The Bologna Process – From futility to utility

Davis (2010) highlights in his Commentary in this issue of Medical Teacher , the Bologna Process with its aims of putting in place a system of easily readable and comparable degrees, a two/three-cycle qualification system, a credit transfer and accumulation mechanism, student mobility, quality assurance, a comprehensive system of lifelong learning, wider access and equality of opportunity and measures to promote the attractiveness of European higher education. The Bologna Process envisages a first or Bachelor cycle anticipated as usually of 2–3 years duration and a second or Master cycle, again of 2–3 years duration. ‘A beautiful futility’, however, was the term used by Gordon et al. (2009) to describe the twocycle model and the Bologna Process. Problems and disagreements over the Bachelor Master two-cycle model, regrettably they believe, have dominated the discussions about the implementation of the Bologna Process in Medicine and have distracted from other important aspects of the process. They argue that the two-cycle model is ‘irrelevant, backward looking and arbitrary’ and has been ‘a regrettable waste of time and other resources’. They believe that this results from the fact that the needs of medical education have not been fully taken into account in the development of the Bologna Process. This, however, is a misunderstanding of the Bologna Process. It is not that Medicine has been excluded but rather that the Bologna action lines have been defined at a system level independent of academic discipline, as described by Davis (2010). Gordon and co-authors are concerned that the two-cycle model imposes an arbitrary divide or partition in medical education courses that do not need to be divided. In an article in this issue of Medical Teacher , Cumming (2010) argues a contrary view – that the two- or three-cycle Bologna system adopted in medical education can bring clarity to what is a historically confused area and can encourage the integration of clinical learning with medical sciences at all stages of the student’s journey. The idea that the two-cycle model is in some way a retrograde step returning medical education to the basic science/clinical divide is one of the common myths about the Bologna Process refuted by Patro´cio and Harden (2010) in a further article in this issue. They argue that the two-cycle model, rather than partitioning the medical curriculum, presents an opportunity to develop a spiral curriculum (Harden & Stamper 1999) that reflects the students’ progression as they pass through the different phases of the undergraduate education programme, increasing their mastery and capabilities as they pass from the first to the second phase, with the basic sciences and clinical medicine closely integrated and appropriate learning outcomes described for each curricular cycle or phase. The Bologna Process envisages that students on the completion of the first cycle may choose to leave their studies and seek employment in another field. Gordon et al. (2009) believe that the employment opportunities in other sectors following completion of the first cycle are illusory. Experience, however, in Switzerland has shown that this is not the case and that, for the small number of students who choose to leave their studies after the completion of the first or Bachelor cycle, job opportunities can exist in areas such as medical communication systems, medico-legal work, the pharmaceutical industry and other health-related occupations. Gordon and co-authors also raise thespectre of a cadreof ‘barefoot doctors’. This is a second myth about the Bologna Process highlighted by Patro´cio and Harden (2010). There is no expectation inherent in the twocyclemodelthatstudentsleavingafterthefirstcyclewillpractise as some sort of second-rate doctor.