Not taught in medical school but needed for the clinical job – leadership, communication and career management skills for final year medical students

Not taught in medical school but needed for the clinical job – leadership, communication and career management skills for final year medical students | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Not taught in medical school but needed for the clinical job – leadership, communication and career management skills for final year medical students Felix Behling, Sasan Darius Adib, Patrick Haas, Hannes Becker, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4196740/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Oct, 2024 Read the published version in BMC Medical Education → Version 1 posted 4 You are reading this latest preprint version Abstract Background: Starting the first job as a young physician is a demanding challenge. Certain skills are important to master this transformation that go beyond the theoretical knowledge and practical skills taught in medical school. Competencies such as communication, leadership and career management skills are important to develop as a young physician but are usually not sufficiently taught in medical school in a structured and comprehensive way. Methods: We performed an online survey among final year medical students regarding how they perceive their current competency level in communication, leadership and career management skills. We also assessed how they rate the importance to acquire these competencies and the current emphasis during their medical school education regarding these topics. Results: Of 450 final year medical students 80 took part in the voluntary survey and 75 complete datasets were returned (16.7%). The majority of respondents rated different communication skills, leadership skills and career management skills as important or very important for their later clinical work. However, most students felt to be poorly or very poorly prepared by the current medical school curriculum, especially for certain leadership and career management skills. Overall, 90.7% of participants expressed interest in an additional educational course that covers subjects of communication, leadership and career management skills during the later stage of medical school, preferably as a hybrid in-person session that also offers synchronous online participation. Conclusions: Final year medical students in Germany express the need to address communication, leadership and career management skills in the medical curriculum to be better prepared for the demands of residency and their further course as physicians. final year medical students communication leadership career management residency Figures Figure 1 Figure 2 Figure 3 Background For final year medical students the start of their residency is a big transition, associated with feelings of doubt and uncertainty[ 1 ]. In Germany, the final year of medical school is designed to give medical students a continuous exposure to practical clinical work and prepare them for the demands and challenges of their upcoming residency. Transferring theoretical knowledge into practice and becoming more familiar with the challenges of the clinical work is the main focus for final year medical students at this stage of their education[ 2 ]. However, with the start of residency young physicians will be faced with additional challenges that are usually not systematically taught in German medical school but are requirements for a successful residency. One example is the importance of good communication skills: While communication with patients, such as breaking bad news, is an established part of the curriculum in some medical schools[ 3 ], a multifaceted teaching of communication skills that includes interprofessional communication or conflict management is usually not included. However, it is an established fact, that most medical errors are based on miscommunication[ 4 ], underlining the need for medical students to be well educated in this aspect on a wide and comprehensive spectrum. Additionally, young physicians are placed into leadership settings from day one, usually with no proper training in this regard. The importance of leadership skills has been recognized in other countries and first concepts to address the educational need for this skill have been suggested[ 5 – 7 ]. Parallel to these demands, young residents need to plan their individual medical career, regarding subspecialty training, additional qualifications, or academic aspirations. These challenges add to the high demands of the long way of becoming a board-certified physician and several publications support the positive impact of mentoring programs that facilitate this professional development[ 8 , 9 ]. It is usually expected that students acquire all these skills on the fly during clinical rotations and residency. In the German medical school curriculum a structured teaching approach comprehensively covering these skills has not yet been formulated[ 10 ]. This appears to be inappropriate when realizing the high importance of these competencies for the development as a competent physician. Therefore, a structured analysis of final year medical students who are facing the transition from medical school to residency seems helpful to address this issue. Materials and Methods A web-based survey was constructed using the online platform “SurveyMonkey” (SurveyMonkey Inc., San Mateo, California, USA). The survey consisted of 18 questions evaluating the current status of the preparedness for residency, the integration of communication, leadership and career management skills into medical school education, as well as the interest to develop these skills and the wish to participate in a new education course during medical school that covers these subjects. The list of communication (n = 4), leadership (n = 5) and career management skills (n = 5) was assembled after focus group interviews with former final year medical students who took part in a mentoring program in the first authors’ department during their final year of medical school and have already made the transition to residency and experienced the associated challenges and demands[ 11 ]. For most questions a five-tiered Likert scale was used for expressing agreement with different statements or interest for specific teaching subjects. The complete survey is provided as supplementary material (Supplementary Material 1). The survey link was distributed to all medical students at the authors’ institution who were in their final year of medical school or preparing for the final oral exam via their institutional email addresses (n = 450). The survey was open from 30th March 2023 until 3rd of June 2023. Overall, 80 students participated in the survey producing 76 complete datasets (16.9%). Approval by the ethical committee was not necessary since the survey was anonymous and completely voluntary. Data processing