The Munich Declaration - Key points for the establishment teaching in the new cross-disciplinary area 13: palliative medicine at German faculties.

Abstract

The development of the teaching of palliative medicine at the medical faculties in Germany and the discussion about the inclusion of palliative care as a subject into the Medical Licensure Act follows a lengthy process [1]. Various publications repeatedly drew attention to existing skills gaps among young physicians and medical students in dealing with terminally ill and dying patients due to inadequate teaching in the field of palliative medicine in Germany [2], [3], [4], [5]. However, the Medical Licensure Act (Appendix 15 to § 29 Para 3 Sentence 2) previously only listed the subject as optional but not mandatory examination material for the second part of the medical examinations towards the end of medical studies. Thus the implementation and delivery of palliative care training remained was left to the commitment of individual universities. Against this backdrop, the development of appropriate structures in Germany was slow. In 2009 only five of 36 medical faculties in Germany had occupied chairs for palliative care, at only 6 universities were compulsory courses in palliative medicine offered, of which only half concluded the course with an exam counting towards the degree [1]. As of 5 August 2009, palliative medicine was integrated into the Medical Licensure Act as the 13th cross-disciplinary area (QB 13) [6]. This means that from 2013 onwards, all medical faculties in Germany will require students to pass relevant examinations in specialist palliative care in order to be admitted to the Practical Year. The fact that by now 34 faculties teach palliative care content - albeit with significant qualitative and quantitative differences - illustrates that in principle both access to qualified lecturers in palliative care and a broad willingness to establish teaching structures exist. So far, only those few faculties with chairs in palliative care can offer high-quality structured training, as described by Alt-Epping et al. for teaching palliative care at the University of Gottingen [7]. To ideally and appropriately facilitate the introduction of palliative care courses which are now legally required into general university curricula at less well-equipped faculties, the chairs of the universities of Aachen, Cologne and LMU Munich in cooperation with the German Society for Palliative Medicine (DGP) and the National Association of Medical Students in Germany (bvmd) organised a workshop on this topic. Lecturers and students from 25 medical schools met on the 2nd and 3rd of July 2010 at the Interdisciplinary Centre for Palliative Medicine in Munich to discuss the possibilities of implementing the new QB 13 “Palliative Care”. The central point of discussion at the event was the question of how high-quality and comparable teaching in palliative care can be established across Germany within the short timeframe and in spite of differences in resources and settings at the various faculties. Common goals and guidelines were recorded in the form of the Munich Declaration and will be presented in the following.