Introduction
The healthcare and medicine sectors are fields that have undergone changes predating ancient antiquities. Historic literature dictates the philosophy of renowned physicians in Ancient Greek Literature quoting ideologies of medical practice by doctors such as Hippocrates, author of the famous Hippocratic Oath and the Corpus Hippocraticum, the law of medical practice. Arguably the field is dynamic and diverse in nature and undergoes various procedures in the training of medical practitioners. According to Buja (2019), traditional medical training methods have been adopted in contemporary training systems and establish that the system has been instrumental in the scientific grounding of students. Additionally, the medical training antiquity supported students in acquiring skills that support clinical practice and public health facilitation. Hence, medicine is considered a renowned profession for the aptness and dedication of its members.
Consequently, medical training is an important and integral part of the healthcare system facilitating the existence of professionals in various fields of medicine. Buja (2019) argues that medical training has become an essential process that ensures the competency of professionals through competency-based systems than cognitive knowledge training. The relatively new research strategies gradually inform clarification studies necessary to establish scientifically sound explanations of factors influencing medical systems. The diversity and dynamism of the field is a subject that puzzles scholars and professionals to establish a comprehensive medical training system. Further, Fang et al. (2017) argue that there has been a transition from a traditional medical evaluation based on descriptive systems and has adapted to changing tides. As a result, curriculum providers make significant adjustments to conform to these changes. Therefore, medical education evaluation has evolved through such research and necessitates continuous monitoring.
The contemporary nature of research has instigated the utilization of justification and curriculum contrasting analysis. Consequently, there are significant variations in how medical training is undertaken from one country to another. Research by Zavlin et al. (2017) stipulates that Germany and the United States are recognized for a substantial history of medical and science prowess from the 19th century. However, the two nations present contrasting medical training systems, tracing the enrollment into medical school and graduating as a certified physician. This forms the basis of the research, which evaluates the medical training systems based in Germany and the US. The research seeks to determine the state of medical training through a comparison model between the practice of training in the US and that of Germany. The study will evaluate the state of training competencies and systems that support the existing pediatric systems of both nations to comprehensively determine the disparities between them.
Aim and Objectives
The study’s central objective is to assess the medical training programs in US and Germany and establish a contrasting analysis of the two organizations. The data considers a multidimensional analysis that seeks to extensively explain the differences and similarities between the medical training system.
The research objectives entail:
- Establishing policy and medical practice in US and Germany
- Determine the contrast between general medical training and pediatric training
Research Hypothesis: Pediatric training relative to general practitioner training has some impact on outcomes in pediatrics.
Justification
The project seeks to elicit the challenges study provides relevant information to professionals in medical practice and scholars in understanding the key issues faced in medical training and the quality of professional healthcare in the world. The information can be influential in developing strategies that modify medical training. The substantial influence of the study is to provide additional information that is anticipated to be instrumental in decision making and policy modification. The medical training field can gain essential gaps and opportunities that are present in their organizational structures. Relatively, the data can also reveal gaps for further research and provide additional info on data gaps for projects and scholarly research in the field of medicine. Therefore, the data is anticipated to influence a positive transformation of medical training, ensuring competency and skill-based practitioners in communities that can support community health care. In particular, the emphasis on Pediatric training will be significant in increasing life expectancies and protecting future generations from diseases.
Literature Review
Medicine is a field that has undergone significant research studies and publications that present a myriad of literature discussing the discipline’s components. In order to gain an understanding of medicine and the factors that control its effectiveness, a literature review is important. As such, in this section, the study will analyze a set of literature to support the analysis outcome of the research process. Foremost, understanding the importance of pediatrics is important for the research to establish a clear definition of the phenomenon and what it entails. Subsequently, Suchdev et al. (2018) define pediatrics as a medical process focused on children’s health. Comprehensively, a pediatrician is assigned the role of facilitating neonatal, child, and adolescent health care (English et al., 2020). Their role is more specialized considering health prognosis and treatment as they affect children. The specialization is considered essential by Suchdev et al. (2018) that argues pediatricians are imperative to achieving global health. Their role is integral as a component or determining factor for policy and strategic plans for public health.
However, there are limitations in the capacity of pediatrics that involve the medical training system and organization. As Shayestefar et al. (2017) reported, medical trainees face a significant challenge in handling ethical conduct issues, particularly in handling pediatric cases. The challenge expresses a limitation of medical training in educating the trainees to deal with patient-centered ethical conditions. The study reveals potential issues that the physicians in training encounter with pediatric patients. The circumstance presented the notion that the difficulties are associated with dealing with the patient’s family due to the patient’s inability to make decisions (Shayestefar et al., 2017). In this instance, the pressures on resident practitioners are limited by inadequate ethical curricular studies.
