The results of the survey show a clear demand of final year medical students to receive specific and structured education on several topics of communication, leadership and career development skills.
Communication skills:
However, courses affecting the subjects of communication, leadership and career development skills are usually not comprehensively taught in German medical schools. Especially regarding communication skill training, there have been some institutions in Germany and in other countries that address certain aspects such as breaking bad news. A widely used tool is the integration of patient actors for training scenarios where medical students have the chance to experience the demands and challenges of a staged difficult communication setting with prior preparation and later discussion and feedback[12, 13]. A similar approach has been established for several years in the authors’ institution, explaining that over 60% of the respondents felt well or very well prepared to deliver bad news to their patients. Learning from this conceptual example, many other difficult scenarios could potentially be taught in this manner, such as interprofessional conflict management or giving and receiving feedback, just to name a few. As an example, it has recently been shown that a realistic learning activity on interprofessional communication can be created, combining students from different professions (nursing, physiotherapy, occupational therapy and physician)[14].
Leadership skills:
In this survey, German final year medical students rated the importance of all listed leadership skills as important or very important for their later clinical job but expressed poor or very poor preparation within their current medical training.
In the corporate world it is without a question that personnel that aspires after leadership position undergoes proper and structured training to meet the demands of the job. It is incomprehensible that this is not the case for medical students that will enter their residency unprepared for their leadership role, where lives and patient safety are at stake[15]. The need to address this discrepancy is reflected in the quantity of publications on this matter, expressed in a recent review[16]. In this publication the authors describe the current standing of leadership training models for medical students focusing on the diversity of methodology and outcome measurements. It becomes clear that courses addressing leadership skills at different stages of training during medical school are well accepted but it is still challenging to produce objective long-term outcome data and assess the longitudinal benefit for participants[16]. A structured leadership training program recently demonstrated that a longitudinal assessment is feasible and produces feedback for further improvement [17].
Comparing the growing evidence of the importance of leadership training for young physicians and the perceived lack of it in the German medical school curriculum, a clear mission to provide a structured and comprehensive curriculum including leadership skill training can be formulated.
Career management skills:
How young physicians see their future career and what they plan to accomplish is highly variable. While all residents who enter a certain residency share a similar goal of being trained for a certain specialty, interests for sub-specialization or further qualifications as well as higher academic aspirations are highly individual. All this is may be influenced by personal life events and plans that are naturally partly unpredictable. Nonetheless, it is important for young residents to be cognizant of early planning and structuring of one’s individual career goals. Many medical schools offer mentoring programs often including career counseling and professional development[18, 19] and its impact on residency training has also been shown[20]. A career counseling program was also tested in Germany 10 years ago and documented good acceptance among medical students. Twelve percent of participants even changed their career choice after the program[21]. It must be stressed that career management skills are not just nice to have, but the lack of it is a source of stress among medical students and young residents. A survey of over 900 medical students in Florida assessed perceived stressors. Students highlighted fear of excessive workload, time management, work-life balance as well health concerns and financial problems, but some students also indicated concerns about lack of assistance with career planning[22]. Furthermore, the new generation of medical students seems to have different career expectations and an increasing emphasis on work-life balance of as well as less eagerness to pursue an academic career[23–25]. Therefore, guidance in career management will remain an important aspect of medical student and young physician mentoring, with a broader diversity of career blueprints. Mentoring in this regard should therefore not just focus on students with high potential and academic aspirations, but especially offer advice to the whole spectrum of medical students and trainees, which in turn requires more career diversity of potential mentors as well.
Limitations:
Although the results of the survey express the need to formulate a supportive educational concept, it is important to keep in mind, that the survey only delineates the current opinion of final year medical students in the authors’ institution that participated in a voluntary survey. Additionally, the participating students were subject to the academic educational recession during the COVID-19 pandemic that highly influenced clinical practical education during medical school[26, 27]. Furthermore, the desired conditions of a new educational course, such as hybrid format, are important impulses, but may not be feasible or in line with the best suited didactic methodologies.
A mandate for a supporting educational format:
The convincing message provided by participating final year medical students suggests including a comprehensive and structured curriculum that covers communication, leadership and career management skills. While single aspects may be already covered in some institutions, medical students seem not to be sufficiently prepared in this regard to meet the demands of residency that they are soon to experience. Therefore, it is plausible to offer a respective educational format in the last years of medical school, as desired by most respondents of the survey. During that time medical students are exposed to more clinical practical courses and rotations where such skills and competencies can be applied and matured. Furthermore, group discussions were chosen as the most preferred format with a volume of 1 to 2 hours every 1 or 2 weeks and a hybrid format. Although, the time frame may be sufficient it remains questionable if a hybrid format holds the same educational yield as a seminar in attendance, especially when group discussions are implemented.
Based on the results of this survey, the authors are planning a teaching session for final year medical students that covers the subjects that were rated as being of the highest importance. With this first attempt the additional demands of final year medical students will be addressed and further assessed. Hopefully an accompanying curriculum for final year medical students can be established to prepare young physicians in a more comprehensive way for the challenges of residency and for their professional development.