GMS Journal for Medical Education最新文献

Background: Professionalism is an important prerequisite for the quality of medical care with specific competencies anchored in the National Competence-Based Learning Objectives Catalogue Medicine 2.0. To date, there are hardly any explicit teaching formats at German universities to achieve these. A longitudinal curriculum for the development of medical professionalism (LongProf) has now been developed, implemented and evaluated at Jena University Hospital.

Methods: The target group of the four-semester-curriculum were medical students from the fifth semester onwards. After a nine-month conception phase, a total of nine courses (6 teaching units each) took place from the winter semester 2021/22. Students also had the opportunity to interact with experienced doctors in mentoring sessions. The courses were evaluated by the participating students (n=23) in terms of acceptance and individually perceived professional development through quantitative surveys and qualitative focus group interviews.

Results: The qualitative and quantitative evaluation revealed mostly positive feedback (mean >7/9). Students stated that the courses had provided them with lasting support in developing their own medical professionalism and in coping with the demands of their studies. The personal and long-term relationship building between students and teachers was considered particularly helpful.

Discussion and conclusion: A multi-semester curriculum opens up ways for implementing the development of medical professionalism in medical studies. A trusting relationship between students and teachers, made possible by the longitudinal structure, is seen as conducive to the development of an individual medical identity. The curriculum is a useful complement to regular medical studies.

Background: Self-directed learning in the workplace should lead to the mastery of predefined learning objectives, with subjective competence judgements steering learning and promoting acceptance of feedback. Rotations should support self-directed learning in basic training by allowing junior physicians (JPs) to apply basic clinical competencies in various internal medicine and surgical departments.

Aim: The study hypothesises that rotations support self-directed learning, as measured by self-judgements and supervisor judgements. Additionally, it describes JPs' willingness to reflect on their learning needs at the end of their basic training.

Methods: This longitudinal study comprises 147 pseudonymised logbooks completed by JPs from three Vienna healthcare group (WIGEV) clinics. The logbook accompanies JPs' training, requiring them and their supervising specialist physicians to rate their training goal completion (10-level % scale) in training months 2, 3, 5, 6, 8 and 9. In addition, in months 3, 6 and 9, the JPs document the level of competence (knowledge, experience and proficiency) they feel they have achieved for each learning objective specified by the Austrian medical association (ÖÄK).

Results: The self-judged level of training goal completion demonstrates a multi-peaked distribution with an increasing trend; the supervisors' judgement of JPs' level of training goal completion is almost parallel. The share of learning objectives where the required level of competence is seen as not yet mastered decreases throughout the training. In the 9^th month of training, approximately ¼ of the JPs indicated a need to learn in ≥10% of the learning objectives, independent of the training clinic.

Conclusions: After switching departments, JPs downgraded their rating of training goal completion. Rotation supports realistic self-judgement, as competencies must be applied and reassessed in a new context. Most JPs consider the required level of competence per learning objective to be mastered at the end of basic training, yet they remain prepared to reflect critically on their learning needs.

Intervention reasoning as a critical component of clinical reasoning has been understudied in medical education in contrast to the well-established field of diagnostic reasoning. This resonates in a lack of comprehensive understanding of the cognitive processes involved and a deficit in research to promote intervention skills in future clinicians. In this commentary, we present a conceptual framework for intervention reasoning that includes four phases: generating, selecting, implementing, and evaluating interventions. The conceptualization highlights cognitive processes such as developing interventions based on a patient's diagnosis and signs and symptoms; selecting the most appropriate option by contrasting, prioritizing, and evaluating interventions in terms of feasibility, effectiveness, and the patient's context-specific needs; and predicting patient outcomes within so-called "developmental corridors" to adjust treatments accordingly. In addition to these cognitive processes, interventions require collaborative activities, such as sharing information with other care providers, distributing roles among care teams, or acting together. Future research should validate the proposed framework, examine the impact of intervention reasoning on clinical outcomes, and identify effective training methods (e.g., simulation and AI-based approaches). In addition, it would be valuable to explore the transferability and generalizability of the model to other areas of health education and contexts outside of health education.

