Pub Date : 2023-09-15eCollection Date: 2023-01-01DOI: 10.3205/zma001645
Lena Dahmen, Maike Linke, Achim Schneider, Susanne J Kühl
Objective: A simulated conversation between a physician and a family member, i.e., a medical conversation, was changed from a conventional face-to-face conversation (SS 2019) to a telehealth conversation (SS 2020) due to the COVID-19 pandemic. The medical education conversation is part of the biochemistry seminar "From Genes to Proteins" which second semester human medicine students take. The objective of this study was to analyze to what extent the switch from face-to-face to telehealth conversations affected student satisfaction and motivation.
Methodology: In the seminar, students study biochemical as well as competency-oriented content, such as how to talk to family members. In the summer semester of 2019, students were trained how to talk to their patients' family members in a traditional conversation setting with the help of lay actors in a classroom format. In the summer semester of 2020, this conversation took place under comparable conditions, but in the form of an online telehealth conversation instead. Student satisfaction and motivation were surveyed by means of an evaluation questionnaire following the seminar in both semesters.
Results: Both conversation formats achieved a high level of satisfaction from students (school grade A-B). For some evaluation items, such as "realistic conversation simulation", the face-to-face conversation was perceived as more satisfying (Md=5.0, IQR=1.0) than the telehealth conversation (Md=5.0, IQR=2.0). In addition, the face-to-face conversation resulted in higher subjective motivation from students (Md=5.0, IQR=1.0) than that of the telehealth conversation (Md=4.0, IQR=2.0).
Conclusion: The high student satisfaction and acceptance of both didactic concepts leads to the conclusion that the simulated telehealth conversation is an adequate substitute for the simulation of a traditional face-to-face conversation with regard to the parameters that were studied.
{"title":"Medical students in their first consultation: A comparison between a simulated face-to-face and telehealth consultation to train medical consultation skills.","authors":"Lena Dahmen, Maike Linke, Achim Schneider, Susanne J Kühl","doi":"10.3205/zma001645","DOIUrl":"10.3205/zma001645","url":null,"abstract":"<p><strong>Objective: </strong>A simulated conversation between a physician and a family member, i.e., a medical conversation, was changed from a conventional face-to-face conversation (SS 2019) to a telehealth conversation (SS 2020) due to the COVID-19 pandemic. The medical education conversation is part of the biochemistry seminar \"From Genes to Proteins\" which second semester human medicine students take. The objective of this study was to analyze to what extent the switch from face-to-face to telehealth conversations affected student satisfaction and motivation.</p><p><strong>Methodology: </strong>In the seminar, students study biochemical as well as competency-oriented content, such as how to talk to family members. In the summer semester of 2019, students were trained how to talk to their patients' family members in a traditional conversation setting with the help of lay actors in a classroom format. In the summer semester of 2020, this conversation took place under comparable conditions, but in the form of an online telehealth conversation instead. Student satisfaction and motivation were surveyed by means of an evaluation questionnaire following the seminar in both semesters.</p><p><strong>Results: </strong>Both conversation formats achieved a high level of satisfaction from students (school grade A-B). For some evaluation items, such as \"realistic conversation simulation\", the face-to-face conversation was perceived as more satisfying (<i>Md=5.0, IQR=1.0</i>) than the telehealth conversation (<i>Md=5.0, IQR=2.0</i>). In addition, the face-to-face conversation resulted in higher subjective motivation from students (<i>Md=5.0, IQR=1.0</i>) than that of the telehealth conversation (<i>Md=4.0, IQR=2.0</i>).</p><p><strong>Conclusion: </strong>The high student satisfaction and acceptance of both didactic concepts leads to the conclusion that the simulated telehealth conversation is an adequate substitute for the simulation of a traditional face-to-face conversation with regard to the parameters that were studied.</p>","PeriodicalId":45850,"journal":{"name":"GMS Journal for Medical Education","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10594035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50163217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-15eCollection Date: 2023-01-01DOI: 10.3205/zma001646
Stefanos A Tsikas, Volkhard Fischer
Objective: The model curriculum HannibaL (Hannoversche integrierter berufsorientierter und adaptiver Lehrplan) differs significantly from other medical study programs in Germany in terms of its structure with which, among other factors, the Hannover Medical School (MHH) saw an opportunity to positively influence the length of study. We investigate how the length of medical study is influenced by the curriculum's structure and whether this has any impact on academic success.
