Medical Faculties In Germany Research Articles

Working hour preferences of female and male residents : Developments over 4years of postgraduate medical training in Germany

This article addresses developments regarding working hours and working hour preferences of residents undergoing postgraduate training in Germany and analyses if, and for what reasons, full-time or part-time working models are preferred. The source of data is the KarMed study, which is based on yearly postal surveys carried out among graduates of the year 2008/2009 from seven medical faculties in Germany. The interviews took place during the entire postgraduate training period. Response rates were 48% in the first year, with subsequent rates of above 85%. For analysis, descriptive statistics and regression models were applied. There is aconsiderable discrepancy between the actual and the preferred working hours of residents undergoing postgraduate training. Postgraduate training is mostly linked to full-time contracts, usually with additional overtime, even though a considerable proportion of doctors prefer apart-time position. More female residents want to work part-time than male doctors. The same applies for the period after medical specialism: in particular, female doctors with children, female doctors trained in former Western Germany states, and those seeking an occupation in outpatient care request part-time contracts for their professional future. Asimilar trend has been increasingly observed over the years for male doctors. Despite the huge number of residents requesting part-time contracts - during postgraduate training and afterward - the reality is still far behind this model. It is apparent that measures should be taken for both genders. Those measures should facilitate the implementation of the favored working-time model.

Preference Changes Regarding Future Work Area and Intended Position Among German Residents after Four Years of Residency

Introduction We investigated the preferences of medical residents in Germany with regard to future working place (hospital or private practice) and position (employment/self-employment in private practice; resp. specialist/senior or chief physician in the hospital). This is analysed in a gender comparative perspective, including the influence of parenthood. Methods Annual postal surveys among graduates of seven medical faculties in Germany from their last year ("Practical Year") until after four years of postgraduate training. The return rate at baseline was 48 % and the four surveys after reached rates from 85 % up. In all samples about two thirds were women, which corresponds to the actual gender differentiation in under- and postgraduate training. Descriptive statistics and regression analyses were performed. Results Compared to private practice the hospital is clearly preferred, although the attraction of hospital jobs decreased over the years. The decision for or against the hospital is connected to the discipline. Working in private practice is seen as possibility for part time work. Men prefer self-employment whereas women prefer to work under an employment contract. In the hospital, male doctors prefer to work in leading positions. Those positions are associated with full-time work. Leadership training especially takes place in university hospitals. Discussion Three trends are recognized: Reluctance against leading positions, growing interest for part time work and rising popularity of work as an employee in private practice. Those trends can be understood as a rejection of traditional professional role models. The realization of these preferences is easily feasible because of the current labour market situation. Therefore, emerging problems have to be faced in another way. A change of gender-typical role models was rarely detected.

Stability and Change of Medical Specialty of Residents over Four Years of Postgraduate Training in Germany

Aim We analyzed medical residents' preferences in Germany with regard to the specialization fields after 4 years of postgraduate training and compared them to their preferences in the years before, e. g. at the end of undergraduate education in a gender comparative perspective, including the influence of parenthood. Methods The study is based on annual postal surveys of students of 7 medical faculties in Germany from their last year of medical school ("Practical Year") until after 4 years of postgraduate training. The return rate at baseline was 48% and in the 4 surveys thereafter the rates were 85% and above. In all samples, about two-thirds of respondents were women, which corresponds to the actual gender distribution in under- and postgraduate training. Descriptive statistics and regression analyses were used. Results Compared to the end of undergraduate education, anaesthesiology and general practice were the disciplines which gained in attraction, whereas surgical disciplines lost significantly in their attraction. These developments were similar in both genders. Specialized internal medicine, paediatrics and gynaecology lost attraction among female physicians only. We found important correlations of disciplinary preferences with parenthood and with the preference for part-time work after graduation. Conclusion The data show that "feminization" is not the reason why both anaesthesiology and general practice gained in attraction, since this happened over the 4 years among both male and female physicians. The loss in attraction in all great clinical disciplines, especially in surgery, orthopaedics and urology, may lead to severe problems in supply of medical manpower in the hospital, especially when combined with preference for part-time work.

A multi-centre student survey on weighing disciplines in medical curricula - a pilot study.

