gms | German Medical Science

GMS Journal for Medical Education

Gesellschaft für Medizinische Ausbildung (GMA)

ISSN 2366-5017

After the game is before the game!

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  • corresponding author Christoph Nikendei - Universitätsklinik für Allgemeine Innere Medizin und Psychosomatik, Sektion Psychotraumatologie, Heidelberg, Germany; Patrick-Henry-Village Heidelberg, Geflüchtetenambulanz des Zentrums für Psychosoziale Medizin der Universitätsklinik Heidelberg, Heidelberg, Germany

GMS J Med Educ 2020;37(3):Doc36

doi: 10.3205/zma001329, urn:nbn:de:0183-zma0013297

This is the English version of the article.
The German version can be found at:

Received: March 25, 2020
Revised: March 25, 2020
Accepted: March 25, 2020
Published: April 15, 2020

© 2020 Nikendei.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at


Dear Readers,

“The ball is round, and a game lasts 90 minutes.” (Sepp Herberger). And we know what to do. We have no choice. We throw everything forward. Every woman, every man. Even if we are acting defensively and time is running out. We go all in – we almost completely blow our cover. We know what to do: nearly anything – really anything. “The round thing has to go into the square thing.” (Sepp Herberger). It's that simple. With this clarity, concentration and stormy composure, thousands of scientists, health and nursing professionals, doctors and members of many other healthcare professions are currently working – no fighting the battle against a much smaller opponent – a tiny one: the new coronavirus 2019-nCoV [1], which cannot even be stopped by the tight netting of a mouth and nose protector, let alone a football net.

Faced with the current situation, it is simply unthinkable to write a medical text without making a reference to this pandemic. Too much suffering, too many exhausted helpers, too many overwhelming experiences. 375,498 confirmed cases and 16,362 deaths in 195 countries and territories have been recorded according to the latest WHO statistics (as of 25.03.2020; []. In Wuhan, people are cautiously hesitant to leave their shelters again, while in other places they are waiting in fear – with reports from Spain and Italy breathing down their necks – for the first offshoots of the great wave of sick and respirator-dependent people. We are all preparing ourselves – bracing ourselves for the unknown. We have one of the best healthcare systems. We are well educated.

Without wanting to overtax the power of association: This issue, too, reflects part of a mosaic of many thousands of individual conceptual and scientific achievements which, taken together, will help us to overcome – and I am sure we will overcome – this current crisis. The scope of this issue ranges from interactive learning methods for improved knowledge acquisition in microscopic anatomy [2], the contribution of international mobility to medical professionalization [3] and the evaluation of interprofessional attitudes [4], to the illumination of the long-term evaluation of the medical didactic qualification within the framework of the Master of Medical Education (MME; [5]), the optimization of the evaluation of clinical-practical trials [6], the strengthening of outpatient care through the curricular implementation of learning content [7], programs to strengthen rural care [8], and train-the-trainer programs for the qualification of continuing education officers in general practice [9]. It is precisely these didacticians, teachers, scientists and authors who are making their contribution so that we do not find ourselves powerless in the face of a crisis.

Yes, they are. As if that were not enough, I am putting you through even more today. Because at the moment, in view of the many deaths caused by the corona crisis, all the stress on the helpers and the social insecurity in society, it is hard to name and believe: the corona crisis will be far eclipsed by another crisis: the climate crisis. The Lancet Countdown on health and climate change [10] has made this very clear: the health of society in future and the generations to come depends entirely on how we deal with climate change today. According to the latest study by the World Bank, 140 million climate refugees [11] will be added to the 70 million refugees currently in the world by 2050 – combined with enormous despair and suffering [12]. By the end of the current century, depending on the type of cereal, we will have seen harvests decline by up to 19% [13] and will be faced with the question of how to feed the 7.7 billion people currently living on earth. Extreme meteorological events, such as storms, floods, high water, heavy rainfall and heat waves, will cause accidents with traumatic injuries or fatalities [14] and up to 70% of the people affected will suffer trauma [15]. 8-12% of the average mortality of the total population will increase during heat waves [16], with an increase in the average earth temperature by a further 1.5°C, 1000 additional heart attacks will occur in Germany each year [17]. Phenomena, like “eco-anxiety” will continue to spread in a manner requiring treatment [18].