Methods: We use data from over 2,500 students who studied medicine at MHH between 2011 and 2021. We measure study time as the number of years which pass until completion of the respective study phases and academic success as the grades achieved on final exams.
Results: Since they more often fail or postpone exams, students admitted based on special quotas (VQ) or a waiting list (WQ) need significantly more time to complete the first study phase (M1) compared to students who were admitted based on a selection process (AdH) or who belong to the "best school graduates" quota (AQ) because they earned the highest scores on the final secondary school exam. Yet, students from all admission groups reach the written state exam (M2) almost simultaneously. In HannibaL, WQ and VQ manage to catch up on delays from M1 with no negative impact on success in M2. In general, however, VQ and WQ achieve lower grades and drop out more often than students from AQ and AdH.
Discussion: In the regular curriculum, students can only proceed with their studies once M1 has been entirely completed. HannibaL, on the other hand, allows for the catching up of delays from the first two years of study by integrating both study phases. The curricular structure thus accommodates students with lower academic performance who accumulate delays early on in their studies. By contrast, delays in the AQ and AdH groups arise during the second phase of study (M2).
目的：HannibaL（Hannoversche integrierter berufsorientierter und adapter Lehrplan）模式课程在结构上与德国其他医学学习项目有很大不同，除其他因素外，汉诺威医学院（MHH）认为有机会对学习时间产生积极影响。我们调查了医学学习的时间长度如何受到课程结构的影响，以及这是否对学业成功有任何影响。方法：我们使用了2011年至2021年间在MHH学习医学的2500多名学生的数据。我们将学习时间衡量为完成各个学习阶段所需的年数，将学业成绩衡量为期末考试的成绩。结果：由于根据特殊配额（VQ）或等待名单（WQ）录取的学生往往无法通过或推迟考试，因此与根据选拔程序（AdH）录取或因在中学期末考试中获得最高分数而属于“最佳学校毕业生”配额（AQ）的学生相比，根据特殊配额或等待名单录取的学生需要更多的时间来完成第一个学习阶段（M1）。然而，来自所有录取组的学生几乎同时参加州笔试（M2）。在汉尼拔，WQ和VQ设法赶上了M1的延迟，而对M2的成功没有负面影响。然而，总的来说，与AQ和AdH的学生相比，VQ和WQ的成绩更低，辍学率更高。讨论：在常规课程中，学生只有在M1完全完成后才能继续学习。另一方面，汉尼拔通过整合两个研究阶段，弥补了前两年研究的延迟。因此，课程结构适应了学习成绩较低的学生，他们在学习初期就积累了延迟。相反，AQ和AdH组的延迟出现在研究的第二阶段（M2）。
{"title":"Effects of the alternative medical curriculum at the Hannover Medical School on length of study and academic success.","authors":"Stefanos A Tsikas, Volkhard Fischer","doi":"10.3205/zma001646","DOIUrl":"10.3205/zma001646","url":null,"abstract":"<p><strong>Objective: </strong>The model curriculum HannibaL (Hannoversche integrierter berufsorientierter und adaptiver Lehrplan) differs significantly from other medical study programs in Germany in terms of its structure with which, among other factors, the Hannover Medical School (MHH) saw an opportunity to positively influence the length of study. We investigate how the length of medical study is influenced by the curriculum's structure and whether this has any impact on academic success.</p><p><strong>Methods: </strong>We use data from over 2,500 students who studied medicine at MHH between 2011 and 2021. We measure study time as the number of years which pass until completion of the respective study phases and academic success as the grades achieved on final exams.</p><p><strong>Results: </strong>Since they more often fail or postpone exams, students admitted based on special quotas (VQ) or a waiting list (WQ) need significantly more time to complete the first study phase (M1) compared to students who were admitted based on a selection process (AdH) or who belong to the \"best school graduates\" quota (AQ) because they earned the highest scores on the final secondary school exam. Yet, students from all admission groups reach the written state exam (M2) almost simultaneously. In HannibaL, WQ and VQ manage to catch up on delays from M1 with no negative impact on success in M2. In general, however, VQ and WQ achieve lower grades and drop out more often than students from AQ and AdH.</p><p><strong>Discussion: </strong>In the regular curriculum, students can only proceed with their studies once M1 has been entirely completed. HannibaL, on the other hand, allows for the catching up of delays from the first two years of study by integrating both study phases. The curricular structure thus accommodates students with lower academic performance who accumulate delays early on in their studies. By contrast, delays in the AQ and AdH groups arise during the second phase of study (M2).