GMS Journal for Medical Education最新文献

Four years after the entry into force of the new allocation rules, this position paper by the Committee on Student Selection of the GMA presents an initial interim assessment of the intended aspects of aptitude, public welfare considerations, and the social state principle, while also addressing equality-based admission. Academic achievement continues to be used as the primary selection criterion, even though it only moderately predicts success in the first phase of study and tends to favor both socioeconomically advantaged applicants and female high school graduates. HamNat and TMS results increase the predictive validity of the school-leaving grade and, in particular, improve the chance of admission for male applicants. Consideration of public welfare aspects is only partially achieved in view of the preferential allocation of study places to federal states with good medical care. Immediate measures in response to already apparent consequences should include: 1) a revision of the state treaty in order to i) reconcile individual fairness with a needs-based distribution of study places to state residents in the algorithm for the federal list based on school-leaving grades, and ii) enable the tracking of individual study trajectories to evaluate the effects of selection criteria and, if necessary, make adjustments; 2) examining whether a combination of HamNat and TMS further improves the predictive validity for study success compared to using only one of them; 3) giving the school-leaving grade less weight in the allocation of study places in favor of HamNat and/or TMS, to increase gender equality and favor socioeconomically disadvantaged applicants, thereby enhancing diversity within the student body; 4) ensuring that the criterion of fairness is examined and weighed in all test procedures considered in student selection. This could promote diversity in medical education and lead to a future medical profession that continues to adequately represent and serve the entire population.

Objective: We aimed to examine how neutral and smiling facial expressions, as indicators of non-verbal first impressions, influence ad hoc entrustment and perceptions of trustworthiness in a person in medical scenarios that demand entrustment decisions.

Methodology: Within the framework of entrustable professional activities (EPA), we tested three hypotheses in an online study using avatar simulations. As a pilot study and for reasons of sample accessibility, 268 medical students (67.2% female) read 36 narrative clinical entrustment situations in a randomized order. The participants then had to decide whether to entrust the clinical task to fellow students who appeared in short videos as standardized avatars. For each scenario, two avatars were presented and randomly matched for different facial expressions (Duchenne smile (DS), neutral), genders, and morphologies. The participants also assessed the avatars' perceived trustworthiness.

Results: Entrustment and trustworthiness were positively correlated (H1). However, when utilizing mixed-effects models, no significant differences were found between the avatars that displayed a DS and those with a neutral expression regarding positive entrustment decisions (H2) or trustworthiness ratings (H3).

Conclusion: We found that trustworthiness was linked to entrustment, which supports previous findings on trustworthiness as a person-related prerequisite for entrustment decisions. Internalized patterns of the DS did not influence the medical students' entrustment decisions in the first-impression situations. This suggests that in ad hoc medical entrustment scenarios, factors such as context or other aspects of a trustee's first impression may shape trustors' decisions.

Background: The accurate assessment of skin lesions is one of the core tasks of professional nursing practice. Cutaneous signs depend on the skin color due to the melanin content. Nursing students must therefore learn how skin lesions look in different skin colors.

Aim: The aim of this short report is to describe the current state of representation of different skin colors in German nursing textbooks. The research question was: To what extent are different skin colors represented in German nursing textbooks?

Methods: A systematic analysis of ten German nursing textbooks was conducted. The included images were divided into the ten skin colors according to the Monk Skin Tone Scale. Categories A to D were classified as light, E to G as medium and H to J as dark skin.

Results: Ten textbooks were included and 475 images analyzed. One hundred images (21.1%) showed skin color A, 118 (24.8%) B, 128 (26.9%) C, 94 (19.8%) D, 29 (6.1%) E, five (1.1%) F, one (0.2%) G and none each of H, I and J. In total, 92.6% (n=441) show light skin tones and 7.4% (n=35) medium skin colors.

Conclusions: There is a significant underrepresentation of darker skin colors in images depicting clinical signs and dermatological diseases. This gap in education may lead to delayed symptom recognition, delayed interventions, and possibly wrong diagnoses. Textbooks should be revised to include a broader representation of skin colors, and darker skin colors should be integrated into nursing education to compensate for this limitation.

The use of patient-related outcomes in medical education research has gained traction over the past 25 years, yet it remains underutilized. In 2001, less than 7% of medical education publications included patient outcomes, despite the goal being the production of high-quality healthcare providers. This commentary discusses common sources of patient outcome data, their applications, and challenges. Administrative databases and Patient-Reported Outcome Measures (PROMs) are key sources of data, with PROMs capturing patients' direct reports of their health status. PROMs are particularly useful when administrative data are scarce, such as in Europe. They can be employed to assess a variety of educational impacts, including the effect of physician experience on patient satisfaction and outcomes, as well as error rates in diagnosis and treatment. Challenges in using such data include difficulty identifying appropriate outcomes and attribution of results to individual providers given patient-specific factors and the growing importance of team-based care. Consequently, large numbers of patients are needed to produce meaningful results. Despite these challenges, PROMs hold promise for improving medical education by focusing on what is most important - outcomes for patients.

