Ärztliches Fortbildungswesen in Deutschland 1871-1945.

The discussion on systematization and methodology combined with the question of state interference and professional political interests accompanies the beginning of Continuing Medical Education (CME) until today. The development of CME for the period 1871 to 1945 shows a process of systematization regarding organizational, administrational and structural level with participation of government and medical professional policies. In the time of the German Empire the foundation for a structured CME was created by establishing a system of charge free and decentralized training courses. For the first time, thought was given to distinguish different types of medical education. During the period of the Weimar Republic the structure of decentralized CME was supported by developing new teaching and learning methods. The medical professional representatives refused any state participation except financial assistance. In the Nazi era CME was brought into line of Nazi ideology concerning structure, organization and administration. CME obligations were mandatory for all physicians and trained them on Nazi ideology especially. CME as a lifelong process centrally guided in combination with decentralized structures is an appropriate way for offering training to all physicians. State support is important and necessary, but shaping the contents should be a duty of the professional associations of Physicians. The quality of patient care is no longer complied as soon as the aspect of cost-efficiency is transformed into a pressure factor concerning political interests and social insurance.

[Continuing Medical Education in Germany - mandatory and voluntary obligations]. / Ärztliche Fortbildung in Deutschland -Pflicht und Freiwilligkeit.

After 1945 the common medical training infrastructure was broken up into two different political systems. While in the Federal Republic of Germany the structure was based on physicians' self-governance, in the German Democratic Republic medical professional structures were organised by the government. After the unification of the two German states, which took place on October 3, 1990, the centralistic structure was replaced by the system of physician self-governance. Before January 1, 2004, continuing medical education (CME) in West Germany relied on a system of voluntary obligations. In East Germany, though, professional CMEs were compulsory; they were called "obligatorische periphere Fortbildung." Based on 15 expert interviews on the topic of "CME in Germany", the different circumstances and conditions were analysed taking account of the historical background. Only selected professionals with experience in both German states (one with a federal, the other with a centralistic system), were chosen for the survey.