Student-Centered Curriculum: The Innovative, Integrative, and Comprehensive Model of “George Emil Palade” University of Medicine, Pharmacy, Sciences, and Technology of Targu Mures

Abstract

Medical education is the paradigm of 21st century education and the current changes involve the adoption of integrative and comprehensive patient-centered teaching and learning approaches. Thus, curricular developers from George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology of Targu Mures (G.E. Palade UMPhST of Targu Mures) have recently designed and implemented an innovative medical curriculum, as well as two valuable assessment tools for both theoretical knowledge and practical skills. Thus, during the first three preclinical years, the students will benefit from an organ- and system-centered block teaching approach, while the clinical years will focus on enabling students to achieve the most important practical skills in clinical practice, based on a patient bedside teaching system. In terms of theoretical knowledge assessment, the UNiX center at G.E. Palade UMPhST of Targu Mures, a recently designed center endowed with the latest next-generation technology, enables individualized, secured multiple-choice question-based assessments of the student’s learning outcomes. Moreover, an intelligent assessment tool for practical skills was also recently implemented in our branch in Hamburg, the Objective Structured Clinical Examination (O.S.C.E). This system uses direct observations for testing the student’s practical skills regarding anamnesis, clinical exams, procedures/maneuvers, the interpretation of laboratory tests and paraclinical investigations, differential diagnosis, management plans, communication, and medical counselling. The integrative, comprehensive, patient-centered curriculum and the intelligent assessment system, implemented in G.E Palade UMPhST of Targu Mures, help define innovation in education and enable the students to benefit from a high-quality medical education.

1. Introduction

A holistic approach to higher medical education is crucial in the era of digitalization. Medical universities and higher education institutions should be aware of the rapid changes that are occurring in regard to the diagnostic and management tools available and should adapt to the growth in their quantitative and qualitative dimensions in response to these changes. Therefore, a balance is required between these two dimensions in order to avoid negative impacts on healthcare systems and patient outcomes, such as due to academic failure and dependance, poor academic achievements, brain drain, no sense of creativity, and a lack of organization skills (Farmad et al., 2023; Hosseinpour & Samii, 2001). Based on the current development of digital techniques and methods worldwide, the goal of medical universities should be to nurture competent and capable healthcare professionals, endowing them with complex knowledge and appropriate attitudes, but above all with the required skills for improving and maintaining the public health status (Amin et al., 2006; Cohen et al., 2005).

The competency-based curriculum is centered on outcomes that are formulated as a result of the needs of future critical professional functions and, at the same time, they represent the basic principles for curriculum design (Carraccio et al., 2016). Major changes have arisen recently in the working life of physicians due to rapid medical progress, evolving patient needs, societal demands, and the desire to implement and improve the medical teaching process (Guse & Kuhlmey, 2018; Maaz et al., 2018). Analysis of the old school, discipline-centered traditional medical teaching model has revealed that graduates receiving such an education have major flaws as working physicians in terms of their practical clinical, teamwork, and scientific skills (Hitzblech et al., 2019). Moreover, the physician–patient relationship was recently emphasized to have a major impact on patient outcomes (Mărginean et al., 2017). Interprofessional collaboration and teamwork are crucial to patient safety and outcomes and the development of interprofessional collaboration skills in undergraduates that are matched to medical realities should guarantee more successful patient management (Mitchell et al., 2005).

Medical educators should be aware of the major lack of future graduates and should respond in an open-minded way to the changes imposed by modern healthcare systems. The teaching strategies in the area of clinical education are incontestably different when compared to other professions due to several peculiarities, such as principles related to patient safety, the major role of the doctor–patient relationship, and the experiential characteristic of students’ learning in clinical environments (Spencer, 2003; Vivekananda-Schmidt & Sandars, 2016). Thus, clinical education was historically based upon different teaching approaches involving the one-minute preceptor model (Aagaard et al., 2004), and outcome-based (Dent et al., 2017) and competency-based education (Frank et al., 2010; Harden, 2014). Although the teaching methods might be different depending on the clinical environment, they are guided by common concepts and principles like the supplemental value of using case studies, the crucial role of medical trainers, and the elaboration of learning activities (P.-H. Huang et al., 2019). The profession of the medical academician is indeed an art, since the teacher is responsible for shaping the mind and the soul of the future graduate in order to ensure that it matches the medical profession’s requirements, and to ensure that the ‘product’ is a worthy next-generation innovative leader within the medical field.

