gms | German Medical Science

2014 marks the 30^th anniversary of the GMS Zeitschrift für Medizinische Ausbildung (GMS Z Med Ausbild), the journal of the Gesellschaft für Medizinische Ausbildung (GMA). Such a milestone is not only an occasion for celebration, but also – since this involves a professional academic journal – a moment for critical self-reflection on the course taken for this important endeavor and on lessons learned for the future.

Through publishing recommendations and the results of innovative research projects, how can the GMS Z Med Ausbild continue to promote positive changes to education in medicine, dentistry, the health professions, and veterinary medicine that ultimately culminate in benefits to patient care? The article on quality management of the practical clinical phase during the fifth year of medical study (the PJ) by Raes et al. [1], with comments from Switzerland [2] and Austria [3], addresses this very issue. It will be seen if the implementation of these quality criteria contributes to real improvement in the final year of training, and if this can also potentially have positive effects on patient care.

How has the GMA’s academic journal grown over three decades from a self-published newsletter to an internationally visible, open-access journal? What further goals have been set for the future by the chief editors and editorial board?

The executive board of the Gesellschaft für Medizinische Ausbildung (GMA) had to attend to everything. That is why Dietrich Habeck (board member 1981 – 1997), in the capacity of sole editor, self-publisher and printer, created a publication for the GMA, whose first volume was distributed in bound form among GMA members in May 1984. He called it Medizinische Ausbildung and gave it the subtitle: Forum zur Erforschung der ärztlichen Aus-, Weiter- und Fortbildung (see Figure 1 [Fig. 1]). It also served as a newsletter for the GMA and the early volumes mainly possess this character. Dietrich Habeck – then the Head of the Department for Epidemiology and Information at the Psychiatric Clinic of the University of Münster and former Dean of the Medical Faculty – had already made it clear in the preface to the first volume that this publication should serve the purpose of the GMA, which is the critical examination and discussion of the concepts and methods shaping medical education, advanced training, and continuing education, as well as the dissemination of scientific knowledge and research findings in this area [4]. Accordingly, an editorial committee and a scientific advisory board were created, on which well-known names can be found (see Figure 1 [Fig. 1]). Dietrich Habeck was the publisher and editor combined in one. The instruction for authors, contained in a footnote to the table of contents, consisted of exactly six lines. The journal had the ISSN 0176-4772 and as a result was clearly classified as a serial publication¹. This was of importance for the future of the journal, since the name Medizinische Ausbildung was established and ownership assigned to the GMA. This proved to be critical for later decisions made by the executive board. This volume (vol. 1, issue 1, May 1984, accessible at https://gesellschaft-medizinische-ausbildung.org/files/ZMA-Archiv/1984/1/01-1984.pdf) marks the origin of today’s GMS Zeitschrift für Medizinische Ausbildung (GMS Z Med Ausbild). We owe much in the way of gratitude to Dietrich Habeck and the former GMA board for this.

In order to appreciate the achievements and importance during this chapter, we should not just look back at the GMA’s development since its founding in 1978, but rather at the international setting, too. Ultimately, the GMA understood itself to be the German section of the Association for Medical Education in Europe (AMEE) and received great encouragement from the then-president of the AMEE, Henry Walton of Edinburgh. The AMEE, which formed in 1972 at the same time as the World Federation for Medical Education (WFME) in the WHO office in Copenhagen, was originally a consortium of the representatives of national associations of educational institutes in medicine. Individual educational institutions (such as medical schools and medical training institutes) were able to join as associated members; personal membership was not intended at the time. The lack of a corresponding institution in the German-speaking countries, along with the disjunction of the Bestallungsordnung für Ärzte (followed by the Approbationsordnung für Ärzte in 1970) and of medical education in Germany from international developments overall, had the consequence that at first both the AMEE and WFME developed without any significant German influence. Since, as of 1972 not only the AMEE, but also the WFME were close and welcome partners of the WHO headquarters, the six regional WHO offices and other UN organizations dealing with health issues (UNESCO, UNICEF, UNDP, World Bank), there was a visible lack of German participation for many important years. This was noticed, and Henry Walton, who was the first AMEE president in 1972 and later became president of the WFME in 1983, personally supported and encouraged the founding of the GMA in 1978 and of the Medizinische Ausbildung in 1984 through his contacts at IMPP in Mainz, at the Deutscher Medizinischer Fakultätentag and even with people such as Dietrich Habeck. This is very clear in his enthusiastic address for the Medizinische Ausbildung, primarily in the following statements and expectations of the AMEE:

