How are social determinants of health represented in German medical education?: a qualitative content analysis of key-curricular documents

Abstract

ObjectiveThe WHO Commission on Social Determinants of Health (SDH) has called for a health workforce trained in recognising, understanding and acting on the SDH. However, little is known about how current medical education prepares graduates for this challenge. This study analyses the extent to which the German medical education incorporates content on SDH.DesignFollowing a published protocol, in 2018, we conducted a qualitative and quantitative content analysis of three key document groups, defining and guiding what medical schools are expected to teach and what medical students are expected to know when graduating in Germany. We developed the coding system in a mixed inductive and deductive approach based on key WHO documents.SettingMedical schools and the medical education system in Germany.ResultsImportant gaps exist in the representation of SDH in medical education in Germany. Between 3% and 27% of the analysed document-elements made reference to SDH and only 0%–3% of those document elements made explicit references to SDH. While some aspects were covered widely (eg, topics of occupational health, early childhood development and hygiene), other topics such as health inequalities or determinants outside of the healthcare system were not or hardly represented.ConclusionsA stronger and more explicit representation of SDH in German medical education is needed to prepare the new health workforce for current and future challenges in our globalised world and for medical schools to be socially accountable.

What Factors Influence the Interest in Working in the Public Health Service in Germany? Part I of the OeGD-Studisurvey

“…Thus, our findings are in line with experts and stakeholders from the public health community calling for a stronger anchoring of the PHS and PHS-related topics in the curricula [ 68 ]. Insufficient coverage of public health-relevant topics may contribute to a lack of awareness of the importance of organized efforts needed to improve population health [ 71 ].…”

“…There are many factors that could explain why students struggle to assess trends and differences in LE correctly. In addition to gaps in general education and misreporting in the media, the correct assessment is also likely to be hampered by the lack of curricular anchoring within medical studies [ 68 , 69 ]. While our findings indicate a more complex relationship between public health knowledge and interest in working in the PHS, the identified gaps in knowledge support previous calls for including or strengthening public and global health components in the curriculum of all PHS-relevant professions [ 70 ].…”

Support for global health and pandemic preparedness in medical education in Germany: Students as change agents

“…9 It is important to note that most complex suggestions for strengthening global health in medical education have been introduced, at first and foremost, by the national medical student association and their various representatives over time. [11][12][13]17,18,27,28,[43][44][45][46] These authors have identified a wide range of topics and challenges relevant to global health education, including a health systems approach and the social determinants of health, among others. 46,47 To this end, developments in global health education seem to mirror wider societal movements strongly driven by young people, most prominently known from climate change activism.…”

“…[11][12][13]17,18,27,28,[43][44][45][46] These authors have identified a wide range of topics and challenges relevant to global health education, including a health systems approach and the social determinants of health, among others. 46,47 To this end, developments in global health education seem to mirror wider societal movements strongly driven by young people, most prominently known from climate change activism. Authors from the networks of medical students and early career professionals also directed attention to the implementation of global health education and the importance of actor networks.…”

How to Increase the Attractiveness of the Public Health Service in Germany as a Prospective Employer? Part II of the OeGD-Studisurvey

“…Furthermore, it was repeatedly proposed to improve contact with and insights into the PHS through providing internships or more exposure to the practice of the PHS during the study [ 7 , 8 , 11 , 12 , 13 , 14 ]. Other options for overcoming the shortage of (young) professionals include a stronger anchoring of public health-related topics in the curriculum of medical studies and other studies with potential relevance for the PHS (e.g., in the social or political sciences) [ 7 , 13 , 15 , 16 ], and a general improvement of research opportunities and/or strengthening public health research within the PHS [ 7 , 13 ].…”