HBI 2022

How to train a doctor for a significantly lower cost

Ahead of speaking at HBI 2022 in June, we interviewed Jürgen Laartz, founder, and Alexandra Cosma, COO, EDU Malta to find out more about their approach to boosting medical training and aiding the health workforce crisis.

A five and a half year education (Batchelor + Masters) as a doctor for just €100,000? That is what is on offer from EDU Malta, a for-profit educational institute with statutes which commit it to working for the public good. It is working closely with Fresenius Helios and other German hospitals and is looking for hospital partners in other countries.  So how does it work, what are EDU’s plans and what role could this play in dealing with the massive world shortage of doctors?

EDU Malta is a small business with big ambitions. At the moment, three years in, it has 130 students enrolled, all of whom are fee-paying, as EDU receives no state support. What makes EDU unique is its digital learning platform, the result of many years of research.

Students work three 14-week terms with 10 weeks of theory followed by four weeks in a teaching hospital in Germany and spend the last six months on clinical rotation in a hospital so they emerge as probationers ready to move into intern roles in hospitals.

EDU has spent many years perfecting a digital learning platform. This is a complete reverse of the standard MOOC approach in which students watch pre-recorded lectures by themselves.

Laartz, a former McKinsey partner, who led its digital practice in Germany and Scandinavia, says: “Most of our teaching is synchronous (live and in person) in tutor groups and we have 12 different didactic formats.”  He says the approach is “deeply collaborative. For instance, we spend a lot of time discussing professionalism and team working and the hospitals report back that our students are better adjusted and stronger team players than the average med student.”

EDU is also closely supervised by MaastrichtUMC.

Laartz is deeply into transparency and quality. Every six months, all students are mandated to sit a set of exams that compare their progress to med students in more traditional settings. “We have so far done three of these and our students are at the same level or better than others in their learning and retention,” he says.

EDU COO Alexandria Cosma claims that it is unique. “These digital education techniques are being deployed in IT and business education, but not, so far as we know, to train doctors – not here in Europe, not in emerging markets, not in the USA.”

All students are fee-paying, although the institution helps them win grants and some of the hospitals they work with are considering offering scholarships. The theory is in English and the practical experience is in German, so EDU’s students have been almost entirely from DACH to date.

At €100,000 in fees, EDU’s fees can only be described as low. How do they compare to the costs to governments of more traditional education? EDU says it is very hard to get an exact figure because systems are siloed between teaching institutions and the training received in university hospitals but claims that it is a lower cost by a factor.

Pushed harder, Cosma  says: “In Germany I have seen costs of €200,000 to half a million but they are distributed within the system.” In the UK, Health Minister Jeremy Hunt in 2016 put the cost of training a doctor at over £200,000. So EDU at €100,000 is a game changer. It is also well within the reach of private individuals to fund themselves.

What of the future?

Laartz expects the current 130 to grow to 500-1,000 in three years, but longer-term he says the platform should be scalable to potentially tens of thousands. At some point, that may mean it will need to raise money from private equity or venture capital.

Laartz says his motivation, and that of his colleagues, is to help the global south. “Africa alone is short of 1m doctors,” he says. So whilst this is a for-profit enterprise, it is motivated by substantial amounts of altruism.

He thinks that the global north shares many of the same problems as the global south when it comes to doctor shortages: “The big problem in Germany and India is how to get doctors in second and third degree cities and in the country. Some of our German partners have empty wards because of workforce shortages.”

He hopes that EDU’s approach will enable students to be anchored in their local setting. The hope is that the students who attend a local hospital in Germany will then stay there on qualification and make their careers there rather than migrating: “The traditional model uproots the student and takes them to a new location for their education, ours allows them to stay put.”

Next steps should see EDU move into another European country forming a similar alliance with local hospitals and also launch an offering for South Asia and/or Africa. When it comes to the private education sector, each is a separate market and there are over 100 private teaching colleges in India. But Laartz says that the costs of training a doctor in Brazil, for instance, are similar to Europe.

That partly depends on getting the Medical Council of Malta to recognise the qualification conformity and equivalence of the degree. The Medical Council of Malta is the competent authority for conferring the certificate of equivalence and conformity of the medical programme, amounting to automatic recognition of the degree within Europe.

Meanwhile, in order to pursue a license to practice medicine, graduates should apply for individual recognition with the competent local authorities within the desired European Member states. Completing EDU’s Bachelor and Masters of Medicine entitles the holder to apply for approbation throughout the EU. EDU’s programme in medicine has been designed to fulfil the requirements to practice as a physician within Europe, including in Germany, in accordance with the EU Directive 2005/36/EG.

You might imagine that traditional university institutions would be interested in the platform and teaching methods that EDU has developed. And when Covid came, EDU tried hard to get its message out and offered to help others with digital learning.

“When Covid started we offered the platform to anyone who would be interested in looking at the model so that people could use it.  We publicised it with the OECD, for instance. We also offered our insights into what works because we have correlated study methods to outcomes. We know what excites students.”

He says the response was nix: “We had no responses from anyone.”  That could reflect the degree to which traditional training institutes are likely to see EDU as a challenger. And university institutes in Germany have told us that they see EDU as a threat to their education budgets. It would be a shame if such a radical and apparently successful innovation should be ignored in a world with such desperate shortages.

So could the platform be adopted for other medical professionals? “Nursing may be difficult because of the way it is regulated; it is more local than medicine. But the World Health Organisation sees a huge gap in a wider range of medical specialists on three year degrees and that is an area we are looking at.”

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