German Medical Education Research Articles

Medical students' perspectives on racism in medicine and healthcare in Germany: Identified problems and learning needs for medical education.

Against the backdrop of considerable lack of research, this study provides the first exploration of medical students' perspectives on racism in medicine and healthcare in Germany. The aim is to identify problems and learning needs for medical education. We address the following research questions: - How do medical students perceive racism in medicine and healthcare in Germany? - How do they address, understand, and discuss different aspects of racism in this context? - What are their expectations regarding the role of medical education? Semi-structured online focus group discussions were conducted with 32 medical students from 13 different medical schools in Germany. The discussions were transcribed and analyzed using qualitative content analysis. Based on the analysis of the focus groups, four main hypotheses could be formulated: 1. Medical students perceive racism in medicine and healthcare in Germany as a ubiquitous phenomenon. 2. They have problems to identify racist behaviour and structures due to conceptual knowledge gaps. 3. They are insecure how to deal with racism on a situational level. 4. They hold medical education accountable to tackle racism in medicine and healthcare on various levels. Our study raises specific learning needs for addressing racism in medicine and healthcare in Germany. Research from the US-context might inspire innovative approaches for German medical education but needs to take national specificities into account. Further research is needed to prepare the implementation of antiracist training in German medical education.

Racism in German medical education – Perspectives of racialized physicians and medical students

Abstract Background The impact of racism on health and the quality of health care services for racialized patients have been the object of prior research. The experiences of racialized medical students and physicians, who operate in a field of tension between natural sciences and practical application and between a ‘medical habitus’ and exclusionary discrimination, have hardly been examined to date. The education of (future) physicians is an especially fruitful research area in the context of the study of institutional racism in the health care system, as informal everyday experiences come together with formal knowledge and normative learning. Methods Based on expert consultations and preliminary interviews with civic stakeholders, teaching and learning materials in German medical studies were randomly sampled and used as a starting point for qualitative guided interviews with physicians and medical students in Germany who are themselves affected by racism. The first steps of the thematic analysis of these interviews are reflected upon and further developed in focus group discussions with the interviewees. Results The study is particularly concerned with the question of how certain dimensions of racism in the health care sector are related, and how racist normativity appears in this context. This is concretized in the relationship between formal and informal medical curricula as well as in the interweaving of everyday experiences and teaching materials. Conclusions There are different dimensions of relation between a hegemonic normativity in the medical curriculum and the everyday experiences of racialized medical students and physicians in Germany. Politics, faculties, publishers, and civic society may be the target of several recommendations for action regarding those diverse dimensions, e.g. the line between omission and stereotyping of several patient groups. Key messages • Hegemonic normativity in German medical education is an important and challenging issue. There are several institutional levels of medical knowledge reproducing racism in the health care sector. • Both racialized physicians and racialized patients are affected by symbolic and material forms of racism in the German health care system, which are interweaving and crucial on diverse levels.

Artificial Intelligence in Undergraduate Medical Education.

AI will take on an increasingly important role in medicine. Therefore, AI competencies should be taught in medical school. We investigated the inventory of AI-related courses at German medical schools. The majority of faculty offer courses on AI, but mainly at the elective and introductory levels. Regarding the topic of AI, there is a gap in German medical education that should be closed.

Presentation and evaluation of a modern course in disaster medicine and humanitarian assistance for medical students

