perceived importance of professionalism in pharmacy practice, and another 18 items adapted from the Pharmacy Professionalism Instrument were used to evaluate students’ attitudes towards pharmacy professionalism. An independent t test was performed to compare the differences in students’ anonymous survey responses before and after the course, with an a priori level of statistical significance of 0.05.ResultsFifty-two pharmacy students participated in the study. They showed significant improvement in three tenets of professionalism, namely, altruism (p = 0.035), accountability (p = 0.026), and duty (p = 0.002), after completing the 5-week experiential course.ConclusionsPharmacy students’ attitudes towards professionalism were modifiable by purposely designed experiential learning programme in the community setting. Such experiences may help socialize students with positive attitudes towards altruism, accountability, and duty.

MEDTEC Students against Coronavirus: Investigating the Role of Hemostatic Genes in the Predisposition to COVID-19 Severity.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiologic agent of the coronavirus disease 2019 (COVID-19) pandemic. Besides virus intrinsic characteristics, the host genetic makeup is predicted to account for the extreme clinical heterogeneity of the disease, which is characterized, among other manifestations, by a derangement of hemostasis associated with thromboembolic events. To date, large-scale studies confirmed that genetic predisposition plays a role in COVID-19 severity, pinpointing several susceptibility genes, often characterized by immunologic functions. With these premises, we performed an association study of common variants in 32 hemostatic genes with COVID-19 severity. We investigated 49,845 single-nucleotide polymorphism in a cohort of 332 Italian severe COVID-19 patients and 1668 controls from the general population. The study was conducted engaging a class of students attending the second year of the MEDTEC school (a six-year program, held in collaboration between Humanitas University and the Politecnico of Milan, allowing students to gain an MD in Medicine and a Bachelor’s Degree in Biomedical Engineering). Thanks to their willingness to participate in the fight against the pandemic, we evidenced several suggestive hits (p < 0.001), involving the PROC, MTHFR, MTR, ADAMTS13, and THBS2 genes (top signal in PROC: chr2:127192625:G:A, OR = 2.23, 95%CI = 1.50–3.34, p = 8.77 × 10−5). The top signals in PROC, MTHFR, MTR, ADAMTS13 were instrumental for the construction of a polygenic risk score, whose distribution was significantly different between cases and controls (p = 1.62 × 10−8 for difference in median levels). Finally, a meta-analysis performed using data from the Regeneron database confirmed the contribution of the MTHFR variant chr1:11753033:G:A to the predisposition to severe COVID-19 (pooled OR = 1.21, 95%CI = 1.09–1.33, p = 4.34 × 10−14 in the weighted analysis).

A validation study of the Korean version of the Toronto empathy questionnaire for the measurement of medical students\u2019 empathy

BackgroundThis study aimed to validate the Korean version of the Toronto Empathy Questionnaire (TEQ) and to determine its suitability for the measurement of empathy in medical students.MethodsThe study sample was Year 1 and 2 medical students at two medical schools on six-year undergraduate medical programs in South Korea. The study participants completed the Korean TEQ, which has a single factor structure and consists of 16 items; responses are scored using a 5-point Likert scale, giving a maximum possible score of 64. Psychometric validation of the questionnaire was performed by exploratory and confirmatory factor analyses and the goodness of fit test. Average variance extracted was calculated to establish convergent validity, and associations between factors and construct reliability were analyzed to establish discriminant validity. Cronbach’s alpha values were utilized for reliability analysis.ResultsA total of 279 students completed and returned the questionnaire (a 96.2% response rate). Participant empathy scores ranged from 20 to 60 (M = 44.6, SD = 7.36). Empathy scores were higher for females than males (p < .05). The cumulative variance of the Korean TEQ was 32%, indicating that its explanatory power was rather weak. Consequently, goodness-of-fit testing was performed on four hypothetical models, among which a three-factorial structure consisting of 14 items demonstrated satisfactory fit indices and explained 55% of the variance. Reliability estimates of the three subscales were also satisfactory (Cronbach’s α = .71–.81). This three-factorial model was validated by confirmatory factor analysis and demonstrated adequate convergent and discriminant validity.ConclusionsThis study demonstrated psychometric validation of the Korean TEQ for measuring medical students’ empathy. We suggest a modified 14-item model with a three-factorial structure, which demonstrated better psychometric properties than the original scale.

