12 of the 17 federal states in Germany were represented, with 37 participants involved in the process. An external advisor came from Denmark. Participants were on average 48 (29-60) years old and mostly male (65%). The majority of the participants (86%) were members of the DEGAM. Sociodemographical data of the participants are shown in Table 1.
Due to the cultural adaption by the peers, the competence-based general practice curriculum consists of three parts: part one for medical expertise, part two for additional competencies and part three for medical procedures.
Selection and translation
A core decision made at the first planning meeting was to base the curriculum on the CanMEDS. Other frameworks, such as the educational agenda of EURACT  were considered, but the structure of the CanMEDS framework was preferred and considered to be easier to transfer to a German context. A further key reason behind the choice of the CanMEDS framework is that there is an ongoing project by the Association for Medical Education and the Association of Medical Faculties in Germany rebuilding the undergraduate medical education curriculum on the basis of the CanMEDS framework . Accessibility was an additional consideration as the CanMEDS based curricula of Canada and Denmark were easily available [22, 23].
The CanMEDS framework was translated from English into German. Each role of the CanMEDS framework was translated by two separate groups. Since participants came from different federal states, they formed smaller regional working groups. Their translations were compared at a consensus meeting of members of the core group. Afterwards, the translation results were compiled into a draft of the curriculum (“Version one”).
In 2010, “Version one” was presented at the national congress of the DEGAM in Dresden at a workshop . During this workshop, more than 30 GPs from all over Germany discussed the results and provided feedback. Suggestions were gathered to support the “trialing phase” of the implementation process. On the basis of the workshop discussions, the following criteria and steps were agreed among the core group:
○ The project was adopted as a project of the DEGAM section postgraduate specialty training.
○ All competencies listed were to denote the minimum baseline, not the maximum.
○ The medical expertise section was to be revised integrating the frequency and importance of patients’ “reasons for encounter” in Germany
○ Other competencies (outside medical expertise) were to be revised
○ An additional chapter of diagnostic-therapeutic procedures performed in German GP practices was to be added
○ Consideration of other curricula was to be undertaken, namely the Swiss general practice curriculum, the curriculum of the former German Democratic Republic (DDR), the content of the former compulsory GP course after the German reunification, the experiences of the participants and the “Canon GP” [25–28].
A group of six GPs and one trainee from three different federal states met to rework the “medical expert” section considering the above mentioned points. In addition, every participant of this group revised one competence of the curriculum. The resulting “version two” of the curriculum had more than 70 pages, including 43 pages for medical expertise. “Version two” was rated by peers for missing topics and feasibility.
Cutting down process
One of the main points peers suggested was to cut down the draft curriculum by at least 50%. Equally, it needed to be ensured that no important competency area was lost during this review process. Therefore, the International Classification of Primary Care (ICPC–2), a classification developed for general practice by the International Classification Committee of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA), was used to frame the medical expertise part of the curriculum. ICPC-2 allows classification of the patient’s reason for encounter, the problems/diagnosis managed, interventions, and the arrangement of these data in order of an episode-of-care structure . Additionally, the reasons for encounter were verified by using the 50 most common GP diagnoses in Germany .
This cutting down process allowed baseline competencies to be identified, which a trainee would need to achieve to become a GP in Germany. At this stage, it was agreed to define the contents of GP specialty training along the requirements of actual daily work. Nevertheless, there was discussion about the depth to which these baseline competencies should be mastered. As a result, a system of self-assessment was integrated into “Version three”. Both the individual trainee and the GP trainer are able to carry out formative assessments using a traffic light scale to identify areas of strengths and weakness. The traffic lights range from red: “I have no competence in this area and therefore I feel unsafe”, yellow: “I gained some competence in this area but I need to improve to feel safe” to green: “I consider myself competent in this area and feel safe”. A second reason to introduce this traffic light assessment scale was to facilitate a culture of providing feedback from the trainer to the trainee. For this reason, a form that can be used for feedback discussions was added to the appendix of the curriculum document. Figure 2 gives an example of the general structure of the medical expertise part.
“Version three” underwent a panel test in November 2011. All “panel test” participants were asked to rate every single chapter with school grades (1 = very good to 6 = insufficient). All chapters reaching a rating of 3 or better were regarded as achieving a “pass” through the panel test. Additionally, participants were asked to comment if they identified missing or inappropriate parts of the curriculum. 15 participants were involved in the panel test. From these 15, one participant did not give grades to every single chapter of the “version three” but gave overall feedback. All chapters passed the first round of the panel test with a result of 2.3 on average from the remaining 14 participants. Furthermore, additional written comments from the participants were considered and where appropriate incorporated in the next revision. The revised “version three” again was sent to all participants for final review.
Following feedback on the revised “Version three”, “Version four” was produced and accepted as the “test version”. Since March 2012, the “Version four” curriculum document has been made freely available online as the “practice test version”:
To download the curriculum an email address has to be provided. After two years, an evaluation process is planned, which involves asking every person downloading the curriculum about his/her experience with the curriculum and the feasibility of implementation. This feedback will be used to build the “Version five”, the finalized competence-based curriculum for general practice training in Germany. To date, the curriculum has been downloaded 428 times, including from colleagues from African and Scandinavian countries. We are aware that copies of the curriculum are distributed freely and assume that this number is underestimating the distribution of the curriculum.