</p>","PeriodicalId":45850,"journal":{"name":"GMS Journal for Medical Education","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10594034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50163215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Trust in the health care system and especially in the doctor who treats them directly leads to an improvement in treatment outcomes [1]. The doctor's behavior influences the patient's trust [2]. In the national average, about 90% of patients have said for years that they are satisfied with their doctor, but 10% of patients have consistently no good or very good relationship with their doctor over years [http://www.kbv.de/html/ versichertenbefragung.php]. There are clear variations depending on the origin of patients and medical persons or also between the federal states. Already the privacy at the reception of a practice or an impersonal hospital, for example, plays a major role in whether the patient feels accepted or not. In 2021, 39% of respondents were less satisfied or not at all satisfied with the privacy at the reception. In 2017, 6% of patients said that despite explaining the acute problem or illness, they did not understand it. Unfortunately, patients then ask too few questions so as not to hold up the health service operation or the omniscient staff members. “It is one of the most important conversations in a person's life when they find out they are seriously ill,” says Jan Stöhlmacher, a hematologist and oncologist. He accompanied two of his closest relatives through these stages of life, observing his own emotions, reflecting on the behavior of himself and, above all, of his caring medical colleagues. Repeatedly, the reaction of the doctors seemed inappropriate to him. These experiences and his individual way of dealing with his own helplessness led to an intensive study of the topic “Trust – what patients and relatives can do for a good climate of discussion”. Thoughts and suggestions for improving communication can be found in the literature, e.g., with oncological patients [3], [4]. But it is precisely the authentic descriptions of situations from the perspective of an affected relative that enable comprehensible emotional reactions promoting empathy for patients, respect their inviolable dignity and point out possible deficiencies in verbal and non-verbal communication. This perspective is certainly new and not yet sufficiently presented in the literature. For which target groups could the book be of relevant use?
{"title":"Jan Stöhlmacher: Damit Vertrauen im Sprechzimmer gelingt: Ein persönlicher Wegweiser für Patienten und ihre Angehörigen","authors":"M. Angstwurm","doi":"10.3205/zma001623","DOIUrl":"https://doi.org/10.3205/zma001623","url":null,"abstract":"Trust in the health care system and especially in the doctor who treats them directly leads to an improvement in treatment outcomes [1]. The doctor's behavior influences the patient's trust [2]. In the national average, about 90% of patients have said for years that they are satisfied with their doctor, but 10% of patients have consistently no good or very good relationship with their doctor over years [http://www.kbv.de/html/ versichertenbefragung.php]. There are clear variations depending on the origin of patients and medical persons or also between the federal states. Already the privacy at the reception of a practice or an impersonal hospital, for example, plays a major role in whether the patient feels accepted or not. In 2021, 39% of respondents were less satisfied or not at all satisfied with the privacy at the reception. In 2017, 6% of patients said that despite explaining the acute problem or illness, they did not understand it. Unfortunately, patients then ask too few questions so as not to hold up the health service operation or the omniscient staff members. “It is one of the most important conversations in a person's life when they find out they are seriously ill,” says Jan Stöhlmacher, a hematologist and oncologist. He accompanied two of his closest relatives through these stages of life, observing his own emotions, reflecting on the behavior of himself and, above all, of his caring medical colleagues. Repeatedly, the reaction of the doctors seemed inappropriate to him. These experiences and his individual way of dealing with his own helplessness led to an intensive study of the topic “Trust – what patients and relatives can do for a good climate of discussion”. Thoughts and suggestions for improving communication can be found in the literature, e.g., with oncological patients [3], [4]. But it is precisely the authentic descriptions of situations from the perspective of an affected relative that enable comprehensible emotional reactions promoting empathy for patients, respect their inviolable dignity and point out possible deficiencies in verbal and non-verbal communication. This perspective is certainly new and not yet sufficiently presented in the literature. For which target groups could the book be of relevant use?","PeriodicalId":45850,"journal":{"name":"GMS