germany - a great place for knowledge - medicine

8/13/2019 Germany - a Great Place for Knowledge - Medicine

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Medicine


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2 Germany a Great Place for Knowledge

Human medicine in Germany

CONTENTS

Studying human medicine in Germany there is hardly any othercareer plan that is more exible and more reliable at the same time.For there is a wealth of opportunities open to graduates in medicine:besides employment in a hospital or in general practice, there are also jobs in research, in industry, in the public health service or in manage-

ment consulting.The practical and high-quality training at German universities enjoysan excellent reputation internationally and is integrated into anetwork of hospitals, universities, research institutes and businessenterprises. Teaching, patient care and research therefore form anintegrated whole from which everyone involved benets especiallythe students.

The state examination and the doctorate leading to the title of Dr.med. are by no means the only academic training opportunitiesin Germany. Via a multitude of international masters or doctoralprogrammes, students of human medicine are able to specialise andenter very different elds of research, whether in basic research, clini-

cal research, the pharmaceutical industry or in the medical engineer-ing sector.

This magazine is intended to provide an overview of universitymedicine in Germany for anyone abroad who is interested in study-

ing medicine or in pursuing academic or medical further training. Therst articles deal with the importance and performance of universityhospitals, health centres and medical competence networks.

The higher education landscape and various degree course concepts

are presented under the heading studying medicine. Foreign stu-dents are also given tips on how to get a place at university and thebest way to commence studying.

Another section is dedicated to doctoral studies and internationalpost-graduate programmes, most of which are conducted entirelyin English and guarantee special support for foreign graduates ordoctoral students both in issues related to their studies and in generalissues. These programmes generally lay the foundations for an aca-demic career.

Finally the excellent career prospects of graduates in human medicineon the German labour market are examined. The development whichis becoming apparent for the coming years is likely to open up good

job opportunities also to foreign graduates and to all foreign studentswho are considering the idea of staying in German after nishing theirdegrees.

We hope you enjoy reading the magazine!

UNIVERSITY MEDICINE4 Everything under one roof

University hospitals train doctors for patient care and medicalresearch

6 University hospitals stand for top-class medicine Interview with Rdiger Strehl, secretary-general of the

Association of University Hospitals in Germany (VUD)7 Combining and linking competences Nobel Laureate Professor Harald zur Hausen on networks in

health research and the passion for research

STUDYING MEDICINE8 Learning for tomorrows medicine An overview of medical degree courses at German

universities10 Effective training with great chances of success Professor Dieter Bitter-Suermann, President of the Associa-Professor Dieter Bitter-Suermann, President of the Associa-

tion of the German Medical Faculties (MFT), on studyingmedicine

11 Helping foreign students to get started Universities support international students to integrate by

means of mentoring schemes12 Training with simulators In Leipzig modern teaching concepts and training centres aid

patient-oriented training14 Medical degree courses in a state of change? At the bedside as soon as possible new degree courses at

seven universities test new training methods15 Lively culture of teaching and learning Professor Stefanie Ritz-Timme, dean of studies of the Faculty

of Medicine, about the teaching model at the Heinrich Heine

University Dsseldorf 16 It becomes routine some time Elina Puska from Finland spends her clinical year at Rostock

University Hospital17 Seeing eye to eye with the patient Professor Bettina Schne-Seifert explains how doctors-to-be are

prepared for ethical challenges of modern medicine


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Medicine 3

CONTENTS

Simulation dolls at the University Hospital Regensburg Mentoring schemes provide support for international students Problem-based learning at Witten/Herdecke University

It all becomes routine during the clinical year Many doctors are involved in research projects Almost half of all graduates in humanmedicine work in a hospital

5 11 14

16 18 26

CAREERS AND OCCUPATIONS26 Shortage of doctors creates career opportunities The German labour market provides excellent basic conditions

and a broad career spectrum for graduates in medicine28 Cold plasma hot stuff At Schwabing Hospital in Munich Dr Georg Isbary is in charge

of a study concerning the use of plasma therapy to disinfectwounds

28 Removing obstacles for young doctors Interview with Dr Martina Wenker, vice president of the

German Medical Association (BK), on the demand for doctorsin Germany

29 From fundamental research to market launch Dr Simone Breitkopf from the German Pharmaceutical Industry

Association (BPI) on elds of work and career opportunities inthe pharmaceutical industry

30 Anaesthesia requires training To Germany for medical specialty training Dr Dejan Arsic from

Serbia is a senior house officer in anaesthesiology

HEADINGS31 Important links at a glance31 Imprint

DOCTORAL STUDIES AND GRADUATE PROGRAMMES18 Alternatives to Dr. med.

Doctors with an interest in science have lots of options forfurther training

20 An interdisciplinary look into the brain In the Medical Neurosciences masters course in Berlin the Rus-In the Medical Neurosciences masters course in Berlin the Rus-

sian student Natalia Denisova, and her colleague from China,Tian Zhang, focus on dementia, Parkinsons and chronic pain

21 Health for everyone Managers for the public health sector are trained in the post-

graduate course International Health in Heidelberg. TheGhanaian Dr Nicholas Kyei is one of them

23 Looking into the body and growing organs The Biomedical Engineering masters programme in Aachen has

the necessary know-how for engineers and doctors like SimoneLaffar, and Donsuk Pongnikorn from Thailand

24 War of the cells how the body defends itself The doctoral students Dr Stephan Halle and Pooja Mishra

from India conduct research in the eld of infection biology inHanover


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UNIVERSITY MEDICINE

Training, research, patient care

Everything under one roof University medicine is the backbone of Germanys health care system. How this is to be understood is bestseen from the structure and function of a university hospital. Medical training, medical research and patientcare take place virtually under one roof there, as can be shown from the example of the University HospitalRegensburg.

The University Hospital Regensburg is sit-uated on extensive premises in the south ofthe city in eastern Bavaria, right next to theUniversity of Regensburg. Founded about 20years ago, it is one of the most modern andmost efficient hospitals in Germany and hasdedicated itself to high-performance medi-cine. Appendectomies and other standardoperations are conducted at the hospitalsthat cooperate with us, says Professor Bern-hard Weber, dean of the Faculty of Medicine,describing the orientation of the hospital.We specialise in serious progressions ofdiseases and sophisticated diagnostics.A development of this type in the eld ofhigh-performance medicine is only possiblebecause the University Hospital Regensburg

is closely linked with hospitals in the regionproviding other health care levels.

1.7 million patients per yearRdiger Strehl, secretary-general of theAssociation of University Hospitals inGermany (Verband der UniversittsklinikaDeutschlands VUD), expresses it veryclearly: Without university hospitals therewould not be a German health care systemfunctioning at such a high level. They coverten percent of all hospital treatment inGermany and are an important employer ofmedical practitioners. They employ a totalof over 26,000 doctors and scientists. About1.7 million patients are treated as in-patientsat the university hospitals per year, with

about four times as many being treated asout-patients, Rdiger Strehl says, substanti-ating the situation with the relevant gures.

This is top-class medicine: in 2009 17 hearts, 61 livers and 64 kidneys were transplanted at the University Hospital Regensburg, and bone marrow was transplanted 109 times.

Professor BernhardWeber is the dean ofthe Faculty of Medi-

cine at the Universityof Regensburg.


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Medicine 5

Taken together the university hospitalsprovide the entire spectrum of medical ser-vices. Each one has its own specialist elds. InRegensburg they are transplantation medi-cine and intestinal and metabolic diseases.They are complemented scientically byspecial research expertise in immunopathol-ogy and immunotherapy and in integratedfunctional genomics. It makes sense toconcentrate highly specialised procedures in just a few locations, Rdiger Strehl empha-sises, in order to bring together expensivestructures and specialists there.

State-of-the-art, high-techequipmentWhat is also important is the fact that theuniversity hospitals function as role modelsfor other hospitals. Rdiger Strehl says, Newprocedures are often developed at univer-sity hospitals. This makes them strong inspecialised operations, such as in the eld ofneurosurgery or in the treatment of specialprogressions of diseases. In Regensburg, forexample, a so-called pacemaker for pain isused to treat patients with chronic back pain.This is a neurostimulator which is unique inthe world and registers how the patientsbody position changes and automaticallyadjusts the stimulation in order to provideadequate pain relief.

