gms | German Medical Science

GMS German Medical Science — an Interdisciplinary Journal

Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF)

ISSN 1612-3174

Undergraduate medical education in Germany

Medizinstudium in Deutschland

Review Article

Suche in Medline nach

GMS Ger Med Sci 2009;7:Doc02

doi: 10.3205/000061, urn:nbn:de:0183-0000617

Eingereicht: 18. Dezember 2008
Überarbeitet: 27. Februar 2009
Veröffentlicht: 6. April 2009

© 2009 Chenot.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Abstract

The purpose of this article is to give international readers an overview of the organisation, structure and curriculum, together with important advances and problems, of undergraduate medical education in Germany. Interest in medical education in Germany has been relatively low but has gained momentum with the new "Regulation of the Licensing of Doctors" which came into effect in 2003. Medical education had required substantial reform, particularly with respect to improving the links between theoretical and clinical teaching and the extension of interdisciplinary and topic-related instruction. It takes six years and three months to complete the curriculum and training is divided into three sections: basic science (2 years), clinical science (3 years) and final clinical year. While the reorganisation of graduate medical education required by the new "Regulation of the Licensing of Doctors" has stimulated multiple excellent teaching projects, there is evidence that some of the stipulated changes have not been implemented. Indeed, whether the medical schools have complied with this regulation and its overall success remains to be assessed systematically. Mandatory external accreditation and periodic reaccreditation of medical faculties need to be established in Germany.

Keywords: undergraduate medical education, Germany, reform

Zusammenfassung

Dieser Artikel soll internationalen Lesern einen Überblick über die Organisation, die Struktur und das Curriculum des Medizinstudiums sowie über wichtige aktuelle Fortschritte und Probleme in der medizinischen Ausbildung in Deutschland geben. Das Interesse an der Qualität der medizinischen Ausbildung war vor der 2003 in Kraft getretenen neuen Approbationsordnung (AppOÄ) relativ gering. Das Medizinstudium war reformbedürftig, insbesondere in Bezug auf die Verbindung von theoretischen Inhalten und praktisch-klinischer Lehre sowie die interdisziplinäre Vermittlung von Kerninhalten. Das Medizinstudium dauert sechs Jahre und drei Monate und wird in drei Abschnitte unterteilt: Vorklinik (2 Jahre), Klinik (3 Jahre) und „Praktisches Jahr“. Auch wenn die durch die neue AppOÄ notwendigen Reformen an vielen Stellen hervorragende Lehrprojekte hervorgebracht haben, gibt es dennoch Hinweise darauf, dass die geforderten Veränderungen nicht überall umgesetzt werden konnten. Eine systematische Evaluation zur Umsetzung der neuen AppOÄ durch die medizinischen Fakultäten steht noch aus. Eine verpflichtende externe periodische Evaluation der medizinischen Fakultäten muss in Deutschland erst noch etabliert werden.

Schlüsselwörter: Medizinstudium, Deutschland, Reform


Background

In Germany, lectures in medicine were first given in 1388 in Heidelberg. The latest medical faculty was founded in Witten-Herdecke in 1992. Medical education in this country was once praised as a role model e.g. for American medical education by Abraham Flexner [1]. Nowadays, however, the German medical faculties are looking towards the United States [2], Canada, and other European countries such as the United Kingdom and the Netherlands for good examples to follow.

Germany has about 80,000 medical students studying in 36 medical faculties (Table 1 [Tab. 1], list with URLs see Attachment 1 [Attach. 1]) [3]. Each year 10,000 new students start medical education and about 6000 students graduate every year. Geographic distribution of medical faculties in Germany reflects historic developments rather than population density (Figure 1 [Fig. 1]).

It is estimated that 180,000 Euros are required to cover the cost of teaching for each graduating medical student in Germany [3]. This compares to 260,000 Euros in the United Kingdom [4]. All but one medical faculty (Witten-Herdecke) are state universities, and until recently higher (undergraduate) education was free – now a few states charge up to 500,- € tuition per semester which is low in comparison to fees required for example in the United States [5]. Grants and student loans are available [6].

Given this background, the aim of this article is to provide international readers with an overview of the organisation, structure and curriculum of undergraduate medical education in Germany following the introduction of the new "Regulation of the Licensing of Doctors". This narrative review is based on data available from official organisations, relevant German medical journals generally not listed in Medline or EMBASE, and on personal experience. It is therefore likely to serve as a reference for reports of research in medical education in Germany and could also help international medical staff seeking to assess medical students taught in Germany who are applying for elective clerkships abroad.


Structure and curriculum of medical education

The new regulation of the licensing of doctors

German Medical Education has not been described in international journals since the new "Regulation of the Licensing of Doctors" [Approbationsordnung für Ärzte (AppOÄ)], which came into effect in 2003 [7], [8], [9]. This structural reform became necessary when reports from governmental and non-governmental institutions concluded that medical education in Germany did not meet actual requirements in medical care or stipulations from the European Union [10], [11]. While interest in medical education in Germany was relatively low compared to e.g. The Netherlands or the United Kingdom, it has now gained momentum with the new AppOÄ, which required substantial changes in the curriculum. The main changes are [8]:

  • Incorporation of the changed requirements in medical care
  • Linkage of theoretical and clinical instruction
  • Extension of interdisciplinary and topic-related instruction
  • Improvement of bedside training, reduction of lectures
  • Reform of examinations
  • Strengthening of General Practice
  • Evaluation of teaching
  • Improving pain management and palliative care

Although of limited importance to medical faculties, for graduating medical students the most tangible change represented the abolishment of the lowly paid 18-month internship [Arzt im Praktikum (AiP)] before obtaining the full license to practise medicine [12].

