Case study: Post-graduate medical education in Germany, a synopsis

W. Antepohl (University of Cologne, Germany)

In contrast to many other European Countries, postgraduate medical education (p.m.e.) , i.e. specialisation, in Germany is not under the responsibility of universities or medical schools. Instead, the guidelines of p.m.e. are defined by the physicians own representative bodies: while the general framework in its latest version from 1992 was elaborated by the "Bundesarztetag", the representative body of all German physicians, the details are regulated by the "Landesarztekammern", the chambers of physicians in the different German "Lander" (states or provinces).

Consequently, p.m.e. is not limited to university hospitals, but takes place in most of the German hospitals, as well as in many other areas in which physicians work (e.g. private practice, research institutes, centres for occupational health, etc.) provided that there is a qualified physician who is entitled to provide p.m.e. in the speciality concerned.

There are no programmes for p.m.e. and accordingly there is no clearly defined number of places available for specialisation. A physician willing to specialise is expected to work in the subject concerned during a certain period of time (family medicine being the shortest with 3 years, as of 1997) defined by the 'Landesarztekammer' in charge.

Periods of time spent in "neighbouring" subjects (e.g. neurology for specialisation in internal medicine) may be recognised to some extent or even obligatory (e.g. one year of psychiatry for specialisation in neurology).

Additionally, he/she will have to perform a certain "catalogue" of diagnostic and curative procedures typical for the speciality chosen. Even this "catalogue" is defined by the 'Landesarztekammer'. Moreover, he might have to take part in certain theoretical/practical courses and will have to prove his knowledge in a specialist exam, which he/she can take when having spent the necessary time and performed the number of procedures in his speciality.

The following example illustrates the above:

Specialisation in internal medicine:
Time to be spent for specialisation: 6 years (minimum) out of which:
- at least 4 years on a ward of internal medicine
- 6 months in a medical intensive care unit

Periods of time in the following departments can be recognised:

up to 6 months: anaesthesiology, anatomy, biochemistry,dermatology, immunology, laboratory medicine, microbiology, nuclear medicine, occupational medicine, pharmacology and toxicology
up to 12 months: clinical pharmacology, neurology, pathology, paediatrics, physiology, psychiatry and psychotherapy, radiology, rehabilitative medicine

Various sub-specialisations are possible, for which an additional specialisation time of 2 years is required: angiology, cardiology, endocrinology, gastroenterology, haematology/medical oncology, nephrology, pneumonology, rheumatology.

Additional certificates can be obtained in: laboratory diagnostics in internal medicine, radiology in internal medicine, sigmoldo-coloscopy in internal medicine.

Additional qualifications can be obtained in: clinical geriatrics and intensive care.

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