To be able to provide patients with thehighest level of care and to take researchforward, more than 100 million are in-vested in high-tech equipment at universityhospitals every year, VUD secretary-generalStrehl knows. Particular progress has beenmade, for example, in the development

UNIVERSITY MEDICIN

Just under two millionpatients per year

About 180,000employees

About 78,000 students About 10,000 graduates per year

Integratedresearch andtreatment centres

Competencenetworks inmedicine

Teaching(36 medical faculties)

Patient care(32 university

hospitals)Research

Tasks of university medicine

of computed tomography (CRT) in recentyears. Regensburg University Hospital haspurchased the latest 128-slice computedtomography scanner, which facilitates inparticular the diagnosis of coronary heartdisease. This miracle of technology managesto create 128 cross-sectional images of thebody simultaneously, each with a density ofless than one millimetre. This means that thecoronary arteries can be examined in detail,which used to be a difficult procedure dueto the beating of the heart. In addition thereis other expenditure for smaller equipment,

such as special incubators for premature ba-bies, which also have to be state-of-the-art,Rdiger Strehl adds.

Transplantation domain ofuniversity hospitalsTransplantation is traditionally a eld ofactivity of the university hospitals, VUDsecretary-general Strehl continues. TheUniversity Hospital Regensburg, too, is well-known for its transplantation centre where allorgans apart from lungs are transplanted. Atthe Paediatric University Hospital of EasternBavaria (KinderUniKlinik Ostbayern KUNO)liver transplants are also conducted on chil-dren and babies. What is more, so far morethan 30 articial heart systems have beenimplanted in Regensburg.

From the example of transplantationmedicine it becomes clear how patient care,research and teaching are linked in universitymedicine and how effectively the interactionis organised: Medical research relies on thelink to clinical application and contact with

patients, Rdiger Strehl emphasises. Thisso-called translation takes place above allat university hospitals. A broad exchange ofspecialised information is also possible bymeans of contact with the other faculties ofthe universities.

New treatment conceptsIn this way the transplant patients benetfrom the medical faculty located at theUniversity Hospital Regensburg and thescientic research conducted in Regensburg.For in addition to actually treating patients,new treatment concepts are also developedand tested in clinical studies. For example,the doctors and scientists want to maketransplants function longer and to reducethe side effects suffered by the patients. Theclinical and operative work is supportedabove all by research into immunology. Howcan the body be prevented from rejecting atransplanted organ? This and other questions

are the focus of numerous scientists and doc-tors-to-be, including doctoral students andundergraduates who are already involved inresearch during their medical degree courses.

A donor organ arrives part of everyday life at theUniversity Hospital Regensburg.

Training for patient care andresearchIn principle the university hospitals train doc-tors and cover the majority of medical furthertraining. At the Student Training Centre(Studentisches Ausbildungs- und Training-szentrum) of the University of Regensburg(StATUR) the students can, for example,practise examining and treating patients onsimulation dolls or prepare for communi-cating with patients. The rst contact withpatients is generally in case presentationswith interdisciplinary questions-and-answerssessions. The University Hospital Regensburgcurrently works together with eight aca-


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UNIVERSITY MEDICINE

Interview with Rdiger Strehl, secretary-general of the VUD

University hospitals stand for top-class medicineRdiger Strehl, the secretary-general of the Association of University Hospitals in Germany (Verband derUniversittsklinika Deutschlands VUD), speaks of the important role of the university hospitals in medi-cal training and explains forward-looking trends in university medicine.

How does medical training benet from

the university hospitals having a strength-ened position?Basic medical training and medical specialtytraining benet from the fact that researchand teaching can be linked directly withpatient care in university hospitals. Stronguniversity hospitals are successful in theentire task network of research, teaching andpatient care; they deliver excellent quality in abroad spectrum of treatment at economicallycompetitive prices. Students and especially

doctors doing medical specialty training therefore benet from stronguniversity hospitals because they are able to experience top-classmedicine in all medical elds there.

How is the economic situation of university hospitals? What sup-port structures are there?The university hospitals are largely dependent on public funding,which provides for investments and the funding of research and teach-ing. The payment for medical services does not differ in principle fromthat in other hospitals.

New forms of funding are being tested in university medicine. For exam-

ple, the government is promoting German Centres of Health Researchon various widespread diseases, each working at several locations. Itremains to be seen how the support structures will develop during thenext decade.

What forward-looking trends can be seen at university hospitals?One trend in medicine is the shift away from in-patient treatmenttowards more out-patient treatment. This development is important forthe university hospitals for several reasons. First, they have to displaythe traditional medical core subjects in order to be able to train doctorsand to maintain the link to research. Second, specialist care in Germanyis reserved for practice-based physicians more strictly than in any othercountry. We need to strike out in new directions in this respect.The huge levels of investment required for university medicine makesthe state governments consider privatisation or partial privatisationagain and again. For this reason in 2006 the University Hospital ofGieen-Marburg was the rst university hospital in Germany to be soldto a private investor. It is still too early to say whether this model for auniversity hospital will be permanently successful.

demic teaching hospitals in the region wherethe students do their practical training in theclinical year. The big advantage of teachingcooperations is that doctors-to-be are alsoable to gain practical experience outside theuniversity hospital, dean Weber emphasises.

The young doctors are also introduced tomedical research. Our students do excellentwork in the labs, the Regensburg dean says,full of praise for a major career step taken byabout 10 percent of medical students eachyear. In the SCIENCE MED programme ourstudents are able to acquire research skillson a voluntary basis and at an early stage intheir studies. The courses are conducted bythe Competence Centre for Medical Didactics(Kompetenzzentrum fr Medizindidaktik)and provide a structured training pro-gramme aimed at improving scientic skills,for example for work in the lab or the ap-plication of statistical procedures in research.Participation in SCIENCE MED is also an

INFORMATIONVerband der UniversittsklinikaDeutschlands e.V. (VUD) (Associationof University Hospitals in Germany) www.uniklinika.deLandkarte Hochschulmedizin www.landkarte-hochschulmedizin.deUniversity Hospital Regensburg www.uniklinikum-regensburg.de

advantage for obtaining one of the covetedplaces on the scholarship programme whichis funded by the faculty and provides nan-cial support for six to eight students per yearwho wish to spend a semester conductingresearch abroad.

In the labs of the University Hospital Regensburg re-search is conducted in the eld of immunopathology,immunotherapy and integrated functional genomics.


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Medicine 7

UNIVERSITY MEDICIN

Interview with Nobel Laureate Professor Harald zur Hausen

Combining and linking competencesProfessor Harald zur Hausen is a highly esteemed German cancer researcher. In 2008 he received the NobelPrize in Medicine for discovering the papillomaviruses that cause cervical cancer. As a long-standing scien-tic director of the German Cancer Research Center (Deutsches Krebsforschungszentrum) in Heidelberg heprovided for a groundbreaking link between basic research and clinical practice.

Professor zur Hausen, what doyou see as the advantage of themedical competence centres orcompetence networks that arebeing initiated and promoted bythe Federal Ministry of Educationand Research?I regard the setting up of a networkof competence centres in health re-search as correct and important. Asearly as the 1990s I spoke in favourof promoting large research centresand made suggestions. Today I amhappy to see these ideas being putinto practice. By combining compe-tences, research ndings can move

more rapidly from the basic and clinical research stages into medicalcare, thus reaching the patients more quickly. The best groups ofmedical researchers from universities and research establishmentsoutside universities work closely together at these centres and alsointegrate industry. In this way path-breaking ndings should beobtained as quickly as possible and treatment opportunities shouldbe established. It is also important, however, for the university institu-tions and the specialised research institutions to be recognised andrespected as equal. Germany is on the right track on the whole withthis research policy.

What importance do you attach to international researcher net-working?We rely on the international exchange of knowledge and informa-tion. When I look at my own research activity at the German CancerResearch Center, then I realise that essential parts of it are based onthe progress made and knowledge gained in worldwide molecularbiology and technology. We received a lot of help from abroad whenwe asked laboratories throughout the world for samples of cancercells in our search for the different types of human papillomaviruses.In return we made copies of our virus cultures unreservedly availableto foreign research centres, which were thus able to benet from ourinsights. What was important to me in this respect was speeding up

progress in cancer prevention.In which areas do you expect new success in cancer research?We understand more and more about the fundamental causes ofcancer and how it develops. What is important now is to integrate thisknowledge as quickly as possible into the clinical care of people suf-fering from cancer. With regard to my own eld of research, into infec-

tious diseases, I see a wealth of challenges to be tackled. Where I alsoexpect key successes for the prevention of cancer, however, is in theidentication of further possible risk factors. I am also condent thatnew methods of individualised cancer treatment will emerge in thelight of ndings in molecular biology. We continue to make progressin basic research, too, for instance in stem cell research and in se-quence analyses of genetic changes in cancer cells. Last but not leastcancer research is focusing on the further development of establishedstandard treatments, for instance the targeted use of chemotherapyfor tumours, known among experts as targeted chemotherapy. I ama passionate researcher and see that there is still so much to do.

