¹Bergische Universität Wuppertal, Interdisziplinäres Zentrum für Wissenschafts- und Technikforschung, Wuppertal, Germany

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The rise of simulation-based training (SBT) for medical skills is often described a success story, as it achieved the institutionalisation in Germany at the state-bound medical faculties as skills labs and training centres [1], [2]. This historic-sociological study uses theories of professionalisation and institutionalisation to analyse this development between the 1980s-2022 and thus contributes to the debate on practical training and medical educational methods.

The analysis is based on three data types. First, the changes in legislation since the 1990s via the national examination regulations and the curricula of all thirty-seven state universities. Second, the German-speaking public expert discourse via publications in the GMS Journal for Medical Education since its onset in 1984. Thirdly, the contemporary working modalities of Skills Labs through expert interviews with medical educators and participatory observation of SBT in the eight state medical faculties in North Rhine-Westphalia. All three were analysed using content analysis and triangulated with each other to provide a thorough historical and contemporary picture.

The ascent of SBT and Skills Labs is closely linked to the debate on practical skills. The examination order of 2002 marks one cornerstone of the German turn towards this competence-orientation. Since then, inertia on the part of government stakeholders has led medical educators and associations such as the GMA and the MFT to form alliances, resulting in the quasi-legislation of the NKLM in 2015. However, the ideas put forward in the NKLM can be traced back to SBT’s pioneering work that occurred before. Examples of SBT can be found in the sample of journal articles since the 1980s, showing it existed before the interviewees could remember or mentioned changes in legislation. One example, among others, that underlines this argument, can be found in the very first JME issue describing the use of simulated patients [3].

This study shows that SBT implementation and professionalisation must be analysed at multiple levels: First, single initiatives and formal institution-founding must be differentiated. SBT has been increasingly integrated by educators since the 1980s, but institutions such as Skills Labs established across Germany in two waves, around the 2000s and the 2010s, parallel with significant legislative changes. Secondly, different types of data on the history and contemporary form of SBT illuminate distinct aspects. The legislative framework does not reveal the educational debate on competence, which is evident in public discourse. Conversely, public discourse does not reveal individual practice, which is evident in expert interviews and observation at specific sites.

The historiography of SBT in Germany is best understood as a professionalization of medical education towards competence-orientation and finds its latest institutionalization in the setup of skills labs at German state-bound medical faculties.

Literatur

[1] Stosch C, Schnabel KP. Didactic, practical, good! 20 years of clinical skills training in the German speaking countries. GMS J Med Educ. 2016;33(4):Doc67. DOI: 10.3205/zma001066
[2] Jaki C, St.Pierre M, Breuer G. Vom Zimmer zum Zentrum – „form follows function“. In: St.Pierre M, Breuer G, editors. Simulation in der Medizin. Berlin, Heidelberg: Springer; 2018. p.21-47. DOI: 10.1007/978-3-662-54566-9_2
[3] Habeck D. Simulationspatienten. Med Ausbild. 1984;1:11-18. Zugänglich unter/available from: https://gesellschaft-medizinische-ausbildung.org/files/ZMA-Archiv/1984/1/Habeck.D-2.pdf