BackgroundDisaster medicine is a component of the German medical education since 2003. Nevertheless, studies have shown some inconsistencies within the implementation of the national curriculum, and limits in the number of students trained over the years. Recently, the SARS-CoV-2 pandemic and other disasters have called attention to the importance of training medical students in disaster medicine on a coordinated basis. The aim of this study is to present and evaluate the disaster medicine and humanitarian assistance course, which was developed in the University of Tübingen, Germany.MethodsThe University Clinic for Anesthesiology and Intensive Care Medicine in Tübingen expanded the existing curriculum of undergraduate disaster medicine training with fundamentals of humanitarian medicine, integrating distance learning, interactive teaching and simulation sessions in a 40 h course for third-, fourth- and fifth- year medical students.This prospective and cross-sectional study evaluates the Disaster Medicine and Humanitarian Assistance course carried out over five semesters during the period between 2018 and 2020. Three survey tools were used to assess participants’ previous experiences and interest in the field of disaster medicine, to compare the subjective and objective level of knowledge before and after training, and to evaluate the course quality.ResultsThe total number of medical students attending the five courses was n = 102 of which n = 60 females (59%) and n = 42 males (41%). One hundred two students entered the mandatory knowledge assessment, with the rate of correct answers passing from 73.27% in the pre-test to 95.23% in the post-test (t [101] = 18.939, p < .001, d = 1.88). To determine the subjective perception of knowledge data were collected from 107 observations. Twenty-five did not complete the both questionnaires. Out of a remaining sample of 82 observations, the subjective perception of knowledge increased after the course (t [81] = 24.426, p < .001, d = 2.69), alongside with the interest in engaging in the field of disaster medicine (t [81] = 7.031, p < .001, d = .78). The 93.46% of the medical students (n = 100) graded the training received with an excellent overall score (1.01 out of 6).ConclusionThe study indicates a significant increase in students’ understanding of disaster medicine using both subjective and objective measurements, as well as an increase interest in the field of disaster medicine and humanitarian assistance. Whereas former studies showed insufficient objective knowledge regarding disaster medical practices as well as subjective insecurities about their skills and knowledge to deal with disaster scenarios, the presented course seems to overcome these deficiencies preparing future physicians with the fundamentals of analysis and response to disasters. The development and successful implementation of this course is a first step towards fulfilling disaster medicine education requirements, appearing to address the deficiencies documented in previous studies. A possible adaptation with virtual reality approaches could expand access to a larger audience. Further effort must be made to develop also international training programs, which should be a mandatory component of medical schools’ curricula.

How are social determinants of health represented in German medical education?: a qualitative content analysis of key-curricular documents

ObjectiveThe WHO Commission on Social Determinants of Health (SDH) has called for a health workforce trained in recognising, understanding and acting on the SDH. However, little is known about how...

Representation of Social Determinants of Health in German Medical Education

The World Health Organization (WHO) has emphasized the need for a health workforce trained in recognising, understanding and acting on the social determinants of health (SDH). However, little is known about how current medical education prepares graduates to meet this challenge. This study analyses the extent to which content on SDH is incorporated in the German medical curriculum. This work is based on a qualitative and quantitative content analysis of 3 key document groups, outlining what medical schools are expected to teach and defining what medical students are expected to know on graduation. The assessment reveals important gaps in the representation of SDH in key frameworks for German medical education. Only between 4 and 27% of the analysed document-elements contained reference to any SDH-related issues, with 0-3% of those elements containing explicit references to SDH. While some aspects were widely covered (e. g. topics of occupational health), other topics such as health inequalities or determinants outside of the health care system were not or hardly represented. A stronger and more explicit representation of SDH during medical education could help to prepare the new health workforce for current and future challenges in our globalised world. The current reform process of the National Competency-Based Catalogue of Learning Objectives for Medicine should strive to fill the gaps, e. g. by putting more emphasis on aspects of poverty and health, health inequalities and issues of access to healthcare.

Beyond the Internationalisation of Higher Education. A Case of a Romanian Medical School on the German Medical Education Services Market

Abstract The internationalisation of higher education has been for the last decade a priority both at the level of the EU and at national levels. However, complying with organizational and institutional criteria is not enough to become visible to future students, as most often they are not aware of the educational opportunities at national and international level. Awareness can be improved by using media channels preponderantly used by the would-be students and doing it non-intrusively, by ranking high on search engine results pages (SERPs).

Representation of social determinants of health in German medical education: protocol of a content analysis study

IntroductionAction on the social determinants of health has been key for improving health and prolonging life in the past, and remains so today. Against this background, WHO’s Commission on Social...

