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DEHEMS project

Description of professional domain – MEDICINE

Country: Germany

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Professional Domain "Medicine and Pharmacy"

1 Which study fields/study areas are covered by this professional domain?

In regard to the defined ISCED categories 721, 724, 725, 726, 727, in Germany the following fields of subject belong to this group:

Medicine (Human Medicine - 721)

Dentistry (724)

Medical therapy (like physiotherapie, speech therapy; occupational therapy)

Health Sciences, Health Management

Biological/Molecular Medicine

Pharmacy (727)

Similar to many training programs in the domain of education, many "health professions" in Germany are traditionally no university fields. Only recently, study programs in the areas of nursing and medical therapy are developing. Before, occupational therapy, speech therapy and physiotherapy were trained at so called Fachschulen which are part of the tertiary level and are classified as ISCED 5b. Still, no university-entrance qualification is demanded (middle school leaving exam is accepted), even so most pupils have this qualification. Due to the internationalization processes, the Bologna reform and the very demanding training at this schools, the number of study programs (BA and MA) is increasing. But, the majority of graduates in this fields are still educated at Fachschulen.

In other medical areas, like optician and audiologist, there are only one or two study programs. But, it can also be expected that the academisation is in process here.

Even so, we excluded nursing as study field in this professional domain due to the argument, that nursing is a vocational training and Fachschulen at hospitals in Germany and not part of the tertiary sector, study programs in this area are included in the following description. The offered courses are in the majority for trained nurses who want to overtake leading

Molecular or biological medicine programs are new developments. These courses are offering medical interested students who are planning to work in medical research, a research oriented medical training. Still, there number is still low and they will not be further described in chapter 4.

2 Which types of institutions are offering this professional domain?

Medicine, pharmacy and dentistry are classical fields of university education. The "younger" programs in Medical therapy, health sciences/management or nursing are mainly offered by university of applied sciences.

3 Please give a quantitative overview about the professional domain

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3.1 Number of offered study programs

Overall, there are around 210 study programs offered in this area. The majority is offered in the classical fields of medicine, dentistry and pharmacy.

Table 1 Number of offered study programs in the field of Medicine and Pharmacy

Study field TOTAL State exam BA MA Explanations Examples

Medicine 60 36 0 24 Masters in different fields either medical ethics,

management or law or in specializations like

oncology, neurosciences etc.

Dentistry 36 30 0 6 Masters in laser technique, implantology etc.

Pharmacy 23 22 0 1 Master in pharmaceutical medicine

Ergotherapy 9 0 8 1

Logopädie 11 0 9 2

Physiotherapy 17 0 14 3

Molecular Medicine (biological medicine)

15 0 6 9

Nursing Sciences/management

49 0 34 15

Source: http://www.hochschulkompass.de

3.2 Number of HEI offering the program

The following table gives an overview about the number of HEI offering each program. An overall number cannot be given as there are many overlappings (e.g. most universities offering dentistry are also offering medicine)

Table 2 Number of HEI offering programs in the field of Medicine and Pharmacy

Study field Number of HEI

Medicine Around 38

Dentistry Around 30

Pharmacy Around 24

Ergotherapy Around 8 (only universities of applied sciences)

Logopädie Around 6 (only universities of applied sciences)

Physiotherapy Around 12 (only universities of applied sciences)

Molecular Medicine (biological medicine)

Around 6

Nursing Sciences/management Around 34

Source: http://www.hochschulkompass.de

3.3 Number of enrolled students (increasing/decreasing?)

The following table gives an overview about the distribution of the around 120.000 students in this area. The number of students in this domain is steadily increasing since 2003 due to an increase in study programs in the area of medical therapy and Health Sciences. The number of students in the traditional

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fields like medicine and dentistry is stable (The number of places in this very expensive programs is regulated by the state).

Table 3 Number of enrolled students in the field of Pharmacy and Medicine (wintersemester 2008/09)

TOTAL Uni FH Female Foreign

Medicine 79.376 79.376 0 61% 11%

Pharmacy 12.052 12.052 0 73% 12%

Dentistry 13.763 13.763 0 61% 12% Nursing (Science, Manag.) 3.057 764 2.293 76% 4%

Other Medical Therapy 4.174 852 3.322 81% 3%

Health Sciences, Manag. 13.721 3.597 10.124 66% 14%

Bio-Medicine 716 408 308 59% 10%

TOTAL 126.859 110.812 16.047 64% 11%

Source: Destatis (Fachserie 11, Reihe 4.2), table 08, table 03 Other medical therapy: physiotherapy, ergotherapy, speechtherapy

3.4 Number of graduates (last available cohort)

The following table gives an overview about the distribution of the around 26.000 graduates in this professional domain.

