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For trade associations for medical professionals, see Medical college.

"Med school" redirects here. For the experimental music label, see Hospital Records.

See also: Medical education and List of medical schools

A medical school is a tertiary educational institution —or part of such an institution— that teaches medicine, and awards a professional degree for physicians and surgeons. Such medical degrees include the Bachelor of Medicine, Bachelor of Surgery (MBBS, MBChB, BMBS), Doctor of Medicine (MD), or Doctor of Osteopathic Medicine (DO). Many medical schools offer additional degrees, such as a Doctor of Philosophy, Master's degree, a physician assistant program, or other post-secondary education.

Medical schools can also carry out medical research and operate teaching hospitals. Around the world, criteria, structure, teaching methodology, and nature of medical programs offered at medical schools vary considerably. Medical schools are often highly competitive, using standardized entrance examinations, as well as grade point average and leadership roles, to narrow the selection criteria for candidates. In most countries, the study of medicine is completed as an undergraduate degree not requiring prerequisite undergraduate coursework. However, an increasing number of places are emerging for graduate entrants who have completed an undergraduate degree including some required courses. In the United States and Canada, almost all medical degrees are second entry degrees, and require several years of previous study at the university level.

Medical degrees are awarded to medical students after the completion of their degree program, which typically lasts five or more years for the undergraduate model and four years for the graduate model. Many modern medical schools integrate clinical education with basic sciences from the beginning of the curriculum (e.g.[1][2]). More traditional curricula are usually divided into preclinical and clinical blocks. In preclinical sciences, students study subjects such as biochemistry, genetics, pharmacology, pathology, anatomy, physiology and medical microbiology, among others. Subsequent clinical rotations usually include internal medicine, general surgery, pediatrics, psychiatry, and obstetrics and gynecology, among others.

Although medical schools confer upon graduates a medical degree, a physician typically may not legally practice medicine until licensed by the local government authority.[3] Licensing may also require passing a test, undergoing a criminal background check, checking references, paying a fee, and undergoing several years of postgraduate training. Medical schools are regulated by each country and appear in the World Directory of Medical Schools which was formed by the merger of the AVICENNA Directory for medicine and the FAIMERInternational Medical Education Directory.

Africa[edit]

See also: List of medical schools in Africa

By 2005 there were more than 100 medical schools across Africa, most of which had been established after 1970.[4]

Ghana[edit]

There are seven medical schools in Ghana: The University of Ghana Medical School in Accra, the KNUST School of Medical Sciences in Kumasi, University for Development Studies School of Medicine in Tamale, University of Cape Coast Medical School and the University of Allied Health Sciences in Ho, Volta Region, the leading private medical school in Ghana - the Accra College of Medicine,[5] and Family Health Medical School another private medical school.

Basic Medical education lasts 6 years in all the medical schools. Entry into these medical schools are highly competitive and it is usually based on successful completion of the Senior High School Examinations. The University of Ghana Medical School has however introduced a graduate entry medical program to admit students with mainly science-related degrees into a 4-year medical school program.

Students graduating from any of these medical schools get the MBChB degree and the title "Dr". For the First 3 years Students are awarded BSc in the field of Medical science for University of Ghana medical school; and Human biology for KNUST and UDS medical schools. The University of Ghana Medical School and KNUST School of Medical Sciences in Kumasi use the Tradition medical education model whiles University for Development Studies School of Medicine uses the Problem-based learning model.

Medical graduates are then registered provisionally with the Medical and Dental Council (MDC) of Ghana as House Officers (Interns). Upon completion of the mandatory 2-year housemanship, these medical doctors are permanently registered with the MDC and can practice as medical officers (General Practitioners) anywhere in the country. The housemanship training is done only in hospitals accredited for such purposes by the Medical and Dental Council of Ghana

Following the permanent registration with the medical and dental council, doctors can specialize in any of the various fields that is organized by either the West African college of Physicians and Surgeons or the Ghana College of Physician and Surgeons.

Medical officers are also sometimes hired by the Ghana Health Service to work in the Districts/Rural areas as Primary Care Physicians.

Kenya[edit]

In Kenya, medical school is a faculty of a university. Medical education lasts for 5 years after which the student graduates with an undergraduate (MBChB) degree. This is followed by a mandatory 12-month full-time internship at an approved hospital after which one applies for registration with the Kenya Medical Practitioners and Dentists Board if they intend to practice medicine in the country. The first two years of medical school cover the basic medical (preclinical) sciences while the last four years are focused on the clinical sciences and internship.

There are no medical school entry examinations or interviews and admission is based on students' performance in the high school exit examination (Kenya Certificate of Secondary Education - KCSE). Students who took the AS Level or the SAT can also apply but there is a very strict quota limiting the number of students that get accepted into public universities. This quota does not apply to private universities.

There are four established public medical schools:

Both Nairobi and Moi Universities run post graduate medical training programs that run over 3 years and lead to the award of master of medicine, MMed, in the respective specialty.

There has been progress made by the Aga Khan University in Karachi, Pakistan and the Aga Khan University Hospital (AKUH) in Nairobi towards the establishment of a Health Sciences University in Kenya with an associated medical school. AKUH in Nairobi, already offers post graduate MMed programmes. These are run over 4 years.

Completion of formal specialty training in Kenya is followed by two years of supervised clinical work before one can apply for recognition as a specialist, in their respective field, by the medical board.

Nigeria[edit]

There are several medical schools in Nigeria. Entrance into these schools is highly competitive. Candidates graduating from high school must attain high scores on the West African Examination Council's (WAEC) Senior School Certificate Exam (SSCE/GCE) and high scores in four subjects (Physics, English, Chemistry, and Biology) in the University Matriculation Examination (UME). Students undergo rigorous training for 6 years and culminate with a Bachelor of Medicine and Bachelor of Surgery (MBBS/MBChB). The undergraduate program is six years and one year of work experience in government hospitals. After medical school, graduates are mandated to spend one year of housemanship (internship) and one year of community service before they are eligible to be fully licensed by the Medical and Dental Council.

South Africa[edit]

See also: List of medical schools in South Africa; Healthcare in South Africa; Category:Teaching hospitals in South Africa
Related: Dental degree#South Africa

There are eight medical schools in South Africa, each under the auspices of a public university. As the country is a former British colony, most of the institutions follow the British-based undergraduate method of instruction, admitting students directly from high school into a 6 or occasionally five-year program. Some universities such as the University of the Witwatersrand in Johannesburg and the University of Cape Town have started offering post-graduate medical degrees that run concurrently with their undergraduate programs. In this instance, a student having completed an appropriate undergraduate degree with basic sciences can enter into a four-year postgraduate program.

South African medical schools award the MBChB degree, except the University of the Witwatersrand, which styles its degree MBBCh. Some universities allow students to earn an intercalated degree, completing a BSc (Medical) with an additional year of study after the second or third year of the MBChB. The University of Cape Town, in particular, has spearheaded a recent effort to increase the level of medical research training and exposure of medical students through an Intercalated Honours Programme, with the option to extend this to a PhD.[6]

Following successful completion of study, all South African medical graduates must complete a two-year internship as well as a further year of community service in order to register with the Health Professions Council and practice as a doctor in the country.

Specialisation is usually a five- to seven-year training process (depending on the specialty) requiring registering as a medical registrar attached to an academic clinical department in a large teaching hospital with appropriate examinations. The specialist qualification may be conferred as a Fellowship by the independent Colleges of Medicine of South Africa (CMSA), following British tradition, or as a Magisterial degree by the university (usually the M Med, Master of Medicine, degree). The Medical schools and the CMSA also offer Higher Diplomas in many fields. Research degrees are the M.Med and Ph.D. or M.D., depending on university.

Medical students from all over the world come to South Africa to gain practical experience in the country's many teaching hospitals and rural clinics. The language of instruction is English but a few indigenous languages are studied briefly. The University of the Free State has a parallel medium policy, meaning all English classes are also presented in Afrikaans, therefore students who choose to study in Afrikaans, do so separately from the English class.

Sudan[edit]

In Sudan, medical school is a faculty of a university. Medical school is usually 6 years, and by the end of the 6 years the students acquires a bachelor's degree of Medicine and Surgery. Post graduating there is a mandatory one-year full-time internship at one of the university or Government Teaching hospitals, then a license is issued.

During the first three years the curriculum is completed, and throughout the next three years it is repeated with practical training. Students with high grades are accepted for free in Government Universities. Students who score a grade less than the required would have to pay and must also acquire a still high grade. Students who take foreign examinations other than the Sudanese High School Examination are also accepted in Universities, students taking IGCSE/SATs and the Saudi Arabia examination.

Tunisia[edit]

In Tunisia, education is free for all Tunisian citizens and for foreigners who have scholarships. The oldest Medical school is a faculty of the University of Tunis. There are four medicine faculties situated in the major cities of Tunis, Sfax, Sousse and Monastir. Admission is bound to the success and score in the baccalaureate examination. Admission score threshold is very high, based on competition among all applicants throughout the nation. Medical school curriculum consists of five years. The first two years are medical theory, containing all basic sciences related to medicine, and the last three years consists of clinical issues related to all medical specialties. During these last three years, the student gets the status of "Externe". The student has to attend at the university hospital every day, rotating around all wards. Every period is followed by a clinical exam regarding the student's knowledge in that particular specialty. After those five years, there are two years on internship, in which the student is a physician but under the supervision of the chief doctor; the student rotates over the major and most essential specialties during period of four months each. After that, student has the choice of either passing the residency national exam or extending his internship for another year, after which he gains the status of family physician. The residency program consists of four to five years in the specialty he qualifies, depending on his score in the national residency examination under the rule of highest score chooses first. Whether the student chooses to be a family doctor or a specialist, he has to make a doctorate thesis, which he will be defending in front of a jury, after which he gains his degree of Doctor of Medicine (MD).