Evolution of EC8 Seismic Design Rules for X Concentric Bracings

Eurocodes are currently under revision within a six-year program by CEN/TC 250. In this framework, concentric bracings, particularly in cross configuration, have been largely debated; indeed, several criticisms affect the seismic design procedure currently codified within Eurocode 8, entailing significant design efforts and leading to massive and non-economical structural systems, even characterized by poor seismic behavior. The efforts of SC8 have been aimed at improving the codified seismic design criteria for concentrically braced frames, by providing requirements and detailing rules conceived to simplify the design process and to improve the seismic performance. The current paper provides recent advances in the field of computational and structural engineering focusing on symmetric X concentrically bracings in seismic area, outlining the evolution of Eurocode 8 (EC8) seismic design rules, by examining the following aspects: (i) ductility class and behavior factor, (ii) analysis and modelling aspects, (iii) design of dissipative members; (iv) design of non-dissipative zones; (v) brace-to-frame connections.

The Politics of Building Effective Water Utilities in the Global South: A Case of NWSC Uganda

Although most public water utilities in developing countries perform poorly, some have achieved remarkable turnarounds and now deliver effectively on their mandate. Current analyses of such turnarounds focus on institutional- and organisational-level explanations that ignore the political economy factors that drive public sector performance in developing countries. This study employed the ‘political settlement analysis’ to explain both Uganda’s National Water and Sewerage Corporation (NWSC) turnaround that happened between 1998 and 2004 and why its performance has since been uneven. For the turnaround to happen, Uganda’s dominant ruling coalition, struggling to chart a developmental trajectory with limited domestic resources, agreed to a World Bank-inspired programme for building NWSC’s commercial and financial capabilities in 1998. The botched privatisation move helped bring the political elite, key technocrats and donors into a rare coalition that enabled a six-year programme of harmonised and uninterrupted support for NWSC. Meanwhile, the post-turnaround phase happened under different political dynamics, characterised by a fractious ruling coalition, increased political competition and frosty government–donor relations. The ruling elite turned to the newly effective NWSC for rents and for building its urban popularity. The pressures from this incentivised NWSC leadership to prioritise activities with visible and immediate commercial benefits, at the expense of long-term operational sustainability. These findings suggest that external support for institution building can succeed, where it is aligned with the dominant incentives generated by the local power relations. And how leaders of public organisations manage the changing political context within which they operate is as important as their technical capacity.

Student evaluation of medical school curriculum transformation in Iraq.

This article was migrated. The article was marked as recommended. Introduction: Decades of political and social unrest negatively impacted medical education in Iraq. Recently, new opportunities arose for medical schools to engage international education organizations and the World Health Organization to implement medical school curriculum changes, replacing older discipline-based, teacher-focused systems with a systems-based, student-focused reformed curriculum. Methods: A descriptive, cross sectional quantitative study was designed to survey medical students near the beginning (years 2-3) and at near the end (years 5-6) of their six-year program at the Al Kindy College of Medicine, University of Baghdad, Iraq. Results: A validated questionnaire collected data on thirty-two issues, including student perception of learning, student perception of teachers, academic self-perception and student self-perception. Seven of the thirty-two questions included in this survey resulted in significantly different responses from group 1 (second and third year) vs group 2 (fifth and sixth year) students. Conclusions: This study concluded that the two student groups were significantly different in their awareness of the need for curriculum change, but that student self-perception in both groups was less than ideal at present. In the future, studies are planned to assess student confidence in their professional development, as teaching institutions advance toward broader accreditation and thus opportunities for their students.

The Creation of a Unified National Health System

In many ways, the year 2019 was supposed to be a watershed for Russia’s healthcare system. This was the final year of the ambitious six-year program set forth in the May 2012 Executive Orders of the President, to be followed by even more substantial transformations under the new national project ‘Healthcare’. Meanwhile, the burgeoning unified national health system was continually evolving, its goal being to provide the entire nation with guaranteed equal rights to medical care.