was done with the JMP® Statistical Discovery Software (Version 15.1.0, SAS Institute, Cary, North Carolina, US) and Microsoft® Excel (Version 16.66.1, Microsoft, Redmond, Washington, US). Results Return rate and descriptive data of respondents: Overall, 80 of 450 final year medical students took part in the online survey (17.8%) and 75 complete datasets were submitted (16.7%), resulting in a completion rate of 93.8%. Forty-nine respondents were female (65.3%) and 26 were male with no participants indicating a diverse gender. The majority was 25 to 30 years of age (72.0%). Regarding the stage of the final year rotations, 21 respondents were in their first of three rotation (28.0%), while 30 were in their second and three in their third and final rotation (40.0 and 4.0%, respectively). Twenty-one students had just finished their three final year rotations and were preparing for the final oral exam (28.0%, see Figure 1). Perceived importance of communication, leadership and career management skills: When asked to rate the importance of different communication skills for their later clinical work, interprofessional communication was valued to be very important or important by 74 of 75 respondents (98.7%). The same result was seen regarding the importance of giving and receiving feedback (98.7% rated as very important or important). The management of conflicts was also assessed as very important or important by a large portion of respondents (72/75 respondents, 96.0%), so was the skill of breaking bad news (71/75 respondents, 94.7%). There were only a few deviating neutral responses and there were no participants who rated the different communication skills as unimportant or very unimportant (see Figure 2A). Among leadership skills, time management and error culture were rated as very important or important for the future clinical work by all respondents (100%). A similar result was observed for the subject stress management (98.7%) with only one neutral response. Team leadership was ranked as very important or important by 88.0% and dealing with hierarchies by 85.3% (see Figure 2B). The importance of different career management skills was confirmed by the majority of participating medical students. Planning of individual training reached the highest agreement regarding its importance with 66 of 75 respondents (88.0%) and 9 neutral answers (12.0%). Compatibility of work and family was valued as important or very important by 94.7% with 3 neutral responses and one individual rating the subject as unimportant for later clinical work. A large portion of students agreed to the importance of medical law and employment law for their future career (74.7 and 81.3%, respectively). Few respondents felt that dealing with additional non-medical assignments was of no importance (22.7%) or gave a neutral response (20.0%), while the majority rated this career management skill as important or very important (57.3%, see Figure 2C). Current curricular preparation for communication, leadership and career management skills: When asked about their level of preparedness in different aspects of communication, differing responses were given by participants: A large group of respondents felt well or very well trained to break bad news to patients (46/75, 61.3%) and only a small portion felt poorly or very poorly prepared (20.0%). Regarding the skill of giving and receiving feedback a similar result was seen, with half of the participants stating to be well or very well prepared (36/75, 48.0%) and a quarter to be poorly or very poorly trained (21/75, 28.0%). When asking about preparation in interprofessional communication the majority of respondents stated to be poorly or very poorly trained (43/75, 57.3%). The subgroup of participants who answered to be poorly or very poorly trained for conflict management was of the same size (43/75, 57.3%) (see Figure 3A). The level of preparation during medical school for leadership skills was rated mostly as poor or very poor by respondents for all addressed subjects of leadership. Eighty percent felt poorly or very poorly prepared for team leadership (60/75), 72.0% for time management (54/75), 78.7% for stress management (59/75), 70.7% for error culture (53/75) and 77.3% for dealing with hierarchies (58/75) (see Figure 3B). The conceived preparation of final year medical students regarding career management skills showed a high rate of poor training as well. The preparation during medical school for planning of individual training is felt to be poor or very poor by 90.7% (68/75) and 88.0% for compatibility of work and family (66/75). Dealing with extra non-medical assignments is also felt to be addressed poorly or very poorly during medical education (54/75, 72.0%). In contrast the majority of respondents feels well or very well prepared in the field of medical law (30/75, 40.0%) but poorly or very poorly in employment law (43/75, 57.3%). For both legal subjects, quite a large group gave a neutral response, 26.7% for medical law and 24.0% for employment law (see Figure 3C). Recommendations for educational formats Sixty-eight respondents expressed an interest in an educational format that covers communication, leadership and career management skills (90.7%). Three gave a neutral response (4.0%) and four had no interest (5.3%). The majority of participating final year medical students responded that the second half of their clinical education or the final year of medical school would be best suited for this (73.3 and 77.3%, respectively) and one or two hours per week was the most desired timely scope (34.7 and 25.3%, respectively), followed by one hour every other week (22.7%). Participating medical students preferred an interactive seminar and group discussions (88.0 and 72.0%, respectively). Simulations with patient actors and role playing were favored by 41.3 and 38.7%, respectively. Frontal lecture and group work were the least selected forms of teaching (28.0 and 24.0%, respectively). Only 10 respondents were in favor of a synchronous webinar as course format (13.3%) and 27 preferred an in-person session (36.0%), while the majority voted for a hybrid in-person session that also offers synchronous online participation (50.7%). Discussion The results of the survey show a clear demand of final year medical students to receive specific and structured education on several topics of communication, leadership and career development skills. Communication skills: However, courses affecting the subjects of communication, leadership and career development skills are usually not comprehensively taught in German medical schools. Especially regarding communication skill training, there have been some institutions in Germany and in other countries that address certain aspects such as breaking bad news. A widely used tool is the integration of patient actors for training scenarios where medical students have the chance to experience the demands