gms | German Medical Science

Currently there are various surveys on the situation of students with children in the research landscape. Probably the largest of these is the Social Survey of the German National Association for Student Affairs (Deutsches Studentenwerk) conducted by the Higher Education Information System (HIS) [1], [2]. In the context of universities in Baden-Württemberg, the study “Fast – Familiengründung im Studium” (Starting a Family at University) has established itself as a fixed reference point [3]. These and other contributions [4], [5], [6], however, have in common that the surveys are conducted across the entire student body, i.e. a lack of detailed subject-specific analyses.

The specific situation of health professionals is usually only addressed at the stage of medical specialisation or practising medicine. In recent years, this aspect has increasingly tackled the question of compatibility of potential family obligations [7], [8]. The impetus for this research on the one hand has been the high proportion of women in medicine, coupled with consistently low percentages of women in top-level careers [9] and the relatively high proportion of permanently childless female academics in Germany [10]. At the same time the controversial discussion surrounding the impending shortage of doctors also provides motivation as it will likely affect the figures of attrition of doctors in rural areas and in surgical specialisations [11], [12], [13], [14]. The issue of compatibility has a key role in this debate as well. The debate surrounding the difficulties of combining a medical career and family and the possible negative effects on careers is not limited to Germany alone [15], [16], [17], [18].

More detailed, empirical analysis of the time span of medical school have so far been absent, except for a pilot study from Ulm [19], [20] and the collaborative research with the Medical Faculty of the Goethe University in Frankfurt am Main [21]. But a differentiated analysis is necessary to advance the debate on compatibility and to find practice-oriented solutions [22]. Focussing on medical subjects is appropriate since, according to the 19^th Social Survey of the German National Association for Student Affairs, the subject group of medicine/health sciences has a comparatively high proportion of students with of children 7%, compared to other subjects [1]. At the same time, however, the study “fast” [3], whose participants included approximately 4% medical students, found that this subject area had the least-well perceived environment regarding child-friendliness.

The fact that students in general and in particular medical students already consider starting a family while at university is illustrated by the HIS survey on the lifestyles of students [23]. Their analysis shows that three quarters of the students would like at least one child in the future. Further studies on the future planning of prospective doctors also illustrate that medical students consider the issue of compatibility during their time at university [24]. Their conclusion, however, is the expectation that workload and career progression will be complicating factors [25].

This study which, headed by the family researcher Prof. Jörg M. Fegert, Medical Director of the Department of Child and Adolescent Psychiatry/Psychotherapy, continues a pilot study by the working group “Family, Time policy and E-Learning” in Ulm under the guidance of Dr. Hubert Liebhardt [19], [20]. Its results shows the desire of students for compatibility of family and the field of medicine starting at undergraduate level.

This state-wide study, initiated by the University of Ulm and the University Hospital of Ulm and supported by the Ministry of Science, Research and the Arts of Baden-Württemberg [26] aims to examine the personal circumstances and study conditions of student parents in medical studies in Baden-Württemberg and, based upon this data, to identify necessary changes for a family-friendly medical school.

This study generates empirical data and creates concepts for practical solutions which will allow creating an environment which enables and fosters family foundation while studying medicine. In the following, the living conditions of student parents in medical school in Baden-Württemberg will be surveyed in detail and the question debated of what the best time is for starting a family while studying. The compatibility issues facing student parents will also be examined and the role of academic advice analysed in order to then relate possible support services into the current research debate afterwards.

The aim of this study is to identify which existing and additionally required factors are necessary for successfully studying medicine with a child in Baden-Württemberg. The analysis of the study and living conditions of student parents studying medicine at the five leading medical universities in Baden-Württemberg will provide the necessary foundation. Based on the pilot study conducted at the University of Ulm in 2008/2009 [19], [20], the first step of the data gathering process was to conduct 60 qualitative, problem-centred interviews during the winter semester 2009/2010. The interviews were then analysed using structured qualitative content analysis [22], [28]. The interview material generated clear problem areas experienced by student parents in medical school, such as compatibility, study organisation and advice.

The problems that were collected then formed the basis of a quantitative online survey of all students with children and pregnant women at the five medical schools in Baden-Württemberg during the summer semester 2010. Due to a lack of opportunities for directly contacting the target group, the invitations addressed at student parents and pregnant women inviting participation in the survey was sent to all medical students in Baden-Württemberg in cooperation with local study deaneries.

