Medical Continuing Training in Germany

1. Introduction
Basic medical training in Germany leads to graduation with an Approbation (License to Practise Medicine). This medical training lasts six years and is done at medical universities. The final year of studies includes 48 weeks of continuous practical training ( Praktisches Jahr / Practical Year). The first stage of medical continuing training begins with the process of qualifying as a Facharzt (Specialist). Building on this foundation, further medical qualifications can be gained through specialisation in one or more Schwerpunkte (Specialties) or by completing a Zusatz-Weiterbildung (Extra Qualification) course in addition to the regular Facharzt- und Schwerpunkt continuing training. Candidates can engage in continuing medical training in Germany after they have gained their Approbation (Medical Licence).

2. Titles and Designations for Fachrzte (Specialists), Schwerpunkte (Specialities) and Zusatzbezeichnungen (Extra Qualifications)
The qualification (title or designation) gained through continuing training serves as proof of the acquired competence. The award of the title Facharzt (Specialist), Schwerpunkt (Speciality) and/or Zusatzbezeichnung (Extra Qualification) is subject to the conditions as defined in 2.1-2.3. Notes: There is no obligation to engage in continuing training for a Schwerpunkt (Speciality) or an Zusatz-Weiterbildung (Extra Qualification). When choosing the medical university at which the continuing training will be offered, please note that not all the Chefrzte (Consultants) hold the teaching qualifications required for providing advanced continuing training in each of the Schwerpunkte (Specialities), especially at smaller municipal hospitals. 2.1 Titles for Fachrzte (Specialists) Candidates who complete their continuing training as a Facharzt (Specialist) in accordance with the prescribed continuing training syllabuses and periods and are able to document the

disciplinary competence required for this by passing an examination, will be awarded the title of Facharzt (Specialist). 2.2 Designations for Schwerpunkte (Specialities) Candidates who complete their continuing training in a Schwerpunkt (Specialty) in accordance with the prescribed continuing training syllabuses and periods and are able to document the disciplinary competence then hold the qualifications required for this Speciality. 2.3 Zusatzbezeichnungen (Extra Qualifications) Candidates who gain Extra Qualifications in accordance with the prescribed training syllabuses and periods and are able to document that they have the disciplinary competence required for this by passing an examination will be awarded a Zusatzbezeichnung (Extra Qualification).

3. Who can do Medical Continuing Training in Germany?

The Approbation, i.e. the Medical Licence to Practise Medicine, is an absolutely indispensable requirement for admission to medical continuing training in Germany. Doctors who hold a basic medical degree awarded in countries outside the European Union (EU), the European Economic Area (EEA) or Switzerland, may, under certain circumstances, practise medicine in Germany. However, they must prove that they have completed their medical training as a doctor or are entitled to practise medicine in their respective home country. Foreign doctors (for example, scholarship holders) can be admitted to practise medicine if they wish to engage in continuing medical training or in-service training in Germany within the scope of scholarship programmes financed from the Federal Budget as is the case for the DAAD.

4. How long does Continuing Medical Training last in Germany?

The specified course lengths for continuing medical training as cited in this document are minimum requirements that may change from case to case, if the continuing training syllabuses cannot be acquired within the minimum allowed time. The tables below only serve 2

as a general overview of the continuing training periods in the various fields, Schwerpunkte (Specialities) and Zusatz-Weiterbildungen (Extra Qualifications). As mentioned above, continuing training as a Facharzt (Specialist) on in a Schwerpunkt (Speciality) can be followed up in many fields of medicine. There is no obligation to engage in any of the latter courses or in any extra qualification courses.