and challenges of a staged difficult communication setting with prior preparation and later discussion and feedback[ 12 , 13 ]. A similar approach has been established for several years in the authors’ institution, explaining that over 60% of the respondents felt well or very well prepared to deliver bad news to their patients. Learning from this conceptual example, many other difficult scenarios could potentially be taught in this manner, such as interprofessional conflict management or giving and receiving feedback, just to name a few. As an example, it has recently been shown that a realistic learning activity on interprofessional communication can be created, combining students from different professions (nursing, physiotherapy, occupational therapy and physician)[ 14 ]. Leadership skills: In this survey, German final year medical students rated the importance of all listed leadership skills as important or very important for their later clinical job but expressed poor or very poor preparation within their current medical training. In the corporate world it is without a question that personnel that aspires after leadership position undergoes proper and structured training to meet the demands of the job. It is incomprehensible that this is not the case for medical students that will enter their residency unprepared for their leadership role, where lives and patient safety are at stake[ 15 ]. The need to address this discrepancy is reflected in the quantity of publications on this matter, expressed in a recent review[ 16 ]. In this publication the authors describe the current standing of leadership training models for medical students focusing on the diversity of methodology and outcome measurements. It becomes clear that courses addressing leadership skills at different stages of training during medical school are well accepted but it is still challenging to produce objective long-term outcome data and assess the longitudinal benefit for participants[ 16 ]. A structured leadership training program recently demonstrated that a longitudinal assessment is feasible and produces feedback for further improvement [ 17 ]. Comparing the growing evidence of the importance of leadership training for young physicians and the perceived lack of it in the German medical school curriculum, a clear mission to provide a structured and comprehensive curriculum including leadership skill training can be formulated. Career management skills: How young physicians see their future career and what they plan to accomplish is highly variable. While all residents who enter a certain residency share a similar goal of being trained for a certain specialty, interests for sub-specialization or further qualifications as well as higher academic aspirations are highly individual. All this is may be influenced by personal life events and plans that are naturally partly unpredictable. Nonetheless, it is important for young residents to be cognizant of early planning and structuring of one’s individual career goals. Many medical schools offer mentoring programs often including career counseling and professional development[ 18 , 19 ] and its impact on residency training has also been shown[ 20 ]. A career counseling program was also tested in Germany 10 years ago and documented good acceptance among medical students. Twelve percent of participants even changed their career choice after the program[ 21 ]. It must be stressed that career management skills are not just nice to have, but the lack of it is a source of stress among medical students and young residents. A survey of over 900 medical students in Florida assessed perceived stressors. Students highlighted fear of excessive workload, time management, work-life balance as well health concerns and financial problems, but some students also indicated concerns about lack of assistance with career planning[ 22 ]. Furthermore, the new generation of medical students seems to have different career expectations and an increasing emphasis on work-life balance of as well as less eagerness to pursue an academic career[ 23 – 25 ]. Therefore, guidance in career management will remain an important aspect of medical student and young physician mentoring, with a broader diversity of career blueprints. Mentoring in this regard should therefore not just focus on students with high potential and academic aspirations, but especially offer advice to the whole spectrum of medical students and trainees, which in turn requires more career diversity of potential mentors as well. Limitations: Although the results of the survey express the need to formulate a supportive educational concept, it is important to keep in mind, that the survey only delineates the current opinion of final year medical students in the authors’ institution that participated in a voluntary survey. Additionally, the participating students were subject to the academic educational recession during the COVID-19 pandemic that highly influenced clinical practical education during medical school[ 26 , 27 ]. Furthermore, the desired conditions of a new educational course, such as hybrid format, are important impulses, but may not be feasible or in line with the best suited didactic methodologies. A mandate for a supporting educational format: The convincing message provided by participating final year medical students suggests including a comprehensive and structured curriculum that covers communication, leadership and career management skills. While single aspects may be already covered in some institutions, medical students seem not to be sufficiently prepared in this regard to meet the demands of residency that they are soon to experience. Therefore, it is plausible to offer a respective educational format in the last years of medical school, as desired by most respondents of the survey. During that time medical students are exposed to more clinical practical courses and rotations where such skills and competencies can be applied and matured. Furthermore, group discussions were chosen as the most preferred format with a volume of 1 to 2 hours every 1 or 2 weeks and a hybrid format. Although, the time frame may be sufficient it remains questionable if a hybrid format holds the same educational yield as a seminar in attendance, especially when group discussions are implemented. Based on the results of this survey, the authors are planning a teaching session for final year medical students that covers the subjects that were rated as being of the highest importance. With this first attempt the additional demands of final year medical students will be addressed and further assessed. Hopefully an accompanying curriculum for final year medical students can be established to prepare young physicians in a more comprehensive way for the challenges of residency and for their professional development. Conclusions Final year medical students in Germany express a lack of communication, leadership