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Full medical registration in Germany requires passing three medical state examinations. The first state exam (M1) regarding pre-clinical subjects consists of a written exam and a viva voce exam. The second state exam (M2) is a written test and comprises the medical specialties. The third state exam (M3)is an oral/viva voce practical exam. The written test questions are published by the German Institute for Medical and Pharmaceutical Examination Questions (IMPP).Both written tests consist of 320 single choice questions with five possible answers each. Recently, artificial intelligence (AI) in the form of ChatGPT passed examinations of the US Medical License exam (USMLE) (1). ChatGPT is a large language model (LLM), which is based on the transformer network architecture "general pre-trained transformer" (GPT) with more than 170 billion parameters (2, 3). It recognizes speech patterns and responds in a context appropriate way to user queries/questions. We investigated whether Chat GPT could pass the first and second state examinations in Germany and thus is able to answer complex medical questions in the German language. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic calls for a skilled health workforce, yet global health is largely missing in the medical curriculum in Germany. The interdisciplinary national student ‘‘Global Health Network’’ therefore initiated an online lecture series. ‘‘Global Health - perspectives, opportunities and challenges’’ included 14 lectures on a range of topics held by German and international academics from October 2020 to January 2021. Methods: Evaluations were performed prior to, at midterm and after the series, including 5-point likert scales and open questions. Using quantitative and qualitative approaches, participants’ motivation and learning outcomes of global health education were analysed. Results: A total of 1393 students registered for the series. Individual lectures attracted on average 400 participants, mainly female medical students between 20-25 years, but also a variety of ages, genders and disciplines. Main reasons for participation included interest in COVID-19-related developments, learning about global health-specific topics, and professional development. More than 40% of participants reported to know little about global health before attending; after the lecture series, only 10% made this statement. In addition, 90% of participants perceived an increase of motivation to learn more about the topics, while about 40% gained motivation to become practically involved in the field. The lecture series was accredited in the curriculum at some universities, thus innovating the curriculum and enabling formal credits. Conclusions: The new model of student-led online teaching proved to be feasible and demonstrated students’ interest and positive impact on global health knowledge. Further institutional change and inclusion of global health in the curricula have to follow. Key messages: Students need global health education to respond to global health-related challenges. Volunteer student-led initiatives can increase knowledge and interest and be an important driver for change towards improving global health education. [ABSTRACT FROM AUTHOR]

Background: Health-related quality of life (HRQOL) has become increasingly important for breast cancer survivors, but clinically relevant declines often persist for many years after treatment. This study aimed to investigate whether social relationships can mitigate or prevent this decline in HRQOL., Methods: Data were used from the German population-based Mamma Carcinoma Risk Factor Investigation (MARIE) cohort of 2022 breast cancer cases with follow-up information for more than 15 years after diagnosis. Correlations between social integration, social support, and global health status (GHS) as an overall measure of HRQOL were analyzed, and linear regression analysis was performed with structural equation modeling., Results: The majority of participants reported high levels of social integration and social support and moderate levels of GHS. Social integration 5 years after diagnosis was associated with GHS 5 years after diagnosis (β = 1.12; 95% CI, 0.25-1.99), but no longitudinal effects were found. Social support 5 years after diagnosis was associated with better GHS 5 years (β = 0.42; 95% CI, 0.36-0.48) and 10 years after diagnosis (β = 0.12; 95% CI, 0.02-0.22), whereas social support 10 years after diagnosis was associated with GHS 10 years (β = 0.29; 95% CI, 0.20-0.39) and 15 years after diagnosis (β = 0.10; 95% CI, 0.01-0.21)., Conclusions: These results confirm that social relationships positively influence HRQOL in long-term breast cancer survivors and that their association should receive more attention clinically and beyond routine care., (© 2024 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Introduction: A profound transformation of all areas of human activities is urgently needed for planetary health. Developing a shared vision of the future that is grounded in values aligned with planetary health is indispensable in this regard. The Planetary Health Academy is the first open online lecture series in Germany aiming for transformative planetary health education. As part of a recent evaluation of the impact of the lecture series, participants' visions for planetary health were also examined., Methods: As part of a retrospective, cross-sectional, self-administered online survey, participants were asked to respond to an open-ended question on their visions for planetary health. Results were analysed using summarising qualitative content analysis according to Mayring. Sociodemographic details of those participants who provided a valid answer (n = 197) were calculated., Results: Eight main categories were developed to summarise participants' visions for planetary health. These were: Awareness for planetary health - Planetary health integrated in all types of education - Establishment and development of the concept - A different understanding of health (care) - A transformative movement and global community - Transforming human activities - Planetary health as a guiding principle - The future state of planetary health., Discussion: Broadly, the participants' visions were about planetary health as a goal and the means necessary to achieve this goal. Our findings can only be seen as a first explorative step in eliciting aspects of a common vision for planetary health, as our study design did not include a mechanism of building consensus towards one common vision. Besides the field of planetary health, similar concepts and associated movements exist or are emerging. Facilitating dialogue and exchange across disciplines and narratives about the prevailing future visions will be key to achieving what we call planetary health and what others might call Ubuntu or buen vivir., Conclusion: The results of this study provide first insights into the planetary health visions of those whom we would consider members of a movement aligned behind the idea of planetary health. In future editions, the Planetary Health Academy could integrate more discursive elements with a particular focus on negotiating future visions to support the creation of a critical mass of change agents within the health community and beyond., (Copyright © 2024. Published by Elsevier GmbH.)

