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On the journey to competency-based assessment for safe patient care. 在以能力为基础的安全病人护理评估之旅中。
Pub Date : 2015-10-15 eCollection Date: 2015-01-01 DOI: 10.3205/zma000989
Jana Jünger, Ara Tekian, John J Norcini
Over the past few decades there has been an internationalmovement towards competency-basedmedical education (CBME). Germany has participated in this development and recently created the NKLM, which is a catalogue of the learning objectives for medical education [http:// www.nklm.de and [http://www.nklz.de] citied 2015-0918], [1]. The recommendations of the German Council for Science and Humanities regarding the further development ofmedical studies in Germany state thatmodified teaching and learning content should also be reflected in assessment [2]. The aims of this movement are to ensure that the graduates of our medical faculties have the necessary knowledge, skills, and attitudes to provide excellent patient care. Implementation of CBME requires appropriate alignment of the learning objectives specified in the NKLM with the curriculum, particularly with the instructional methods and assessment strategies. A number of institutions have been experimenting with ways of making the appropriate changes within the resources available. These exciting developments have been driven by enlightened initiatives in association with the German community of medical educators and it has generated a new culture for the academy. Central to CBME is the ability to determine when students have achieved the competencies specified in the NKLM and that requires advances in the way we do assessment. It is in this context that we have assembled the papers for this special issue. One critical feature of this new culture is the increased involvement of the students. An example of this is the article byWagener et al. that reports the results of student-driven competency-based progress test [3]. Not only did the students create the material across faculties for this assessment, but it also informs them about their progression during their studies in light of the NKLM-competencies. One aspect of the culture change is an increased emphasis on using assessment to support learning. For example the article by Profanter et al. focuses on workplace-based assessment which is intended to provide feedback tailored to the strengths and weaknesses of the students [4]. As a result, the teachers modified their educational activities to enhance student learning. Students are often concerned about the fairness in their assessment. One area of on-going concern is the great variability in the grades assigned by various examiners. The paper by Schickler et al. demonstrates the importance of rater training [5]. This calibration of the examiners is important in oral examinations, especially where the stakes are high. It is clear that examiner training is an essential aspect of quality assurance. The paper by Tekian and Norcini focuses on setting standards (i.e., selecting the pass-fail score) for examinations [6]. This topic has been largely ignored in Germany and it is essential to fairness to students. Moreover, the assumption of a 60% standard has the effect of influencing the examination c
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引用次数: 1
"May I help you?" - Evaluation of the new student service at the reception desk during the clinical courses at the Department of Operative Dentistry and Periodontology as a part of a longitudinal curriculum of social and communicative competences for dental students. “我能为您效劳吗?”-在牙科外科和牙周病科临床课程期间,对前台的新学生服务进行评估,作为牙科学生社交和沟通能力纵向课程的一部分。
Pub Date : 2015-08-17 eCollection Date: 2015-01-01 DOI: 10.3205/zma000973
Nora Lichtenstein, Isabelle Ensmann, Rainer Haak, Houda Hallal, Jana Kupke, Jan Matthes, Michael Noack, Michael Wicht, Christoph Stosch

Objectives: Since 2009, the University of Cologne has been developing a longitudinal curriculum for teaching social and communicative skills to dental students (LSK-Dent) based on the recommendations of the Association for Dental Education in Europe (ADEE). As a part of this curriculum it was considered to develop a reception service in the undergraduate treatment courses of the Department of Operative Dentistry and Periodontology involving the organizational and administrative handling of the patients by the students. Students should gain an insight into everyday practice and the reception service should function as a learning environment for social und communicative competences. This article introduces the LSK-Dent project, the implementation of the reception service and presents initial evaluation results.

Methods: Patients (n=575) and students (n=53) filled out a questionnaire. Additionally, four semi-structured interviews with students were conducted.

Results: The reception service was successfully implemented and endorsed by the students. First indications suggest that the reception service was well received by students as a learning environment for social und communicative competences and viewed as an opportunity to gain an insight into everyday practice.

Conclusion: The reception service is an innovative addition to the treatment courses and an example for transforming an already existing reality in a course into a new learning environment for students. To what extent the implementation of reflexive elements can increase the subjectively perceived additional benefit by students, has to be addressed in further studies.

