Croatian training model for medical teachers: Strenghts and weaknesses


  1. Gordana
  2. Pavlekovic and Mladenka
  3. Vrcic Keglevic


3JJ Staff development


School of Medicine, University of Zagreb, Croatia
Croatian Association for Medical Education (CAME)


Medical teaching is a complex task and tendency of „professionalization“ of medical education is recognized in academic and professional societies. At the begining of 1990s, Department of Educational Technology at School of Medicine in Zagreb University started with the first short training programmes for medical teachers. Based upon those activities, Croatian Association for Medical Education was founded. Since 2000, one-week courses entitled „The Art of Medical Education“ have been organized several times per year, mainly for younger teachers with the aims to encourage and enable them early in their career to learn and put into practice contemporary approaches in teaching and learning medicine.        

Summary of Work

From 2000 to 2014, the Course „The Art of Medical Education“ was attended by 532 participants/medical teachers from all medical schools in Croatia, with various professional backgrounds.  A wider concept and deeper understanding of medical education and its development are the main tasks of the Course and participants are encouraged for inquiring:
• basic understanding of the concepts of medical study, challenges and dilemmas in teaching and learning;
• theoretical framework for understanding factors influencing the quality of teaching-learning process;
• rang of evidence-based strategies, both traditional and innovative methods;
• framework for planning, implementing and evaluating medical education;
• awareness of ethical issues relating to medical education.

To achieve the Course objectives, the principles of adult learning and multiple instructional methods are used: self-directed and task-based learning, small group discussion, individual and group projects, microteaching using interactive video, self-reflection and peer reflection, role-play, demonstration, round-tables discussion and others. Simply completing the Course is not sufficient for award of a certificate: the participants have to prepare an educational module in the written form, it has to be orally presented and discussed in front of a three-member committee, but also preferably in front of teachers from the presenter’s department.

This presentation is based on the 14 years of experiences with the aim to review the strengths and weaknesses of the Course. The results are obtained from (a) process evaluation at the end of the Course using quantitative and qualitative methods (written questionnaire and group discussion), (b) data collected by individual questionnaire sent to past participants (response rate 68%) and (c) students' assessment of participants/teachers before and after the Course.


Summary of Results



Organizational structure: Who is responsible?

Support from Faculty Board, Department for Medical Education, CAME

Lack of a real School of Medicine support (learning environment, curricula changes, financial support…)

Compulsory of voluntary training?

External and internal motives

Mainly external motives

Aims, contents, participants: For whom, for what?

Pedagogical skills and the art of medical education (culture of medical education)


Younger medical teachers



Interdisciplinary mixed group

Expectations: more practical skills


Average: 45 years

Lack of „older teachers“ and key decision makers

Teachers/educators and methods: Who and how?

Well experienced MD/teachers, not (formal) experts in pedagogical skills


Interactive, multiple instructional methods

Discussions with guests

Exchange of experiences, sharing doubts, peer support in teaching…

Number of teachers/educators

Impact of the programme: Is it measurable?

Comparation of students average evaluation score of teachers (positive)


Small design innovations, introduction of elective courses…

Lack of active work in School of Medicine


Lack of interest for research in medical education

The study results showed that for all respondents the most important motive for coming was to learn something new, and renovation of existing knowledge and need to complete the course as a requirement for future promotion. Less important motives were associated with promotion in assistant professor, referral by Chair and least desire for renewal of existing knowledge.

The whole course is very highly evaluated - very good grade scored by 48.4% and excellent by 22% of respondents.

According to the feedback, the elements of the course scoring most highly in the evaluation are:
• builds on and expands their previous teaching and learning experiences,
• directing interests to teaching,
• stimulates exchange of experience with colleagues from different departments,
• peer discussion as a continuous support for their advancement in teaching,
• satisfaction in communication and sharing doubts with experienced teachers, and
• panel discussions with guests and an overview of present situation in medical education.
Two aspects of the Course evaluated less highly were:
• insufficient participation of “older teachers” and key decision makers within the faculty, and
• doubts as to whether implementation of the skills mastered in the course would be transferred to practice.

In personal evaluation of effectiveness of the course on their teaching work the participants stated that after the course the biggest change occurred in development of positive attitudes to teaching, followed by small design innovations in methodological units and relation with students. The least change occurred in involvement of Chair work, introduction of elective courses and even less in active work in School of medicine committees and interest for research in medical education. Most of participants think that all teachers should attend such a course, regardless of age, academic and scientific professions (69% of respondents) while 31% of participants think that attendees should be only younger teachers.

Comparison of students average evaluation score of teachers, who teach same subject, showed higher score (23/35) of teachers who passed the course, same score (4) and just one lower score.

Compared to other “training for trainers” courses in medical education with similar aims and objectives, the Croatian model has at least two positive characteristics and strengths:
• trainers are not experts in pedagogical or didactical knowledge and skills. They are well experienced medical doctors/teachers sharing their own experiences and reflections with participants,
• putting together a mixed group of participants (with different prior knowledge, field of work, interests, expectations, and teaching environment) has a positive impact on their motivation and encouragement.



Besides positive examples, several challenges have been encountered, which do not differ from worldwide topical dilemmas: (1) Organisational structure to support teaching and teachers: Who is responsible; (2) Compulsory or voluntary training for medical teachers: To whom, for what; (3) Content of training programme: Pedagogical skills or the art of medical education; (4) Impact of teaching the teachers programmes: Is it meassurable; (5) Barriers and opportunities for effective teaching: Competent medical teacher or supportive institutional environment?

Take-home Messages

Long-term studies and responsibility to support future research and development in this field belong to both academic and medical professional societies. Beside the differences in opinions or experiences, the educational mission of medical schools and teachers professional development, are strongly recommended. A comprehensive research on quality of medical teaching might contribute to answering previously posed questionas and dilemmas.

Summary of Work
Summary of Results
Take-home Messages
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