Are passion and enthusiasm necessary driving forces for re-searchers?Yes, I think enthusiasm is an important prerequisite for exceptionalachievements in science and research. The eld of virology, which wasstill young at the time, triggered this enthusiasm in me very early on.However, enthusiasm is only a driving force for often tedious researchactivity. From my own experience I regard stamina and discipline asadditional important characteristics that researchers should possess.A healthy amount of belief in the correctness of ones own hypothesesis also necessary, since as a researcher one frequently has to defendthem with good arguments and scientic evidence.

INFORMATIONIn 2010 the German Cancer Research Center (Deutsches Krebs-forschungszentrum) took on the function of a core centre cooperat-ing with excellent university-based cancer centres in seven locations.It is therefore one of the total of sixGerman Centres of HealthResearch initiated by the Federal Ministry of Education and Research(Bundesministerium fr Bildung und Forschung BMBF).

In addition there are currently 21 Competence Networks in Medi-cine which are funded by the Federal Ministry of Education and Re-search and conduct research into various diseases. True to the mottoof disease-oriented research, expertise networking, knowledge

transfer, scientists, doctors and patient organisations have joinedtogether in these networks.

In the umbrella organisation TMF e.V. the competence networkswork together with other medical research associations in order tosolve general issues and to improve quality standards.

www.kompetenznetze-medizin.de


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STUDYING MEDICINE

Studying medicine an overview

Learning for tomorrows medicineAnyone opting to study medicine in Germany can expect challenging and at the same time fascinatingstudies. For medical training is embedded in an excellent research environment in the faculties of medicineand is closely linked with the professional medical care at the university hospitals. Modern teaching con-

cepts bring the future doctors to the bedside at ever earlier stages in order to prepare them optimally fortheir profession.

In Germany medical training takes placesolely at universities. Across the wholeof Germany the degree course in humanmedicine is offered at 35 state universitiesand one private university. At the universi-ties human medicine is a key element inthe spectrum of life sciences. Some 11,000university places are available for new stu-dents of human medicine between Kiel andMunich, and between Aachen and Dresden

The students already wear white coats medical degree courses involve a large proportion of practical training.

During a language course in Berlin I decided to startstudying medicine in Germany. here were a lot of factorsthat influenced me in this decision, including the good reputa-tion of German universities, the fact that the tuition feesare not so high, and the hospitality of the country. he firstsemester was complicated because I first had to get used tostudent life and to overcome language barriers, but both the professors and my fellow students were always very open andhelpful. My experiences were positive throughout.

ess Nuez Quiroga comes from Mexico and is in her second semester of a degree inhuman medicine at the Martin Luther University Halle-Wittenberg.

every year. About 1,700 of the freshmanstudents are from abroad.

What all universities have in common istheir high-quality standards in training. Thisapplies equally to the teaching staff and thestudents. Anyone interested in studying med-icine should therefore have excellent schoolmarks in biology, chemistry and physics aswell as a basic understanding of medicineand natural sciences, a good spatial sense and

powers of observation, as well as communica-tion skills. Good German language skills areessential in order to be able to follow lecturesor to talk to patients. Good English languageskills are also required for reading specialistliterature, much of which is written in English.Knowledge of Latin, on the other hand, is notabsolutely necessary. Studying medicine isvery time-intensive and involves a lot of ex-aminations. You therefore need comparativelyhigh levels of personal resilience.

High training standardsThe contents and requirements of medicaldegree courses and the practical training inthe hospitals and doctors surgeries are regu-lated in Germany by the Medical LicensureAct (Approbationsordnung fr rzte AppO). This guarantees high-quality teach-ing which is patient-oriented and followspre-dened standards (see also the interviewabout the teaching model on page 15). Ina year of practical training at the end of thedegree course the students are prepared forprofessional practice (article on page 16).


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Medicine 9

STUDYING MEDICIN

INFORMATIONwww.hochschulkompass.deInformation provided by the GermanRectors Conference (Hochschulrektoren-konferenz - HRK) about higher educa-tion opportunities, universities andcolleges, doctorate opportunities and

international cooperations with Germanhigher education institutions

www.hochschulstart.deInternet portal of the Foundation forHigher Education Admission (Stiftungfr Hochschulzulassung) for applica-tions for degree courses in medicine andother subjects with national admissionrestrictions in Germany

www.uni-assist.deInternet portal of the University Applica-tion Service for International Students(Arbeits- und Servicestelle fr auslndis-che Studienbewerber)www.anabin.deInformation system of the Central Officefor Foreign Education Systems Zentral-stelle fr Auslndisches Bildungswesenfor the recognition and evaluation offoreign educational qualications

When I was in Germany the first time five years ago Ialready liked it here very much. hen I started to learn Ger-man, partly because I have a lot of German friends. hey aremuch more fun than I used to think, by the way. I am veryinterested in the German health system and in medicine,especially the field of surgery. In addition I wanted to get toknow German working methods.

Pablo Garca Gonzalez comes from Spain and is in his tenthsemester of a degree in human medicine at the University ofHamburg.

The Medical Licensure Act (AppO) andthe good reputation of the medical degreesabroad also guarantee unrestricted occupa-tional mobility within Europe (see also theinterview on page 10 regarding the interna-tional comparability of the medical degrees).The proximity to university and clinicalresearch guarantees that medical trainingkeeps up with the latest research. It pro-vides students and graduates with diverseopportunities to enter academic careers atuniversities and research institutions.

The state examination is a qualitysealStandardised training standards do notmean uniformity, however. The faculties ofmedicine make use of the freedom theyhave in organising their degree courses andconstantly strive to integrate new medicalknowledge and new social challenges intotheir syllabuses. In order to optimise medicalteaching, motivating and practical forms oflearning are being developed, for example,by setting up skills labs or by using multime-dia-based and interactive forms of teachingand examinations (see article starting onpage 12). Innovative teaching concepts arecurrently being tested at seven universities in

the context of so-called new degree coursesin medicine (see article on page 14).

The quality of medical training is also clearfrom the high success rates: 95 percent of allstudents who start a degree in human medi-cine graduate successfully (Federal StatisticalOffice, Hochschulen auf einen Blick, 2011). Incontrast to the majority of degree courses atGerman universities, which lead to bachelorsor masters degrees, a degree in medicineends with the national Final Examinationfor Doctors (Zweite rztliche Prfung), alsoknown as the state examination. Those whopass this examination can then go on toapply for their licence to practise medicine(Approbation) and are allowed to work as adoctor.

Students in general: 78,314of which German students: 70,974of which international students(foreign students): 7,340

Sources: Wissenschaft weltoffen 2011, www.wissen-schaft-weltoffen.de; Studentenstatistik StatistischesBundesamt (student statistics of the Federal StatisticalOffice), www.destatis.de

Students of human medicine in 2010 German students

International students

90.6%

9.4%

Aachen

Berlin

Bochum

Bonn

DresdenDsseldorf

Erlangen

Essen

Frankfurt am Main

Freiburg

Gieen

Gttingen

Greifswald

Halle an der Saale

Hamburg

Hanover

Heidelberg

Saarbrcken/Homburg

Jena

Kiel

CologneLeipzig

Lbeck

Magdeburg

Mainz

Mannheim

Marburg

Munich

Mnster

Regensburg

Rostock

Tbingen Ulm

Witten/Herdecke

Wrzburg

R

R

R

MR

MM

M

MM

M

R R

R

RR

RR

R

R

RRR

R

RR

R

R

R

RR

R

R

RR

R

Universities offeringdegree courses

in medicine

R

M

= regular degree courses

= new degree courses


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STUDYING MEDICINE

Interview with Professor Dieter Bitter-Suermann (MFT)

Effective training with great chances of successDegree courses in medicine in Germany differ in various aspects from those in other European countries.Professor Dieter Bitter-Suermann, President of the Association of the German Medical Faculties (Medi-zinischer Fakulttentag der Bundesrepublik Deutschland MFT) explains why this is not a disadvantageand what requirements foreign students should full.

Medical degree courses in Anglo-Saxoncountries have the reputation of beingespecially practice-oriented. The languagebarrier is also lower there for most foreign-ers interested in studying. Is studyingmedicine in Germany attractive to interna-tional students in your opinion?Yes, denitely. Medical degree courses inGermany have become far more practice-oriented in recent years. Clinical subjects arealso considerably more prominent right at thebeginning of the course. In this respect I see

no substantial differences compared with medical training in our neigh-bouring countries. A degree success rate of over 95 percent is also a clearindicator of how effective the training at our universities is.Adequate knowledge of the German language is essential, however. Itis very important for the students to be able to communicate with thepatients. If the students have already gained some knowledge of the Ger-man language in their home countries, for example at school, that givesthem a better start in their studies here. In the eld of research, English isof course common as the language of science at German universities, too.

