Medical education in France, Germany, Italy and the United Kingdom compared

1. The purpose of the visit was to compare postgraduate medical education and training in the United Kingdom with that in France, the Federal Republic of Germany, and Italy. 2. Except in Italy, there appeared to be widespread agreement that specific postgraduate training for general practitioners was essential to improve the quality of practice and to relieve the undergraduate curriculum from the necessity to provide comprehensive medical training to prepare a graduate for independent practice. The main difficulty appeared to be the development of good 'teaching' practices. 3. Direct comparison between training programmes for specialist practice is not straightforward in view of the different staffing structure in continental hospitals and the existence of private specialist practice to which patients have direct access. Training appears to be generally longer in the United Kingdom, possibly due to the necessity of passing postgraduate diploma examinations, but outside the university hospitals the fully trained specialist (consultant) enjoys a higher status and independence than most hospital specialists in other countries. The absence of equivalent bodies to the Royal Colleges and Faculties places responsibility upon universities for specialist training on the continent; standards are not coordinated nationally, and vary significantly from region to region. 4. The need for continuing medical education for all doctors is accepted; this is essentially voluntary, although there are variable direct and indirect incentives. Programmes are organized on a local or regional basis in most countries, but in Germany and the U.K. there is a growing trend towards national coordination of both training programmes and the provision of continuing education. 5. The recent reorganization of the National Health Service in the United Kingdom provides opportunities for 'public health' doctors to become involved in the coordination of clinical services and to relate these to the needs of the public at large, as well as to provide preventive health services. These opportunities do not exist in France, Germany and Italy, where public health services remain discrete from clinical medicine, and postgraduate training is largely confined to formal teaching at designated institutes which are university based only in Italy. Opportunities for university staff to become involved in the organization and delivery of health care appear to be greater, therefore, in the United Kingdom than in other countries.