Moreover, medical educators are not only teachers, since, concomitantly, they have to be diligent researchers and experienced physicians, combining these three traits for the sake of their students in order to become role models for their trainees, continuously striving to participate in activities that are beyond the state-of-the-art advancements within the field. Medical universities need to foster an environment conducive of innovation, research, and clinical skills development to achieve the supreme goal of education, which is defined by the success of its graduates. Aside from the complex needs described so far, health education developers should also take into account the students’ needs and should ensure their participation in the competence-based curriculum, ensuring the continual enhancement of the opportunities for them to become better practitioners. Recently, medical training has adopted active learning as a crucial component of the teaching process, which is, in fact, a mirror of student engagement. Nevertheless, active learning requires the support of medical academicians, who should be willing to adjust their teaching and learning approaches to ensure that students’ interest is sustained during this process (Grijpma et al., 2022). Thus, medical schools that sustain active learning are responsible for creating a facilitating environment for students’ engagement with their educators, peers, and study content, a sine qua non condition for building their own knowledge (Chi & Wylie, 2014; Grijpma et al., 2022).

One of the most important problems in Romania regarding medical education is the lack of proper clinical competencies of students after graduation, due to both students’ disengagement and the inability of medical educators/curricula to adjust to students’ needs. Therefore, medical universities, through their academicians and the implemented curriculum, are fully responsible for improving these aspects and for providing medical students with the required skills to achieve the desired clinical competencies before their graduation, a core component of their future profession as healthcare providers. The competency-based curriculum should be considered as a puzzle, where medical students are the centerpiece, but in which the other pieces, including patients’ needs, academic principles, socio-economic demands, hospital and working physicians’ opinions, as well as national and international standards, are critical components for success.

The aim of this narrative overview was to highlight the importance of innovation in medical teaching by comparing the innovative integrative teaching model implemented in our university with other teaching models reported worldwide.

2. Literature Search

According to the lines of search for a narrative review, we identified the most relevant information regarding our topic by performing an electronic search of the literature in PubMed. Thus, we introduced medical curriculum, medical higher education, medical school, medical students’ examination, medical internships, and OSCE as search terms (Figure 1). A literature search was performed for the present review based on the lines of search for a narrative overview. Initially, we included all the articles on the topic of medical higher education, and then all of these articles were critically evaluated taking into account the accuracy of the methods used to check the hypothesis, the interpretation and quality of the results, the key results, the limitations, and the impact of the conclusions on the field (Derish & Annesley, 2011). Finally, we excluded the articles that did not comply with the critical tools for assessing scientific papers, articles written in another language other than English, and those with no full text available.

The same steps were followed for the articles of interest found by a manual search in the reference lists of the manuscripts included during the initial search, which were included in this review only after their critical assessment. All the relevant findings collected from the content of the included articles were synthetized in order to provide an objective narrative overview.

3. Medical Innovation in Romania

The University of Medicine, Pharmacy, Sciences, and Technology ‘G.E. Palade’ of Targu Mures (G.E. Palade UMPhST of Targu Mures), Romania, is one of the top medical universities in the country (“George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, n.d.; Overall Rankings 2023—UI GreenMetric, n.d.; University | Ranking Web of Universities: Webometrics Ranks 30000 Institutions, n.d.). With an important satellite branch in Hamburg, Germany, UMPhST–University Medical Campus Hamburg (UMCH) was founded in 2019 as an extension of G.E. Palade UMPhST, creating an international educational bridge between Romania and Germany; the university strongly defines and sustains the concept of complementarity in medical teaching. Moreover, G.E. Palade UMPhST of Targu Mures and UMPhST–UMCH are both informed by innovation, which informs the main educational patient-centered concept and furnishes the students with the opportunity to achieve essential medical competencies and practical skills as preparation for future real-life clinical situations.

