German government shortens medical trainingBMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7424.1127 (Published 13 November 2003) Cite this as: BMJ 2003;327:1127
The German government has decided to abolish the final practical phase of medical education, the so called “Arzt im praktikum” or prequalifying medical placement.
Before fully qualifying as doctor, medical students have had to work in this houseman-like position for one and a half years on low pay but with similar duties to those of a junior doctor.
The scheme was introduced in 1988 because it was felt that medical students needed to acquire more practical skills before they were accepted as fully qualified doctors. Doctors and medical student organisations criticised it heavily, however, because it covered up the severe deficits in practical clinical teaching of earlier student years and prolonged the time at university unnecessarily. Furthermore, medical students on the scheme were grossly underpaid, the German hospital doctors' association (the Marburger Bund) said.
Currently, a medical student in Germany qualifies after a minimum of seven and a half years. This includes two years of preclinical studies, three years of clinical studies, one year of clinical practice in three medical subjects, and the final one and a half years on the prequalifying medical placement. They have to pass four examinations, the last one before the placement.
But from 1 October 2004 medical students finishing their studies in that year will be able to finish their studies after a minimum of six years. As a fully qualified junior doctor they will receive about €;3000 (£2062; $3455) a month—about three times the salary under the current scheme.
There will be only two major examinations, one after the preclinical phase and the last one after the practical year, but examinations on the individual clinical subjects will be held after each course.
The abolition of the prequalifying medical placement was preceded by a major reform of medical education in 2002, which now has fewer theoretical and more practical parts, including bedside teaching and problem orientated learning.
The German health minister, Ulla Schmidt, welcomed the decision and said that she expected the medical profession, especially in hospitals, to become a more attractive job option again. Currently, about a third of qualified doctors leave medicine.
The president of the German hospital doctors' association, Frank Ulrich Montgomery, said that it was high time to dismiss the scheme but pointed out that junior doctors are still grossly underpaid. He also criticised the fact that medical students who pass their examinations before October 2004 still have to undergo 18 months on the scheme, although partly with higher pay.
German hospitals, already under financial pressure from the health reform, face further increases in their budgets—of about 20%—through the abolition of the scheme.