and career management skills in their current medical school curriculum and demand a supportive educational format that addresses these topics to be better prepared for the challenges of residency. Declarations Ethics approval and consent to participate: According to the ethics committee of the authors’ institution no separate consent by participants in the voluntary anonymous online survey was necessary (Project number: BO242/2024). Availability of data and material: The dataset analyzed during the current study is available as supplementary file. Competing interest: The authors declare that they have no competing interests. Funding: None. Authors’ contributions: FB, JG and MT are responsible for the conception and the study design. PH, HB, LO, EW and INK took part in the mentoring program for final year medical students as mentors. Focus group interviews with former mentees produced the items for the constructed survey. Survey implementation, statistical analysis, preparation of figures and writing of the first draft was done by FB, SDA, CR and JG. All authors read and approved the final manuscript. Acknowledgment: We acknowledge support by the Open Access Publishing Fund of the University of Tübingen. References Moczko TR, Bugaj TJ, Herzog W, Nikendei C. Perceived stress at transition to workplace: a qualitative interview study exploring final-year medical students' needs. Adv Med Educ Pract. 2016;7:15–27. Nikendei C, Krautter M, Celebi N, Obertacke U, Junger J. Final year medical education in Germany. Z Evid Fortbild Qual Gesundhwes. 2012;106(2):75–84. Dale MacLaine T, Lowe N, Dale J. 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Supplementary Files SupplementaryFile1.xlsx Cite Share Download PDF Status: Published Journal Publication published 11 Oct, 2024 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 06 Jun, 2024 Editor assigned by journal 06 Jun, 2024 Submission checks completed at journal 06 Jun, 2024 First submitted to journal 31 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4196740","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":311425901,"identity":"af8b9a4d-5a94-4c20-88b9-3a0c85df170a","order_by":0,"name":"Felix 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Nasi-Kordhishti","email":"","orcid":"","institution":"Department of Neurosurgery and Neurotechnology, University Hospital Tübingen, Eberhard Karls University Tübingen","correspondingAuthor":false,"prefix":"","firstName":"Isabella","middleName":"","lastName":"Nasi-Kordhishti","suffix":""},{"id":311425908,"identity":"c0cffa51-2953-40a4-b508-6f42ec5d4a1b","order_by":7,"name":"Constantin Roder","email":"","orcid":"","institution":"Department of Neurosurgery and Neurotechnology, University Hospital Tübingen, Eberhard Karls University Tübingen","correspondingAuthor":false,"prefix":"","firstName":"Constantin","middleName":"","lastName":"Roder","suffix":""},{"id":311425910,"identity":"f38a1f86-8300-4faa-8b65-0d580c2a3275","order_by":8,"name":"Jan Griewatz","email":"","orcid":"","institution":"Tübingen Institute of Medical Education (TIME), Eberhard Karls University Tübingen","correspondingAuthor":false,"prefix":"","firstName":"Jan","middleName":"","lastName":"Griewatz","suffix":""},{"id":311425911,"identity":"27d81a0b-9a5f-4f78-b72c-4607dcff6ae6","order_by":9,"name":"Marcos Tatagiba","email":"","orcid":"","institution":"Department of Neurosurgery and Neurotechnology, University Hospital Tübingen, Eberhard Karls University Tübingen","correspondingAuthor":false,"prefix":"","firstName":"Marcos","middleName":"","lastName":"Tatagiba","suffix":""}],"badges":[],"createdAt":"2024-03-31 17:59:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4196740/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4196740/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-024-06091-w","type":"published","date":"2024-10-11T15:56:59+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":59123909,"identity":"124075cc-2881-4a16-8976-cbfd890e9ca7","added_by":"auto","created_at":"2024-06-26 15:18:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36982,"visible":true,"origin":"","legend":"\u003cp\u003eBar graphs showing the distribution of participants age (A), gender (B) and level of final year training (C).\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4196740/v1/b3ed8582cc2f0283658cdce5.png"},{"id":59123910,"identity":"0d0ab579-e4b7-44ff-8c77-0035f070c523","added_by":"auto","created_at":"2024-06-26 15:18:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":109576,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of participants answers regarding the perceived importance of different communication skills (A), leadership skills (B) and career management skills (C) for their later clinical career.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4196740/v1/e6ece50e26b86c33dd53c118.png"},{"id":59123911,"identity":"8efa4a15-13be-4e61-9978-faaa4bd32791","added_by":"auto","created_at":"2024-06-26 15:18:37","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":111121,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of participants answers regarding the current training for communication skills (A) leadership skills (B) and career management skills (C) during medical school.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4196740/v1/abbfa0186ad451a1767ee0b6.png"},{"id":66597367,"identity":"f1b94f1c-4aa0-48d6-927c-d43b56788968","added_by":"auto","created_at":"2024-10-14 16:10:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":531601,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4196740/v1/90a83f66-2edd-417f-a6a1-73465e381c3b.pdf"},{"id":59123912,"identity":"2aaff13e-71b8-410d-9753-7d0520565fae","added_by":"auto","created_at":"2024-06-26 15:18:38","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":28945,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4196740/v1/6ede82f7a5961a64259875c3.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Not taught in medical school but needed for the clinical job – leadership, communication and career management skills for final year medical students","fulltext":[{"header":"Background","content":"\u003cp\u003eFor final year medical students the start of their residency is a big transition, associated with feelings of doubt and uncertainty[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In Germany, the final year of medical school is designed to give medical students a continuous exposure to practical clinical work and prepare them for the demands and challenges of their upcoming residency. Transferring theoretical knowledge into practice and becoming more familiar with the challenges of the clinical work is the main focus for final year medical students at this stage of their education[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, with the start of residency young physicians will be faced with additional challenges that are usually not systematically taught in German medical school but are requirements for a successful residency. One example is the importance of good communication skills: While communication with patients, such as breaking bad news, is an established part of the curriculum in some medical schools[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], a multifaceted teaching of communication skills that includes interprofessional communication or conflict management is usually not included. However, it is an established fact, that most medical errors are based on miscommunication[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], underlining the need for medical students to be well educated in this aspect on a wide and comprehensive spectrum.