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Summary and Recommendations

In this project we looked into the changing context of medicine and translated this into a new qualifications reference framework for medicine. 

The healthcare crisis is emerging everywhere in Europe. The European population is ageing rapidly causing, on the one hand, an increase in the burden of disease and therefore on the demand for healthcare, but on the other hand, an outflow of health professionals. This outflow is partly due to retirement but also a consequence of the increasing workload. 

Healthcare systems in Europe are considered as the best in the world both in terms of quality and in terms of accessibility. However, the healthcare crisis is jeopardizing this position and demands change. At the same time, we see new technologies being developed resulting in opportunities in medicine.

So, to prepare our graduates for all this change, we have developed a new qualifications reference framework for Medicine: EU-MedEd model 2023 (MedicalEducation model) focusing on final competences. This model incorporates two European frameworks: the Qualifications Framework of the European Higher Education Area (QF-EHEA) and the European Qualifications Framework for Lifelong Learning (EQF). The model is inspired by the CanMeds model, the national qualification frameworks of the participating countries, participant degree programmes, and the expertise of the participants.


 Qualification Reference Framework for Medicine: EU- MedEd model 2023 (extended version)

This model provides tools to define the content of medical degree programmes, but not the means of delivery or educational approach. 

In medical education, workplace learning is considered the most important way to facilitate learning and the development of competences. Because of the increased workload placed upon healthcare professionals (due to increasing demands in patient care and outflow of staff) we need to develop new educational methods to partly substitute workplace learning. Everyone in the field of educating healthcare professionals should critically evaluate the role, place, and amount of workplace learning.

Here we can think of making use of simulation and advanced technologies to create a safe learning environment to prepare students before entering the workplace during their educational journey. We all agree that workplace learning is a crucial element in the training of healthcare professionals.

European cooperation and support is crucial for the development of these advanced learning technologies. We strongly advise the EU to facilitate this, and to further support our subject area group financially to continue the work in cooperation with partners in the field of educational technologies to develop and evaluate these tools to partly substitute workplace learning.

About Medicine

A medical degree provides its graduates with education and training related to the professional qualification of medical doctor or physician. Medical education is regulated nationally through frameworks and directives that define the professional profile of the medical doctor and set the standards for learning outcomes of degree programmes. 

Typical Degrees Offered in the Subject Area of Medicine

Medical education in Europe typically consists of basic medical education (i.e., the medical degree) often followed a period of supervised clinical work, and postgraduate training in a medical specialty or general practice. To practice medicine, graduates must obtain a license from the national authority that regulates the medical profession. Depending on the country, licensure may coincide with the conferral of the medical degree, may require a period of postgraduate clinical work, or is obtained following specialization. 

Most common training path in Medicine, showing the points at which the medical license is obtained is different countries.

The European Directive 2005/36/EC2 states that “basic medical training shall comprise a total of at least six years of study or 5500 hours of theoretical and practical training”. In most European countries, medical degrees are single cycle programmes. A limited number of countries have adopted the two-cycle Bachelor-Master structure compatible with the Bologna Process. However, the application of the Bologna process to medical education has been controversial, and arguments pro and con have been extensively discussed (AMEE/EMSA/IFMSA 2010; Cumming 2010).

Postgraduate training in a medical specialty varies from two to six years and is organized in the context of professional education by professional bodies. The training of medical specialists is therefore not considered as the third cycle in the Bologna process. Medical degree graduates can also choose to enter a Ph.D. programme in biomedical sciences to develop research competencies.

Typical Occupations 

offered in the subject area of Medicine

A degree in Medicine is the first step toward a career as medical doctor in public and private healthcare facilities, including hospitals, outpatient clinics and numerous other clinical settings. Some medical doctors continue their careers in academic hospitals and combine patient care with research and education. A limited number of graduates choose not to practice medicine but instead follow careers in health-related sectors such as the pharmaceutical/medical device industry, healthcare administration, health policy development and regulatory affairs.

Qualifications Reference Frameworks (QRF)

Qualifications and Assessment Reference Frameworks (QRF and ARF respectively) were created through the collaborative effort of the working group during face-to-face workshops and online meetings held between May 2022 and September 2023. Given that most institutions offer single-cycle programmes, priority was given to EQF level 7 (master/single-cycle). A complementary QRF was also developed for the bachelor degree (EQF level 6) to address the needs of institutions offering two-cycle medical degrees.

The overall approach used by the working group is shown in the figure below:

Development of Calohee reference frameworks

The new framework, named EU-MedEd model 2023 (MedicalEducation model), focuses on the final competences of graduates completing basic medical training. The model is inspired by CanMeds (a physician competency framework developed by the Royal College of Physicians and Surgeons), as well as the national qualification frameworks of participating countries, participant degree programmes, and the expertise of the working group. 