Competing Interests: Es bestehen keine finanziellen oder persönlichen Interessenkonflikte. Aus Transparenzgründen möchten die Autor:innen folgende Hintergründe erläutern: L. Arnold, L. Kellermann, F. Hommes, L. Jung, S. Gepp, F. Fischer und J. M. Stratil sind Mitglieder im Nachwuchsnetzwerk Öffentliche Gesundheit, einer informellen Plattform zum Austausch und der Vernetzung zwischen Studierenden, Nachwuchskräften und an Nachwuchsförderung Interessierten (https://noeg.org/). L. Arnold koordiniert im das Forschungsprojekt EvidenzÖGD, das darauf abzielt, neue Qualifizierungsmodelle für die Schnittstelle zwischen Wissenschaft und Praxis im ÖGD zu erarbeiten (https://www.akademie-oegw.de/die-akademie/projekte/evidenzoegd). L. Jung und S. Gepp waren 2018/2019 im erweiterten Vorstand der Bundesvertretung der Medizinstudierenden in Deutschland (bvmd e. V.). J.M. Stratil und F. Hommes haben während der Projektlaufzeit eine berufliche Tätigkeit am Robert Koch Institut (RKI) aufgenommen. Das RKI war in keiner Form an dieser Studie oder an der Erstellung des Manuskripts beteiligt. B. Szagun ist Beisitzer im Bundesvorstand des Bundesverbands der Ärztinnen und Ärzte des öffentlichen Gesundheitsdienstes e. V. (BVÖGD). Der Inhalt dieses Manuskripts kann, muss aber nicht die Position einer Institution widerspiegeln, mit der die Autor:innen verbunden sind, die aber nicht als Zugehörigkeit der Autor:innen zu diesem Manuskript genannt wird. Wir erheben nicht den Anspruch, die Organisationen in dieser Hinsicht in irgendeiner Form zu vertreten.

Planetary health education focuses on the climate and ecological crises and their adverse health effects. Given the acceleration of these crises, nationwide integration of planetary health education into undergraduate and graduate education, postgraduate training and continuing education for all health professionals has repeatedly been called for. Since 2019, planetary health education has been promoted by several national initiatives in Germany that are summarized in this commentary: 1. National Working Group Planetary Health Education, 2. Manual for planetary health education, 3. Catalog of National Planetary Health Learning Objectives in the National Competency-Based Catalog of Learning Objectives for Medical Education, 4. Working Group Climate, Environment and Health Impact Assessment at the Institute for Medical and Pharmaceutical Examinations, 5. Planetary Health Report Card, and 6. PlanetMedEd study: planetary health education in medical schools in Germany. We hope these initiatives promote collaboration across institutions involved in educating and training health professionals, inter-professional cooperation as well as rapid implementation of planetary health education., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2023 Schwienhorst-Stich et al.)