Table 4 Number of graduates in the field of Medicine and Pharmacy (wintersemester 2008/09)

Total Bachelor Master Other PhD PhD quota

Medicine 16.114 0 0 9798 6315 39%

Pharmacy 2.305 64 32 1883 326 14%

Dentistry 2.710 0 0 1729 981 36%

Nursing (Science, Manag.) 683 n.i n.i 679 4 1%

Other Medical Therapy 615 n.i n.i 606 9 1%

Health Sciences, Manag. 3.257 883 496 1842 36 1%

Bio-Medicine 115 n.i n.i 111 4 3%

TOTAL 25.799 947 528 16.648 7.675 6%

Source: Destatis (Fachserie 11, Reihe 4.2) Other degrees: State-exams, diploma, teaching degrees, magister Other medical therapy: physiotherapy, ergotherapy, speechtherapy

3.5 PhD quota (Type B - Phd graduates to second-cycle graduates)

Medicine (and dentistry) has traditionally the highest percentage of PhD graduates. This is mainly due to the fact that medicine graduates does not automatically receive a M.D. (medical doctor) like in the US. Instead, they need to do a "regular" PhD. The specific characteristic of medicine and dentistry is that most students do their PhD already during their study - parallel to their study. Many start their PhD project around the sixth semester aiming to finish their thesis together with their study. So, medical PhD have a reputation for a rather low research quality and are often finished in a comparatively short time (1-2 semesters full time equivalent). Many universities even allow that students defend their thesis

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before their graduation. They receive the title - in the case of successful defense - at time of graduation. As medical graduates receive no other titles (the state-exam is no title) the doctor title is the only title they get. Additionally, the patients expect that their "doctor" is a "doctor" - which is why many are pursuing a PhD to legally be called "Herr Doktor".

3.6 Gender distribution

The percentage of women is in all study programs in this domain very high (over 50%) - in particular in nursing and "other medical therapy-programs" - both traditional female fields. The number of women in medicine and dentistry has continuously increased over the last decades. Today, some comments see the higher number of women as a problem for the German Health system. It is argued that women go less into surgery and are more often leaving their job for family reason. Both factors supporting the often "claimed" (but not proved) shortage of doctors in Germany.

3.7 Quota of foreign students and students with a migration Background

The quota of foreign students in this domain is 11% - this corresponds to the average quota over all subjects. The quota is only in nursing and "other medical therapy" lower, which might be due to the young age of these programs in Germany. Most other European countries have longer traditions for study programs in these fields.

4 Please give for each study programme covered by the professional domain a short descriptions refering to the following aspects

In the following only the major programs (medicine, pharmacy, dentistry and Health Sciences) will be described. Bio-medicine is still a rather small field preparing for medical research and study fields in nursing and other medical therapy are still emerging.

4.1 Study programme: Human Medicine

4.1.1 General description and duration

The curriculum covers around twenty subjects, from anaesthesiology to urology, as well as so-called "cross-section areas" such as medicine for the elderly and emergency medicine. It is centrally regulated by the "Approbationsordnung" (Approbation is the official license as medical doctor. During the standard course duration of six years three months, they work on over twenty subjects, from anaesthesiology to urology, as well as so-called "cross-section areas" such as medicine for the elderly and emergency medicine. 1

The study program is splitted in to main parts: pre-clinic (the first two years - four semesters) and the clinical phase (the next three years - 6 semesters) as well as a one year practical period (practical year) in the last year of the study program. The pre-clinical phase finished with the first state exam (Physicum). The Physicum covers subjects like chemistry, biology and physics as well as anatomy and physiology. The second state-exam covers over twenty different disciplines, from occupational medicine through surgery, dermatology and paediatrics to pharmacology as well as combined subjects like on immunology, imaging processes, clinical environmental medicine and health economics.

1 Partly copied from CHE-Ranking subject descriptions: http://ranking.zeit.de/che2010/en/fachinfo?esb=36

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The standard duration is six years and three months or 12 semesters and three months. The average study time is 13 semesters.