In the following description of the medical curriculum and in the discussion, the main goals of the new AppOÄ will be referred to.

Admission criteria for medical students

With few exceptions, the General Certificate of Aptitude for Higher Education [Abitur] is a prerequisite for admission to higher education in a university. It usually requires 12 or 13 years of schooling. Roughly 39% of all school children will obtain the Abitur [13]. The Abitur cannot be compared to a high school diploma in the United States; it is closer to the associate degree of US colleges. Secondary school diplomas obtained inside the European Union are mutually recognised; however students with diplomas obtained outside the European Union have to apply for a certificate of equivalence. Undergraduate education e.g. preparatory classes for medical school, prevalent in some countries, do not exist in Germany. Therefore, the term undergraduate or graduate education does not apply in the strict sense.

In Germany, the average age of medical students is 21.4 years when they start medical school [14]. There are several reasons for this. Germany still has mandatory service of nine months for men either in the military or an alternative civilian service [Zivildienst] for conscientious objectors. Additionally due to waiting time or professional training in other areas, a significant proportion of students are older. Although there is no formal regulation, an age of 40 years is considered the upper limit for entering medical school. Similar to many other countries, the number of women studying medicine has increased steadily and is now exceeding the proportion of male students [15]. This however is not yet reflected in higher academic ranks.

Selection of medical students

The number of applicants to medical schools largely exceeds the number of available places; therefore admission is subject to restrictions [numerus clausus]. On average four to five prospective students apply for each place, however there are large differences between the faculties. In Germany, application to medical schools is administered by a federal organisation, the Central Office for the Allocation of Places in Higher Education [Zentralstelle für die Vergabe von Studienplätzen (ZVS)] [16]. Criteria for admission are the overall Abitur grade, which is roughly comparable to the American Grade Point Average (GPA), and waiting time. The Abitur is considered the best predictor for successful completion of the curriculum [17]. Each student can rank and apply to 6 medical schools at once. The majority of medical students (80%) used to be admitted by this process and there is a quota for foreign medical students and the military.

The proportion of students who are selected by the medical schools themselves is supposed to increase to 60%. Usually students apply with a letter of motivation to medical schools. After screening the applications a few are invited for interview [18]. However the process is time consuming and sometimes the number of applicants is overwhelming. Therefore faculties find it difficult to motivate faculty members to participate in the selection process. There is also often no consensus on the criteria that should be used to select future doctors. Given this situation, the nationwide medical admission test [Test für Medizinische Studiengänge (TMS)], which had been abandoned in 1997, has been reintroduced by some faculties [19]. The TMS is comparable to the American Medical college admission test (MCAT) [20]. The TMS is not mandatory but allows students to improve their score and their chance of being selected to come for an interview.

Structure of the curriculum

In Germany, medical education is structured, not in years like many other countries, but in semesters or in a few instances, trimesters (Hamburg, Hannover). It takes six years (12 semesters) and three months to complete the curriculum, however on average, students require 6.8 years [3]. The curriculum is divided into three sections (Table 2 [Tab. 2]):

  • Basic science (2 years)
  • Clinical science (3 years)
  • Clinical year (1 year)

The majority of medical students follow this track. Some medical faculties have chosen to offer an experimental curriculum [Modellstudiengang] which offers an alternative process to becoming a doctor (Table 1 [Tab. 1]) [21].

Basic science [Vorklinik]

The content and structure of the basic science section (also preclinical science) has remained largely unchanged. The main topics are anatomy, physiology, biochemistry and social sciences (Table 2 [Tab. 2]). Courses are usually not graded beyond pass or fail. The distinction between clinical and basic science has been criticised and graduate students have rated large parts of the curriculum as clinically irrelevant [22]. Therefore there are increased efforts to place basic science in a clinical context [23], [24]. A three month nursing stage is a mandatory part of the basic science section to ensure first patient contact. However private institutions are increasingly offering additional preparatory classes, which might indicate the failure of the faculties to provide the necessary skills and knowledge to pass the state medical licensing examinations.

Clinical science [Klinik]

The clinical science section covers 21 medical specialties as listed in Table 2 [Tab. 2]. Previously each subject was taught separately. Now subjects are often taught in interdisciplinary teaching modules e.g. a “head module” combining Ear, Nose & Throat Medicine with Ophthalmology [25]. Additionally 12 new interdisciplinary teaching modules [Querschnittsbereiche] have been introduced (Table 3 [Tab. 3]). Usually the first year is dedicated to the introduction of the clinical sciences with basic skill training in history taking and physical examination, general pathology, general microbiology, general pharmacology and laboratory medicine. Traditionally the clinical science section consisted mainly of lectures and seminars with limited patient exposure. To strengthen clinical experience, mandatory clerkships [Blockpraktikum] have been introduced in Internal Medicine, General Surgery, Paediatrics, Obstetrics & Gynaecology and General Practice. It is notable that a clerkship in Psychiatry, which is considered a core subject in many countries, is not mandatory. Clinical skills labs have been newly established in most faculties [26]. Additionally students have to complete four one-month elective clerkships, traditionally called Famulatur [famulus latin: servant]. One clerkship has to be completed in the ambulatory setting. It is very popular to perform at least one elective outside Germany with a preference for English speaking countries.