In recent decades, medical education research has increasingly investigated the subjectivity and viewpoints of (pre-service) healthcare professionals. A promising approach for exploring subjectivity is Q-methodology (Q). Q, which combines qualitative and quantitative methods, involves a card-sorting process in which participants are asked to sort statements into a (normal distribution) grid according to their preferences. Similar sorting patterns are then summarized into profiles and described narratively. A central element of this process is the design of the Q-sample - a set of statements representing a wide range of opinions, beliefs, or perspectives on the subject of study. The Q-sample is, therefore, critical for the success of a Q-study and requires precise development steps. Currently, these steps are only preliminarily described in the literature. The present paper addresses this gap by defining a seven-step approach to Q-sample design based on interview data. It offers a systematic and methodological approach that captures the diversity of viewpoints on a particular research topic. Building on a previous qualitative study, it demonstrates how to translate interview data into a Q-sample while ensuring coverage and balance through the use of a mapping technique. The paper also addresses the significance of editing and how to preserve the everyday language of participants when modifying the Q-sample to facilitate self-reference. A comprehensive overview of the criteria for designing a Q-sample is provided. Practical recommendations for selecting a Q-sample and implementing Q-methodology in medical education are offered, and potential challenges are discussed in detail.

This article explores the question of how document analyses can be used as a research methodology in academic training resp. teaching and learning research. Documents are texts of different origins, types and quality that are not influenced by researchers, were not created for the research itself and can therefore be understood as objectifications of social reality. Therefore, they contain research-relevant information for which certain conditions of origin are unknown at the same time. In academic teaching, documents such as examination regulations often standardise or structure the practice of teaching and learning and are therefore particularly relevant for academic training and teaching-learning research. The decisive factor for the use of document analysis is the research interest. Documents are often used as a first or additional data source. Document analyses are then usually part of a multi-method approach or are used in preparation for further research steps or to examine relevant research results with regard to their significance. The increase in non-textual, multimodal documents means that document analyses are becoming increasingly important as an independent method in research. The article reflects on the method using a case study of a two-stage document analysis in the form of a website analysis and a textual document analysis.

Science is dependent on philosophy for many of its core concepts, for its ongoing development, and for the means to appraise what it does and what it produces. Despite this, medical education scholars often seem to have little grounding in philosophy as it applies to the work they do. In this commentary, the author considers some key philosophical questions related to medical education. For example, what is the purpose of medical education? What are the meanings, uses, and implications of generalizability and the middle-range in medical education? How are theory and practice connected? What are the ontological, epistemological, and axiological capabilities of different theories and methodologies? In what ways and to what ends should knowledge claims be appraised? What are the limitations of science and the knowledge it can produce? What makes a 'good' researcher? Medical education scholars need to be able to answer these kinds of philosophical questions if the quality and utility of medical education science is to be assured.

Background: Medical education research (MER) seeks to contribute to the scientific knowledge in this area and to the further development of educational practice. However, the lack of relevance of the studies conducted in this field has been criticized for years. The present work therefore aims to clarify the tasks and objectives of MER and the nature of research in this area. To this end, the subjects, objectives, and types of research that are common to MER are analyzed and categories for these are developed.

Method: The categories for research subjects and research objectives were developed iteratively in three phases with multiple rounds based on samples of peer-reviewed articles. Depending on the round, two to six people were involved in the independent categorization, finding mutual consent, and further development of the categories. At the same time, research types were defined for MER.

Results: 169 articles were assessed. Eleven subject categories and eight categories of research objectives were identified, and four types of research were defined as relevant.

Discussion: The categories found for research subjects partly coincide with existing category systems but also broaden them. The research objectives identified are more specific than they have been before, which limits the scope for interpretation.

Conclusion: The category systems developed can help to define the subjects and objectives of medical education research more precisely and to differentiate between the research types and their significance. In addition, trends and temporary phenomena can also be depicted using the categories found.

Background: The focus of educational research has shifted from teaching to learning. Psychological theories and methods on student learning are increasingly used in health sciences education (HSE) research. However, applying those theories, methods and practices to HSE poses several challenges.

Key statements: The first challenge relates to theoretical foundations in HSE studies. They are often inadequately described due to differences in writing conventions between psychological and medical disciplines. Moreover, HSE researchers are often trained in medical sciences but not in psychology, leading to potential misconceptions. Interdisciplinary collaboration and more thorough theoretical foundations are essential to overcoming these barriers. The second challenge is implementing effective study designs. HSE research often focuses on improving teaching within individual institutions, but generalizable results require data from multiple institutions. Additionally, HSE researchers without social science training may struggle with study design. Resources for capacity building and systematic educational research are needed, as well as establishing interinstitutional, interdisciplinary networks. The third challenge is the transfer of scientific evidence into educational practice. While it is common sense to provide evidence-based healthcare, less effort is put into providing evidence-based HSE. Quality assurance agencies and ministries can establish regulations pertaining to teacher education to enhance education.

Conclusion: In conclusion, the integration of educational psychology into HSE research poses significant challenges. We need collaborative and interdisciplinary effort, incorporating thorough theoretical frameworks, supportive institutional policies, and effective study designs to address these challenges.