Exploring the nature of undergraduate clinical placements in Germany in the context of developing a collaborative European undergraduate medical programme

Abstract

Fragestellung/Zielsetzung*
In 2013 the University of Southampton (UoS) established a new medical degree programme, the BM(EU), together with a German healthcare provider, Gesundheit Nordhessen. After two years in the UK, the first cohort will move to Kassel in the Autumn 2015. The entire programme is subject to the UK regulator’s requirements and quality control – and, coincidentally, meets the Wissenschaftsrat’s recommendations.
As is typical for medical education in the UK, the BM(EU) students will spend the majority of their programme on clinical placements. Through ongoing collaboration, intensive staff development and quality assurance visits, we are ensuring that our German colleagues are equipped to deliver the Southampton curriculum. From our reading of the literature, we understand that the BM(EU) differs significantly from the majority of programmes delivered in Germany.
To better understand our colleagues’ perspectives of clinical placements, we conducted an exploratory applied medical education research project in Kassel. Our research questions were:
1. What happens during clinical placements in the medical education system in Germany?
2. What is the nature of apprenticeship learning in the medical education system in Germany?
Theoretically, the study was informed by the Communities of Practice model developed by Lave and Wenger.

Methoden
We conducted semi-structured interviews with senior clinical teachers who will be involved in the delivery of the BM(EU); n=13. All interviews were transcribed and a thematic analysis was conducted.

Ergebnisse
The German medical education system differentiates between four different types of clinical placements. However, it seems that only the Blockpraktika are organised by and form part of university teaching. The other three placement types are mandatory and signed off at the end, they seem to be organised by the students themselves, without any medical school involvement. As such, this clinical experience appears not to be subject to regulatory guidance and supervision and is without minimum staff training requirements. The lack of external quality control does not necessarily impede opportunities for apprenticeship learning but means the experience is quite variable. Participants provided examples of both good and bad learning opportunities.

Diskussion/Schlussfolgerung
Given the experiences reported by the clinical teachers in Kassel, the Southampton approach, is likely to be new (and potentially challenging). The key differences, as we see them, are the UK emphasis on clear learning outcomes and assessments for all clinical placements, ongoing teacher training and the evaluation by an external regulator.
It is important that we discuss and examine our definitions and underlying assumptions about the nature of clinical placements. In fact, we consider it an essential starting point for providing effective staff development and support for our clinical teachers in Germany.


Literaturhinweise:
[1] Chenot JF. Undergraduate medical education in Germany. German Medical Science 2009; Doc02.
[2] Nikendei C, Weyrich P, Jünger J, Schrauth M. Medical education in Germany. Medical Teacher 2009; 31: 591-600.
[3] Lave J, Wenger E. Situated Learning. Legitimate peripheral participation, Cambridge: University of Cambridge Press. (1991)

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