Clinical year [Praktisches Jahr: PJ]

The final year is divided into three full-time clinical rotations, each lasting about 4 months (Table 2 [Tab. 2]). Rotations in Internal Medicine and Surgery are mandatory and one rotation can be freely chosen from all the clinical specialties. Previously, the final year had been restricted to hospital based training sites. The new AppOÄ made it possible for the first time to complete a clinical rotation in an ambulatory setting, e.g. in General Practice [27].

Students usually assume more responsibilities gradually during the final year, comparable to a sub-internship. Legal issues regarding delegation and liability limit students’ opportunity to gain hands on experience [28]. Hospitals often rely on the work accomplished by the final year students [PJler]. Unfortunately, taking blood samples and inserting intravenous lines, which is done by auxiliary nurses in most other countries, keeps PJ students busy [29]. It is generally taken for granted that students learn skills on the job, but the degree of supervision and instruction varies widely [30]. Multiple projects to improve the quality of teaching in the clinical year have been presented and only a few can be cited here [31], [32].

As the German-speaking region of Switzerland offers a basic remuneration to final year students, there is a debate as to whether students should be paid. With the increasing shortage of physicians, some teaching hospitals are known to make special efforts to retain some students for postgraduate training.

Examinations

Until the new AppOÄ, the achievements of medical students in courses and clerkships were evaluated simply with a pass or fail. Only state licensing examinations were graded. From the faculties perspective the most radical changes with the new regulations for medical education were 1. the requirement to grade each course and clerkship and 2. the reduction of the number of licensing examinations from three to two. Grades are given on an ordinal scale ranging from 1 (excellent) to 5 (fail).

Strengthening the responsibility of faculties had mixed effects. Previously faculties invested only a minimal effort with respect to examinations. This was left to the centrally organised state licensing examination administered by state authorities [Landesprüfungsamt]. Students received certificates [Scheine] with little or no formal assessment in each of the subjects required in order to register for the licensing examinations. Most often physical attendance during the course was sufficient to obtain the course certificate. Only a few subjects such as anatomy required time consuming oral examinations. Previously, on the final licensing examination certificate only one summative grade of the written multiple choice exams and the final oral examination appeared on the diploma.

Now each subject must be graded and appears on the final diploma. On the one hand this has led to the introduction of modern assessment tools to evaluate practical skills like the objective structured clinical examination (OSCE) in several faculties [33]. On the other hand time and staff consuming examinations turned out to be a burden especially for smaller departments. For example psychosocial sciences in the preclinical section had to stop administering oral exams exceeding their staff capacities.

The new licensing examination consists of a written test with multiple choice questions (MCQs) and an (unstructured) oral examination. The administration and development of MCQs continues to be organised by the Institute for medical and pharmaceutical examination questions [Institut für Medizinische und Pharmazeutische Prüfungsfragen (IMPP)] [34]. Although each medical faculty has its own curriculum, the IMMP has a catalogue of topics covered by the written exams [Gegenstandskatalog].

The first part of the medical licensing examination [Erster Abschnitt der Ärztlichen Prüfung], traditionally called “Physikum”, is the first hurdle students have to take. In order to proceed to the clinical section, this examination must be passed. The average initial failure rate is roughly 20%. The examination can be repeated twice; about 5% of all students never pass. This exam is not equivalent to the USMLE step 1 (United States Medical Licensing Examination).

The new second part of the medical licensing examination [Zweiter Abschnitt der Ärztlichen Prüfung] of the clinical year has colloquially been termed “Hammerexamen” which can roughly be translated as “monster exam”. It has replaced three previously separate examinations and covers the entire spectrum of the clinical sciences. It consists of a written exam and a combined oral and practical exam. This exam lives up to its nickname since the previously low failure rate associated with the written part rocketed from 2% to 9%. Only a few students fail the oral and practical examination, which is only one of several reasons that this exam format has been criticised [35]. It is also felt that final year students are less well prepared than previous generations who took the last written examination before entering the clinical year. It is suspected that students focus on preparing for the “monster exam” and are distracted from clinical practical work and learning [36]. It had been hoped that the tendency of the IMPP to create multiple choice questions around rare syndromes would be abandoned in favour of more interdisciplinary and clinically relevant topics. Although the new case-based format still consisting of multiple choice questions is considered a significant improvement, remembering medical oddities and irrelevant facts still remains important [37].

Ranking of medical faculties

Ranking of faculties is rather new in Germany and, as elsewhere, dependent on the selection criteria. The German Academic Exchange Service has ranked medical faculties in various topics including research, infrastructure and student evaluation [38]. Ranking based on students’ performance in state licensing examination is also available [39]. Adjustment for differences in allocation of resources per capita or the proportion of foreign medical students has a significant impact on ranking.

