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

Abstract

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.

Acknowledgments

All four authors have subsequently served as a program director of Utrecht undergraduate medical education, in this order, from 1999 to 2017.

The authors wish to acknowledge numerous faculty members and students involved in the subsequent Utrecht curricular reforms. Space restrictions preclude us from naming all, but the following collaborators deserve to be named: Thomas Assink, Vera Batenburg, Hans Bijlsma, Ronald Bleys, Edith ter Braak, Sjoukje van den Broek, Carla Bruynzeel-Koomen, Joop Buddingh’, Jaap Buis, Gerda Croiset, Marco D’Agata, Hans van der Donk, Vivian Eijzenbach, Rik Endeman, Tom Fick, Samuel Fidder, Tanja Frakking, Joost Frenkel, Sibyl Geelen, Frans Grosfeld, Hein Gooszen, Timon van Haeften, Karlijn Hofstraat, Els de Jonge, Habo Jongsma, Bastiaan van der Klis, Kirsten Korte, Jan Koudstaal, Marjan Kromkamp, Marijke Kuyvenhoven, Margriet Leenen, Floor van Leeuwen, Sanne van den Munckhof, Hanneke Mulder, Marja Nieuwhof, Boris Peltenburg, Berent Prakken, Martien Quaak, Guy Rutten, Lieke Sanders, Patricia Schothorst, Anke Steerneman, Isabel Thunnissen, Suzanne van der Velden, Theo Voorn, Lisanne Welink, Margot Weggemans, Foppe Wiersma, Dick de Wildt, and Dorien Zwart.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Notes on contributors

Olle ten Cate, PhD, is a Professor of Medical Education, Scientific Director of Education, and Senior Scientist at the Center for Research and Development of Education at University Medical Center, Utrecht, The Netherlands and was the Program Director for 1999–2003 and is the Vice-chairman of the CRU + Curriculum Committee.

Jan Borleffs, MD PhD, was the Program Director and Chair of the Curriculum Committee “CRU2006” 2003–2008 at University Medical Center, Utrecht and is the Dean of Education at University Medical Center Groningen, The Netherlands until 2018.

Marijke van Dijk, MD PhD, was the Program Director 2008–2017 and Chairman of the CRU + Curriculum Committee until 2017 at University Medical Center, Utrecht, The Netherlands.

Tineke Westerveld, MD PhD is the Program Director and Chair of the CRU + Curriculum Committee at University Medical Center, Utrecht, the Netherlands since 2017.