3.1. The Teaching Model

The need for innovation and change in medical education is no longer a myth. Therefore, G.E. Palade UMPhST of Targu Mures, Romania, has designed and implemented an innovative, integrative, and holistic curriculum for the students of the medical faculty (Figure 2). This approach to medical education will provide the students from the 1st to the 6th year with the opportunity to gain a blended understanding of theoretical and practical competences. In addition, our intention is to prepare the students for their future profession by endowing them with the required competences to deal with real-life medical situations before they actually enter the medical field.

Each year of the 6 years will be divided into two semesters of 14 weeks, and each semester is divided into two modules of 7 weeks, resulting in a modular medical training program made up of four modules per year. After each module, the students will be assessed on their theoretical and practical knowledge and competences gained during the module for each study discipline.

The first three years of medical education consist of preclinical training. Thus, during the first year, the students will study general elements of anatomy, biochemistry, biophysics, cellular and molecular biology, histology, physiology, medical informatics, medical deontology, bioethics, first aid, foreign languages, and physical education.

In addition, they will choose an optional discipline, which they will study during the entire year. The 2nd and the 3rd years of medicine focus on an ‘organ-centered approach’, meaning that each module will deal with a system or an organ, and all the disciplines included in that particular module will detail the theoretical and practical elements related to that organ or system (Figure 2). Therefore, during the 2nd year, the students will be introduced to the first module through introductory lectures on general pathological anatomy, general pharmacology, and general physiology regarding the pathogenesis of human disorders. The second module will focus on elements of pathology, pharmacology, physiopathology, and histology regarding the ‘blood’; followed, in the 3rd and 4th modules, by the same approach involving cardiovascular and respiratory systems.

Aside from the aforementioned disciplines, the 2nd year studies will also include genetics, microbiology, ethics and academic integrity, hygiene, behavioral sciences, medical psychology, medical sociology, foreign languages, physical education, and another optional discipline. The assessment model remains the same as in the first year. The 3rd year of preclinical medical education in our university focuses on the digestive, renal, endocrine, reproductive, and nervous systems, involving the same disciplines as in the 2nd year, providing theoretical and practical information that is matched to each of these systems: pathology, pharmacology, physiology, physiopathology, and histology. The curriculum for the 3rd year also includes medical and surgical semiology; primary healthcare assistance; immunology; surgery of the mouth, joints, and face; and medical embryology (Figure 2).

The last 3 years of medical study at our university consist of disciplines that are meant to orientate the medical students to specific clinical departments and each discipline has a theoretical part and a practical one that involves an internship within a hospital or clinic. Thus, in the 4th year, the students will learn the following medical specialties, based on a modular approach: orthopedics and traumatology, urology, vascular surgery, clinical biochemistry, general surgery, child care, radiology and medical imaging, work medicine, endocrinology, emergency medicine, hematology, plastic and aesthetic surgery, reconstructive microsurgery, pediatric surgery and orthopedics, diabetes mellitus, nutrition and nutritional disorders, as well as clinical allergology and immunology. The 5th year of clinical medicine at our university consists of gastroenterology, nephrology, dermatology and venerology disorders, pneumology, rheumatology, neurosurgery, oncology, ear–nose–throat disorders, pediatrics, physical medicine and rehabilitation, anesthesiology and intensive care, neurology, and ophthalmology. The last year of medical school includes the following disciplines, based on the same 4-module approach: infectious diseases, epidemiology, clinical microbiology, family medicine, public health and management, clinical pharmacology, obstetrics and gynecology, clinical echography, palliative care, geriatrics and gerontology, psychiatry, neonatology, and legal medicine (Figure 2).