In 2002 the "Approbationsordnung" was changed and hereby, the structure of the medical study program. Before 2002, the student had to pass four exams. The first pre-exam (Physikum) was after the first two years and is now called the first state-exam. In contrast, the old first state exam was taken after the third year of study. The second-state exam - which was the main and most comprehensive exam, including one written and one oral part - was taken before the practical year after the 5 years of study. Finally, the third state-exam, which was a comparatively short oral examination, was taken after the practical year at the end of the study.

Current discussion/development:

Since the 2003/2004 medical courses are attempting to move closer to practical realities and prepare students better for their practical work doctors. The first results of this development are reformed course timetable. The practical application of what is taught is to be worked on with more emphasis even in the earlier semesters. Alternative training methods are gaining in popularity. So-called "bedside teaching", for example, is done alongside the patient, and "problem-based learning" confronts students with case studies.

4.1.2 Formal general curricula elements like practical training period

The first practical period is the so called "nursing traineeship" (Pflegepraktikum). Most students already do this before starting their study (sometimes even as pre-condition for their application). This traineeship must be three months long (can be splitted) and it must be finished until the first state exam (after two years of study). Additionally, medical students have to do a first-aid course.

The first state exam marks the end of the pre-clinical phase. In the clinical phase the students have to complete another four months of clinical traineeships (famulaturen) during their university holidays. The overall duration is four months. The following conditions must be fulfilled:

One month of work in a medical practice or another center for ambulant care

Two months in a hospital

One month either in a hospital or a medical practice

This overall four month has the purpose to give the students an insight into what they will be doing later on in real life during their clinical traineeship, which involves practical work in hospitals and medical practices. For being accepted to the second state exam (at the end of the study) they have to certify these four months of practical traineeship. Additionally, also many courses and seminars during the semester are practical which means they are taught in the clinic (bedside-teaching).

Finally, there is a one year practical year (48 months) in which the students are working as kind of "doctor assistant" in a hospital. The focus is here on training doctoral competences and to work with the patients. The practical year is splitted into three parts:

One part (16 weeks) in surgery

One part (16 weeks) in internal medicin

One part (16 weeks) in one other medical specialization

After the practical year the study finishes with the second state exam which covers all clinical fields. After graduation, most graduates go into the clinic in order to finish their five year specialization. Only as specialized doctor, one can open one`s own medical practice.

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Before October 2004 all medical graduates had to complete another 1,5 year practical period after graduation to get the license as medical doctor - the so called "Doctor in internship" (AiP - Arzt im Praktikum) phase. During this phase, the medicine graduates were paid relative poorly: around 1000 € gross income per month but worked a high number of hours. In comparison: After abolishment of the AiP the graduates were directly employed as residents/assistant doctors and were paid three times so much. This very unsatisfied position for young graduates needs to be considered when interpreting the REFLEX data.

4.1.3 Degrees and certificates; state of art particularities

The medical study ends with a state-exam without granting a title. The graduates can apply their "approbation" (license as medical doctor) with the passed exam.

4.2 Study programme: Dentistry

4.2.1 General description and duration

The dentistry study programs aims of educating dentists. The study is divided up into so-called pre-clinical and clinical parts. The five-semester pre-clinical phase mainly involves basic studies of natural sciences and medicine, which are tested in a preliminary exam on the natural sciences (after the 2nd semester) and one on dentistry (after the 5th semester - the so called physicum). The dentistry exam involves both oral and practical testing. The examinees have five days to, for example, grind down teeth in a dummy skull and create different types of denture. 2

Real patients are not usually seen until after the 5th semester. In the clinical phase (5th to 10th semester), students get in contact with patients. Dentists from partner practices examine them first, but later on they have to provide treatment themselves. The study finishes with the second state exam. This exam includes several oral exams as well as practical exam which take several days (e.g. in prosthesis the examinee has to build a fixed and a removable prosthesis at a patient. He has to make the diagnosis, build the prosthesis, adapt it to the patient etc. Overall, the duration of the exam is on average 10 days).

Similar to medicine, the curriculum of dentistry is centrally regulated by the "Approbationsordnung" (registration of dentists). It includes subjects biology, chemistry, physics, physiology, physiological chemistry, anatomy. This in the pre-clinical phase acquired knowledge is later consolidated in exercises, and then further developed in seminars and practical work. The course regulation prescribes 19 different subjects and practical courses during the first five semesters, and as many as 34 subjects and courses in later semesters from dental maintenance to radiology, from internal medicine to health care, from the course on operating to the placement in an ear-nose-throat clinic.