Title

A student who passes the final licensing examinations is awarded a license to practice medicine [Approbation als Arzt], but does not receive an academic degree with an academic title [40]. Graduates are authorised to use the German professional title Arzt/Ärztin (Physician), but are generally addressed informally with the honorary title "Dr." [Doktor]. As in other countries, writing a dissertation/thesis is an option required to obtain the academic degree “Dr. med.”. It is estimated that 70% of all graduates will eventually complete a dissertation, which is perceived to be important for career promotion and to attract patients [41].


Discussion

Implementation of reforms in medical education

Excellent doctors are the result of an excellent medical education. The new "Regulation of the Licensing of Doctors (AppOÄ)" has certainly fostered important improvements in the education of medical students in Germany. The increased interest in medical education is documented by the dynamic development of the German Society for Medical Education [Gesellschaft für Medizinische Ausbildung] [42] and the introduction of the first postgraduate Master of Medical Education (MME) programme in Germany in 2005 [43]. Previously the only German-speaking MME-program was offered by the University of Bern in Switzerland.

It is uncertain if the goals of the new AppOÄ have been achieved as there are no official reports available. However, some professional organisations have conducted surveys.

Strengthening the role of General Practice in the face of an anticipated shortage of general practitioners was one of the multiple goals of the reform. Although some faculties have founded new Departments of General Practice, more than half of all faculties have no such department [44]. Similarly the stipulated strengthening of palliative care and pain management has also not yet been achieved in all faculties [45]. A national survey of teaching in Geriatrics, which had not previously been a component of the curriculum but is now covered by a mandatory interdisciplinary teaching module “Medicine of aging and the elderly”, revealed that less than half of all medical faculties provide teaching in this topic [46].

Mandatory evaluation of teaching was also among the aims of the AppOÄ. The main purpose of evaluation is quality control but also distribution of funds [47]. The last national survey on the evaluation of medical teaching in Germany was performed in 2000 before the reform [48]. Multiple evaluations of courses have been reported (selected examples [49], [50]) however there is no national standard and reporting bias is likely.

Unlike other university programmes awarding degrees to students, medical faculties in Germany are not subject to formal mandatory accreditation and reaccredidation procedures, since the final degree is a license awarded by the state. Although the German Council of Science and Humanities [Wissenschaftsrat] [51] has evaluated medical faculties, it is left to the discretion of the states as to how to ensure compliance with the stipulated requirements [52]. So far only one faculty has been on probation in 2005. It is conceivable that the states, which are responsible for funding medical faculties, have a conflict of interest given that external accreditation might reveal deficiencies due to under-funding.

Barriers to the implementation of stipulated reforms

Enacting the new AppOÄ was a pure administrative act and unfortunately was not provided with a budget to ensure its implementation [53]. Medical faculties are facing incredible difficulties to fulfil all the new requirements. The reduction in the number of lectures and rise in bedside teaching has increased the need dramatically for both clinical teachers and available patients. Although lip service is paid to the commitment for medical education, young academics are not rewarded for their efforts, and teaching, which must compete with research and patient care, is sometimes considered a lost cause [54].

At the same time, virtually all university hospitals to which medical schools are attached are in serious financial crisis, partly due to a new invoicing system and budget cuts [55]. Some of the previously state-owned university hospitals have been privatised (e.g. Giessen and Marburg) or transformed into foundations (e.g. Göttingen). This has increased the already pressing need for separate accounting of patient care financed by hospital revenues and teaching, and research covered by state grants or third-party funds. This has turned out to be extremely difficult since a significant proportion of the faculty is actively involved in both [56]. Only a few medical faculties (e.g. Kiel/Lübeck, Dresden/Leipzig) are administered completely separately from university hospitals [57]. The funding of medical education has been described in more detail elsewhere [58].

European perspective

In 1999, the Education Ministers from 29 European countries including Germany adopted the Bologna declaration [59]. The principal goals of this were to permit easily readable and comparable university degrees within Europe and to introduce a system essentially based on two main cycles, undergraduate and graduate, thus increasing mobility within Europe. In fact the mobility of medical students is already hampered at a national level by the multitude of non-compatible curricula although the Bologna declaration should also theoretically apply to medical education. However, this idea is neither encouraged by the German Medical Association nor some other medical associations [60]. The main reason to reject the implementation of the Bologna declaration for medical training is the fear of introducing a fast track “barefoot doctor”.


Conclusion

Improving and adapting education of medical students to the health needs of the population is a continuous process. The new "Regulation of the Licensing of Doctors (AppOÄ)" in Germany has stimulated multiple excellent projects to help future doctors meet these needs, but there is evidence that some of the stipulated changes have not been implemented. This review is an initial attempt to assess the compliance with the requirements of the AppOÄ and the success of the changes stipulated therein. Unfortunately it has not been possible to do justice to the educational activities in all 36 faculties, and while it is recognised that only a few selected projects have been discussed here, it is clear that mandatory external accreditation and periodic reaccreditations of medical faculties needs to be established in Germany [61].


List of abbreviations used

  • AppOÄ: Approbationsordnung für Ärzte [Licensing Law for Medical Doctors]
  • GPA: grade point average
  • IMPP: Institut für Medizinische und Pharmazeutische Prüfungsfragen [Institute for medical and pharmaceutical examination questions]
  • MCAT: Medical College Admission Test
  • MCQ: multiple choice questions
  • PJ: Praktisches Jahr [final year in medical school]
  • TMS: Test für Medizinische Studiengänge [Test for medical education]
  • USMLE: United States medical licensing examination
  • ZVS: Zentralstelle für die Vergabe von Studienplätzen [Central office for the allocation of places in higher education]

Notes

Competing interest

I am a general practitioner working part-time in academia and part time in private practice which has influenced my review.

