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GERMANY

Basic Medical Education

The new federal regulations (Approbationsordnung, ÄAppO) for BME became effective for all medical faculties on October 1^st , 2003. General Practice will have a stronger role in most medical faculties. It will play a role in integrated teaching in epidemiology, health economics, ethics, prevention, geriatrics, complementary medicine and other subjects, but the actual role in each Medical School depends on the willingness of other subjects to co-operate and share and on the engagement of the GP-teachers in that respective Medical School. There is now an obligatory term in teaching practices of one to two weeks, usually in the 4^th or 5^th year of the curriculum, and General Practice can be an elective of four months in the 'practical year', the 6^th year. As all subjects now are obliged to give grades to the students at the end of each course, discussions started on adequate assessment procedures. A national workshop at the Department of General Practice in Kiel on May 16-18, 2003, discussed different ways to answer to this challenge (German materials: www.degam.de/s_2/material/index_material.htm) This discussion will be continued during the coming months and in a 2^nd workshop next spring. German members of EURACT play a central role in this process. Different from other European countries, there is no experience with OSCE and on-site assessment in general practice teaching so far.

Vocational Training

After years of discussion and dispute, the 106^th 'Deutscher Ärztetag', the parliament of all doctors in Germany, in May 2003 has finally decided to melt the vocational training of general practitioners, general internists and specialised internists into a common trunc. Both disciplines will 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 will be the only primary care physician (besides pediatricians and gynecologists) in the future, or to specialties like gastroenterology or cardiology. The primary care track will require at least two years in general practice; surgery was thrust into the background. Up to now GPs and general internists compete in primary care; patients can choose freely which one to consult. As VT legislation is federal legislation, these new regulations need further approval and adaption in the Federal Chambers of Physicians and in Federal Governments which will be done in Spring 2004. The camp of the internist has sworn to undo the melting process on that level - I will report.

The German Association for General Practice and Family Medicine (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM)) (the scientific society) has published a booklet about planning and establishing general practice VT rotations in co-operation of hospitals and GP practices ('Verbundweiterbildung zum Allgemeinarzt'; author: N. Donner-Banzhoff). There is no rotation scheme in general practice VT in Germany; future GPs have to 'patchwork' their combination of posts.

CME

Politics is putting growing pressure on the Federal Chambers of Physicians to take action in the field of recertification, saying that voluntary CME alone is no sufficient prerequisite for competence of doctors. The planned new regulations ('Gesundheitsreformgesetz') agreed upon by both, Government and opposition, see mandatory and regular CME probably with credits controlled by the Federal Chambers as a practicable way. Denial of individual doctors will lead to financial punishment and finally to extinction of the licence. DEGAM has installed a task force on 'CME and re-certification' in September 2003, led by N. Donner-Banzhoff and S. Wilm, to develop answers going beyond CME to maintenance of professional competence and CPD.

What have I done as EURACT representative in Germany?

The 13 German EURACT members will meet during the next workshop of the German Association of University Teachers in General Practice in Cologne on November 21, 2003, to exchange ideas especially in the field of assessment. At least twice a year members get a report of EURACT activities and new documents; via e-mail they are immediately informed about new developments.

During national assemblies, congresses, workshops and task force meetings, in DEGAM and the teachers association German EURACT members influence the discussion about and progress of general practice medical education very much.