Staatsexamen cheat sheet

Staatsexamen is a German state examination: the state (Land) sets and administers it, universities teach but do not award the final grade; results are recognized nationwide under framework regulations (e.g., JAPrO, ÄApprO).

Two-stage structure applies to law (Erste Prüfung: university focus areas ~30% plus state compulsory-exam part ~70%; Zweite Prüfung after Referendariat) and medicine (Physikum/M1 after 2 years, M2 written, M3 oral-practical).

Grading uses a fixed scale in law: 0-3 insufficient, 4-6 sufficient, 7-9 satisfactory, 10-12 good, 13-15 very good; pass mark is 4.0 points; below 4 points the exam is failed.

In medicine, the written M1/M2 use a percentage-based pass threshold set by IMPP; approximately 60% correct is the standard cutoff for the written sections, with item review before scoring.

Doctrine of sources (Rechtsquellenlehre): EU law primacy, Grundgesetz, formal statutes (Gesetz), statutory instruments (Rechtsverordnung), and autonomous municipal statutes (Satzung); customary law is residual only.

Gutachtenstil versus Urteilsstil: the expert opinion style tests each element hypothetically (Obersatz, Definition, Subsumtion, Ergebnis); the judgment style states the result first, then reasons.

Subsumption scheme: identify the applicable norm, break it into elements (Tatbestandsmerkmale), define contested concepts, apply facts to each element, then conclude on the legal consequence.

Evidence hierarchy in clinical evidence: systematic review/meta-analysis > randomized controlled trial > cohort > case-control > case series > expert opinion; GRADE rates certainty downward for risk of bias, inconsistency, indirectness, imprecision.

Case method sequence: presenting complaint → focused history → differential diagnosis ranked by probability and danger (rule out can't-miss conditions) → targeted examination/tests → management plan → follow-up and safety-netting.

Sensitivity rules out, specificity rules in: a highly sensitive test with a negative result makes disease unlikely (SnNOut); a highly specific test with a positive result makes it likely (SpPin).

Bayes update in practice: post-test odds = pre-test odds × likelihood ratio; a positive LR above 10 or negative LR below 0.1 substantially shifts probability.

Number needed to treat = 1/absolute risk reduction; absolute risk reduction = control event rate − treatment event rate; NNT is reported with its time horizon.

In law, the case solution follows claim-basis analysis: Anspruchsgrundlage, contract/statutory requirements, defenses (Einwendungen/Einreden), and burden of proof allocation (who bears the risk of non-persuasion).

Administrative case review order: admissibility (jurisdiction, standing, prior administrative procedure) before merits (legality of the act, then proportionality).

Proportionality test in four steps: legitimate aim, suitability, necessity (least intrusive means), and proportionality in the narrow sense (balancing).

Case documentation must be contemporaneous, signed, dated, and attributable; retrospective alteration creates evidentiary weakness and can trigger professional sanctions.

Examination procedure: written admission requirements must be met (e.g., regular study, seminar certificates, practical training); rejection decisions are administrative acts appealable within the statutory period (often one month, Widerspruch).

Medical licensing: Approbation requires completed studies, health suitability, reliability, and sufficient German language proficiency (B2/C1 depending on Land); the license can be restricted or revoked.

Professional secrecy (Berufsgeheimnis, §203 StGB) binds physicians, lawyers, and other professions; disclosure requires consent or statutory authorization.

Informed consent doctrine: the patient must be informed about nature, risks, and alternatives before the intervention; failure can constitute bodily harm (Körperverletzung) even if performed correctly.

Data protection: processing health data requires a legal basis under GDPR Art. 6 and Art. 9(2); documentation, retention periods, and access rights follow national professional rules.

Legal remedies in administrative law: Widerspruch (objection) precedes Anfechtungsklage; the burden of proof for the legality of the administrative act lies with the authority.

Criminal law structure: Tatbestand (elements), Rechtswidrigkeit (unlawfulness), Schuld (culpability); justification grounds include self-defense (§32 StGB) and necessity (§34 StGB).

Regulatory supervision: professional chambers (Kammern) enforce professional codes; violations can lead to warnings, fines, or revocation of licensure.

Four-principles framework in medical ethics: autonomy (respect informed choices), beneficence (act in patient's interest), non-maleficence (avoid harm), justice (fair distribution of resources).

Informed consent as a communication process: assess capacity, disclose material risks, confirm understanding (teach-back), document the decision, and honor refusal.

Public health metrics: incidence (new cases per population-time), prevalence (existing cases at a point), case fatality rate, and basic reproduction number R0 (secondary cases per index case in a fully susceptible population).

Herd immunity threshold = 1 − 1/R0; for measles with R0 ≈ 12-18 the threshold exceeds 90-95% vaccination coverage.

Pedagogical models: Bloom's taxonomy (remember, understand, apply, analyze, evaluate, create) and constructive alignment (learning outcomes, activities, assessment must match).

Feedback principles: specific, timely, actionable, and focused on task rather than person; formative feedback improves learning more than summative grades alone.

Health literacy and shared decision-making: use plain language, check numeracy (absolute risks, natural frequencies), and elicit patient values before choosing among options.

Interprofessional collaboration requires role clarity, closed-loop communication (read-back), and structured handover (SBAR: situation, background, assessment, recommendation).

OSCE station structure: standardized scenario, checklist-based scoring, time limit (often 5-10 minutes), and global rating; assess communication, examination technique, and clinical reasoning separately.

Vital sign thresholds for escalation: respiratory rate >25/min, systolic BP <90 mmHg, heart rate >120/min, altered consciousness (GCS <15), or oxygen saturation <92% trigger urgent review.

Structured examination sequence: inspection, palpation, percussion, auscultation; compare sides, and always examine the patient's dignity and privacy first.

Hand hygiene per WHO five moments: before patient contact, before aseptic task, after body fluid exposure risk, after patient contact, after contact with surroundings.

Safe prescribing checks: right patient, drug, dose, route, time; check allergies, renal/hepatic function, interactions, and pregnancy status before administration.

SBAR handover: Situation, Background, Assessment, Recommendation - delivered in under 60 seconds with read-back confirmation of critical items.

Basic life support sequence: check responsiveness and breathing, call for help, start chest compressions at 100-120/min with 5-6 cm depth, and use an AED as soon as available.

Clinical documentation standard: SOAP format (Subjective, Objective, Assessment, Plan), with date, time, signature, and clear identification of the author.