Uganda[edit]

Main article: Medical school in Uganda

As of April 2017[update], there are nine accredited medical schools in Uganda.[7] Training leading to the award of the degree of Bachelor of Medicine and Bachelor of Surgery (MBChB) lasts five years, if there are no re-takes. After graduating, a year of internship in a hospital designated for that purpose, under the supervision of a specialist in that discipline is required before an unrestricted license to practice medicine and surgery is granted by the Uganda Medical and Dental Practitioners Council (UMDPC).

There is Postgraduate training such as the degree of Master of Medicine (MMed) which is a three-year programme, available at Makerere University School of Medicine in several disciplines. Makerere University School of Public Health, offers the degree of Master of Public Health (MPH) following a twenty-two (22)-month period of study, which includes field work.[8]

Zimbabwe[edit]

In Zimbabwe there are three medical schools is offering Medical degrees. For undergrads, these are University of Zimbabwe - College of Health Sciences {MBChB}, National University of Science and Technology (NUST) Medical school {MBBS} and Midlands State University (MSU) {MBChB}. Only UZ is offering postgrad degrees in the Medical faculty.

Training lasts 5 1/2 years. The curriculum is as follows:

  • Part 1 (1 year) – Biochemistry, Communication Skills for Academic Purposes, Anatomy, Physiology and Behavioral Sciences. Professional exams are written in the first two and failure to attain a pass in Biochemistry warranties a repeat of first year.
  • Part 2 (1 year) – Communication Skills for Professional Purposes, Anatomy, Physiology, Behavioral Sciences. Professional exams are written at the end of second year and failure to attain a passmark in any of the last three courses on the list warranties a repeat of the year. Communication Skills can be carried to the next year, but the student should pass the course before graduation.
  • Part 3 (1.5 years) – Pathology (Histopathology), Medical Microbiology, Chemical Pathology, Hematology, Forensic Pathology, Immunology and Toxicology. A professional exam is written at the end of the third year and the student has to pass to proceed. There are also surgery and medicine rotations during the year. Also, the students cover most of the basic Pharmacology during the third stage of the degrees.
  • Part 4 (1 year) – Community Medicine, Psychiatry and Clinical Pharmacology
  • Part 5 (1 year) – Medicine, Surgery, Obstetrics and Gynecology, Pediatrics

Internship is 2 years duration, with the first year spent in medicine and surgery and the second year doing pediatrics, anesthesia/psychiatry and obstetrics and gynecology. Thereafter one can apply for MMED at the university which last 4–5 years depending on specialty. Currently no subspecialist education is available.

Americas[edit]

Argentina[edit]

See also: List of medical schools in Argentina

Medical degree programs in Argentina typically are six years long, with some universities opting for 7 year programs. Each one of the 3000 medical students who graduate each year in Argentina are required before graduation to dedicate a minimum of 8 months to community service without pay; although in some provinces (especially round the more developed south) there are government-funded hospitals who pay for this work. Some universities have cultural exchange programmes that allow a medical student in their final year to serve their community time overseas.

Upon graduation, one of the following degrees is obtained, according to the university: Doctor of Medicine, or both Doctor of Medicine and Doctor of Surgery. Public universities usually confer both degrees, and private universities bestow only Doctor of Medicine. In daily practice, however, there is no substantial difference between what a Doctor of Medicine or a Doctor of Medicine and Doctor of Surgery are allowed to do. When the degree is obtained, a record is created for that new doctor in the index of the National Ministry of Education (Ministerio Nacional de Educación) and the physician is given their corresponding medical practitioner's ID, which is a number that identifies him and his academic achievements. In addition, there is a provincial ID, i. e. a number to identify doctors in the province they practise medicine in.

Doctors wishing to pursue a speciality must take entrance exams at the public/private institution of their choice that offers them. It is easier for students in private Medical Schools to obtain a residency in a Private Hospital, especially when the university has its own hospital, as the university holds positions specifically for its graduates. Speciality courses last about two to five years, depending on the branch of medicine the physician has chosen. There is no legal limit for the number of specialities a doctor can learn, although most doctors choose to do one and then they sub-specialise for further job opportunities and less overall competition, along with higher wages.

In Argentina there are public and private medical schools, however the prestige of the public institutions is undeniable and the private institutions do not normally appear in international rankings. A person who can afford to attend a private university, quite expensive for the average Argentinian, will choose that option over public education because of the smaller groups of students in each class and because of the lack of strictness in course evaluation. By law entrance into public institutions is open and tuition-free to all who have a high school diploma, and universities are expressly forbidden[9] from restricting access with difficult entrance exams. Point in case, in 2016 La Universidad Nacional de la Plata was obligated by the governing bodies to stop forcing its students to write an entrance exam. As a result, that university experienced a major increase in the size of its student population. When it comes to educational quality, la Universidad de Buenos Aires, a public university, is widely recognised as the top medical school in the country.[10]

Bolivia[edit]

In Bolivia, all medical schools are faculties within a university and offer a five-year M.D. equivalent. To acquire a license to exercise medical science from the government, all students must also complete 1 year and 3 months of internship. This consists of 3 months each of surgery, internal medicine, gynecology, pediatrics and public health. At least one of the internships must be done in a rural area of the country. After getting the degree and license, a doctor may take a post-graduate residency in order to acquire a specialty.

Brazil[edit]

The Brazilian medical schools follow the European model of a six-year curriculum, divided into three cycles of two years each.[11] The first two years are called basic cycle (ciclo básico). During this time students are instructed in the basic sciences (anatomy, physiology, pharmacology, immunology etc.) with activities integrated with the medical specialties, allowing the student an overview of the practical application of such content. After its completion, the students advance to the clinical cycle (ciclo clinico). At this stage contacts with patients intensify and work with tests and diagnostics, putting into practice what was learned in the first two years. The last two are called cycle internship (ciclo do internato). In this last step the students focus on clinical practice, through training in teaching hospitals and clinics. The teaching of this last step respecting an axis of increasing complexity, enabling students to make decisions and participate effectively in form and operative care under the direct supervision of faculty and qualified to act as teaching aids physicians. The performance of the internal develops redemption of ethical and humanistic dimensions of care, causing the student to recognize the values and principles that guide the physician-patient relationship.

After six years of training, students graduate and are awarded the title of physician (Médico) allowing them to register with the Regional Council of Medicine (Conselho Regional de Medicina). The recent graduate will be able to exercise the medical profession as a general practitioner and may apply to undertake postgraduate training. In 2012, the Regional Council of Medicine of São Paulo (Conselho Regional de Medicina do Estado de São Paulo) established that physicians who graduate from this year must pass a test to obtain professional registration. Passing the exam, however, is not linked to obtaining registration. It required only the presence of the candidate and the test performance. Already at the national level, pending in the Senate a bill creating the National Proficiency Examination in Medicine (Exame Nacional de Proficiência em Medicina), which would make the race a prerequisite for the exercise of profession.

Physicians who want to join a specialization program must undergo a new selection examination considered as competitive as that required to join a medical school. Works in health institutions under the guidance of medical professionals with high ethical and professional qualification. The specialization programs are divided into two categories: direct access and prerequisite. The specialties with direct access are those in which the doctor can enroll without having any prior expertise. Any physicians can apply to examinations for these specialties, regardless of time of training or prior experience. To apply to proprietary pre-requisite, the doctor should have already completed a specialty prior. The programs may range from 2 to 6. In Brazil are currently recognized by the Federal Council of Medicine, the Brazilian Medical Association and the National Commission of Medical Residency 53 residency programs. Fully complied with, gives the title of resident physician specialist.

Canada[edit]

Main article: Medical school in Canada

See also: List of medical schools in Canada

In 2013, the Association of American Medical Colleges lists 17 accredited MD-granting medical schools in Canada.

In Canada, a medical school is a faculty or school of a university that offers a three- or four-year Doctor of Medicine (M.D. or M.D.C.M.) degree. Generally, medical students begin their studies after receiving a bachelor's degree in another field, often one of the biological sciences. However, admittance can still be granted during third and fourth year. Minimum requirements for admission vary by region from two to four years of post-secondary study. The Association of Faculties of Medicine of Canada publishes a detailed AFMC.ca, guide to admission requirements of Canadian faculties of medicine on a yearly basis.

Admission offers are made by individual medical schools, generally on the basis of a personal statement, undergraduate record (GPA), scores on the Medical College Admission Test(MCAT), and interviews. Volunteer work is often an important criterion considered by admission committees. All four medical schools in Quebec and two Ontario schools (University of Ottawa, Northern Ontario School of Medicine) do not require the MCAT. McMaster requires that the MCAT be written, though they only look for particular scores (6 or better) on the verbal reasoning portion of the test.

The first half of the medical curriculum is dedicated mostly to teaching the basic sciences relevant to medicine. Teaching methods can include traditional lectures, problem-based learning, laboratory sessions, simulated patient sessions, and limited clinical experiences. The remainder of medical school is spent in clerkship. Clinical clerks participate in the day-to-day management of patients. They are supervised and taught during this clinical experience by residents and fully licensed staff physicians.