The EU-MedEd model defines the graduate profile in terms of physician roles: Medical Expert, Scholar, Innovator, Collaborator, Leader, Professional, Communicator, Health Advocate, and Lifelong Learner. For each role, competences are expressed using descriptors for Knowledge, Skills and Autonomy and Responsibility.

Click left or right below to view the Knowledge, Skills and Autonomy and Responsibility  for the expected roles of the medical degree graduate:

Demonstrate a depth and breadth of understanding of biomedical and clinical sciences, and other domains which are relevant to health.


Demonstrate the ability to perform patient-centered clinical assessment, make an informed shared decision to establish a management plan, and deliver supportive and empathetic care.


Act on the basis of professional values to provide evidence-informed, effective, efficient and safe patient- or community-oriented care.

Autonomy and Responsibility



Demonstrate knowledge and understanding of relevant ethical, legal and professional standards, quality assurance, reflective practice and accountability towards patients, and one’s own professional identity and well-being.


Demonstrate the ability to act in accordance with ethical, legal and professional standards; reflect and manage personal and professional demands and uncertainties; recognize and manage conflicts of interest; engage in self- and peer-reflection and feedback.


Act professionally in accordance with ethical, legal, and professional standards, be accountable for patient safety within the healthcare system, and engage in self-care and reflection.

Autonomy and Responsibility


Demonstrate knowledge and understanding of communication methods and strategies to handle complex information in multidimensional contexts.


Demonstrate the ability to communicate with patients and their networks, with members of interprofessional and multidisciplinary teams, with members of the community and with other relevant stakeholders.


Communicate effectively and respectfully with patients and their networks, healthcare teams, members of the community and other relevant stakeholders.

Autonomy and Responsibility


Demonstrate knowledge and understanding of the determinants of health, healthcare systems and policies for disease prevention and health promotion, the interdependence of human and planetary health, and the role of climate and environmental crises in local and global health threats.


Demonstrate the ability to identify the health needs of individuals and populations, and the barriers to healthcare they may encounter; discuss the link between human health and the health of the planet; propose sustainable measures for health promotion and disease prevention to address local and global health challenges, including those related to climate and environmental crises.


Promote human health, including health empowerment on an individual, community and planetary level, health literacy, and change in healthcare systems and policies to encourage sustainability, equality, equity, diversity and inclusiveness.

Autonomy and Responsibility



Demonstrate knowledge and understanding of strategies and resources for lifelong learning and professional development.


Identify professional development needs and use available resources to address them.


Commit to excellence in practice through lifelong learning and take responsibility for continuous personal and professional development.

Autonomy and Responsibility



Demonstrate knowledge and understanding of the role and function of a leader in a healthcare team and in healthcare systems.


Demonstrate the ability to lead a multidisciplinary healthcare team, manage time and resources effectively, and delegate or handover patient care appropriately.


Lead a healthcare team and foster teamwork to facilitate strategic planning and decision-making in patient care. 

Autonomy and Responsibility


Demonstrate a depth and breadth of knowledge required to collaborate effectively with patients and their personal networks, healthcare professionals, the community and other relevant stakeholders.


Demonstrate the capability to engage in effective collaboration with patients and their personal networks, healthcare professionals, the community and other relevant stakeholders.


Participate in effective collaboration with patients and their personal networks, healthcare professionals, the community and other relevant stakeholders to promote healthcare.

Autonomy and Responsibility


Demonstrate knowledge of the strategies and resources necessary for innovation and implementation in order to improve and ensure equitable and sustainable healthcare. 


Demonstrate critical and strategic thinking to contribute to equitable and sustainable healthcare in diverse multidisciplinary settings.


Identify the need for change and drive innovation in order to improve equitable and sustainable healthcare.

Autonomy and Responsibility


Demonstrate knowledge and understanding of relevant medical humanities, and of the strategies and methods of scientific research, communication, and facilitated learning.


Identify, interpret and communicate medical knowledge; propose and design research in accordance with scientific and ethical principles; use tools and strategies to facilitate learning relevant to healthcare.


Contribute to the advancement of evidence-informed medical practice through research, learning facilitation and scientific communication.

Autonomy and Responsibility


An extended version of the EU MedEd model was developed in which each physician role was divided into distinct dimensions associated with learning outcomes that can be assessed. Detailed descriptors are provided for level 7 in the Assessment Reference Framework (ARF).

Click below to download the Assessment Reference Framework for level 7. 

Qualifications Reference Frameworks: bachelor & long cycle (bachelor and master) 

Click to view and download and view pdf documents of both the bachelor & long cycle QRF tables

QRF for Bachelor’s degrees

(Level 6)

QRF for Master’s/Single Cycle (Level 7)

Typical Medicine Learning, Teaching and Assessment methods and techniques, including examples of good practice.