The study received an affirmative vote by the Ethics Committee of the University of Ulm and all participants were informed about the use of the data and the applicable data protection regulations.

The total number of medical students with children was calculated based on their exemption from university tuition fees in Baden-Württemberg on account of caring for children under the age of 14 [29]. Due to a lack of data on the family status held by the universities, this approach provides the most accurate alternative.

In the summer semester 2010 according to the figures on exemption from tuition fees a total of 448 students with children were studying medicine at the five medical schools in Baden-Württemberg. These are distributed as follows amongst the respective faculties: 76 students with children in Freiburg (3.1% of all medical students in Freiburg)¹, 79 in Heidelberg (3.1%), 57 in Mannheim (4.4%), 168 in Tübingen (7%) and 68 in Ulm (3.2%). This represents an average of 4.2% of the 10,742 medical students in Baden-Württemberg in total. 238 students with children or pregnant women participated in the online survey, with the results presented below. On the basis of the exemptions from tuition fees for student parents, this corresponds to a return rate of around 52.3%. The gender distribution is 81.1% female to 18.9% male participants.

88.6% of respondents are German nationals, 4.2% identify themselves as having acquired university access qualifications (immigrant background with a German Abitur), 3.0% of the surveyed students are citizens of other EU countries and 4.2% are citizens of non-European countries.

Of the students with children, 41.9% were admitted to medical school due to the number of terms waited for admission (40.1% female; 55.0% male). 23.4% were awarded places due to their A-Level results (25.9% female; male 5.0%) and 13.8% of those surveyed were admitted through the university’s own clearing system. The remaining 20.9% fall into other categories such as admission by lottery method, international/foreign office, admission by court order and transfer students.

At time of the survey, the average age of the student parents was 29.6 years of age, women 29.7, men 29.0. The average age varies according to the type of admission to medical school. The youngest, with an average age of 26.8 years, are students who were admitted on the basis of their final grade point average. Students who have gained their admission through selection by the university on average were 27.4 years of age and thus younger than students who were admitted due to waiting credits (31.9 years). In the survey, students from all semesters are represented; the average semester of study is 8.7.

67.7% of the respondents are married, 22.0% are cohabiting, 9.8% are single parents and 0.6% of students live separately from their child. 18.4% of the parents have a partner who is currently also studying whereas 81.6% of the partners do not currently study. There are no discernible gender differences.

58.4% of the respondents (56.8% female/70.0% male) had already gained a job qualification before embarking on a medical degree. The free text answers show that 62.7% hold a qualification in a health profession, with paramedic and nurse being the most frequent responses. On average students with children had been working for 3.7 years prior to university, with female students on average having spent 3.8 and male students 3.3 years in employment. 42.2% of students with children (39.0% female/65.0% male) are still working in this profession while at university or have employment in a different field, with average weekly working hours of 10.7 hours/week.

Data on the household income (family) was collected. The largest percentage of families (23.5%) lives on a monthly income between €1500-€1999 for the entire family, including state support (see Figure 1 [Fig. 1]). Another 22.2% of families have a monthly income of €3000 or more.

The income is conditioned by several factors, with income distribution affected by the age of the participants amongst other things. The older the student with children, the higher the family income of the whole family². At the same time, older students have more children on average³. Income and state support for families also increases with the number of children⁴.

The marital status also highlights the impact of these factors on earnings. Students in non-marital cohabitation are on average 27 years old and have 1.3 children. 63.9% of students in non-marital cohabitation have a monthly income of €1000-2000. Married students are on average 31 years old and have an average of 1.6 children. 42.1% of married students indicated a monthly income between €1500-2000. At the same time, 31.8% of married students were in the bracket of more than €3000 per month. Only 5.6% of students in non-marital cohabitation and no single parents have more than €3000 on a monthly basis. 75.1% of single parents indicated an income of less than €1500 per month.

The income of students consists of child benefits for the child (85.5%), partner’s income (76.4%), employment (38.8%) and parenting benefits (32.7%). At the same time families are supported by their own parents (36.4%) and by through BAföG (federal student support; 20.6%) and child support (17.6%). Other sources of funding were the Practical Year allowance (15.8%), housing benefits (12.1%), personal child benefits (7.3%), child-raising allowance (7.3%), unemployment benefits (ALG II; 5.5%), scholarships (4.2%) and student loans (2.4%).

80.0% of female students and 50.0% of male students are supported by their respective partners. 33.1% of female students and 60.0% of male students are supported by their own parents.