Hippocratic law and oath offer a universal acknowledgment in didactics of medical training expectations and from practitioners released into healthcare systems. According to Indla and Radhika (2019), the Hippocratic oath serves as a code of ethics stipulating codes of conduct to be adhered to in the field of medical practice. The law has been preset since the antiquities of 400 b.c dictating a framework authored by the revered Hippocrates, guiding his medical students that sought to examine philosophies of medicine as physicians (Indla & Radhika, 2019). Despite changes in the equity of gender inclusivity, the law has maintained its exclusivity in imparting knowledge to students as a scientific art of healing (Indla & Radhika, 2019). Just as the doctors and physicians in antiquity expressed their recognition of the gravity of their role and responsibility as healers, modern training has established the oath as a template of ethical considerations in training medical personnel on a global platform. The factor is associated with the study that seeks to identify similarities in medical practice that can be consolidated and contrasted in formulating an effective system.
The Hippocratic Oath has significantly been remodified over history as a policy that gives a policy and regulatory framework. According to Henry (2017), the Geneva declaration significantly influences the medical field. The World Medical Association adopted the declaration as an update to the Hippocratic Oath’s antiquity. The declaration was incepted in 1948 to establish a global framework guiding medicine as a contemporary form of policy and regulations (Henry, 2017). The global community has made substantial efforts toward establishing a global medical system to unify the objectives of the medical field. Synonymously, the World Health Organization has been dedicated to developing a medical organization policy system that can be universally accepted as a strategy to improve global health (Weisz & Nannestad, 2021). Similarly, World Health Organisation supports establishing a pediatrics-related toolkit by ECHO that is dedicated to promoting children’s rights within hospitals (ECHO, 2019). The properties of the proposals are anticipated to have a significant influence on global health to allow an inter-transfer of knowledge and skills.
The pediatric field of medicine presents discrepancies in establishing equity in child healthcare. Additionally, Lin et al. (2018) present the notion that medical training has inadequacies in the standardization of the programs. There have been ethical disparities in association with international rotations that arise from variations of the medical training organizations. Consequently, Sherrif et al. (2020) propose a set of global health strategies in medical training that are essential in enhancing global health. Based on global health tracks, the study will be influential in addressing the needed formalization of a global health training system. Therefore, the analysis of organizations is essential in assessing and equipping medical trainees in acquiring relevant technical, interpersonal communication, and ethical skills that are essential in establishing global health targets and standards. The inference of such data emphasizes the existing challenge faced globally in ensuring quality healthcare. In particular, the pediatric field of medicine endeavors to create suitable environments that effectively sustain a healthy global community.
Methodology
The research takes a case study methodology that tries to distinguish the state and structure of medical training in the US and Germany, focusing on the subspeciality of pediatrics relative to general medical training. Research by Bartlett and Vavrus (2017) informs the methodology adopted through which the research avidly seeks to establish a comparative analysis and assessment of the two case nations. The study will incorporate two logic comparisons starting with the common compare and contrast and tracing variables across various scales and sites (Bartlett & Vavrus, 2017). Consequently, qualitative data comparison was instrumental in the multidimensional analysis of medical training. The study’s implications were anticipated to reveal the variation in medical training for general medicine and pediatric training.
Analysis and Findings
Medical Training in Germany
General training in Germany has a concise system that has been extensively researched on its significance. The general medical practice in Germany is constituted by a 6-years program divided into two stages. The first stage involves a 2-year pre-clinical segment that supports the student in acquiring basic science knowledge in subjects such as biology, chemistry, physiology, physics, organic chemistry, psychology, and microscopic and macroscopic anatomy (Zavlin et al., 2017). The data will be essential in establishing a relevant competency for the studies related to medical studies. At this stage, the trainee is anticipated to partake in a 3-month nursing program that is mandatory for all students to qualify for progression into the last 6-year German medical training segment (Zavlin et al., 2017). Consequently, the German framework allows the consistency of relevant training associated with medical practice, unlike the US, which has a disjointed requirement for bachelor’s degrees that may be unassociated with medical practice.
Further, the second segment is a 4-year program that entails clinical training that entails a three-year theoretical education in the fields of orthopedics, pathology, genetics, microbiology, and surgery. The stage has been modified in recent years incorporating interdisciplinary approaches to medical training. The concept entails the combination of relevant clinical subjects such as surgery and pathology as one block linked to disease entities (Zavlin et al., 2017). German general medical training stipulates the necessity of a 4-month clinical dealing with 2-month in-patient care, 1-month outpatient scenes, and a 1-month apprenticeship with a family doctor certified by the board (Zavlin et al., 2018). The stage of clinical training integrates innovation and practical concepts such as computer-based learning to improve the medical student’s coursework. The combined system enhances their theoretical and practical knowledge and skillsets in clinical settings equipping them for professional medicine.
