gms | German Medical Science

The state-wide study by the University of Ulm on family friendliness in medical school found a mixed picture at the Freiburg faculty from the perspective of those interviewed. On the one hand, some specific aspects of the Freiburg faculty are singled out for praise by the interviewees, for example the flexibility introduced through the block structure at the second stage of studies since the introduction of the new Licensure Act in 2004. At the same time, however, students are still calling for improvements in some areas as balancing medical school and children still constitutes a challenge for many of the respondents, not least of all because of the peculiarities of the medical curriculum.

Expressing in school grades, the family friendliness of the faculty is rated as 3.5¹ on average by the respondents. This result puts Freiburg, along with Heidelberg and Tübingen, into midfield across the state. Around three percent of students in Freiburg have children. As is the case in other faculties in the state, it is striking that many student parents (60%) have already some form of professional training prior to starting medical school. The average age of students with children is about 30 and over 90% of respondents are married or cohabiting (see table 1 [Tab. 1]). Financial problems play a lesser role than timing issues in balancing medical school and caring for children.

A large proportion of respondents (71%) appear to have problems balancing medical school and family life in Freiburg, both in the preclinical stage of studies (82%) and, although not as many, the clinical stage of studies (68%). The perception is that the main detrimental factors regarding compatibility in Freiburg are the number of compulsory courses, the high number of afternoon events, the relatively rigid timetable and the exam cluster in a short period of time at the end of the semester (exam week). Due to the structure of medical studies, these are problems which are of course also criticised on other campuses but they appear to be particularly strongly felt in Freiburg according to the survey. Points seen as positive by the majority are the block structure and flexible group assignments at the second stage of studies. Similarly, a number of special solutions for students with children are highlighted as being positive, such as consideration for the preferred location when assigning places for the Practical Year.

To improve the situation of student parents, the primary demand is fully customised and flexible timetabling. A majority of respondents also are in favour of primarily offering compulsory courses in the mornings, with lectures mainly offered in the afternoon. Furthermore, there are wishes for announcing course lists and timetables for each subject as early as possible to enable them to plan ahead. And finally, special regulations regarding options for making up for missed classes caused through childcare issues, in particular if due to the illness of a child, are advocated. On this point, 90% of respondents call for greater flexibility regarding compulsory attendance, 71% for options to re-sit missed dates or exams and 93% of respondents think that the introduction of a parent passport makes sense. The introduction of a parent passport was already planned at medical faculties in Ulm and Frankfurt am Main last year. Using this parent passport, special “services for families can be accessed. In addition, in conflict situations in education a parent passport can help reaffirm the rights of student parents” [1].

The evaluation of the results also showed that with regard to certain points the respondents have a great need for advice (e.g. regarding study organisation, childcare facilities or a part-time studying). However, it is noticeable at the same time that only a small proportion of respondents (31%) actually take advantage of advisory services run by the office of the dean regarding study organisation. In contrast, 71% state they would make use of individual advisory services on study organisation with a child, 70% of respondents did not know that such an offer exists. This clearly shows that in future existing advisory services must be more clearly advertised by the academic dean’s office. The most frequent requests from students were for an information booklet, a dedicated office for advisory services and coordinating the various advisory services within the university. And finally, the inadequate provision of childcare places and the very rigid and inadequate opening times of the care facilities within the university are criticised.

The minimum number of compulsory courses is fixed through the Medical Licensure Act (ÄAppO) and in contrast to other courses, is very high [2]. Apart from a large amount of theoretical knowledge, a medical career requires a multitude of different practical skills and a high level of social skills. These extensive requirements are reflected in a very time-intensive curriculum (according to ÄAppO). Thus reconciling family life and medical studies can be seen as difficult in general. Nevertheless, the number of compulsory courses in the curriculum in Freiburg is higher than prescribed by the ÄAppO. The office of the dean of studies is currently looking into reducing the number of compulsory hours in general as part of the planned curriculum reform. The lectures offered are usually optional.

The design of the Freiburg curriculum in the first and second stage of studies is, with only a few exceptions, structured in such a way that the main lectures are offered in the morning and courses and practical training in the afternoon. This, according to the present study, is a major problem for students with children, especially as childcare is normally only on offer until early afternoon, with the courses and the practical training in some cases running into evening hours. The dean’s office in Freiburg takes these issues affecting students with children very seriously. It has not been possible, however, to develop solutions together with the institutes and clinics that meet the requirements of all parties involved. Timetables and clinical routines for years have been structured so that patient care and routine processes occur mainly in the mornings, making simultaneous teaching in small groups impossible. The needs of staff with children are certainly also taken into account, who themselves prefer core working hours to be in the mornings.

Since changing the times of the main lectures also seems difficult, the dean’s office is prioritising the way of offering more lectures online as video podcasts, thus enabling flexible access to these teaching events. Whether it will be possible to offer some courses and practical training for students with children in the mornings in the long term, will certainly be tested in the context of implementing the new curriculum.

With the introduction of the new Licensure Act, the medical faculty in Freiburg has opted for the introduction of block teaching in the second phase of studies. This has the advantage that the individual blocks can be easily combined and interchanged. Also, any number of courses can be chosen and thus balanced with childcare, work on MD theses or other obligations.