Students enter into the Canadian Resident Matching Service, commonly abbreviated as CaRMS in the fall of their final year. Students rank their preferences of hospitals and specialties. A computerized matching system determines placement for residency positions. 'Match Day' usually occurs in March, a few months before graduation.[12] The length of post-graduate training varies with choice of specialty.

During the final year of medical school, students complete part 1 of the Medical Council of Canada Qualifying Examination (MCCQE). Upon completion of the final year of medical school, students are awarded the degree of M.D. Students then begin training in the residency program designated to them by CaRMS. Part 2 of the MCCQE, an Objective Structured Clinical Examination, is taken following completion of twelve months of residency training. After both parts of the MCCQE are successfully completed, the resident becomes a Licentiate of the Medical Council of Canada. However, in order to practice independently, the resident must complete the residency program and take a board examination pertinent to his or her intended scope of practice. In the final year of residency training, residents take an exam administered by either the College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada, depending on whether they are seeking certification in family medicine or another specialty.

Caribbean[edit]

See also: List of medical schools in the Caribbean

In 2011, the International Medical Education Directory listed 59 current medical schools in the Caribbean. 54 grant the MD degree, 3 grant the MBBS degree, and 2 grant either the MD or MBBS degree.

30 of the medical schools in the Caribbean are regional, which train students to practice in the country or region where the school is located. The remaining 29 Caribbean medical schools are known as offshore schools, which primarily train students from the United States and Canada who intend to return home for residency and clinical practice after graduation.[13] At most offshore schools, basic sciences are completed in the Caribbean while clinical clerkships are completed at teaching hospitals in the United States.

Several agencies may also accredit Caribbean medical schools, as listed in the FAIMER Directory of Organizations that Recognize/Accredit Medical Schools (DORA). 25 of the 29 regional medical schools in the Caribbean are accredited, while 14 of the 30 offshore medical schools are accredited.

Curaçao[edit]

Curaçao currently (2015), has 5 medical schools and one other medical university under construction. The majority are located within the city of Willemstad. All six medical schools on the island of Curaçao, only provide education in Basic Medical Science (BMS) which goes towards the degree of Medical Doctor or Doctor of Medicine (2016). Presently, none of the medical schools offer other degrees; such as MBBS or PhD (2016). All students after completing their medical school's Basic Medical Science program in Curaçao; will then have to apply to either take USMLE Step Exams, The Canadian or UK Board Exams. A large percentage of these medical students who attend these medical schools in Curaçao are either from North America, Africa, Europe or Asia.

Chile[edit]

In Chile, there are 21 medical schools. Principal medical schools are Pontificia Universidad Católica de Chile in Santiago, Universidad de Chile, Universidad de Concepción and Universidad de Santiago de Chile. The pre-grade studies are distributed in 7 years, where the last 2 are the internship, that include at least surgery, internal medicine, gynecology and pediatrics. After getting the degree of Licenciate in Medicine (General Medicine) the M.D. must pass a medicine knowledge exam called National Unic Exam of Medical Knowledge (EUNACOM "Examen Único Nacional de Conocimientos de Medicina" in Spanish) and can take a direct specialty or work before in primary attention in order to gain access to a residency.

Colombia[edit]

In Colombia, there are 50 medical schools listed in the World Directory of Medical Schools, 27 of which have active programs and are currently registered and accredited as high-quality programs by the Colombian Ministry of Education. The main medical programs are offered by the Universidad Nacional de Colombia, Pontificia Universidad Javeriana, Universidad del Rosario, Universidad El Bosque, Universidad de los Andes, Universidad del Valle, Universidad de Antioquia, and Universidad de la Sabana. Most programs require between 6–7 years of study, and all offer a Doctor of Medicine (MD) degree. In some cases the school also allows for a second degree to be studied for at the same time (this is chosen by the student, though most students end up needing to do alternate semesters between their degrees, and mostly in careers like microbiology or biomedical engineering). For example, the Universidad de los Andes has a program whereby the medical student could graduate with both an MD and a Master of Business Administration (MBA) degree, or an MD and a master's degree in public health. Admission to medical school varies with the school, but is usually dependent on a combination of a general application to the university, an entrance exam, a personal statement or interview, and secondary (high) school performance mostly as reflected on the ICFES score (the grade received on the state exam in the final year of secondary/high school).

In most medical programs, the first two years deal with basic scientific courses (cellular and molecular biology, chemistry, organic chemistry, mathematics, and physics), and the core medical sciences (anatomy, embryology, histology, physiology, and biochemistry). The following year may change in how it is organized in different schools, but is usually organ system-based pathophysiology and therapeutics (general and systems pathology, pharmacology, microbiology, parasitology, immunology, and medical genetics are also taught in this block). In the first two years, the programs also usually begin the courses in the epidemiology track (which may or may not include biostatistics), a clinical skills track (semiology and the clinical examination), a social medicine/public health track, and a medical ethics and communication skills track. Modes of training vary, but are usually based on lectures, simulations, standardized-patient sessions, problem-based learning sessions, seminars, and observational clinical experiences. By year three, most schools have begun the non-elective, clinical-rotation block with accompanying academic courses (these include but are not limited to internal medicine, pediatrics, general surgery, anaesthesiology,orthopaedics, gynaecology and obstetrics, emergency medicine, neurology, psychiatry, oncology, urology, physical medicine and rehabilitation, ophthalmology, and otorhinolaryngology). Elective rotations are usually introduced in the fourth or fifth year, though as in the case of the non-elective rotations, the hospitals the medical students may be placed in or apply to for a given rotation depend entirely on the medical schools. This is important in terms of the medical training, given the particular distinction of patients, pathologies, procedures, and skills seen and learned in private vs. public hospitals in Colombia. Most schools, however, have placements in both types of hospitals for many specialties.

The final year of medical school in Colombia is referred to as the internship year ("internado"). The internship year is usually divided into two semesters. The first semester is made up of obligatory rotations that every student does though in different orders, and the medical intern serves in 5-7 different specialties, typically including internal medicine, paediatrics, general surgery, anaesthesiology, orthopaedics, gynaecology and obstetrics, and emergency medicine. The extent of the responsibilities of the intern varies with the hospital, as does the level of supervision and teaching, but generally, medical interns in Colombia extensively take, write, and review clinical histories, answer and discuss referrals with their seniors, do daily progress notes for the patients under their charge, participate in the service rounds, present and discuss patients at rounds, serve shifts, assist in surgical procedures, and assist in general administrative tasks. Sometimes, they are charged with ordering diagnostic testing, but, under Colombian law they cannot prescribe medication as they are not graduate physicians. This, of course, are to be completed in addition to their academic responsibilities. The second semester is made up of elective rotations, which can be at home or abroad, in the form of clerkships or observerships. A final graduation requirement is to sit a standardized exam, the State Exam for Quality in Higher Education ("Examen de Estado de Calidad de la Educación Superior" or ECAES, also known as SABER PRO) specific to medicine, which tests, for example, knowledge in public health and primary care.

After graduation, the physician is required to register with the Colombian Ministry of Health, in order to complete a year of obligatory social service ("servicio social obligatorio"), after which they qualify for a professional license to practice general medicine and apply for a medical residency within Colombia. If, however, the student wishes to practice general medicine abroad or continue onto their postgraduate studies, for example, they can independently begin the appropriate application/equivalency process, without doing their obligatory social service. In this case they would not be licensed to practise medicine in Colombia and if they wish to do so, will have to register with the Ministry of Health. N.B. If the graduate physician gets accepted immediately into a residency within Colombia in internal medicine, paediatrics, family medicine, gynecology and obstetrics, general surgery or anaesthesiology, they are allowed to complete a 6-month-long social service after their residency.

In contrast with most countries, residencies in Colombia are NOT paid positions, since one applies for the program through the university offering the post, which requires a tuition. However, on 9th May, 2017, legislation was formally introduced in Congress that would seek to regulate payment for medical residents, regulate their tuitions, and advocate for their vacation time and working hours. As in other countries, length of residency training depends upon the specialty chosen, and, following its completion, the physician may choose to apply for a fellowship (subspecialty) at home or abroad depending on the availability of their desired training programs, or practice in their specialty.

El Salvador[edit]

The Universidad de El Salvador (University of El Salvador) has a program of 8 years for students who want to study medicine. The first six years are organized in a two semesters fashion, the seventh year is used for a rotating internship through the mayor specialty areas in a 10-week periods fashion (psychiatry and public health share a period) and the eighth year is designated for Social service in locations approved by the Ministry of Health (usually as attending physician in Community Health Centers or non-profit organizations). The graduates receive the degree of MD and must register in the Public Health Superior Council(CSSP) to get the medical license and a registered national number that allows them to prescribe barbiturates and other controlled drugs. In order to attend further studies (Surgery, Internal medicine, G/OB, Pediatrics, Psychiatry), the students in the year of Social service or graduates of any Salvadorian university must apply independently for the residency to the hospital of choice; the preliminary selection process is based on the results of clinical knowledge tests, followed by psychiatric evaluations and interviews with the hospital medical and administrative staff. The basic residencies mentioned above commonly last 3 years; at the last trimester of the third year, the residents can apply to the position of Chief of residents (1 year) or follow further studies as resident (3 years) of a specialty (for example:orthopedic surgery, urology, neurology, endocrinology...). No further studies are offered to the date; therefore, specialist looking for training or practice in a specific area (For example: a neurosurgeon looking for specialty in endovascular neurosurgery, spine surgery or pediatric neurosurgery) must attend studies in other countries and apply for such positions independently.

