Educación médica basada en resultados. II: ¿Fascinación transitoria o nuestro futuro? Translated title: Outcome-Based Medical Education II: Transitional fascination or our future?

The Tuning Project is an initiative funded by the European Commission to develop learning outcomes/competences for degree programmes in Europe and to promote harmonisation in the Higher Education sector. It is closely linked to the Bologna Declaration and subsequent developments. Under the auspices of the MEDINE Thematic Network for Medical Education in Europe, the Tuning (Medicine) Task Force has generated a draft set of learning outcomes for primary medical degree qualifications in Europe. These take account of previous work on learning outcomes in medicine, have been generated through an iterative process of expert review and development, and have been the subject of a Europe-wide internet-based opinion survey and subsequent analysis. They have been approved by the MEDINE Network and validated (subject to some additional analysis) by an Expert Panel of the European Commission.

Significant progress has been made with the move to outcome-based education (OBE) in medicine and learning outcomes are on today's agenda. Learning outcomes have been specified in a number of areas and frameworks or models for communicating and presenting learning outcomes have been described. OBE has, however, two requirements. The first is to make the learning outcomes explicit and the second is the use of the specified outcomes as a basis for decisions about the curriculum. It is the second requirement that is often ignored. Three patterns of behaviour have been identified - the 'ostriches' who ignore the move to OBE believing it to be a passing fad or irrelevance, the 'peacocks' who display, sometimes ostentatiously, a specified set of outcomes but stop there and the 'beavers' who, having prepared their set of learning outcomes, use this as a basis for curriculum related decisions. An OBE implementation inventory is described that allows schools to assess their level of adoption of an OBE approach in their institution. Schools can use this to rate their level of OBE adoption on a five point scale on nine dimensions - a statement of learning outcomes, communication with staff/students about the outcomes, the educational strategies adopted, the learning opportunities available, the course content, student progression through the course, assessment of students, the educational environment and student selection. A profile for OBE implementation can be prepared for the institution.

The advantages of outcome-based education for medical students have been recognised for several years and in several countries. Until recently in Vietnam, as in many countries, the curriculum for medical doctors was a broad framework that individual teachers filled in according to their own ideas and experience. During the past few years, the main eight medical schools in Vietnam have worked together to develop detailed learning objectives within the framework from the Ministries of Health and of Education and Training. The process was planned in an innovative and participatory way that involved more than one thousand teachers and other experts and resulted in a book listing the expected outcome in the form of the knowledge, attitudes and skills expected of a medical doctor graduating from any medical school in Vietnam. The process of identifying the objectives was followed by revision of the curriculum to be more community-oriented and to include more focus on teaching of skills, and by production of teaching, learning and assessment materials to fit the new curriculum. The process is described as an example of a comprehensive and bottom-up approach to curriculum development that could provide an example for other disciplines and schools in Vietnam or elsewhere.