Aim: Initiated by students, this pilot study examines how obtaining medical students’ perspectives via a structured online survey may prove useful for curriculum deliberation. Methods: In 2012, 747 students of 32 medical faculties in Germany assessed disciplines specified in the Medical Licensure Act (AÄpprO) thereby concerning the allocation of teaching time, perceived usefulness regarding preparation for state examination and medical practice, their interest and motivation for studying as well as consideration for future work. Results: Internal medicine, surgery, paediatrics, gynaecology/obstetrics and general medicine rank amongst the upper third regarding allocation of teaching time and perceived usefulness for future medical practice. Concerning both preparation for state examination and medical practice internal medicine ranks second, while surgery only 22nd and 28th of 32, respectively. Some clinical-theoretical disciplines (e.g. pharmacology) are in the top ten regarding perceived preparation for state examination, too. Students who consider choosing internal medicine for future work rate associated disciplines significantly higher regarding usefulness for clinical practice (e.g. pharmacology) or motivation for studying (e.g. microbiology) than other students do.Conclusion: A simple survey reveals interesting data on students’ perceptions and ideas of medical studies. Though the data are plausible, interpretations should be done with caution. Nonetheless, data like these should give rise to further questions and discussions, e.g. as part of curriculum deliberation.

Attitude towards organ donation in German medical students.

It is well known that personal decision making in respect to organ donation is highly dependent on the balance of knowledge, trust, and fear. We wanted to explore the attitude of German medical students towards organ donation and investigate the relationship between knowledge, trust, and fear in this special subgroup. We conducted an online survey utilizing (1) the snowball effect of using Facebook groups and advertisement as well as (2) mailing lists of medical faculties in Germany for distribution. We surveyed 1370 medical students. 75.8% (N=988) of the participants stated to carry an organ donor card and allowed their organs to be donated. 1.8% (N=23) refused donation. 22.5% (N=293) did not carry an organ donor card. Analysis of the "decided" versus the "undecided" group revealed substantial differences regarding transplantation knowledge (mean knowledge score of 4.23 vs. 3.81; P<0.001), trust in (mean trust score 4.11 vs. 3.39; P<0.001), and fear of (mean fear score 1.63 vs. 2.22; P<0.001) organ donation. 45.9% of the undecided group (N=134) opted for accessing additional information material. After reading the info material, 22.7% (N=29) stated their willingness to sign a donor card, whereas 76.6% (N=98) still could not reach a decision. The willingness to potentially act as organ donor was related to the pre-existent knowledge, trust, and fear. Access to information material did promote the decision towards organ donation in a group of previously undecided medical students. This advocates initiating information campaigns even in population groups with strong medical background.

Student assessments in palliative medicine as the cross-disciplinary subject 13: Survey of 34 medical faculties in Germany

In 2009 palliative medicine was integrated into the undergraduate curriculum as cross-disciplinary subject 13 and is now part of mandatory education in German medical faculties (MF). Surveys across German MFs have shown an inhomogeneous development of this cross-disciplinary subject. The aim of this study was to assess the current state and the needs in terms of assessments in the cross-disciplinary subject 13 at German MFs. Palliative care coordinators at German MFs were surveyed by using a standardized telephone interview. Closed-ended questions were analyzed by descriptive analysis and open-ended questions by content analysis. A total of 34 out of 36 MFs participated. Multiple choice tests were the major form of assessment (94.1%) and 9 MFs planned to implement another form of assessment, mainly an objective structured clinical examination (OSCE) station (55.5%). The majority of the MFs (91.2%) had no blueprint to develop assessments but conducted a review (78.8%) afterwards. A successful implementation of the assessment was mostly achieved when the concept of the assessment was felt to be suitable. The lack of human resources was found to be the most relevant obstacle for the implementation of a practical assessment format. The major form of assessment in palliative care is still a written examination, especially multiple choice tests. This format is considered to be of limited value for assessing communicative competencies and attitudes in palliative medical care. Further steps should include the development of a competence-based assessment that is also feasible for smaller MFs with limited resources.

Undergraduate education in palliative medicine in Germany: a longitudinal perspective on curricular and infrastructural development.

