title: Undergraduate education in palliative medicine in Germany: a longitudinal perspective on curricular and infrastructural development.
abstract: BACKGROUND
  In 2009, palliative medicine became an integrated and compulsory part of undergraduate training in Germany by legislation. After a transitional period, all medical faculties were required to provide adequate teaching with an according examination and certification procedure. In parallel, we conducted bi-annual surveys on all medical faculties in Germany to examine for potential discrepancies between the implementation process and their intended consequences on teaching time and content.
  
  
  METHODS
  Four consecutive bi-annual surveys (2006, 2008, 2010, 2012) of all 36 medical faculties in Germany were performed, using purposively for this study developed questionnaires. Likert scales and closed questions were analyzed descriptively.
  
  
  RESULTS
  Medical Faculty response rate increased from 50 % in 2006 to 88.9 % in 2012. Teaching coordinators in palliative medicine primarily had an anesthesiology or internal medicine background. There was a noted increase over time of the involvement of specialized palliative care units (PCUs) as providing the setting for education. The number of faculties that were able to offer a complete 16 weeks of training in palliative medicine during the "final year" rose steadily. In addition, increased patient-centered teaching formats have been implemented over time. The faculties which offered innovative teaching formats with actors as patients (standardized patient interaction) increased, as did the total number of mandatory examinations. The number of faculties that provided compulsory teaching in a condensed manner within a single academic year increased sharply from 3 of 31 responding faculties in 2010 to 19 of 32 responding faculties in 2012.
  
  
  CONCLUSIONS
  Until now, teaching conditions and structures in palliative medicine in Germany have proven to be extraordinarily heterogeneous. Although professorships ("Chairs") in palliative medicine proved to be particularly beneficial and supportive in curricular and structural development, only a minority of faculties provide leading academic positions in palliative medicine.
authors.affiliation: Department of Neurology, University Medical Center, Göttingen, Germany. Benjamin.ilse@med.uni-goettingen.de.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Ilse
authors.affiliation: Department of Palliative Medicine, University Medical Center, Göttingen, Germany. bernd.alt-epping@med.uni-goettingen.de.
authors.forename: Bernd
authors.initials: B
authors.lastname: Alt-Epping
authors.affiliation: Department of Palliative Medicine, Munich University Hospital, Munich, Germany. Isabel.Kiesewetter@med.uni-muenchen.de.|Department of Anesthesiology, Munich University Hospital, Munich, Germany. Isabel.Kiesewetter@med.uni-muenchen.de.
authors.forename: Isabel
authors.initials: I
authors.lastname: Kiesewetter
authors.affiliation: Department of Palliative Medicine, Uniklinik RWTH Aachen University, Aachen, Germany. felsner@ukaachen.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Elsner
authors.affiliation: Vestische Children's Hospital, University of Witten/ Herdecke, Datteln, Germany. johannahildebrandt@gmx.de.
authors.forename: Johanna
authors.initials: J
authors.lastname: Hildebrandt
authors.affiliation: Department of Anaesthesiology, University Medicine Greifswald, Greifswald, Germany. alexander.laske@berlin.de.|Sana Arztpraxen Rügen, Bergen, Germany. alexander.laske@berlin.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Laske
authors.affiliation: Interdisciplinary Centre for Palliative Medicine, University Hospital Dusseldorf, Dusseldorf, Germany. alexandra.scherg@med.uni-duesseldorf.de.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Scherg
authors.affiliation: Department of Anesthesiology, University of Erlangen-Nuremberg, Erlangen, Germany. schiessl@algesiologikum.de.|Algesiologikum - Pain Center, Munich, Germany. schiessl@algesiologikum.de.
authors.forename: Christine
authors.initials: C
authors.lastname: Schiessl
mesh_terms: D003479:Curriculum / Q000592:standards / Q000639:trends; D004504:Education, Medical, Undergraduate / Q000331:legislation & jurisprudence / Q000379:methods / Q000706:statistics & numerical data*; D005858:Germany; D006284:Health Plan Implementation / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006801:Humans; D065126:Palliative Medicine / Q000193:education* / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires