The Ulm Study and the implications for the advisory services of the Dean of Studies at the Medical Faculty of Heidelberg.

Increasing the flexibility of medical degree courses as well as individual advice and curriculum planning are essential needs of pregnant students and student parents. The results of the Ulm Study gave the academic advisers in the Dean of Studies' office in Heidelberg a large number of suggestions on how to offer sensitive, competent and needs-based advice to this target group. Comprehensive reflection on many years of experience in giving advice and recent survey results leads to a series of concrete measures which will contribute to more family-friendliness in Heidelberg's medical school.

Advisory activities in the Dean of Studies’ Office

Study deaneries have, in addition to their tasks of organising the core curriculum and the administration of students and course achievements, the task of providing advisory and information services to students across subjects regarding all aspects of university regulations and course organisation. The academic advisors do not evaluate the course performance of students but their study progression. If required, an individual curriculum is developed in consultation with the student, taking into account their personal life and study situation.

Pregnant students or students with children who require special support and initiatives in organising their studies and family life have always been an important group for the student advisory services in Heidelberg. The results of the study funded by the Ministry of Science of Baden-Württemberg, carried out by the Department of Child and Adolescent Psychiatry at the University Hospital of Ulm on “Family-friendly Medical Studies in Baden-Württemberg” [1] and the workshops held in the Dean’s Office at Heidelberg on the presentation of the study results in December 2010 have given additional impulse to the Dean’s Office and increased the awareness of the special situation of student parents.

We shall summarise the findings and the resulting consequences for the day to day advisory services of the Dean’s Office at the Medical School of the University of Heidelberg. This paper presents the status quo of advisory services as well as possible and planned measures to improve family-friendliness at the Dean’s Office of the Medical School in Heidelberg.

Findings from the Ulm Study, a survey at the Medical Faculty and a discussion at the workshop

Because the qualitative and quantitative survey of student parents at the Medical School in the Ulm Study only managed to survey 3.1% of the entire student body, it is not possible to speak of representative findings but many of the results provide interesting indications [1].

From our point of view, the most important results of the Ulm Study are as follows:

Students with children on average are 29 years of age, older than other students in their cohort and studying medicine for many is a second qualification.

The majority of student parents consciously planned the birth of their child and are planning to have more children while at university; often students even choose the most favourable phase of studies for pregnancy and birth.

The majority of surveyed parents said that having children prolonged their studies and that they had real problems balancing having family and education.

The students would like:

better advice and information

ability to pre-plan semesters, the option of choosing groups and group swaps

no strict attendance requirement and options for compensating in case of exceeding allowable absences

compulsory courses during core times (preferably in the morning)

ability to bring children to classes

special groups for parents

part-time studying

better infrastructure (childcare, parking, changing tables, etc.)

A survey by the Dean’s Office at the Medical School in Heidelberg of all teaching and coordinators and Practical Year (PY) officers investigated factors restricting the compatibility of pregnancy and medical studies. The Dean’s Office asked the teaching coordinators and the PY officers what issues must be taken into account in their subject or at their clinic in case of a student pregnancy and what practical steps are taken. The survey was meant to serve as a useful baseline for the Dean’s Office in their advisory work. The aim is to enable pregnant students seamlessly to continue their studies and to avoid prolonging the period of study. The study yielded the following results:

Health hazards for pregnant students or the unborn child exist in subjects where students come in contact with chemicals, radiation, anaesthetic gases, infectious materials or blood. Where physical stress, such as emergency care or where long periods of standing in the operating theatre are to be expected, the maternity policy guidelines apply.

Many of the preclinical and clinical courses and the compulsory and elective courses during the Practical Year can be completed by pregnant students without restrictions. In other cases, compensating offers can be made to ensure that the training objectives are achieved in spite of the precautions. Only the electives in infectious diseases and orthopaedics during the Practical Year can not be taken. The PY supervisors of the electives in infectious diseases and orthopaedics do not see opportunities for pregnant students during the practical year in their clinic. In infectious diseases, dealing with infectious patients is a prerequisite and the orthopaedic clinic provides comprehensive training in the operating theatre central to the subject and, in contrast to surgery, cannot offer alternative educational opportunities on a ward or in rehabilitation.

Appropriate opportunities for compensating include learning using models, observing or taking minutes during experiments in the laboratory, working on a ward rather than in the operating theatre, postponing parts of the course or switching to alternative electives.

Because solutions must be sought individually, comprehensive advice from the careers officer in conjunction with the teaching coordinators in the institutions or clinics is critical.

The workshop “Family-friendly Medical Studies” on 17.12.2010 additional problem areas were discussed:

Family-friendliness and flexibility in medicine is not only an important topic at university but also in the recruitment of junior medical staff and scientific personnel, HR management in the clinics and medical CPD.

The possibility of networking “Family-friendliness in Medical School” with a project at the University of Heidelberg called “Study Models at Individual Speeds” [http://mwk.baden-wuerttemberg.de/index.php?id=2714] was discussed.

One employee in the Prenatal (Conflict) Advisory Services run by the diakonia reported her impression that medical students feel under extreme pressure to perform in comparison to students in other subjects which can lead to the view that an abortion is the only solution.