“As the German Section of AMEE, the Gesellschaft has the responsibility to study, describe and promote medical education – in its undergraduate, postgraduate and continuing phases – for the Federal Republic of Germany. The Gesellschaft² also has responsibility to the other countries in Europe: to convey accurately and in detail the condition of medical education in the Federal Republic – its present state, its current problems, its particular strengths, and the proposals for necessary change.” [5]. This led to the election of people such as Florian Eitel, Martin Lischka, R. Peter Nippert and Peter Dieter to the AMEE board and the WFME committees, making the founding of the GMA and its journal a distinct sign that a race to catch up had begun in terms of research and practice in medical education in the German-speaking countries, particularly in Germany. The lively activities of the GMA during this time, ranging from the 8^th and 9^th amendments of the medical licensure act to the revision of the new licensure act in 2002, can be followed in suspenseful detail in the archived volumes.

In 1986 Dietrich Habeck had acquired the Hans Neuffer Foundation of the Bundesärztekammer to finance the Medizinische Ausbildung and in his prefaces to these volumes repeatedly expressed his gratitude to the then-president Prof. Dr. W. Heim and the board, as well as the foundation’s board of trustees. After the Munich-based surgeon Florian Eitel was elected as the new GMA president in 1995, Dietrich Habeck remained publisher and editor until 1997. To continue professionalizing the journal, the board decided to involve a publisher for the production and printing. This was accomplished with the Thieme Verlag of Stuttgart, which was willing to publish the Medizinische Ausbildung as a supplement to its established journal, Das Gesundheitswesen. The first volume appeared in May 1998 (see Figure 2 [Fig. 2]). An editorial council was formed consisting of Florian Eitel, Johannes Gostomcyk and Dietrich Habeck; Jörg-Dietrich Hoppe joined starting with the second volume. Florian Eitel dedicated himself with great vigor to these changes, with the goal of seeing the journal listed in the international citation index for the purpose of finally attaining an impact factor. The editorial office was spread out over different locations and there was a very large and impressive advisory council. The costs increased considerably in comparison with before, and despite continued support from the Hans Neuffer Foundation and other sponsors, Florian Eitel soon complained of financing difficulties. The GMA was still a small association and not able to shoulder the costs of a journal on its own. On the other hand, the membership fees sent in continued to increase, so that two issues were published each year, and in 2003 four issues appeared. The final volume was published in 2004 – without having attained the sought-after impact factor.

In 2003 elections were held for a new executive board. President was Eckhart G. Hahn, who in view of the GMA’s precarious financial situation quickly began negotiations with the Thieme Verlag. At the same time, in talks with the German Medical Science (GMS) – a consortium of the Deutsche Zentralbibliothek für Medizin (ZB MED), the Deutsches Institut für Dokumentation und Information (DIMDI) and the working group of the Wissenschaftliche Medizinische Fachgesellschaften (AWMF) – the possibility emerged to publish the journal as an open-access one, subject to the Creative Commons licensing conditions (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). The articles may be reproduced, disseminated and made publicly accessible on the condition that the author and source are cited, with authors retaining the rights to their work. It quickly turned out that the advantages (see Table 1 [Tab. 1]) heavily outweighed any disadvantages, so that, in pursuance with the board decision, a contract was signed by the GMA and GMS on November 26, 2004, giving rise to the GMS Zeitschrift für Medizinische Ausbildung (GMS Z Med Ausbild) that is now accessible at http://www.egms.de/en/journals/zma/. Already in 2005 (vol. 22), the first four issues appeared [6]. Eckhart G. Hahn was appointed chief editor by the executive board. The tradition in which the GMA president is also the chief editor of the journal has been kept since Dietrich Habeck’s time and continues today (see below).

Naturally, the digital issues of the GMS Z Med Ausbild from 2005-2014 (vols. 22-32) are available in the GMS archive (http://www.egms.de/en/journals/zma/archive.htm), but volumes 1-21 (1984-2004) are kept in another archive on the GMA website. Thanks goes to our member, Thomas Shiozawa, for digitalizing all issues of the printed volumes of Medizinische Ausbildung – Mitteilungsblatt der Gesellschaft für Medizinische Ausbildung. These are now on the GMA’s website under the GMS Z Med Ausbild-Archiv and can be searched using the differentiated search function (https://gesellschaft-medizinische-ausbildung.org/publizieren/zma-archiv.html) [7].