Each of the 6 years of medical education involves an optional discipline, i.e., not included in the standards set by the Romanian Agency for Quality Assurance in Higher Education (e.g., biomedical data science, recreational drugs, ethics and non-discrimination, advanced medical simulation, pediatrics semiology, case-based pathology, echocardiography, robotics surgery, neuroimmunology, sleep disorders, malpractice, fetal echography, etc.), that the student will choose, and which will become mandatory in regard to its inclusion for several weeks of specialty practice throughout the course.

Based on this curriculum, our university acknowledges that medical education is not a process that merely involves resource consumption, but, in fact, is a process meant to produce up-skilled future physicians. Through this curriculum, our university decided to invest more in the students’ achievement of effective clinical competencies and to provide them with the opportunity to receive a competency-centered education. The student-centered teaching approach, defined by the development of the required self-study abilities in medical students, represents the core of competency-centered education. All of the practical lectures and clinical internships are meant to develop students’ creativity and their abilities to self-study by transforming the medical trainer into a supervisor, a guide in the learning process. Thus, students are usually divided into teams, and each team is assigned a particular task related to the content of the practical/clinical theme, which they will have to solve and discuss afterwards in class. The academic educator is, in fact, responsible for silently managing each team and supporting them in regard to how best to manage each problem or case. Thus, problem-based and case-based learning are the most representative models implemented at our university to develop the skills of self-study in medical students.

3.2. The Assessment of Theoretical Knowledge

The theoretical exam is organized as a summative exam, consisting of questions related to several disciplines taught during the module. The questions are selected and provided by a modern platform implemented recently in our university called the UNiX center, and each student will be scored at the end of the exam.

The methodological implementation of summative exams is a challenge, due to the requirement to ensure the accuracy, reliability, and reproducibility (overall fairness) of the measurements for the assessed students (Bauer et al., 2020). These assessments are used to measure the acquisition of knowledge to establish competence and, especially in medical teaching, to promote patient safety. Over the years, this type of examination has been implemented as a necessary part of physician certification and licensure exams. These assessments promote the use of innovative standard-setting methods in teaching (Boulet, 2008).

Multiple-choice questions (MCQs) represent a valuable method for assessing the student’s knowledge and is successfully used in different training programs in order to improve their theoretical and practical skills (Coughlin & Featherstone, 2017). Appropriately and correctly designed MCQs are a reliable mirror of the student’s knowledge, comprehension, and practical application. MCQ-based tests are better indicators of skills and predictors of student performance than other methods, such as written assignments, redactional answers, open questions or case examinations, and simulation games (Coughlin & Featherstone, 2017). Creating high-quality MCQs enhances the validity of standardized tests, which is important for ensuring fair and objective assessments (Gupta et al., 2021). When appropriately designed, MCQs have been shown to promote thorough learning in medical students (Vegi et al., 2022).

Therefore, an innovative platform for creating and selecting MCQs to improve the assessment quality of the theoretical exam for medical students at G.E. Palade UMPhST of Targu Mures was implemented during the academic year 2023–2024. Thus, at the end of each module, the students will have to pass an integrative exam for the preclinical years and a summative one for the clinical disciplines. For example, the teachers created five MCQs/course based on the material taught during each module, with each question providing ten answers, five correct and five wrong. After creating the questions, the teachers are responsible for uploading the relevant chapters onto the intelligent online platform at the UNiX center, where we used our own customized software to mix up the answers, providing 250 questions, with five answers for each initial question, which will be used in the integrative or summative exams. During the exam, each student will be given individualized MCQs, selected by the software from the database of each discipline forming the summative exam, according to the specified module. The student will be scored by the same software after completing the exam. Our university has designed and built a dedicated center for the summative exams created using advanced technology, intelligent electronic pads, and the UNiX center, which provides the opportunity for more than 400 students to undertake the exam at the same time.

