Catalogue of Subjects in the Socio-medical Sciences for the German Medical Licensing Regulations (revised June 27, 2002)

What understanding of economics do medical students have?

Introduction: Economic topics appear in the medical studies curriculum at different times. Despite socio-political relevance, there is hardly any information about the degree of understanding that medical students have of "economics in medicine". The present study addresses the questions: What understanding of "economics in medicine" do medical students have before the start of the Practical Year? To what extent is economic teaching content understood as "economization" from outside the profession? Method: Magdeburg medical students in the 5^th year of study, who participated in preparatory seminars for the Practical Year (PY) in 2014 and 2015 (60 participants each), assessed the relevance of various seminar topics four months prior to the start of the semester. On the basis of a three-stage qualitative-reconstructive partial evaluation, students' economic understanding is explored through secondary analysis: deductive derivation of the analysis units; integrative basic method ("segmentation", "micro-linguistic detailed analysis", "central theme"); development of a theoretical model by placing the central themes in context following Grounded Theory. Results: Based on the theory, 19 free-text answers with economic reference were identified from the total of all free-text answers. Each answer was assigned to at least one of a total of six themes of the students' understanding of economics: de-professionalizing economization, deciding and working economically, ambivalent requirements for efficiency and equity, the doctor as an entrepreneur, economics as relevant learning content, PY as a conflict-laden setting for economized working and learning. The theoretical model contains social, praxeological and professional references, which can themselves be ambivalent and conflicting. Conclusion: Despite their critical attitude, the surveyed medical students are neither hostile to economics nor do they regard economics in medicine as a taboo subject. Economic learning content is recognized as relevant. Educational formats that tackle the tension between patient and system orientation in a problem-oriented manner can be a productive setting for economic reflection.

Global Health Education: a cross-sectional study among German medical students to identify needs, deficits and potential benefits (Part 2 of 2: Knowledge gaps and potential benefits)

BACKGROUND

In Germany, educational deficits or potential benefits involved in global health education have not been analysed till now.

OBJECTIVE

We assess the importance medical students place on learning about social determinants of health (SDH) and assess their knowledge of global health topics in relation to (i) mobility patterns, their education in (ii) tropical medicine or (iii) global health.

METHODS

Cross-sectional study among medical students from all 36 medical schools in Germany using a web-based, semi-structured questionnaire. Participants were recruited via mailing-lists of students' unions, all medical students registered in 2007 were eligible to participate in the study. We captured international mobility patterns, exposure to global health learning opportunities and attitudes to learning about SDH. Both an objective and subjective knowledge assessment were performed.

RESULTS

1126 online-replies were received and analysed. International health electives in developing countries correlated significantly with a higher importance placed on all provided SDH (p ≤ 0.006). Participation in tropical medicine (p < 0.03) and global health courses (p < 0.02) were significantly associated with a higher rating of 'culture, language and religion' and the 'economic system'. Global health trainings correlated with significantly higher ratings of the 'educational system' (p = 0.007) and the 'health system structure' (p = 0.007), while the item 'politics' was marginally significant (p = 0.053).In the knowledge assessment students achieved an average score of 3.6 (SD 1.5; Mdn 4.0), 75% achieved a score of 4.0 or less (Q25 = 3.0; Q75 = 4.0) from a maximum achievable score of 8.0. A better performance was associated with international health electives (p = 0.032), participation in tropical medicine (p = 0.038) and global health (p = 0.258) courses.

CONCLUSION

The importance medical students in our sample placed on learning about SDH strongly interacts with students' mobility, and participation in tropical medicine and global health courses. The knowledge assessment revealed deficits and outlined needs to further analyse education gaps in global health. Developing concerted educational interventions aimed at fostering students' engagement with SDH could make full use of synergy effects inherent in student mobility, tropical medicine and global health education.

[Gender in epidemiology. State of discussion and perspectives]

Against the background of sex-specific and sex-comparative approaches in health research, this article aims to clarify to what extent the category sex/gender with its biological dimensions (sex) and social dimensions (gender) has systematically and conceptually been consider ed in epidemiology and which methods have been developed. Epidemiologic research has been criticized for routinely controlling statistically for age and sex but often ignoring aspects of gender. Inadequate consideration of sex/gender may result in systematic errors (gender bias), on the one hand, if sex/gender is ignored as an important variable, and, on the other hand, if differences between men and women are assumed when there are actually similarities. There are examples of adequate consideration of gender in exposure assessment, analysis of social position or modelling of interactions in current articles of scientific journals. How ever, epidemiologic reference books and textbooks as well as university training in epidemiology show that the category sex/gender has not been integrated with both dimensions sex and gender into the currently predominating thought style of epidemiology. For the further development of valid epidemiologic research clarification of terms, generation of unambiguous concepts and sophisticated statistical tools are necessary. This is the only way to succeed in analysing the complex interactions between sex-linked biology and gender relations.