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GERMANY

Basic Medical Education

Surprisingly fast the new federal regulations (Approbationsordnung, ÄAppO) for BME have passed the Bundesrat in June 2002 and will become effective for all medical faculties from October 1^st, 2003. General Practice has a stronger role in the new regulations. There is an obligatory term in practices of at least one week (usually two weeks) in the 4^th or 5^th year of the curriculum, and General Practice can be an elective in the 'practical year', the 6^th year. General Practice can also be a part of integrated teaching in epidemiology, health economics, ethics, prevention, geriatrics and other subjects. Nevertheless the latter is up to curriculum design in every single medical faculty. Those Departments of General Practice (10 out of 37) which are well integrated into their medical faculties will try to enlarge their proportion of teaching in the local curriculum; those with a weak or no integration will need a lot of help for example to establish teaching practices. The German Association of University Teachers in General Practice (Vereinigung der Hochschullehrer und Lehrbeauftragten für Allgemeinmedizin; President: Prof. Waltraud Kruse) and the German Association for General Practice and Family Medicine (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM); President: Prof. Heinz-Harald Abholz) (the scientific society) will try support them.

Vocational Training

The 105th Deutscher Ärztetag (the 'parliament' of all doctors) in May 2002 has decided to melt the vocational training of general practitioners, general internists and specialised internists into a common trunc. Both disciplines would then have a compulsory VT of 5 years; at least two years of internal medicine are mandatory. VT leads either to a specialist in 'Internal Medicine and General Practice', who would be the only primary care physician (besides pediatricians and gynecologists), or to specialties like gastroenterology or cardiology. Up to now GPs and general internists compete in primary care; patients can choose freely which one to consult. This leads for example to competition in the technical field, resulting in ultrasound machines in 3/4 of all GP practices. The next Ärztetag in May 2003 will finally decide on the details of this new concept.

CME

Since 1999 credit points can be gathered by every doctor on a voluntary basis (150 credit points in 3 years) to get a 'certificate' (freiwilliges Fortbildungszertifikat), but there are no incentives and no consequences. The Federal Chambers of Physicians (Landesärztekammern) are responsible for issuing these certificates.

The 75^th Conference of Federal Ministers of Health (June 20-21, 2002) has started to put pressure on the Federal Chambers of Physicians to take action in the field of recertification, saying that CME alone is no sufficient prerequisite for competence of doctors. This fosters a discussion about recertification and CPD that had not started so far.

The New European Definition of General Practice 2002 will be translated by Austrian colleagues into German and being published on all levels. In a parallel process the German scientific society DEGAM together with its members has developed a new German definition of General Practice overlapping with the new European definition, but taking into account the national health care system and national traditions. This definition has been adopted by the annual assembly in Koblenz on September 21, 2002.