4.1 Examples
The following examples aim to explain the summary table "Facharztund

Schwerpunktkompetenz" (Specialist and Speciality Competence). They specify the minimum time needed for four different "Facharzt" (Specialist) qualifications. At the end of each Specialist, Specialty or Extra Qualification course, the trained doctor must document the required disciplinary competencies by passing an examination in order to gain the relevant title: Specialist, Speciality or Extra Qualification. 4.1.1 Anaesthesiology A doctor must complete at least 60 months (5 years) of continuing medical training to qualify as an Anaesthetist. 4.1.2 Surgery To gain the specialist competencies listed in the table for the field of "Surgery", a doctor must initially complete at least 24 months (2 years) of basic continuing training. This is then followed by specialist continuing surgical training in the desired field. The choice of specialist competencies in the field of surgery are: General Surgery; Vascular Surgery; Cardiac Surgery; Paediatric Surgery; Orthopaedics and Trauma Surgery; Plastic and Aesthetic Surgery; Thorax Surgery and Visceral Surgery. In other words: A doctor wishing to gain qualification as a Facharzt (Specialist) in the field of thorax surgery must, for example, complete at least 24 months of basic continuing training plus at least 48 months of subsequent specialist continuing training in thorax surgery. This means 24 months + 48 months = a minimum of at least 72 months (6 years).

4.1.3 Internal Medicine and General Medicine Continuing training in the fields of "Internal and General Medicine" lasts (a total of) at least: - 60 months (5 years) for disciplinary competence (Fachkompetenz) as a "General Practitioner" 12.1, - 72 months (6 years) for specialist competence (Facharztkompetenz) as an "Internist" 12.2, and - 72 months (6 years) for specialist competence (Facharztkompetenz) as an "Internist + additional disciplinary competencies (e.g. Internist and Pneumologist)" 12.3. 4.1.4. Paediatrics Continuing training in the field of Paediatrics lasts at least 60 months. After passing the final examination, the qualified doctor is given the title: "Facharzt fr Kinder- und Jugendmedizin" "Paediatrician". Subsequent specialisation, for example in the field of "Neuropaediatrics / Child Neurology", takes at least 36 months and is completed with a further examination.

4.2 Summary Table of Specialist and Speciality Competence

The following table lists the minimum times required for medical continuing training in the various medical fields and Specialty Competencies. Remarks: The figures listed in this table are based on the Model Continuing Education Rules of the Bundesrztekammer (German Medical Association). The study regulations of the respective Landesrztekammern (State Medical Associations) may differ slightly. Number of Months
60 48 60 60 48 24 Basis+48 24 Basis+48 24 Basis+48

Field
1. Anaesthesiology 2. Anatomy 3. Industrial Medicine Occupational Medicine 4. Ophthalmology 5. Biochemistry 6. Surgery

Specialist and Speciality Competence

Anaesthetist Anatomist Specialist in Industrial Medicine Specialist in Occupational Medicine Ophthalmologist Biochemist 6.1 Specialist in General Surgery 6.2 Vascular Surgeon 6.3 Cardiac Surgeon

6.4 Paediatric Surgeon 6.5 Orthopaedic and Trauma Surgeon 6.6 Plastic and Aesthetic Surgeon 6.7 Thorax Surgeon 6.8 Visceral Surgeon 7. Gynaecology and Obstetrics Gynaecologist and Obstetrician Specialities: Gynaecological Endocrinology and Reproductive Medicine Gynaecological Oncology Special Obstetrics and Perinatal Medicine 8. Ear-Nose-Throat Medicine 8.1 Ear-Nose-Throat Specialist 8.2 Speech, Voice and Paediatric Hearing Disorders Phoniatrician Dermatologist and Venereologist Human Geneticist Hygiene and Environmental Medicine Specialist 12.1 Internist (General Practitioner) 12.2 Internist: 12.3.1 Internist and Angiologist 12.3.2Internist and Endocrinologist and Diabetologist 12.3.3 Internist and Gastroenterologist 12.3.4 Internist and Haematologist and Oncologist 12.3.5 Internist and Cardiologist 12.3.6 Internist and Nephrologist 12.3.7 Internist and Pneumologist 12.3.8 Internist and Rheumatologist 13. Paediatrics Paediatrician Specialities Paediatric Haematology and Oncology Paediatric Cardiology Neonatology 14. Paediatric Psychiatry and Psychotherapy 15. Laboratory Medicine 16. Microbiology, Virology and Infection Epidemiology 17. Oral and Maxillofacial Surgery 18. Neurosurgery 19. Neurology Neuropaediatrics / Child Neurology Paediatric Psychiatrist and Psychotherapist Laboratory Medicine Specialist Microbiologist, Virologist and Infection Epidemiologist Oral and Maxillofacial Surgeon Neurosurgeon Neurologist

