Zeitschrift fur arztliche Fortbildung最新文献

A computer diary was developed for physicians to create a portfolio of their self-directed learning. Each item of learning is recorded in the form of a question along with the stimulus, the learning resources used and the outcome planned for the learning. The records of 123 physicians which volunteered to use the diary were analyzed. Their response to the software, elicited by survey, is described. Items of learning were most often stimulated by scanning the literature and while seeking information to manage a patient. The physicians recorded their intent to change their practice as the outcome to learning most often when the learning was stimulated while managing a patient. One-half of the physicians reported that keeping the diary made them think about their patient care.

This article outlines a nationwide quality improvement project in counselling funded by the German Ministry of Health. To develop the project, expert surveys and consensus conferences are currently organized by the coordination center. A questionnaire with mainly open questions was sent to 32 teachers in general practice. Counselling for psychiatric, psychosomatic and psychosocial problems in primary care was regarded as an important field for quality assurance. The experts believed short psychotherapy to be an integral part of family medicine as some 30% of our patients present with complaints caused by psychosocial or psychological reasons. However, only some 70% of patients receive a specific treatment. The experts rated better recognition of psychosomatic problems as the most important area for quality improvement. Suitable interventions to improve the physicians' ability in the area mentioned were continuing medical education, balint groups, quality circles and flexible guidelines. The experts made invaluable contributions to the development of a practice documentation for psychosocial problems.

In this paper, our experience with training courses for quality circle moderators is reported. Basic principles of the peer review method in general and the specific model of the topic-oriented quality circle approach in the ambulatory care in Sudbaden is described. Peer review in quality circle groups demands specific participants' skills. Thus, training courses for quality circle leaders have been set up to prepare moderators for their task. Attention is given to the goals and contents of training courses for physicians. Key elements are the supervisory role of the moderator and specific tasks in handling the group dicussions. Evaluation questionnaires after the courses showed that the participants (n = 41) judged the programme very positively.

Since 1994, new rules for continuing medical education (CME) for general practitioners have been implement in Germany. It is currently necessary to participate in internal medicine, surgery and general medicine for three years. For the first time, CME seminars have been implemented. Postgraduates have to absolve 240 hours for becoming general practitioner. A first evaluation from the area of the "Nordrheinische Akademie für árztliche Fort- und Weiterbildung" (Academy of continuing medical education) is presented. The results are discussed in the context of further questions looking into the future of CME training of general practitioners.

Quality circles (peer review) are a process of a continuous, systematic and critical reflection of care providers on their own and colleagues' performance by using structured procedures with the aim of achieving a continuous improvement. Main goal of the topic-oriented quality circle model in Sudbaden (Germany) is the development of guidelines for primary health care. The quality circle programme of the society of health insurances of Sudbaden is currently given a systematic evaluation. The results presented refer to 246 participants and moderators of 25 groups who have completed questionnaires. Attention is given to the general goals of the doctors participating in quality circle groups. When asked about the most important goals of peer review the participants scored the highest ranking on (1) exchanging practice experiences with colleagues (2) the personal reflection of one's way of working (3) agreeing on guidelines and targets for desirable performance and (4) developing guidelines for general practice. From the results, conclusions regarding the concept of quality circles and the methods for developing practice guidelines are drawn.

The CASUS-project, a three year publicly funded effort to improve the quality of continuing medical education in Germany, has one major goal: The development and evaluation of an easy-to-handle author-system for problem-oriented learning in medicine. On the theoretical basis of the cognitive apprenticeship-approach, the concept of a teaching and learning database as a hypermedia system was built. The student should learn to manage authentical problems in the form of authentical clinical cases. The step-by-step learning process is expert-guided by the clinical authors of each case. The creation of various differential diagnoses by the learner is strongly supported in the process. The structure of the program can also be used for case-based examinations. In parallel to the technical development, a case-selection process for medical students students in internal medicine was initiated. About 120 relevant diseases were identified to be represented in the CASUS-case library. Prevalence, transferability of knowledge, treatability, urgence of treatment and preventive aspects were used as selection criteria. The system will be evaluated during the implementation of test cases and will then be available to be used by authors and students on a routine basis in 1997.

In reply to depersonalization of teaching, students hiding behind anonymity and their decreasing effective presence in campus life, academic teaching has to become practice-oriented, attractive and at least more effective. The traditional teacher-based lecture competes with student-centered and issue-related academic events like problem-based learning, thus, concerning student-teacher interaction. The model of a clockwork represents the components of a traditional lecture. The model of a windmill is suitable for explaining synergistic effects in scope and experience during an interaction concerned lecture. An example of student-teacher interaction and students' activation even in a preclinical course of lectures on anatomy and radiology is given. A high response and acceptance of the lecture is assured by structure-and process-oriented features.

The purpose of this study was to evaluate the acceptance of the statutory course of radiation protection, which is attended by physicians. As a first step towards problem based quality management, an anonymous questionnaire was used to assess the participants' opinions. The present methods in teaching, practice-orientation of the educational objectives, the prize and efficiency of the course were judged poor. Neither valid indicators of quality nor a quality management of the course exists. Facing the status quo and future demands within the medical community and society there is a serious need for reshaping radiology. It is emphasized that instead of marginal corrections only a strategic and fundamental approach to a paradigmatic reorganization will meet success.

In Saxonia, an agreement of shared care was reached between health insurances and the society of general practitioners with the objective to have a better medical care for patients with diabetes mellitus. This model of shared care means integrated medical care for out-patient diabetics between general practitioner and specialists. It must be accompanied by quality assurance measures. After a training of moderators according to a structured programme of the Central Research Institute for Outpatient Health Care, quality circles started with seven to ten members and two moderators in five Saxonian cities in May 1994. General practitioners interactively improved their medical knowledge about diabetes mellitus during five sessions with two hours each. The regional specialist participated in the first and the last session. He also answered open questions left in a mail box. Based on patient data the following results were achieved: 553 documentations.

The aim of the study was to evaluate the practicability and efficacy of a structured treatment and teaching programme (STTP) for Type II diabetic outpatients on conventional insulin treatment after introducing a remuneration for physicians. Reimbursement policy was introduced in the state of Brandenburg, Germany, in July 1993. Between August 1993 and February 1994, 108 practices in Brandenburg participated in a postgraduate seminar, which is a prerequisite for remuneration. Within the first year 10% of the target group of physicians participated in the seminars. A standardised interview was performed with 103 physicians. Twenty of the practices who had performed STTP were visited in order to collect data on all the patients who had participated in the programme. The seminar and the programme were well accepted. An improvement of HbA1c levels was observed in patients (n = 54) who had started insulin treatment (9.7 +/- 1.6% of total Hb before, 8.2 +/- 1.3% of total Hb after the programme) and in those (n = 189) who were already being treated with insulin before the STTP (9.6 +/- 2.5% of total Hb before, 8.1 +/- 1.4% of total Hb after the programme). The results of the study demonstrate the efficacy and practicability of an STTP for Type II diabetic patients on conventional insulin therapy in ambulatory health care.