Guyana[edit]

In Guyana the medical school is accredited by the National Accreditation Council of Guyana. The medical program ranges from 4 years to 6 years. Students are taught the basic sciences aspect of the program within the first 2 years of medical school. In the clinical sciences program, students are introduced to the hospital setting where they gain hands on training from the qualifying physicians and staff at the various teaching hospitals across Guyana.

Students graduating from the University of Guyana are not required to sit a board exams before practicing medicine in Guyana. Students graduating from the American International School of Medicine sit the USMLE, PLAB or CAMC exams.

Haiti[edit]

Medical schools in Haiti conduct training in French. The universities offering medical training in Haiti are the Université Notre Dame d'Haïti, Université Quisqueya, Université d'Etat d'Haïti and Université Lumière.

The Université Notre Dame d'Haïti (UNDH) is a private Catholic university established by the Episcopal Conference of Haiti. According to the UNDH website, "the UNDH is not just about academic degrees, it is mainly the formation of a new type of Haiti, which includes in its culture and moral values of the Gospel, essential for serious and honest people that the country needs today."

The other two private schools offering medical degrees are Université Quisqueya and Université Lumière. The Université d'Etat d'Haïti is a public school.[14]

Attending medical school in Haiti may be less expensive than attending medical universities located in other parts of the world, but the impact of the country's political unrest should be considered, as it affects the safety of both visitors and Haitians.

Duration of basic medical degree course, including practical training: 6 years

Title of degree awarded: Docteur en Médecine (Doctor of Medicine)

Medical registration/license to practice: Registration is obligatory with the Ministère de la Santé publique et de la Population, Palais des Ministères, Port-au-Prince. The license to practice medicine is granted to medical graduates who have completed 1 year of social service. Those who have qualified abroad must have their degree validated by the Faculty of Medicine in Haiti. Foreigners require special authorization to practice.

Panama[edit]

The system of Medical education in Panama usually takes students from high school directly into Medical School for a 6-year course, typically with a two years internship.

This section needs expansion. You can help by adding to it.(January 2013)

United States[edit]

Main article: Medical school in the United States

See also: List of medical schools in the United States

In 2012, the Association of American Medical Colleges and American Association of Colleges of Osteopathic Medicine listed 141 accredited M.D.-granting[15] and 30 accredited D.O.-granting medical schools[16] in the United States.

The Doctor of Medicine (MD) and Doctor of Osteopathic Medicine (DO) are graded to be equivalent to a Professional Doctorate.[17][18][19]

Admission to medical school in the United States is based mainly on a GPA, MCAT score, admissions essay, interview, clinical work experience, and volunteering activities, along with research and leadership roles in an applicant's history. While obtaining an undergraduate degree is not an explicit requirement for a few medical schools, virtually all admitted students have earned at least a bachelor's degree. A few medical schools offer pre-admittance to students directly from high school by linking a joint 3-year accelerated undergraduate degree and a standard 4-year medical degree with certain undergraduate universities, sometimes referred to as a "7-year program", where the student receives a bachelor's degree after their first year in medical school.

As undergraduates, students must complete a series of prerequisites, consisting of biology, physics, and chemistry (general chemistry and organic). Many medical schools have additional requirements including calculus, genetics, statistics, biochemistry, English, and/or humanities classes. In addition to meeting the pre-medical requirements, medical school applicants must take and report their scores on the MCAT, a standardized test that measures a student's knowledge of the sciences and the English language. Some students apply for medical school following their third year of undergraduate education while others pursue advanced degrees or other careers prior to applying to medical school.

In the nineteenth century, there were over four hundred medical schools in the United States. By 1910, the number was reduced to one hundred and forty-eight medical schools and by 1930 the number totaled only seventy-six. Many early medical schools were criticized for not sufficiently preparing their students for medical professions, leading to the creation of the American Medical Association in 1847 for the purpose of self-regulation of the profession. Abraham Flexner (who in 1910 released the Flexner report with the Carnegie Foundation), the Rockefeller Foundation, and the AMA are credited with laying the groundwork for what is now known as the modern medical curriculum.[20] The restriction of the supply of physicians that resulted from the Flexner Report has been criticized by classical economists as one of the principal factors in the increased prices relative to quality observed in medicine over the past 100 years.[21]

The standard U.S. medical school curriculum is four years long. Traditionally, the first two years are composed mainly of classroom basic science education, while the final two years primarily include rotations in clinical settings where students learn patient care firsthand. Today, clinical education is spread across all four years with the final year containing the most clinical rotation time. The Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) has published mandatory rules, obliging on all inpatient and outpatient teaching settings, laying down the guidelines for what medical students in the United States may do, if they have not completed a clerkship or sub-internship. These rules apply to when they are in the clinical setting in school, not when they are, for example, helping staff events or in other non-formal educational settings, even if they are helping provide certain clinical services along with nurses and the supervising physicians- for example, certain basic screening procedures. In the formal clinical setting in school, they can only assist with certain patient evaluation and management tasks, after the vital signs, chief complaint and the history of present illness have been discerned, but prior to the physical examination: reviewing the patient's signs and symptoms in each body system, and then reviewing the patient's personal medical, genetic, family, educational/occupational, and psychosocial history. The student's supervising physician (or another physician with supervisory privileges if the original doctor is no longer available, for some reason) must be in the room during the student's work, and must conduct this same assessment of the patient before performing the actual physical examination, and after finishing and conferring with the student, will review his or her notes and opinion, editing or correcting them if necessary, and will also have his or her own professional notes; both must then sign and date and I.D. the student's notes and the medical record. They may observe, but not perform, physical examinations, surgeries, endoscopic or laparoscopic procedures, radiological or nuclear medicine procedures, oncology sessions, and obstetrics. The patient must give consent for their presence and participation in his or her care, even at a teaching facility. Depending on the time they have completed in school, their familiarity with the area of medicine and the procedure, and the presence of their supervisor, and any others needed, in the room or nearby, they may be allowed to conduct certain very minor tests associated with the physical examination, such as simple venipuncture blood draws, and electrocardiograms and electroencephalograms, for learning and experience purposes, especially when there is no intern or resident available.

Upon successful completion of medical school, students are granted the title of Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.). Residency training, which is a supervised training period of three to seven years (usually incorporating the 1st year internship)typically completed for specific areas of specialty. Physicians who sub-specialize or who desire more supervised experience may complete a fellowship, which is an additional one to four years of supervised training in their area of expertise.

Upon completion of medical school in the United States, students transition into residency programs through the National Resident Match Program (NRMP). Each year, approximately 16,000 US medical school students participate in the residency match. An additional 18,000 independent applicants—former graduates of U.S. medical schools, U.S. osteopathic medical schools, U.S. podiatry students, Canadian students, and graduates of foreign medical schools—compete for the approximately 25,000 available residency positions.[22]

Unlike those in many other countries, US medical students typically finance their education with personal debt. In 1992, the average debt of a medical doctor after residency was $25,000. For the class of 2009, the average debt of a medical student is $157,990 and 25.1% of students had debt in excess of $200,000 (prior to residency).[23] For the past decade the cost of attendance has increased 5-6% each year (roughly 1.6 to 2.1 times inflation).[24]

Licensing of medical doctors in the United States is coordinated at the state level. Most states require that prospective licensees complete the following requirements:

  • Graduation from an accredited medical school granting the degree of D.O. or M.D.
  • Satisfactory completion of at least one year of an AOA- or ACGME-approved residency.
  • Passing the United States Medical Licensing Examination or the Comprehensive Osteopathic Medical Licensing Examination (USMLE, COMLEX, or simply "the boards"). USMLE and COMLEX both consist of four similar parts:
    • Step or Level I is taken at the end of the second year of medical school and tests students' mastery of the basic sciences as they apply to clinical medicine.
    • Step II Clinical Knowledge (CK) or Level II Cognitive Evaluation (CE) is taken during the fourth year of medical school and tests students' mastery of the management of ill patients.
    • Step II Clinical Skills (CS) or Level II Performance Evaluation (PE) is taken during the fourth year of medical school and tests students' mastery of clinical skills using a series of standardized patient encounters.
    • Step or Level III is taken after the first year of a residency program and tests physicians' ability to independently manage the care of patients.

Uruguay[edit]

The University of Montevideo in Uruguay is the oldest in Latin America, being public and free, co-governed by students, graduates and teachers. The progress of medical and biological sciences in the nineteenth century, the impact of the work of Claude Bernard (1813–1878), Rudolf Virchow (1821–1902) Robert Koch (1843–1910), Louis Pasteur (1822–1895) and all the splendor of French medical schools, Vienna, Berlin and Edinburgh, was a stimulus for the creation of a medical school in the country. The basic medical school program lasts seven years. There is also a second medical school in the country, it is private and located in Punta del Este, Maldonado.

Venezuela[edit]

These are the universities with a medical school in Venezuela:

Asia and Oceania[edit]

Australia[edit]

See also: Medical education in Australia

Historically, Australian medical schools have followed the British tradition by conferring the degrees of Bachelor of Medicine and Bachelor of Surgery (MBBS) to its graduates whilst reserving the title of Doctor of Medicine (MD) for their research training degree, analogous to the PhD, or for their honorary doctorates. Although the majority of Australian MBBS degrees have been graduate programs since the 1990s, under the previous Australian Qualifications Framework (AQF) they remained categorised as Level 7 Bachelor degrees together with other undergraduate programs.