Acknowledgements

I would like to thank Wolfgang Himmel, Ilidkó Gagyor and Michael M. Kochen for helpful criticism.


References

1.
Bonner TN. Abraham Flexner and the German University: the progressive as traditionalist. Paedagog Hist. 1997;33:99-116. DOI: 10.1080/0030923970330105 Externer Link
2.
Grunze H, Strupp M, Rönneberg T, Putz R. Problemorientiertes Lernen im Medizinstudium [Problem-based learning in medical education. Integrated "Nervous System and Behaviour" course at the Munich Ludwig Maximilian University]. Nervenarzt. 2004;75(1):67-70. DOI: 10.1007/s00115-003-1572-8 Externer Link
3.
Statisches Bundesamt [Federal Statistical Office]. Hochschulstandort Deutschland [Higher education in Germany]. Wiesbaden: Statistisches Bundesamt [Federal Statistical Office]; 2007. Available from: http://www.destatis.de/jetspeed/portal/cms/Sites/destatis/Internet/DE/Presse/pk/2007/Hochschulstandort/begleitmaterial,property=file.pdf Externer Link
4.
Brown CA, Lilford RJ. Selecting medical students. BMJ 2008;336(7648): 786. DOI: 10.1136/bmj.39517.679977.80 Externer Link
5.
Association of American medical colleges (AAMC). Tuition and student fees report. Washington, DC: AAMC; 1995-2009. Available from: http://services.aamc.org/tsfreports/ Externer Link
6.
Bundesministerium für Bildung und Forschung [German Federal Ministry of education and research]. Das neue Bafög [New federal law on education grants]. Berlin: Bundesministerium für Bildung und Forschung [German Federal Ministry of education and research]; [cited 2009]. Available from: http://www.das-neue-bafoeg.de Externer Link
7.
Bundesministerium der Justiz [Ministry of Justice]. Approbationsordnung für Ärzte - ÄApprO [Regulation of the Licensing of Doctors]. Berlin: Bundesministerium der Justiz [Ministry of Justice]; [cited 2009]. Available from: http://bundesrecht.juris.de/_appro_2002/index.html Externer Link
8.
Bundesministerium für Gesundheit [German Ministry of Health]. Licensing Regulation for Doctors. (Valid as from 1 October 2003. Amended by Article 3 of the Act of 21 July 2004 I 1776). Berlin: BMG; [cited 2009]. Available from: http://www.bmg.bund.de/cln_110/nn_1168248/SharedDocs/Downloads/DE/GV/GT/Gesundheitsberufe/verordnungen/Approbationsordnung-fue-Aerzte__englisch,templateId=raw,property=publicationFile.pdf/Approbationsordnung-fue-Aerzte_englisch.pdf Externer Link
9.
Pabst R. Medical education and reform initiatives in Germany. Acad Med. 1995;70(11):1006-11. DOI: 10.1097/00001888-199511000-00019 Externer Link
10.
Fragen der Neuordnung des Medizinstudiums: Kurzfassung des Berichtes der Sachverständigengruppe beim Bundesminister für Gesundheit (März 1993). [Topics in revision of medical education: Short report of the expert commission of the ministry of health (March 1993)]. Unfallchirurgie. 1993;19:190-3. DOI: 10.1007/BF02588044 Externer Link
11.
Haage H. Ausbildung zum Arzt: Was ist erreicht, was bleibt zu tun? [Medical education in Germany: past successes and future challenges. An overview]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2006;49(4):325-9. DOI: 10.1007/s00103-006-1237-4 Externer Link
12.
Haage H. Abschaffung des AiP [Abolishment of the AiP. Transformation and further regulations] Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2006;49(4):351-7. DOI: 10.1007/s00103-006-1236-5 Externer Link
13.
Statisches Bundesamt [Federal Statistical Office]. Weiter steigende Abiturientenquote [Increasing rate of higher aptitude certificates.]. Wiesbaden: Statisches Bundesamt; 2004. Available from: http://www.destatis.de/jetspeed/portal/cms/Sites/destatis/Internet/DE/Presse/pm/2004/03/PD04__140__21,templateId=renderPrint.psml Externer Link
14.
Brugger P, Scharfe S, Stroh A. Hochschulen auf einen Blick. Wiesbaden: Statistisches Bundesamt; 2008. Available from: http://www.destatis.de/jetspeed/portal/cms/Sites/destatis/Internet/DE/Content/Publikationen/Fachveroeffentlichungen/BildungForschungKultur/HochschulenAufEinenBlick,property=file.pdf Externer Link
15.
Kopetsch T. Ärztinnen Potentiale werden (noch) nicht genutzt [The potential of female doctors is still underused]. Dtsch Ärztebl. 2003;100:891-5. Available from: http://www.aerzteblatt.de/v4/archiv/pdf.asp?id=36308 Externer Link
16.
Zentralstelle für die Vergabe von Studienplätzen [Central Office for the Allocation of Places in Higher Education] [Homepage on the Internet]. Dortmund: ZVS; [cited 2009]. Available from: http://www.zvs.de/ Externer Link
17.