The average age of the students’ children is 4.8 years. However, 57.0% of children are under the age of four (see Figure 2 [Fig. 2]). 27 women were pregnant at the time of the survey and did not yet have any children. Their age average was 26.6 years. 67.5% of students who already have children live in single-child families with the child on average 2.7 years of age and the students on average 29.0 years of age. 26.2% were families with two children. The older child in these families is 8.1 years old on average and the students 33.0 years of age on average. 7.8% have three children, 9.8% have four or more children.

35.9% of children had been born before their parents began to study, 18.8% were born in the pre-clinical section. 39.8% of children were born in the clinical study section or the Practical Year (5.5%). 62.0% of children who were born during medical school were born in the clinical section.

62.9% of all children who were born to parents who were already in medical school by that time and the current pregnancies were consciously planned by the students⁵. However, 26.4% of students stated they had not intentionally planned having children while in medical school. Amongst the students who were planning for one or more children while at medical school, 68.2% agreed that at least one child was planned for a particular section of their studies. Only 5.7% of the respondents stated that the specific study section played no role in the planning.

When asked about the best time for children in medical school and specialisation, 36.1% indicated that there is no ideal time. However, 42.0% identified the clinical study section (after the 1^st State Examination) (40.5% female; 52.4% male) as the best time for having children.

The students surveyed who had their first child prior to entering university predominantly stated that there is no ideal time (58.3%) for starting a family in medicine (see Figure 3, right [Fig. 3]). The students who had their first child in the pre-clinical section mostly stated that the clinical section (44.0%) would be the best time for starting a family in medicine. But also 36.0% of students who had their first child in the pre-clinical section stated that there is no ideal time. The majority of surveyed students, who had their first child in the clinical section of studies, indicated that the clinical section (72.0%) is the best time to have a child.

56.8% of students surveyed are planning to have more children. When analysing the group of women pregnant at this point in time without previous children, 88.9% plan to have more children. Of those students who had their first child prior to starting university and who plan more children, they indicated specialisation (30.8%) and the clinical section of studies (23.1%) as the best time (see Figure 3, left [Fig. 3]).

If student parents who had their first child in the pre-clinical section are planning another child, they state that the clinical section (30.0%) and the time after specialisation (30.0%) as the best time.

Parents who had their first child in the clinical section and are planning more children indicated that they are aiming for the time during specialisation (45.7%).

The surveyed students who had their first child in the Practical Year stated that they plan to have more children during specialisation (50.0%) and immediately following the M2 State Examination (33.3%).

Advantages for having children during medical training perceived by the students are primarily the positive effects of early parenthood (71.2%), non-deferred desire to have children (71.2%) and easier compatibility of having children while in medical school compared to future medical practice (66.7%) (see Figure 4 [Fig. 4]).

Disadvantages perceived by the students on the other hand include less time to study (84.3%), less time for themselves (70.2%) and the impossibility of planning childcare through changing course times (66.9%) (see Figure 5 [Fig. 5]).

The family-friendliness of the universities surveyed was judged as mediocre by the participating students in Baden-Württemberg, awarding it a school grade average of 3.4 (scale of 1/best to 6/worst) on average.

60.6% of students had problems reconciling family and studies in the last semester, with women and men equally affected. However, there is a significant difference⁶ in the frequency of compatibility issues between students in the pre-clinical and the clinical studies section. Students at the pre-clinical stage of study far more often had problems with reconciling studies and family in the last semester compared to students in the clinical section of studies.

Among the most common problems, which the students encountered in the last semester (see Figure 6 [Fig. 6]), were independent of the section of studies, the high number of compulsory courses, afternoon events as well as numerous examinations in a short period of time. A rigid schedule, frequently changing course times and the impossibility of planning the semester also made it more difficult for student parents to reconcile university with family. However, external factors such as the lack of childcare also led to problems for the students.

Only 11.4%⁷ of parents agreed with the statement that the teaching staff is generally willing to make exceptions for students with children. 50.3% of students rejected the statement that the teaching staff is willing to make exceptions.

Against the backdrop of the compatibility problems with afternoon events, 59.5% of respondents said that compulsory courses should be offered in the morning between 8am-1pm or in the core working hours of 8am-4pm (13.3%).