Reflections and Conclusions

Information and Networking

Student parents need a lot of information, support and networking. Here, the Medical Faculty and Deans’ Offices cannot operate in isolation but must establish links with existing services run by the university, the city or the country, churches and so on. For example, KidS (Children at University), an initiative by the University of Heidelberg, the German National Association for Student Affairs (Studentenwerk) and the Equality Office collated all key institutions, advisory services, initiatives, childcare and financial support offers on the university’s website in cooperation with local authorities and the state in a helpful and comprehensive way (http://www.uni-heidelberg.de/studium/imstudium/KidS/).

Advice on Organising Degree Courses

The deaneries are responsible for giving advice to students, their individual term plans and planning the academic progress of students. Thus it gives food for thought if 56% of students state a need for advice regarding curriculum planning that 93% of respondents at the same time said that they are not in regular contact with their academic advisor about their study organisation, with 62% of respondents even claiming they do not know that the academic dean’s office offers academic advisory services.

Everyday experience cannot explain the survey results for the Dean’s Office; particularly in the light of conscious pregnancy planning and raising children while studying advice is vital, sometimes even before pregnancy. From the outset, the academic advisors present themselves as a first point of contact for study-related problems and pregnant students and students with children are always made to feel welcome when dropping in and sensitive advice is given when giving advice regarding the extra difficulties of their situation.

Perhaps the Dean’s Office is seen by some students primarily as a body dealing with course regulations and examinations rather than as a neutral advisory office offering to take up problems without negative consequences for the students’ studies. The offers and advisory services the Academic Dean offers can thus be perceived as less low threshold.

The Dean’s Office will develop strategies for engaging the target groups more effectively and encouraging them to regularly visit the academic advisor in the Dean’s Office.

Increasing the Flexibility of Degree Courses

Increasing the flexibility of degree courses is a legitimate request from student parents; considering their group placement and exchange requests or the possibility of taking a break from the course and a flexible return to it should go without saying.

Similar requests have also been made by many other students who are in comparably difficult situations, for example, ill or disabled students, students caring for relatives, students who must self-finance their studies and foreign students, some of whom require support because of language problems, different learning cultures or problems with immigration issues. Students who began their studies at a later stage of life, often following a first qualification, who resume studying after a break or as extreme long-time students who have exceeded the regular length of study require advice.

Many students approach the academic advisory services with special requirements regarding study planning that are not limitations through personal or social hardships but through their additional commitments or special engagements while studying. For example students who study two degrees in parallel, students on scholarships or students on other forms of sponsorship, students with unusual commitments in competitive sports, art, music, politics or social or scientific projects, as well as students who are active on the student council or hired as tutors by the faculty or aspiring to study abroad.

From this angle, students with children are one of many student groups with legitimate needs and prioritisation of special groups is not possible. In addition, study regulations and principles of equal treatment and achievement of learning targets must apply to all students, even groups of students with special needs or problems.

In general, timetables cannot be adjusted according to the wishes and needs of students as many fixed aspects must be taken into account in the organisation of teaching. The number of teaching hours, examinations and group sizes are often specified by law, there are accommodation and staffing factors and, not least of all, didactic aspects of the curriculum. Grouping together certain types of students into their own groups seems difficult due to the heterogeneity of needs and is also questionable from a didactic point of view.

Structured part-time medical studies are also not really an option as extending the period of study, which under normal circumstances is already six years and three months, could not be justified. On the other hand, an individual study extension for students can be easily arranged as the state examinations must not be taken at fixed dates and credits gained do not expire. Individual solutions for part-time study in the Practical Year are available upon request for student parents.

Performance Pressure

The feedback from the prenatal clinic that medical students are under extreme pressure to perform, discouraging pregnant students and sometimes leading to abortions is disconcerting. A survey carried out in Heidelberg on motivation in medical studies (HeiMi 2010) confirmed that performance pressure and fear of failure concerns many students: 11% of surveyed students are frequently or constantly afraid of not being able the meet the demands of the course, only 31% of students have never been worried about possibly having to quit the course.

The idea of studying at an elite university can lead students to believe that only unburdened students who are able to fully perform permanently are welcome. Not only is the quality of teaching important for the motivation of the students but also supportive environments and the certainty that students are not perceived as a nuisance. The university must recognise it as a special achievement when students manage to combine studying with raising children and that their studies are completed with and for the children.

Concrete measures in Heidelberg

Better advertising of the advisory services offered by Dean’s Office, e.g. by promoting them on the homepage.

Improved information through networking the Dean’s Office with the advisory services offered by the university for student parents

Responsiveness and flexibility in the organisation of studies for pregnant women and student parents

Reducing presence requirements in some blocks and modules of some clinical courses or reducing attendance control. This is done in those teaching forms and course sections which permit independent study of the contents by the students at home, where possible supported by electronic media.

Forum on the learning platform for networking and exchange of experiences among the students with children

Ensuring prenatal advisory centres inform students that they should also approach academic advisors at the Dean’s Office in case of problems.

Requesting management to provide changing and nursing facilities in the Dean’s Office

Competing interests

The autors declare that they have no competing interests.