24 Basis+48 24 Basis+48 24 Basis+48 24 Basis+48 24 Basis+48 60

60 Basis+36 60 Basis+36 60 Basis+36 24 Basis+36 24 Basis+36 60 60 60 60 60 72 72 72 72 72 72 72 72 60 60 Basis+36 60 Basis+36 60 Basis+36 60 Basis+36 60 60 60 60 72 60

9. Dermatological and Venereal Diseases 10. Human Genetics 11. Hygiene and Environmental Medicine 12. Internal and General Medicine

20. Nuclear Medicine 21. Public Health 22. Pathology 23. Pharmacology

Nuclear Medicine Specialist Public Health Specialist 22.1 Neuropathologist 22.2 Pathologist 23.1 Clinical Pharmacologist 23.2 Pharmacologist and Toxicologist Physical Medicine and Rehabilitation Specialist (Physiatrist) Physiologist Psychiatrist and Psychotherapist Forensic Psychiatrist Psychosomatic Medicine Specialist and Psychotherapist Radiologist Specialities: Paediatric Radiology Neuroradiology

60 60 24 Basis+48 24 Basis+48 24 Basis+36 24 Basis+36 60 48 60 60 Basis+36 60 60 60 Basis+36 60 Basis+36 60 60 60 60

24. Physical Medicine and Rehabilitation 25. Physiology 26. Psychiatry and Psychotherapy 27. Psychosomatic Medicine and Psychotherapy 28. Radiology

29. Forensic Pathology 30. Radiation Therapy 31. Transfusion Medicine 32. Urology

Forensic Pathologist Radiation Therapist Radiation Oncologist Transfusion Medicine Specialist Urologist

4.3 Summary Table of Extra Qualifications

In addition to medical continuing training and qualification in the Schwerpunkte (Specialities), doctors wishing to further specialise can gain a Zusatz-Weiterbildung (Extra Qualification). The minimum time needed for the individual disciplinary competencies is as follows: As already mentioned above, such Extra Qualification is not counted as part of the time prescribed for training as a specialist. The following special competencies are gained, in particular, by completing an Extra Qualification course.

Extra Qualifications
Medical Quality Management Acupuncture

Number of Months (m) / Hours (h)

200 h 120 h + 60 h +20 h

Allergology Andrology Occupational Health Dermatological Histology Diabetology Aviation Medicine Geriatric Medicine Gynaecological Exfoliative Cytology Haemostaseology Hand Surgery Homeopathy Infectology Intensive Care Paediatric Endocrinology and Diabetology Paediatric Gastroenterology Paediatric Nephrology Paediatric Orthopaedics Paediatric Pneumology Paediatric Rheumatology Laboratory Diagnosis subject specific Magnetic Resonance Imaging (MRI) subject specific Manual Medicine/Chirotherapy Pharmacological tumour therapy Medical Information Systems Naturopathy Emergency (Trauma) Medicine Orthopaedic Rheumatology Palliative Medicine Phlebology Physical Therapy and Balneology Plastic Operations Proctology Psychoanalysis Psychotherapy subject specific Rehabilitation Medicine X-ray Diagnostics subject specific Sleep Medicine Social Medicine Special Orthopaedic Surgery Special Pain Therapy Special Trauma Surgery Sports Medicine

18 m 18 m 36 h + 360 h 24 m 18 m 6 m + 180 h 18 m No proof of minimal continuing training hrs required 12 m 36 m 6 m +160 h 12 m 24 m 36 m 18 m 36 m 18 m 36 m 18 m 6m 24 m 120 h +200 h 12 m 12 m +360 h +480 h 3 m / or 80 h + 160 h 6 m + 80 h + proof of 50 emergency (trauma) care assignments 36 m 12 m + 40 h 18 m 12 m + 240 h 24 m 12 m 250 h + 240 +600 h 100 h + 16 double hr + 15 double hr + 15 double hr + 120 h +100 h + 120 h + 16 double + 15 double hr +15 double hr +15 double +120 h + 100 h. 12 +160 h + 160 h 18 m and/or 12 m (depending on the subject) 18 m 12 m +160 h +160 h 36 m 12 m + 80 h 36 m 12 m +240 h +120 h

Addiction Medicine Tropical Medicine

50 h 12 h +12 h +3 m