Journal for Medical Education","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42776893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In 2020, theGerman Federal Constitutional Court deemed the prohibition of businesslike assisted suicide unconstitutional. In doing so, it made a judgment of historic singularity. Its reasoning echoes the increasingly individualistic orientation of both individual and social life. Two years later, Joachim Küchenhoff and Martin Teising published a book that critically examines this verdict and its significance for the individual and the “others” considered in the title from different perspectives. A contextualizing preface by the editors is followed by a total of 14 separate contributions in four parts. The most comprehensive one is the first part, which deals with the framework of the discussion on assisted suicide. Here, the focus is particularly on the addressed verdict and its “misinterpreted” understanding of the concepts of autonomy and freedom as a central point of criticism. This is followed by reflections on assisted suicide in medicine in the second part. In addition to a broad plea by physician and philosopher Giovanni Maio to society in general andmedicine in particular for more commitment to not give people a reason to consider suicide, the other two contributions focus primarily on the psychiatric context. The third part addresses the relationship between suicidal persons and their helpers, which has been little discussed in the public debate so far. This is done primarily from a psychoanalytic perspective, which repeatedly traces the psychodynamic process to the root of suicidality. Finally, the fourth part with its last two contributions is devoted to social and cultural aspects of assisted suicide. Noteworthily, the contribution by Lisa Werthmann-Resch, in which she analyzes the dynamics of suicide in “Winterreise” by Franz Schubert and in the contemporary same-titled film by Hans Steinbichler, stands out due to its unique approach. The broadness of perspectives as well as the resulting solutions and demands (in the sense of a more or less constructive criticism) vary between the contributions from broad and general to focused and concrete: powerful philosophical argumentations stimulate far-reaching thoughts, but may leave solution-oriented readers unsatisfied due to the lack of a practicable outlook. In other contributions, the discussed aspects and concrete possibilities of dealing with them are vividly illustrated by means of case reports rooted in history or the authors‘ own experiences. The cover blurb promises a broad interdisciplinary approach to the topic. However, at first glance, the 17 authors appear to be quite homogeneous due to their mostly psychiatric and psychotherapeutic, especially psychoanalytic backgrounds. This fact is also mentioned in the preface of the editors. Indeed, redundancies of some central aspects in the various contributions cannot be denied. For instance, given the psychoanalytic focus it is not surprising that Freud appears regularly in the contributions, both as the forefather of psychoanalytic
2020年，德国联邦宪法法院认为禁止商业协助自杀违宪。在这样做的过程中，它对历史奇点做出了判断。它的推理与个人生活和社会生活中日益增长的个人主义倾向相呼应。两年后，Joachim k chenhoff和Martin Teising出版了一本书，从不同的角度批判性地审视了这一结论及其对个人和标题中所考虑的“他者”的意义。编辑的上下文化序言之后是总共14个单独的贡献，分为四个部分。最全面的是第一部分，论述了协助自杀的讨论框架。在这里，重点特别放在所处理的判决及其对作为批评中心点的自治和自由概念的“误解”理解上。第二部分是对医学辅助自杀的反思。除了内科医生兼哲学家乔瓦尼·马约(Giovanni Maio)向社会，尤其是医学界广泛呼吁，不要给人们一个考虑自杀的理由，其他两项贡献主要集中在精神病学方面。第三部分讨论了自杀者和他们的帮助者之间的关系，到目前为止，这在公众辩论中很少被讨论。这主要是从精神分析的角度来做的，它反复追溯精神动力学过程到自杀的根源。最后，第四部分和最后两篇文章是关于协助自杀的社会和文化方面。值得注意的是，Lisa Werthmann-Resch的贡献，她分析了Franz Schubert的《Winterreise》和Hans Steinbichler的当代同名电影中的自杀动态，因其独特的方法而脱颖而出。观点的广度以及由此产生的解决方案和要求(在或多或少建设性批评的意义上)在从广泛和一般到集中和具体的贡献之间有所不同:强大的哲学论证激发了深远的思想，但可能会让以解决方案为导向的读者不满意，因为缺乏切实可行的前景。在其他文章中，所讨论的方面和处理这些问题的具体可能性都通过根植于历史或作者自己经验的案例报告生动地说明。封面上的简介承诺了一个广泛的跨学科的方法来研究这个话题。然而，乍一看，这17位作者似乎相当同质，因为他们大多是精神病学和心理治疗，尤其是精神分析的背景。这一事实也在编者的序言中提到。的确，不能否认各种贡献中某些中心方面的重复。例如，鉴于精神分析的焦点，弗洛伊德经常出现在贡献中并不奇怪，他既是精神分析思想的先驱，也是一个人在他人帮助下死亡的杰出历史例子。此外，许多贡献阐述了两种不相容的愿望的悖论:一方面，自治被理解为绝对独立于他人，另一方面，人类的基本社会条件导致终身依赖他人。一贯地，对这种冲突的反复强调是真实的书名，它特别关注其他人:自杀助手，治疗师，亲属和社会。尽管明确强调精神分析，但这本书为感兴趣的读者提供了各种方法和论证线，以参与辅助自杀的选定方面。对这样一个存在主义话题的不同思考引起了读者的不同