The standard course duration is ten to eleven semesters. The average study length is currently 11 to 12 semester. After the exam, the graduates can directly work as dentist. There is no further education demanded to open ones one dental practice.

Dentistry is the most expensive study course. Even so there are no student fees (at least only in few Länder/states - 500€ per semester), the students have to pay for their course material which is quite expensive.

New developments in this subject:

2 Partly copied from CHE-Ranking subject descriptions: http://ranking.zeit.de/che2010/en/fachinfo?esb=37

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The study of dentistry is in the process of being reformed. The drafting of new regulations on medical registration are particularly intended to make dentists‘ basic studies more similar to those required in general medicine. Another current discussion - fostering this development - is the low research quota in dentistry.

In 2005 the German Council of Science and Humanities (Wissenschaftsrat) which provides advice to the German federal government and the state (Länder) governments on the structure and development of higher education and research criticized the current regulation of license ("Approbationsordnung") and formulated several recommendations for change. This year (2010) it shall be evaluated in how far these recommendations were transferred into innovations and change. In the case of a negative results, the Council of Science and Humanities threads to close several dentistry departments at universities.

One recommendation covers the structure of the dentistry study program. The first two years of dentistry shall be taught together with medicine. After this pre-clinical phase the students shall take the same state-exam as the medical students (Physikum). After another year of studying propaedeutic dentical courses an additional state exam (the first) will be introduced. The second state-exam follows after another four semester which are concentrating on patient-treatment. Another innovation will be that dentistry students must complete a nursing internship like medical students (also three months).

4.2.2 Formal general curricula elements like practical training period

The study program includes many practical exercises at student colleagues or real patients. No further practical training periods are part of the program.

4.2.3 Degrees and certificates; state of art particularities

The medical study ends with a state-exam without granting a title. The graduates can apply their "approbation" (license as medical doctor) with the passed exam.

4.3 Study programme Pharmacy

4.3.1 General description and duration

The objective of pharmacy courses is to teach students everything about how medication is developed, produced, analysed, stored and used. Furthermore, pharmacy students are learning about side effects and how certain medication react with other medications.

As dentistry and medicine, pharmacy is a state-examined and a very structured course. As in medicine and dentistry, the national regulation for approbation ("Approbationsordnung") is defining the major parts of the curriculum. "Course timetables are laid down and compulsory attendance is required at seminars and practicals for which credits must be acquired. Students can choose an optional required subject from amongst the pharmaceutical sciences. Thirty-five to forty hours per week are generally spent in the university, of which most is devoted to doing practical exercises and experiments in the laboratory. From Freiburg to Kiel, the course has a similar structure in all 22 faculties of pharmacy. The main differences lie in the additional classes that can be attended on a voluntary basis. Some universities offer seminars in psychology, pharmaceutical biotechnology or business, while others arrange field trips to pharmaceutical companies."3

The pharmacy program is divided into a four-semester basic stage in which the concentration lies on chemistry, biology and physics. Pharmacology is only introduced in the third semester. The program is

3 Copied from the CHE-Ranking: http://ranking.zeit.de/che2010/en/fachinfo?esb=19

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very practice oriented. Several lab practicals allow students to practise using chemicals, lab equipment and microscopes. Additionally, pharmacy students have to complete eight weeks of clinical training. Four weeks of it should be in a public pharmacy known as an "Offizin", or dispensary, while the other four weeks may be spent, for example, in a hospital dispensary or a drug testing centre.

The first part of the study ends with the fourth semester and the first state exam. In the second part the curriculum contains pharmacy-specific knowledge like toxicology, pharmacology, illnesses, biochemistry and molecular biology. The second state-exam marks the end of this study part. Afterwards, the students have to fulfill a 12 month practical training: 6 months must be completed in a pharmacy and the other 6 months in a hospital, pharmaceutical industry, at the university or another research institute (always under the supervision of a fully-trained chemist).

The standard course duration is eight semesters plus 12 month of practical training.

New developments in this subject

For some years, changes have been appearing in the course content. The proportion of chemistry has been declining, while pharmacology and basic medicine have acquired increasing importance. Courses are thus adapting to the changing needs of the career chemist. Chemists need to look after chronically ill patients, carry out simple examinations and work more closely with the patients‘ doctors.

