Undergraduate education in palliative medicine in Germany: a longitudinal perspective on curricular and infrastructural development

Abstract

BackgroundIn 2009, palliative medicine became an integrated and compulsory part of undergraduate training in Germany by legislation. After a transitional period, all medical faculties were required to provide adequate teaching with an according examination and certification procedure. In parallel, we conducted bi-annual surveys on all medical faculties in Germany to examine for potential discrepancies between the implementation process and their intended consequences on teaching time and content.MethodsFour consecutive bi-annual surveys (2006, 2008, 2010, 2012) of all 36 medical faculties in Germany were performed, using purposively for this study developed questionnaires. Likert scales and closed questions were analyzed descriptively.ResultsMedical Faculty response rate increased from 50 % in 2006 to 88.9 % in 2012. Teaching coordinators in palliative medicine primarily had an anesthesiology or internal medicine background. There was a noted increase over time of the involvement of specialized palliative care units (PCUs) as providing the setting for education. The number of faculties that were able to offer a complete 16 weeks of training in palliative medicine during the “final year” rose steadily. In addition, increased patient-centered teaching formats have been implemented over time. The faculties which offered innovative teaching formats with actors as patients (standardized patient interaction) increased, as did the total number of mandatory examinations. The number of faculties that provided compulsory teaching in a condensed manner within a single academic year increased sharply from 3 of 31 responding faculties in 2010 to 19 of 32 responding faculties in 2012.ConclusionsUntil now, teaching conditions and structures in palliative medicine in Germany have proven to be extraordinarily heterogeneous. Although professorships (“Chairs”) in palliative medicine proved to be particularly beneficial and supportive in curricular and structural development, only a minority of faculties provide leading academic positions in palliative medicine.

Undergraduate curriculum in palliative medicine at Tampere University increases students’ knowledge

“…The teaching in palliative care has increased at medical schools in many countries, but its availability still differs between universities [18, 19]. A recent study from 43 European countries demonstrated that 28 (65%) of the countries include PM in the curriculum of at least one of its medical schools, but teaching in PM in all universities was compulsory in only six (14%) of the countries [19].…”

“…Many medical schools report teaching PM, but the exact content of this education is either unknown or differs markedly [9, 18, 20]. In the medical schools of the USA, education in PM ranges from 2 hours of lecturing to weeks of patient contacts and clinical training [11].…”

Palliative care for all: An international health education challenge

“…Recently, a small number of policy initiatives have developed across Europe to redress this imbalance and increase the access to training in Palliative Care (Harden et al, 1997; Rhodes-Kropf et al, 2005; Radwany et al, 2011; Eyigor, 2013; Schiessl et al, 2013; Horowitz et al, 2014; Sweeney et al, 2014; Carrasco et al, 2015; Crawford and Zambrano, 2015; DeCoste-Lopez et al, 2015; Eychmüller et al, 2015; Ilse et al, 2015; Centeno et al, 2014; General Medical Council, 2018; White et al, 2019). For example, Ilse et al (2015) report on the effects of the 2009 legislation in Germany that resulted in undergraduate education in Palliative Care being compulsory across all medical schools. Whereas White et al (2019) report from the UK that training in Palliative Care is inconsistent across courses and professions and the course organizers express frustration at the lack of resources, funding and time to include more training.…”

Comprehensive Cancer Center (CCC) in Deutschland: Ergebnisse einer Befragung zu Empfehlungen für die Palliativmedizinische Lehre im Medizinstudium

“…Der SWS-Anteil in anderen Einrichtungen ist um ein Zweifaches höher [6 -8]. Die Hälfte der deutschen Universitätskliniken hat für die palliativmedizinische Lehre 23 Unterrichtseinheiten eingeplant [8]. Eine Wahlmöglichkeit im Rahmen des Praktischen Jahres (PJ) in der spezialisierten Palliativmedizin wahrzunehmen, ist derzeit in 64 % der CCCs im CCC-Netzwerk gegeben [7].…”

“…Eine Wahlmöglichkeit im Rahmen des Praktischen Jahres (PJ) in der spezialisierten Palliativmedizin wahrzunehmen, ist derzeit in 64 % der CCCs im CCC-Netzwerk gegeben [7]. Unterschiede bezüglich der Integration palliativmedizinischer Lehre in die medizinischen Fakultäten sind sowohl deutschlandweit [6,8] Methods In a panel of experts from the Palliative Medicine workinggroup within the CCC network, nine statements about teaching in the CCCs were formulated based on guidelines and catalogues. 14 physicians with management and teaching responsibilities from the palliative care facilities of the CCCs were surveyed about a quantitative design using an online questionnaire.…”