Global Health as \u201cumbrella term\u201d \u2013 a qualitative study among Global Health teachers in German medical education

BackgroundThe increasing impact of globalisation on healthcare demands new knowledge, skills and attitudes from healthcare professionals. One consequence of this is the rise of Global Health (GH) programs in health education all over the world. In Germany no consensus exists on what GH is and how it should be taught. This study used a grounded theory approach. We conducted eleven in-depth interviews with GH teachers in German medical education to ask them about their views on Global Health and the approaches they took in teaching these topics. Data collection and Analysis informed each other and followed an inductive approach.ResultsOur research identified three major questions: (1) What is GH? (2) What belongs to GH? (3) How can GH be taught? A central finding of our study is the understanding of GH as an umbrella term. We show how this understanding helps clarify the relation between GH and Public Health, International Health and Tropical medicine. At the core of GH we see the supraterritorial determinants of health. Surrounding the core, we describe a wide variety of topics that are a facultative, but not necessarily a compulsory part GH. One of the key characteristics of GH within all its aspects is its multidisciplinary nature. Based on this understanding we present models about the content of GH, how it can be taught and how GH teaching improves and strengthens overall medical education.ConclusionsThis is to our knowledge the first study that conducts in-depth interviews with GH teachers to explore the practical understanding of GH in medical education. While the generalisability of our results needs to be subject of further research, the models presented can help shape the future discourse around GH and its integration into medical education.

Tempora mutantur... et nos? The future of the Hungarian anatomy teaching in reflection of the German trends

The traditional four-semester anatomy is a subject to change: next to the external pressure, there is an intrinsic need to shift the emphasis. The mapping of the strengths, weaknesses and threats of the Hungarian anatomy teaching helps to formulate the directions of possible development. Current trends in the German medical education should be carefully followed. Nowadays, nearly 25% of the medical students in Germany are studying according to the new, integrated "Modellstudiengang", i.e. all the conventional subjects are reorganised into organ system thematic blocks. The unified German written final exam system provides an objective assessment parameter: to rank the 36 German medical schools according to the results of the anatomy exams. The homepage-published data, the number of semesters or teaching hours, or the thematic concept of the subject alone cannot explain the rankings of the medical schools according to the anatomy exam results. The greatest challenges of the Hungarian anatomy teaching today are: the development of an outcome-oriented, unified, practical system of requirements, the redefinition of the subject, the more effective interaction with the clinical colleagues, solving the problems of faculty recruitment and establishing the vertical integration of anatomy.

Comparison of curriculum and degree conferment in higher medical education between Germany and China

The higher medical education in China starts late and needs further exploration and improvement. While in Germany, it is elite education with a long history. Compared with China, in curriculum setting, Sociology, Medical health security, Humanities and Social Sciences and Organ system classification courses are more emphasized, and in terms of degree, it only has Doctor degree but with higher quality in Germany. Higher medical education in China will also take the path of the elite education. We can learn from the German medical education development experience and pay attention to solving the lack of the curriculum by supplementing social medicine and medical health security, increase the autonomy of the instructors in the training process, strengthen the medical students' social responsibility, and improve the quality of higher medical education in China. Key words: Medical education; Curriculum setting; Confer degree; China; Germany

CORR® Curriculum--Orthopaedic Education: The Evolution of Orthopaedic Surgery Education in Germany.

