gms | German Medical Science

Medical school is changing. The Federal Council and its committees are debating changes to the Medical Licensure Act. The Dental Licensure Act which hasn’t been amended since the 50’s is also being discussed intensively. In Salzburg medical school takes only five years of study and at the EU level there are discussions about shortening the study period. The rules for the recognition of professional qualifications from non-EU countries have been reorganised and represent a challenge. A lot of things are in motion. All these changes will affect the provision of medical care and the role of medical schools and associations.

Are medical schools training the right kind of doctors? How much general medicine has to be prescribed at university and would more of it positively affect the number of doctors? Will we really have a shortage of doctors in Germany in the foreseeable future or is it just a distribution problem? Distribution only in terms of geography or rather of division of labour in the health care system?

What is the role of the Association for Medical Education in these change processes?

Medical under- and post-graduate education in future will be geared more towards the needs of the health care system. In the design of under- and post-graduate studies, competency-oriented graduate profiles will play a key role. In this way, medical school will tie in much better with the requirements of clinical post-graduate education under the aegis of the state medical boards and can thus create incentives focussing on patient care. In addition, a description of the competencies of a medical graduate is an essential precondition for dialogue with other health professionals, which critically includes the question of responsibilities and their delegation or substitution. The Association for Medical Education (GMA) and the Medical Faculties’ Day (MFT) are jointly developing a competency-based medical learning target catalogue (NKLM) which is to include a medical core curriculum within the legal framework of the ÄAppO in order to facilitate curriculum design by the faculties (http://www.nklm.org), [1], [2]. For this purpose, NKLM draws upon the Canadian CanMEDS framework which was originally designed for post-graduate education (http://www.royalcollege.ca/public/resources/aboutcanmeds). It is intended to prepare medical students for their future medical roles. The future doctor in the role of a medical expert will utilise medical knowledge, clinical skills and professional attitudes, in conjunction with the expertise of other medical roles, to implement a patient-centred care. The first version of NKLM is slated for 2013. Until then, an intensive consultation and discussion process is taking place which also includes the Working Group of the Scientific Medical Societies (AWMF). The project is supported by the Robert Bosch Foundation as well as the development of professional qualifications for the other health professions under the umbrella of Universities for Health e.V. The Robert Bosch Foundation is particularly interested in new ways of cooperation in the health system and has given important and challenging impulses in its memorandum “20 Choices for the Implementation of Interdisciplinary Collaboration in Health Care” (http://www.bosch-stiftung.de/content/language1/downloads/Gesundheitsversorgung_von_morgen_Memorandum.pdf).

The new national competency-based learning target catalogue for dentistry (NKLZ) has also been initiated against the backdrop of the debate on the new Dental Licensure Act. The experiences from the NKLM project were used in this process and cooperation between the GMA and MFT was agreed for this project. Synergies between the two projects have already been realised and there is reason to hope that NKLM and NKLZ can be submitted to the medical faculties jointly in 2013. Looking critically at the tasks ahead, these can surely be tackled better together - towards a joint release of the results on the internet (see http://www.nklm.org). At this point, we would like to thank all participating GMA members for their volunteer efforts in these two key projects. There is much attention on the development process: The German Physicians’ Newsletter has recently written about it (https://www.aerzteblatt.de/archiv/125171?src=toc) and the current state of affairs will be discussed at the Annual Medical Faculties’ Day in June 2012 in Göttingen.

In order to continue the dialogue on interdisciplinary competencies and skills among health professionals, a monitoring group has been set up for mutual exchange of information. The GMA’s annual conference picked the motto “Medical Education - International, Interdisciplinary and Interprofessional” and will provide important contributions from 27^th to 29^th September 2012 in Aachen (see http://www.gma2012.de). The newly created GMA Committee “Interprofessional Education in Health Professions,” led by Professor Uursula Walkenhorst (University of Health Bochum) works to identify and establish sustainable structures and processes which in turn enable shared learning in health professions. The opportunity to design joint teaching and learning experiences between professionals in specific training situations and to conduct educational research are to be exploited much more in future than previously. It provides the dialogue between the GMA and other professional societies like the German Society for Higher Education or in February 2012, founded Society for Empirical Educational Research huge potential for new and interdisciplinary research projects in an area of conflict, in which general academic teaching, education, psychology, medical teaching and the substantive expertise of the participating professions meet. The dialogue between the GMA and other professional societies like the German Society for Higher Education or the Society for Empirical Educational Research which was founded in February 2012 offers huge potential for new interdisciplinary research projects in a complicated area where general academic teaching, education, psychology, medical teaching and technical expertise of the participating professions meet.