目标:自2009年以来,科隆大学根据欧洲牙科教育协会(ADEE)的建议,开发了一套纵向课程,用于教授牙科学生社交和沟通技巧(LSK-Dent)。作为课程的一部分,我们考虑在牙科外科和牙周病科的本科治疗课程中发展接待服务,包括学生对病人的组织和行政处理。学生应该深入了解日常实践,接待服务应该成为社交和沟通能力的学习环境。本文介绍了LSK-Dent项目中接待服务的实施情况,并给出了初步的评价结果。方法:575例患者和53例学生分别填写问卷。此外,对学生进行了四次半结构化访谈。结果:接待服务实施顺利,得到了学生的认可。最初的迹象表明,接待服务受到学生的欢迎,因为它是一个学习社交和沟通能力的环境,并被视为一个深入了解日常实践的机会。结论:接待服务是治疗课程的创新补充,是将课程中已经存在的现实转化为学生新的学习环境的一个例子。在多大程度上实施反身要素可以增加学生主观感知的额外利益,还有待进一步的研究。
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引用次数: 0
Is German Medical Education Research on the rise? An analysis of publications from the years 2004 to 2013. 德国医学教育研究正在兴起吗?对2004年至2013年出版物的分析。
Pub Date : 2015-08-17 eCollection Date: 2015-01-01 DOI: 10.3205/zma000972
Kristina Ackel-Eisnach, Patricia Raes, Lisa Hönikl, Daniel Bauer, Stefan Wagener, Andreas Möltner, Jana Jünger, Martin R Fischer

Objectives: The point of departure for the present work is the observation that, in comparison with Anglo-American countries or the Netherlands, Germany was responsible for only a marginal number of international publications in the field of medical education research before 2004. Recent years, however, have seen an increase in the importance of medical education research in Germany. The objective of this article is to evaluate the extent to which this trend can be substantiated by increased German publishing activity since the year 2004 in international, English-language journals in the subject area of "medical education research".

Methods: In the framework of a literature and content analysis, German-author articles from the years 2004 to 2013 in six international, English-language medical education research journals were evaluated. In order to obtain an overview of German research activity in this area, all project and original works with German first and last authors were identified and subjected to a more in-depth content analysis.

Results: In total, 10,055 articles were examined. The evaluation shows that between the years 2004 and 2013 179 articles (of which 145 are project or original works) by German authors were published in the journals examined. Fluctuations over the course of time were evidenced. The project and original works are primarily cross-sectional studies (27.8%) and randomised control studies (25.6%) on the subject of "teaching and learning methods" (43.6%).

Conclusions: In comparison with the years 2004-2008, a significant rise can be seen in the number of publications by German education researchers in international journals since the year 2009.