The faculties of medicine continue to hold on to the state exami-nation and are not planning to introduce bachelors and mastersdegrees in medicine. Could that not be an obstacle to the graduatesinternational mobility?Not at all, this impression is misleading. Only about a third of the facul-ties of medicine in Europe offer bachelors and masters degrees in medi-

cine. In countries such as Great Britain, the Netherlands or Switzerland,where there are bachelors and masters degrees in human medicine,training is continuous and is aimed at the masters degree from theoutset as the qualication required in order to be able to practise as adoctor. There are no doctors with bachelors degrees in these countrieseither. In this respect I do not see any disadvantages for our graduates ifwe hold on to the state examination in Germany.Incidentally, students of medicine are some of the most mobile at Ger-man universities. They spend an average of four months of their degreecourses studying in another country and more than a quarter of thestudents spend part of their clinical year abroad.

As a professor, what do you expect of students who come to Ger-many to study medicine?A degree course in medicine is a challenging course of studies, demand-ing the students total commitment. They should be aware of that. Actuallinguistic competence is very important in order to be able to followthe lectures and to be able to cope with the theoretical and practicalworkload. Language certicates that the students have gained are notalways a guarantee of this.Apart from that, I would wish international students to take the opportu-nity to get to know Germany outside of the lecture theatres more oftenand to get to know the country and its people. It is certainly also one ofthe faculties tasks to encourage this.

Association of the German Medical Faculties (MedizinischerFakulttentag der Bundesrepublik Deutschland e.V.)www.mft-online.de

There are admission restrictions for de-gree courses in medicine at all universitiesin Germany. When selecting applicants theuniversities can take into account not onlythe average mark of the qualications en-titling the applicant to go to university butalso other criteria, for example grades incertain subjects, the results of an interview,a vocational qualication gained before ap-plying to university, the students preferreduniversity etc. What is also important is thewaiting period for a university place.

University applicants from a memberstate of the European Union (EU), fromIceland, Liechtenstein and Norway orforeign nationals and stateless personswho have gained German qualications

entitling them to go to university (so-calledBildungsinlnder) are treated as equal toGerman applicants and, like them, alwayshave to apply via the Internet portal of theFoundation for Higher Education Admis-sion (Stiftung fr Hochschulzulassung)hochschulstart.de .

All other international applicants foruniversity places who full the basicrequirements for starting a degree courseat a German university apply directly totheir preferred university, which will alsoinform them about admission require-ments for the degree course. Dependingon the university, up to ve percent of theuniversity places are reserved for this groupof applicants. For a number of universities,

applications have to be submitted via theUniversity Application Service for Interna-tional Students, uni-assist . You can nddetails about the member universities anddetailed information about the applicationprocedure at www.uni-assist.de.

In general the application for admissionmust have arrived at hochschulstart.de orat the relevant university by 15th July forthe winter semester and by 15th Januaryfor the summer semester. The applicationdeadlines may differ from this dependingon the university, however.

Anyone interested in postgraduate stud-ies (Master, PhD) has to apply directly tothe university or to uni-assist.

A place at university in Germany admission restrictions, application, admission


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Medicine 11

STUDYING MEDICIN

MENTORING

Helping foreign students to get startedMany German universities have integration schemes that help freshman students from abroad to settledown in their new environment. Most of these initial support schemes are open to all faculties. Others, how-ever, such as MENTORING international at the Julius Maximilian University of Wrzburg, are aimed speci

cally at students of medicine.

My exper iences with MEN ORING international were

very good. As a result of the scheme I was able to get to knowinternational and German fellow students. By means of tu-torials and clinical events mentoring g ives especially interna-tional students ideal opportunities for the best possible startto their studies. I am doing my medical degree in Germany, bythe way, because I believe that the German health and educa-tion systems are among the best in Europe.

Dejan Krajnc comes from Slovenia and is in his second semesterof a degree in human medicine at the University of Wrzburg.

One central idea is essentially pursuedby all of the schemes: they are aimed atboth German and international students atthe same time. They focus on learning andexperiencing together because it has beenproven that integration works best that wayand that success in studying sets in sooner.

The PIASTA integration programme runby the University of Hamburg comprises anumber of components that are aimed in

Learning together: the degree success of international studentsdepends essentially on their successful integration

ships, in which each partner learns the otherpartners native language, this increases bothstudents intercultural competence.

MENTORING international is a projectrun by the University of Wrzburg and isaimed specically at students in the facultyof medicine. Like in the inter-faculty servicesprovided by other universities, the studentmentors explore the city of Wrzburg withtheir foreign fellow students or give them atour of the university campus. Interculturalseminars are also organised for participants

in the scheme and for members of theuniversity administration staff, and contactsare arranged. Everything else refers directlyto the subject of medicine, for example whenthe mentors introduce the hospital or helpthe international students to organise thestudy plan for their medical studies and tocope with German medical terminology.

INFORMATIONPIASTA Intercultural Living andLearning at the University of Hamburg www.uni-hamburg.de/piasta

Mentoring International at theUniversity of Wrzburg www.uni-wuerzburg.de/ueber/fakultaeten/medizin/studium_und_lehre/men-toring/ > Mentoring International

principle at all students. One of these com-ponents is the International Welcome Week,when a varied programme helps students toget to know Hamburg and the university andto make rst contacts. The PIASTA mentorssupport students from all faculties in theirrst and second semesters, helping themwith learning and practising the most im-portant basic skills. When, for example, pairsof students form so-called tandem partner-

Hamburg

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Innovative teaching concepts

Training with simulatorsMedical faculties in Germany combine tried-and-tested training methods with innovative teaching con-cepts. One example is the Universitt Leipzig, where they have seen measurable success: 98.2 percent of thestudents in Leipzig passed the written part of the Final Examination in Medicine in autumn 2009. That put

the Universitt Leipzig at the top of the list in Germany.

Students at the LernKlinik in Leipzig practise resuscitation on a simulation doll.

Tobias Uhing is in his tenth semester ofa degree in human medicine at the Univer-sitt Leipzig and is one of the tutors in thenewly set up LernKlinik Leipzig. This trainingcentre has been available to Leipzig studentssince the end of 2010. The centre consists ofa total of 14 sections where the students cantrain in practical medical skills, such as takingblood, performing ultrasound examinations,listening to the heart, performing variousmedical check-ups and suturing techniques,on more than 200 lifelike models and simula-tors. The practice opportunities are a greathelp you gain more condence for practicaluse. That is also a huge advantage for thepatients, Uhing says with certainty.

That is one reason why some two thirdsof Germanys medical faculties have alreadyset up facilities like the LernKlinik Leipzig,often called skills labs, as an integral part ofa modern teaching concept.

Practising emergency procedureson dollsThe practice opportunities go down verywell with the students, the 26-year-old

tutor says, summing up his experiences.He instructs groups of three to six partici-pants in the elds of basic life support andadvanced life support. On two simulationdolls the students realistically practise howto conduct basic resuscitation, what to do incases of ventricular brillation or how to useemergency equipment correctly. It is vitalthat every step taken is right. The dolls areequipped with skills-reporters, which giveimmediate optical feedback on the measuresthat have just been conducted. On anotherdoll you can perform an ECG and debrillateif necessary, measure blood pressure andperform intubation.

Actors simulate patientsIn room E 07 Mister K., the cardiology patientsimulator, is waiting. Im sure we are oftenenvied for our cardiac auscultation simula-tor, says Tobias Uhing. With this device wecan simulate all heart sounds and murmursand obtain over 80 different results. Theequipment wasnt exactly cheap, he adds.

Communication with the patients, forexample when asking questions about

their medical histories (anamnesis), is alsopractised in the LernKlinik. Specially trainedactor-patients simulate the role of the pa-tients for this. The group observes the inter-view from an adjoining room and evaluates avideo recording of the conversation togetherafterwards.

It is not only the routine medical tech-niques that are trained in the LernKlinik.Less common procedures can also betrained here, the young tutor explains, suchas central venous catheterisation, where a

thin plastic tube is inserted into a vein andpushed towards the heart.Other components of the modern teach-

ing concept in Leipzig are a mentoring pro-gramme (MedMentoL), E-learning opportuni-ties and regular lecturer training, teachingevaluation and PBL

Close to everyday routine in thehospitalThe abbreviation PBL stands for problem-based learning, a teaching method that wasoriginally developed in Canada and is alsoused in medical training at numerous Ger-man universities. The students feel betterprepared as a result of PBL as they have runthrough the entire process thoroughly, fromdiagnosis through to treatment, Tobias Uh-ing explains.

