How well does German medical education prepare future physicians for evidence-based practice? A comprehensive survey of over 4,000 students across nearly all German medical faculties reveals critical gaps — and a strong demand for change.
Every physician relies on scientific evidence — whether interpreting a guideline, appraising a study, or explaining a diagnosis. Yet scientific education in German medical curricula remains fragmented, inconsistently implemented, and poorly evaluated.
Between June and October 2023, 4,133 medical students from 45 of Germany’s medical faculties participated in an online survey developed by the student research group at TU Dresden in cooperation with the German Medical Students’ Association (bvmd). The study population was 69.6% female, with a mean age of 22.9 years. 77.4% were enrolled in traditional (“Regelstudiengang”) curricula. Respondents covered all academic years, from first-semester preclinical students to those in their practical year. A total of 3,005 questionnaires were completed in full.
The survey combined self-assessment of scientific competencies with a 25-item objective competency test covering research ethics, study design, statistics, literature search, and scientific reasoning. It also captured students’ views on curricular structure, relevance, and satisfaction.
Distribution of respondents from 45 medical schools — hover for details
A striking finding at the outset: nearly half of all students could not describe how scientific training was organized at their own university. Over 60% reported that their scientific skills had never been formally assessed. This lack of curricular transparency and accountability sets the stage for the competency gaps documented in the following sections.
Students rated their own competence across 12 scientific domains using the NKLM 2.0 competency framework, ranging from “no knowledge” (0) to “independent competence” (3b). Separately, they completed a 25-item multiple-choice test.
The self-assessment reveals a clear hierarchy: students feel most confident in literature search and patient communication, but substantial deficits persist in study design, research ethics, and statistics — even among final-year students. Fewer than 20% of students in their last academic year report independent competence in study design.
Stacked distribution across NKLM competency levels (≥ 6th academic year, n = 222). Red dashed line = 50%.
The objective competency test paints a similar picture. Final-year students achieved a mean score of 16 out of 25 (SD 4.1), with scores increasing moderately across academic years. Notably, there was a statistically significant but modest positive correlation between self-assessment and test performance, suggesting that students have some awareness of their gaps — but that self-assessment alone is an unreliable proxy for actual competence.
Jittered scatter plot with linear regression (filtered for > 20 items answered, n = 1,606). Spearman ρ = 0.327, p < 0.001.
of final-year students report at least supervised competence
report competence — the lowest-rated domain
Mean score, final year (SD 4.1)
Students were asked to rate their satisfaction with the teaching of scientific skills at their faculty. The results show a consistent decline over the course of medical school.
While first-year students show moderate satisfaction — likely reflecting limited exposure to clinical and research settings — the picture changes dramatically as students progress. By the final year, more than half express clear dissatisfaction, and only 1.8% report full satisfaction. This trajectory suggests that as students gain more clinical experience and begin their doctoral theses, the gap between what they need and what they have been taught becomes increasingly apparent.
Likert scale by academic year. Dashed line = 50% threshold.
Despite this dissatisfaction, students are not disengaged from the topic. On the contrary: 72.4% agree or strongly agree that scientific training should be included in the mandatory curriculum. This demand is remarkably stable across all academic years, indicating that it is not driven by frustration alone but reflects a genuine perceived need.
Likert scale by academic year.
Students are not asking for less science — they are asking for better science teaching. 72.4% want it in the mandatory curriculum, and this demand is consistent from the first to the final year.
Final-year students were asked to rate the relevance of specific scientific competencies for their future professional practice.
The results reveal a clear pattern: students assign highest relevance to competencies directly applicable at the bedside — understanding guideline evidence, explaining scientific findings to patients, and taking informed ethical stances. Competencies associated with independent research activity, such as applying statistical methods or collaborating on guidelines, are rated as less relevant but still acknowledged by a majority. This suggests that students view science primarily through a clinical lens: they want to be competent consumers and communicators of evidence, not necessarily independent researchers.
Final-year students (≥ 6th AY, n = 222). Dashed line = 50%.
This finding has direct implications for curricular design: a scientific curriculum that prioritizes evidence-based medicine, critical appraisal, and shared decision-making is more likely to be perceived as relevant — and therefore more likely to be engaged with — than one centered on bench research or publication skills alone.
The data converge on a clear message: scientific education in German medical schools is valued by students but inadequately delivered. Six concrete recommendations emerge from the findings.
Scientific education should be a compulsory, longitudinal element across all years — not relegated to electives or extracurricular activity. Currently, nearly half of students are unaware of how their faculty structures this teaching.
Rather than isolated research modules, scientific competencies should be woven into clinical teaching across disciplines. Students rate clinically contextualized scientific skills as most relevant.
Priority should be given to evidence-based medicine, critical appraisal of literature, guideline interpretation, and communicating evidence to patients — the competencies students themselves identify as most important.
Structured, mentored research experiences within the mandatory curriculum have been shown to enhance both self-assessed and objectively measured competence.
Over 60% of students report no formal assessment of their scientific skills. Without evaluation, there is no accountability, no feedback, and no incentive for engagement.
Medical faculties must clearly and proactively communicate the structure, objectives, and expectations of their scientific curriculum to students.
Data Availability: All data generated or analysed are included in the supplement of the publication.
Funding: FOSTER initiative (BMBF / State of Saxony, Excellence Strategy). DIPROM (TU Dresden).