Strauß B, Brähler E. Der Kampf um die Besten: das neue Zulassungsverfahren zum Medizinstudium [Fighting for the best: the new procedure for the selection of medical students]. Psychother Psychosom Med Psychol. 2005;55(7):321-3. DOI: 10.1055/s-2005-866922 Externer Link
18.
Waydhas C, Heue M, Nast-Kolb D. Strukturierte Interviews zur Studienplatzvergabe in der Medizin: Erste Erfahrungen [Structured interviews of applicants at a medical school: first experiences]. GMS Z Med Ausbild. 2007;24:Doc186. Available from: http://www.egms.de/en/journals/zma/2007-24/zma000480.shtml Externer Link
19.
TMS.Test für Medizinische Studiengänge [Test for medical education]. Heidelberg: TMS; 2008. Available from: http://www.tms-info.org Externer Link
20.
Association of American Medical Colleges. Medical college admission test. Washington DC: AAMC; 1995-2009. Available from: http://www.aamc.org/students/mcat/ Externer Link
21.
Dahlmann C. Modellstudiengänge Medizin [Experimental medical curricula]. Via medici; 2005 Jan 28. Available from: http://www.thieme.de/viamedici/aktuelles/politik/modellstudiengaenge.html Externer Link
22.
Strate J, Rothkötter HJ, Pabst R. Wie beurteilen Medizinstudenten das vorklinische Studium? Ergebnisse von Befragungen nach dem 1. und 2. Stduienjahr [How do medical students judge preclinical studies? Results of questionnaire analysis after the first and second year of studies]. Dtsch med Wochenschr. 1998;123(38):1093-6. DOI: 10.1055/s-2007-1024129 Externer Link
23.
Quellmann T, Fobbe G, Gesenhues S. Der Patient in der Vorklinik – Schlüssel zu Motivation und Lernerfolg? [The patient in preclinical science – recipe for success?]. GMS Z Med Ausbild. 2008;25(1):Doc19. Available from: http://www.egms.de/en/journals/zma/2008-25/zma000503.shtml Externer Link
24.
Sennekamp M, Gilbert K, Gensichen J, Gerlach F. "Anamneseerhebung und Gesprächsführung": Bedarfs- und Erwartungsanalyse bei Studierenden der Vorklinik als Grundlage für eine modulare Kurs-Neugestaltung [History taking and communication: expectations and needs of preclinical students]. GMS Z Med Ausbild. 2007;24(1):Doc10. Available from: http://www.egms.de/en/journals/zma/2007-24/zma000304.shtml Externer Link
25.
Schäfer T, Köster U, Huenges B, Burger A, Rusche H. Systematische Planung fächerübergreifenden Unterrichts am Beispiel des Modellstudiengangs Medizin an der Ruhr-Universität Bochum [Systematic planning of interdisciplinary teaching in the medical model curriculum at the Ruhr-University Bochum]. GMS Z Med Ausbild. 2007;24(3):Doc147. Available from: http://www.egms.de/en/journals/zma/2007-24/zma000441.shtml Externer Link
26.
Segarra LM, Schwedler A, Weih M, Hahn EG, Schmidt A. Der Einsatz von medizinischen Trainingszentren für die Ausbildung zum Arzt in Deutschland, Österreich und der deutschsprachigen Schweiz [Clinical Skills Labs in Medical Education in Germany, Austria and German Speaking Switzerland]. GMS Z Med Ausbild. 2008;25(2):Doc80. Available from: http://www.egms.de/en/journals/zma/2008-25/zma000564.shtml Externer Link
27.
Baum E, Schmittdiel L, Simmenroth-Nayda A, Träder JM. Allgemeinmedizin im praktischen Jahr: Begeisterte Studenten - zurückhaltende Umsetzung [Practical year in General Practice. Enthusiastic students - difficulties with implementation]. Dtsch Ärztebl. 2007;104(34-35):A 2333-4. Available from: http://www.aerzteblatt.de/v4/archiv/pdf.asp?id=56707 Externer Link
28.
Klement A, Schröder-Printzen J, Bretschneider K, Lichte T, Herrmann M. Praktika im Medizinstudium: Rechtliche Grenzen des Delegierens. [Clerkships in medicine: legal boundaries of delegation]. Dtsch Ärztebl. 2007;104(40):A 2706-8. Available from: http://www.aerzteblatt.de/v4/archiv/pdf.asp?id=57120 Externer Link
29.
Hibbeler B. Praktisches Jahr: Geld ist nicht alles, aber Wertschätzung motiviert [Clinical year: Money is not everything but appreciation is motivating]. Dtsch Ärztebl. 2008;105(14):A 755-6. Available from: http://www.aerzteblatt.de/v4/archiv/pdf.asp?id=59625 Externer Link
30.
Fischer T, Chenot JF, Simmenroth-Nayda A, Heinemann S, Kochen MM, Himmel W. Learning core clinical skills--a survey at 3 time points during medical education. Med Teach. 2007;29(4):397-9.
31.
Andreesen S, Hoffmann K, Jünger J, Nikendei C. PJ-Tutoren-Programm in der Inneren Medizin zur Verbesserung der studentischen Ausbildung auf Station: eine Studie im Kontrollgruppendesign [Senior student peer teaching program in internal medicine for the improvement of student education on the ward: a group control design study]. GMS Z Med Ausbild. 2008;25(1):Doc17. Available from: http://www.egms.de/en/journals/zma/2008-25/zma000501.shtml Externer Link
