Niels A. Foit1, Siobhán G. Ewert1, Prof. John Ryan2

1 Faculty of Medicine, Albert Ludwig University of Freiburg, Fahnenbergplatz, 79085 Freiburg, Baden-Württemberg, Germany.2 Dept. of Emergency Medicine, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland



Electives form an integral part of undergraduate medical education in Germany. During a six-year program, consisting of five years of medical school and 12 months of internship, stu- dents must complete at least four months of elective rotations. The German Board of Examination encourages students to take at least some electives abroad to gain insight into differ- ent healthcare systems. Students are free to choose electives that reflect their personal interests, but are expected to spend at least one month in an ambulatory setting of a hospital or in clinics. 





Traditionally, emergency medicine in Germany is focussed on the pre-hospital environment. German ambulance services are operated by paramedics, who are joined by an emergency doc- tor at the scene. Hospital-based emergency medicine also dif- fers significantly from the Irish model; German emergency de- partments are commonly divided into “trauma” and “medicine” sections, which operate independently from each other. A triage system is also not used in Germany (1). The emergency de- partments are staffed by junior doctors in early stages of their specialty training (mostly surgery, general medicine). Lacking a formal, board-recognised training scheme in emergency medi- cine, electives abroad in this specialty are a valuable experi- ence for German medical students. This report will detail the experiences of two German 4th year medical students during an emergency medicine elective at St. Vincent’s University Hos- pital (SVUH) in the summer of 2010 (2).


Although not referred to as a “sub-internship” by the consultant in charge or the department administrator, an elective rotation at SVUH’s emergency department (ED) fulfils all necessary criteria for a sub-internship, as listed in the model curriculum of the International Federation of Emergency Medicine. Major educational criteria include, but are not limited to, basic and advanced life support skills, airway management, the ABC ap- proach, toxicology, etc. as well as clinical decision making in an emergency environment, focused physical exam and others (2,3).

The elective was based on three “columns”: a 1) formal taught

program, 2) experience on the floor and 3) interaction with senior staff. The taught program was divided into attendance at regular lectures for house staff and residents as well as student-only conferences, which were tailored to the student’s needs and interests. Formal teaching was provided once a week by the senior house officers and a consultant, along with registrars from other departments. Students were encouraged to participate actively during these sessions. Lectures covered various common topics in emergency medicine and the so- called “radio-rounds” helped both house staff and students to familiarise themselves with common x-ray findings in an emer- gency medicine setting. New insights from research were dis- cussed in a journal club.

Two senior registrars were in charge of the student-only con- ferences. In these daily, two-hour long seminars, which were either held as a lecture or at skills stations, common diseases and patient conditions in an ED were discussed. These confer- ences covered topics such as basic and advanced life support, advanced trauma life support, airway management, burn care, suturing and a brief introduction to FAST scanning.

FAST (“focused assessment in severe trauma”) ultrasound is a fast and reliable method to diagnose free intra-abdominal fluid in trauma. The FAST scanning introduction was a highlight and was highly appreciated by the students, as this is an integral part of trauma assessment in Germany. It should be added to the in-house curriculum of SVUH’s ED elective (4).


The clinical program slightly differed from the usual curriculum, because both visiting students stayed for more than four weeks. This left time for a ‘step-by-step’ introduction to a typical Irish Emergency Department. In the first week, each visiting student worked under the direct supervision of an experienced registrar, who assessed the student’s competencies and to whom the student presented the patients he had seen. Common proce- dures were taught if the student was not able to perform them. The supervising doctor provided a brief introduction to the com- puter system and the Irish way of documentation in the patients’ files, which proved to be very different to its German equivalent. During the following weeks, the students were allowed to see patients first and present their findings to the supervising doc- tor while rotating through the different parts of the ED. Every patient was discussed and in most cases a ‘bed-side-teaching’ took place, where an emphasis lay on differential diagnosis and diagnostics. In major situations, such as cardiac arrests or trau- ma, every student was assigned a task and closely supervised. We must point out that every aspect of teaching and interaction with the senior staff happened in a warm, friendly and encour- aging way.


A medical elective abroad in emergency medicine is a valuable experience and will dramatically increase the level of knowl- edge as well as the clinical skills of a medical student. Being ex- posed to an ED environment helps the student to focus on the important details and improves one’s skills in clinical decision- making in emergency cases. For a German medical student in particular, it is important to gain insight into a modern ED, as the concept of multidisciplinary EDs is on the verge of replacing the current practice of EM in Germany in the near future. Currently, in Germany ongoing and very controversial discussion about introducing emergency medicine as a board recognised spe- cialty is taking place (5). We can only encourage every visiting student to take the opportunity to go abroad. 




The authors would like to thank Prof. John Ryan, consultant in emergency medicine at SVUH, for accepting them into his department, and to all the staff for their strong commitment to undergraduate education. 



  1.  Bey T, Hahn S, Moecke H: The current state of hospital- based emergency medicine in Germany. Int J Emerg Med 2008; 1:273–277

    2. Hobgood C, Anantharaman V, Bandiera G et al.: International Federation forEmergency Medicine, model curriculum for medical student education in emergency medicine. Emerg Med J 2010; 27: 766-769.

    3. Coates WC. The emergency medicine subinternship—an educator’s guide to planning and administration. Acad Emerg Med. 2005; 12: e1–4

    4. Gogalniceanu P, Sheena Y, Kashef E et al.: Is Basic Emer- gency Ultrasound Training Feasible as Part of Standard Un- dergraduate Medical Education? J Surg Education 2010; 67, 3: 152-156

    5. Fleischmann T, Fulde G: Emergency medicine in modern Eu- rope. Emerg Med Australas 2007; 19: 300–2