GMS Journal for Medical Education最新文献

Objective: Management of osteoarticular infections (OAI) represents a major public health challenge. To deal with this, the French Ministry of Health created the Complex Osteoarticular Infections Referral Centers (CRIOAC) in 2008. CRIOAC functions as a national network of reference centers for OAI, with the aim of coordinating, providing expertise, offering training, and conducting research at the regional level. Through multidisciplinary team meetings (MTM-CRIOAC), experts discuss complex OAI cases and formulate optimal treatment decisions. This study aims to evaluate the perception of the teaching potential of MTM-CRIOAC among orthopedic residents and identify potential areas for improvement.

Methods: To conduct this cross-sectional study a validated questionnaire was distributed to orthopedic residents who participated in said meetings to evaluate their perceptions and benefit. Opinions were then collected using a Likert scale for further evaluation.

Results: Results showed that (75%) found MTM useful for training, and (71%) considered it appropriate for teaching. The majority (84%) reported acquiring valuable skills, with (78%) emphasizing knowledge about complex osteoarticular infections. Residents recommended integrating more classes, active engagement, and thorough case summaries for improvement. Notably, 94% recommended MTM participation for colleagues. The study highlights MTMs' potential in medical education, enhancing clinical skills and collaborative healthcare practices among orthopedic residents.

Conclusion: Previous studies have shown that MTM-CRIOACs have improved patient outcomes. However, the literature has not yet addressed the potential teaching opportunities that MTM-CRIOACs could provide to residents. The study shows that these meetings offer grounds for teaching, enrichment of clinical judgment, professionalism, and collaborative skills of orthopedic residents.

Background: A competency-based education approach calls for frequent workplace-based assessments (WBA) of Entrustable Professional Activities (EPAs). While mobile applications increase the efficiency, it is not known how many assessments are required for reliable ratings and whether the concept can be implemented in all sizes of residency programs.

Methods: Over 5 months, a mobile app was used to assess 10 different EPAs in daily clinical routine in Swiss anesthesia departments. The data from large residency programs was compared to those from smaller ones. We applied generalizability theory and decision studies to estimate the minimum number of assessments needed for reliable assessments.

Results: From 28 residency programs, we included 3936 assessments by 306 supervisors for 295 residents. The median number of assessments per trainee was 8, with a median of 4 different EPAs assessed by 3 different supervisors. We found no statistically significant differences between large and small programs in the number of assessments per trainee, per supervisor, per EPA, the agreement between supervisors and trainees, and the number of feedback processes stimulated. The average "level of supervision" (LoS, scale from 1 to 5) recorded in larger programs was 3.2 (SD 0.5) compared to 2.7 (SD 0.4) (p<0.05). To achieve a g-coefficient >0.7, at least a random set of 3 different EPAs needed to be assessed, with each EPA rated at least 4 times by 4 different supervisors, resulting in a total of 12 assessments.

Conclusion: Frequent WBAs of EPAs were feasible in large and small residency programs. We found no significant differences in the number of assessments performed. The minimum number of assessments required for a g-coefficient >0.7 was attainable in large and small residency programs.

Background: Competency Based Medical Education (CBME) is a global movement in graduate medical training but implementation on a national scale is challenging. One crucial element of fostering CBME is to establish faculty development. We report the design of a national program, the process of implementation, and the results of the first two years.

Methods: Following Kern's cycle of curriculum development, a group of medical education experts designed a training program covering the basic skills for teaching in clinical settings. In addition, we outlined a qualification pathway for future educators in the program.

Results: The program was built upon 1-day-workshops with the topics: "clinical teaching", "feedback and assessment", "clinical leadership", "supporting trainees in difficulties". More than 30 workshops were delivered in two language regions to more than 500 clinical teachers. The median rating whether participants' expectations were met was 9 (of 10 points, IQR 8-9). The qualification pathway for future educators in the program included a nomination, a 2.5-day introductory workshop, shadowing of workshops, and stepwise acquisition of workshop parts as an educator candidate.

Discussion: This faculty development program was well attended and well-received. Using Kern's established model for the design process including an extensive needs assessment helped to serve the goals of the program. Developing future educators for expanding this program proved resource intensive.

Conclusion: Implementing a national faculty development program was successful based on a rigorous design process, a highly motivated expert team, and learning content tailored to the needs of the audience. Effects on the implementation of CBME still need to be evaluated.

