European education ministers have big changes in mind for higher education. Their vision sees students moving between Europe's universities, taking courses that all count towards comparable qualifications, and, as a result, finding it easier to move around as employees. Governments hope that promoting this agenda will make their universities more attractive around the world and deliver a supply of high quality graduates to the workplace.

They signed up to the idea with a declaration in Bologna in 1999.1 Since then, despite a low profile in some countries, the wheels of the Bologna process have been turning steadily, bringing closer the goal of a common European higher education area by 2010.

Medicine, however, seems to have been left behind. It is not that medical educators disagree with the Bologna process's main points, and indeed it would be hard to argue that more exchange within European institutions, more comparable qualifications, and overall higher standards would be a bad thing.

The most obvious problem is that in the Bologna model, harmonisation of the course of study across Europe has meant countries adapting their curriculums to fit a two cycle model, with a three year bachelors degree and a two or three year masters. Ministers agreed to this from the outset, and have reaffirmed it since then, even though it has required considerable upheaval in the many countries where longer study culminating in a masters level degree has been the norm. By the time education ministers met in London in May this year, most declaration signatories were well on the way to making the necessary changes.