{"title":"Joachim Küchenhoff, Martin Teising: Sich selbst töten mit Hilfe Anderer. Kritische Perspektiven auf den assistierten Suizid","authors":"L. Wagner","doi":"10.3205/zma001622","DOIUrl":"https://doi.org/10.3205/zma001622","url":null,"abstract":"In 2020, theGerman Federal Constitutional Court deemed the prohibition of businesslike assisted suicide unconstitutional. In doing so, it made a judgment of historic singularity. Its reasoning echoes the increasingly individualistic orientation of both individual and social life. Two years later, Joachim Küchenhoff and Martin Teising published a book that critically examines this verdict and its significance for the individual and the “others” considered in the title from different perspectives. A contextualizing preface by the editors is followed by a total of 14 separate contributions in four parts. The most comprehensive one is the first part, which deals with the framework of the discussion on assisted suicide. Here, the focus is particularly on the addressed verdict and its “misinterpreted” understanding of the concepts of autonomy and freedom as a central point of criticism. This is followed by reflections on assisted suicide in medicine in the second part. In addition to a broad plea by physician and philosopher Giovanni Maio to society in general andmedicine in particular for more commitment to not give people a reason to consider suicide, the other two contributions focus primarily on the psychiatric context. The third part addresses the relationship between suicidal persons and their helpers, which has been little discussed in the public debate so far. This is done primarily from a psychoanalytic perspective, which repeatedly traces the psychodynamic process to the root of suicidality. Finally, the fourth part with its last two contributions is devoted to social and cultural aspects of assisted suicide. Noteworthily, the contribution by Lisa Werthmann-Resch, in which she analyzes the dynamics of suicide in “Winterreise” by Franz Schubert and in the contemporary same-titled film by Hans Steinbichler, stands out due to its unique approach. The broadness of perspectives as well as the resulting solutions and demands (in the sense of a more or less constructive criticism) vary between the contributions from broad and general to focused and concrete: powerful philosophical argumentations stimulate far-reaching thoughts, but may leave solution-oriented readers unsatisfied due to the lack of a practicable outlook. In other contributions, the discussed aspects and concrete possibilities of dealing with them are vividly illustrated by means of case reports rooted in history or the authors‘ own experiences. The cover blurb promises a broad interdisciplinary approach to the topic. However, at first glance, the 17 authors appear to be quite homogeneous due to their mostly psychiatric and psychotherapeutic, especially psychoanalytic backgrounds. This fact is also mentioned in the preface of the editors. Indeed, redundancies of some central aspects in the various contributions cannot be denied. For instance, given the psychoanalytic focus it is not surprising that Freud appears regularly in the contributions, both as the forefather of psychoanalytic ","PeriodicalId":45850,"journal":{"name":"GMS Journal for Medical Education","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46915829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-15eCollection Date: 2023-01-01DOI: 10.3205/zma001636
Sören Moritz, Bernd Romeike, Christoph Stosch, Daniel Tolks
“The use of chatbots inmedical education is an emerging trend that is welcomed by many educators and medical professionals. In particular, the use of ChatGPT, a large languagemodel of OpenAI, offers a variety of benefits for students and educators alike [...]” [1]. So far so amazing, the passage already points to the whole dilemma: will teaching at universities ever be the same after ChatGPT as it never was anyways? We had a Cologne term paper in the “field of competence carcinogenesis” (interdisciplinary teaching in the first preclinical study semester) generated in triplicate by ChatGPT, each with identical queries, and received three different two-page texts including literature citations according to APA style. These have been examined by two detector programs (Groover, Writer) to determine whether they were written by a human or a bot. Both programs could not detect them as machine-written (cave: short texts are practically undetectable). The search for plagiarism with the software PlagAware did not reveal any conspicuous passages worthy of consideration (approx. 3-5% agreement with already published texts). The papers were forwarded unchanged to the assessing tutors with the result that two papers were assessed as “passed” and one as “failed”. The poor performance was due to certain terms used in the field of competence that was not named, as well as a non-matching literature citation. What next? Let’s ask ChatGPT: “...If students were able to access ChatGPT and ask questions during the exam, they could theoretically receive answers from ChatGPT that could help them answer exam questions...” [2].