4.3.2 Formal general curricula elements like practical training period

See above (8 weeks of internship before the first state-exam and 12 month practical training after the second state-exam)

4.3.3 Degrees and certificates; state of art particularities

The pharmacy study program ends with the state-exa

4.4 Health Sciences , Health Management (Public Health)

4.4.1 General description and duration

The term "Health Sciences" covers different study programs in the area of Public Health. Often the focus is either on pedagogic, management aspects or health economics. Because of this diversity it is quite complicated summarizing the different study programs.

The curricula cover (in general) subjects in the area of:

Medicine

Business studies

Nursing

Human Resource Management

Health System (Management, Ethics, laws,

Psychology

Research methods

The intention is to educate people for working in the in the management of Health institutes like hospitals, nursing homes, sanatoria. Graduates with the focus on research are either working in higher education or as counselors for politics, municipals, associations etc.

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4.4.2 Formal general curricula elements like practical training period

Often, an already completed vocation education in the area of nursing is often a prerequisite for acceptance as student.

Internships of different length are included in most programs.

4.4.3 Degrees and certificates; state of art particularities

The Bologna reform is strongly processing in this field. Still, besides Bachelor and Master programs there are still a number of "traditional" diploma programs.

5 Please summarize the general impact of Bologna on this study field as well as the general issues discussed in this regard

So far, the classical medical disciplines (medicine, dentistry and pharmacy) were immune against any change as a consequence of the Bologna reform. With the exception of a few master courses, which were introduced as part of the Life Long learning programs of universities, all classical medical disciplines are still have the state-exam as degree. There is a discussion to change also these disciplines to the BA/MA-structure, but so far, only one university has announced its plan to offer medicine as a Bachelor course together with a university in the Netherlands.4

At least in medicine and pharmacy, there is currently a debate about introducing the new Bachelor and Master courses. In pharmacy the first Bachelor programs are developing. Still, the pharmacy BAs will not be allowed to work as chemists selling prescription drugs as the permit to do this still requires to pass the state exam after five years training. It is expected, that the level of specialization in the course will increase if the Bachelor/Masters system were to be introduced as normal degrees. Possible additional subjects could be molecular medicine, biotechnology, nutritional science and business studies.

Another development which can roughly be describes as a consequence of the Bologna reform is the introduction of so called "reform study programs" in the field of medicine. These programs are still "state-examined", but they are more modern in their didactics. The pre-clinical and clinical phases are less separated: the students are learning case-based which means they are learning the chemical, biological, physical and anatomical basics with the help of case studies (e.g. a patient comes with stomach ache etc.).

5.1 Please describe the role of stakeholders in this professional domain

See below

5.2 Are there any stakeholders outside HEI which have an influence on content and structure of the professional domain? If yes, what kind of stakeholders?

Each domain (medicine, pharmacy, dentistry) have strong associations (Zahnärztekammer, Ärztekammer, Apotherkammer) in which each professional must be a member. These associations

represent their profession - lobby their profession

4 University of Oldenburg:

http://www.aerztezeitung.de/praxis_wirtschaft/unternehmen/article/529381/oldenburg-will-bachelor-studiengang-medizin.html

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regulate the Lifelong Learning process

develop the Medical Association's professional code of conduct

do and publish statistical data about their profession

provide social insurances for their members (e.g. medical doctors are not part of the public pension fund as they have their own "medical-profession" pension fund)

One of the main stakeholders for the study fields: medicine and pharmacy is the Institute for medical and pharmaceutical examinations (IMPP - Institut für medizinische und pharmazeutische Prüfungsfragen). The IMPP is a central institution of the Länder (federal states) and has the legal status of a statutory public body.

It was founded in 1948 in order to secure a more objective examination in the state-exams. The institute develops with the help of experts the written part (multiple choice) of each state-exam in medicine and pharmacy. It is also responsible for evaluate, correct and mark the exams. Furthermore, it is publishing preparation material for each exam.

Another stakeholder (in the field of medicine) is the "Marburger Bund" - the union of employed medical doctors in Germany. It was founded in 1974 and has currently around 108.000 members - which makes it the biggest union of medical doctors in Europe. As it originally evolved out of a student association, it often gives its statements to actual developments or problem regarding the university education of young doctors. Services of the Marburger Bund include:

Insurances (like liability insurance)

Seminars

Career Services (support in the application process, information to become self-employed)

Information about study and work abroad

As dentists and chemists are more often (respectively: earlier) working self-employed there are no respective organizations for them. Chemists owning a pharmacy can be a member of the Association of German chemistry employers (ADA - Arbeitgeberverband deutscher Apotheken).