PBL always starts out from a specic casedrawn from medical practice. The studentssolve complex problems or patient casesindependently in small groups under thesupervision of a specially trained tutor.This starts with obtaining medical results,diagnostics and treatment and goes rightthrough to pathogenesis. Closely approxi-

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STUDYING MEDICIN

Problem-based learning right from the start: students of medicine at the University of Hamburginterpret X-rays and CAT scans on a modern hospital trolley.

mating reality in everyday hospital life, thismeans that they can put their knowledgeinto patient-oriented practice at a very earlystage. Any questions remaining unansweredare then discussed in a tutorial.

Almost like House M.D.We often deal with more routine cases, suchas an elderly patients femoral neck fracture

and the possible complications. Sometimes,however, the cases concern rare diseases though not quite such tricky cases as those ofHouse M.D., the doctor-to-be explains. Whathe and most of his fellow students in Leipzigappreciate about PBL is that this teachingconcept leaves a relatively large amount offreedom for their own studies. It is worth theeffort in order to learn medical thinking anddecision-making as early as possible, TobiasUhing is convinced.

Structure of regular degree coursesin medicine

PartSemester Practical training, courses and

seminarsAdditionalachievements

1Scientic basis of medicine:Physics, chemistry and biology fordoctorsPhysiology, biochemistry/molecularbiology, anatomyMedical psychology and medicalsociologyIntroduction to clinical medicine(with case presentations), introduc-tion to careers in medicine, medicalterminology

First-aid course2

3

Nursing service3 months

4

Intermediate Examination in Medicine

1

PartSemester Practical training, courses and

seminarsAdditionalachievements

5 General clinical studies; pathology,microbiology and immunology,pharmacology and toxicology, hu-man genetics, radiology, biomath-ematics and othersPractical-clinical training in all majorclinical sub-disciplines (generalmedicine, surgery, internal medicine,paediatrics, gynaecology, ophthal-mology, urology, orthopaedicsetc.) and interdisciplinary subjects(epidemiology, history and ethics,emergency medicine, health eco-nomics and health care, preventivemedicine, radiography and others)

Clinical elective4 months

6789

10

11 Clinical year (48 weeks) at a teachinghospital or university hospital:16 weeks each in internal medicineand surgery, as well as in eithergeneral medicine or another clinical-practical discipline

12

Final Examination in Medicine

2


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STUDYING MEDICINE

New types of degree courses in medicine

Medical degree courses in a state of change?More practical elements with early patient contact, the removal of the rigid boundaries between the pre-clinicaland the clinical stage, interdisciplinary teaching instead of subject-centred teaching these are just a few of thefeatures characterising the new degree courses in human medicine that are being introduced in pilot projects.

Practical training in the learning and examination centre at Witten/Herdecke University.

Even though the structure and thesubject-related requirements of medicaldegrees are regulated uniformly in Germanyvia the Medical Licensure Act (rztliche Ap-probationsordnung AppO) the universi-ties have the possibility to break new groundin medical training. Seven universities haveso far developed and introduced reformconcepts for reorganising the teaching andthe syllabuses (see map).

These concepts do not just place greateremphasis on self-regulated learning, theypursue a new philosophy: problem- andsolution-oriented learning and the model ofan adaptive medical personality are some ofthe fundamental pillars of medical trainingin Witten, as is patient contact from the rstsemester, Marzellus Hofmann, head of thedeanery of human medicine in the Facultyof Health at Witten/Herdecke University

explains to dene the orientation of thenew course of studies. The clinical-practicaltraining at the bedside also takes place atcooperating hospitals providing all stages ofcare. In addition there is the general medi-cine adoption programme, where studentsare introduced to outpatient care in doctorssurgeries, the head of the Witten deaneryexplains.

Combining theory and practiceUnlike in the regular medical degree courses(Regelstudiengnge), there is no longer a

division between the pre-clinical stage withits predominantly scientic syllabus and ex-aminations and the clinical stage. The resultis a stronger link between scientic theoryand clinical practice.

In the teaching, for example, the anatomi-cal, physiological or clinical aspects of anorgan are no longer dealt with one by one inisolation in the individual disciplines. Instead,the students get to know the organs or entireorgan systems of the human body as topicareas. Within one subject area they learn, forexample, about the structure and functionof the human liver, how it can be examined,how liver diseases arise and develop andhow they can be treated.

In line with this concept new types of ex-aminations have been introduced in the newdegree courses: instead of the preliminaryexamination in medicine (Physikum) at the

From the rst semester onwards we have direct contactwith patients; rst we take medical histories, later we conduct physical examinations and nally we learn how to deal with

patients receiving palliative care. Te specialist knowledge thatwe acquire initially refers to patient cases and later to complexcase histories. Instead of working chapter by chapter throughbooks which are structured according to subjects, I had to learnfrom the rst semester onwards that many problems are undis-ciplined and that physiology, biochemistry and anatomy can be grasped more quickly if they are combined. After the numerous

blocks of practical training in the hospital we practise how to deal systematically withcomplex diseases in differential diagnosis weeks, when we are often also able to buildon knowledge acquired in the patient cases of the rst semester.

Giovanni Federico orsello comes from Italy and is in his ninth semester of a degree inhuman medicine at Witten/Herdecke University.

Aachen

Berlin

Bochum

Hanover

Cologne

Mannheim

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STUDYING MEDICIN

end of the fourth semester, assessment testsare conducted at regular intervals. Here notonly knowledge is tested but also medicalskills. At the end of the degree course, how-ever, all medical students take the same nalexamination, no matter whether they tooka regular degree course or a new degreecourse.

Owing to the different teaching concepts

of the individual new degree courses, how-ever, it is more difficult to change university.This is generally not possible or only to alimited extent.

Choosing your own specialitiesSome of the new degree courses allowthe students to select their own individual

specialist areas, often also in coopera-tion with other faculties. For instance, thestudents on the new degree programmeat RWTH Aachen University can acquirea quite specific qualification profile bycombining courses from the fields of clini-cal neurosciences, public health or com-munication sciences. Marzellus Hofmannexplains the studium fundamentale at

Witten/Herdecke University, which is anintegral component of the new degreeprogramme there, here subjects from art,philosophy, politics and culture are dealtwith from an interdisciplinary perspec-tive. The curriculum also includes ethics,science, communication and health policy/health economics.

Trainings pathsAn even more far-reaching focus is pro-vided for in the new degree programme atHeidelberg University (Mannheim Facultyof Medicine). Here, while training as a doc-tor, the students are able to do additionaltraining aimed at their desired occupation-al field: the qualification Clinical Practicespecifically promotes practical medicalskills. Medicine plus Masters enablesthe students to take a Masters degree inhealth economics or medical physics at thesame time as studying medicine. MedicalResearch teaches skills in molecular medi-cine as well as knowledge of experimentaldiagnostics and experimental therapy.

Interview with Professor Stefanie Ritz-Timme, Dean of Studies at Dsseldorf University

A lively culture of teaching and learningSupported in academic and personal matters and accompanied by the lecturer right through to workinglife what student would not want that? At the Heinrich Heine University Dsseldorf (HHU) great empha-sis is placed on such intensive support for students. Professor Stefanie Ritz-Timme, dean and director ofthe Institute for Forensic Medicine at the HHU explains the teaching model developed jointly by teach-ers and students of the Faculty of Medicine there in 2009.

What self-image did the Faculty of Medi-cine formulate in its teaching model?

The self-image of the whole faculty is for-mulated in the teaching model, includingthe students who were actively involved indeveloping the model. That is why it says inthe preamble, the Faculty of Medicine is acommunity of students and teachers whichdevelops with lively interaction and mutualesteem. According to this principle our teach-ing staff do not see themselves simply as

lecturers with didactic skills but also as contact persons, condants androle models, who engage in dialogue with the students and with oneanother. The teaching model stands for a lively culture of teaching andlearning.

What does this mean for the training of the future doctors?We do not only want to prepare our students for the state examinations we want to accompany them into a fullled and successful workinglife. This requires more than just knowledge that is tested in the stateexaminations. Being a doctor or a scientist involves various elds ofcompetence. Against this background the faculty formulated primarylearning objectives. This applies, for example, not only to the elds ofdiagnosis, therapy and prevention, but also to social, ethical and com-municative competence. In future we will be giving the students moreoptions and more freedom to foster and demand their own initiative intheir studies and their own development. In order to be able to supportour students on a personal level, too, we are currently setting up a men-toring scheme.