A disadvantage of the block structure, however, is that all teaching units of a subject must be offered in a short period of time. This results in a rigid, inflexible schedule with little room for manoeuvre. Many subjects strive to provide students with children options for changing but this is not always possible, especially not when such requests are made short-term.

Both the winter and the summer semester in Freiburg run over 14 weeks in the clinical section of studies. Each is followed by a study week and an exam week. The extreme stress on the students during the exam week (usually 6 to 8 exams in one week) has already been modified in the past so that dates during the study week are also available for exams. In addition, many of the “small subjects” hold their exams immediately after their block of classes during the semester. The trend towards holding examinations in “small subjects” immediately after the block has been taught is strongly supported by the dean’s office.

Compulsory attendance or regular lecture attendance and any possible ways of making good missed dates are covered in the study regulations in Freiburg.

This wording was deliberately chosen so that the personal circumstances of students can be taken into consideration. It thus lies within the discretion of each subject area when or how missed classes can be retaken or compensated for in other ways.

When compensating for missed practical coursework, it is key to note that in medical school - unlike in the humanities - especially the high proportion of practical work cannot be compensated through other tasks such as papers or homework. The successful participation in obligatory practical coursework by the students is essential for the benefit of future patients.

The core message of the survey conducted by the University Hospital Ulm is confirmed by a study carried out by the Centre of Competence for the Evaluation of Teaching in Medicine Baden-Württemberg in the winter semester 2008/09 on the study and live situations of medical students in Freiburg [4]. 32% of students with children stated here childcare is causing them study-related problems. Again, time related issues regarding the compatibility of studies and childcare were identified as a particular challenge for students with children. The respondents’ hopes for a flexible and individual design of medical studies are juxtaposed with the relatively fixed structure of medical school.

The understandable desire of students with children for individual and flexible timetabling cannot always be met due to the high numbers of students enrolled in the medical programme, although the office of the dean of studies preferentially allocates places to student mothers and fathers. It would undoubtedly constitute a structural improvement if appropriate timetable software could be installed which would allow for more personal requests being met than is possible with the traditional manual model. For this to work, however, it would be necessary for the subject areas to agree to central timetabling.

The results of the Ulm study showed a surprising lack of knowledge about the advice services offered by dean’s office regarding study planning for students with children. These services are explicitly referred to during the introductory events at the beginning of the first pre-clinical and the first clinical term. Since this does not appear to be sufficient, in future the existing advisory services will be made visually clearer in the introductory PowerPoint presentation. In addition, prompted by the results of the survey on family-friendliness, simultaneously a website will be set up containing information services on the homepage of the dean’s office especially for students with children. It will contain all of the services offered by the dean’s office and the appropriate links to the medical faculty and the university. Any additional services, for example a coordinating office or social services for students with children can, however, not be offered by the dean’s office with current staffing levels. The same applies to the introduction of a parent passport. This would incur personnel and operating costs that exceed the current budget of the dean’s office.

Overall, the medical faculty is keen to improve the study environment for students with children. But currently only an insufficient number of child and infant care places are available at the university and the university hospital. It would certainly be desirable to resolve this situation through appropriate offers by the university and university hospitals, especially in view of the increasing number of female medical students (60 to 70% of the total cohort). A first success in this regard was achieved by the equal opportunities officer at the faculty of medicine as recently a nursing room in the women’s clinic for children under 6 months can now also be used by female medical students.

As the Centre of Competence for the Evaluation of Teaching in Medicine Baden-Württemberg had already carried out its survey regarding the study and live situations of medical students in Freiburg during the winter semester 2008/2009, the medical faculty was not surprised by the results of the Ulm study on family-friendliness. For some of the issues had already been highlighted by the Freiburg survey. This raised awareness of the current situation of students with children early on.

The existing predominant block structure, the flexible assignment to groups in the clinical section and the advantages in the placements for the Practical Year, all of which were already introduced in the context of the new Medical Licensure Act in 2004, received a correspondingly positive assessment from the students in the Ulm survey on family friendliness.

The results of this survey have also encouraged the faculty of medicine to retain the tried and tested block structure in the last two years of clinical studies as part of current curriculum developments in medical degree courses following fundamental basic training in theory and practice in the first year of clinical studies in order to ensure the continuity of the flexibility achieved to date.

In addition, the existing information strategy of the dean’s office has been revisited in terms of students with children. This is to be further improved in order to facilitate the students’ access to information. A planned website with specific information and advisory services for students with children on the homepage of the dean’s office will serve as a basis. Existing advisory services offered by the academic dean’s office must be more clearly referred to in future, as the survey points to an information deficit in this area.

But the problem of a lack of human resources in the dean’s office remains. And given the extremely large number of medical students, some 2,200, and a proportion of 60 - 70% of female students which is tending towards increasing, these problems will further intensify in the coming years. It is therefore absolutely necessary to consider possible solutions today.

¹ In this system, 1=very good, 6=bad fail

The authors declare that they have no competing interests.