Toronto Faculty of Medicine

The responsibility for the education system in Germany lies primarily with the states (Länder), while the federal government plays a minor role. Optional Kindergarten (nursery school) education is provided for all children between one and six years old, after which school attendance is compulsory.[1] The system varies throughout Germany because each state (Land) decides its own educational policies. Most children, however, first attend Grundschule from the age of six to eleven.

German secondary education includes five types of school. The Gymnasium is designed to prepare pupils for higher education and finishes with the final examination Abitur, after grade 12 or 13. The Realschule has a broader range of emphasis for intermediate pupils and finishes with the final examination Mittlere Reife, after grade 10; the Hauptschule prepares pupils for vocational education and finishes with the final examination Hauptschulabschluss, after grade 9 and the Realschulabschluss after grade 10. There are two types of grade 10: one is the higher level called type 10b and the lower level is called type 10a; only the higher-level type 10b can lead to the Realschule and this finishes with the final examination Mittlere Reife after grade 10b. This new path of achieving the Realschulabschluss at a vocationally oriented secondary school was changed by the statutory school regulations in 1981 – with a one-year qualifying period. During the one-year qualifying period of the change to the new regulations, pupils could continue with class 10 to fulfil the statutory period of education. After 1982, the new path was compulsory, as explained above.

Other than this, there is the Gesamtschule, which combines the Hauptschule, Realschule and Gymnasium. There are also Förder- or Sonderschulen. One in 21 pupils attends a Förderschule.[2][3] Nevertheless, the Förder- or Sonderschulen can also lead, in special circumstances, to a Hauptschulabschluss of both type 10a or type 10b, the latter of which is the Realschulabschluss. The amount of extracurricular activity is determined individually by each school and varies greatly.

Many of Germany's hundred or so institutions of higher learning charge little or no tuition by international comparison.[4] Students usually must prove through examinations that they are qualified.

In order to enter university, students are, as a rule, required to have passed the Abitur examination; since 2009, however, those with a Meisterbrief (master craftsman's diploma) have also been able to apply.[5][6] Those wishing to attend a "university of applied sciences" must, as a rule, have Abitur, Fachhochschulreife, or a Meisterbrief. If lacking those qualifications, pupils are eligible to enter a university or university of applied sciences if they can present additional proof that they will be able to keep up with their fellow students through a Begabtenprüfung or Hochbegabtenstudium (which is a test confirming excellence and above average intellectual ability).

A special system of apprenticeship called Duale Ausbildung allows pupils on vocational courses to do in-service training in a company as well as at a state school.[3]

History[edit]

Prussian era[edit]

Main article: Prussian education system

Historically, Lutheranism had a strong influence on German culture, including its education. Martin Luther advocated compulsory schooling so that all people would independently be able to read and interpret the Bible. This concept became a model for schools throughout Germany. German public schools generally have religious education provided by the churches in cooperation with the state ever since.

During the 18th century, the Kingdom of Prussia was among the first countries in the world to introduce free and generally compulsory primary education, consisting of an eight-year course of basic education, Volksschule. It provided not only the skills needed in an early industrialized world (reading, writing, and arithmetic), but also a strict education in ethics, duty, discipline and obedience. Children of affluent parents often went on to attend preparatory private schools for an additional four years, but the general population had virtually no access to secondary education.

In 1810, after the Napoleonic wars, Prussia introduced state certification requirements for teachers, which significantly raised the standard of teaching. The final examination, Abitur, was introduced in 1788, implemented in all Prussian secondary schools by 1812 and extended to all of Germany in 1871. The state also established teacher training colleges for prospective teachers in the common or elementary grades.

German Empire[edit]

When the German Empire was formed in 1871, the school system became more centralized. In 1872, Prussia recognized the first separate secondary schools for females. As learned professions demanded well-educated young people, more secondary schools were established, and the state claimed the sole right to set standards and to supervise the newly established schools.

Four different types of secondary schools developed:

  • A nine-year classical Gymnasium (including study of Latin and Classical Greek or Hebrew, plus one modern language);
  • A nine-year Realgymnasium (focusing on Latin, modern languages, science and mathematics);
  • A six-year Realschule (without university entrance qualification, but with the option of becoming a trainee in one of the modern industrial, office or technical jobs); and
  • A nine-year Oberrealschule (focusing on modern languages, science and mathematics).

By the turn of the 20th century, the four types of schools had achieved equal rank and privilege, although they did not have equal prestige.

Weimar Republic[edit]

After World War I, the Weimar Republic established a free, universal four-year elementary school (Grundschule). Most pupils continued at these schools for another four-year course. Those who were able to pay a small fee went on to a Mittelschule that provided a more challenging curriculum for an additional one or two years. Upon passing a rigorous entrance exam after year four, pupils could also enter one of the four types of secondary school.

Nazi Germany[edit]

See also: Nazi university

During the Nazi era (1933–1945), teaching of National Socialist ideology was integrated into the school system, however the basic education system remained unchanged. The Hitler Youth accepted students aged 7-18, and education often focused more on Nazism and Nazi-related activities, rather than traditional academic subjects. Children who were not interested in learning about Nazism would automatically have all other aspects of their education suffer, and risk never graduating from school.

East Germany[edit]

Main article: Education in East Germany

The German Democratic Republic (East Germany) started its own standardized education system in the 1960s. The East German equivalent of both primary and secondary schools was the Polytechnic Secondary School (Polytechnische Oberschule), which all students attended for 10 years, from the ages of 6 to 16. At the end of the 10th year, an exit examination was set. Depending upon the results, a pupil could choose to come out of education or undertake an apprenticeship for an additional two years, followed by an Abitur. Those who performed very well and displayed loyalty to the ruling party could change to the Erweiterte Oberschule (extended high school), where they could take their Abitur examinations after 12 school years. Although this system was abolished in the early 1990s after reunification, it continues to influence school life in the eastern German states.[citation needed]

West Germany[edit]

After World War II, the Allied powers (Soviet Union, France, United Kingdom, and the U.S.) ensured that Nazi ideology was eliminated from the curriculum. They installed educational systems in their respective occupation zones that reflected their own ideas. When West Germany gained partial independence in 1949, its new constitution (Grundgesetz) granted educational autonomy to the state (Länder) governments. This led to widely varying school systems, often making it difficult for children to continue schooling whilst moving between states.

Multi-state agreements ensure that basic requirements are universally met by all state school systems. Thus, all children are required to attend one type of school (five or six days a week) from the age of 6 to the age of 16. A pupil may change schools in the case of exceptionally good (or exceptionally poor) ability. Graduation certificates from one state are recognized by all the other states. Qualified teachers are able to apply for posts in any of the states.

Federal Republic of Germany[edit]

Since the 1990s, a few changes have been taking place in many schools:

  • Introduction of bilingual education in some subjects
  • Experimentation with different styles of teaching
  • Equipping all schools with computers and Internet access
  • Creation of local school philosophy and teaching goals ("Schulprogramm"), to be evaluated regularly
  • Reduction of Gymnasium school years (Abitur after grade 12) and introduction of afternoon periods as in many other western countries

After 2000 much public debate about Germany's perceived low international ranking in Programme for International Student Assessment (PISA) there has been a trend towards a less ideological discussion on how to develop schools. These are some of the new trends:

  • Establishing federal standards on quality of teaching
  • More practical orientation in teacher training
  • Transfer of some responsibility from the Ministry of Education to local school

Overview[edit]

In Germany, education is the responsibility of the states (Länder) and part of their constitutional sovereignty (Kulturhoheit der Länder). Teachers are employed by the Ministry of Education for the state and usually have a job for life after a certain period (verbeamtet) (which, however, is not comparable in timeframe nor competitiveness to the typical tenure track, e.g. at universities in the US). This practice depends on the state and is currently changing. A parents' council is elected to voice the parents' views to the school's administration. Each class elects one or two "Klassensprecher" (class presidents; if two are elected usually one is male and the other female), who meet several times a year as the "Schülerrat" (students' council).

A team of school presidents is also elected by the pupils each year, whose main purpose is organizing school parties, sports tournaments and the like for their fellow students. The local town is responsible for the school building and employs the janitorial and secretarial staff. For an average school of 600 – 800 students, there may be two janitors and one secretary. School administration is the responsibility of the teachers, who receive a reduction in their teaching hours if they participate.

Church and state are separated in Germany. Compulsory school prayers and compulsory attendance at religious services at state schools are against the constitution. (It is expected, though, to stand politely for the school prayer even if one does not pray along.) In 1995, it was ruled that the Christian cross was not allowed in classrooms, as it violates the religious freedom of non-Christian students. The cross is allowed if none of the pupils object, but must be removed in the event of an objection.[7] Some German states have banned teachers from wearing headscarves.

Literacy[edit]

Over 99% of Germans age 15 and above are estimated to be able to read and write.[8] However, a growing number of inhabitants are functionally illiterate.[9]

Preschool[edit]

The German preschool is known as a Kindergarten (plural Kindergärten) or Kita, short for Kindertagesstätte (meaning "children's daycare center"). Children between the ages of 2 and 6 attend Kindergärten, which are not part of the school system. They are often run by city or town administrations, churches, or registered societies, many of which follow a certain educational approach as represented, e.g., by Montessori or Reggio Emilia or "Berliner Bildungsprogramm", etc. Forest kindergartens are well established. Attending a Kindergarten is neither mandatory nor free of charge, but can be partly or wholly funded, depending on the local authority and the income of the parents. All caretakers in Kita or Kindergarten must have a three-year qualified education, or be under special supervision during training.