BackgroundIn 2009, palliative medicine became an integrated and compulsory part of undergraduate training in Germany by legislation. After a transitional period, all medical faculties were required to provide adequate teaching with an according examination and certification procedure. In parallel, we conducted bi-annual surveys on all medical faculties in Germany to examine for potential discrepancies between the implementation process and their intended consequences on teaching time and content.MethodsFour consecutive bi-annual surveys (2006, 2008, 2010, 2012) of all 36 medical faculties in Germany were performed, using purposively for this study developed questionnaires. Likert scales and closed questions were analyzed descriptively.ResultsMedical Faculty response rate increased from 50 % in 2006 to 88.9 % in 2012. Teaching coordinators in palliative medicine primarily had an anesthesiology or internal medicine background. There was a noted increase over time of the involvement of specialized palliative care units (PCUs) as providing the setting for education. The number of faculties that were able to offer a complete 16 weeks of training in palliative medicine during the “final year” rose steadily. In addition, increased patient-centered teaching formats have been implemented over time. The faculties which offered innovative teaching formats with actors as patients (standardized patient interaction) increased, as did the total number of mandatory examinations. The number of faculties that provided compulsory teaching in a condensed manner within a single academic year increased sharply from 3 of 31 responding faculties in 2010 to 19 of 32 responding faculties in 2012.ConclusionsUntil now, teaching conditions and structures in palliative medicine in Germany have proven to be extraordinarily heterogeneous. Although professorships (“Chairs”) in palliative medicine proved to be particularly beneficial and supportive in curricular and structural development, only a minority of faculties provide leading academic positions in palliative medicine.

Effectiveness of Organ Donation Information Campaigns in Germany: A Facebook Based Online Survey.

BackgroundThe German transplantation system is in a crisis due to a lack of donor organs. Information campaigns are one of the main approaches to increase organ donation rates. Since 2012, German health insurance funds are obliged by law to inform their members about organ donation. We raised the hypothesis: The willingness to sign a donor card rises due to the subsequent increase of specific knowledge by receiving the information material of the health insurance funds.ObjectiveThe objective of the study was to assess the influence of information campaigns on the specific knowledge and the willingness to donate organs.MethodsWe conducted an online survey based on recruitment via Facebook groups, advertisements using the snowball effect, and on mailing lists of medical faculties in Germany. Besides the demographic data, the willingness to hold an organ donor card was investigated. Specific knowledge regarding transplantation was explored using five factual questions resulting in a specific knowledge score.ResultsWe recruited a total of 2484 participants, of which 32.7% (300/917) had received information material. Mean age was 29.9 (SD 11.0, median 26.0). There were 65.81% (1594/2422) of the participants that were female. The mean knowledge score was 3.28 of a possible 5.00 (SD 1.1, median 3.0). Holding a donor card was associated with specific knowledge (P<.001), but not with the general education level (P=.155). Receiving information material was related to holding a donor card (P<.001), but not to a relevant increase in specific knowledge (difference in mean knowledge score 3.20 to 3.48, P=.006). The specific knowledge score and the percentage of organ donor card holders showed a linear association (P<.001).ConclusionsThe information campaign was not associated with a relevant increase in specific knowledge, but with an increased rate in organ donor card holders. This effect is most likely related to the feeling of being informed, together with an easy access to the organ donor card.

International medical students--a survey of perceived challenges and established support services at medical faculties.

Introduction: Medical students with a non-German background face several challenges during their studies. Besides support given by foreign student offices further specific projects for international students have been developed and are offered by medical faculties. However, so far, neither a systematic survey of the faculties’ perceived problems nor of the offered support exists.Method: All study deaneries of medical faculties in Germany were contacted between April and October 2013 and asked for their participation in a telephone interview. Interview partners were asked about 1.) The percentage of non-German students at the medical faculty; 2.) The perceived difficulties and problems of foreign students; 3.) The offers for non-German students; and 4.) The specification of further possibilities of support. Given information was noted, frequencies counted and results interpreted via frequency analysis.Results: Only 39% of the medical faculties could give detailed information about the percentage of non-German students. They reported an average share of 3.9% of students with an EU migration background and 4.9% with a non-EU background. Most frequently cited offers are student conducted tutorials, language courses and tandem-programs. The most frequently reported problem by far is the perceived lack of language skills of foreign students at the beginning of their studies. Suggested solutions are mainly the development of tutorials and the improvement of German medical terminology.Discussion: Offers of support provided by medical faculties for foreign students vary greatly in type and extent. Support offered is seen to be insufficient in coping with the needs of the international students in many cases. Hence, a better coverage of international students as well as further research efforts to the specific needs and the effectiveness of applied interventions seem to be essential.

