“Are we teaching our medical students how to communicate effectively with patients, or just how to pass a test?”
This was the question in my mind when we visited the Center for Teaching and Learning (MedCUL) at Lund University’s Faculty of Medicine on September 8, 2025. This visit was part of an ongoing project at Shimane University to develop educational e-learning content for medical English consultation skills, particularly with patients from diverse cultural and linguistic backgrounds. The discussion offered valuable insights into how Swedish medical education addresses diversity, active learning, and quality assurance, issues that are highly relevant to Japanese medical English education.
MedCUL as an Educational Development Hub
MedCUL is not merely a faculty development office; it serves as a central hub for quality assurance and curriculum development across the Faculty of Medicine. It collaborates closely with the faculty’s four educational boards, which oversee medicine, nursing, biomedical/public health, and rehabilitation programs. Importantly, students are formally represented on these boards, ensuring that their voices are heard from the earliest stages of course design.
Government-led external evaluations are conducted every 4–7 years, and MedCUL plays a key role in preparing evidence for these assessments, particularly through digital systems such as Quality & Progress System (QPS). The strong integration of MedCUL into both governance and practice makes it a model for how a teaching and learning center can shape faculty-wide quality.
Systematic Use of PBL and TBL
At Lund University, the medical curriculum is organized into 12 semesters (six years in total). For readers in Japan, it may be easier to understand if we align this with our system
• Term 1–4 = equivalent to Years 1–2 at medical schools in Japan
• Term 5–9 = equivalent to Years 3–4 in Japan
• Term 10–12 = equivalent to Years 5–6 in Japan
Problem-Based Learning (PBL) is applied in the early semesters (Term 1-4), Case-Based Learning (CBL) is used in the middle years, and Team-Based Learning (TBL) is now being expanded into the later semesters (Term 5–9, Term 11–12). A significant reform is currently underway to make the 11th and 12th semesters fully TBL-based, supported by a new tutor training course to be launched next spring.
The introduction of active learning was not without challenges. Senior clinicians initially resisted changing their long-standing teaching habits. However, decisive leadership from program directors, combined with faculty development courses that modeled the new methods, ensured implementation. This experience highlights the importance of leadership and structured support, lessons highly relevant for Japan, where active learning methods are still unevenly adopted.
Putting Diversity “on the Table”
One of the most striking aspects of MedCUL’s philosophy is its commitment to Inclusive Pedagogy. Faculty are encouraged to incorporate diversity: gender, LGBTQ identity, cultural background, or language, into clinical cases, even when these attributes are not medically essential. This practice ensures that diversity is always “on the table” as a normal part of medical education, rather than treated as an exception.
Furthermore, the interview emphasized that individual diversity: differences in motivation, engagement, and personality, often poses a greater challenge than group-level diversity. This perspective is particularly relevant to medical English education in Japan, where growing numbers of students and future doctors will encounter diverse patient populations.
From Feedback to “Feed-Forward”
Assessment and feedback are underpinned by the QPS, developed at Lund and now adopted nationally by Swedish medical schools. QPS records continuous feedback from clinical placements as well as data from written assessments. Students, teachers, and program boards can all access the data, making progress and quality transparent.
What is especially noteworthy is MedCUL’s emphasis on “feed-forward” rather than just feedback. Instead of focusing solely on what students did right or wrong in the past, supervisors discuss what the student should do next time. This orientation encourages continuous improvement and makes assessment a driver of future learning. For medical English education, adopting a feed-forward approach could help students not only reflect on errors but actively build toward stronger communication and consultation skills.
Lessons for Japan
Several key takeaways from the MedCUL interview are directly applicable to Japanese medical English education:
• Leadership and supportive FD: Strong leadership decisions combined with faculty development are crucial for implementing new teaching methods.
• Scalability of TBL: Team-Based Learning can function effectively even with large cohorts, offering an alternative to lecture-heavy instruction.
• Feed-forward assessment: Orienting feedback toward future performance encourages continuous development for both students and faculty.
• Embedding diversity into cases: Systematically including cultural and social diversity in case design fosters the ability to communicate with patients from different backgrounds.
Concluding Reflections
This interview highlighted how MedCUL integrates active learning, inclusivity, and quality assurance into a coherent system. By linking curriculum reform with strong leadership, faculty development, and digital tools like QPS, Lund University offers a model that is both innovative and practical.
For Japan, where medical schools are still heavily lecture-oriented and where the need for intercultural communication skills is rapidly growing, MedCUL’s practices provide not just inspiration but also practical pathways for reform. Strengthening medical English education will require us to learn from such international models combining active learning, inclusivity, and future-oriented assessment to prepare physicians who can successfully work in a multicultural world.
What active learning methods have you found effective in your own practice?
We invite readers to share their ideas and experiences. We welcome your ideas and experiences, and would be delighted to feature your work in a future blog post.
For further information about this blog post, please contact:
Jun Iwata and Rie Sato
Faculty of Medicine, Shimane University
Email: j_iwata@med.shimane-u.ac.jp, riesato@med.shimane-u.ac.jp
Active Learning, Diversity, and Feed-Forward Assessment: Insights from MedCUL at Lund University, Sweden © 2025 by Jun Iwata is licensed under CC BY-ND 4.0 