\u003c/p\u003e \u003cp\u003eAdditionally, young physicians are placed into leadership settings from day one, usually with no proper training in this regard. The importance of leadership skills has been recognized in other countries and first concepts to address the educational need for this skill have been suggested[\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Parallel to these demands, young residents need to plan their individual medical career, regarding subspecialty training, additional qualifications, or academic aspirations. These challenges add to the high demands of the long way of becoming a board-certified physician and several publications support the positive impact of mentoring programs that facilitate this professional development[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is usually expected that students acquire all these skills on the fly during clinical rotations and residency. In the German medical school curriculum a structured teaching approach comprehensively covering these skills has not yet been formulated[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This appears to be inappropriate when realizing the high importance of these competencies for the development as a competent physician.\u003c/p\u003e \u003cp\u003eTherefore, a structured analysis of final year medical students who are facing the transition from medical school to residency seems helpful to address this issue.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eA web-based survey was constructed using the online platform \u0026ldquo;SurveyMonkey\u0026rdquo; (SurveyMonkey Inc., San Mateo, California, USA). The survey consisted of 18 questions evaluating the current status of the preparedness for residency, the integration of communication, leadership and career management skills into medical school education, as well as the interest to develop these skills and the wish to participate in a new education course during medical school that covers these subjects. The list of communication (n\u0026thinsp;=\u0026thinsp;4), leadership (n\u0026thinsp;=\u0026thinsp;5) and career management skills (n\u0026thinsp;=\u0026thinsp;5) was assembled after focus group interviews with former final year medical students who took part in a mentoring program in the first authors\u0026rsquo; department during their final year of medical school and have already made the transition to residency and experienced the associated challenges and demands[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor most questions a five-tiered Likert scale was used for expressing agreement with different statements or interest for specific teaching subjects. The complete survey is provided as supplementary material (Supplementary Material 1).\u003c/p\u003e \u003cp\u003eThe survey link was distributed to all medical students at the authors\u0026rsquo; institution who were in their final year of medical school or preparing for the final oral exam via their institutional email addresses (n\u0026thinsp;=\u0026thinsp;450). The survey was open from 30th March 2023 until 3rd of June 2023. Overall, 80 students participated in the survey producing 76 complete datasets (16.9%). Approval by the ethical committee was not necessary since the survey was anonymous and completely voluntary.\u003c/p\u003e \u003cp\u003eData processing was done with the JMP\u0026reg; Statistical Discovery Software (Version 15.1.0, SAS Institute, Cary, North Carolina, US) and Microsoft\u0026reg; Excel (Version 16.66.1, Microsoft, Redmond, Washington, US).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eReturn rate and descriptive data of respondents:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOverall, 80 of 450 final year medical students took part in the online survey (17.8%) and 75 complete datasets were submitted (16.7%), resulting in a completion rate of 93.8%. Forty-nine respondents were female (65.3%) and 26 were male with no participants indicating a diverse gender. The majority was 25 to 30 years of age (72.0%). Regarding the stage of the final year rotations, 21 respondents were in their first of three rotation (28.0%), while 30 were in their second and three in their third and final rotation (40.0 and 4.0%, respectively). Twenty-one students had just finished their three final year rotations and were preparing for the final oral exam (28.0%, see Figure 1). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePerceived importance of communication, leadership and career management skills:\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWhen asked to rate the importance of different communication skills for their later clinical work, interprofessional communication was valued to be very important or important by 74 of 75 respondents (98.7%). The same result was seen regarding the importance of giving and receiving feedback (98.7% rated as very important or important). The management of conflicts was also assessed as very important or important by a large portion of respondents (72/75 respondents, 96.0%), so was the skill of breaking bad news (71/75 respondents, 94.7%). There were only a few deviating neutral responses and there were no participants who rated the different communication skills as unimportant or very unimportant (see Figure 2A).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAmong leadership skills, time management and error culture were rated as very important or important for the future clinical work by all respondents (100%). A similar result was observed for the subject stress management (98.7%) with only one neutral response. Team leadership was ranked as very important or important by 88.0% and dealing with hierarchies by 85.3% (see Figure 2B).