Germany: doctors' training to change
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7187.832a (Published 27 March 1999) Cite this as: BMJ 1999;318:832
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Dear Madam, Sir
I would like to comment on your "News" article from Déirdre Cooper-
Mahkorn on changes in the German medical education, published in BMJ No
7187, page 832.
Reading this article, as a German graduate now working in the NHS for
the past 2½ years, I was quite appalled at the generalised and in certain
parts simply false statements by the author. To point out the incorrect
statements first:
1. German exams do not include "occasional oral examinations", but every
student has a compulsory viva for his second MB and his two-leg final, in
which he/she is subject to a 45 minute - 1 hour examination in 4 clinical
subjects.
2. Bedside clinical examination in the finals have not been compulsory,
but many universities have conducted them for years and place considerable
emphasis on them.
The German medical education is more focused on theoretical and
pathophysiological aspects of medicine and disease process than the
British system. To partially counteract this, all students have to have
done a total of 16 weeks clinical elective before graduation and all
students spend their last year entirely on the wards attached to a
clinician in the subjects of General Medicine, General Surgery and one
subject of their own choice.
For the author to generalise that because of its more scientific
approach the German system is therefore "inefficient" and of "far lower
standard in comparison with medical training elsewhere in Europe" lacks
any criteria on which this statement is based upon and is harsh and
unfair.
I have worked as a Junior and Senior House Officer in the U.K. and
neither myself nor my consultants had reason to complain about me being an
unsuitable doctor because of my "low standard training". At times it
seemed in fact rather advantageous to be able to understand the clinical
problems from scratch, rather than being able to rhyme off a list of 20
causes for any condition at which British final year students so often
excel.
The ever rising numbers of German graduates working in the NHS act as
further proof that the education in Germany cannot be as bad as it is made
out in this article.
Yours Sincerely
Dr. J. Seidel
SHO in Anaesthetics
Competing interests: No competing interests
Germany: doctor's training to change
Dear Sir
Please let me comment on the article "Germany: doctor's training to
change", BMJ No 7187, 27 March 1999, page 832, by Deirdre Cooper-Mahlkorn.
Your author has very obviously either never studied medicine in
Germany or did not bother to talk to people who do.
Attempts to change the existing training scheme are not new. For many
years lecturers and students have been working together on national level
to improve some aspects of the medical training in Germany. As a elected
student representative for the Medical University of Luebeck in two years
I was involved in some of the ongoing activities. Your author got some
facts about the existing system absolutely wrong:
First, there is no whatsoever evidence that "German medical training
is inefficient, costly and far lower in standard" compared to other
European countries. Statements like these are usually made by people
completely unfamiliar with the matter and should not be printed without
verification.
Second, the final medical examination does NOT "consist mainly of
multiple choice tests and the occaisonal oral examination". In fact, the
final mark is composed of exactly 50 % multiple choice and 50% oral exams
on up to six different major clinical subjects. EVERY student has to pass
these oral exams. Therefor you can hardly call them "occasional".
Third, the German medical trainig does not really lack practical
aspects. In the first two years at Medical School every student must work
as a assistant nurse for 60 days. In the three following years every
student must do four months of electives in major clinical subjects. The
sixth and last year is entirely spent in hospital with patient work in
three major clinical subjects.
This article is embarrassing for the BMJ. You deserve better authors.
Your readers deserve them, too.
Sincerely
Dr Rolf Vogel
SHO in Anaesthetics
Royal Hallamshire Hospital
Sheffield
Competing interests: No competing interests