What role will E-learning and learning information systems play inmedical training in future?

In order to cover the elds of competence listed above you need a lot ofpractical, patient-oriented teaching in small groups. This teaching canonly be done during the time when the students are actually on site.E-learning opportunities and learning information systems are valuableadditions because knowledge can be imparted and consolidated in thisway without the students having to be on site longer; a free choice ofwhen to learn provides for additional freedom. These options also makeit possible to depict clearly what we require of our students and whatopportunities we are offering them.

In Dsseldorf the students are able to submit assessments oflectures and courses. What are the actual consequences of thisteaching evaluation?The results of the course evaluations constitute valuable feedback from

the students. To critics who say that the students only give well-beingmarks, we can reply that the students also give constantly good assess-ments over long periods for strict lecturers and courses with difficultexaminations. Together with my colleagues, I myself have developedour teaching over time, partly with reference to the comments andevaluations submitted by the students with the result that the teach-ing is now very practice-oriented and lively and is a pleasure for boththe students and my colleagues.

Teaching modelof the Faculty of Medicine of the Heinrich Heine University Dsseldorf:www.medizinstudium.uni-duesseldorf.de > Studieninteressierte >Medizin in Dsseldorf


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Clinical year

It becomes routine some timeTaking blood and holding hooks students are confronted with these or similar tasks for the rst time intheir year of practical training, the clinical year. The Finnish student Elina Puska began this nal part of herdegree course at Rostock University Hospital with the necessary portion of pragmatism and was therefore

soon accepted by the doctors as a member of the team.

Test of endurance in the hospital students are coached by the responsible doctors during the clinical year.

For Elina Puska it was clear: You cant as-sume that you will be given new tasks everyday. The clinical year is designed in such away that routine tasks are the order of theday. In this way the students can gain thenecessary condence for their future work.This includes introducing patients during themorning rounds just as much as inserting aurinary catheter. At the same time the clini-cal year is one of the best opportunities tosound out which specialist eld of medicine

you prefer. The feedback from the seniorphysicians and consultants gives you animportant indication of the direction of yourmedical career.

Training in three partsThe clinical year consists of three periodslasting three months each, one to be com-pleted in surgery, one in internal medicineand the other in either general medicine oranother discipline of clinical medicine. Elina

Puska is considering becoming a generalpractitioner later on, so she completed thegeneral medicine part of her training at a GPsurgery in Rostock.

Why does she want to work in a doctorssurgery later on? As a GP you know your pa-tients and have a special relationship of trustwith them. Working close to people appealsto me more than scientic work. I would alsolike to have time for my family in additionto working. During the two periods of workin the hospital Elina Puska worked normal

working hours from 7 a.m. to 4 p.m. and hadthe weekends off, so she was able to organisechildcare for her young son more easily.

Demonstrating initiativeEspecially younger doctors who completedtheir degrees and their clinical years not solong ago generally make a great effort tolook after the students, as the 30-year-oldknows from her own experience. If youshow commitment you will be regarded asan equal member of the team. It dependson how you treat people. If you get on well

with the senior house officers and win theircondence, they hand over lots of tasks andyou are also given more responsibility.

She has always got along well with thepatients, too after more than seven years inGermany she speaks German with hardly anytrace of an accent. Only her name sometimesarouses the patients curiosity. A questionabout my nationality has always been a goodconversation starter when talking to patients.I like it when people are interested in where Icome from.

Lectures and learning in additionThe students doing their clinical year atRostock University Hospital are always off-duty on Fridays. On these days, the studentsattend compulsory lectures from the variousdisciplines. The afternoon is reserved forprivate study. In addition, Elina Puska tells us,there are special events where the studentscan talk and exchange information inter-actively, and there are lectures and classesconducted by the doctors.

Elina Puska comes from Finland and is doing herclinical year at Rostock University Hospital.


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STUDYING MEDICIN

Medical ethics

Seeing eye to eye with the patientIn order to prepare future doctors for the moral and ethical conicts in medical practice or in connectionwith their research activity, the subject history, theory and ethics of medicine is an integral part of medi-cal training. Professor Bettina Schne-Seifert, head of the medical ethics department at Mnster Univer-sity, talks about the ethical challenges of modern medicine.

How does a department for medical ethicscontribute to topics such as the admis-sibility of prenatal diagnosis or embryonicstem cell research, euthanasia, living willsor assisted suicide?First of all medical ethics gives the studentsopportunities to examine the issues men-tioned. When they begin to see medical eth-

ics in systematic relationships and to debatewith one another in the seminars, they notonly increase their own sensitivity in dealingwith issues of medical ethics, they also learn

to take other peoples opinions seriously.Anyone who deals with medical ethics on a professional basis can helpto analyse and position the problems and opinions more precisely andto get to the heart of the controversies. However, we do not have aprofessional head-start in the search for the ultimately right bioethicaland biopolitical answers by any means. This can already be seen fromthe fact that there are just as many different opinions concerning theissues you mentioned among professional ethicists as there are amonglaymen or politicians.I consider it important that our future doctors do not learn to perceive

conicts in the eld of medical ethics primarily as a nuisance and anadditional burden of their occupation, but as enriching challenges.

How can the future doctors be prepared specically for the deci-sional conicts in everyday medical life?Take the way that living wills are dealt with as an example. As is wellknown, living wills concern the possibility to decide while you are stillhealthy how you wish to be treated should you one day no longer beable to make such decisions for example if you are in a coma or haveadvanced dementia.

In summer 2009 the German Federal Parliament (Bundestag) passeda law recognising such documents of preemptive self-determinationas absolutely binding if they full certain conditions. However, it allremains ethically controversial and, moreover, is frequently interpretedincorrectly.Here medical students require profound knowledge of the legal ethicalsituation and the ethical controversies. For their future work they haveto learn to distinguish between genuine problems of medical practice,

such as decision-making processes in the case of vague living wills,and illusory problems, such as conicts with a carer when a living willis clear.Another example, which is less conict-ridden but even more importantin daily life, has to do with decisions about treatment towards the endof life in the case of patients who are able to give their consent. Here itmakes no difference how detailed the legislation is, the crucial startingpoint for advising the patients successfully is an ethical attitude a vir-tue if you like namely respect and goodwill on an eye-to-eye level. Youdont learn to develop this by theorising about ethical issues but youcan learn to understand that this is a key issue of good doctor-patientrelationships.

Occasionally one has the impression that medical research in Ger-many is hampered by ethical regulations. Is that really the case?The answer of course depends whether you are more worried withregard to biomedical research and its possibilities for misuse or whetheryou are optimistically pro-research. I myself belong more to the secondcamp under todays conditions of very extensive research control andtransparency. From this point of view, the obstacles in the shape ofethics commissions that have to assess all biomedical research projectsinvolving people and then authorise them from an ethical standpointare perhaps wearisome but they are in principle very welcome. Ethicscommissions rightly hamper research.

Nonetheless the clinical year does not al-ways leave enough freedom for the studentsto manage the required amount of studying,especially if, like Elina Puska, they have a fam-ily. During the clinical year I didnt do muchadditional learning from books in addition tomy daily work at the hospital.

Despite that she is still condent ofpassing the Final Examination in Medicine.For during the clinical year she had enoughtime to put into practice the theoretical

knowledge she had acquired in the previoussemesters. The theory becomes more tan-gible and eventually things like taking bloodor inserting a peripheral venous catheterbecome routine.

What Elina Puska sees as the greatestsuccess of the clinical year is the certaintythat your decision to study medicine was theright one and that you will be a good doctor

one day.

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DOCTORAL STUDIES AND GRADUATE PROGRAMMES

A survey of academic further training

Alternatives to Dr. med.Licence to practise medicine, doctoral studies, residency with further training to become a specialist themedical career path in Germany used to be fairly clear cut. Now the options for academic further traininghave become more diverse and newly qualied medical practitioners can begin a career in research in struc-

tured doctoral programmes or graduate schools. A masters degree can be taken before or after gaining theDr. med. title, for example, in neurosciences, molecular biology or medical engineering.

Doctors conduct research in many areas, for example in human genetics: here a chromosome analysis is being conducted.

You do not need a doctorate to work asa doctor. Nevertheless medicine producesmore doctorates at German universitiesthan any other subject apart from biol-ogy and chemistry, even among studentsfrom abroad. In 2009, 481 foreign studentsgraduated in medicine in Germany with 414doctorates completed in the same year.