目的:本工作的出发点是观察到,与英美国家或荷兰相比,德国在2004年之前仅负责少量医学教育研究领域的国际出版物。然而,近年来,医学教育研究在德国的重要性有所增加。本文的目的是评价自2004年以来,德国在"医学教育研究"主题领域的国际英语期刊上增加的出版活动在多大程度上证实了这一趋势。方法:在文献和内容分析的框架下,对2004年至2013年发表在6种国际英语医学教育研究期刊上的德国作者文章进行评价。为了获得德国在这一领域的研究活动的概述,所有的项目和原创作品都有德国的第一和最后作者,并进行了更深入的内容分析。结果:共检查10055篇文献。评估显示,在2004年至2013年期间,被调查的期刊上发表了179篇德国作者的文章(其中145篇是项目或原创作品)。随着时间的推移,波动得到了证实。项目和原创作品主要是关于“教学方法”(43.6%)的横断面研究(27.8%)和随机对照研究(25.6%)。结论:与2004-2008年相比,自2009年以来,德国教育研究人员在国际期刊上发表的论文数量显著增加。
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引用次数: 11
GMS publishes your research findings - and makes the related research data available through Dryad. GMS发布您的研究成果,并通过Dryad提供相关研究数据。
Pub Date : 2015-08-17 eCollection Date: 2015-01-01 DOI: 10.3205/zma000976
Ursula Arning
Since 2013, ZBMED – Leibniz Information Centre for Life Sciences has been actively committed to archiving and publishing research data. To offer authors an opportunity to publish research data in parallel with GMS publications, ZBMEDhas become amember of Dryad, an open access repository for the research data underlying articles in peer-reviewed journals. Presently, ten of the journals published by GMS have shown interest in making data accessible, including GMS Zeitschrift für Medizinische Ausbildung (ZMA). What is research data in medicine? Research data in the field of medicine can be statistical data (e.g. from anonymized diagnostic findings), materials (e.g. International Statistical Classification of Diseases and Related Health Problems (ICD)), classifications and codes for diseases, pictures from imaging procedures (e.g. MRT), sensor data from biosignals or vital parameter measurements (e.g. ECG, EEG), biomaterial data from laboratory testing (e.g. blood samples, genome data), administrative patient information (e.g. from hospital information systems), as well as audio-visual data, models, and visualizations. Why should research data be available? Repeated criticism is voiced in the sciences that research findings cannot be verified because the underlying research data have not been published. To aid transparency, good scientific practice should include making data publicly accessible. In addition, a duplication of work can be avoided if certain data do not need to be collected multiple times and can be re-used, even in new contexts. Another advantage is that data can be cited, potentially strengthening the author’s own scientific reputation. Plus, publishing the data can often fulfill the requirements or recommendations of different sponsors, such as DFG, BMBF, EU, NIH, or even the guidelines of the author’s own institution. What are the advantages of making data accessible through Dryad? With scientific societies and publishers among its members, Dryad is an internationally established repository. Its long-term preservation system, CLOCKSS, ensures permanent availability of the data. Dryad makes the data accessible under the terms of a Creative Commons Zero (CCO) license to allow for the widest possible use. In addition, the repository is widely disseminated making the research data easily discoverable. Through cross-referencing between a journal article and the related data set, the documents get new accessibility (see Figure 1). Each data set receives its own permanent digital object identifier (DOI) allowing the data to be cited. Dryad also generates user statistics with which it is possible to ascertain the interest in the data and their potential scientific relevance (see Figure 2). How does publication take place via GMS? ZMA authors can indicate their wish to publish the underlying research data when submitting their manuscripts. If an author agrees, a message is sent directly to Dryad from the manuscript operating system, and a pr
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引用次数: 6
See your GP, see the world - An activating course concept for fostering students' competence in performing vaccine and travel consultations. 看你的全科医生,看世界-一个激活课程的概念,以培养学生的能力进行疫苗和旅行咨询。
Pub Date : 2015-08-17 eCollection Date: 2015-01-01 DOI: 10.3205/zma000970
Esther Beltermann, Sibylla Krane, Jan Kiesewetter, Martin R Fischer, Jörg Schelling

Aim: Performing vaccine and travel consultations is a crucial aspect of the daily routine in general medicine. However, medical education does not provide adequately and structured training for this future task of medical students. While existing courses mainly focus on theoretical aspects, we developed a course aiming to foster practical experience in performing vaccine and travel consultations. Project report: The course was implemented in the simulation clinic at the University of Munich in the summer 2011 semester using role-plays in a simulation-based learning environment. The course represents different disciplines involved in vaccine and travel medicine. Students' learning is supported through active engagement in planning and conducting consultations of patients.

Discussion and summary: The course was implemented successfully and students' acceptance was high. However, there is a need for structured teaching of theoretical basics in vaccine and travel medicine earlier in medical curriculum. The insights gained through our course are used for the development of the structured longitudinal curriculum "vaccine medicine".

目的:开展疫苗和旅行咨询是普通医学日常工作的一个重要方面。然而,医学教育并没有为医学生的未来任务提供充分和结构化的培训。虽然现有课程主要侧重于理论方面,但我们开发了一门课程,旨在培养开展疫苗和旅行咨询的实践经验。项目报告:该课程于2011年夏季学期在慕尼黑大学的模拟诊所实施,在基于模拟的学习环境中使用角色扮演。本课程涉及疫苗和旅行医学的不同学科。学生的学习是通过积极参与计划和进行患者咨询来支持的。讨论与总结:课程实施顺利,学生接受度高。然而,在医学课程的早期,有必要对疫苗和旅行医学的理论基础进行结构化的教学。通过我们的课程获得的见解被用于开发结构化的纵向课程“疫苗医学”。
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引用次数: 0
Towards a measurement of internalization of collaboration scripts in the medical context - results of a pilot study. 对医疗环境中协作脚本内部化的测量——一项试点研究的结果。
Pub Date : 2015-08-17 eCollection Date: 2015-01-01 DOI: 10.3205/zma000974
Jan Kiesewetter, Martin Gluza, Matthias Holzer, Barbara Saravo, Laura Hammitzsch, Martin R Fischer

Background: Collaboration as a key qualification in medical education and everyday routine in clinical care can substantially contribute to improving patient safety. Internal collaboration scripts are conceptualized as organized - yet adaptive - knowledge that can be used in specific situations in professional everyday life. This study examines the level of internalization of collaboration scripts in medicine. Internalization is understood as fast retrieval of script information.