Postgraduate medical education (PGME) is an essential part of medical education and increasingly shifts into focus of educational stakeholders. Structured postgraduate medical training programs are required in the U.S. through the "American Council for Graduate Medical Education" (ACGME) guidelines with their six core competencies as common program requirements. The basis for this development was provided in Germany with the implementation of the "Standard Framework for Postgraduate Medical Training" (Musterweiterbildungsordnung) issued by the German Medical Association (Bundesärztekammer). However, implementation has been gradual and program development is often conducted in a time consuming, lengthy and top-down approach without that trainee experiences or needs are being assessed or evaluated for their impact on successful medical training. We demonstrate how application of agile working can enable rapid and efficient creation and implementation of a novel postgraduate training program. The postgraduate training program ped.tracks aims to achieve a high-quality, structured and reliable postgraduate training. Moreover, it provides the opportunity to select a priority on scientific or clinical education. The entire process from the first draft to full release of the program was completed within 8 months through agile working. Our team worked using agile working techniques, creating a trainee- customized and -centred program. We anticipate that the quantity of structured postgraduate training programs will significantly increase in Germany and Europe to improve training quality and employee satisfaction. Therefore, the use of agile methods for the creation and implementation of structured training programs represents a useful approach to support program directors rapidly and effectively in this effort.

Background: The attractiveness of general practice (GP) is increasing, as is evident in its growing popularity among students and the sharp rise in specialist certifications. However, in view of the future challenges at the GP level of care, there is a shortage of young doctors. It would thus be desirable if postgraduate training could be completed quickly, particularly in this area.

Objective: The aim of this article is to improve the state of knowledge of the actual length of postgraduate training in general practice and to identify the motives for choosing this specialty and possible factors influencing postgraduate training length.

Project description: The cross-sectional study conducted of general practitioners (GPs) after completion of the medical specialist examination (survey period January 2020 to September 2023, population 530 persons, response rate 50%, n=265) examines the decision-making processes and the individual course of postgraduate training as pursued by newly certified general practitioners (Fachärzt*innen für Allgemeinmedizin - FÄ AM) in Hesse, Germany.

Results: Excluding lateral entrants (Quereinsteiger*innen), the respondents' length of postgraduate training was 8.88 years on average (SD=3.97, median 7.75 years, Q1=6.0, Q3=10.0). The main reasons stated for choosing the specialty were personal role models and experiences made while studying. The descriptive analysis of the data collected indicates that an early choice of specialization could be associated with a shorter length of postgraduate training.

Conclusion: Positive experiences during medical studies can contribute to a doctor's decision in favor of a specialty and may possibly be a factor in shortening the subsequent length of postgraduate training. From a healthcare perspective, medical education and postgraduate training should therefore be more closely linked so that those starting postgraduate training in general practice have a firm specialty preference in mind more frequently in future.

Introduction: Integrative oncology combines evidence-based methods of oncological therapy, supportive medicine, nutrition and physical activity as well as complementary medicine and can significantly improve the effectiveness of therapy and the quality of life for cancer patients. However, scientifically based continuing education in this area has so far rarely been available.

Project outline: The part-time continuing education program in "Integrative Onkologie" at the University of Jena is the first in Germany to offer scientifically based training for various healthcare professions. The focus lies on evidence-based content regarding the diagnosis, therapy, prevention and survivorship of cancer from the fields of complementary medicine, sport and nutrition. The course comprises 3 semesters of distance learning with one attendance weekend in Jena and concludes with a Master's thesis (M.Sc.). All healthcare professionals with a first university degree in medicine or health sciences and at least one year of professional experience are eligible for admission. The development of the study program was supported by surveys and statements from students and experts.

Results: A demand survey of students (N=128) and statements (N=15) from healthcare professionals show that the course closes a gap in education and training. The course was seen as an attractive and suitable alternative to subject-specific consecutive Master's courses. Its interdisciplinary focus and its high relevance with regard to improvements in healthcare were rated particularly positive. From the students' point of view, the topics of nutrition and physical activity were seen as particularly interesting, while the expert's statements emphasized the need for evidence-based discussion, especially in the field of complementary medicine.

Discussion: The course fills an important gap and provides evidence-based further training in integrative oncology. The presented conditions are rated as appropriate and the extended professional options and improvement of care in everyday practice are emphasized. The course was approved in April 2023 and has already started with the first cohort in the winter semester 2023 (October).