Kindergärten can be open from 7 a.m. to 5 p.m. or longer and may also house a Kinderkrippe, meaning crèche, for children between the ages of eight weeks and three years, and possibly an afternoon Hort (often associated with a primary school) for school-age children aged 6 to 10 who spend the time after their lessons there. Alongside nurseries, there are day-care nurses (called Tagesmutter, plural Tagesmütter – the formal, gender-neutral form is Tagespflegeperson(en)) working independently from any pre-school institution in individual homes and looking after only three to five children typically up to three years of age. These nurses are supported and supervised by local authorities.

The term Vorschule, meaning ‘pre-school’, is used both for educational efforts in Kindergärten and for a mandatory class that is usually connected to a primary school. Both systems are handled differently in each German state. The Schulkindergarten is a type of Vorschule.

Not without interest is the fact that in the German Empire, children were able to pass directly into secondary education after attending a privately run, charged "Vorschule" which then was another sort of primary school. The Weimar Constitution banned these, feeling them to be an unjustified privilege, and the Basic Law still contains the constitutional rule (Art. 7 Sect. VI) that: Pre-schools shall remain abolished.

Primary education[edit]

Parents looking for a suitable school for their child have a wide choice of elementary schools

  • State school. State schools do not charge tuition fees. The majority of pupils attend state schools in their neighbourhood. Schools in affluent areas tend to be better than those in deprived areas. Once children reach school age, many middle-class and working-class families move away from deprived areas.
  • or, alternatively

Homeschooling[edit]

Main article: Homeschooling international status and statistics § Germany

Homeschooling is illegal in Germany, so some families have sought asylum abroad in order to home-school their children.[11] The illegality has to do with the prioritization of children's rights over the rights of parents: children have the right to the company of other children and adults who are not their parents, also parents cannot opt their kids out of sexual education classes because the state considers a child's right to information to be more important than a parent's desire to withhold it. [12]

Secondary education[edit]

See also: Education in Berlin and Education in Hamburg

After children complete their primary education (at 10 years of age, 12 in Berlin and Brandenburg), there are five options for secondary schooling:

  1. Gymnasium (grammar school) until grade 12 or 13 (with Abitur as exit exam, qualifying for university); and
  2. Fachoberschule admission after grade ten until grade twelve (with Fachhochschulreife (between Abitur and Realschulabschluss) as exit exam) it is also possible to leave after grade thirteen and get either the ″fachgebundene Abitur″ (if you haven′t learned a language besides English) or get the ″Abitur″ (with a second language on European level B1) ;[13]
  3. Realschule until grade ten (with Mittlere Reife (Realschulabschluss) as exit exam);
  4. Mittelschule (the least academic, much like a modernized Volksschule [elementary school]) until grade nine (with Hauptschulabschluss and in some cases Mittlere Reife = Realschulabschuss as exit exam); in some federal states the Hauptschule does not exist and pupils are mainstreamed into a Mittelschule or Regionale Schule instead.
  5. Gesamtschule (comprehensive school)

(sorted by the quality and relevance of the exit exam. The comprehensive schools stands apart as it offers each of the mentioned exit exams)[13]

After passing through any of the above schools, pupils can start a career with an apprenticeship in the Berufsschule (vocational school). The Berufsschule is normally attended twice a week during a two, three, or three-and-a-half year apprenticeship; the other days are spent working at a company. This is intended to provide a knowledge of theory and practice. The company is obliged to accept the apprentice on its apprenticeship scheme. After this, the apprentice is registered on a list at the Industrie- und Handelskammer IHK (chamber of industry and commerce). During the apprenticeship, the apprentice is a part-time salaried employee of the company. After passing the Berufsschule and the exit exams of the IHK, a certificate is awarded and the young person is ready for a career up to a low management level. In some areas, the schemes teach certain skills that are a legal requirement (special positions in a bank, legal assistants).

Some special areas provide different paths. After attending any of the above schools and gaining a leaving certificate like Hauptschulabschluss, Mittlere Reife (or Realschulabschuss, from a Realschule) or Abitur from a Gymnasium or a Gesamtschule, school leavers can start a career with an apprenticeship at a Berufsschule (vocational school). Here the student is registered with certain bodies, e.g. associations such as the German Bar Association Deutsche Rechtsanwaltskammer GBA (board of directors). During the apprenticeship, the young person is a part-time salaried employee of the institution, bank, physician or attorney’s office. After leaving the Berufsfachschule and passing the exit examinations set by the German Bar Association or other relevant associations, the apprentice receives a certificate and is ready for a career at all levels except in positions which require a specific higher degree, such as a doctorate. In some areas, the apprenticeship scheme teaches skills that are required by law, including certain positions in a bank or those as legal assistants. The 16 states have exclusive responsibility in the field of education and professional education. The federal parliament and the federal government can influence the educational system only by financial aid to the states. There are many different school systems, but in each state the starting point is always the Grundschule (elementary school) for a period of four years; or six years in the case of Berlin and Brandenburg.

1970198219912000
Hauptschulabschluss87,7 %79,3 %66,5 %54,9 %
Realschulabschluss10,9 %17,7 %27 %34,1 %
Abitur1,4 %3 %6,5 %11 %

Grades 5 and 6 form an orientation phase (Orientierungsstufe) during which students, their parents and teachers decide which of the above-mentioned paths the students should follow. In all states except Berlin and Brandenburg, this orientation phase is embedded into the program of the secondary schools. The decision for a secondary school influences the student's future, but during this phase changes can be made more easily. In practice this rarely comes to bear because teachers are afraid of sending pupils to more academic schools whereas parents are afraid of sending their children to less academic schools. In Berlin and Brandenburg, the orientation is embedded into that of the elementary schools. Teachers give a so-called educational (path) recommendation (Bildungs(gang)empfehlung) based on scholastic achievements in the main subjects (mathematics, German, natural sciences, foreign language) and classroom behavior with details and legal implications differing from state to state: in some German states, those wishing to apply for a Gymnasium or Realschule require such a recommendation stating that the student is likely to make a successful transition to that type of school; in other cases anybody may apply. In Berlin 30% - 35% of Gymnasium places are allocated by lottery. A student's performance at primary school is immaterial.[citation needed]

The eastern states Saxony, Saxony-Anhalt and Thuringia combine Hauptschule and Realschule as Sekundarschule, Mittelschule and Regelschule respectively. All German states have Gymnasium as one possibility for the more able children, and all states - except Saxony - have some Gesamtschulen, but in different forms. The states of Berlin and Hamburg have only two types of schools: comprehensive schools and Gymnasium.

Learning a foreign language is compulsory throughout Germany in secondary schools and English is one of the more popular choices. Students at certain Gymnasium are required to learn Latin as their first foreign language and choose a second foreign language. The list of available foreign languages as well as the hours of compulsory foreign language lessons differ from state to state, but the more common choices, besides Latin, are English, French, Spanish, ancient Greek. Many schools also offer voluntary study groups for the purpose of learning other languages. At which stage students begin learning a foreign language differs from state to state and is tailored according to the cultural and socio-economical dynamics of each state. In some states, foreign language education starts in the Grundschule (primary school). For example, in North Rhine-Westphalia, English starts in the third year of elementary school. Baden-Württemberg starts with English or French in the first year. The Saarland, which borders France, begins with French in the third year of primary school and French is taught in high school as the main foreign language.

It may cause problems in terms of education for families that plan to move from one German state to another as there are partially completely different curricula for nearly every subject.

Adults who did not achieve a Realschulabschluss or Abitur, or reached its equivalent, have the option of attending evening classes at an Abendgymnasium or Abendrealschule.

School organization[edit]

A few organizational central points are listed below. It should however be noted that due to the decentralized nature of the education system there are many more additional differences across the 16 states of Germany.