We are unable to see the virus. But we can all feel the rising temperature, we can all see the effects of rising sea levels, we can all hear the reports of droughts. Yet these issues are underrepresented in our medical curricula [19]. Here too, as in the Corona crisis, we must learn to listen to and trust the scientific knowledge we have been so wise in fostering and nurturing ourselves [20], even if “the truth, through its incredibility, threatens to elude detection”. (Heraclitus). This is a central task of us scientists, doctors, medical didactics and lecturers. “We are staying you! Stay home for us!” is the current motto. We have the chance of learning from the corona crisis in a way that will help us address our biggest threat: the climate crisis “by design” instead of “by disaster” as is currently the case, i.e. reacting in a controlled and targeted manner in a similarly solidarity as we are successfully mustering today instead of letting ourselves be overrun by the disaster which is inevitably coming. So as in football: we need to attack. Immediately. With all our strength. “After the game is before the game!” (Sepp Herberger). Otherwise, we are in danger of resuming the thread of a global pan-suicide [21] after the corona crisis has been overcome.

Stay healthy, everyone,

Yours, Christoph Nikendei

Competing interests

The author declares that he has no competing interests.


Zylka-Menhorn V, Grunert D. Coronavirus 2019-nCoV: Der Steckbrief des Virus ist im Fluss. Dtsch Arztebl. 2020;117(6):A-250/B-219/C-215.
Drees C, Ghebremedhin E, Hansen M. Development of an interactive e-learning software "Histologie für Mediziner" for medical histology courses and ist overall impact on learning outcomes and motivation. GMS J Med Educ. 2020;37(3):Doc35. DOI: 10.3205/zma001328 External link
Gartmeier M, Reimer M, Huber J, Epstein N, Fischer MR, Berberat PO. International mobility of students in the medical disciplines from a comparative perspective. GMS J Med Educ. 2020;37(3):Doc34. DOI: 10.3205/zma001327 External link
Pedersen TH, Cignacco E, Meuli J, Habermann F, Berger-Estilita J, Greif R. The German interprofessional attitudes scale: translation, cultural adaptation, and validation. GMS J Med Educ. 2020;37(3):Doc32. DOI: 10.3205/zma001325 External link
Jünger J, Pante SK, Ackel-Eisnach K, Wagener S, Fischer MR. Do it together! Conception and long-term results oft he trans-institutional Master of Medical Education (MME) Program in Germany. GMS J Med Educ. 2020;37(3):Doc33. DOI: 10.3205/zma001326 External link
Klein Nulend R, Harris P, Shulruf B. Predictive validity of a tool to resolve borderline grades in OSCEs. GMS J Med Educ. 2020;37(3):Doc31. DOI: 10.3205/zma001324 External link
Becker N, Barthen L, Paucher L, Gerlach FM, Sader R, Ravens-Taeuber G. The "practice track" - How can teaching content related to outpatient healthcare be integrated into medical studies? Learning objectives, conception and implementation of a specialized voluntary prgram. GMS J Med Educ. 2020;37(3):Doc30. DOI: 10.3205/zma001323 External link
Seeger L, Becker N, Ravens-Taeuber G, Sennekamp M, Gerlach FM. "Landpartie 2.0" - Conceptual development and implementation of a longitudinal priority pgroam ito promote family medicine in rural areas. GMS J Med Educ. 2020;37(3):Doc29. DOI: 10.3205/zma001322 External link
Sonntag U, Koch A, Bayer G, Heintze C, Döpfmer S. Train the trainer course for general practice trainers in ambulatory care: the Berlin model. GMS J Med Educ. 2020;37(3):Doc28. DOI: 10.3205/zma001321 External link
Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Belesova K, Boykoff M, Byass P, Cai W, Campbell-Lendrum D, Capstick S, Chambers J, Dalin C, Daly M, Dasandi N, Davies M, Drummond P, Dubrow R, Ebi KL, Eckelman M, Ekins P, Escobar LE, Montoya LF, Georgeson L, Graham H, Haggar P, Hamilton I, Hartinger S, Hess J, Kelman I, Kiesewetter G, Kjellstrom T, Kniveton D, Lemke B, Liu Y, Lott M, Lowe R, Odhiambo Sewe M, Martinez-Urtaza J, Maslin M, McAllister L, McGushin A, Mikhaylov SJ, Milner J, Moradi-Lakeh M, Morrissey K, Murray K, Munzert S, Nilsson M, Neville T, Oreszczyn T, Owfi F, Pearman O, Pencheon D, Phung D, Pye S, Quinn R , Rabbaniha M, Robinson E, Rocklöv J, Semenza JC, Sherman J, Shumake-Guillemot J, Tabatabaei M, Taylor J, Trinanes J, Wilkinson P, Costello A, Gong P, Montgomery H. The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate. Lancet. 2019;394(10211):1836-1878. DOI: 10.1016/S0140-6736(19)32596-6 External link
Rigaud KK, Jones B, Bergmann J. Groundswell: Preparing for Internal Climate Migration. Washington, DC: World Bank, Washington; 2018. DOI: 10.1596/29461 External link
Nikendei C, Greinacher A, Sack M. Traumafolgestörungen und psychische Komorbidität: Konzeption und Diagnostik. In: Borcsa M, Nikendei C, editors. Psychotherapie nach Flucht und Vertreibung: eine interprofessionelle Perspektive auf die Hilfe für Flüchtlinge. Stuttgart: Thieme Verlag; 2017. p.73-86.
Leng G, Hall J. Crop yield sensitivity of global major agricultural countries to droughts and the projected changes in the future. Sci Total Environ. 2018;654:811-821. DOI: 10.1016/j.scitotenv.2018.10.434 External link
Bunz M, Mücke HG. Klimawandel - physische und psychische Folgen. Bundesgesundheitsbl. 2017;60:632-639. DOI: 10.1007/s00103-017-2548-3 External link
Lowe SR, Bonumwezi JL, Valdespino-Hayden Z, Galea S. Posttraumatic stress and depression in the aftermath of environmental disasters: a review of quantitative studies published in 2018. Curr Environ Health Rep. 2019;6(4):344-360. DOI: 10.1007/s40572-019-00245-5 External link
An der Heiden M, Buchholz U, Uphoff H. Schätzung der Zahl hitzebedingter Sterbefälle infolge der Hitzewelle 2018. Epidem Bull. 2019;23:193-197.
Chen K, Breitner S, Wolf K, Rai M, Meisinger C, Heier M, Kuch B, Peters A, Schneide A. Zukünftige Häufigkeit temperaturbedingter Herzinfarkte in der Region Augsburg. Eine Hochrechnung auf der Grundlage der Zielwerte der Pariser UN-Klimakonferenz. Dtsch Ärztebl Int. 2019;116:521-527. DOI: 10.3238/arztebl.2019.0521 External link
Searle K, Gow K. Do concerns about climate change lead to distress? Intern J Clim Change Strat Management. 2010;2(4):362-379. DOI: 10.1108/17568691011089891 External link
Nikendei C, Cranz A, Bugaj TJ. Two slides to make you think: 2slides4future, an initiative for teachers and lecturers advocating climate change education and teacher-learner dialogue. Med Educ. in press.
Hagedorn G, Kalmus P, Mann M, Vicca S, Van den Berge J, van Ypersele JP, Bourg D, Rotmans J, Kaaronen R, Rahmstorf S, Kromp-Kolb H, Kirchengast G, Knutti R, Seneviratne SI, Thalmann P, Cretney R, Green A, Anderson K, Hedberg M, Nilsson D, Kuttner A, Hayhoe K. Concerns of young protesters are justified. Science. 2019;6436(364):139-140. DOI: 10.1126/science.aax3807 External link
Nikendei C. Klima, Psyche und Psychotherapie: kognitionspsychologische, psychodynamische und psychotraumatologische Betrachtung einer globalen Krise. Psychother. 2020;65:3-13. DOI: 10.1007/s00278-019-00397-7 External link