All findings were stratified following the typical chronological career path of a medical student. No studies on human or animal subjects were performed. Medical education in the Federal Republic of Germany is offered through one of the 36 medical faculties of public universities that are tax-funded through the respective states [ 11 ].
Private universities, including but not limited to the Universitaet Witten Herdecke, or the Austrian-based Paracelcus Medizinische Privatuniversitaet with a location in Nuremberg, are a small minority and are not considered within this review. Almost 80, students are enrolled in a medical program. Each year, almost 10, new students begin medical school while 6, successfully graduate [ 12 ]. The curriculum defining the number of classes, minimum requirements, and guidelines for examinations is designed by federal officials of legislature and subsequently written into law: It aims to ensure that all students in Germany receive the same level of education and can later provide high quality patient care regardless of the location of medical training.
The universities have the freedom, however, to execute these requirements in a fashion and order as they see fit, as long as they follow the legal guidelines [ 14 ]. Every German resident with an advanced high school diploma Abitur or foreign equivalent is eligible to apply to a medical program. Due to the increasing popularity of spots in medical faculties, matriculation into medical school has become extremely competitive.
Recent estimates demonstrate approximately 5 or more applicants per spot in public universities, depending on class and year [ 15 ]. The major criterion for a succesful application and matching in one of the medical programs is the grade point average, or GPA Abiturschnitt , after leaving high-school Gymnasium. Certain faculties even provide additional GPA credit for superior performance in scientific classes during high school. During the application process, the high school graduates need to choose up to 6 universities they are planning to apply for and rank them in order of preference.
Moving on, the Stiftung fuer Hochschulzulassung distributes the available over 9, spots in German medical schools threefold [ 18 ]: Cutoffs for GPA with bonuses via the internal distribution process were around 1. Defining ideal admission criteria will remain a subject of ongoing debate between students, medical faculties, and politics [ 14 ]. Overall, the process is not without some intricacies.
Three rounds of ranking and matching are typically needed to assign all the available spots and the last students are informed about their successful acceptance as late as October — at which point most universities have already begun orientation and first lectures. The six year German medical curriculum consists of 2 major parts: During the first four semesters of medical school the students partake in classes of basic science such as chemistry, biology, organic chemistry, physiology, physics, psychology, as well as microscopic and macroscopic anatomy.
Teaching is provided by voluntary lectures, mandatory seminars and practical courses, such as the cadaver lab.
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Upon succesful completion of all 16 credits and a mandatory unpaid 3-month nursing internship, which is comparable to a nursing assistant in the U. This exam consists of two stages, a two-day multiple-choice part of items [ 21 ] and a one-day oral test in small groups lead by three faculty members of anatomy, organic chemistry, and physiology.
Upon passing both parts of the first exam with a grade of 4 American equivalent: D or better, the medical student is permitted to start his clinical segment of medical school [ 20 ]. The initial three-year segment of semesters five through ten covers all relevant clinical subjects from surgery, orthopedics to pathology, microbiology, and genetics. In recent years, many faculties have additionally started so-called interdisciplinary classes combining medical, surgical, and pathological aspects into one block based on disease entity. In addition to the core clerkships that usually last one or two weeks each, each student must individually select 4 months of rotation during their vacation between winter and summer semesters: Once these criteria are fulfilled, medical students in Germany typically partake in the second state board exam after their 5 th year of education.
It entails multiple-choice questions [ 21 ] over a course of three consecutive days. In recent years, German universities have begun to implement more innovative and practical aspects into the clinical segment of medical training. This includes the use of standardized actor-patients and classes for communication skills together with colleagues from psychosomatics. Problem-based and computer-based learning are gaining the attention of faculties, too. In addition, students are now required to evaluate their lectures and courses on a regular basis, which has helped raise satisfaction with the current teaching formats [ 14 ].
They employ curricula that simultaneously spread both theoretical knowledge and clinical skills from the very first day. In addition, they suggest changes to the current board exams, the division of the final year of medical school into four instead of three segments, and mandate scientific projects for all students [ 22 ]. The German Council of Sciences Wissenschaftsrat , an independent counseling agency for scientific-political topics, has recently issued an official statement advising German lawmakers to expend these model programs to all public universities [ 23 ].
Next, the final year of medical school constitutes three rotations of 16 weeks each: Sub-rotations within the institutions are common and this period is often also used as an opportunity for away rotations at affiliated teaching hospitals or even abroad at accredited medical universities [ 9 ]. This final year additionally serves the purpose for the medical students to get in contact with their desired departments and plan their application process for a future residency.
Afterwards, the third and final state board exam takes place. This is a 4-hour oral examination similar to the oral stage of the first board exam. Overall, the minimum length of medical school in Germany is defined as 6 years and 3 months [ 20 ]. Depending on the underlying nature of the project, it might necessitate one or a few semesters of absence from classes.
