At the weekend it was that time again: all over the country, young people fought in congress halls and exhibition halls for one of the coveted medical study places. 15,802 people applied for the test for medical courses (TMS for short). The test is designed similarly to intelligence tests; it tests memory, spatial imagination, basic medical and scientific understanding, mathematical skills and text comprehension.
In Berlin, my godson Basti also underwent the almost seven-hour procedure. Yesterday at nine o’clock he found himself in the large hall of a hotel with almost five hundred competitors. “Everyone was very tense,” is how he describes the atmosphere. People didn’t talk much to each other, not even during the lunch break. He had to leave his backpack in the cloakroom and was only allowed to enter the room with a transparent zip-lock bag containing a pencil, sharpener, highlighter, glucose and chewing gum. Scrapbooking paper for notes was forbidden.
Basti had to do better than 70 percent of the others, he figured. Because his average grade of 1.2 isn’t quite enough for the “Abitur best quota”, through which 30 percent of the study places are allocated, you would need 1.0 – although it would then depend on which federal state and exactly how many points. For Lower Saxony and Bavaria, a worse 1.0 is sufficient than for Berliners, whose Abitur is considered particularly easy.
The aptitude test determines the allocation of a further 60 percent of the study places. In the complex selection algorithm, the Abino grade still plays a major role, as well as, depending on the university, vocational training, a winning place in “Jugend forscht” or honorary positions. There are also study places for future general practitioners, which in many federal states are awarded according to a “rural doctor quota”, for prospective medical officers in the Bundeswehr, for cases of social hardship, and a very small experimental field where universities can try out something new.
But one thing is clear: nine out of ten study places are awarded to an intelligent and high-achieving elite according to strict criteria. Are these really the doctors we need? Who are empathetic when sharing a fatal cancer diagnosis with someone. Who carry out eye or heart operations with great technical skill. Who can use the right questions to find out whether a patient is suffering from depression, is at acute risk of burnout or is simply lonely? Neither high school diplomas nor test results test such social and psychological skills. That’s not the goal at all, says Frank Wissing, general secretary of the Medical Faculty Association, which represents the interests of the 38 state universities where medicine is offered. “What makes a really good doctor is difficult to measure. We still have the best evidence for predicting study success.” This is also an important criterion for the selection, after all, a medical study place costs up to 300,000 euros.
Of course, in times of school grade inflation and in view of high school graduation rates of up to more than 50 percent of a year, not everyone has the intellectual and analytical skills for the medical profession. School grades and test results remain a useful tool. That’s why proposals from the ranks of the CSU to completely suspend the numerus clausus in view of the alleged shortage of doctors are pure populism.
But even a high school graduate with a 2.0 grade point average can become an excellent internist or psychiatrist. I even know someone who became a successful dermatologist with a 3.5 grade point average. Medicine is not rocket science.
The selection process must also necessarily include “soft talents”. Even a selection interview can weed out intellectual high-flyers with major social deficits. Today you only have the chance to do this at a state university. Even more interesting appears to be a newly developed selection process that has so far only been used at the University of Heidelberg and through which a very small proportion of study places are allocated there. The applicants meet five actor-patients in a course who confront them with personally challenging situations from practice. We need such tests and they must be given considerable weight alongside school grades or traditional aptitude tests.
Healthcare is facing enormous challenges. We are getting older, we are getting sicker, we are becoming more in need of care. We need doctors who are not only up to this task intellectually, but also personally.