Parents also indicated that a more flexible approach to attendance (82.4%) and the possibility of making up for missed classes through an alternative credit system (61.7%) would have made studying easier. 53.7% of respondents believe that being assigned to a morning course group for student parents would have helped in their studies. The felt disadvantage of not being able to plan childcare is reflected in the wish for announcing course timetables at the end of the previous semester (67.5%). Not surprisingly, 92.1% of students would also like separate regulations for missed dates due to the illness of a child.

Two thirds of the respondents (68.7%) said that they are currently studying full time, women and men in equal proportion. Nearly a third referred to themselves as part-time students of a degree fundamentally designed for full-time study.

40.9% of students have taken study leave due to their children. It can also be noted that female students were absent because of their children significantly more often⁸ (45.1%) than male students (9.1%). On average, both sexes had accumulated about a two-semester leave of absence.

Overall two-thirds (63.7%) of student parents in total stated that at the time of the survey, they were behind students on the regular course progression. 36.3% stated that to date they managed to complete their studies without any delay. Again, women are significantly more often⁹ affected by study delays (72.0% delayed /28.0% on schedule) compared to male students (21.6% delayed /78.4% on schedule). Most students who deviate from the regular study schedule are one (30.7%) or two (35.0%) semesters behind.

When asked how many delayed semesters could have been avoided with better compatibility of family and studies through better study organisation, regardless of gender 38.1% of respondents said that one additional semester could have been avoided. 17.1% stated that with better study organisation they believe two additional semesters could have been avoided. However, 29.1% of surveyed students stated that even with modified study organisation the delay would have been unavoidable.

The analysis of the link between delayed semesters and the perceived family-friendliness of the university shows there is no connection between the duration of the delay and the perceived family-friendliness. However, there is a significant correlation¹⁰ between the number of semesters, which according to the students could have been avoided through better organisation and the perceived family-friendliness of the university. It seems that a delay does not leave a negative impression as long as it does not arise inadvertently or as long as it is not perceived as avoidable.

Students were also asked to assess whether interrupting studies for starting a family is necessary and wise. This shows that 28.5% (31.2% female; 9.0% male) consider an interruption as necessary. Many more parents (44.1%) on the other hand consider interrupting studies to start a family as wise (46.5% female, 27.2% male). At the same time it is clear that women are far more likely to consider an interruption both as necessary and sensible compared to men.

Judging by the grades, students with children do not appear to be disadvantaged in comparison to students without children. 70.5% of respondents judge their grades to be at the same level as those of their childless classmates. 11.3% of women and 21.7% of men consider the grades they achieve as above-average. On the other hand, 18.7% of female students and 4.3% of male students consider their grades as below the average.

When asked about their learning behaviour, 43.5% of parents agree that their learning is highly structured. At the same time, 35.6% of participants state that their learning had become more structured since the birth of their children. A significant positive correlation¹¹ between the degree of structure to learning and the perceived comparative grades compared to their childless peers suggests a link between structured learning and positive exam results.

The students’ learning behaviour was further specified through the question about the preferred learning time. Both male and female students alike indicated 8am-12am (29.1%) and 8pm-12pm (49.5%) as the preferred time to study during the week. This preference does not change at the weekend (35.5%; 29.0%).

When asked to assess the statement “I was able to find all necessary information regarding studying with a child without any problems”, 45.5% of students did not agree, i.e. they encountered problems in locating information. 37.5% found searching for information somewhat problematic. Only 17.0% of parents had no trouble at all to find all the necessary information. There was also a significant positive association¹² between the ease of access to information regarding studying with a child and the positive assessment of the family-friendliness of the university.

At the same time, students were asked to estimate to what extent they actively had sought information from talking to advice services regarding studying with a child. This shows that less than one third (28.2% female, 20.7% male) had actively sought out advisory staff. There is also a significant positive correlation¹³ between actively gathering information from advice services and the perception that all necessary information could be found without problems.

The students were able to select multiple items from a list of possible answers about where they perceive to have a continuing need for advice (see Figure 7 [Fig. 7]). 68.9% selected curriculum planning (68.4% female, 72.0% male) and 60.2% studying part-time (63.7% female, 36.0% male) as areas where they could do with more advice. More advice is also needed regarding childcare options (66.8%), with women (69.0%) stating a slightly higher need compared to men (52.2%). When looking at the 36 respondents who are currently pregnant, the continuing need for advice regarding childcare options is at 75.0%.

