How is the course structured?
Medicine students need perseverance, as the degree takes at least twelve semesters to complete. "There's a great deal to learn, but at the end, you are familiar with the entire body," affirms Tim Rattay, who is studying in Münster and currently on his practical year. The standard period of study until the second part of the doctor's exam (Ärztliche Prüfung, as the second state exam is officially called) takes an average of six years and three months. It is possible to apply for a licence to practice as a doctor after this (Approbation), however further qualification as a specialist doctor is required to open a practice. This takes five to seven years during which the young doctors generally work as assistant doctors in a clinic. The course is divided into two sections: the pre-clinical study phase and the clinical training phase. The three main subjects during the pre-clinical study phase are Anatomy, Physiology and Biochemistry; Physics, Chemistry, Biology, Terminology and Medical Psychology and Sociology are also covered. The knowledge imparted to students during the Anatomy lectures is developed in the dissection course: they open up cadavers. "Setting eyes on a dead person for the first time is a bizarre experience," recalls Tim Rattay. "But you then spend week after week with the 'body donor', as we call it. The fascination with anatomy soon overshadows this." Lectures are the typical form of teaching, though there are also seminars, lab sessions and dissections courses. During the semester breaks in the pre-clinical study phase, students complete a first-aid course and a three-month nursing placement. The first major exam is taken after four semesters at the earliest: the first part of the doctor's exam (Ärztliche Prüfung, previously known as the Physikum). Over a two-day period, students must answer more than 300 multiple choice questions and complete three oral exams in Anatomy, Physiology and Biochemistry. This is followed by the clinical phase comprising 22 disciplines, which range from Occupational Medicine to Pharmacology, and 13 interdisciplinary intersecting subject areas such as Medical Computer Science and Health Economics. Palliative Medicine, so treatment of the dying, constitutes the most recent addition. Everyday working life is introduced through block placements in university clinics and teaching hospitals in small groups mostly comprising four to ten students that last several days. In the clinic, they watch doctors perform operations and learn examination techniques: how do I listen for lung diseases? Has the patient ruptured a ligament, or merely strained it? Students learn how to stitch wounds in the suture course ? often on pig skin first. During the clinical phase, students complete their medical traineeship (Famulatur) in the lecture-free period ? work placements lasting a total of four months, some of which are spent at a doctor's surgery and some in hospital wards. In the last year of study, the practical year (Praktisches Jahr ? PJ), students work in a hospital ? generally without pay. Four months in Internal Medicine and Surgery are mandatory; students are then free to select a third station. "The practical year is the dress rehearsal for the training received," tells Dieter Bitter-Suermann, President of Hanover Medical School. The practical year is followed by the second part of the doctor's exam (Ärztliche Prüfung). Students call these exams the "Hammerexamen" (lit. "hammer exams"): knowledge from all areas of medicine is assessed over a three-day period, whereby each day features five hours straight of multiple choice tests. During the bedside oral exams, the students make diagnoses and suggest the appropriate treatment.
New developments
Pilot courses have for years examined how the degree in Medicine can be made more practice-oriented. A few such offers are already available ? at the universities in Aachen, Berlin, Bochum, Hanover, Cologne and Witten/Herdecke, for example. "In the pilot courses, students are in contact with patients from the offset; no distinction is made between the pre-clinical and clinical subjects," explains Bitter-Suermann. During problem-oriented learning, students work in groups to diagnose patients according to their clinical history and seek treatments options. In most pilot degrees, such courses already feature on the syllabus in the first few semesters. "From the second week, I was already examining my first patients under the supervision of a senior ward physician," tells David Weber, a student in the fourth semester of the pilot course at the Charité in Berlin. "This is tremendously motivating." Similar to other Bachelor's courses, his degree in Medicine is organised into modules. In the "sense organs" module, for example, teachers from all medical disciplines teach together, such as about the structure of the eye, which diseases it can be affected by, and how these can be treated using surgical procedures. While the pilot courses also lead to the state exam, the route to this is set by the universities themselves. At other universities, such as Heidelberg, attempts are also being made to improve the training, however they adhere more closely to the new regulations from 2002 on licensing doctors (Approbationsordnung). These courses are known as "reform courses" ("Reformstudiengänge").
Aptitude, obstacles, misconceptions
The workload is high from day one in the degree in Medicine. The cohesion among students often helps ease this however: "The large amount of learning late into the night and the shared experience ? of dissection, for example, means you quickly grow together," says Berlin student, David Weber. This perhaps also explains why the dropout rate is so low for Medicine: it is under ten per cent. A further reason could be that it is extremely difficult to obtain a study place. Those who manage to gain one tend to make it through the course. Applications are made centrally via hochschulstart.de (formerly ZVS). For most study places, the universities select applicants, whereby the average marks always play an important role and are sometimes even the only criterion. In the past ? and even when other selection criteria were applied ? a minimum of a 1.9 had to be obtained; at sought-after universities such as Heidelberg, even applicants with an average of 1.1 have been unable to gain a place on a course in the past. The waiting period for those with lower marks is several years. 14 universities also take the Medicine test (Medizinertest) into account: those who achieve good marks in this can improve their chances. Those who have to wait can bridge the time with vocational training ? as a nurse or medical technical assistant, for example. Some go overseas when unable to fulfil the numerus clausus. Besides German-language courses in Austria and Hungary, English-speaking courses in Eastern Europe are also popular.
Career prospects
After qualifying as a specialist doctor, most medics work in a hospital or a doctor's practice. The job prospects are excellent; earnings vary a great deal depending on the specialisation. While radiologists earn very well; dermatologists' pay is at the other end of the scale. According to a survey conducted in 2010 by the Hochschul-Informations-System GmbH, 90 per cent of graduates had found a job one year after completing their exams. The starting salary lay at 49,800 EUR. German doctors also work overseas ? primarily in Sweden and Switzerland. Some medics also go into research ? to develop new vaccines, for example. Others supervise studies in the pharmaceutical industry, or work in politics for the health lobby.
REPORT BY: CHRISTIAN HEINRICH
LINKS
thieme.de/viamedici: Platform on the degree in Medicine with tips for older students.
medi-learn.de: Portal featuring a discussion forum, study place exchange, tips on applying, and reports from selection interviews and clinical placements.
tms-info.org:Information page on the Medicine test ("Medizinertest").