The final year of the second segment, in this case, is dedicated to clinical rotations that enhance the application of training. The stage requires the selection of 3 sectors which are surgery and internal medicine, and a final elective outside of surgery or internal medicine (Zavlin et al., 2017). The last clinical year allows students to be more interactive with opportunities for the next stage of their training geared towards residency (Zavlin et al., 2017). The data reveals that Germany’s whole medical training organization is accommodated in a 6-year program.
Pediatric Training in Germany
Consequently, in the case of pediatric training in Germany, aspiring practitioners are accredited as specializations from general medicine programs. Students in medical training have been attributed to undergoing specialization during the final year of medical training, which is considered the clinical year (Zavlin et al., 2017). At this stage, German medical training employs a semblance of work-based learning systems that influence meeting the new policy stipulations and objectives of putting theory to practice. The students are placed in practice, to which they are required to dedicate 3-years for accreditation as specialized pediatricians. In addition, the system contributes to 12 general pediatricians per 100,000 rate in Germany (WHO, 2022). The data reveals the significant deficiency of specialized training that necessitates strategies to increase professionals in Germany.
Moreover, Germany has policy dictations proposed on the entrustable professional activities (EPA) as integral components of pediatric training. According to research, the EPA referred to as the PaedCompenda, provides a regulatory framework and guideline for ensuring competency-based learning for pediatric medicine that is lacking (Fehr et al., 2017). The German Society of Primary Care Paediatrics’ identified the lacking competencies and stipulated the EPA fundamentals (Fehr et al., 2017). Fehr et al. (2017) stipulate that these EPAs are monitored by the German Medical Association, focusing on the use and effectiveness of the policy stipulations. The system becomes instrumental in facilitating the transition from theory and curricular pediatrics into practical professional consideration. Subsequently, German healthcare training has embraced the use of work-based learning systems. Research by Cedefop (2020) indicates that medical students in undergo vocational educational learning for medical training to expose the medical students to practical learning scenarios. Therefore, Germany’s final year of medical training presents opportunities to incorporate the EPA and vocational training inputs in enhanced pediatric health quality. According to Fehr et al. (2017), in the final year of medical training, the EPA will offer competency-based exposure and preparation for post-graduate career endeavors.
Medical Training in the US
General medical practice in the US has a unique training program presenting opportunities for medical students to be accredited in medical professions. According to Zavlin et al. (2017), medical training in the US begins with enrollment and studies in undergraduate training as a premedical course. Subsequent to undergraduate studies, US healthcare requires an aspiring doctor to clear 4-years of medical school training, involving theoretical learning and supplementary clinical rotation within particular fields, including pediatrics (Zavlin et al., 2017). Unlike that of Germany, the medical school system has 2 years of basic medicine that correlates with the 2-year pre-clinical segment of Germany.
The students undergo a problem-based learning system and traditional didactics during this period. The subsequent 2-year duration of clinical rotations entails exposure to core disciplines of medicine, including internal medicine, surgery, psychiatry, obstetrics, and gynecology (Zavlin et al., 2017). The student is allowed to tailor their rotations subject to their preferred fields of specialty, which they are advised to select during the final year. Unlike the German system, which has fixed clinical rotations, the American system is more flexible. In this instance, the medical school period is relatively shorter and concise in the US to prepare medical students for residency.
Pediatric Training in the US
In the case of pediatricians, the medical qualification to be acknowledged as a professional is an intrinsic subject. According to research, to qualify as a professional pediatrician, an individual must undergo additional training for 3 years (American Board of Pediatrics, 2022). The additional training is acquired during the student’s residency in hospitals that offer such programs. This stage of medical training in the US is facilitated by a residency matching framework that is determined by the National Residency Matching Program (NRMP). The program supports graduated students to acquire applications to relevant organizations offering residency in a formal and organized manner. According to Zavlin et al. (2017), the NPRM is supported to facilitate an impartial application process due to a stipulated bias and bureaucracy in residency applications. The strategy was significant in alleviating the challenge of a decentralized and substantially competitive market for residency in distinguished institutions (Zavlin et al., 2017). The organization prevents association between applicants and the programs as a strategy to maintain the integrity of the application process.
At this juncture, a student is expected to partake in specialized training within work-based learning environments. In finality, a specialized fellowship program and subspecialty training take place to establish competency for certification taking 2-5 years (Zavlin et al., 2017). These are essential as a prerequisite that qualifies an individual as a pediatric professional recognized under the American Pediatric Board. As stipulated in the Academic Board of Pediatrics (2022), the requirement specifies accredited programs that are certified by the Accreditation Council for Graduate Medical Education. The pediatric training framework has a specific framework in the American system governed by a specialized board that distinguishes the medical subspecialties in medical practice.
