To address the intertwined challenges of physician shortage, inconsistent research preparedness, and curricular ambiguity, this Perspective critically examines the current status of SC in German medical education. Thus, in this Perspective, we first dissect the curricular gap in the definition and assessment of scientific competence within German medical education, highlighting how the absence of clearly differentiated knowledge and utility dimensions undermines both teaching and evaluation. We then draw actionable lessons from established international CBME exemplars—such as Canada’s Competence by Design and the U. S. LCME’s EPAs—to illustrate how explicit mapping of competences to milestones and assessments can drive measurable improvements in trainee research engagement and clinical confidence. Finally, we propose concrete, scalable reforms—including the introduction of EPA-based milestones at each training phase, the development of shared digital CBME platforms for workplace-based assessments and e-portfolios, and robust faculty development programs—to reinvigorate scientific training across all stages of German medical education. Through this integrated approach, our goal is to move beyond problem description toward a cohesive framework for reform. By unifying both the knowledge and utility dimensions of scientific competence within a competency-based framework, Germany can standardize graduate outcomes, strengthen its pipeline of physician-scientists, and ultimately enhance the quality and safety of patient care.

However, despite this well-established theoretical foundation, current educational frameworks in German medical education rarely distinguish or systematically incorporate these dimensions. Neither the NKLM 2.0 nor current drafts of the new ÄApprO provide separate learning objectives for knowledge-oriented vs. utility-oriented scientific competencies. As a result, students often perceive scientific competence merely as a technical skill for clinical practice, not as a pathway to academic inquiry or autonomous research. This lack of conceptual clarity in the curriculum contributes to an underdeveloped perception of SC, reducing it to procedural knowledge rather than fostering it as a longitudinal academic trajectory. While the conceptual differentiation between knowledge- and utility-oriented scientific competence draws on established theoretical frameworks by Stokes (8) and Kölbl (10), one might question whether this model resonates beyond academic discourse and is accepted within the broader German medical education community. In fact, recent national initiatives suggest that these ideas are gaining institutional traction: the updated NKLM 2.0 explicitly defines “scientific competence” as a key graduate attribute, and the forthcoming revision of the ÄApprO echoes this multidimensional approach (3, 18). Moreover, position papers by the German Council of Science and Humanities (Wissenschaftsrat, WR) and policy frameworks such as the “Masterplan Medizinstudium 2020” increasingly reflect a shared understanding that scientific competence must encompass both the capacity for critical inquiry and its practical application in care delivery (19). These developments indicate growing alignment between educational policy and the multidimensional concept of SC, even if full curricular operationalization remains a work in progress.

Thus, while not yet universally operationalized, the dual conception of scientific competence articulated here is aligned with national reform goals and is increasingly accepted among medical faculties and policymakers. Building on this policy alignment, it remains critical to explore how these curricular frameworks translate into actual student experiences and perceptions. To this end, we conducted empirical investigations to assess medical students’ understanding of scientific competence and its role in their education and career aspirations.

In this regard, based on competency-based education, the requirements of the curriculum and the expectations of those involved in the learning process are of relevance (20, 21).

Accordingly, in an online survey of 339 medical students recruited via internal mailing lists and voluntary lecture announcements, our group recently interviewed students at three university locations (University of Hamburg): n = 162, Otto-von-Guericke University, Magdeburg: n = 97, Johannes Gutenberg University, Mainz: (n = 80). Participants were recruited via internal mailing lists and voluntary lecture announcements. The inclusion of students from three different medical faculties allowed for a broad representation across both preclinical and clinical phases of medical education. However, the generalizability of the findings to all German medical students may be limited due to potential institutional differences in curriculum design and research culture.

We found that, in both the early and later phases of their medical studies, the students, despite the likely presence of self-selection bias typical for convenience sampling, had very clear and, above all, uniform ideas about the definition of SC. For the vast majority of respondents, and with increasing agreement as students gained more experience, SC was described as the “acquisition of skills and experiences that ultimately enabled them to pursue and successfully carry out independent scientific projects” and that for doing so SC as an adjunct to the “ability to think, work and act in a scientific manner” was needed (Figure 2). This definition, rooted in both knowledge and application, aligns with the dual-dimensional model of scientific competence and highlights students’ intuitive grasp of its multifaceted nature. From the students’ perspective, medical doctors require SC regardless of whether they would perform in research or clinical practice.

These findings highlight a key disconnect within German medical education: while the majority of medical students—even in the early study phases—report a surprisingly coherent and experience-dependent understanding of SC and explicitly consider it relevant for both clinical and research roles, only a small fraction actually continues into structured research careers. This gap between perceived importance and later engagement highlights the need for curricula that not only define SC within the abovementioned framework but also enable its longitudinal development and application.

While this Perspective focuses on educational levers to support academic career interest, it is important to acknowledge that broader systemic factors—such as the structural challenges of residency training, including service load, lack of protected research time, and the “triple burden”—may also significantly limit the translation of student interest into long-term academic engagement. In this context, we found that at the beginning of medical students’ studies, approximately 70% of respondents were interested in pursuing a doctoral project and thesis, while at the end of their training, even more students obtained this interest (Figure 3). This is complemented by further data: regardless of study phase, over 90% of respondents indicated a general intention to pursue a doctorate (Figure 3), and at the time of the survey, 70% were already planning a specific scientific project (data not shown). As expected, this proportion was higher among students in the latter half of their studies (81 vs. 54%, p < 0.0001). These high levels of interest suggest that motivation alone is not the limiting factor—rather, the lack of structured, supportive training environments may be responsible for the attrition of future physician-scientists.

