[Candidate selection in internal medicine regarding the new licensing regulation for doctors]

Since October 2003, a new licensing regulation for doctors exists in Germany. Due to this reform medical students obtain individual grades for each clinical subject. At the end of 2006, these grades appeared in the students' leaving certificates for the first time. As the significance of these grades concerning their influence on selection criteria is still very uncertain, the aim of this study was to further investigate criteria for residency selection focusing on the evaluation of the new grades.

The importance of selection criteria was assessed by an electronic questionnaire based on a five-point Likert scale (1 = unimportant; 5 = critical). The questionnaire was sent to 7,766 members of the German Society of Internal Medicine in May 2006. 897 questionnaires were returned (11.6%): 133 heads of department, 158 senior physicians, 269 specialists, and 337 residents. 43% of the respondents were involved in the selection process.

Factors ranking as most important for respondents involved in residency selection included personally knowing an applicant, e.g., after a rotation (mean 4.1; standard deviation 1.3), and personal recommendations from colleagues (3.8 +/- 1.2). High emphasis was also placed on social commitment and additional skills. Concerning the grades given according to the old licensing regulation for doctors, the final grade of the Medical Licensing Examination (3.5 +/- 1.1) and the grade of the Medical Licensing Examination step 3 (3.4 +/- 1.1) were ranked as important. Regarding the new licensing regulation for doctors, 38% of the respondents (3.0 +/- 1.2) considered the individual grades more important than the results of the Medical Licensing Examination step 2. 49% of the respondents stated, that the grade D ("sufficient") in internal medicine would be an exclusion criterion when selecting residents (3.3 +/- 1.3).

Whether the results are representative of all physicians involved in the selection process has to remain open taking a response rate of 11.6% into account. Personal knowledge of applicants, personal recommendations and additional skills were considered more important than the grades in the Medical Licensing Examination when selecting residents. The new individual grades were evaluated heterogeneously, but there is a tendency toward ranking the grades of their own clinical subject as important; especially minor grades are considered an exclusion criterion.