19. DESIGN AND IMPLEMENTATION OF A FLEXIBLE PEDIATRIC SCIENTIST DEVELOPMENT TRACK

BackgroundCurricula for pediatric scientist development are not standardized in pediatric residency and fellowship, despite the dire need for pediatric physician scientists. We examined existing educational models and developed an integrated residency/fellowship pediatric scientist training program (PedSDP).ObjectiveOur primary objective was the development of an integrated six-year program, spanning residency and fellowship, for training of pediatric physician scientists.MethodsWe reviewed 20 existing pediatric residency tracks for scientist development. An integrated six-year program was constructed using the non-standard American Board of Pediatric pathways (Accelerated and Integrated Research Pathways) and individual components modeled on programs from other residencies. We formed a steering committee comprised of departmental leadership to support and provide input into our curriculum development. With the support of the Chair, we were able obtain approval for acceptance into fellowship programs at time of residency selection as a key obstacle to overcome. We also developed internal educational activities to support scientist development. (See Figure for overall design)ResultsFrom 2014-2018, our PedSDP recruited 8 residents, improving our overall MD PhD recruitment to 3 per year. While six of eight PedSDP trainees were MD PhD, we also recruited two MD only residents into our program. Residents have pursued fellowship in Infectious Disease and Allergy/Immunology (2 each), and Neonatology, Rheumatology, Critical Care Medicine and Cardiology (1 each). All residents have average milestones in the top half of their class.DiscussionWe successfully implemented a training program which has increased both MD PhD recruitment but also has provided opportunity for MD residents to pursue research careers. We have found new strategies for recruitment (adding a dedicated ERAS track) but continue to struggle to identify and attract MD/DO only resident applicants interested in being physician-scientists to the program. URL http://www.chp.edu/health-care-professionals/education/residencies/pedsdp Curricula for pediatric scientist development are not standardized in pediatric residency and fellowship, despite the dire need for pediatric physician scientists. We examined existing educational models and developed an integrated residency/fellowship pediatric scientist training program (PedSDP). Our primary objective was the development of an integrated six-year program, spanning residency and fellowship, for training of pediatric physician scientists. We reviewed 20 existing pediatric residency tracks for scientist development. An integrated six-year program was constructed using the non-standard American Board of Pediatric pathways (Accelerated and Integrated Research Pathways) and individual components modeled on programs from other residencies. We formed a steering committee comprised of departmental leadership to support and provide input into our curriculum development. With the support of the Chair, we were able obtain approval for acceptance into fellowship programs at time of residency selection as a key obstacle to overcome. We also developed internal educational activities to support scientist development. (See Figure for overall design) From 2014-2018, our PedSDP recruited 8 residents, improving our overall MD PhD recruitment to 3 per year. While six of eight PedSDP trainees were MD PhD, we also recruited two MD only residents into our program. Residents have pursued fellowship in Infectious Disease and Allergy/Immunology (2 each), and Neonatology, Rheumatology, Critical Care Medicine and Cardiology (1 each). All residents have average milestones in the top half of their class. We successfully implemented a training program which has increased both MD PhD recruitment but also has provided opportunity for MD residents to pursue research careers. We have found new strategies for recruitment (adding a dedicated ERAS track) but continue to struggle to identify and attract MD/DO only resident applicants interested in being physician-scientists to the program. URL http://www.chp.edu/health-care-professionals/education/residencies/pedsdp

Medical education in Romania: Tradition and innovation

Romania is a country in south-east Europe, which has experienced major changes in political, educational, and healthcare systems. At the time of writing this paper, there are thirteen accredited Faculties of Medicine, which offer students from all over the world the possibility of becoming doctors. Students in Romania follow a six-year program of activity and there are courses taught in Romanian, English, French, and Hungarian. In this paper, we outline the organization of Romanian medical education at undergraduate and postgraduate levels and we indicate the opportunities for curriculum development.

Programme for maintenance and evolution of Eurocodes: Drafting of the future EN 1993-1-9 on fatigue of steel structures

A four-phase six-year programme dedicated to maintenance and evolution of structural Eurocodes has entered its fourth and final phase. The main objectives for all the phases have been "reduction of nationally-determined parameters" and "ease of use". The new versions of the standards are about to be finalized by the designated CEN Project Teams and their publication and mandatory use in construction is expected for 2024.The work on drafting a new version of EN 1993-1-9 belongs to Phase 3. The five-member Project Team responsible for drafting the standard started thus its work in autumn 2018. The Project Team has based its work on several grounds:• Results of the CEN Systematic Review on EN 1993-1-9• Particularities in National Annexes of EN 1993-1-9• Proposals by all 43 official experts, members of CEN/TC 250/SC 3/WG 9 on EN 1993-1-9, and many others, members of ECCS/TC6 on Fatigue and fracture, including:- harmonization with other EN standards- integration of new experimental results- clarified unified fatigue data analysis- integration of execution quality- enlargement in order to follow modern design and execution practices.The aim of the programme is to obtain harmonized and user-friendly design rules able to cover standard cases in steel construction, representing about 80% of all cases. For more complex problems, the new Eurocodes will present a necessary basis for the search of an adapted solution.This paper is exploring all the modifications on EN 1993-1-9 "Fatigue" proposed and integrated in its latest draft.

Organizacja i funkcjonowanie Wyższego Seminarium Duchownego w Koszalinie w latach 1981–2011

The study hereby proposed presents the activity of a Catholic college - Higher Theological Seminary in Koszalin in the years 1981-2011. The College came into being thanks to the efforts of Bishop Ignacy Jeż. In the abovementioned period, the college was administered by five rectors and seven administrative directors. There were 658 students (alumni) and 362 deacons, who took holy orders. During the six-year program of education, students learned the obligatory, pastoral and theological subjects as well as underwent practical training. The thesis defense took place in the fifth year of studies. The sixth year was intended for practicing and taking religious vows.