Crucial for the further development of the journal was instituting a GMA-based editorial office that works in close cooperation with the editorial office of the GMS consortium. For years, Beate Herrmannsdörfer has guaranteed the efficiency of the GMA office and the editorial office of the GMS Z Med Ausbild; in particular, this includes production of the journal and administration of the review process, website maintenance, along with the creation and distribution of the GMA Nachrichten. A most heart-felt thanks is extended to Ms. Herrmannsdörfer by the chief editors of the GMS Z Med Ausbild on behalf of all the editors and authors. With her inexhaustible energy and can-do optimism, Ms. Herrmannsdörfer contributes to the journal in a significant manner. The high level of independence shown by the editorial office has allowed for a substantial decrease in costs in relation to the publisher GMS. The cooperation with the colleagues at GMS – Simone Haas, Anita Eppelin and Ursula Arning – is excellent.

Fortunately, the GMS Z Med Ausbild is supported by a large circle of editors and reviewers, who, with their dedication and skill, have made the dynamic developments of recent years possible. Since its start in 2005, the GMS Z Med Ausbild has profited from the expertise of almost 100 reviewers. The value of their work for the quality of this journal is not to be underestimated: they all work anonymously, on their own time and without compensation. The editors, authors, and readers of the GMS Zeitschrift für Medizinische Ausbildung and the operators of the German Medical Science portal are very grateful and are aware that the journal’s quality is significantly influenced by its reviewers.

In 2010 a critical step was taken toward achieving an international profile: each entire issue is now published in two languages (German and English). An application to be included in MEDLINE^® was submitted on April 27, 2010; on March 24, 2011 the GMS Zeitschrift für Medizinische Ausbildung was accepted for indexing in MEDLINE^®/PubMed, the most important database for medical literature and one that is made available by the U.S. National Library of Medicine. Along with recognition of the academic and editorial quality of the GMS, this is also a substantial move toward better visibility of research in medical education and shows the growing acceptance of open-access publishing.

The journal enjoys an increasing number of hits (filtered, meaning without robots) (see Figure 3 [Fig. 3]); through the end of July 2014 there had already been over 80,000.

After election of a new GMA board (president: Martin Fischer) in 2011, seven new international co-editors were acquired to obtain an impact factor as quickly as possible. The current university culture forces young academics to publish in journals with impact factors, so that excellent papers are lost to the GMS Z Med Ausbild. Despite this, the number of original works has continued to increase; the rejection rate is currently about 50%. Martin Fischer has been appointed chief editor by the board, as Dietrich Habeck, Florian Eitel and Eckhart G. Hahn were before him, and he currently shares this responsibility with Götz Fabry in the function of assistant chief editor.

Together with all the editors, the chief editors are working toward even higher international visibility for the GMS Z Med Ausbild. To accomplish this, a number of well-known editors from Australia, the Netherlands, the USA and other countries have been pulled on board. The quality of the review process is extremely important to us – just as its speediness. We will be striving for further improvements in cooperation with the GMS. We are also intensively working on encouraging more international authors from non-German-speaking countries to submit their manuscripts to the GMS Z Med Ausbild. More articles dealing with dentistry, the healthcare professions, and veterinary medicine would also be desirable in future, as would be articles on interprofessionalism in healthcare. The interprofessional character of the GMA is also to be reflected more strongly by the GMS Z Med Ausbild. We are hoping that, along with topics involving education in the future, more contributions dealing with post-graduate training and continuing education will find their way into the GMS Z Med Ausbild. As can be seen, there is yet a lot to be done. The positive developments of recent years will continue for the GMA and its journal, GMS Z Med Ausbild. An impact factor will indeed be achieved and bring with it further momentum to place behind the significant academic efforts put forth to improve our field [8].

¹ An international standard number for serial publications (International Standard Serial Number or ISSN) that clearly identifies a journals or serial publication; the Centre International d'ISSN in Paris is responsible for its administration.

² Reference here is to the GMA.

The authors declare that they have no competing interests.