"Peer-assisted learning" (PAL) in the Skills-Lab--an inventory at the medical faculties of the Federal Republic of Germany.

Background: Over multiple years, the didactic concept of „peer-assisted learning“ (PAL) has proved to be valuable for medical education. Particularly in the field of the nowadays widely established Skills-Labs, the assignment of student tutors is both popular and effective. The aim of the underlying study is to assess the current status of PAL programs within German medical faculties’ Skills-Labs regarding their distribution, extent, structure and content based on a nation-wide survey.Methods: All 36 medical faculties in Germany were contacted and asked for their participation (via telephone or in written form) in the survey encompassing 16 central questions as to the structure of established PAL programs. Data obtained were subject to quantitative and qualitative analysis.Results: 35 of 36 (97.2%) medical faculties participated in the survey. A PAL program was shown to be established at 33 (91.7%) faculties. However, the results show distinct differences between different faculties with respect to extent and content of the PAL programs.Conclusions: Among German medical Skills-Labs, PAL has been established almost ubiquitously. Further studies on the conception and standardization of training concepts appear to be pivotal for the advancement of PAL in the context of Skills-Labs.

A Pilot Study on Undergraduate Palliative Care Education – A Study on Changes in Knowledge, Attitudes and Self-Perception

Background: Since 2013 medical faculties in Germany have to teach and assess palliative care issues. Objective: Evaluation of a one-week intensive seminar in palliative care with regard to cognitive and affective learning objectives. Methods: Exploratory prospective naturalistic study with pre (T1) and post (T2) measurement, investigating medical students' (N=31) knowledge, opinions and attitudes as well as estimation in self-efficacy regarding palliative care issues. The sample contains of undergraduate medical students before and after an interdisciplinary palliative care course (40 teaching units) held at the Medical Faculty of Heinrich Heine University Dusseldorf, Germany. Results: Upon completion of the seminar, students demonstrated a significant increase of palliative care-related knowledge and a positive self-estimation in competence and self-efficacy with regard to treating and caring for dying patients. However, no changes were found on the subject of a greater acceptance and reduced fear of death and dying. Conclusions: The acquisition of affective learning objectives with regard to essential attitudes towards death and dying may require a longer learning process and thus a longitudinal implementation into medical school curricula.

Have "new" methods in medical education reached German-speaking Central Europe: a survey.

BackgroundSimulation-based-training (SBT) in the education of health professionals is discussed as an effective alternative for knowledge and skills enhancement as well as for the establishment of a secure learning environment, for learners and patients. In the Anglo-American region, SBT and simulation and training centers (STC) are numbered as standard for medical training. In German-speaking Central Europe, priority is still given to the establishment of SBT and STC. The purpose of this study was (i) to survey the status quo relating to the existence and facilities of simulation and training centers at medical universities in German-speaking Central Europe and (ii) the evaluation of training methods, especially in the area of emergency medicine skills.MethodsAll public and private medical universities or medical faculties in Germany (36), Austria (4) and German-speaking Switzerland (3) were interviewed. In the survey, information regarding the existence and facilities of STCs and information with regards to the use of SBT in the area of emergency medicine was requested. The questions were partly posed in a closed-ended-, in an open-ended- and in a multiple choice format (with the possibility of selecting more than one answer).ResultsOf a total of 43 contacted medical universities/medical faculties, 40 ultimately participated in the survey. As decisive for the establishment of a STC the potential to improve the clinical-practical training and the demand by students were listed. Obligatory training in a STC during the first and sixth academic year was confirmed only by 12 institutions, before the first invasive procedure on patients by 17 institutions. 13 institutions confirmed the use of the STC for the further training of physicians and care-staff. Training for the acute care and emergency medicine skills in the field of pediatrics, for the most part, occurs decentralized.ConclusionsNew methods in medical training have reached German-speaking Central Europe, but the simulation and training centers vary in size, equipment or regarding their integration into the obligatory curriculum as much as the number and variety of the offering to be trained voluntarily or on an obligatory basis.

