The Tuning Project (Medicine)

The Tuning Project (Medicine) began in 2004, under the auspices of the MEDINE Thematic Network for Medical Education in Europe, coordinated by the University of Bristol (http://www.bristol.ac.uk/medine). The Tuning Project (Medicine) is led by the University of Edinburgh, with a local steering group and a European Task Force (Appendix C).

Previous work

A great deal of work has already been done to define curriculum-level outcomes/competences for medical education. Some well-known examples are “Tomorrow’s Doctors” (UK General Medical Council, 2003); the “Scottish Doctor” document (Scottish Deans Medical Curriculum Group, 2002); the Global Minimum Essential Requirements (Institute for International Medical Education, 2005) ; guidance issued by the Association of American Medical Colleges (1998); and the CANMEDS Competency Framework, designed primarily for postgraduate medical training (Frank JR, 2005). Many other national and institutional outcomes frameworks have been developed in Europe and elsewhere.

Process and methods

The Tuning Project (Medicine) was funded by the European Commission on the basis that the methodology would be similar and results comparable with the “parent” Tuning Project (Tuning Educational Structures in Europe. Final Report, Phase 2, 2005).
It involved the following procedures:

  1. Review of existing frameworks.
    Existing learning outcomes/competency frameworks were reviewed by the Project steering group.

  2. Development of draft framework.
    A preliminary draft learning outcomes framework for Tuning (Medicine) was generated by the Project steering group.

  3. Tuning workshops.
    In a series of European workshops, members of the Tuning (Medicine) Taskforce sequentially reviewed and refined the draft document in the light of expert opinion and the Internet opinion survey (see below). Workshops were held in Budapest (April 2005), Amsterdam (September 2005), Edinburgh (February 2006), Prague (May 2006), Genoa (September 2006), Oslo (May 2007) and Antalya (September 2007). In addition, presentations of the draft framework were made and feedback obtained at numerous other meetings in Europe and elsewhere.

  4. Web-Based Opinion Survey.
    Tuning methodology specifies an opinion survey, to include academics, graduates and employers, who are asked to rate learning outcomes in terms of their importance for graduates. Ratings were averaged and the outcomes arranged in rank order. These rankings inform the formulation of the final outcomes framework by the Task Force.

For Tuning (Medicine), a detailed questionnaire was created using an online survey instrument (www.surveymonkey.com) in English and translated into German and French. The survey asked respondents to rate 115 learning outcomes as essential, very important, quite important or not important for a primary medical degree qualification.


The first section consisted of twelve Level 1 outcomes which together were felt to encompass the competences required of medical graduates.
The second section included, under each Level 1 outcome, a series of Level 2 outcomes.


The third section consisted of the generic outcomes for Higher Education degrees previously agreed by the main Tuning Project. It was found that these generic outcomes encompassed many aspects of professionalism, as understood in medical schools.

Respondents were also asked to rate the importance of 39 knowledge domains related to medical practice, and 14 practice settings in which students might gain experiential learning.
The online questionnaire was open from March to October 2006. 1302 responses were obtained, with responses from all European member states with medical schools. Ranking of the outcomes and detailed statistical analysis of the responses was carried out looking for cluster effects such as national influences and differences between categories of respondents. Free text comments underwent qualitative analysis using the NVivo7 software tool. All data and analyses were evaluated and interpreted in Tuning taskforce workshops.

  1. Approval by the MEDINE Thematic Network.
    The ranked outcomes/competences, outputs of statistical analysis and qualitative analysis of free text responses, were presented to the MEDINE Thematic Network meeting, Oslo, May 2007. The outcomes framework was approved at the Final Meeting of MEDINE, Antalya, Turkey, September 2007.

  2. Validation by Expert Panel.
    The final outcomes framework, as part of a “Tuning Brochure” for medicine, was presented at a Sectoral Validation Conference, Brussels, June 2007. An Expert Panel, external to the Tuning Task Force, reviewed the outcomes framework and met with members of the Task Force. The Expert Panel endorsed the approach of the project and content of the outcomes framework.

  3. Final report to the European Commission.
    The final report and outcomes framework were presented to the European Commission in January 2008.