Goal: The goals of the current study were the assessment of collaborative information, which is part of collaboration scripts, and the development of a methodology for measuring the level of internalization of collaboration scripts in medicine.

Method: For the contrastive comparison of internal collaboration scripts, 20 collaborative novices (medical students in their final year) and 20 collaborative experts (physicians with specialist degrees in internal medicine or anesthesiology) were included in the study. Eight typical medical collaborative situations as shown on a photo or video were presented to the participants for five seconds each. Afterwards, the participants were asked to describe what they saw on the photo or video. Based on the answers, the amount of information belonging to a collaboration script (script-information) was determined and the time each participant needed for answering was measured. In order to measure the level of internalization, script-information per recall time was calculated.

Results: As expected, collaborative experts stated significantly more script-information than collaborative novices. As well, collaborative experts showed a significantly higher level of internalization.

Conclusions: Based on the findings of this research, we conclude that our instrument can discriminate between collaboration novices and experts. It therefore can be used to analyze measures to foster subject-specific competency in medical education.

背景:协作作为医学教育和日常临床护理的关键资格,可以大大有助于提高患者安全。内部协作脚本被概念化为可用于专业日常生活中的特定情况的有组织的(但具有适应性的)知识。本研究探讨医学合作剧本的内化程度。内部化可以理解为脚本信息的快速检索。目标:当前研究的目标是评估协作信息,这是协作脚本的一部分,以及开发一种测量医学协作脚本内部化水平的方法。方法:选取20名协作新手(医学生)和20名协作专家(内科或麻醉学专科医师)进行内部协作脚本的对比研究。通过照片或视频向参与者展示了八种典型的医疗协作情况,每种情况5秒钟。之后,参与者被要求描述他们在照片或视频中看到的东西。根据答案,确定属于协作脚本(脚本-信息)的信息量,并测量每个参与者回答所需的时间。为了测量内化程度,计算了每次回忆时间的脚本信息。结果:正如预期的那样,协作专家比协作新手陈述了更多的脚本信息。同时,协作型专家的内化水平明显更高。结论:基于本研究的结果,我们得出结论,我们的工具可以区分合作新手和专家。因此,它可以用来分析在医学教育中培养特定学科能力的措施。
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引用次数: 3
How do Supervising Clinicians of a University Hospital and Associated Teaching Hospitals Rate the Relevance of the Key Competencies within the CanMEDS Roles Framework in Respect to Teaching in Clinical Clerkships? 大学医院和附属教学医院的督导临床医生如何评价CanMEDS角色框架中与临床见习教学相关的关键能力?
Pub Date : 2015-08-17 eCollection Date: 2015-01-01 DOI: 10.3205/zma000975
Stefanie Jilg, Andreas Möltner, Pascal Berberat, Martin R Fischer, Jan Breckwoldt

Background and aim: In German-speaking countries, the physicians' roles framework of the "Canadian Medical Education Directives for Specialists" (CanMEDS) is increasingly used to conceptualize postgraduate medical education. It is however unclear, whether it may also be applied to the final year of undergraduate education within clinical clerkships, called "Practical Year" (PY). Therefore, the aim of this study was to explore how clinically active physicians at a university hospital and at associated teaching hospitals judge the relevance of the seven CanMEDS roles (and their (role-defining) key competencies) in respect to their clinical work and as learning content for PY training. Furthermore, these physicians were asked whether the key competencies were actually taught during PY training.

Methods: 124 physicians from internal medicine and surgery rated the relevance of the 28 key competencies of the CanMEDS framework using a questionnaire. For each competency, following three aspects were rated: "relevance for your personal daily work", "importance for teaching during PY", and "implementation into actual PY teaching".

