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

Background: Disaster 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. Objective: We 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. Methods: We 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. Results: Of 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). Conclusions: Two 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.