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Although Germany?s reunification process is more than 10 years old, it is far from complete. Yet scientific institutions in the new states have made great strides, and some have even grasped the opportunities opened by the fall of the iron curtain to leapfrog their generally better-endowed neighbours in the western part of the country. The Technical University of Dresden?s Medical Faculty Carl Gustav Carus is a case in point. Although only founded as a full medical faculty in the autumn of 1993, by adopting some innovative approaches it is aiming to create a special environment for clinical research and teaching that will allow it to compete with more traditional institutions in Heidelberg, Tübingen, Göttingen, and Munich.

?Our main principle is to make unconventional things happen,? says the Medical Faculty?s dean, Prof. Detlev Michael Albrecht. ?If people say ?This is impossible?, we feel challenged even more to prove the opposite.? Having a comparatively young and dynamic academic staff helps. (The majority of the professors were not appointed until after 1993.) ?It is easier to break new grounds here than in the older and bigger institutions?, he asserts. Dr. Martin Bornhäuser, who works in the medical clinic and is also involved in research on stem cell transplantation and therapies for leukaemia patients, agrees: ?People here tend to be more co-operative than in the traditional institutions?, he finds.

Although at one time lack of infrastructure meant that ?We had to improvise? quite a lot, Bornhäuser says, the infrastructure has been greatly improved over the last few years and construction is still under way on campus. Clinical researchers now have excellent labs and support facilities, such as the Centre for Theoretical Medicine (Medizinisch-Theoretisches Zentrum, MTZ) and the Experimental Centre.

But Dresden?s success in turning things around is as much about attitude as facilities. The German system is traditionally neglectful of clinical research. ?Most clinical researchers in Germany are expected to work their regular shifts of clinical duty and do research at night?, says Dr. Anke Heintz, from the Institute of Physiology. But in Dresden, several new mechanisms have been introduced to improve the linkage between clinical research and clinical duties. Heintz is on a ?rotation model?, which means she is on leave from her clinical duties for a whole year. Meanwhile the anaesthetist can concentrate on her research interests, on the effect of CO2 on the regulation of circulation by the heart, using the isolated heart model of wildtype and transgenic rodent. She keeps her hand in the clinic by working night and weekend shifts on a regular basis.

Medical Training at Dresden

Germany?s medical students spend night after night with their books in order to acquire the huge amount of factual knowledge needed to pass their state exams. The loser is practical experience, a pattern the Dresden faculty is seeking to change. A successful grant proposal to the German Donors? Association ( Stifterverband) has allowed Dresden to become an official Harvard Medical International Associated Institution. One result is that teaching has switched to problem-focused learning, a method successfully used at Harvard. Rather than studying textbooks, students have to work on actual problems in groups of up to eight. This approach has been shown to integrate the acquisition of knowledge and practical experience.

Dr. Axel Heller from the department of anaesthesiology and intensive care medicine also gets dedicated research time--one week out of four, he can devote himself to his research, which mainly focuses on the problem of acute lung failure. ?The combination of research and practical work is very helpful?, he says. ?I am always bringing new questions from the clinic into the lab.?

To strengthen its clinical research profile, Dresden has created a strategic plan, to be funded by the German Research Ministry (BMBF), that focuses on three aspects of clinical research: tissue engineering and development of physical and molecular medical technologies for clinical application; therapeutic strategies after cell and tissue damage; and diagnosis and therapy of malignant diseases. A fourth research area, public health, is likely to be added later.

In creating its research profile, the Carl Gustav Carus Faculty is also trying to overcome another deficit of clinical research in Germany--the lack of interdisciplinary crossover between medicine and science. The first people are already benefiting from this approach: Biologist Jana Wohlfarth has recently started her doctoral thesis project in clinical radiation biology at the department of radiotherapy and radiooncology under the guidance of Prof. Michael Baumann and Dr. Cordula Petersen. Supporting young scientists is important, says Petersen: ?Many times, young scientists are facing structural problems: Writing grant proposals to German research funders is a process that takes forever. On the contrary, the university has introduced the 'MeDDrive' Programme. This enables young scientists to apply for funding from the university directly, and grants are usually given on a short-term basis.?

The faculty hopes to drive its reforms still further in the future through a mechanism by which the individual institutes compete for a portion their faculty funding. At the same time, external collaborations have a role to play. The recently opened Max-Planck-Institute for Cellular Biology and Genetics is a co-operating partner, as are several other institutes of the Technical University of Dresden.

The reform attempts are already paying off. Dr. Susanne Gretzinger decided to return to her native Germany after 3 years at Stanford University, mainly for personal reasons. She chose her new host institution carefully. Although Dresden was not among her initial selection of locations, weighing her options made her come to a different conclusion. She is not disappointed: ?So far, everything has been a positive surprise?, she says. ?Everyone is open to new projects and co-operation between the institutes works really well.?