  • Every state has its own school system.
  • Each age group of students (born roughly in the same year) forms one or more grades or classes ("Klassen") per school which remain the same for elementary school (years 1 to 4 or 6), orientation school (if there are orientation schools in the state), orientation phase (at Gymnasium years 5 to 6), and secondary school (years 5 or 7 to 10 in "Realschulen" and "Hauptschulen"; years 5 or 7 to 10 (differences between states) in "Gymnasien"[15]) respectively. Changes are possible, though, when there is a choice of subjects, e.g. additional languages; Then classes will be split (and newly merged) either temporarily or permanently for this particular subject.
  • Students usually sit at tables, not desks (usually two at one table), sometimes arranged in a semicircle or another geometric or functional shape. During exams in classrooms, the tables are sometimes arranged in columns with one pupil per table (if permitted by the room's capacities) in order to prevent cheating; at many schools, this is only the case for some exams in the two final years of school, i.e. some of the exams counting for the final grade on the high school diploma.
  • There is usually no school uniform or dress code existing. Many private schools have a simplified dress code, for instance, such as "no shorts, no sandals, no clothes with holes". Some schools are testing school uniforms, but those are not as formal as seen in the UK. They mostly consist of a normal sweater/shirt and jeans of a certain color, sometimes with the school's symbol on it. It is however a common custom to design graduation class shirts in Gymnasium, Realschule and Hauptschule.
  • School usually starts between 7.30 a.m. and 8:15 a.m. and can finish as early as 12; instruction in lower classes[which?] almost always ends before lunch. In higher grades[which?], however, afternoon lessons are very common and periods may have longer gaps without teacher supervision between them. Usually, afternoon classes are not offered every day and/or continuously until early evening, leaving students with large parts of their afternoons free of school; some schools (Ganztagsschulen), however, offer classes or mainly supervised activities throughout the afternoons in order to offer supervision for the students rather than increasing the hours of teaching. Afternoon lessons can continue until 6 o'clock.
  • Depending on school, there are breaks of 5 to 20 minutes after each period. There is no lunch break as school usually finishes before 1:30 for junior school. However, at schools that have "Nachmittagsunterricht" (= afternoon classes) ending after 1:30 there's sometimes a lunch break of 45 to 90 minutes, though many schools lack any special break in general. Some schools that have regular breaks of 5 minutes between every lesson and have additional 10 or 15 minute breaks after the second and fourth lesson.
  • In German state schools lessons have a length of exactly 45 minutes. Each subject is usually taught for two to three periods every week (main subjects like mathematics, German or foreign languages are taught for four to six periods) and usually no more than two periods consecutively. The beginning of every period and, usually, break is announced with an audible signal such as a bell.
  • Exams (which are always supervised) are usually essay based, rather than multiple choice. As of 11th grade, exams usually consist of no more than three separate exercises. While most exams in the first grades of secondary schools usually span no more than 90 minutes, exams in 10th to 12th grade may span four periods or more (without breaks).
  • At every type of school, pupils study one foreign language (in most cases English) for at least five years. The study of languages is, however, far more rigorous and literature oriented in Gymnasium. In Gymnasium, students can choose from a wider range of languages (mostly English, French, Russian - mostly in east German Bundesländer - or Latin) as the first language in 5th grade, and a second mandatory language in 7th grade. Some types of Gymnasium also require an additional third language (such as Spanish, Italian, Russian, Latin or Ancient Greek) or an alternative subject (usually based on one or two other subjects, e.g. British politics (English & politics), dietetics (biology) or media studies (arts & German) in 9th or 11th grade. Gymnasiums normally offer further subjects starting at 11th grade, with some schools offering a fourth foreign language.
  • A number of schools once had a Raucherecke (smokers' corner), a small area of the schoolyard where students over the age of eighteen are permitted to smoke in their breaks. Those special areas were banned in the states of Berlin, Hessen and Hamburg, Brandenburg at the beginning of the 2005-06 school year. (Bavaria, Schleswig-Holstein, Lower Saxony 2006-07)). Schools in these states prohibit smoking for students and teachers and offences at school will be punished. Other states in Germany are planning to introduce similar laws.
  • As state schools are public, smoking is universally prohibited inside the buildings. Smoking teachers are generally asked not to smoke while at or near school.
  • Students over 14 years are permitted to leave the school compound during breaks at some schools. Teachers or school personnel tend to prevent younger students from leaving early and strangers from entering the compound without permission.
  • Tidying up the classroom and schoolyard is often the task of the students themselves. Unless a group of volunteering students, individuals are being picked sequentially.
  • Many schools have AGs or Arbeitsgemeinschaften (clubs) for afternoon activities such as sports, music or acting, but participation is not necessarily common. Some schools also have special mediators who are student volunteers trained to resolve conflicts between their classmates or younger students.
  • Only few schools have actual sports teams that compete with other schools'. Even if the school has a sports team, students are not necessarily very aware of it.
  • While student newspapers used to be very common until the late 20th century, with new issues often produced after a couple of months, many of them are now very short-lived, usually vanishing when the team graduates. Student newspapers are often financed mostly by advertisements.
  • Usually schools don't have their own radio stations or TV channels. Therefore, larger universities often have a local student-run radio station.
  • Although most German schools and state universities do not have classrooms equipped with a computer for each student, schools usually have at least one or two computer rooms and most universities offer a limited number of rooms with computers on every desk. State school computers are usually maintained by the same exclusive contractor in the entire city and updated slowly. Internet access is often provided by phone companies free of charge. Especially in schools the teachers' computer skills are often very low.
  • At the end of their schooling, students usually undergo a cumulative written and oral examination (Abitur in Gymnasien or Abschlussprüfung in Realschulen and Hauptschulen). Students leaving Gymnasium after 9th grade do have the leaving examination of the Hauptschule and after 10th grade do have the Mittlere Reife (leaving examination of the Realschule, also called Mittlerer Schulanschluss).
  • After 10th grade Gymnasium students may quit school for at least one year of job education if they do not wish to continue. Realschule and Hauptschule students who have passed their Abschlussprüfung may decide to continue schooling at a Gymnasium, but are sometimes required to take additional courses in order to catch up.
  • Corporal punishment was banned in 1949 in East Germany and in 1973 in West Germany.
  • Fourth grade (or sixth, depending on the state) is often quite stressful for students of lower performance and their families. Many feel tremendous pressure when trying to achieve placement in Gymnasium, or at least when attempting to avoid placement in Hauptschule. Germany is unique compared to other western countries in its early segregation of students based on academic achievement.

School year[edit]

The school year starts after the summer break (different from state to state, usually end/mid of August) and is divided into two terms. There are typically 12 weeks of holidays in addition to public holidays. Exact dates differ between states, but there are generally six weeks of summer and two weeks of Christmas holiday. The other holiday periods occur in spring (during the period around Easter Sunday) and autumn (during the former harvest, where farmers used to need their children for field work). Schools can also schedule two or three special days off per term.

Timetables[edit]

Students have about 30-40 periods of 45 minutes each per week (depending on year and state), but especially secondary schools today switch to 90 minutes lessons (Block) which count as two 'traditional' lessons. To manage classes that are taught three or five lessons per week there are two common ways. At some schools teaching 90 minutes periods there is still one 45-minute lesson each day, mostly between the first two blocks; at other schools those subjects are taught in weekly or termly rotations. There are about 12 compulsory subjects: up to three foreign languages (the first one is often already taken in primary school, the second one beginning in 6th or 7th grade, another is taken somewhen between 7th and 11th grade), physics, biology, chemistry, civics/social/political studies, history, geography (starting between 5th and 7th grade), mathematics, music, visual arts, German, PE and religious education/ethics (to be taken from primary school on). The range of offered afternoon activities is different from school to school however, most German schools offer choirs or orchestras, sometimes sports, theater or languages. Many of these are offered as semi-scholastic AG's (Arbeitsgemeinschaften – literally "working groups"), which are mentioned, but not officially graded in students' reports. Other common extracurricular activities are organized as private clubs, which are very popular in Germany.

TimeMondayTuesdayWednesdayThursdayFriday
08.00–08.45EnglishPhysicsBiologyPhysicsGreek
08.45–09.30HistoryEnglishChemistryMathematicsChemistry
09.30–09.40break
09.40–10.25LatinGreekMathematicsLatinEconomics
10.25–11.10GermanGeographyReligious studiesGreekGerman
11.10–11.30break
11.30–12.15MusicMathematicsGeographyGermanBiology
12.15–13.00Religious studiesCivic educationEconomicsEnglishLatin
13.00–14.00break
14.00–14.45ArtsIntensive course
14.45–15.30Intensive courseGreek
15.30-16.15PE
16.15–17.00PE

There are three blocks of lessons where each lesson takes 45 minutes. After each block, there is a break of 15–20 minutes, also after the 6th lesson (the number of lessons changes from year to year, so it's possible that one would be in school until 4 o'clock). "Nebenfächer" (= minor fields of study) are taught two times a week, "Hauptfächer" (=major subjects) are taught three times.

In grades 11–13, 11–12, or 12–13 (depending on the school system), each student majors in two or three subjects ("Leistungskurse"). These are usually taught five lessons per week. The other subjects ("Grundkurse") are usually taught three periods per week.

TimeMondayTuesdayWednesdayThursdayFriday
08.00–08.45EnglishReligious studiesFrenchPhysicsGerman
08.50–09.35EnglishReligious studiesFrenchPhysicsGerman
09.55–10.40GermanGeography/Social Studies (taught in English)MathematicsGeography/Social Studies (taught in English)Mathematics
10.45–11.30GermanGeography/Social Studies (taught in English)MathematicsGeography/Social Studies (taught in English)Mathematics
11.50–12.35PhysicsPolitics-EconomyHistoryEnglishFrench
12.40–1.25PhysicsPolitics-EconomyHistoryEnglishFrench
1.40–2.25Arts"Seminarfach"+HistoryPE (different sports offered as courses)
2.30–3.15Arts"Seminarfach"+HistoryPE (different sports offered as courses)

+"Seminarfach" is a compulsory class in which each student is prepared to turn in his/her own research paper at the end of the semester. The class is supposed to train the students' scientific research skills that will be necessary in their later university life.

There are huge differences between the 16 states of Germany having alternatives to this basic pattern such as Waldorfschulen or other private schools. Adults can also go back to evening school and take the Abitur exam.

Public and private schools[edit]

In 2006, six percent of German children attended private schools.[16]

In Germany, Article 7, Paragraph 4 of the Grundgesetz, the constitution of Germany, guarantees the right to establish private schools. This article belongs to the first part of the German basic law, which defines civil and human rights. A right which is guaranteed in this part of the Grundgesetz can only be suspended in a state of emergency, if the respective article specifically states this possibility. That is not the case with this article. It is also not possible to abolish these rights. This unusual protection of private schools was implemented to protect them from a second Gleichschaltung or similar event in the future.

Ersatzschulen are ordinary primary or secondary schools which are run by private individuals, private organizations or religious groups. These schools offer the same types of diplomas as in public schools. However, Ersatzschulen, like their state-run counterparts, are subjected to basic government standards, such as the minimum required qualifications of teachers and pay grades. An Ersatzschule must have at least the same academic standards as those of a state school and Article 7, Paragraph 4 of the Grundgesetz, allows to forbid the segregation of pupils according to socioeconomic status (the so-called Sonderungsverbot). Therefore, most Ersatzschulen have very low tuition fees compared to those in most other Western European countries; scholarships are also often available. However, it is not possible to finance these schools with such low tuition fees: accordingly all German Ersatzschulen are subsidised with public funds.