5.3 Does the state play a major role as influential stakeholder? (e.g. in Germany certain subjects are state examined whereas the HEI defines the content of exams in most fields)

The state plays a major stakeholder in the state-examined fields of medicine, pharmacy and dentistry. The Health Ministry passes the "regulation of approbation" (Approbationsordnung) for all three professions which strongly define not only the curriculum but also the exams.

6 Please describe the transition process from Higher Education to the Labour market

6.1 Is the transition process individualized or is it defined by national legislation?

Medicine:

Medical graduates can directly apply for their "approbation" after successfully passing the second (since change of the study reform, before it was the third) state exam and hence, are full member of the profession. But, they can at that point not open their own practice. The public health insurance does only accept medical doctors with a finished specialization (on average five year of work in the specific

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department of a hospital and passing an exam) like surgery, internal medicine or general medicine. A medical without such a specialization can only open a private practice which means that patients insured via the public health system need to pay themselves and get no refund by their insurance.

Graduates of 2000 which were surveyed in the REFLEX survey were still obliged to complete 1,5 year of practical training (after their third state-exam) in order to apply for their approbation. Before October 2004 all medical graduates had to complete another 1,5 year practical period after graduation to get the license as medical doctor - the so called "Doctor in internship" (AiP - Arzt im Praktikum) phase. During this phase, the medicine graduates were paid relative poorly: around 1000 € gross income per month but worked a high number of hours. In comparison: After abolishment of the AiP the graduates were directly employed as residents/assistant doctors and were paid three times so much. This very unsatisfied position for young graduates needs to be considered when interpreting the REFLEX data.

Dentistry:

Dentistry graduates also can apply for their "approbation" after successfully passing the second state-exam. The graduates can then directly work as dentist and open their own practice. There is no further education demanded to open ones one dental practice. But, of course, there are possibilities for further education like oral surgery and orthodontics. Some universities also offer special postgraduate courses for dentists.

Pharmacy:

Pharmacy is the only subject in which a demanded practical period follows the last official exam. The second state-exam marks the end of the study part. Afterwards, the students have to fulfill a 12 month practical training: 6 months must be completed in a pharmacy and the other 6 months in a hospital, pharmaceutical industry, at the university or another research institute (always under the supervision of a fully-trained chemist) in order to apply for their approbation. Afterwards they can work as pharmacist/chemist and open their own pharmacy.

6.2 Are there any additional elements/exams/working periods required to become a full member of the profession? (e.g. like in medicine in most countries)

No, the additional working periods are part of the study. Additional information, see above.

7 Are there any domain specific data sources or regular research conducted (e.g. surveys, statistics by an association); Please describe the main findings ? Technical descriptions should be part of 4_DOP_ProfessionalDomains)

Besides of the statistical reports provided by the national associations of each profession (medicine, dentistry and pharmacy), there is no regular conducted survey which is specific for this group.

The Center for Higher Education Development has conducted a tracer study of medical graduates (cohorts 1996 - 2002) in 2002 using a unique approach. They did not use the addresses provided by the universities but sent the questionnaires via the federal medical associations. The result of this survey is summarized in a 4_DOP - document.

8 Is the Life Long Learning Process in any way regulated/demanded for graduates of this professional domain? If yes, who regulates it and what are the general rules?

Since 2003 the Life Long Learning process for medicine and dentistry graduates is regulated by law. Based on a decision by the European parlament (2001/19/EG) the formerly only recommended participation in the Life Long Learning process is no regulated by law. All medical doctors and dentists

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have to participate (and to prove this participation) in Life Long Learning offers which are adequate to their subject/specialization and represent the current state of research. The detailed regulation is done by the respective medical association of each federal state. But, the national medical association has published guidelines in which it is recommended that each medical doctor needs to do around 150 hours (à 45 min.) in a three year period. Additionally, the national medical association recommends that different kinds of courses need to be attended - this means, one cannot only participate in conference but also needs , for example, to take part in structured seminars. Additionally, one can receive points for own presentations at conferences, seminars.

An accreditation process by the medical associations of each federal state ensures the quality of the Life Long learning courses/conferences.

If somebody is not fulfilling these requirements the "honorary" can be shortened by certain percentage.

In pharmacy a similar system was installed in 2003 (also 150 points in three years). But in contrast to medicine and dentist the collection of points are still voluntary (the participation in LLL is recommended and expected but not controlled). After reaching a certain amounts of points, the pharmacist can apply for a certificate ("Freiwilliges Fortbildungszertifikat").