Evidenzbasierte Medizin in Aus-, Weiter- und Fortbildung im deutschsprachigen Raum: Ein Survey

In the last 15 years Evidence-based Medicine (EbM) has gained much publicity in the German-speaking countries, but it is currently difficult to conclude how much the contents of EbM with its five steps according to Sackett have spread. Data from the year 2006 show that less than half of all medical faculties in Germany have introduced EbM into undergraduate teaching and that there is a shortage in EbM teaching activities for graduates in the German-speaking countries as well. The goal of this survey is to display the undergraduate and graduate Evidence-based Practice teaching activities in the German-speaking countries. In a two-step survey, we first sent out a total of 551 letters to medical faculties, colleges, boards of physicians, the German Hospital Association, the associations of statutory health insurance physicians in Germany, the Medical Service of the German health insurances and asked the 30 participants of the 2011 EbM Academy as key informants in writing to give details about potential providers of EbM teaching activities. Via email we also consulted the members of the German-speaking colleges of general practitioners and family medicine and the German Network for EBM, course participants and contact persons of familiar teaching activities. In a second step a pre-tested detailed questionnaire with 36 items in the five categories framework and structure, participant characterisation, contents and didactics, evaluation and publication, and planning and publicity was sent to potential providers. Altogether 185 teaching activities were identified, 80% of which were located in Germany, 13% in Austria and 7% in Switzerland. In 82.6% of the cases it was either a seminar, a course or a workshop with a median of 20 participants and an average duration of 17.9hours. The teaching activities mainly addressed students (63.2%), physicians (37.8%), caregivers and members of other health care professions with little or no prior knowledge of EbM. The first three steps of EbM (formulating clinical questions, search for and appraisal of the literature) were taught in more than 75% of the teaching activities, whereas steps four and five (integration of results, evaluation) were only taught in 53.9% and 33.3% of the cases, respectively. Compared to 2006, a remarkable increase in EbM teaching activities was observed in the German-speaking areas. These activities address different target audiences; the main content focus is on the first steps of EbM.

Similar Results

We have read the original article by Gibis et al. with interest. For the subject areas “compatibility of work and family life” and “career aspirations,” this nationwide survey showed similar results to a survey conducted by our working group from the Baden-Wurttemberg General Practice Competence Center (1– 3). This survey was conducted among medical students in the state of Baden-Wurttemberg (n=12 062, response rate 11%) with a validated questionnaire (1). In contrast to the study reported by Gibis et al, this questionnaire provides only a single-choice answer to the question of which specialty the respondent wants to embark on. The six most popular specialties were internal medicine (11.7%), gynecology (9.8%), pediatrics (9.6%), surgery (8.9%), anesthesiology (7.8%, and general practice (6.8%). A comparison of the surveys shows a clear overlap of the top positions, with our data showing notably more students with an interest in gynecology and fewer for general practice. On the other hand, the comparison with the results of our study also entails a possibility of misinterpretation of the study data reported by Gibis et al., which results from the study method (multiple responses allowed for the specialty of choice). Altogether, as the presented data suggest, we can certainly expect far fewer interested students for the different specialties. The proportions for the specialty of choice in our data were all below 11%—not enough to meet demand in the main specialties. All specialties should work in equal measures to present their discipline as attractive at the universities and to entice future generations of doctors into posts accordingly. Especially for general practice this is a competition with a handicap if one remembers that to date, only half of all medical faculties in Germany actually hold a chair for general practice.

Palliative Care teaching in Germany - concepts and future developments.