Finance (57.7%) is the most commonly selected issue amongst men with 76.0% while 55.0% of female students indicate further needs. The aspect of childbirth/maternity protection (36.2%) primarily affects the women currently pregnant, with 63.9% expressing a need for further advice. Legal advice (53.6%), student advice from student parents (50.0%) and housing services (32.1%) were named less frequently. No further need for advice is stated by only 17.9% (18.7% female; 12.0% male) of the students.

Regarding their study organisation, 11.8% of students (13.7% female, 0.0% male) are in regular contact with the academic advice services. A quarter (25.1%) indicated having received advice about studying with a child from the deanery of student affairs, e.g. through the academic advice services.

When asked how they came about the advice from the deanery regarding studying with a child, 62.0% indicated that they had approached the deanery regarding a specific problem. 34.0% contacted the deanery for general advice. 4.0% stated that they had made contact prior to the birth of the child and maintained contact.

Those 74.9% of respondents who have received no advice about studying with a child from the deanery were asked why they did not use this service. The most common answer is (55.6%) that they had not been aware of this offer. Only 18.8% state that they have no need for advice. Other responses included difficulties in locating the right person (6.3%) or the assumption that organising studies with a child was their own responsibility (7.6%).

When comparing the reasons for not using the advice services with the question on compatibility issues in the last semester, it turns out that amongst those who did not indicate a need for advice from the deanery, 39.1% had problems reconciling studies and the family in the last semester, while 60.9% did not have problems. Looking at the group of those who had declared themselves ignorant of the services offered by the deanery, it turns out that 67.1% had problems with reconciling studies and family and 32.9% did not¹⁴ (see Figure 8 [Fig. 8]). It would seem that compatibility issues and a corresponding need for advice seem to occur mainly in the group which has no knowledge of advice services on studying with a child by the deanery of student affairs.

In return, those 51 students who had received advice about studying with a child from the deanery were asked about the quality of advice. 71.4% agreed with the statement that their concerns had been taken seriously. In addition, these students were asked to indicate whether the advice received from the academic dean’s office was sufficiently detailed. Nearly half the students (48.0%) who received advice stated it had been sufficiently detailed for them. So the students feel that while their concerns are taken seriously in many cases the extent of advice given was lacking.

Especially the detail of the advice given¹⁵ as well as the impression of being taken seriously¹⁶ seem to be indicators of whether students feel that they managed to acquire all the necessary information about studying with a child without any problems. Again there is a significant positive correlation between the feeling of being taken seriously when seeking advice and the assessment of the family-friendliness of the university¹⁷.

65.2% of students indicated that they would use an individual advice service on the organisation of studying with a child. However, there is a big gender difference. 72.9% of female students would use such an advice service but only 17.8% of male students state that they would use such a service. However, both male and female students (64.4% female, 50.0% male) would consider a mentor who acts as a contact across semesters e.g. a member of staff from the dean’s office or a student with a child from a higher semester as being helpful.

Referring to the models for study support already implemented in Ulm following the previous pilot study, 70.6% of respondents considered a possible cross-semester agreement regarding course progression between students and the deanery useful. In the Ulm model of a course progression monitoring (Studienverlaufsmonitoring) [30] attempts are made to address individual needs surrounding the organisation of study through the academic advice services in collaboration with the student parents.

The introduction of a university parent card (Elternpass) was also discussed based on the pilot from Ulm. This document, for example in the form of a smart card or ID card, could facilitate access to discounts and special services for student parents. When described in this way, 88.5% of student parents in Baden-Württemberg consider such a parent card appropriate. It would be considered particularly useful for facilitating early course signup and for negotiating absences and alternate course credits with university teaching staff. Accordingly, 91.0% of parents say that they would use such a passport.

This data, showing an average rating for family-friendliness, confirms the results of the study “fast” which also found average ratings for the child-friendliness of the medical departments [3]. The data indicates the need for improving university structures and environments regarding issues of compatibility and family-friendliness.

Both the HIS survey on Student Family Planning [23], Buddenberg Fischer et al. [25] and the Evaluation of Teaching by the Scientific Advisory Board for Family Matters [31] show that the time at university is not seen as the primary phase for starting a family. Nevertheless, this study demonstrates that there are reasons for starting a family while studying, especially in medical careers, such as the reasonable expectation by students that starting a family later in their career will not get easier and the time at university offers a comparatively wide space for personal development [32].