Results: In respect to the main study objective, all questionnaires could be included into analysis. All seven CanMEDS roles were rated as relevant for personal daily work, and also as important for teaching during PY. Furthermore, all roles were stated to be taught during actual PY training. The roles "Communicator", "Medical Expert", and "Collaborator" were rated as significantly more important than the other roles, for all three sub-questions. No differences were found between the two disciplines internal medicine and surgery, nor between the university hospital and associated teaching hospitals.

Conclusion: Participating physicians rated all key competencies of the CanMEDS model to be relevant for their personal daily work, and for teaching during PY. These findings support the suitability of the CanMEDS framework as a conceptual element of PY training.

背景和目的:在德语国家,“加拿大专家医学教育指令”(CanMEDS)的医生角色框架越来越多地用于概念化研究生医学教育。然而,目前尚不清楚,它是否也适用于临床见习的本科教育的最后一年,称为“实践年”(PY)。因此,本研究的目的是探讨大学医院和附属教学医院的临床活跃医生如何判断七种CanMEDS角色(及其(角色定义)关键能力)在临床工作和PY培训学习内容方面的相关性。此外,这些医生被问及在PY培训中是否真正教授了关键能力。方法:124名内科和外科医生使用问卷对CanMEDS框架的28项关键能力的相关性进行评分。对于每一项胜任力,分别从“与个人日常工作的相关性”、“对PY教学的重要性”、“在实际PY教学中的实施情况”三个方面进行打分。结果:就主要研究目的而言,所有问卷均可纳入分析。所有七个CanMEDS角色都被评为与个人日常工作相关,并且对PY期间的教学也同样重要。此外,所有的角色都是在实际的PY培训中讲授的。在所有三个子问题中,“沟通者”、“医学专家”和“合作者”这三个角色被评为比其他角色重要得多。内外科两个学科之间没有差异,大学附属医院和附属教学医院之间也没有差异。结论:参与的医生认为CanMEDS模型的所有关键能力与他们的个人日常工作和PY期间的教学相关。这些发现支持CanMEDS框架作为PY培训概念要素的适用性。
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引用次数: 26
Finding the right doctoral thesis - an innovative research fair for medical students. 寻找合适的博士论文——为医科学生举办的创新研究博览会。
Pub Date : 2015-08-17 eCollection Date: 2015-01-01 DOI: 10.3205/zma000971
Julius Steffen, Markus Grabbert, Tanja Pander, Maximilian Gradel, Lisa-Maria Köhler, Martin R Fischer, Philip von der Borch, Konstantinos Dimitriadis

Introduction: The importance of research, as promoted by the CanMEDS framework, is widely acknowledged. Many medical students in Germany work on a research project as part of their doctoral thesis whilst still going to medical school. However, a significant amount of projects are abandoned unfinished, which leads to substantial wastage of resources. One reason for this is an information deficit concerning undergraduate research projects.

Project description: To counteract this, we introduced an annual event at LMU Munich called DoktaMed with more than 600 visitors each year. It combines medical convention and research fair including keynote lectures, workshops and poster sessions as well as an exhibition of research groups and institutes. DoktaMed is a peer-to-peer event organized by a team of 40 students.

Results: A needs analysis before its implementation underlined the information deficit as a possible cause for the high rate of abandoned projects. In the annual evaluation, visitors of DoktaMed rate the event with an average grade of 2.1 on a six-level Likert scale (n=558, SD=1.06, with "1=very good", "6=poor"). They stated to now feel better informed about the topic and regarded visiting DoktaMed as a worthwhile investment of time.

Discussion: Students are generally satisfied with the event and feel better informed after visiting DoktaMed. However, many students never visit DoktaMed for various reasons. A possible improvement would be to present a greater number of clinical studies in addition to the laboratory work that DoktaMed focuses on now.

Conclusion: Evaluation after six years of DoktaMed is very promising. Visitors seem to be better informed. Nevertheless there is space for improvement in order to get more students and more faculty members involved. More studies are needed to assess long-term effects.