Independent of study progress, about half of the surveyed students could envision engaging in academia after the doctorate, while 38% expressed interest in a general scientific career in medicine (Figure 3)—a motivation further reinforced by targeted, high-engagement experiences such as international electives (22). Despite this, students repeatedly expressed a lack of adequate guidance and support, citing insufficient preparation for research-related tasks and a lack of continuity in developing SC.

However, students expressed a lack of adequate support for these goals, reflected in free-text responses such as: “I am at the beginning of my doctoral research and have to laboriously figure everything out by myself,” and “Never having written a term paper or engaged independently and scientifically with a topic, the skills that would enable students to work scientifically—perhaps once acquired at school—are becoming somewhat buried.”

In contrast, a 2011 graduate survey showed that while students described their medical training as fundamentally scientific and research-oriented, only a very small proportion were interested in the methodology behind research outcomes. These findings reinforce the theoretical distinction made by Stokes (8) and Kölbl (10): although students may conceptually differentiate between the application-oriented and knowledge-driven dimensions of science, this distinction is often blurred in practical training contexts. Students reported receiving sufficient preparation for SC through projects lasting only 2–6 weeks or, at most, 10 weeks—despite most having completed the majority of their degree programs. This reveals a persistent mismatch between student expectations, the design of scientific training, and the longitudinal integration demanded by frameworks such as NKLM (2.0) and the German Council of Science and Humanities (Wissenschaftsrat, WR) recommendations.

Even though guidelines from the WR define SC as a necessary skill to apply scientific evidence in complex care situations, students did not perceive a need for longitudinal structures or translational concepts (such as the physician as a “lifelong learner”) at any point in their studies (24).

Thus, from a curricular perspective, this empirical insight highlights a crucial gap: while scientific thinking and working are valued, the structural conditions supporting independent research capacity are insufficiently developed for cultivating students’ independent research capacity and academic identity. This aligns with the previously stated concerns that SC is often reduced to technical competence for clinical practice, rather than cultivated as an academic or research trajectory (25).

The ongoing discussion about SC in medical education in Germany has gained increased relevance due to the structural shortage of specialist doctors and the declining number of research-oriented physicians. While political and curricular reforms (e.g., NKLM 2.0, the long-anticipated but still pending revised ÄApprO) explicitly aim to promote scientific skills, and initiatives such as DFG (Deutsche Forschungsgesellschaft, German Research Society) research grants for students and the establishment of Excellence Clusters have begun to incentivize early engagement in research, current empirical studies and student reports reveal a profound mismatch between aspirational goals and educational reality (26). The persistent increase in workload caused by clinical responsibilities and the lack of structured postgraduate training paths significantly undermines the scientific motivation of young doctors. The “triple burden” of clinical work, teaching, and research leads to research being perceived more as an additional stressor rather than as an integral part of the professional identity at university centers. This perception causes many young doctors to pursue more accessible, practice-oriented career paths, which in turn contributes to the erosion of interest in academic medicine (12).

Despite normative progress, the curricular integration of SC remains conceptually and didactically confusing. The NKLM 2.0 and current drafts of the new ÄApprO fail to systematically distinguish between knowledge-based and application-oriented competencies, as theorized by Kölbl (10) and Stokes (8). This ambiguity often leads to SC being understood narrowly as a technical skill for clinical problem-solving rather than as the foundation for critical reflection or independent scientific development. Empirical findings show that students recognize the general importance of SC but lack lasting opportunities and structural support for engaging in research beyond short-term project work (27). A more detailed discussion of the distinction between knowledge-based and application-oriented competencies would clarify how these concepts could strengthen SC in practice. For instance, Kölbl emphasizes the importance of not only acquiring scientific facts but fostering scientific reasoning, while Stokes’ framework differentiates between pure and use-inspired research, both relevant to the design of medical curricula.

Another key issue is the lack of curricular visibility and accessible role models for scientific inquiry. The observed decline in students’ interest in pursuing a doctoral thesis reflects a broader disconnect between the ideal of research-oriented medicine and the actual educational experience. Although many students begin their studies with a willingness to engage in research, this enthusiasm diminishes over time due to insufficient institutional support and the absence of meaningful research pathways embedded within the curriculum (20, 28). In addition, although medical students increasingly value scientific competence, only a minority go on to pursue research careers. This gap stems from the perceived challenges of academia—such as job insecurity, excessive bureaucracy, and limited mentorship—when contrasted with more stable and appealing alternatives in clinical practice. In this context, valuing scientific skills does not necessarily translate into a desire to follow a scientific or academic career path.

Conceptualizing SC as a multidimensional educational objective—embedded throughout the entire curriculum and supported by clearly defined, operationalized learning objectives—would represent a decisive step toward revitalizing interest in academic medical careers. Integrating knowledge generation and practical application across all phases of training, along with the establishment of protected research time, mentoring, and translational learning environments, could foster a new generation of physician-scientists. International comparisons emphasize that while Germany has set normative frameworks such as the NKLM and the awaited revised ÄApprO, its practical curricular development currently lags behind countries with established “Scholarly Concentrations” or MD–PhD programs. A stronger adaptation of best-practice models—such as modular research project units, mandatory peer-review workshops, and interdisciplinary Global Health initiatives—could help close the gap between curricular objectives and student experience. Ultimately, scientific competence should be more than an abstract curricular goal–it should be practiced, visible, and actively cultivated within the realities of medical education.