Prior to World War I, German medical education strongly influenced training in the United States. One example of this influence is William Steward Halsted MD, a young surgeon from New York who observed postgraduate education while traveling to Germany and Austria in the late 19th century. When Halsted returned to New York, he created the Halsted residency, which set itself apart from less-formal training programs by educating surgeons for a set period of time with a slow, but progressive increase in responsibility and operating time, culminating with independent practice [10, 14]. Surgical education in Germany has a long tradition of excellence [2, 3, 5, 6, 10, 11, 13, 14], producing giants in the field like Billroth [1], Volkmann [18], and Kirschner [9]. In the past, the United States and Europe took their cues from German postgraduate surgical training, which relied heavily on mentorship. But the traditional postgraduate surgical training model in Germany has recently been challenged on several fronts. First, by the ever-increasing specialization of medicine, which required more sophisticated, innovative, and dynamic training programs. Second, by the formation of the European Union and the reunification of Germany, which underscored the need to have a similar, streamlined educational experience throughout the European Union. Because of these pressures, German postgraduate education became more aligned with other European Union educational standards. In this column, we will examine the educational structure of German postgraduate training, review the recent changes to residency programs in Germany, and determine how those changes have influenced the quality of German medical education.

Qualification of ship doctors: a German approach.

While a steady growth of cruise tourism since the 1970s created an increasing demand for ship doctors medical postgraduate specialty training did not sufficiently reflect the scope of skills and knowledge required from a physician being left to himself at sea. The German Maritime Health Association therefore tasked a working group with analysing the situation and coming up with suggestions for an adequate postgraduate training for ship doctors. The working group consisted of 19 experts with various backgrounds in maritime medicine. A literature review was done on cruise ship epidemiology as well as an assessment of tasks and environmental factors influencing medical care on board of cruise ships. Necessary knowledge and skills were derived and compared with those imparted by standard German medical education. Mandatory knowledge and skills were identified as well as elements of standard medical education contributing to these goals. Those aspects that would or could not be adequately covered by German standard education were catalogued and summarised in a course curriculum. In 2013 after approval by its board of directors the German Maritime Health Association published a qualification and training recommendation addressing colleagues planning to muster as ship doctors.

Barriers in the implementation of interprofessional continuing education programs--a qualitative study from Germany.

BackgroundInsufficient communication and coordination is one of the most problematic issues in German health care delivery leading to detrimental effects on health care outcomes. As a consequence interprofessional continuing education (CIPE) is gathering momentum in German health policy and health care practice aiming to enhance service quality and patient safety. Nevertheless, there is limited evidence on the course of implementation and the perceived effectiveness/acceptance of CIPE in German health care. This paper describes the objectives and formal characteristics of CIPE trainings and maps important determinants influencing the success of CIPE implementation from the perspective of providers offering CIPE trainings for German health care professionals.MethodsForty-nine training institutions offering CIPE for health care professionals were identified by a structured web search including the websites of German medical education associations and public/private training institutions. Directors and managers of the identified institutions were invited to participate in a semi-structured interview. The interview guideline was developed using the SPSS method by Helferich and colleges. Interviews were analyzed using the summarizing content analysis developed by Mayring resulting in a paradigm that contextualizes hindering factors regarding the implementation of CIPE in the German health care system.ResultsOverall, 19 of the identified institutions agreed to participate with one director/manager per institution resulting in a response rate of almost 38.8%. The included institutions offer n = 85 CIPE trainings for health care professionals. Trainings offered mainly address the enhancement of domain, social and personal competencies of the participating health care professionals and follow three main objectives comprising better care of severely ill patients, improvement of patient safety by sustained risk management as well as a more patient centered care. Implementation of CIPE in Germany is influenced by various hindering factors mostly coming from systemic (missing incentives), behavioral (hierarchy problems) and methodological (limited quality assurance) factors.ConclusionCIPE is an evolving concept in the German health care system. There are various difficulties that impede a successful implementation of CIPE and might be mitigated by specific health policy interventions such as mandatory CIPE participation of health care professionals and comprehensive pre-license interprofessional education.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6920-14-227) contains supplementary material, which is available to authorized users.

International electives in the final year of German medical school education--a student's perspective.