研究的重要性在CanMEDS框架下得到了广泛认可。在德国,许多医科学生在上医学院的同时,还在做一个研究项目,作为他们博士论文的一部分。然而,大量的项目没有完成就被放弃了,这导致了大量的资源浪费。造成这种情况的一个原因是有关本科生研究项目的信息不足。项目描述:为了解决这个问题,我们在慕尼黑大学引入了一个名为DoktaMed的年度活动,每年有600多名参观者。它结合了医学会议和研究博览会,包括主题演讲、研讨会和海报会议,以及研究小组和研究所的展览。DoktaMed是一个由40名学生组成的团队组织的点对点活动。结果:实施前的需求分析强调了信息缺失是导致项目废弃率高的可能原因。在年度评价中,doktamamed的游客在6级李克特量表(n=558, SD=1.06,“1=很好”,“6=差”)中对该活动的平均评分为2.1分。他们表示,现在对这个话题有了更好的了解,并认为参观doktamamed是一项值得的时间投资。讨论:学生们普遍对活动感到满意,并在参观了DoktaMed后感到更加了解。然而,由于各种原因,许多学生从未访问过DoktaMed。一个可能的改进是,除了doktamamed目前关注的实验室工作外,还将提供更多的临床研究。结论:经6年的临床评价,疗效良好。游客似乎更了解情况。然而,为了让更多的学生和教师参与进来,还有改进的空间。需要更多的研究来评估长期影响。
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引用次数: 6
Position statement GMA Committee--"Interprofessional Education for the Health Care Professions". GMA 委员会的立场声明--"医疗保健专业的跨专业教育"。
Pub Date : 2015-05-13 eCollection Date: 2015-01-01 DOI: 10.3205/zma000964
Ursula Walkenhorst, Cornelia Mahler, Regina Aistleithner, Eckhart G Hahn, Sylvia Kaap-Fröhlich, Sven Karstens, Karin Reiber, Beate Stock-Schröer, Beat Sottas
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引用次数: 0
Assessing family medicine trainees--what can we learn from the European neighbours? 评估家庭医学学员——我们能从欧洲邻国学到什么?
Pub Date : 2015-05-13 eCollection Date: 2015-01-01 DOI: 10.3205/zma000963
Elisabeth Flum, Roar Maagaard, Maciek Godycki-Cwirko, Nigel Scarborough, Nynke Scherpbier, Thomas Ledig, Marco Roos, Jost Steinhäuser

Background: Although demands on family physicians (FP) are to a large extent similar in the European Union, uniform assessment standards for family medicine (FM) specialty training and assessment do not exist. Aim of this pilot study was to elicit and compare the different modalities and assessment methods of FM specialty training in five European countries.

Methods: A semi structured survey was undertaken based on a convenient sample in five European countries (Denmark, Germany, Poland, the Netherlands and the United Kingdom). The respondents were asked to respond to ten items about aspects of FM specialty training and assessment methods in their respective countries. If available, this data was completed with information from official websites of the countries involved.

Results: FM specialty training is performed heterogeneously in the surveyed countries. Training time periods range from three to five years, in some countries requiring a foundation program of up to two years. Most countries perform longitudinal assessment during FM specialty training using a combination of competence-based approach with additional formative and summative assessment. There is some evidence on the assessments methods used, however the assessment method used and costs of assessment differs remarkably between the participating countries.

Conclusions: Longitudinal and competence-based assessment is the presently preferred approach for FM specialty training. Countries which use less multifaceted methods for assessment could learn from best practice. Potential changes have significant cost implications.

背景:虽然欧盟对家庭医生(FP)的需求在很大程度上是相似的,但家庭医学(FM)专业培训和评估没有统一的评估标准。本初步研究的目的是引出并比较欧洲五个国家FM专业培训的不同模式和评估方法。方法:在五个欧洲国家(丹麦、德国、波兰、荷兰和英国)进行半结构化调查。受访者被要求回答关于各自国家FM专业培训和评估方法方面的十个问题。如果有的话,这些数据是根据有关国家官方网站提供的信息完成的。结果:FM专业培训在被调查国家中存在异质性。培训时间从三到五年不等,在一些国家需要长达两年的基础课程。大多数国家在FM专业培训期间进行纵向评估,使用基于能力的方法与额外的形成性和总结性评估相结合。关于所使用的评估方法有一些证据,但是所使用的评估方法和评估费用在参与国之间差别很大。结论:纵向和基于能力的评估是目前FM专业培训的首选方法。使用较少多方面评估方法的国家可以借鉴最佳做法。潜在的变化会带来巨大的成本影响。
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引用次数: 27
期刊
GMS Zeitschrift fur Medizinische Ausbildung
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