Background: Following recent modifications of the Medical Licensure Act (ÄApprO) in the year 2009, palliative care was introduced as a compulsory 13th cross-disciplinary subject (Q13) in the undergraduate curriculum. Its implementation must have taken place before the beginning of the final year (´practical year´) in August 2013 and has to be substantiated for the medical exams taking place in October 2014. Very diverse structures pertaining to palliative care teaching were described in previous surveys at various medical faculties in Germany. As a result, the current and future plans and concepts related to content and exams of a mandatory Q13 course at the respective faculty sites should be ascertained. Methods: Since 2006, the German Medical Students' Association (bvmd) has been carrying out a bi-annual survey at all medical faculties in Germany regarding the current situation of teaching in the field of palliative care. After designing and piloting an online survey in May 2010, a one-month online survey took place. The data was assessed using a descriptive approach. Results: 31 of 36 medical faculties took part in the survey. At the time of questioning, 15 faculties already taught courses according to the requirements of the new ÄApprO; at three sites the Q13 is yet to be introduced commencing in 2012. A teaching curriculum for Q13 already existed at 15 faculty sites, partly based on the curricular requirements of the German Association for Palliative Medicine (DGP). Six sites described an implementation process as yet without an independent curriculum. Most of the faculties aim for 21-40 course hours, which will for the most part be provided as lectures, seminars or less often in more assisted and intense formats. The majority of the participating faculties intend an examination containing multiple choice questions. At 8 universities there is an independent Chair for palliative medicine (5 more are planned); this was linked with a higher degree of mandatory teaching in alignment with the requirements of the ÄApprO. A broad spectrum of educationally-involved occupational groups, specialist disciplines and external co-operating partners, were mentioned. Conclusion: The infrastructural prerequisites of the present curricular concepts and the degree of implementation of the Q13 according to the requirements of the new ÄApprO diverge significantly among the various medical faculties. The efforts made to produce a qualitatively high standard of teaching with regard to the multifaceted questions concerning the support for severely and terminally ill patients is as much reflected in the survey, as the special implications of an independent Chair for palliative medicine for the implementation of the requirements by law. The participation of various occupational groups in this survey as well as the broad spectrum of those involved highlights the interdisciplinary and multi-professional dimension of teaching in palliative care.

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

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.

Integration and health-related quality of life of undergraduate medical students with migration backgrounds - Results of a survey.

Objective: Most medical faculties in Germany are still lacking differentiated counseling programmes for specific target groups. The purpose of the present study was to determine the quality of life and integration of students with migration backgrounds and their interests in counseling programmes.Methods: Data was collected at the University Medical Center Hamburg-Eppendorf in Germany. Participants were students of the undergraduate medical course; n=890 (89.3%) students without migration backgrounds were compared to n=107 (10.7%) students with an existing migration background.Results: The results showed that medical students with migration backgrounds reported lower scores for health-related quality of life compared to students without a migration background. They felt less accepted and supported by their fellow students and had fewer contacts with other students. Medical students with migration backgrounds were characterised by a higher interest in the implementation of a counseling programme (Z=–3.420; p=.001).Conclusions: In summary, medical students with migration backgrounds were identified as a group with an increased need for a specific counseling service. Lower scores of mental health and feelings of inferior integration set the necessity for early counseling and intervention needs.

Undergraduate medical education in emergency medical care: A nationwide survey at German medical schools

BackgroundSince June 2002, revised regulations in Germany have required "Emergency Medical Care" as an interdisciplinary subject, and state that emergency treatment should be of increasing importance within the curriculum. A survey of the current status of undergraduate medical education in emergency medical care establishes the basis for further committee work.MethodsUsing a standardized questionnaire, all medical faculties in Germany were asked to answer questions concerning the structure of their curriculum, representation of disciplines, instructors' qualifications, teaching and assessment methods, as well as evaluation procedures.ResultsData from 35 of the 38 medical schools in Germany were analysed. In 32 of 35 medical faculties, the local Department of Anaesthesiology is responsible for the teaching of emergency medical care; in two faculties, emergency medicine is taught mainly by the Department of Surgery and in another by Internal Medicine. Lectures, seminars and practical training units are scheduled in varying composition at 97% of the locations. Simulation technology is integrated at 60% (n = 21); problem-based learning at 29% (n = 10), e-learning at 3% (n = 1), and internship in ambulance service is mandatory at 11% (n = 4). In terms of assessment methods, multiple-choice exams (15 to 70 questions) are favoured (89%, n = 31), partially supplemented by open questions (31%, n = 11). Some faculties also perform single practical tests (43%, n = 15), objective structured clinical examination (OSCE; 29%, n = 10) or oral examinations (17%, n = 6).ConclusionEmergency Medical Care in undergraduate medical education in Germany has a practical orientation, but is very inconsistently structured. The innovative options of simulation technology or state-of-the-art assessment methods are not consistently utilized. Therefore, an exchange of experiences and concepts between faculties and disciplines should be promoted to guarantee a standard level of education in emergency medical care.