After gaining their licence to practisemedicine, most medical practitioners in Ger-many study for a doctorate following the tra-ditional model of one-to-one supervision bya doctoral supervisor. A doctorate is proof of

the graduates ability to conduct independ-ent research. For most medical practitioners,however, it is not intended to be the rststep of a career in research. Nonetheless, theDr. med. title is acquired by medical gradu-ates almost as if it were mandatory becauseit is part of the self-image of a doctor andinspires condence in patients.

Structured doctoral programmesThe structures of academic further educa-tion have expanded over the past few years:anyone wishing to go into research or at

least retain the option of doing so can applyfor a place in one of the structured doctoralprogrammes or graduate schools.These include Research Training Groups of the German

Research Foundation (Deutsche Forschun-gsgemeinschaft),

Graduate schools at universities, Doctoral programmes at universities, Helmholtz International Graduate or

Research Schools and International Max Planck Research

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Medicine 19

DOCTORAL STUDIES AND GRADUATE PROGRA

Graduate schools or research schools(article on page 24) are usually internationalin nature and are supported by a numberof closely cooperating research groups.Especially when looking from abroad, it iseasier to get an overall picture of the optionsin Germany than with traditional individuallysupervised doctoral studies. Internationaldoctoral candidates nd their feet morequickly in a team with intensive support fromseveral professors. The research activities ofthe individual participants are integratedinto the overall project. The interdisciplinaryenvironment permits research work at thehighest level.

Some programmes have a narrow focuswhile others allow a wide choice of research

topic. The range offered for medical gradu-ates includes Life Sciences, Molecular Biol-ogy, Neurosciences, Infection Research,Bioengineering, International Health, Cel-lular Stress Responses in Ageing-AssociatedDiseases, Physiology of the Brain and Oli-gonucleotides in Cell Biology and Therapy.

INFORMATIONDAAD International Programmes inGermanyOn the website of the German AcademicExchange Service (Deutscher Akademis-cher Austauschdienst), you can searchfor internationally recognised, accreditedbachelors, masters and doctoral pro-grammes in the eld of medicine, most ofthem taught in English. All the pro-grammes offered in the database ensurespecial course-related and personal sup-port for students and doctoral candidatesfrom abroad.www.daad.de/international-programmes

You will nd a list of postgraduatecourses related to development under:www.daad.de/entwicklung > Informationfor Students and Alumni > PostgraduateEducation > Postgraduate Courses

Further linksto nd out about the programmesoffered for graduates andpostgraduates:

www.hochschulkompass.deGerman Rectors Conference (HRK)

www.dfg.deGerman Research Foundation (DeutscheForschungsgemeinschaft DFG)

www.research-explorer.de

The Research Explorer of the DAAD andthe DFG

www.helmholtz.deHelmholtz Association

www.mpg.deMax Planck Society

During my two-week practical training at the departmentof otolaryngology, head and neck surgery at the University of Mainz, the director, Professor Mann, offered me the opportunityto take a doctorate under his supervision. Because the MainzUniversity Medical Center has a good reputation, it was obviousto me that I would make use of this opportunity. I am convinced

that the German Dr. med. title will open doors for me outsideGermany, too. In fact, my impression is that any doctorate froma German university is highly regarded in many parts of theworld. It is also a chance for me to get to know Germany, its

culture, language and people.

Martynas Drigotas comes from Lithuania and is working towards a doctorate in cancerresearch at the Mainz University Medical Center.

I deliberately opted for the structured doctoral courseat the Graduate School of Neural and Behavioural Sciencesin bingen because I would like to work in international re-search later on. he course here prepares us perfectly for such

a career as it is taught in English and we work in multicultur-al and interdisciplinary teams. If I have a question to do withmathematics or statistics I can simply go downstairs and visitthe mathematicians. If it is a question of physics I go upstairsand ask for advice there.

Natalia Zaretska comes from Russia and is a doctoral student atthe Werner Reichardt Centre for Integrative Neuroscience (CIN) at the InternationalMax Planck Research School (IMPRS).

Masters programme as an entryroute to researchOne reason why medical practitioners mightenrol on a masters course is to enter researchand obtain a solid grounding in a particularscientic discipline. Many medical gradu-ates applying from abroad do not yet have adoctorate and aim to acquire a doctorate in aconnected PhD programme after completingtheir masters degree. Other medical practi-tioners complete a masters degree prior toor parallel to their specialist training to aug-ment their qualication prole, for example,in medical neurosciences at the Charit inBerlin (article on page 20).

Interdisciplinary studies are availableat the masters level, too: the programmes

offered provide interfaces to neurobiologyand ethology, medical engineering (articleon page 23), computer science, psychology,public health, environmental science and de-velopment cooperation (article on page 21).

Mainz

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Masters programme in Medical Neurosciences

An interdisciplinary look into the brainWhat happens when basic mechanisms in our brain no longer function correctly? How do dementia, Par-kinsons or chronic pain arise? Students on the Medical Neurosciences masters programme at the CharitUniversity Hospital in Berlin are conducting research into these and other questions.

During my medical studies, I always wanted to deal withdisorders of the brain. It was the right decision to join the International Graduate Programme at the Charit on gradu-

ating. Here, I can gain the basic theoretical knowledge that Ineed to be successful later on in my clinical work. As part ofmy studies, I have numerous opportunities to attend lecturesby excellent researchers in neuroanatomy, neurophysiologyand neuropathology and to work on my own research projectin the laboratory. I am convinced that the experience I have gained here will give me a competitive advantage during my

time as a house officer at the hospital.

Natalia Denisova comes from Russia, graduated in medicine and is now studyingMedical Neurosciences at the Charit University Hospital in Berlin.

How does a diseased brain differ from one that functions properly?This is the key question investigated in medical neurosciences.

Programme coordinator Lutz Steinerknows that his four-semester masters pro-gramme held completely in English arousesthe interest of many students. And there aregood reasons for that: The neurosciencesare a very young discipline that is very muchcharacterised by interdisciplinary links, forexample, with medicine, microbiology, psy-chology and even philosophy.

Research into the complex processes inour brain and nervous system are the focus

of several scientic disciplines. The breadthof the training is therefore one of the hall-marks of the Berlin masters programme:the students learn both about the neurobio-logical basis and about physiological andpathophysiological changes in the brain andthe resulting clinical diseases. Neurodegen-erative diseases, which are occurring morefrequently due to the demographic develop-ment of the population, can be investigatedfrom different angles with this approach.

Technology also plays an important role.Neuroscience research has been given aboost by developments in imaging methodsenabling brain activities to be represented asimages, Dr Benedikt Salmen, research coor-dinator of the programme, explains.

From bench to bedsideA further aim of the programme is to cre-ate the preconditions to enable scienticknowledge from fundamental research to betranslated into clinical practice (translation).

In our case, the main elds concerned arestroke research, epilepsy research, neuroim-munology and multiple-sclerosis research.The name of our programme MedicalNeurosciences is therefore an apt descriptionof what we intend to achieve, Lutz Steinerexplains.

Dr Salmen illustrates translation usingan example from epilepsy research: Weexamined the physiological processes infebrile seizures in early childhood, which maybe the cause of epilepsy occurring later on. Itemerged that the faster respiration result-ing from the raised body temperature is onecause of the cerebral attack. It results in anincrease in the pH value of the blood whichtriggers convulsion. This result is signicantfor clinical practice because it shows howsimple therapies can be once you know thebackground: For example, it would be con-ceivable to have children breathe into a bagduring an attack. This raises the CO2 contentof the blood again and the cerebral attackceases.

An appealing route to researchOur international students, in particular,currently around two thirds of the partici-pants, appreciate the possibility of enteringneuroscience research, Lutz Steiner reports.Almost all graduates of the masters pro-gramme subsequently continue their neuro-science research; about one third remain inBerlin and complete doctorates as part of ourMedical Neurosciences PhD programme. Thecourse is also interesting for medical gradu-ates who would like to combine their trainingas a specialist with research work, Dr Salmen


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Medicine 21


In the past two years, the Medical Neuroscience masters programme has given me, as a student of medicine, a compre-hensive overview both of the basic knowledge of neurosciencesand of the latest studies on different neurological diseases.

he time I spent on my three lab rotations was characterisedby a very open and friendly atmosphere. My main focus is onstroke research. I will do my doctorate here in Berlin, which Isee as one of the best places for highly qualified training in thefield of neuroscience.

ian Zhang comes from the Peoples Republic of China, is a graduate in medicine and isstudying Medical Neurosciences at the Charit University Hospital in Berlin.

INFORMATIONInternational Graduate Program forMedical Neurosciences at the CharitUniversity Hospital in Berlinwww.medical-neurosciences.de/en/program/master/NeuroCure, Cluster of Excellence at theCharit University Hospital in Berlinwww.neurocure.de

says, explaining the career plans of the medi-cal target group.