32.
Kraus B, Jünger J, Schrauth M, Weyrich P, Herzog W, Zipfel S, Nikendei C. Logbücher im klinisch-praktischen Einsatz: Profitieren die Studenten? Eine Bestandsaufnahme bei PJ-Studenten der Inneren Medizin [Logbooks in clinical use - is there a benefit for the students? An Evaluation among final-year-students in internal medicine]. GMS Z Med Ausbild. 2007;24(2):Doc112. Available from: http://www.egms.de/en/journals/zma/2007-24/zma000406.shtml Externer Link
33.
Kruppa E, Jünger J, Nikendei C. Einsatz innovativer Lern- und Prüfungsmethoden an den Medizinischen Fakultäten der Bundesrepublik Deutschland - Eine aktuelle Bestandsaufnahme [Innovative teaching and examination methods - taking stock at German medical faculties]. Dtsch Med Wochenschr. 2009;134(8): 371-2. DOI: 10.1055/s-0028-1124008 Externer Link
34.
Institut für Medizinische und Pharmazeutische Prüfungsfragen [Institute for medical and pharmaceutical examination questions] [homepage on the Internet]. Mainz: IMPP; 2009. Available from: http://www.impp.de Externer Link
35.
Hibbeler B. Medizinstudium: "Hammerexamen" in der Kritik [Medical education: "monster exam" criticised]. Dtsch Ärztebl. 2007;104(7):A 390-2. Available from: http://www.aerzteblatt.de/v4/archiv/pdf.asp?id=54505 Externer Link
36.
Kühn J, Westermann J. Praktisches Jahr: Zwischen Patientenwohl und "Hammerexamen" [Final year: Between patient welfare and "monster examination"]. Dtsch Ärztebl. 2006;103(24):A 1654-6. Available from: http://www.aerzteblatt.de/V4/archiv/pdf.asp?id=51786 Externer Link
37.
Hibbeler B. Angst vor dem Hammerexamen [Fear of the monster examination]. Deutsches Ärzteblatt Studieren.de; 2006. Available from: http://www.aerzteblatt-studieren.de/doc.asp?docid=101599 Externer Link
38.
Deutscher akademischer Austauschdienst [German academic exchange service]. University ranking. Bonn: DAAD; [cited 2009]. Available from: http://www.daad.de/deutschland/hochschulen/hochschulranking/06543.en.html?module=MatrixRanking&esb=36&hstyp=1 Externer Link
39.
Zimmermann T, Wegscheider K, Bussche H. Medizinische Fakultäten: Der Ausbildungserfolg im Vergleich [Medical faculties: comparison of educational success]. Dtsch Ärztebl. 2006;103(25):A 1732-8. Available from: http://www.aerzteblatt.de/V4/archiv/pdf.asp?id=51865 Externer Link
40.
Riemer M. Dr. med. ungleich M.D. [Dr. med. is not equivalent to M.D.]. Dtsch med Wochenschr. 2004;129 (51-52):2790-2. DOI: 10.1055/s-2004-836115 Externer Link
41.
Weihrauch M, Strate J, Pabst R. Die medizinische Dissertation - kein Auslaufmodell: Ergebnisse einer Befragung von Promovierenden stehen im Widerspruch zu oft geäußerten Meinungen [The medical dissertation - results of a survey contradict frequently stated opinions]. Dtsch Med Wochenschr. 2003; 128(49):2583-7. DOI: 10.1055/s-2003-45206 Externer Link
42.
Gesellschaft für Medizinische Ausbildung [German society for medical education] [homepage on the Internet]. Erlangen: GMA; 2009. Available from: http://www.gesellschaft-medizinische-ausbildung.de Externer Link
43.
Postgraduierten-Studiengang Master of Medical Education (MME) Deutschland [Post-graduate study course Master of Medical Education (MME) Germany]. Heidelberg: MME; [cited 2009]. Available from: http://www.mme-de.de Externer Link
44.
Baum E, Niebling W. 40 Jahre DEGAM: Allgemeinmedizin an der Hochschule: Ist-Zustand und Ausblick [40 years DEGAM: General Practice at German universities - present state and perspective]. Z Allg Med. 2006;82:415-9. DOI: 10.1055/s-2006-942189 Externer Link
45.
Hibbeler B. Palliativmedizin im Studium: Berührungsängste abbauen [Palliative care in medical education: reducing reservations]. Dtsch Ärztebl. 2007;104(28-29):A 2036-7. Available from: http://www.aerzteblatt.de/v4/archiv/pdf.asp?id=56322 Externer Link
46.
Kolb GF. Umfrage der Deutschen Gesellschaft für Geriatrie zur akademischen Situation, Studentenunterricht und zur Situation der Weiterbildung im Fachgebiet [Survey of German Geriatrics Society on the academic situation, student education and the state of further training]. Eur J Geriatrics. 2005;7(4):239-48. Available from: http://www.dg-geriatrie.de/download/EJG0405.pdf Externer Link
47.
Syed Ali A, Schulze J, Frankenbach R, Nürnberger F. Die Evaluation der studentischen Lehre - Basis für eine leistungsorientierte Mittelvergabe (LOM)? [Teaching evaluation - Incentives to improve Teaching Quality?]. GMS Z Med Ausbild. 2008;25(1):Doc53. Available from: http://www.egms.de/en/journals/zma/2008-25/zma000537.shtml Externer Link