Learning, Teaching & Assessment

Learning objectives, learning approaches (or teaching), and assessment are interconnected elements in the educational process. Effective alignment ensures that the instructional design, delivery, and assessment all work together to help learners achieve the desired outcomes. 

Constructive alignment in education:

Biggs, J., & Tang, C. (2014). Constructive alignment: An outcomes-based approach to teaching anatomy. In Teaching anatomy: A practical guide (pp. 31-38). Cham: Springer International Publishing.

When learning objectives, learning approaches, and assessment are well-aligned, it creates a cohesive and effective learning experience for medical students. Students understand what is expected of them, and the teaching methods and assessment support their attainment of these expectations. This alignment not only promotes successful learning outcomes but also ensures that graduates are well-prepared to enter the medical profession as competent and safe healthcare practitioners.

Professional competence represents the basis for performing tasks of high complexity (ten Cate et al, 2010).It is defined as the integral use of knowledge, skills, clinical reasoning, values and reflection in daily practice for the benefit of the individual and the health care needs of the community (Epstein et al., 2002)

There are two contrasting approaches to assessing competence. The analytic approach, which strives to precisely measure observable elements and facets of competence and the holistic approach, which focuses on a comprehensive evaluation of competences in complex real-life scenarios that reflect actual performance. Each approach plays a distinct role in assessing different aspects of competence, and they differ in terms of their underlying conditions and the types of measurements employed (Rotthoff et al., 2021).

The analytic approach seeks objective and reliable measurements of competence constituents ((individual elements of knowledge, skills and attitude), utilizing a range of specific, mostly quantitative methods. Examples of such methods include multiple-choice question (MCQ) tests, standardized structured oral assessments, all of which employ clearly defined and uniquely measurable criteria. In contrast, assessments of competence facets (components of a patient encounter), which can be evaluated through simulations ranging from simple to complex tasks resembling real-world settings, require less standardization and objectivity. However, they offer higher authenticity and validity. To minimize rater subjectivity assessment anchors can be employed. Assessing competence of a physician from a holistic perspective involves evaluating their performance in the workplace. In such assessments, assessors subjectively determine whether they would entrust a task to a candidate and at what level of supervision. To mitigate the lack of standardization and objectivity in such assessment situations, assessment anchors can be used as well and a larger number of expert raters can be utilized (Rotthoff et al., 2021).

Matching assessments should evaluate various aspects of competence throughout an academic programme. These assessments occupy a continuum between the analytic and holistic approaches, ultimately culminating in the observation of performance. Competence-based assessment does not favor either standardization or authenticity, nor does it favor control over trust. Instead, both approaches should be seen as interconnected rather than opposing poles (Rotthoff et al., 2021).

View & Download the 'Overview different assessment formats and measurement of competence' Table

Examples of assessing competency

As stated before in medicine, workplace learning and its assessment is key. Click the boxes below to view four examples of Learning, Teaching and Assessment.

As stated before in medicine, workplace learning and its assessment is key.

Click below to view some examples of good practices which exemplify this compliance.

Student workload & ECTS

The European Credit Transfer and Accumulation System (ECTS) defines that one ECTS credit corresponds to a workload of approximately 25-30 hours of student work. This workload includes various types of activities, such as:

  • Lectures: Time spent attending formal lectures or classes.

  • Seminars: Participation in smaller group discussions or interactive sessions

  • Laboratory Work: Time spent in laboratory experiments or practical sessions.

  • Independent Study: Self-directed study, which includes reading, research, and preparation for assessments.

  • Examinations: Time spent preparing for and taking exams or assessments.

  • Project Work: Time devoted to working on projects or coursework

  • Group Work: Time devoted to working in a group, for example in problem-based learning or team-based learning

  • Internships or Work Placements: Time spent in practical training or work experience.

Quality Enhancement

In working on the qualification framework and defining the learning outcomes/competences for the two cycles the SAG stresses the outcomes are not to be taken as prescribing the content and curriculum of university programmes in medicine but helping the institutions to ensure the quality and standards of their programmes. 


The enrolment into a medical degree, the content of the programmes, the educational approaches, the programme learning outcomes, used within the SAG are diverse. This is also shown in the results of the matching exercise.


The SAG of Medicine stresses the content and distinctiveness of the programmes are:


o  the primary responsibility of Higher Education Institutions (HEIs) in assuring the quality of their own provision and in accordance with national regulation.

o  being responsive to the diversity of higher education systems, institutions, programmes and students. 

o  taking into account the needs and expectations of students, other stakeholders and society. 


All programmes of the participating members are accredited within the national context and  fulfill national requirements.

The Medicine Subject Area Group (SAG)

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