Some students attend private schools through welfare subsidies. This is often the case if a student is considered to be a child at risk: students who have learning disabilities, special needs or come from dysfunctional home environments.

After allowing for the socio-economic status of the parents, children attending private schools are not as able as those at state schools. At the Programme for International Student Assessment (PISA) for example, after considering socioeconomic class, students at private schools underperformed those at state schools.[17] One has, however, to be careful interpreting that data: it may be that such students do not underperform because they attend a private school, but that they attend a private school because they underperform. Some private Realschulen and Gymnasien have lower entry requirements than public Realschulen and Gymnasien.

Special schools[edit]

Most German children with special needs attend a school called Förderschule or Sonderschule (special school) that serves only such children. There are several types of special schools in Germany such as:

  • The "Sonderschule für Lernbehinderte" - a special school serving children who have learning difficulties
  • The "Schule mit dem Förderschwerpunkt Geistige Entwicklung" - a special school serving children who have very severe learning difficulties
  • The "Förderschule Schwerpunkt emotionale und soziale Entwicklung" - a special school serving children who have special emotional needs

Only one in 21 German children attends such a special school. Teachers at those schools are qualified professionals who have specialized in special-needs education while at university. Special schools often have a very favourable student-teacher ratio and facilities compared with other schools. Special schools have been criticized. It is argued that special education separates and discriminates against those who are disabled or different. Some special-needs children do not attend special schools, but are mainstreamed into a Hauptschule or Gesamtschule (comprehensive school) and/or, in rare cases, into a Realschule or even a Gymnasium.

Elite schools[edit]

There are very few specialist schools for gifted children. As German schools do not IQ-test children, most intellectually gifted children remain unaware that they fall into this category. The German psychologist, Detlef H. Rost, carried out a pioneer long-term study on gifted children called the Marburger Hochbegabtenprojekt. In 1987/1988 he tested 7000 third graders on a test based on the German version of the Cattell Culture Fair III test. Those who scored at least two standard deviations above the mean were categorised as gifted. A total of 151 gifted subjects participated in the study alongside 136 controls. All participants in the study were tested blind with the result that they did not discover whether they were gifted or not. The study revealed that the gifted children did very well in school. The vast majority later attended a Gymnasium and achieved good grades. However, 15 percent, were classified as underachievers because they attended a Realschule (two cases) or a Hauptschule (one case), had repeated a grade (four cases) or had grades that put them in the lower half of their class (the rest of cases). The report also concluded that most gifted persons had high self-esteem and good psychological health.[18] Rost said that he was not in favour of special schools for the gifted. Gifted children seemed to be served well by Germany's existing school system.[19]

International schools[edit]

As of January 2015 the International Schools Consultancy (ISC)[20] listed Germany as having 164 international schools.[21] ISC defines an 'international school' in the following terms "ISC includes an international school if the school delivers a curriculum to any combination of pre-school, primary or secondary students, wholly or partly in English outside an English-speaking country, or if a school in a country where English is one of the official languages, offers an English-medium curriculum other than the country’s national curriculum and is international in its orientation."[21] This definition is used by publications including The Economist.[22] In 1971 the first International Baccalaureate World School was authorized in Germany.[23] Today 70 schools offer one or more of the IB programmes including two who offer the new IB Career-related Programme.[24]

International comparisons[edit]

The Programme for International Student Assessment (PISA), coordinated by the OECD, assesses the skills of 15-year-olds in OECD countries and a number of partner countries. The assessment in the year 2000 demonstrated serious weaknesses in German pupils' performance. In the test of 41 countries, Germany ranked 21st in reading and 20th in both mathematics and the natural sciences, prompting calls for reform.[25] Major newspapers ran special sections on the PISA results, which were also discussed extensively on radio and television. In response, Germany's states formulated a number of specific initiatives addressing the perceived problems behind Germany's poor performance.[26]

By 2006, German schoolchildren had improved their position compared to previous years, being ranked (statistically) significantly above average (rank 13) in science skills and statistically not significantly above or below average in mathematical skills (rank 20) and reading skills (rank 18).[27][28] In 2012, Germany achieved above average results in all three areas of reading, mathematics, and natural sciences.[29]

The PISA Examination also found big differences in achievement between students attending different types of German schools.[30] According to Jan-Martin-Wiadra: "Conservatives prized the success of the Gymnasium, for them the finest school form in the world – indeed, it is by far the number one in the PISA league table. But what they prefer to forget is that this success came at the cost of a catastrophe in the Hauptschulen."[31] The socio-economic gradient was very high in Germany, the students' performance there being more dependent on socio-economic factors than in most other countries.[27][28]

Performance on PISA 2003 (points earned) by school attended and social class
type schoolsocial class "very low"social class "low"social class "high"social class "very high"
Hauptschule400429436450
Gesamtschule438469489515
Realschule482504528526
Gymnasium578581587602
PISA 2003 – Der Bildungsstand der Jugendlichen in Deutschland – Ergebnisse des 2. internationalen Vergleiches.[32]

Some German teachers' representatives and a number of scientists disputed the PISA findings.[33] They claimed, amongst other things, that the questions had been ill-translated, that the samples drawn in some countries were not representative, that German students (most of whom had never done a multiple choice tests in their lives before) were disadvantaged by the multiple choice questions, that the PISA questions had no curricular validity and that PISA was "in fact an IQ-test",[34][35] which according to them showed that dysgenic fertility was taking place in Germany.[36][37][38][39][40] Additionally, the OECD was criticized for following its own agenda of a strictly economically utilitarian education policy—as opposed to humanist education policy following the German ideal of Bildung—and for trying to establish an educational testing industry without democratic legitimation.[41][42]

Apprenticeship[edit]

Germany has high standards in the education of craftspeople. Historically very few people attended college. In the 1950s for example, 80 percent had only Volksschule ("primary school")-Education of 6 or 7 years. Only 5 percent of youths entered college at this time and still fewer graduated. In the 1960s, 6 percent of youths entered college. In 1961 there were still 8,000 cities in which no children received secondary education.[43] However, this does not mean that Germany was a country of uneducated people. In fact, many of those who did not receive secondary education were highly skilled craftspeople and members of the upper middle class. Even though more people attend college today, a craftsperson is still highly valued in German society.

Historically (prior to the 20th century) the relationship between a master craftsman and his apprentice was paternalistic. Apprentices were often very young when entrusted to a master craftsman by their parents. It was seen as the master's responsibility not only to teach the craft, but also to instill the virtues of a good craftsman. He was supposed to teach honour, loyalty, fair-mindedness, courtesy and compassion for the poor. He was also supposed to offer spiritual guidance, to ensure his apprentices fulfilled their religious duties and to teach them to "honour the Lord" (Jesus Christ) with their lives. The master craftsman who failed to do this would lose his reputation and would accordingly be dishonoured - a very bad fate in those days. The apprenticeship ended with the so-called Freisprechung (exculpation). The master announced in front of the trade heading that the apprentice had been virtuous and God-loving.[44][45][46] The young person now had the right to call himself a "Geselle" (journeyman). He had two options: either to work for a master or to become a master himself. Working for another master had several disadvantages. One was that, in many cases, the journeyman who was not a master was not allowed to marry and found a family. Because the church disapproved of sex outside of marriage, he was obliged to become a master if he did not want to spend his life celibate.[47] Accordingly, many of the so-called "Geselle" decided to go on a journey in order to become a master. This was called "Waltz" or Journeyman years.

In those days, the crafts were called the "virtuous crafts" and the virtuosness of the craftspersons was greatly respected. For example, according to one source, a person should be greeted from "the bricklayer craftspersons in the town, who live in respectability, die in respectability, who strive for respectability and who apply respectability to their actions"[48] In those days, the concept of the "virtuous crafts" stood in contrast to the concept of "academic freedom" as Brüdermann and Jost noticed.

Nowadays, the education of craftspersons has changed - in particular self-esteem and the concept of respectability.[49] Yet even today, a craftsperson does sometimes refer to the "craftspersons codex of virtues" and the crafts sometimes may be referred to as the "virtuous crafts" and a craftsperson who gives a blessing at a roofing ceremony may, in many cases, remind of the "virtues of the crafts I am part of". Also certain virtues are ascribed to certain crafts. For example, a person might be called "always on time like a bricklayer" to describe punctuality.[50]

Sign of different coexisting school types on a school complex in Germany
Classroom furniture from 1900 (left) to 1985 (right)
Pupils of the Gymnasium Nonnenwerth, an all-girls Catholic school in 1960
Overview over German school system
Education system in Germany
Standard classroom at a primary school in Germany
The Witten-Annen Freiligrathschule, a Hauptschule
Cadets of the German Navy taking exercises in front of one of the gyms of Germany's naval officers school, the Marineschule Mürwik
A special school for children with special emotional needs in Kötitz, Germany
St. Afra is one of few specialist schools that serve only gifted children
A Meisterbrief (master craftsman's certificate) from the Berliner Handwerkskammer (Berlin chamber of handicrafts), the motto on the certificate reads "Work is the ennoblement of the citizen; boon will be the reward for his labour
A master discusses a vacuum compressor with his apprentice and several other craftsmen
A German roofer thatching a roof with reeds (he is wearing the traditional waistcoat and trousers of a craftsman)

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