The final year of medical school has a unique role for introducing students to their future responsibilities and challenges. At many medical schools, electives at an accredited institution abroad are a common part of the student’s final year experience. International electives provide an opportunity for a personal and academic experience that will often create new perspectives on clinical medicine and research, medical education and healthcare policy. In this article the authors reflect on their experience as elective students abroad and discuss the contribution of international electives to the constant development and progress of local final year rotations. They identify key areas for improving final year electives and outline essential features for a valuable and successful final year elective.

German undergraduate medical students’ attitudes and needs regarding medical errors and patient safety – A national survey in Germany

Introduction: Errors in medicine and patient safety are topics with growing scientific and public attention. In undergraduate medical education, these issues are little investigated so far. The aim of this study was to collect data regarding attitudes and needs of medical students.Methods: In a sample of 269 German medical students, data were collected using an anonymous online questionnaire. It consisted of three parts: (1) international validated questionnaire, (2) questions about the German medical education system and (3) demographic data. Data were analysed quantitatively and qualitatively.Results: One-hundred sixty-seven data sets were analysed (completion rate 62%). Twenty-five percent of the respondents stated that they already had committed a medical error. Almost half of the participants reported that they had been assigned tasks they had not been qualified for (47%), or where medical errors could have happened easily (50%). Final year students showed less confidence in error disclosure compared to younger students (p < 0.001). The majority of respondents (64%) wished for more education on the issues.Discussion: With regard to future curricular developments, a consideration of attitudes and needs of medical students regarding the topics of medical errors and patient safety seems necessary. A goal-directed undergraduate education can promote an open culture and can lead to safety and satisfaction for both patients and medical professionals.

The Flexner report: 100 years later

The Flexner Report of 1910 transformed the nature and process of medical education in America with a resulting elimination of proprietary schools and the establishment of the biomedical model as the gold standard of medical training. This transformation occurred in the aftermath of the report, which embraced scientific knowledge and its advancement as the defining ethos of a modern physician. Such an orientation had its origins in the enchantment with German medical education that was spurred by the exposure of American educators and physicians at the turn of the century to the university medical schools of Europe. American medicine profited immeasurably from the scientific advances that this system allowed, but the hyper-rational system of German science created an imbalance in the art and science of medicine. A catching-up is under way to realign the professional commitment of the physician with a revision of medical education to achieve that purpose.

The Bologna agreement is not suitable for medical education: a German view

Central elements of the Bologna declaration have been implemented in a huge variety of curricula in humanities, social sciences, natural sciences and engineering sciences at German universities. Overall the results have been nothing less than disastrous. Surprisingly, this seems to be the perfect time for German universities to talk about introducing a curriculum that is fully compatible with the Bologna declaration for medical education as well. However, German medical education does not have problems the Bologna declaration is intended to solve, such as quality, mobility, internationalization and employability. It is already in the Post-Bologna age.

The “Bologna Process” in European Higher Education: Impact of Bachelor's and Master's Degrees on German Medical Education

Background: The introduction of the Bologna Process, in particular the implementation of a tiered structure of study programs and degrees, imposes quite some changes in most European higher education systems. The purpose of this article is to introduce some major points of the Bologna Process with regard to medical education in Germany and Europe and to reflect the process of the adoption of a two-cycle bachelor–master system in medicine. Summary: International positions and perspectives of professionals, students, and politicians are discussed which underline the complexity and dynamics of the whole process in contemporary higher education. A short reflection to key aspects of the two-cycle system, and student mobility is provided. Conclusions: Higher education in the whole health care sector may benefit from the Bologna objectives leading to a more permeable, comparable, and compatible medical education system across Europe.

The Bologna agreement is not suitable for medical education: a German view

Central elements of the Bologna declaration have been implemented in a huge variety of curricula in humanities, social sciences, natural sciences and engineering sciences at German universities. Overall the results have been nothing less than disastrous. Surprisingly, this seems to be the perfect time for German universities to talk about introducing a curriculum that is fully compatible with the Bologna declaration for medical education as well. However, German medical education does not have problems the Bologna declaration is intended to solve, such as quality, mobility, internationalization and employability. It is already in the Post-Bologna age.