The planetary crises require health professionals to understand the interlinkages between health and environmental changes, and how to reduce ecological harm (ie, ecological footprint) and promote positive change (ie, ecological handprint). However, health professions' education and training are mostly lacking these aspects. In this Viewpoint, we report findings from the evaluation of the Planetary Health Academy, the first open online lecture series for transformative planetary health education in Germany. In a retrospective online survey, 458 of 3656 Planetary Health Academy participants reported on their emotions towards climate change, attitudes towards health professionals' responsibilities, self-efficacy, and the contribution of the Planetary Health Academy to their knowledge and actions. Additionally, motivators and barriers to acting were assessed. Our findings provide insights that can inform future efforts for transformative education. Combined with network and movement building, education could act as a social tipping element toward actions to mitigate global environmental changes., Competing Interests: Declaration of interests TG works for the Planetary Health Academy as a member of the organising team. SGe and HO previously worked for the Planetary Health Academy as members of the organising team. SGe and KW work at the Centre for Planetary Health Policy, which receives institutional funding from Stiftung Mercator. All other authors declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

As in many European countries, the Public Health Service (PHS) in Germany has had considerable difficulties in attracting well-qualified personnel for decades. Despite ongoing political and societal debate, limited empirical research on possible causes and explanations is available. To identify areas of action, we explored reasons for the (lack of) interest in working in the PHS by conducting two cross-sectional surveys among 3019 medical students (MS), public health students, and students from other PHS-relevant fields (PH&ONM) in Germany right before (wave 1, 2019/2020) and during the COVID-19 pandemic (wave 2, 2021). While interest in working in the PHS among MS was low, it was considerably higher among PH&ONM. The prevalent underestimation of the importance of public health and low levels of knowledge about the PHS were identified as potential barriers. Although core activities of the PHS were often considered attractive, they were repeatedly not attributed to the PHS. A negative perception of the PHS (e.g., it being too bureaucratic) was prevalent among students with and without PHS interest, indicating that both a negative image and potentially structural deficits need to be overcome to increase attractiveness. Based on the findings, we propose approaches on how to sustainably attract and retain qualified personnel.

The Public Health Service (PHS) in Germany has had difficulties in recruiting enough qualified staff for years, but there is limited research on what factors drive decisions to (not) join the PHS workforce. We explored reasons for this perceived (lack of) attractiveness. We conducted two cross-sectional surveys among medical students (MS), public health students and students from other PHS-relevant fields (PH&ONM) in Germany before (2019/2020) and during the COVID-19 pandemic (2021). Both waves surveyed self-reported reasons for why students did (not) consider working in the PHS as attractive and how this could be improved, using open-question items. Qualitative and quantitative content analyses were conducted according to Mayring. In total, 948 MS and 445 PH&ONM provided valid written responses. Reasons for considering the PHS as attractive were, among others, the perception of a good work-life balance, high impact, population health focus, and generally interesting occupations. Suggestions to increase attractiveness included reducing bureaucracy, modernization/digitalization, and more acknowledgement of non-medical professionals. Among MS, reasons against were too little clinical/patient-related activities, low salary, and occupations regarded as boring. Our findings indicate areas for improvement for image, working conditions in, and institutional structures of the PHS in Germany to increase its attractiveness as an employer among young professionals.

The COVID-19 pandemic has both exposed and intensified various challenges for Public Health and the Public Health service (ÖGD) in Germany. However, it also offers a window of opportunity for effective long-term transformation of the country's Public Health system. Against this backdrop, an online survey was carried out among the members of the German Network of Young Professionals in Public Health (Nachwuchsnetzwerk Öffentliche Gesundheit (NÖG)) in October and November 2020. It sought to elicit members' experiences and views related to Public Health during the COVID-19 pandemic. The resulting preliminary "lessons learned" for the German Public Health context are presented in this article. Based on the results of the survey, recommendations were formulated which are intended to provide targeted and concrete advice for the strengthening and transformation of Public Health in Germany. The main issues that preoccupied the young professionals were the increased public and political attention to Public Health and the narrow focus on infectious disease control, the standing of Public Health in Germany and the strengths and weaknesses of Public Health structures and workforce. The recommendations are aimed at promoting long-term and holistic strengthening of Public Health, with the training of an interdisciplinary workforce of young professionals presenting a key focus., Competing Interests: Laura Arnold ist als Referentin für Epidemiologie und Gesundheitsberichterstattung an der Akademie für Öffentliches Gesundheitswesen in Düsseldorf tätig. Die anderen Autor:innen haben keine wirtschaftlichen oder persönlichen Interessenkonflikte., (Thieme. All rights reserved.)