The benefits of the UNiX center are remarkable, offering the possibility of creating a diverse, but, at the same time, highly secured and standardized exam, which also offers flexible planning and positive feedback capabilities. This type of evaluation enables a continuous, comprehensive, and integrative learning process, and will shape and define the high quality of the teaching and learning process for the future graduates at G.E. Palade UMPhST of Targu Mures.

3.3. The Assessment of Clinical Competencies

Unlike traditional oral examinations, the Objective Structured Clinical Examination (O.S.C.E.) represents a structured method of examination with high validity, reliability, and acceptability in regard to medical students (Abuzied & Nabag, 2023). Its benefits include the ability to assess a wide range of learning outcomes across varying specialties and disciplines for both formative and summative purposes at all phases of health professions education, from the early years of the undergraduate curriculum, and to offer all students the chance to practice and perform their practical knowledge in a safe environment (Malau-Aduli et al., 2022).

The O.S.C.E. was implemented at G.E. Palade UMPhST of Targu Mures during the academic year 2021–2022, as a pilot plan for the 3rd year international medical students from the UMFST–UMCH branch, respecting the general recommendations in the literature and adjusting them to the local institutional culture and vision. The structure of each complex examination was based on blueprints created by all the coordinators of the clinical subjects, with the obligatory inclusion of all the elements of a medical clinical case: anamnesis, clinical exam, procedures/maneuvers, the interpretation of laboratory tests and paraclinical investigations, differential diagnosis, management plan, communication, and medical counselling.

All the students were ‘exposed’ to the same clinical experiences by rotating them between different ‘stations’, where the observers (UMPhST teachers) gradually examined each student individually. The evaluation was based on checklists, with different item weighting (points were offered for ‘done/not done’ or ‘not done/done/well done’, according to the author of the scenario and the specificity of each subject). For every station, the passing score was 5.00 (out of 10) and represented a maximum of 30% of the final grade for each subject. In general, the students had to complete an average of six stations per exam (a minimum of four, a maximum of eight), with a maximum of two stations per subject, during two consecutive days. The duration of the tasks involving these stations was between 5 and 8 min, with 30 extra seconds offered for reading the task. For the program of study at the Hamburg branch, the O.S.C.E. is considered as part of the quality control management plan for clinical teaching, offering a unitary assessment for all students trained in different medical institutions, by different tutors.

The positive experience and results from the Hamburg branch, according to the internal reports on student satisfaction, offer a premise for extending the implementation of this assessment method to all medical students from our institution during the next few academic years.

It is true that the implementation of this new curriculum, the UNiX, and the O.S.C.E. was not smooth and both students and academic staff expressed their reluctance regarding this process. Nevertheless, they benefited from specialized training sessions before the implementation of these assessment tools and their concerns were addressed with professionalism, tact, and patience, when needed. Moreover, the discussion sessions continued even after their implementation, addressing, each time, the students’ negative emotions or fear, as well as the academic staff’s reluctance. Also, the tricky aspects signaled by both students and teachers that were encountered during the implementation were thoroughly assessed and corrected if needed. We consider that providing continuous support to both students and teachers represents the key to the successful implementation of these new processes.