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe importance of different career management skills was confirmed by the majority of participating medical students. Planning of individual training reached the highest agreement regarding its importance with 66 of 75 respondents (88.0%) and 9 neutral answers (12.0%). Compatibility of work and family was valued as important or very important by 94.7% with 3 neutral responses and one individual rating the subject as unimportant for later clinical work. \u0026nbsp;A large portion of students agreed to the importance of medical law and employment law for their future career (74.7 and 81.3%, respectively). Few respondents felt that dealing with additional non-medical assignments was of no importance (22.7%) or gave a neutral response (20.0%), while the majority rated this career management skill as important or very important (57.3%, see Figure 2C). \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCurrent curricular preparation for communication, leadership and career management skills:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWhen asked about their level of preparedness in different aspects of communication, differing responses were given by participants: A large group of respondents felt well or very well trained to break bad news to patients (46/75, 61.3%) and only a small portion felt poorly or very poorly prepared (20.0%). Regarding the skill of giving and receiving feedback a similar result was seen, with half of the participants stating to be well or very well prepared (36/75, 48.0%) and a quarter to be poorly or very poorly trained (21/75, 28.0%). When asking about preparation in interprofessional communication the majority of respondents stated to be poorly or very poorly trained (43/75, 57.3%). The subgroup of participants who answered to be poorly or very poorly trained for conflict management was of the same size (43/75, 57.3%) (see Figure 3A).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe level of preparation during medical school for leadership skills was rated mostly as poor or very poor by respondents for all addressed subjects of leadership. Eighty percent felt poorly or very poorly prepared for team leadership (60/75), 72.0% for time management (54/75), 78.7% for stress management (59/75), 70.7% for error culture (53/75) and 77.3% for dealing with hierarchies (58/75) (see Figure 3B).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe conceived preparation of final year medical students regarding career management skills showed a high rate of poor training as well. The preparation during medical school for planning of individual training is felt to be poor or very poor by 90.7% (68/75) and 88.0% for compatibility of work and family (66/75). Dealing with extra non-medical assignments is also felt to be addressed poorly or very poorly during medical education (54/75, 72.0%). In contrast the majority of respondents feels well or very well prepared in the field of medical law (30/75, 40.0%) but poorly or very poorly in employment law (43/75, 57.3%). For both legal subjects, quite a large group gave a neutral response, 26.7% for medical law and 24.0% for employment law (see Figure 3C). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRecommendations for educational formats\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSixty-eight respondents expressed an interest in an educational format that covers communication, leadership and career management skills (90.7%). Three gave a neutral response (4.0%) and four had no interest (5.3%). The majority of participating final year medical students responded that the second half of their clinical education or the final year of medical school would be best suited for this (73.3 and 77.3%, respectively) and one or two hours per week was the most desired timely scope (34.7 and 25.3%, respectively), followed by one hour every other week (22.7%). Participating medical students preferred an interactive seminar and group discussions (88.0 and 72.0%, respectively). Simulations with patient actors and role playing were favored by 41.3 and 38.7%, respectively. Frontal lecture and group work were the least selected forms of teaching (28.0 and 24.0%, respectively). \u0026nbsp;Only 10 respondents were in favor of a synchronous webinar as course format (13.3%) and 27 preferred an in-person session (36.0%), while the majority voted for a hybrid in-person session that also offers synchronous online participation (50.7%).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results of the survey show a clear demand of final year medical students to receive specific and structured education on several topics of communication, leadership and career development skills.\u003c/p\u003e \u003cp\u003eCommunication skills:\u003c/p\u003e \u003cp\u003eHowever, courses affecting the subjects of communication, leadership and career development skills are usually not comprehensively taught in German medical schools. Especially regarding communication skill training, there have been some institutions in Germany and in other countries that address certain aspects such as breaking bad news. A widely used tool is the integration of patient actors for training scenarios where medical students have the chance to experience the demands and challenges of a staged difficult communication setting with prior preparation and later discussion and feedback[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A similar approach has been established for several years in the authors\u0026rsquo; institution, explaining that over 60% of the respondents felt well or very well prepared to deliver bad news to their patients. Learning from this conceptual example, many other difficult scenarios could potentially be taught in this manner, such as interprofessional conflict management or giving and receiving feedback, just to name a few. As an example, it has recently been shown that a realistic learning activity on interprofessional communication can be created, combining students from different professions (nursing, physiotherapy, occupational therapy and physician)[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLeadership skills:\u003c/p\u003e \u003cp\u003eIn this survey, German final year medical students rated the importance of all listed leadership skills as important or very important for their later clinical job but expressed poor or very poor preparation within their current medical training.\u003c/p\u003e \u003cp\u003eIn the corporate world it is without a question that personnel that aspires after leadership position undergoes proper and structured training to meet the demands of the job. It is incomprehensible that this is not the case for medical students that will enter their residency unprepared for their leadership role, where lives and patient safety are at stake[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The need to address this discrepancy is reflected in the quantity of publications on this matter, expressed in a recent review[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In this publication the authors describe the current standing of leadership training models for medical students focusing on the diversity of methodology and outcome measurements. It becomes clear that courses addressing leadership skills at different stages of training during medical school are well accepted but it is still challenging to produce objective long-term outcome data and assess the longitudinal benefit for participants[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. A structured leadership training program recently demonstrated that a longitudinal assessment is feasible and produces feedback for further improvement [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eComparing the growing evidence of the importance of leadership training for young physicians and the perceived lack of it in the German medical school curriculum, a clear mission to provide a structured and comprehensive curriculum including leadership skill training can be formulated.