Lesson to learn from German medical school admission system

In Germany, there are three paths to medical school. The first is through grades. Applicants are selected based on their Abitur scores, which are similar to the Korean SAT scores. This method accounts for 20% of the total capacity. The largest proportion, 60%, is left to the discretion of the universities. The remaining 20% is selected through a unique method called the 'waiting period procedure.' Applicants are admitted based on the length of time they have waited, up to a maximum of 7 years. The key here is experience in medical and health-related fields. The applicants often include medical professionals with extensive experience in onsite jobs such as emergency medical services, intensive care nursing, nursing in nursing homes, or midwifery as they tend to have higher scores. Among German medical students, one out of five enter through this pathway, including those with paramedic or nursing backgrounds.

Medical school admission is also fierce in Germany. The waiting period method was introduced as a considerate approach to distribute limited opportunities as evenly as possible. They believe that the path to becoming a doctor should be diverse, and even if one is not academically excellent, having a strong sense of duty and passion for patient care qualifies them for admission. Concerns arose about late entrants' inability to keep up with medical studies, but those from the waiting period procedure have shown resilience. While most fail the national medical exam, the pass rate for those from the waiting period procedure is comparable to those from other pathways. The German perception is that those who verify their aptitude and develop empathy towards patients on the ground are eligible to become better doctors.

Two years ago, Germany pushed for an expansion of medical school admissions, in response to the realization of a shortage of medical personnel due to the COVID-19 crisis. They decided to increase the enrollment capacity, which was around 10,000 back then, by 50%. Germany already has more than twice the number of doctors per capita compared to South Korea, and despite concerns, most doctors supported this increase. The main reason behind this was the overwhelming workload that affected the quality of medical services. German doctors view the additional doctors not as competitors but as colleagues who will share the workload in patient care.

Doctors are also a high-income profession in Germany. Doctors' income is 5.6 times higher than the average wage earner, ranking third among OECD member countries, not far from Korea, which ranks first with a gap of 6.8 times. The difference in perspective between German and Korean doctors regarding the increase in medical school admissions may stem from their experiences during medical school. Learning alongside colleagues from diverse backgrounds, especially those who have experienced hardships in medical settings, is considered an essential part of medical education in Germany. This differs from the atmosphere in Korean medical schools, where only the top-performing students across the country are selected to compete for collective elitism.

"People want the best doctors, not those who lack skills," is echoed by some of the Korean medical circle when opposing the expansion of medical school admissions. Considering that medical school admissions have been based on academic performance for decades, it's understandable. Having the bar lowered now - after struggling through the narrow path to medical school and enduring various inhumane treatments during training - would certainly be a bitter pill to swallow.

One limitation of the government's current policy of expanding medical school admissions is keeping intact the same grade-centric, uniform admission process. Increasing the quota by 1,500 doesn't necessarily change medical students' attitudes toward the profession. If the expansion materializes, it's predicted that the medical school admission score will decrease by 2.9 points, with those scoring 2.9 points lower than their predecessors filling the increased quota. To strengthen essential medical services, the fee structure needs improvement, and the admission system needs to change to instill social responsibility among medical students. It would be a good start if the gateway to medical school broadens to evaluate experiences with patients over several years as much as academic performance.