4. Concepts of Medical Education Worldwide

Current evidence suggests that implementing an outcome-based, modular curriculum could significantly improve the clinical impact of graduates, even in low-resource settings (Ali et al., 2023). The modular approach to medical education should increase the student’s desire to study and assimilate information by facilitating the learning process, due to the structured manner used in providing the information. According to the Association of American Medical Colleges and the Howard Hughes Medical Institute ‘Curiosity, skepticism, objectivity and the use of a scientific reasoning are fundamental to the practice of medicine. These attributes should permeate the entire medical education continuum.’ Therefore, faculty curriculum developers should be aware that their teaching pattern is responsible for the development of clinical and research skills in their students (Calkins et al., 2012). Over the past decade, the trends in medical education have shifted from passive lecture-based learning to active learning fostering high-quality competencies, which are the key to professional success and the best outcome for the patient (Yannier et al., 2021). Medical universities carry the huge responsibility of educating and training healthcare professionals regardless of any crises that are taking place, and the COVID-19 pandemic was definitely a major determinant of this shift, since it forced academicians to adjust their teaching methods in response to the face-to-face meeting restrictions (Iwanaga et al., 2021; Jahani et al., 2023; Nasr El-Din et al., 2023). Thus, active learning embraces problem-based learning, case-based learning, and team-based learning, promotes the educator as a facilitator of the learning process and encourages them to be prepared to participate in such activities, enables the students to develop interpersonal and teamwork skills, as well as critical thinking, and actively involves the students in the teaching process by engaging them in the discourse or by ‘forcing’ them to ask questions or to search for answers themselves (Torralba & Doo, 2020). Other studies also support the effectiveness of active learning in similar medical curricula involving problem-based, case-based, and team-based learning (McLean, 2016; Onyura et al., 2016; Reimschisel et al., 2017; Yew & Goh, 2016). Similarly, the described Romanian curriculum is also based on active learning, since it implements team-based learning for courses, problem-based learning in the practical activities during the preclinical years, and clinical-based learning during the internships in the clinical years.

In

Table 1. The strengths and weaknesses of the presented curriculum.

Strengths	Weaknesses
- Student-centered approach	- Difficulties in regard to its application in all medical schools (e.g., low-income ones)
- Promotes active learning	- A challenge for academicians who are refractory to change, who have adaptability issues, or who lack flexibility
- Facilitates the achievement of clinical competencies	- Requires a high number of medical educators
- Encourages collaboration between students and teachers/peers	- High time and expertise demands
- Supports the development of students’ critical thinking	- Difficult for students with communication, collaboration, or creativity issues
- Sustains student’s creativity
- Favors the development of effective interprofessional communication and collaboration
- Meets the student’s needs
- Innovative
- Integrative
- Comprehensive
- Evidence-based teaching techniques
- Content delivered through high-quality tools
- Bedside teaching
- Objective assessment of theoretical and practical knowledge
- Critical and fair assessment of the skills that are difficult to quantify otherwise (anamnesis, clinical examination, and medical communication, etc.)
- Enables comprehensive sampling of the competencies among several disciplines, increasing content validity
- Aligned to international standards
- Clinical practice relevance
- Ensures patient safety and consent, specific training for students and the use of an informed consent form for patients

Legend: Meaning of practical skills = skills required in clinical practice; optional discipline = an academic discipline selected by the students; foreign language = a language that is not the official language of Romania.

, we describe the strengths and weaknesses of the G.E. Palade UMPhST curriculum. Approximately 10 years ago, our university decided to begin a process of curricular reform based on innovation in teaching, learning, and examination. Thus, most of these strengths and weaknesses were analyzed from the beginning of this project, based on theoretical models or comparative frameworks, which were guided partly by the experience of other universities worldwide. The initially determined weaknesses were partly addressed during the first few years of implementation, such as the increase in the university infrastructural capacity. Others occurred during the implementation process, and, at each step, finding a proper resolution to such problems was a major concern for the university.

It is also worth mentioning that after each module, the students’ results are statistically assessed and, since the implementation of the O.S.C.E., the overall promotion percentage varies between 47.41% and 98.64% and, despite the initial reluctance of the students and academic staff, the O.S.C.E. offers a reliable mirror of the students’ knowledge, resulting in a more accurate classification of medical students’ attainment. Moreover, the students are asked to complete a feedback questionnaire at the end of each module, which is meant to assess the academic staff’s performance, the content of the lectures, and the examination method. The answers are centralized and assessed by designated people and the students’ feedback is communicated to the academic staff. Moreover, any suggestions regarding the curriculum or the examination methods used are also critically assessed and respected according to their relevance. To further improve the analysis of our curriculum, we will consider implementing in the future a model based on that developed by Al-Therwah et al. (2025).

