Taught but not retained: disaster medicine in the education of seven health professions in Germany-a nationwide cross-sectional survey of 8,133 students and trainees
- 1University of Luebeck, Medical Clinic III, 23562 Luebeck, Germany
Abstract
BackgroundDisaster medicine has been a formal curricular recommendation in German health professions education since 2006, and comparable recommendations exist internationally. Evidence on implementation is confined almost entirely to human medicine, rests on faculty self-reports or small student samples, and measures delivery rather than retention. Whether curricular exposure is associated with willingness to serve has not been adequately examined in interprofessional samples.
ObjectiveWe aimed to characterize disaster medicine education across 7 health professions in Germany, distinguishing delivery from retention, to identify profession-specific gaps and training priorities, and to examine how educational and experiential factors relate to willingness to serve.
MethodsWe conducted an anonymous nationwide online cross-sectional survey of students and trainees across 7 health professions in Germany between July 9 and August 25, 2026, recruited through institutional distribution lists. The interprofessionally developed instrument comprised 48 items. We assessed delivery and retention of 12 disaster medicine topics (4-point scale), self-rated confidence in 22 clinical and nursing skills (6-point scale), desired content, formats, motivators and barriers, and formal and spontaneous willingness. For all rating scales, higher values denote the more favorable level. We derived a delivery-retention gap and a want-deficit index, examined the dimensional structure of the competence battery, tested for differential item functioning by prior civil protection engagement, and modeled willingness with a cumulative link model.
ResultsOf 8133 respondents (completion rate 87.5%), 33.1% had never been taught disaster medicine and 25.0% only in passing; 22.1% had comprehensive teaching including practical exercises. Across the 12 topics, the proportion able to retrieve content confidently never exceeded 23.9%; the delivery-retention gap reached 47.3 percentage points. More than half (54.6%) had never taken part in a practical exercise. Competence formed more than 1 dimension: 18 acute-technical items loaded 0.54-0.86 on the first factor, 4 relational and nursing items 0.14-0.28. Prior civil protection engagement was associated with higher confidence on every acute-technical item (Cliff delta 0.26-0.55) and lower confidence on all 4 relational items (-0.22 to -0.09). Willingness was high and homogeneous across groups (78.7% formal, 84.1% spontaneous), whereas competence varied by about 2 scale points. Adjusted, active civil protection engagement (odds ratio 2.49, 95% CI 2.12-2.94) and practical exercise experience (odds ratio 1.78, 95% CI 1.54-2.05) were the strongest predictors; curricular exposure contributed weakly (odds ratio 1.06 per SD, 95% CI 0.99-1.14).
ConclusionsTwo decades after the curricular recommendation, disaster medicine is largely absent from health professions education in Germany, and what is delivered is not retained. Willingness is nevertheless high and largely decoupled from competence, so qualification and recruitment require separate instruments. Curricula should be prioritized by the coincidence of demand and deficit rather than by coverage, built for retention, and should treat relational and nursing competence as a distinct learning objective.
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BibTeX
@misc{franzen2026taught,
title = {{Taught but not retained: disaster medicine in the education of seven health professions in Germany-a nationwide cross-sectional survey of 8,133 students and trainees}},
author = {K. F. Franzen and M. Ries and T. Ziegmann and V. Goehren and B. Gleitz and F. Fischer and V. Edwards and A. Klapproth and E. Schneider and B. Elsner and R. Wunderlich and P. Bradl and A. Follmann and L. Over-Mueller and W. Zweig and P. Franzen and K. Buescher and D. Droemann and O. Franzen and K. Mortensen and M. Reppel and P. Ristau and A. C. Franzen and M. von der Forst},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.04.26363870},
url = {https://www.medrxiv.org/content/10.64898/2026.10.04.26363870v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Taught but not retained: disaster medicine in the education of seven health professions in Germany-a nationwide cross-sectional survey of 8,133 students and trainees
AU - K. F. Franzen
AU - M. Ries
AU - T. Ziegmann
AU - V. Goehren
AU - B. Gleitz
AU - F. Fischer
AU - V. Edwards
AU - A. Klapproth
AU - E. Schneider
AU - B. Elsner
AU - R. Wunderlich
AU - P. Bradl
AU - A. Follmann
AU - L. Over-Mueller
AU - W. Zweig
AU - P. Franzen
AU - K. Buescher
AU - D. Droemann
AU - O. Franzen
AU - K. Mortensen
AU - M. Reppel
AU - P. Ristau
AU - A. C. Franzen
AU - M. von der Forst
PY - 2026
DA - 2026/10/04
PB - medRxiv
DO - 10.64898/2026.10.04.26363870
UR - https://www.medrxiv.org/content/10.64898/2026.10.04.26363870v1
AB - BackgroundDisaster medicine has been a formal curricular recommendation in German health professions education since 2006, and comparable recommendations exist internationally. Evidence on implementation is confined almost entirely to human medicine, rests on faculty self-reports or small student samples, and measures delivery rather than retention. Whether curricular exposure is associated with willingness to serve has not been adequately examined in interprofessional samples. ObjectiveWe aimed to characterize disaster medicine education across 7 health professions in Germany, distinguishing delivery from retention, to identify profession-specific gaps and training priorities, and to examine how educational and experiential factors relate to willingness to serve. MethodsWe conducted an anonymous nationwide online cross-sectional survey of students and trainees across 7 health professions in Germany between July 9 and August 25, 2026, recruited through institutional distribution lists. The interprofessionally developed instrument comprised 48 items. We assessed delivery and retention of 12 disaster medicine topics (4-point scale), self-rated confidence in 22 clinical and nursing skills (6-point scale), desired content, formats, motivators and barriers, and formal and spontaneous willingness. For all rating scales, higher values denote the more favorable level. We derived a delivery-retention gap and a want-deficit index, examined the dimensional structure of the competence battery, tested for differential item functioning by prior civil protection engagement, and modeled willingness with a cumulative link model. ResultsOf 8133 respondents (completion rate 87.5%), 33.1% had never been taught disaster medicine and 25.0% only in passing; 22.1% had comprehensive teaching including practical exercises. Across the 12 topics, the proportion able to retrieve content confidently never exceeded 23.9%; the delivery-retention gap reached 47.3 percentage points. More than half (54.6%) had never taken part in a practical exercise. Competence formed more than 1 dimension: 18 acute-technical items loaded 0.54-0.86 on the first factor, 4 relational and nursing items 0.14-0.28. Prior civil protection engagement was associated with higher confidence on every acute-technical item (Cliff delta 0.26-0.55) and lower confidence on all 4 relational items (-0.22 to -0.09). Willingness was high and homogeneous across groups (78.7% formal, 84.1% spontaneous), whereas competence varied by about 2 scale points. Adjusted, active civil protection engagement (odds ratio 2.49, 95% CI 2.12-2.94) and practical exercise experience (odds ratio 1.78, 95% CI 1.54-2.05) were the strongest predictors; curricular exposure contributed weakly (odds ratio 1.06 per SD, 95% CI 0.99-1.14). ConclusionsTwo decades after the curricular recommendation, disaster medicine is largely absent from health professions education in Germany, and what is delivered is not retained. Willingness is nevertheless high and largely decoupled from competence, so qualification and recruitment require separate instruments. Curricula should be prioritized by the coincidence of demand and deficit rather than by coverage, built for retention, and should treat relational and nursing competence as a distinct learning objective.
ER -