In the United States, however, a doctoral degree, either as M. The highest rank of teaching at German universities is a postdoctoral lecture qualification Habiltation. This status is implemented in a very standardized fashion at all public German universities but certain details may differ. After habilitation, the faculty member must continue to be involved in his clinical field in terms of science and student education to maintain this high academic status [ 25 ].
Nevertheless, current trends seem to favor teaching in the practical setting and in smaller groups rather than large lectures. Due to limited numbers of academic personnel, the participation of resident physicians, fellows, and even senior students in peer-teaching sessions [ 26 ] is becoming more crucial.
Ferdinand Sauerbruch
In these instances, faculty members with Habilitation need to educate and prepare their younger colleagues individually for their upcoming classes to ensure high-quality education for all medical students. Furthermore, those physicians interested in academic careers have the option to pursue graduate education to demonstrate their teaching qualification objectively.
Graduate programs leading to a Master of Medical Education MME [ 23 ] and similar degrees are available and have shown positive impact on healthcare professionals in previous studies [ 27 ] yet their value still needs to be verified on a larger scale. The public universities and their respective medical faculties discussed in this report are predominantly government- and thus tax-funded, as it has been the norm for many decades in Germany. Today, merely administrative fees exist ranging around 50—90 Euros per semester as well as discounted tickets provided by the universities for unlimited use of public transportation ranging from 50 to Euros per semester.
Generally, cost of living, particularly housing [ 30 ] in the more expensive cities, has been the major financial burden for students in Germany. For these reasons, many scholarship offers are more focused on specific student groups, such as political parties or religious communities rather than reaching out to the general student body [ 31 ]. The largest providers of collegiate financial support are the so-called Deutschlandstipendium , which reached merely 0.
Akin to many other industriliazed nations, Germany is facing the challenge of a constantly aging population requiring attention from medical professionals [ 36 ]. Unfortunately, this demand does not seem to be met by the large numbers of new physicians graduating every year. Of those that start medical school, about a third do not graduate. Of those that do, many opt for alternative careers outside of patient-care, such as research, administration, or the private industry sector.
Others may only work part-time or pursue a residency abroad in the pursuit of better training, a harmonic work-life balance, or higher compensation [ 37 ]. For these reasons, Switzerland has been the number one destination for emigrating German physicians. Young physicians that decide to commence residency Facharztausbildung in Germany need to apply independently at various accredited institutions unlike during the centralized and nation-wide application for medical school.
Residencies in general last a minimum of 48 to 72 months depending on specialty. An array of fellowships Zusatzbezeichnung can be obtained after succesful completion of residency. Interestingly, some smaller hospitals and their respective program directors may not have full credentials for the entire spectrum of clinical rotations to complete the specific residency, so residents may have to complete parts of their residents at different institutions.
One upside to this tradition is that a residency can commence at any time of the year when there is a free resident employment offer at an accredited instritution. While there are guidelines for resident hours and compensation [ 38 ], employment length and other minor details can be negotiated individually. More competitive specialties with greater numbers of applicants may therefore have more leverage in their hiring process.
Futhermore, particularly surgical specialties bear catalogues of minimum procedures that need to be performed before applying for the board certification with the state [ 39 ]. A thorough analysis of each specialty would be beyond the scope of this report. In summary, residency training in Germany is highly variable and dependant on multiple factors. There is a total of medical schools in the United States, of which are allopathic [ 40 ] and 33 of which are osteopathic schools [ 41 ].
Of the allopathic schools that graduate students with an M. The osteopathic programs have become very similar to allopathic ones with the difference that their curriculum includes bone and joint manipulation. Considering the continuously rising popularity of careers as physicians, these osteopathic schools are quickly increasing in numbers to somewhat compensate for the rising demand [ 7 ]. Many American students, finding acceptance into US medical schools exceedingly competitive, often opt for international schools, most commonly in the Caribbean.
However, detailed discussion of medical training through Caribbean medical schools is beyond the scope of this review. The Flexner Report, written by Abraham Flexner and published in , has been attributed to greatly influencing the current medical education system in the United States [ 43 ].
More specifically, the report called for higher admission and graduation standards at medical schools in addition to teaching more structured and established aspects of mainstream science and medicine. There has been concern in the past that the medical school curriculum places too much emphasis on the natural sciences at the expense of the psychosocial, humanistic, and professional aspects of medicine [ 44 ]. The 4-year-long Flexner model of two years of basic science instruction followed by two years of clinical experience has been rigorously maintained.
This process ensures and maintains educational rigor across institutions [ 45 ]. Pre-clinical years generally span 2 years, during which students attend didactic lectures and focus on the natural sciences. Clinical exposure is standardized to 2 years, providing students the opportunity to practice clinical sciences and patient interactions. However, similar to German tendencies, recent medical education reform has transitioned to including greater integration of clinical application and humanistic qualities of the profession earlier during training, moving away from the traditional Flexner model [ 46 ].