That a demand for family-friendly conditions in medical school exists is also demonstrated by the fact that the majority of parents surveyed either already have children when they enter university or are already planning to have children while taking the timing within the degree course and the anticipated compatibility aspects into account in their plans. The assessment by students that the best time for having children is in the clinical study section coincides with a seemingly better compatibility in the respective semesters as shown by the data. But as the rate of compatibility issues experienced by students in all phases of study remains high, this indicates that on the one hand the more school-like pre-clinical section should offer more individual freedom and flexibility of organising studies to allow students who already are parents the space to reconcile both. At the same time, the time following the first state examination is recommended for students wishing to have children and should be further supported by appropriate measures through the deaneries of medical schools as a time of family planning [33].

Recommendations for appropriate family-friendly measures can be derived from the present study results, with similarities to existing recommendations by the Federal Union of Female Physicians [7], [34] and the Scientific Advisory Board for Family Matters [31] and a synopsis of Family Research (FamilienForschung) Baden-Württemberg (FaFo) [35] and the results of studies and pilot projects examining the compatibility issue [3], [23], [36], [37], [38], all reinforce one another.

Recommendations regarding study organisation include, for example, allowing individualised study organisation with cross-semester advisory mechanisms, more flexibility and way of compensating for missed events to prevent unnecessary delays in course progression. Medical schools should address the specific compatibility issues found in medicine involving long course days, multiple exams in a short period of time and unpredictable changes to class schedules during the semester and offer appropriate solutions, for example earlier course registration, seminar groups during core hours and opportunities for parents to re-sit exams. Separate rules regarding missed days due to a child’s illness would also be recommended.

The insight gained from the study that many students also state problems with finding relevant information about studying with a child while at the same time having no knowledge about the specific advice on offer from the medical schools reinforces the need for easily accessible, networked advisory services for students with children. The FaFo and a model project from Giessen [35], [36] observed that smooth communication between the university advice centres is critical and that these should be supported, for examples through a central coordination point. At the same time, information about studying with a child, childcare, financing, university and municipal services for (future) parents, maternity leave, etc. should be made widely available, for example online or as printed brochures. The following graphic shows (see Figure 9 [Fig. 9]) which issues frequently arise in the search for relevant information and how these can be addressed through advisory services:

It should be also made clear to student parents that the student advisory services are usually responsible for offering individual advice to student parents, taking account of their personal circumstances, for example on the homepage of the dean of studies. Attempts should be in particular to reach out to those parents who according to our data have compatibility issues but are unaware of the possibility of individual advice in order to tackle them at an early stage.

The data of the present state-wide study on family-friendliness in medical schools in Baden-Württemberg answers the question of which factors are prerequisites for studying with children successfully. The survey shows that the family-friendliness is rated average and that there are significant compatibility problems facing student parents and that in general universities need to do more work in the area of family-friendliness. Key areas that need to be tackled are the organisation of studies and advisory services and information for student parents. Student parents who entered medical school with children or are planning to start a family during their university time should be enabled to do so successfully through support mechanisms, in spite of their double workload.

Taking into account both our data and the wider societal matter of the comparatively high rate of childless female academics and the reduced proportion of female academics in the senior levels of the medical profession, enabling parents to start families while at university should be considered as an alternative solution. And improving the environment of universities and teaching hospitals with regard to family-friendliness in general and specifically for student parents is just as important as structural measures and advisory services.

¹ All figures on students from the official student statistics of the according universities for the summer semester 2010

² Pearson Correlation (p<0.01) is 0.3

³ Pearson Correlation (p<0.01) is 0.5

⁴ Pearson Correlation (p<0.01) is 0.3

⁵ All figures on students from the official student statistics of the according universities for the summer semester 2010

⁶ Chi-Square test (p<0.05)

⁷ Judgements were given on a 6-point scale but for reasons of legibility these were merged as 1+2, 3+4 and 5+6 in the following.

⁸ Fisher-Yates test (p<0.05)

⁹ Chi-Square test (p<0.01)

¹⁰ Pearson Correlation (p<0.05) is 0.2

¹¹ Pearson Correlation (p<0.01) is 0.3

¹² Pearson Correlation (p<0.01) is 0.3

¹³ Pearson Correlation (p<0.01) is 0.2

¹⁴ Chi-Square test (p<0.05)

¹⁵ Pearson Correlation (p<0.01) is 0.4

¹⁶ Pearson Correlation (p<0.05) is 0.4

¹⁷ Pearson Correlation (p<0.05) is 0.3

Our thanks to the Ministry of Science, Research and the Arts for funding the study Family-friendliness in Medical Studies in Baden-Württemberg.

The authors declare that they have no competing interests.