Taking into account the major importance of patient safety for both our university and its affiliated hospitals, students benefit from proper training provided by their teacher before the O.S.C.E. and at the beginning of each clinical internship regarding the expected interaction with patients, the required behavior during bedside teaching, as well as the specific internal rules of each clinic, where they will benefit from bedside learning. Moreover, at the time of admission, each patient admitted to a university hospital is asked to sign an informed consent form acknowledging that students are entitled to passively and/or actively participate in their diagnostic procedure and treatment. During a clinical internship, the students are continuously supervised by their teacher, and the patients offer feedback regarding their interaction with the students in order to preempt undesirable events. In fact, our university focuses on the proper development of students’ skills in regard to their interaction with future patients, even during the preclinical years, through ethical and communication courses that are focused on creating a triangle between the teacher–student–patient, with a further major impact in the clinical years, during which time the students will already be trained to participate actively and to act responsibly during bedside training and in guaranteeing patient safety. Therefore, the G.E. Palade UMPhST curriculum is definitely centered on students, proving them with the opportunity to become highly qualified doctors, but, at the same time, it ensures and maintains patient safety during bedside training.

The art of teaching medicine should be fostered by a curriculum meant to develop the student’s critical thinking and their ability to make conceptual connections between the learned concepts. A similar modular approach for postgraduates in obstetrics and gynecology was implemented in Yorkshire through the Yorkshire Modular Training Programme and it was underlined that it provides a comprehensive educational pattern, ensuring the quality of the education provided (Duffy et al., 2004). According to a recent comparative study that assessed the curriculum in regard to the master’s degree of medical education from seven universities worldwide, namely Monash University in Australia, Kebangsaan University in Asia, the University of Michigan in America, the University of Toronto in Canada, the University of Bern and Imperial College in Europe, and universities in Iran, it was concluded that medical universities should provide outcome-oriented education through a competency-based curriculum (Farmad et al., 2023). Modular teaching models were also reported in regard to ultrasound and endoscopy and proved to have a significant positive impact on the attainment of knowledge, practical skills, confidence, and technical performance (Tomasi et al., 2020; VanDruff et al., 2023).

Thus, the modular curriculum enabled the students to become active players in a student-centered innovative learning environment. In addition, a similar integrated modular model for undergraduates was reported in India for dermatology and the results of the feedback indicated that the learning experience was more interesting and useful, a fact also proved by the students’ scores for the posttest compared with the pretest (Karthikeyan & Kumar, 2014). Likewise, the German Society of Radiology designed a modular curricular model for undergraduate medical education, aimed at teaching essential radiological theoretical elements, along with core scientific competences in the field of imaging sciences (Ertl-Wagner et al., 2016). A modular model medical degree program called ‘human medicine’ was also reported in Germany, centered on practical skills and patients, as well as on developing the students’ research skills by integrating early in the curriculum scientific activities, which were in fact the defining features of the program (Gehlhar, 2019). A recent report from China proved the success of the modular teaching method in ophthalmology trainee courses and indicated that the implementation of this type of curriculum was effective and positively rated by the medical students (Xin et al., 2020).