The transitions may include the change from large audience lectures to classes of smaller groups and the earlier implementation of clinical knowledge. Due to many federal regulations in form of Institutional Review Boards IRB any reforms demand time to be successfully tested [ 7 ]. There are two paths to gaining acceptance into a medical school in the United States.
These requirements vary by school but most commonly include one year of biology with lab, one year of general chemistry, one year of organic chemistry with lab, and one year of physics. Alternatively, high school students may enter a combined B. One benefit to these programs is that students may forego the typical medical school admissions process that most pre-medical students undergo at the end of their undergraduate careers.
Additionally, these programs are often in the form of accelerated 6- or 7-year programs as opposed to the traditional 8 and most, but not all, relinquish the student from MCAT requirement. Application numbers to medical schools in the United States are at an all-time high and increasing every year. Most recently, 53, applicants applied in and 21, matriculated, yielding an acceptance rate of The rate of growth in medical school positions has not matched the rate of demand, and therefore the last several years have demonstrated an average downward trend in acceptance rate with few exceptions.
Studies have shown that scores on the MCAT have limited predictive validity for medical school performance and licensing exam measures [ 48 ]. With the understanding that objective measurements including test scores and grades are not sufficient to identify candidates who will go on to become competent and successful physicians, the medical school admissions process has moved toward a more holistic approach including increasing the weight of nonacademic data [ 44 ].
In recent years, the educational format in many U. Several studies have reported that group learning in PBL may have positive effects. However, additional research is required to obtain more insight on the cognitive and emotional effects on medical students in this format. Simulated patient encounters and improvements in simulation technology, now providing students with mannequin-robots that talk, blink, breathe, and move, have provided medical students of this era with increased opportunity to develop autonomy in a safe, realistic, yet artificial environment [ 45 ].
This test holds great weight in residency admissions, therefore medical students commonly spend large amounts of time studying on their own or in groups [ 50 ]. The USMLE Step 1 is generally taken at the end of the second year of medical school, although there are a few exceptions. Immediately following Step 1, students generally begin their third year, marking their transition into the clinical years. The third year of medical school is structured to ensure exposure to core disciplines of medicine, including internal medicine, surgery, obstetrics and gynecology, psychiatry, and others.
Students are encouraged to decide on a specialty to pursue by the beginning of their fourth year, as this time is more flexible, allowing students the opportunity to create a schedule tailored to increasing exposure to their desired specialty. This exam is divided into two sections: The test is assessed by three criteria: Students graduating with an M. Regulatory bodies as well as individual institutions have enacted policies to maintain teaching standards in U.
In March , the American Medical Association AMA on Medical Education approved faculty credit for teaching medical students and residents as an activity that can be certified for credit. Physicians use CME credit to demonstrate participation in educational activities to meet requirements for state medical boards, medical specialty societies, specialty boards, hospital medical staffs, the Join Commission, insurance groups, and others [ 52 ], [ 54 ]. Several medical schools in the U. Ohio State University OSU , for example, states that the receipt of University salary entails a requirement to teach, principally to medical students, but may also be applied to the teaching of undergraduate and graduate students as well.
OSU expects faculty physicians to allocate one half-day per week for teaching obligations [ 56 ]. Harvard Medical School Masters in Medical Education Program similarly places high priority on the advancement of medical education through research, skill building, and innovation, thereby seeking to transform medical education in the service of advancing the health sciences and healthcare [ 57 ].
Professionalism standards nationwide have also received much attention at medical schools, particularly during recent curricular reform. This increased attention to professionalism at the medical student level has also been attributed to propagating attention to professionalism among faculty, residents, and staff [ 58 ]. The cost of medical school tuition in the United States has developed a reputation worldwide for being exceedingly expensive. These figures do not include living expenses, which vary in each locale. The majority of tuition and living expenses are paid by family contribution or loans.
Part-time employment is uncommon among medical students in the United States, and in many schools strictly forbidden. Few students are fortunate to receive significant scholarships to alleviate the financial burden of medical school. The significant debt of graduating medical students is considered the major burden of becoming a US physician. These costs translate to the fact that the United States operates the most expensive healthcare system in the world [ 7 ]. The NRMP came about in in response to dissatisfaction with a decentralized and highly competitive market in securing a residency position.
This program standardizes the entire application process across nearly all specialties and somewhat mitigates the bureaucratic difficulties for foreign medical graduates. Two specialties, including urology and ophthalmology, utilize their own separate matching process outside of the NRMP. Both urology and ophthalmology do, however, use the NRMP in securing preliminary or transitional training years. Medical students apply to the residencies in their desired specialty during their fourth year. The application cycle is standardized using one of the three matching processes listed above, depending on specialty.
Strict restrictions and regulations regarding contact between applicants and programs is enforced to maintain the integrity of the matching process and reduce inequities in securing a residency position. Share your thoughts with other customers. Write a customer review. There's a problem loading this menu right now.
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