48.
Theisel N, Stosch C, Koebke J. Evaluationsbemühungen an den Medizinischen Fakultäten in Deutschland - Ergebnisse einer Umfrage [Evaluation in medical faculties in Germany: a survey]. Med Ausbild. 2000;17(1):18-21.
49.
Gutenbrunner C, Schiller J, Fischer M, Smorag U, Lidia T, Küther G. Querschnittsbereich "Rehabilitation, Physikalische Medizin, Naturheilverfahren": Verbesserungen durch systematische Evaluation [Rehabilitation, physical medicine and naturopathic medicine: improvement by systematic evaluation]. GMS Z Med Ausbild. 2008;25(1):Doc50. Available from: http://www.egms.de/en/journals/zma/2008-25/zma000534.shtml Externer Link
50.
Emmert B, Hitz A, Hallier E, Chenot JF, Simmenroth-Nayda A. Verbesserung der Lehre im Fach Arbeits- und Sozialmedizn durch Einsatz von Schauspielpatienten [Improvement in education of occupational and social medicine with simulation patients]. In: Jahrestagung der Gesellschaft für medizinische Ausbildung (GMA) Hannover [Annual conference of German society for medical education (GMA) Hanover], 16. - 18.11.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. Doc07gma17. Available from: http://www.egms.de/en/meetings/gma2007/07gma017.shtml Externer Link
51.
Wissenschaftsrat [German Council of Science and Humanities] [homepage on the Internet]. Köln: WR; [cited 2009]. Available from: http://www.wissenschaftsrat.de/engl_start.htm Externer Link
52.
Wissenschaftsrat [German Council of Science and Humanities]. Stellungnahme zur organisatorisch-strukturellen Entwicklung der Universitätsmedizin der Johannes Gutenberg-Universität Mainz [Report on the organisational and structural development of the medical faculty of the Johannes Gutenberg-University Mainz]. Köln: WR; 2008. Available from: http://www.wissenschaftsrat.de/texte/8610-08.pdf Externer Link
53.
Clade H. Gebhard von Jagow: "Privatisierung ist ein Irrweg" [Gebhard von Jagow: "Privatisation is a mistake"]. Dtsch Ärztebl. 2005;102(25):A 1787-8. Available from: http://www.aerzteblatt.de/v4/archiv/pdf.asp?id=47387 Externer Link
54.
Pabst R. Medizinstudium: Kritische Bewertung der Reform braucht Zeit [Medical education: critical assessment of the reform needs time]. Dtsch Ärztebl. 2005;102(51-52):A 3572-4. Available from: http://www.aerzteblatt.de/V4/archiv/pdf.asp?id=49650 Externer Link
55.
Flintrop J, Richter-Kuhlmann EA. Umbruch in der Hochschulmedizin: Experimente mit ungewissem Ausgang [Change in medical education: experiment with uncertain outcome]. Dtsch Ärztebl. 2005;102(28-29):A 1996-9. Available from: http://www.aerzteblatt.de/V4/archiv/pdf.asp?id=47675 Externer Link
56.
Ott R. Grenzen und Lösungsansätze einer Kostenzuordnung auf Forschung, Lehre und Krankenversorgung in Universitätsklinika [Limits and solutions of assigning costs to research, teaching and patient care in university hospitals]. München: Bayerisches Staatsinstitut für Hochschulforschung und Hochschulplanung; 2003. Availabe from: http://www.ihf.bayern.de/dateien/monographien/Monographie_65.pdf Externer Link
57.
Wissenschaftsrat [German Council of Science and Humanities]. Allgemeine Empfehlungen zur Universitätsmedizin [General recommendation for university medicine.] Köln: WR; 2007. Available from: http://www.wissenschaftsrat.de/texte/7984-07.pdf Externer Link
58.
Fraunhofer Institute for Systems and Innovation Research (ISI). Map of university medicine. Karlsruhe: Fraunhofer ISI; 2008. Available from: http://www.landkarte-hochschulmedizin.de/pdf/Final%20Report%20Map%20of%20University%20Medicine.pdf Externer Link
59.
Oliver R, Sanz M. The Bologna Process and health science education: times are changing. Med Educ. 2007;41(3):309-17. DOI: 10.1111/j.1365-2929.2006.02650.x Externer Link
60.
Hoppe JD. Pressegespräch "Arzt mit Bachelor? Die Irrwege des Bologna-Prozesses" am 25. August 2005 in Berlin. Statement von Prof. Dr. Jörg-Dietrich Hoppe [Statement from Jörg-Dietrich Hoppe on the Bologna-Process on 25th August 2005 in Berlin (views of the President of the German Medical Association)]. Available from: http://www.bund-freiheit-der-wissenschaft.de/downloads/b_statement_hoppe.pdf Externer Link
61.
Wissenschaftsrat [German Council of Science and Humanities]. Empfehlungen zur Qualitätsverbesserung von Lehre und Studium [Recommendations for quality improvement in education and studies]. Köln: WR; 2008. Available from: http://www.wissenschaftsrat.de/texte/8639-08.pdf Externer Link