Are you asking about the general framework in the paper, or for a specific aspect of the paper relative to modern medical education?

The German system seems quite similar in content to the Sydney system up to the introduction of the Graduate program and problem-based learning. One thing I liked was that medical students are meant to get some general University life and that lectures and ,labs were not compulsory. I believe lectures should not be compulsory but I think things like histology and biochemistry need specific teaching and systematic lab work. I think anatomy dissection is still important and should be systematic but the extent could vary between students according to interest. Physiology practical is more problematic and selection of exercises more difficult.

Studies on problem based learning versus traditional now seem to show little difference in quality of clinical work after a few hospital years.

I guess two aspects are striking and unfortunately no longer seen as being of any great importance - (1) to educate broadly across all aspects of knowledge, and (2) and emphasis on understanding the physiology underlying health and disease.

 indeed, I wasn't quite specific which aspect of the paper I meant. Friedrich von Müller  Apparently influenced even in medical education in the US as some of his ideas were taken up in the so-called Flexner report (J Hist Med Allied Sci (1990) 45 (4): 556-569.

doi: 10.1093/jhmas/45.4.556).  in this regard one of his key demands was to base medical education on a solid understanding of  basic science or what today would be called: evidence-based medicine. This recommendation was based in a time where many medical professors obtained their position and reputation based on personal experience rather than systematic studies.

But the paper includes also interesting aspects regarding the health system in general and the employment arrangements for medical University staff.

 Let me furthermore do a "declaration of interest"  in the context of promoting this paper:  Friedrich von Müller  was my great grandfather.

Your feedback and reaction therefore has shown me that his work still can elicit discussions in our modern times. Many thanks!

Well, his concerns are really as pressing now as they were then. We have to decide if we want trained technicians in medical practice or educated doctors for medical practice. I certainly know which of the two I prefer, reaching a stage in my life where I might have to engage with the system at the receiving end.

Having co-designed and co-implemented an alternative approach to medical education in the context of a rural medical school has demonstrated that education of physicians in an interactive, patient/person/human focused way is rewarding for all involved in the process and results in accelerated performance at the cognitive, technical and interpersonal level - something that may be even more pertinent in our times of more rapid change than at the beginning of the 20th century.

I would rather see an emphasis being put back on understanding basic physiological functioning rather than more "evidence-based medicine". The interconnected nature of physiological networks and their regulation results in "whole system (body)" changes, the current preoccupation with achieving "normality" of single surrogate indicators of disease within an EBM framework has to result in dys-regulation of the whole system resulting in the many undesired unintended side effects of contemporary treatment approaches. The appreciation of the dynamic mechanisms of health and disease make evidence a moving feast - today's best evidence all to often turns out to be yesterday's great fallacy (may be that the nature of medical practice since its beginnings, best evidence resulted in leaching the king to death).

I hope this discussion may result in a broader discourse of "what medicine is all about".