Similarities
The research reveals the associated similarities in the education systems of the two countries. Particularly, the two systems have indicated a distinct emphasis on the importance of work-based learning for medical personnel. The activities are associated with providing clinical rotations in both nations that require the students to be incorporated in practical work. As stipulated in Zavlin et al. (2017), both systems have a 2-step process in completing medical school, constituting a pre-clinical stage followed by a clinical education period. Despite the difference in specific requirements, frameworks, and organization, the training systems present a level of parallel activities that correlate. Zavline et al. (2017) reveal additional similarities in the examination process as both nations present standardized examinations that are centralized for the entire system. The exams are instrumental in ensuring quality standards are similar throughout the nation and prevent biased school exams.
The introduction to pediatric studies is initiated in both systems during the clinical rotations. The duration allows the medical practitioner to be exposed to the fields during the stage of training, becoming more familiar with the practical form of medicine (Zavlin et al., 2017). The similarity allows exposure of the trainees to the specialties in practical clinical environments. The strategy allows the medical trainees to familiarize themselves with the clinical and practical work and encounter potential issues to expect in the field.
Differences
There are significant dissimilarities from the onset of the contrasting factors that begin in this stage of the medical training process distinguishing the two organizations in their approach. Initial requirements for medical school vary between the two as medical training, whereby the requirements in the US are quite strenuous for students that require a 4-year bachelor’s degree to qualify for consideration in applying for medical school (Zavlin et al., 2017). Conversely, the significance of this is incomparable to that of Germany, where students undergo a simpler application process, allowing a transition from high school training into medical school without an undergraduate degree. Zavllin et al. (2017) argue that any resident of Germany at this stage of medical training holding an advanced high school diploma is eligible for medical training. This marks the beginning of German medical training allowing the trainees to be incorporated in continuous 6-year training for students in Germany in medicine-related programs. The variation is evident in the qualification for medical training; However, the US structure requires a bachelor’s degree that may be unrelated to medicine: Hence, Zavllin et al. (2017) considers the structure to be inefficient in comparison to the US system.
Subsequently, the conceptualization of residency in the US is a unique program that entails a standardized application process due to the centralized competitiveness of particular medical organizations (Zavlin et al., 2017). The system, therefore, is a control measure to ensure the orderly management of the students offering an impartial framework of application and placement. As reported in Zavlin et al. (2017), foreign students are considerably aided in avoiding bureaucratic difficulties and bias in the application process for residency. Comparison to the individual application Germans system creates a significant disparity. However, the German system allows flexibility in residency, creating a suitable framework that tailors a student’s interests.
Financing Frameworks
The funding of medical training in both nations presents a substantial variation in the medical structures of Germany and the US. A critical analysis reveals that the funding structure of medical training has relative distinctions. In Germany, medical school tuition is government-funded (tax-funded), whereas tuition is privately sponsored in the US. The disparity has affected the medical system in the US that forces students into expensive loans (Zavlin et al., 2017). The circumstances are significant factors to consider in ensuring the efficient studies of the two systems. Arguably, Zavlin et al. (2017) argue that the tuition fee abolished in Germany is able to support the students’ accommodation, as rents are considerably high within cities and living conditions are high. German medical training supports students to meet the need for an increase in professional doctors to sustain the demand for healthcare. The organization of American medical training has an average tuition and insurance fee of approximately $34,000for resident students. Foreign students are more tasked with meeting the tuition and insurance of $50,000 yearly, excluding accommodation and significant essentials for studying in the United States. In pursuit of medical training, 76% of the graduates end up in debt, which is an inefficiency of the system that is required to support the student. Comparably, the German system is more economical and supports a significant improvement in medical training. Financial constraints may be significant factors hindering the effective performance of students.
Conclusion
Common ground in the assessment of both nations is that they have established governable medical practice and established relevant monitoring and policy frameworks that meet particular global health standards. The healthcare systems in both scenarios have a significant influence on the state of healthcare and pediatric training. The study invokes the importance of pediatric training, which is considered a medical specialty field that requires an adequate background in general medical training. The consensus is that the field of pediatric medicine is associated with general exposure to the field before specializing.
These discrepancies support a conclusive assumption that the global standardization of particular healthcare organizations is possible by aligning the existing medical training systems. The two nations serve as practical examples of how medical practice may conform to additional training. The study objectives were met, and the research finding elicited the significant variation of medical training systems and instances in which they function in tandem. Therefore, the research supports a move to consolidate professional medical training to support a comprehensive, universally flexible framework and guidelines that stipulate how physicians’ training and certification are approved within the policy’s provisions.
The extensive differences in the educational system are significant factors that create the vast difference in the qualitative nature of medical practice in the two nations. The research embraces the efforts of global health systems that are able to standardize practice that facilitates the international transfer of medical practitioners. The study perceives the strategy to create a notion of interchange of labor and resource between nations with similar systems. The conceptualization would mean that it will be more efficient for certification to practice across nations extending the scope of influence for the medical practitioners.
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