The type and number of patients available for medical under- and post-graduate education seems less and less suitable to the university hospitals to represent the required width of real-life conditions. Should care structures and clinics which work on an out-patient basis today, below the maximum level of care, be systematically included in under- and post-graduate education more than previously? In medical school, this is already common practice in many places through the inclusion of GP teaching surgeries and the medical faculties in Bochum and Witten/Herdecke have experience with decentralized inpatient care structures for teaching. The need to align the curricula more than ever with the needs of the health care system and societal needs in the future has been summarised by Frenk et al. [3] in a synopsis of international reform developments in medical education: the development leads from scientific and subject-specific structures at universities towards a competency-based curriculum model which focuses on the needs and the structures of care, via more problem-oriented multidisciplinary structures with greater involvement of academic teaching hospitals. The focus on competence and outcomes has a key impact on the exam system and educational needs, less so on the interests of individual subjects.

What contribution can the model degree programs at the medical schools and the Hannover Medical School make to the development of the curriculum and hence to the new Medical Licensure Act? Currently there are seven model degree courses, with more likely to come. At a symposium at the beginning of March 2012 in North Rhine-Westphalia (NRW), the “motherland of model degree courses”, under Professor Thorsten Schäfer (RUB Bochum) the possibilities for evaluating degree courses and their comparability were discussed extensively. The State of NRW will initially approve all renewal applications for model degree courses up until September 2018 in order to summarize the key points of these models and incorporate them into the design of the new Licensure Act. Mr. Schäfer was elected chairman of the newly formed GMA committee “Further Development of Medical Studies and Training Regulations” and will follow these developments actively.

It is currently difficult to estimate how many medical schools there will be in the German-speaking countries by 2018. In addition to the near-complete establishment of the European Medical School in Oldenburg-Groningen under the leadership of founding Dean of the new Faculty of Medicine and Health Sciences of Oldenburg and former GMA chairman Professor Eckhart G. Hahn, there are a number moves towards founding new medical schools in North Rhine-Westphalia, Bavaria and Austria with new funding and sponsorship models. The GMA will monitor these developments closely and take part in the discussion about the development of medical curricula.

This also applies to the further development of clinical training curricula, the structure and quality of which is being evaluated by the medical associations and professional societies. The recently released second evaluation by the Federal Medical Council on the quality of post-graduate education (http://www.evaluation-weiterbildung.de/) highlights the need for action towards a stronger focus on competences and better and more transparent post-graduate training structures for all involved parties, as had been demanded by the German Congress of Physicians back in 2006. The GMA committee for post-graduate education also prepared a position paper which will be published shortly and describes a vision for the advancement of education.

The medical role of the scientist is essential and the basis for medical under- and post-graduate education. Without these skills, a medical career and critical assessment of new scientific findings regarding diagnoses and treatments is not feasible. Teaching research methodology skills, for example, is an indispensable prerequisite for literature reviews. It would also be desirable for as many medical students as possible to have the opportunity to gain their own research experience so that on the one hand they gain a deeper understanding of research and innovation in medicine and on the other to inspire them towards careers in medical research. An MD is one of the much-discussed classical steps along this path which is usually taken while at university.

The competition for excellence set up by the federal and state governments to promote cutting-edge research in science in Germany closed recently and the results of the selection of graduate schools, excellence clusters and future concepts are expected at the end of June 2012. One pillar is researchoriented teaching, which however is not funded. There is a possibility here for connecting with the federal pact on the quality of teaching, which provides two funding rounds in the period 2011-2020 with a total of about €2 billion for supporting good conditions for studying at German universities. The medical sector succeeded with two collaborative projects in Baden-Württemberg and Hesse with the participation of the GMA. The comprehensive integration of longitudinal research paths into under- and post-graduate education to improve the methodological skills of graduates and to promote enthusiasm for research is a major challenge and can be significantly developed further through the above mentioned programs with GMA participation.

The new GMA Board was elected in October 2011 and has set itself ambitious goals. Changes also means a chance for something new and a chance for progress. We want to move forward together with all active GMA members and with the cooperating organizations and institutions to further develop the NKLM and NKLZ, to intensify and better understand the dialogue with other health professions. We want to encourage and continue to expand interdisciplinary and interprofessional educational research. We therefore want to intensify the contacts and exchanges between our sister organisations in neighbouring countries and other professional organisations active in this field in Germany, Austria and Switzerland. The annual meeting 2012 in Aachen will clarify and energise this path. The GMA wants to continue to grow and modernise. This requires critical inward self-reflection and an outwardly confident behaviour. The re-establishment of the committee on “Gender, Diversity and Career Development in Medical Under- and Post-Graduate Education” under the direction of Dr. Melanie Simon (RWTH Aachen) is part of this development process. Another aspect is the position paper of the GMA on the appointment process of professors of medical didactics and educational research in this issue of ZMA which itself is under new editorship [4]. Medical education will continue to become more professional in future this will require decisions for corresponding structures in many places in German-speaking countries. The GMA will accompany and comment on this process through its journal on medical education. The task of the GMA as a professional society can and should always be critical forward thinking. You can play an active role in this process in the GMA!

The author declare that he has no competing interests.