Design and Rationale of a New UME
Curriculum: Recent Plans at One
Institution in the Netherlands
Olle ten Cate PhD
Center for Research and Development of Education
University Medical Center Utrecht
Some background notes
on Dutch Medical Education
The Netherlands has eight medical schools
Courses are (generally) six years
Students enrol directly from high school
The government determines total national
enrolment of medical students (now 3150)
• Admission procedure in transition: 100% weighted
lottery to 100% school-determined selection
• National blueprint of objectives (now based on
CanMEDS); no national exams
The International Conference on Residency Education
La conférence internationale sur la formation des résidents
Short history of the Utrecht
undergraduate medical curriculum
Until 1999: curriculum considered old-fashioned
and inadequate (national review committee)
1999: Curriculum Utrecht 1999 (“CRU’99”): totally
new concept
2006: The EU Bachelor-Master structure for higher
education applied to medicine  slight
rearrangements in CRU2006 (3 yrs Ba + 3 yrs Ma)
2015: New curriculum to start (both Ba and Ma
Current features of Utrecht’s 6 year
UME curriculum (CRU99/CRU06)
- Annual enrolment of 304 (government determined);
entrance selection through weighted lottery
- Integration of basic sciences in 5-week almost full
time blocks in first two years (B1+B2)
- Much small group work; limited lectures;
constructivist philosophy, not fully PBL
- Early clinical rotations in 3rd year (6 weeks internal
medicine; 6 weeks surgery)
- PGY 6: transition to residency: longer clerkships, more
Curriculum innovation planning
• Decision to innovate: September 2011 (after
national “LCME” review)
• “Horizon Scanning Committee” report July 2012
• Curriculum committee installed September 2012
• Blueprint for a New Curriculum 2015 (July 2013)
• UMCU Board of Directors to allocate funds for
renewal (September-October 2013)
• Experiments and preparations before 2014/15
• New Ba and Ma curricula starting Sept 15
Actions and conclusions of the
Horizon Scanning and Curriculum
Committees 2011-2013
• Literature scanning: a.o. 2010 Carnegie
report; 2010 Frenk Lancet paper; LIC
• Visit of Dr David Hirsh 2012 to explain LICs
• Consultations with target groups on clinical
teaching, student assessment, admission
and selection, small group teaching and with
many individuals
Actions and conclusions of the
Horizon Scanning and Curriculum
Committees 2011-2013
Retaining and strengthening what was already
- Vertical integration of basic sciences with clinical
teaching and roughly its balance
- Small group, active education
- Opportunities for electives (20% of the program)
- Teaching roles and opportunities for students
- Professionalism, scholarship
Actions and conclusions of the
Horizon Scanning and Curriculum
Committees 2011-2013
Innovations / adaptations:
- Retention of acquired knowledge in the bachelor
needs strengthening
- Selection of students in unavoidable
- Profiling opportunities of students in the master years,
serving UME-GME continuum is desired
- Acquaintance with elderly health and some other less
visible but critical clinical domains need attention
- Educational technology should be blended in
- Curriculum should serve motivation of learners and
New features planned in CRU 2015
Bachelor phase
• Qualitative entrance selection; no lottery
• Small group teaching: an option to register for
• Every small group session requires preparation
through e-learning assignment the previous day
• Focus on knowledge retention. Repeated testing
of knowledge. Students must pass block tests
and four “Crux” tests (each including the content
of one semester)
New features planned in CRU 2015
Bachelor phase
• The class of B1 & B2 to be organised in 4
communities of learners of 76 students each
• B3 will include an integrated clerkship of 12
weeks (internal medicine, surgery and family
• Every student to be assigned a panel of 10
patients to adopt for 3-4 year
New features planned in CRU 2015
Master phase
• M1 & M2: 4 big units of 6 weeks block
preparation + 12 weeks of longitudinal
Integrated clerkship (LIC), each including 2-4
• Every student has own clinical preceptor for
each LIC
• Clinical training preparing to bear
responsibility will be structured using EPAs
and entrustment decisions
New features planned in CRU 2015
Master phase
• M1 & M2 each have a 6 week profiling block.
Every student to develop a clinical profile,
but to remain eligible for all residencies
• M3 basically remains in tact.
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Directorate of Finances
Directorate of Personnel
Directorate of IT
Directorate of Education
UMCU Board
Education Center (until recently:
“Directorate of Education”)
• +/- 150 personnel
• Responsible for university programs (medical,
health, life sciences; BSc, MSc, MD, PhD)
• Responsible for non-university health professions
eduction (nursing specialities etc)
• Departments: Student admin and educational
affairs; Allied health education; Biomedical science
training (Ba and Ma); Clinical health sciences (Ma);
UME (6 & 4 year courses); PGME; Center for Res
and Dev of Education
Center for Research and
Development of Education
Established 2005; 6 Task fields
1. Development and Educational advice/consultancy
2. Quality Assurance
3. IT in education support and development
4. Faculty Development
5. Teaching of Students
6. Research
19 fte (tenure to 65 and temporary)
Budget 1.4 m€; 60% fixed; 40% paid services

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