Objectives: As part of the further development of an existing training program on scientific skills for health services research at the University Hospital Tübingen, the aim of the study is to determine the level of knowledge, utilization and needs for continuing education among staff.

Methods: In 2022, a semi standardized anonymous cross-sectional survey was conducted at the University Hospital Tübingen. The content of the questionnaire survey was the level of knowledge and utilization of various research methods, the need for continuing education on these and other healthcare research-related topics and the preferred training concept. The data analysis was carried out descriptively based on absolute and relative frequencies overall and grouped according to the scientific experience of the participants.

Results: Participants' self-assessment indicated that a proportion of them had research skills. However, the level of knowledge and utilization varied greatly with regard to different research methods. The 222 participants most frequently expressed a desire for continuing education in the preparation of meta-analyses (56%), questionnaire validation (43%) and -development (42%). There was also great interest in continuing education in the fields of project coordination (57%), third-party funded projects (46%) and science communication (45%).

Conclusion: The survey highlights existing research skills and the need for methodological qualification in the field of healthcare research among the staff of the University Hospital Tübingen. The focus appears to be on evidence generation, methods of empirical social research and general research-related skills. The results will be used to design new training courses with a focus on health services research.

Objective: Teaching by trainee doctors is also established practice in general practice in English-speaking countries. This study examines the involvement of trainee doctors in the supervision of students in German general practices and the acceptance of trainee doctors as teachers from the perspective of physicians with a license for post-graduate training (PLT) and the trainee doctors themselves.

Methodology: Semi-structured qualitative interviews were conducted with 9 PLTs and 9 trainees. The interview guide was developed based on the Theoretical Framework of Acceptance. Interviews were recorded, transcribed and evaluated using Kuckartz's qualitative analysis.

Results: Trainee doctors are involved in student supervision in GP teaching practices to varying degrees and often in unstructured ways. Supervision by trainees is considered advantageous as they are closer in terms of hierarchy, possess more up-to-date knowledge and are less far ahead in terms of knowledge and function as role models. However, professional uncertainty or revealing knowledge gaps to patients and students is experienced as difficult by some trainees. Competing for time with patient care is seen as a challenge. Better time planning and didactic preparation could avoid pressure in this area. Teaching is seen as part of the GP profession, especially by trainee doctors. However, a potential obligation to teach is seen as more of a hindrance to encouraging the next generation of doctors by both trainee doctors and PLTs.

Conclusion: The inclusion of trainee doctors in student teaching is frequently practiced by those surveyed, which suggests a high level of acceptance but is not consistently implemented. Structured organization of teaching in real life, didactic qualifications and offering credits for teaching activities might further improve inclusion and acceptance.

Objective: The aim of the study was to investigate how medical students' deal with their own questions of meaning during their studies, how they cope with patients' questions of meaning or crises of meaning, to what extent their experience of meaning changes during their studies, and what role medical studies play in this.

Methods: In 2022, we conducted an exploratory cross-sectional study in the form of an online survey at two German universities with students in the clinical part of their studies. Quantitative data were analyzed descriptively, and group differences were analyzed using Mann-Whitney U tests. Free-text comments were analyzed using thematic analysis.

Results: Of the 111 participants (response rate 12%), 92% had addressed questions of meaning. 64% of the students felt that their studies were meaningful, and 45% felt that their clinical internships were meaningful. 59% reported that they had been confronted with questions of meaning in their contact with patients, although many of them felt that they had been inadequately prepared for this (56%). This impression was stronger among respondents at the beginning of the clinical phase compared to respondents at the end (U(56,34)=660, p=0.012). According to the students, strategies for dealing with questions of meaning were active engagement with topics of meaning, tolerance of uncertainties, or avoidance. In addition to the basic requirement of openness to all topics of meaning, students expressed the wish to be better prepared for professional questions of meaning and for follow-up work on stressful events. A wide range of critical experiences with training and the healthcare system had an inhibiting effect on the experience of meaning.

Conclusion: Since a higher sense of purpose can be associated with improved health and motivation, university programs might have the potential to support students' sense of purpose and, in the long term, improve their capacities to support patients who grapple with questions of meaning.

The high performance of generative artificial intelligence (AI) and large language models (LLM) in examination contexts has triggered an intense debate about their applications, effects and risks. What legal aspects need to be considered when using LLM in teaching and assessment? What possibilities do language models offer? Statutes and laws are used to assess the use of LLM: - University statutes, state higher education laws, licensing regulations for doctors - Copyright Act (UrhG) - General Data Protection Regulation (DGPR) - AI Regulation (EU AI Act) LLM and AI offer opportunities but require clear university frameworks. These should define legitimate uses and areas where use is prohibited. Cheating and plagiarism violate good scientific practice and copyright laws. Cheating is difficult to detect. Plagiarism by AI is possible. Users of the products are responsible. LLM are effective tools for generating exam questions. Nevertheless, careful review is necessary as even apparently high-quality products may contain errors. However, the risk of copyright infringement with AI-generated exam questions is low, as copyright law allows up to 15% of protected works to be used for teaching and exams. The grading of exam content is subject to higher education laws and regulations and the GDPR. Exclusively computer-based assessment without human review is not permitted. For high-risk applications in education, the EU's AI Regulation will apply in the future. When dealing with LLM in assessments, evaluation criteria for existing assessments can be adapted, as can assessment programmes, e.g. to reduce the motivation to cheat. LLM can also become the subject of the examination themselves. Teachers should undergo further training in AI and consider LLM as an addition.

Aim: Placebo and nocebo effects are based on expectations that are formed by how doctors communicate and can influence the efficacy of medical treatment. Given the implications for doctor-patient communication and the learning objectives listed in NKLM 2.0, we herein present a novel teaching and learning concept to impart competency-based knowledge about placebo and nocebo effects.

Method: The teaching and learning concept was piloted with N=324 third-semester medical students. It combines a self-guided, small-group component to gather communication strategies and apply them in a video-recorded conversation, followed by a classroom-based session to reflect on and discuss the videos and to learn basic scientific and theoretical knowledge. The evaluation involved written feedback from the students and lecturers (structure/process) and an analysis of the videos (students' learning success). To supplement this, the overall course evaluation was included since this new teaching concept was not specifically evaluated by the students.

Results: Course structure and process were rated positively. The active involvement of the students in the subject matter and the balance between theoretical, scientific and practical content was emphasized positively. Analysis of the learning success showed that the students were able to effectively transfer the knowledge gained about placebo and nocebo effects to conversational situations.

Conclusion: The topic of placebo/nocebo is optimally suited to teach communication skills with its many links to knowledge, translational approaches and added value for medical practice. When doing this, video-recorded conversations appear to be an effective tool to achieve learning objectives. This teaching and learning strategy offers possibilities for expanding communication curricula.

Introduction: Clinical reasoning ability is one of the core competencies of physicians. It should already be trained during undergraduate medical education. At University Medical Center Göttingen (UMG), medical students can participate in formative key feature examinations in which they work on virtual patient cases in order to apply and deepen the procedural knowledge acquired in lectures and seminars.

Problem and objective: While this teaching format is already established in the medical curriculum at the UMG, it has not yet been implemented in the dental curriculum at the same institution. Therefore, the current project aimed to evaluate the feasibility of formative key feature examinations in dental education.

Methods: In 2022, new key feature cases focusing on dental-surgical teaching content were created. For pilot testing, the new cases were worked on by two cohorts of dental students via an online learning platform in February 2023. The students were also asked to complete an anonymous online questionnaire in order to evaluate the new teaching format.

Results: Overall, the formative key feature examinations were evaluated positively by the dental students, and they demanded for further dental key feature cases. However, descriptive analyses of item characteristics as well as students' comments in the questionnaire revealed some potential for improvements, so that a few cases were partly revised afterwards.

Conclusion and outlook: This project shows that formative key feature examinations are feasible in dental education and that dental students can benefit from working on virtual case scenarios. Whether dental students' clinical reasoning competence can be improved by completing formative key feature examinations is being investigated in an ongoing study at the UMG.