Entwicklung der Lehre im Querschnittsbereich „Rehabilitation, Physikalische Medizin, Naturheilverfahren” an den medizinischen Fakultäten 2004-2006/07

Rehabilitation, Physical Medicine, Naturopathic Treatment (Querschnittsbereich Q-12) was introduced as a compulsory interdisciplinary subject in the revised Federal Medical Licensing Regulations (Approbationsordnung für Arzte) in October 2003. This offered the opportunity to increase the students' interest in rehabilitation-related issues and to integrate current evidence of rehabilitation research. The implementation of the Q-12 in the German medical faculties was investigated by yearly questionnaires during a three-year-period. In 2004, 2005, and 2006/07 anonymous postal questionnaires concerning the teaching in Q-12 were sent to the 36 medical faculties in Germany. Non-responders were reminded at least once by a repeat postal questionnaire. The response rates were 67% in 2004, 72% in 2005, 50% in 2006/07, respectively. Of the 36 faculties 34 responded at least once. Ten faculties responded to all questionnaires. In a considerable number of faculties, Q-12 is being coordinated by university institutions which are not denominated as one of the subjects designated in the Q-12 title. Major differences regarding the implementation of Q-12 were found between the faculties. Further development of Q-12 faces several limitations of resources. Almost all faculties provide curricula for teaching Q 12, some of which are still incomplete. During all three examinations lecturer-centered teaching methods (lectures, seminars, other presentations) were used most frequently. POL-cases and other structured patient oriented teaching were also reported less frequently. E-learning was very rarely offered to the students. Musculoskeletal and neurological disorders were the most frequent specific indications for practice-related integration of Q-12 issues. Compulsory election subjects (Wahlpflichtfächer) related to Q-12 issues before and during the final year of the medical students, are not being offered by all faculties. The vast majority of the faculties advocate an exchange of materials for teaching and examinations. During the three examinations, major differences concerning the implementation of Q-12 were found between the faculties. Therefore, it is recommended that all faculties verify whether they adequately cover the joint educational objectives recommended for Q-12 by two German scientific societies. Furthermore, the more frequent application of up-to-date practice-oriented teaching and examination methods, an intensified implementation of Q-12-related issues in teaching specific indications, the completion of curricula, enhanced offer of compulsory election subjects related to Q-12 issues, continued scientific investigations and symposia/workshops concerning the promotion of Q-12-related teaching as well as the generation and exchange of teaching and examination materials are recommended.

Aktuelle Lehr-, Lern- und Prüfungsmethoden in der medizinischen Ausbildung und ihre Anwendungsmöglichkeiten für die Rehabilitation

With introduction of the new Federal Medical Licensing Regulations (Approbationsordnung) in Germany, integrated teaching in "Rehabilitation, Physical Medicine, Naturopathic Treatment" (Querschnittsbereich Q12) has become obligatory for the first time. Furthermore, the new Regulations require the medical faculties in Germany to realize an innovative didactic orientation in teaching. This paper provides an overview of recent applications of teaching techniques and examination methods in medical education with special consideration of the new integrated course Q12 and further teaching methods related to rehabilitative issues. Problem-oriented learning (POL), problem-based learning (PBL), bedside teaching, eLearning, and the examination methods Objective Structured Clinical Examination (OSCE) and Triple Jump are in the focus. This overview is intended as the basis for subsequent publications of the Commission for Undergraduate and Postgraduate Training of the German Society of Rehabilitation Science (DGRW), which will present examples of innovative teaching material.