gms | German Medical Science

Dietmar Kreikenbohm-Romotzky

Die Medizinischen Fakultäten in Nordrhein-Westfalen: Strukturdeterminanten, Aufgabengebiete, Kompetenzen und Entwicklungsperspektiven

Südwestdeutscher Verlag für Hochschulschriften

year of publication: 2009; 256 pages, € 98,00

This book with the somewhat unwieldy title “Die Medizinischen Fakultäten in Nordrhein-Westfalen, Strukturdeterminanten, Aufgabengebiete, Kompetenzen und Entwicklungsperspektiven” (The medical schools in North Rhine-Westphalia, structural determinants, task areas, competencies and development perspectives) surprises in many ways. One primarily expects, as the title suggests, a detailed overview of the six medical schools of North Rhine-Westphalia but finds these embedded in a broad discussion on the theoretical foundations of tertiary education as well as the development of academic medicine and its political determinants. It soon becomes apparent that for the author medical schools are of central importance for the future development of universities and their supporting role in the state system.

Even the introductory chapter of this book is noteworthy. In a friendly tone but with decisive clarity, it describes the fundamental problems currently facing medical faculties in Germany, which are mainly the result of political issues. Although the author assumes a rather pessimistic view, he strives to give decision makers at universities means for developing the organisations given into their care.

After evaluating various theoretical scientific approaches, the author reveals in no uncertain terms that he chiefly bases his research design on the Frankfurt School’s critical theory but that this should not be seen as a claim for the veracity of his analyses and findings. Also, to the author publicly funded medical research and teaching is not an end in itself but the foundation for optimal health care of present and future generations.

With reference to the Science Council, the author believes that the main problem is that health and education, research and teaching are seen primarily as a cost factor by politicians and not as a prerequisite for productivity and economic growth and as a basis for a humane society. This explains why the challenges facing medical schools and the health care systems in general are seen in the larger context of basic socio-economic theories and that the development of the healthcare market, the instruments of quality assurance, the influence of the health lobby and social structural changes are taken into account, supported by a body of data and condensed into exemplary form.

The chapters which describe the financial situation of the universities of North Rhine-Westphalia are illuminating. They clearly show that in contrast to developments in other parts of Germany there is a definite upward trend. But it is also clear how much intense pressure universities are under in their efforts to raise the funds necessary to successfully compete in the international science community, through a nigh unmanageable tangle of competences, programs and funding bodies. In this regard, the federal excellence initiative with its resounding impact on the German research landscape for further developing universities is seen as well targeted and successful by the author.

The author very clearly elaborates that the wage structure, despite the boasts of being performance oriented, should ultimately be seen mostly as a cost-cutting exercise, with all its negative consequences on motivating young people towards a university career.

Regarding NRW, the University Freedom Law (HFG) and the University Medicine Act (TPA) and their consequences for the interaction of the different university levels are explained with a degree of caution. The comparison of integration and cooperation models and the explanation of the different legal clinical structures in Germany remain a current interest.

If the final chapter of the book contains a number of demands and recommendations, these are systematically derived from the general discussion in the previous chapters. Fortunately there is not simply a general demand for higher levels of funding; the need for additional resources in each case is clearly justified and the different models of performance-based funding allocation are presented.

The author does not restrict himself purely to financial questions, he does indeed call for structural reform of the faculties towards forming departments and moving to a BA/MA system in education, down to a much-needed new understanding of university (professional) management.

This book is a treasure trove for anyone who - using the example of universities in North Rhine-Westphalia - is interested in the discussion on the situation and development possibilities of medical schools and their clinics in Germany. The great merit of this book is that in addition to the clear presentation of key figures, these are placed in the context of the theoretical basis of university education. Especially academic leaders who prefer viewing issues from a the university’s narrower point of view will find a body of current and clearly presented data that can enrich and clarify any discussion. It also contains comprehensive overviews of legal principles. Informed and very practical recommendations can be drawn based on the plausible and graphic conclusions. To put it boldly, one can see that this book picks up all the usual buzzwords of the debate but in contrast to many publications which unduly simplify matters, it discusses the issues with data and factual substance. It is almost superfluous to say that the book contains a comprehensive bibliography.

One would hope that many political decision-makers and those responsible in the universities will read Chapters 2 and 5 in particular. Once the book has grabbed your interest, the remaining chapters will add a lot to understanding the special situation of medical education at our universities.

The author declares that he has no competing interests.