36 different ways to study medicine

There are 35 public and one private medical school in Germany and almost as many ways to study medicine. Curricula vary hugely in the way subjects are taught, when they are taught and for how long they are taught and there is a bewildering variety of additional mandatory courses offered. Officially, there are only two different medical curricula in Germany: the traditional and the model curriculum. The latter is offered by only a few universities. An important difference between the two types is that in the model curriculum students are not required to take the first national medical licensing examination at the end of the second year. This could be an excellent opportunity for universities that have adopted the model curriculum to develop an integrated curriculumand to design innovative courses. Most medical faculties offer the traditional curriculum, which starts with two years of basic science education and three months of nursing training in a hospital. The nursing experience is intended to give students a first impression of working in health care and of the organization of a hospital as well as first-hand knowledge of nursing as a profession, which may facilitate interprofessional teamwork later on. At the end of the first two years students have to pass the first of two national medical licensing examinations, which consists of a written test with multiple-choice questions and an oral examination. The multiple-choice questions are developed by the national Institute for Medical and Pharmaceutical Examination Questions (IMPP), a public-law institution which is authorized by the state examination offices to develop the multiple-choice questions and which is also responsible for quality assurance of questions. The oral examination is not structured by nationally defined guidelines or a blueprint nor is it subject to an external quality assurance process. This precludes comparisons between the different curricula. Having passed the first national medical licensing examination, students move on to the three-year clinical science part of the curriculum. Clinical science teaching covers all clinical disciplines. It is during this part of medical education that the differences between the universities are particularly marked. Curricula differ in the sequencing of subjects as well as in the duration and depth of teaching. When they reach the end of this curricular phase students have passed at least 34 summative exams [1]. Themedical licensing requirements (Approbationsordnung für Ärzte (ÄAppO)) state that, in addition to theoretical education, students must attend 476 hours of smallgroup bedside teaching including five clerkships (Block-