Well networked communityWith our mentoring programme, wesupport all new students during the rstsix months of their studies. That helps thestudents to bond into a group quickly, pro-gramme coordinator Steiner explains.

The curriculum gives students enoughfreedom to dene their own research focus.They can access the research infrastructure ofthe neuroscience community in Berlin, which

is very well networked. This also includes thecluster of excellence NeuroCure, an interdis-ciplinary research network, which awards PhDand masters grants for the Medical Neurosci-ence programme. In addition to the CharitUniversity Hospital in Berlin, neuroscientistsof the Freie Universitt Berlin, the HumboldtUniversitt zu Berlin and the non-universityresearch institutes Max Delbrck Center forMolecular Medicine (MDC), Leibniz-Institutfr Molekulare Pharmakologie (FMP) and theDeutsche Rheuma-Forschungszentrum Berlin(DRFZ) are all members of the consortium.

Berlin

Master of Science in International Health

Health for everyoneIn many parts of the world, especially in developing and emerging countries, even the most rudimentaryrequirements for an effective public health care system are not met. In the International Health programmesspecialists like Dr Nicholas Kyei from Ghana are trained to set up such systems.

Improvements in health care in developing and emerging countries canbe achieved by means of cooperation at international, national and local level.

In my home country, Ghana, and in manyother developing countries, diseases suchas AIDS, tuberculosis or malaria do a lot ofdamage, Dr Nicholas Kyei says, who knows itfrom his own experience. In order to be ableto contribute more to strengthening healthcare systems in the future, he enrolled on themasters course in International Health at theUniversity of Heidelberg. As a practising doctorI became aware that there are factors outsideof medical practice which make an importantcontribution to good-quality medical care.

Health care systems in developingand emerging countriesAnalysing these factors is one of the em-phases of this masters course in Heidelberg,which takes a close look at elements andstructures of public health systems andthe demands on health care in developing


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Medicine 23


Biomedical Engineering masters programme

Looking into the body and growing organsDoctors have to deal with technology every day: ultrasound scanners, pacemakers or computer tomogra-phy have become indispensible in modern medicine. In order to continue developing medical technology,masters students at RWTH Aachen University who are from different countries and different scientic disci-

plines are conducting research together on the international Biomedical Engineering programme.

An operating theatre is a high-tech room: patient recordsand x-rays can be examined at an information terminal there.

I chose this course because later on Iwould like to work in a research team whichdrives ahead medical technology and alsoclinical diagnostics, Simone Laffar, mastersstudent on the Biomedical Engineering pro-gramme, says. In order to achieve this goalshe took the bold step from clinical medicineinto medical engineering. After completingher basic medical training, the 31-year-oldhad already begun medical specialty trainingin psychiatry before deciding to take an engi-neering course: In the hospital I noticed thattechnical equipment and procedures, suchas magnetic resonance tomography (MRT),are gaining importance in diagnosis, therapy

and follow-up, and that there is a hugedevelopment potential for it. That arousedmy interest.

A research-intensive, future-orient-ed sectorIn Germany, medical engineering is an in-novative, future-oriented industry and oneof the focuses of the High-Tech-Strategy ofthe Federal Ministry for Education and Re-search (Bundesministerium fr Bildung undForschung BMBF). In this sector, interdisci-plinary teams are constantly developing newequipment, be it for operating proceduresusing so-called keyhole techniques or the

tiniest telemetric blood pressure capsules.Experts from industry and science see Ger-man manufacturers special strengths in im-aging techniques, minimal invasive surgery,micro- and nanosystems, diagnostic imaging,endoscopy, biomaterials and active and pas-sive implants.

The specialised modules of the course inAachen that the students can choose from inthe second and third semesters cover manyof these elds: Tissue Engineering, Medi-cal Imaging/Guided Therapy and ArticialOrgans/Devices. In tissue engineering,biological processes and engineering tech-niques are used to produce natural tissue inthe laboratory. The scientists often combinethese tissues with metal or plastic parts toproduce implants such as heart valves andstents, or articial organs. Medical imagingcovers all techniques that enable us to lookinto the human body. Diagnostic imagingtherefore covers ultrasound, MRT, computertomography and nuclear medicine.

Bringing knowledge levels into lineThe course is a potpourri of all possibledisciplines, Simone Laffar says, describ-ing the interdisciplinary composition ofthe programme. There are graduates inmechanical engineering, molecular biologyand electronics as well as students from theeld of chemistry or medicine in our ranks.The different levels of knowledge have tobe aligned: That is why the students withtechnical degrees, such as mechanical engi-neering or electronics, attend courses in, say,anatomy and physiology in the rst semester,

whereas we medical graduates rst deepenour knowledge of mathematics and physicsand learn the basics of electronics, SimoneLaffar explains.

Cambridge or TOEFLThe 30 course participants came to Aachenfrom all over the world. The multiculturaland international composition makes thecourse so special. Because students fromEurope, Mexico, Thailand, Pakistan and othercountries work together we also expand ourintercultural competence while studying, Si-

Dr Simone Laffar is a student on the biomedical engi-neering masters programme at the RWTH University

in Aachen.


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INFORMATIONRWTH University Aachen (Rheinisch-Westflische Technische HochschuleAachen - RWTH)www.rwth-aachen.de/go/id/liu/

Aachen University Hospital(Universittsklinikum Aachen)www.ukaachen.de > Studierende &Lehrende > Biomedical EngineeringM.Sc.

mone Laffar says. The language of instructionon the biomedical engineering programmeis English, so all applicants have to have aninternational language certicate such asCambridge or TOEFL.

There is a wealth of opportunities forgraduates of the biomedical engineeringmasters course. In addition to the medical

Aachen

stem cell research or the development ofbiomaterials, such as articial organs.

Structured doctoral studies in Infection Research

War of the cells how the body defends itself At the Institute for Immunology of Hanover Medical School, Professor Reinhold Frster and his team inves-tigate the dynamic processes which the immune system undergoes while ghting pathogens like bacteria,viruses, parasites and fungi. Dr Stephan Halle is a member of the team.

The processes occurring in organs during viral infections are examined using various microscopy techniques.

During my basic medical training atHanover Medical School I already dealtwith immunobiology intensively. I foundit fascinating and it aroused my interest inworking in research, the 31-year-old doctorremembers. Today he is a doctoral student atthe Helmholtz International Research Schoolfor Infection Biology (HIRSIB) studying on theInfection Biology PhD programme at Hano-

ver Medical School. The aim of the three-yearstructured programme is to provide intensivetraining for young researchers in the eld ofinfection biology.

Observing what happens in a cellI was able to build on my previous medicalresearch here and am now using mod-ern microscopy techniques to examinethe processes occurring in organs duringviral infections. Thanks to the two-photonmicroscope that we have here we are ableto observe three-dimensional biological cell

At the Lampang Cancer Center we lacked know-how inthe field of biomedical engineering. hat is why I was awardeda grant by the government of hailand to attend the mas-ters programme in Aachen. I have a doctorate in medicineand it was not easy for me to start studying engineering. But in my future job as Chief of echnology ransfer and Academic Supporting Division I will be fully committed. Mytask will be to coordinate the transfer of technical knowledgein cancer treatment and research and specialised medicine. Iwill develop new medical technologies and set up information

systems in the field of cancer research. One important aspect in this respect willbe cooperation with other universities in hailand that offer courses in biomedicalengineering.

Donsuk Pongnikorn comes from Tailand and is studying on the Biomedical Engineer-ing masters programme at the RW H University of Aachen.

engineering industry and the health caresector they are also sought after in researchlaboratories. Their tasks include researchand development, production and productadvice, sales and marketing and servicing formedical products. Simone Laffar already hasplans for her career at any rate. Later on shewould like to work in diagnostic imaging,


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populations and tissues as well as immuneresponses. This is fundamental research.However, we also examine clinically relevantviruses, he says, describing his eld ofresearch.

VaccinesTogether with approximately 20 colleaguesfrom all over the world who are selectedeach year in a rigorous selection procedure,he is interested in clarifying the fundamen-tal cellular and molecular mechanisms ofthe immune system. The information theydiscover is the prerequisite for the future de-velopment of vaccines. The HI virus showedus that there is still such a lot to researchbefore suitable vaccines become available,Dr Halle explains.

He sees the clear structure of the gradu-ate programme as a denite advantage:You are well integrated right from the startand communication with colleagues fromthe virology or immunology departmentsis intensive. Attending seminars in addi-tion to conducting

germany - a great place for knowledge - medicine

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