\u003c/p\u003e \u003cp\u003eCareer management skills:\u003c/p\u003e \u003cp\u003eHow young physicians see their future career and what they plan to accomplish is highly variable. While all residents who enter a certain residency share a similar goal of being trained for a certain specialty, interests for sub-specialization or further qualifications as well as higher academic aspirations are highly individual. All this is may be influenced by personal life events and plans that are naturally partly unpredictable. Nonetheless, it is important for young residents to be cognizant of early planning and structuring of one\u0026rsquo;s individual career goals. Many medical schools offer mentoring programs often including career counseling and professional development[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and its impact on residency training has also been shown[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. A career counseling program was also tested in Germany 10 years ago and documented good acceptance among medical students. Twelve percent of participants even changed their career choice after the program[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. It must be stressed that career management skills are not just nice to have, but the lack of it is a source of stress among medical students and young residents. A survey of over 900 medical students in Florida assessed perceived stressors. Students highlighted fear of excessive workload, time management, work-life balance as well health concerns and financial problems, but some students also indicated concerns about lack of assistance with career planning[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Furthermore, the new generation of medical students seems to have different career expectations and an increasing emphasis on work-life balance of as well as less eagerness to pursue an academic career[\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Therefore, guidance in career management will remain an important aspect of medical student and young physician mentoring, with a broader diversity of career blueprints. Mentoring in this regard should therefore not just focus on students with high potential and academic aspirations, but especially offer advice to the whole spectrum of medical students and trainees, which in turn requires more career diversity of potential mentors as well.\u003c/p\u003e \u003cp\u003eLimitations:\u003c/p\u003e \u003cp\u003eAlthough the results of the survey express the need to formulate a supportive educational concept, it is important to keep in mind, that the survey only delineates the current opinion of final year medical students in the authors\u0026rsquo; institution that participated in a voluntary survey. Additionally, the participating students were subject to the academic educational recession during the COVID-19 pandemic that highly influenced clinical practical education during medical school[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Furthermore, the desired conditions of a new educational course, such as hybrid format, are important impulses, but may not be feasible or in line with the best suited didactic methodologies.\u003c/p\u003e \u003cp\u003eA mandate for a supporting educational format:\u003c/p\u003e \u003cp\u003eThe convincing message provided by participating final year medical students suggests including a comprehensive and structured curriculum that covers communication, leadership and career management skills. While single aspects may be already covered in some institutions, medical students seem not to be sufficiently prepared in this regard to meet the demands of residency that they are soon to experience. Therefore, it is plausible to offer a respective educational format in the last years of medical school, as desired by most respondents of the survey. During that time medical students are exposed to more clinical practical courses and rotations where such skills and competencies can be applied and matured. Furthermore, group discussions were chosen as the most preferred format with a volume of 1 to 2 hours every 1 or 2 weeks and a hybrid format. Although, the time frame may be sufficient it remains questionable if a hybrid format holds the same educational yield as a seminar in attendance, especially when group discussions are implemented.\u003c/p\u003e \u003cp\u003eBased on the results of this survey, the authors are planning a teaching session for final year medical students that covers the subjects that were rated as being of the highest importance. With this first attempt the additional demands of final year medical students will be addressed and further assessed. Hopefully an accompanying curriculum for final year medical students can be established to prepare young physicians in a more comprehensive way for the challenges of residency and for their professional development.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eFinal year medical students in Germany express a lack of communication, leadership and career management skills in their current medical school curriculum and demand a supportive educational format that addresses these topics to be better prepared for the challenges of residency.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate:\u003c/p\u003e\n\u003cp\u003eAccording to the ethics committee of the authors\u0026rsquo; institution no separate consent by participants in the voluntary anonymous online survey was necessary (Project number: BO242/2024).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAvailability of data and material:\u003c/p\u003e\n\u003cp\u003eThe dataset analyzed during the current study is available as supplementary file. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompeting interest:\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNone.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions:\u003c/p\u003e\n\u003cp\u003eFB, JG and MT are responsible for the conception and the study design. PH, HB, LO, EW and INK took part in the mentoring program for final year medical students as mentors. Focus group interviews with former mentees produced the items for the constructed survey. Survey implementation, statistical analysis, preparation of figures and writing of the first draft was done by FB, SDA, CR and JG. All authors read and approved the final manuscript. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcknowledgment:\u003c/p\u003e\n\u003cp\u003eWe\u0026nbsp;acknowledge support by the Open Access Publishing Fund of the University of T\u0026uuml;bingen.\u003cu\u003e\u003c/u\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMoczko TR, Bugaj TJ, Herzog W, Nikendei C. Perceived stress at transition to workplace: a qualitative interview study exploring final-year medical students' needs. Adv Med Educ Pract. 2016;7:15\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNikendei C, Krautter M, Celebi N, Obertacke U, Junger J. Final year medical education in Germany. Z Evid Fortbild Qual Gesundhwes. 2012;106(2):75\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDale MacLaine T, Lowe N, Dale J. The use of simulation in medical student education on the topic of breaking bad news: A systematic review. Patient Educ Couns. 2021;104(11):2670\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStarmer AJ, Spector ND, Srivastava R, West DC, Rosenbluth G, Allen AD, Noble EL, Tse LL, Dalal AK, Keohane CA, Lipsitz SR, Rothschild JM, Wien MF, Yoon CS, Zigmont KR, Wilson KM, O'Toole JK, Solan LG, Aylor M, Bismilla Z, Coffey M, Mahant S, Blankenburg RL, Destino LA, Everhart JL, Patel SJ, Bale JF Jr., Spackman JB, Stevenson AT, Calaman S, Cole FS, Balmer DF, Hepps JH, Lopreiato JO, Yu CE, Sectish TC, Landrigan CP. I.P.S. Group, Changes in medical errors after implementation of a handoff program. N Engl J Med. 2014;371(19):1803\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVo A, Torti J, Haddara W, Sultan N. Exploring medical students' perspectives of physician leadership. BMC Med Educ. 2023;23(1):10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilkie V. Leadership and management for all doctors. Br J Gen Pract. 2012;62(598):230\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGriewatz J, Yousef A, Rothdiener M, Lammerding-Koeppel M. Collaborators of the, Are we preparing for collaboration, advocacy and leadership? Targeted multi-site analysis of collaborative intrinsic roles implementation in medical undergraduate curricula. BMC Med Educ. 2020;20(1):35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarid H, Bain P, Huang G. A scoping review of peer mentoring in medicine. Clin Teach. 2022;19(5):e13512.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKashiwagi DT, Varkey P, Cook DA. Mentoring programs for physicians in academic medicine: a systematic review. Acad Med. 2013;88(7):1029\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFakult\u0026auml;tentag M. 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A survey among medical students in Germany: Results of study arm XIII of the KARiMED study]. Z Evid Fortbild Qual Gesundhwes. 2023;177:73\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSorg H, Bagheri M, Ehlers J, Hauser J, Tilkorn DJ, Leifeld IH, Fuchs P, Sorg CGG. [Balancing Family and Career in Medicine: Greatly Desired but Given Little Consideration Results of the Study Arm VI of the KARiMED Study]. Gesundheitswesen. 2023;85(6):505\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerrel MN, Ryan JJ. The Impact of COVID-19 on Medical Education. Cureus. 2020;12(3):e7492.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkers A, Blough C, Iyer MS. COVID-19 Implications on Clinical Clerkships and the Residency Application Process for Medical Students. Cureus. 2020;12(4):e7800.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"final year medical students, communication, leadership, career management, residency","lastPublishedDoi":"10.21203/rs.3.rs-4196740/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4196740/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eStarting the first job as a young physician is a demanding challenge. Certain skills are important to master this transformation that go beyond the theoretical knowledge and practical skills taught in medical school. Competencies such as communication, leadership and career management skills are important to develop as a young physician but are usually not sufficiently taught in medical school in a structured and comprehensive way.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eWe performed an online survey among final year medical students regarding how they perceive their current competency level in communication, leadership and career management skills. We also assessed how they rate the importance to acquire these competencies and the current emphasis during their medical school education regarding these topics.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eOf 450 final year medical students 80 took part in the voluntary survey and 75 complete datasets were returned (16.7%). The majority of respondents rated different communication skills, leadership skills and career management skills as important or very important for their later clinical work. However, most students felt to be poorly or very poorly prepared by the current medical school curriculum, especially for certain leadership and career management skills. Overall, 90.7% of participants expressed interest in an additional educational course that covers subjects of communication, leadership and career management skills during the later stage of medical school, preferably as a hybrid in-person session that also offers synchronous online participation.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eFinal year medical students in Germany express the need to address communication, leadership and career management skills in the medical curriculum to be better prepared for the demands of residency and their further course as physicians.\u003c/p\u003e","manuscriptTitle":"Not taught in medical school but needed for the clinical job – leadership, communication and career management skills for final year medical students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-26 15:18:32","doi":"10.21203/rs.3.rs-4196740/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-06T15:14:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-06T11:18:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-06T11:17:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2024-03-31T17:57:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bbe7e90e-0e7c-438a-9102-06f32a8800ac","owner":[],"postedDate":"June 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-14T16:05:24+00:00","versionOfRecord":{"articleIdentity":"rs-4196740","link":"https://doi.org/10.1186/s12909-024-06091-w","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2024-10-11 15:56:59","publishedOnDateReadable":"October 11th, 2024"},"versionCreatedAt":"2024-06-26 15:18:32","video":"","vorDoi":"10.1186/s12909-024-06091-w","vorDoiUrl":"https://doi.org/10.1186/s12909-024-06091-w","workflowStages":[]},"version":"v1","identity":"rs-4196740","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4196740","identity":"rs-4196740","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}