Pastoralism as a sustainable development tool in the Sahel

Since 2015, the World Bank has provided funding of USD 248 million to the Regional Sahel Pastoralism Support Programme (PRAPS) in six countries (Burkina Faso, Chad, Mali, Mauritania, Niger and Senegal) as part of a six-year programme administered regionally by the Permanent Interstate Committee for Drought Control in the Sahel (CILSS).

Health Sciences cultural safety education in Australia, Canada, New Zealand, and the United States: a literature review.

ObjectivesTo review the research literature on cultural safety education within post-secondary health science programs. MethodsWe conducted health and social science database searches from 1996-2016, using combined keywords: cultural competence or safety; teaching or curriculum; universities, polytechnics or professional programs; and Aboriginal or Indigenous. In dyads, authors selected, and reviewed studies independently followed by discussion and consensus to identify thematic linkages of major findings. ResultsA total of 1583 abstracts and 122 full-text articles were reviewed with 40 selected for final inclusion. Publications from Australia, Canada, New Zealand and the United States described curriculum development and delivery. A variety of evaluation approaches were used including anecdotal reports, focus groups, interviews, course evaluations, reflective journals, pre-post surveys, critical reflective papers, and exam questions. Duration and depth of curricular exposure ranged from one day to integration across a six-year program. Changes in student knowledge, attitude, self-confidence, and behaviour when working with Indigenous populations were reported. Cultural safety education and application to practice were shown to be linked to improved relationships, healthier outcomes, and increased number of Indigenous people entering health education programs and graduates interested in working in diverse communities. ConclusionsThis review provides a summary of multidisciplinary didactic and experiential instructional approaches to cultural safety education and the impact on students, educators and Indigenous people. Institutional support, strategic planning and cultural safety curriculum policy within post-secondary settings and community engagement are imperative for positive student experiences, advocacy, and actions toward health equity and improved health for Indigenous people and communities.

Second language teaching of vocation-specific isiZulu communication skills to health sciences students

The importance of integrating teaching of the previously disadvantaged languages of South Africa in the mainstream courses offered in higher education is widely acknowledged. IsiZulu is taught formally to first-year health science undergraduates, complying with the 2006 University of KwaZulu-Natal (UKZN) Language Policy. However, in the Bachelor of Medicine and Bachelor of Surgery (MBChB) programme, this has been shown to be inadequate to equip students with the necessary language skills to engage meaningfully with patients in a consultation when they reach the clinical years. Consequently, the College of Health Sciences at the University of KwaZulu-Natal is in an early stage of teaching vocation-specific isiZulu communication skills to second language health sciences students. This is necessary as good communication is considered essential for clinical competence. This position paper refers to relevant theories of second language acquisition and the teaching methods that have been used to integrate the teaching of isiZulu communication skills into the three preclinical years of the medical curriculum. This interprofessional collaborative initiative is intended to prepare students for the clinical years of study. Recommendations are made for full vertical integration of isiZulu communication skills throughout the six-year programme, with specific assessment in either simulated or clinical settings, to motivate students and drive learning of isiZulu for clinical communication.

Training medical students for the twenty-first century: Rationale and development of the Utrecht curriculum “CRU+”

Aim: The aim of this report, written for the 40th anniversary issue of Medical Teacher, is to document 20 years of development of the Utrecht undergraduate medical curriculum, as both to exhibit accountability and to inform the community of the process and choices that can be made in long-term curriculum development.Methods: We used the SPICES model, created by Medical Teacher’s Editor Ronald Harden and colleagues in 1984.Results: The Utrecht six-year program, now called “CRU+”, has many distinct features that were introduced, most of which are well documented. A limited selection includes • A new 3+3 years Bachelor-Master structure following the EU Bologna rules leading to MD registration for cohorts of about 300. • Horizontally integrated classroom teaching of basic sciences with clinical disciplines predominantly in groups of 12 and limited lectures. • Mandatory knowledge retention tests, retesting the clinically relevant core knowledge from block tests of semesters one through four. • Vertical integration not only linking clinical experience with background knowledge, but also exemplified by a stepwise increase in health care responsibilities throughout the curriculum. • A final year focussing on growth towards the level of a primary responsible physician in a 12-week sub-internship for a limited number of patients and beds, in a chosen specialty. The student is called a semi-physician in the clerkship of this transitional year to residency. • Teaching skills training for all medical graduates, an elective teaching rotation and various peer-teaching arrangements throughout the curriculum. • Integrated semi-longitudinal clerkships with an assessment focus on entrustment decisions for Entrustable Professional Activities.Conclusion: UMC Utrecht has made a continuous attempt to both develop its medical curriculum and to study and report on its development in the literature, regarding new methods found and insights derived. UMC Utrecht will remain committed to developing training to meet twenty-first century demands of medical graduates.