Conclusion: The postgraduate course in integrative oncology at the University of Jena offers thorough training for healthcare professionals and fulfills the requirements for continuing education programs. It can therefore make a significant contribution to medical consultation needs and improving care in oncology and enable a faster path to specialized continuing education for many specialties.

Aim: Both teachers and learners had clear reservations in the beginning about the usefulness and benefits of supervision and feedback, which were to be implemented as a teaching method in the competency-based, post-graduate curriculum in general ambulatory pediatrics, known as PaedCompenda (www.paedcompenda.de). This paper investigates the different perceptions of the physicians undergoing specialist training (Ärzte in Weiterbildung) and elucidates these differences.

Method: The following data were collected as part of the research on the three-year-long implementation (2019-2023):1) Four focus group discussions (N=28) with physician trainees who had no experience in primary care pediatrics or with the post-graduate curriculum;2) Problem-oriented interviews, one at the beginning and again at the end, with physician trainees (N=28) undergoing specialist training at 19 participating medical practices belonging to two post-graduate education networks;3) Videos of patient consultations with the physician trainees (N=23);4) Videos of feedback conferences regarding the videotaped patient consultations (N=7).This data was evaluated using reconstructive grounded theory.

Results: A distinctly more positive perception of the benefits of supervision and feedback as a teaching and learning method was seen in the physicians who received specialist training at the practices following the PaedCompenda curriculum. In regard to method, it is crucial that the educational setting can be experienced as a learning opportunity. Playing a central role in this is constructive and conducive feedback (a. dysfunctional routines, b. underlying lack of confidence, and c. overlooked problems).

Conclusions: This paper shows the opportunities of an institutionalized form of supervision and feedback as part of a competency-based, post-graduate curriculum while also making it clear that implementation is challenging. Furthermore, the medical specialists who serve as trainers need to be specifically trained to know which approaches promote learning effectively.

Objective: In addition to patient consent, learning sonography requires considerable time and personnel resources. To implement patient-friendly and resource-saving ultrasound teaching, a comprehensively equipped sonography simulator (SoSim) was purchased at the Medical Interprofessional Training Centre (MITZ) of the Faculty of Medicine at TU Dresden. In a first step, the SoSim training was trialed in a sample (n=5) in cooperation with the Clinic and Polyclinic for Gynecology and Obstetrics at Dresden University Hospital (GYN). Based on the findings, the aim is to extend the project to University Medicine Dresden.

Description of the project: After creating the necessary structural and organizational conditions, five female GYN trainees trained two defined modules in SoSim on transvaginal and abdominal ultrasound. The evaluation was carried out by online-based evaluation of the participants and process analysis.

Results: The process analysis showed that close supervision of the learners is required and that booking individual appointments is time-consuming. The evaluation of the participants showed a positive mean change in the approval ratings for 11 out of 14 competency-based questions.

Conclusion: Despite the integrated SoSim learning program, support for learners is necessary. By piloting the use of SoSim to teach transvaginal ultrasound as part of gynecological specialist training, University Medicine Dresden is a pioneer in innovative and patient-friendly teaching. The pilot project has laid the foundations for the expansion of the project into other areas.

Aims: Comprehensive provision of general healthcare (i.e. primary care) within the populace is contingent on there being enough general practitioners (GPs) in proximity to patients. It is no longer the case that vacated allocated positions for primary-care physicians are being filled in all regions. Support for specialist training in general medical practice is one of the measures intended to ensure provision of GP services. This analytical project aims to make a data-driven contribution to gauging the impact of such support on primary care in Germany, while also delivering pointers for further research.

Methods: On the basis of routinely collected data, the history of such support was examined in detail for all practice-based, statutory health insurance (SHI)-accredited GPs during the period 2016-2022. In the analysis, GPs were broken down by whether they took up full-time or part-time roles, self-employed or salaried roles, and roles in a practice or in an ambulatory healthcare centre (MVZ).

Results: During the period under review, the proportion of those who have both recently commenced work as SHI-accredited GPs and had previously used support for their specialist training, increased from 57% to 81%. The total number of new GPs (headcount) rose from 1,590 to 1,955. Results indicate that those who had availed themselves of this support take up self-employed and full-time roles more often than those who had not.

Conclusions: Both take-up of support for specialist training, and the number of new GPs, increased markedly during the period under review. The data does not indicate any causal links. However, these results could form a jumping-off point for further research (in general) into support for specialist training, and (in particular) into how this may impact these individuals' subsequent work roles.

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.