A similar curricular approach to ours was described in regard to the Augsburg University Medical School, focused on well-defined specific competencies like medical expertise, argumentation and scholarship, independent scientific reasoning, and communication skills. Thus, the mandatory disciplines, according to the German regulations for obtaining a medical degree, are structured into organ- and system-centered blocks, in the same format as that adopted within the University of G.E. Palade UMPhST of Targu Mures. Preclinical medical sciences are provided in the blocks, ‘movement’, ‘balance’, and ‘contact’, while the clinical disciplines are structured into six pillars: conservative medicine, surgical medicine, men’s–women’s–children’s medicine, the senses, the nervous system, and the mind, as well as general medicine (Härtl et al., 2017). Based on this approach, this curriculum strengthens undergraduate medical training with the power of integration, intensity, and targeted development of students’ academic, social, and communication skills (Härtl et al., 2017). The results of the implementation of this modular approach in Germany were evaluated based on the students’ responses, which taken together summarized that after the implementation of the modular curriculum, their medical education significantly improved and that this type of teaching was significantly better than the traditional type, particularly due to its integrated, outcome-oriented design (Hitzblech et al., 2019). The Faculty of Medicine at the University of Hamburg also complies with modular medical training and implemented in 2012/2013 the integrated medical degree program called iMED, which involves a blended approach in terms of theoretical knowledge, scientific orientation, as well as practical, psychosocial, and communication skills (Rheingans et al., 2019). The curriculum in Hamburg is structured into two parts, a modular compulsory core curriculum, which consists of 19 modules, and elective courses. Thus, iMED offers comprehensively coordinated teaching content and learning objectives for the students participating in the theoretical and practical process, beginning with the first step in the learning spiral, i.e., real patients’ medical histories (Rheingans et al., 2019).

The most recent approach in regard to the medical curriculum has highlighted the importance of involving research education in the development of medical curricula, a crucial need in regard to the future of medicine. Thus, recent analysis by the International Federation of Medical Students Associations underlined that research education is a core component of medical education and, according to the medical students’ opinion, it should be included in the formal curriculum (Pierre et al., 2022). More than 95% of the students involved in this study considered that medical research education should be a component of the formation of their medical education, but unfortunately less than a half reported having specific mandatory courses in this regard included in their curricula (Pierre et al., 2022). Taking into account that the main goal of all medical curricula is to achieve the best possible clinical competencies in medical students, several studies have proved that physicians’ research competencies are vital for achieving the best patient outcomes (Clarke & Loudon, 2011; Du Bois et al., 2005; Majumdar et al., 2008; Selby & Autier, 2011). Moreover, the evidence-based model in regard to treating patients should be taught to all medical students during their formation in medical school, since it is the most effective model in regard to their future clinical practice (Lee et al., 2021). In addition, a recent Canadian study emphasized the importance of equipping medical students with artificial intelligence skills, an essential asset in clinical practice that is shaping the next generation of healthcare professionals (Singla et al., 2024). Therefore, medical research education and artificial intelligence skills represent two major pillars in regard to developing student-centered medical curricula, according to the current medical progress, enabling future clinicians to be equipped to face the daily challenges.

Several medical schools worldwide have included this type of examination in their medical curriculum (Agarwal et al., 2010; Ben-Menachem et al., 2011; Berkenstadt et al., 2012; Chipman et al., 2007; Corrie et al., 2011; Hastie et al., 2014; Maker & Bonne, 2009; Sloan et al., 1995; Stewart et al., 2010) proving that the O.S.C.E. improves not only the students’ medical skills, but also their communication abilities, their desire to attain more medical knowledge, their empathy, and their relationship with patients (Y.-S. Huang et al., 2007). Therefore, the O.S.C.E. is an extremely valuable examination tool, and it can be defined as an effective pathway towards the best clinical outcome, which, in fact, is the main goal of all medical schools.

To the best of our knowledge, the G.E. Palade UMPhST of Targu Mures is the first university in Romania, and among only a few worldwide, to have designed and implemented an innovative, comprehensive, and integrated modular-based curriculum for medical students.

5. Conclusions

Medical education remains the cornerstone of healthcare, and its continuous upgradation should represent the main concern of medical schools. The particular innovative feature of the medical curriculum designed and implemented by the University of Medicine, Pharmacy, Sciences, and Technology of Targu Mures, Romania, is represented by the switch from a discipline-based curriculum to an integrative, human body-centered curriculum, which is meant to develop the critical clinical thinking of future physicians for the best patient outcomes.