The problem with combining medical and basic science training in Germany is not really a case of too many titles and too little time. It is, rather, that the academic titles given to medics and biologists are mutually exclusive--or were, until recently. In Germany, medical students who undertook a doctoral thesis get an MD (Dr. med.); students in biology, including basic biomedical science, got a PhD (Dr. rer. nat.). Different programs, different degrees.

As discussed last week in Next Wave, a very large proportion of medical students in Germany do embark on an MD thesis. Most of these candidates complete a short-term (6 months to 1 year) research project to get this title. But even medical students who worked on longer projects could not officially receive a PhD title for the work, even if it was every bit as good as any biology PhD thesis. In Germany, the title PhD cannot be granted by a medical faculty.

Markus Feuerer already had an MD when he went on to spend a further 3 years on a basic science project. Dr. Feurer is awaiting a decision from Heidelberg University's Faculty of Biology on whether he is entitled to a PhD for the work. "It is difficult," Feuerer admits, "because there is no structure in place at the university to facilitate cases like mine."

Happily, things are changing; university programs that allow medical graduates to undertake an official PhD are slowly appearing on the German scene. Bureaucratic obstacles are avoided by these programs because they are joint ventures of medical and biology faculties.

These MD/PhD dual-degree programs normally entail 1 year of seminars and practical courses followed by a compulsory examination. Students then commence their research projects, which take 3 years, on average. In general, no tuition is charged, and financial support is provided for living expenses. The DAAD, DFG and BMBF are involved at various capacities in many of these programs. Most of the courses are in English and have a large international participation. Entry requirements vary considerably from program to program. Most but not all of these programs incorporate some of the 18-month clinical practise permit training ("Arzt im Praktikum", AiP).

The University of Würzburg has the longest-running MD/PhD program in Germany, in operation since 1997. Medical graduates who successfully completed their medical doctorate and passed the third state examination can apply. The university medical and biology faculties work in conjunction with the Interdisciplinary Center for Clinical Research to run the program, which takes approximately 4 years.

The first year comprises courses taught in German and practical rotations, in parallel with the AiP, which stretches over two semesters plus the intervening semester vacation. Prof. Ulrich Walter of the medical faculty told Next Wave that so far the "feedback from students and the university has been very positive." But he believes that the course is only suitable "for highly motivated students". Applicants go through a rigorous interview process during which, Prof. Walter advises, "a proven interest in science is essential". To date, the programme has 22 students and nine graduates. Five new positions are available currently.

The University of Göttingen , in junction with the Max Planck Institute for Experimental Medicine, the German Primate Center and the European Neuroscience Institute, have an MD/PhD program in neurosciences that has been running since 2000. Candidates can already be admitted to this program with a bachelor's degree or, in the case of German medical students, after their "Physicum" and two semesters of advanced studies (Hauptstudium) in medicine. The first year is a so-called master's training programme; after successful completion of an examination, candidates can enter the PhD program and do a research thesis. All courses are in English. The AiP is not officially integrated, but many medical faculty members will assist students to get AiP time at the university hospital.

According to Dr. Simone Cardoso, who co-ordinates the program, the program takes 20 applicants per year. Presently the majority are coming from a basic science background. They are accepting applications for 2004 until the end of January next year. Candidates should not be older than 27 years of age.

The Medical School Hannover (Medizinische Hochschule Hannover) offers an MD/PhD in Molecular Medicine. The 3-year program accepts 20 students per year. Lecture and practical courses are carried out over four semesters, with an intermediate examination. Students then undertake their research. The AiP is integrated. The programme kicks off every October with an application deadline of 1 May. See the Next Wave article reviewing the program for more details.

Berlin Humboldt University Medical School Charité -- Its MD/PhD Program in the Medical Neurosciences has been running in junction with several other Berlin institutions since Autumn 2002.

Candidates who want to enter the doctoral program ideally should have already completed a MSc. in Medical Neurosciences or at least have a proven interest in the subject (evaluated by examination). Furthermore candidates must have a PhD position endorsed by a faculty member of the program before they start. Applications are accepted all year round.

Prof. Ulrich Dirnagl, from Charité's Department of Experimental Neurology, hopes that, in the long run, MD/PhD programs should help to break down the "barriers that separate natural sciences from medicine". He sees the real strength of their Medical Neurosciences MD/PhD program is in the fact it is run by a strong neuroscientific community in Berlin. Dirnagl believes that universities and research institutes that participate in such programs are investing in their own future as they will train and eventually attract back excellent scientists and clinicians.

The European Molecular Biology Laboratory (EMBL, Heidelberg) grants an MD/PhD degree as part of its International PhD programme. Applications are assessed on an individual basis.

The MD/PhD plot may thicken in the coming years. German Health Minister Ulla Schmidt wants to change the present clinical training regimen and scrap the AiP in its present form. Furthermore, a major revision of pedagogic methods in medical education is occurring in many German universities. The effects, if any, of these developments on the structure of MD/PhD programs is uncertain.

But progress is already being made. The system has, finally, become more flexible so that "Dr. med." medical graduates can also become "Dr. rer. nat." Soon, those familiar with the peculiar Teutonic habit of addressing people with every title they have to their name might be reminded of that 1980s hit "Doctor, doctor, can't you see I'm burning?"