{"title":"Generative AI (gAI) in medical education: Chat-GPT and co.","authors":"Sören Moritz, Bernd Romeike, Christoph Stosch, Daniel Tolks","doi":"10.3205/zma001636","DOIUrl":"10.3205/zma001636","url":null,"abstract":"“The use of chatbots inmedical education is an emerging trend that is welcomed by many educators and medical professionals. In particular, the use of ChatGPT, a large languagemodel of OpenAI, offers a variety of benefits for students and educators alike [...]” [1]. So far so amazing, the passage already points to the whole dilemma: will teaching at universities ever be the same after ChatGPT as it never was anyways? We had a Cologne term paper in the “field of competence carcinogenesis” (interdisciplinary teaching in the first preclinical study semester) generated in triplicate by ChatGPT, each with identical queries, and received three different two-page texts including literature citations according to APA style. These have been examined by two detector programs (Groover, Writer) to determine whether they were written by a human or a bot. Both programs could not detect them as machine-written (cave: short texts are practically undetectable). The search for plagiarism with the software PlagAware did not reveal any conspicuous passages worthy of consideration (approx. 3-5% agreement with already published texts). The papers were forwarded unchanged to the assessing tutors with the result that two papers were assessed as “passed” and one as “failed”. The poor performance was due to certain terms used in the field of competence that was not named, as well as a non-matching literature citation. What next? Let’s ask ChatGPT: “...If students were able to access ChatGPT and ask questions during the exam, they could theoretically receive answers from ChatGPT that could help them answer exam questions...” [2].","PeriodicalId":45850,"journal":{"name":"GMS Journal for Medical Education","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9986280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The climate crisis threatens our natural livelihoods and civilization in many ways. With the steady increase in mean global temperature, the crossing of irreversible climate tipping points is becoming increasingly likely. There is a threat of a massive acceleration of biodiversity loss, acidification of the oceans, more frequent food shortages, an increase in extreme weather events, and climate-related refugee movements. As a compact “pocket book”, the Heidelberg standards of climate medicine provides broad knowledge, as well as practice-oriented recommendations for action on the scientific basics, the (medical) treatment of physical and psychological effects of the climate crisis, and the necessary transformation processes towards a more ecologically sustainable health sector. In 12 chapters with a total of 45 articles, the participating authors summarize the current state of research and information from their (medical) practice and provide useful tips and advice for the everyday professional life of all participants in the health sector. First, the Heidelberg standards of climate medicine provide a brief and concise overview of the scientific basics of the climate crisis (chapter 1) and their impact on natural and social systems (chapter 2). The knowledge of these basics will, on the one hand, help the reader with regard to the following book chapters, and, on the other hand, it should serve as a practical tool in (scientific) discourse. Two comprehensive chapters then highlight the numerous direct and indirect impacts of the climate crisis on human health. In the third chapter on the physical impacts of the climate crisis, it becomes evident how closely environmental changes (e.g., more frequent extreme weather events, heat waves, increased incidence of tropical pathogens) are linked to human health: The occurrence of many diseases, such as heat stroke, COPD, allergies, diabetes, or kidney failure, are influenced by the climate crisis. In addition to explaining this relationship, the chapter presents definitions relevant to clinicians, pathophysiological processes, key recommendations for clinical care, and helpful therapeutic strategies. The psychological effects of climate change are reflected upon in more detail in chapter 4, ranging from trauma in the context of natural disasters, to connections between climate, weather, and suicidality. Additionally, chapter 5 is dedicated to general cognitive processes and biases in psychological perceptions and processing of climate change. The discrepancy between knowledge and action regarding the climate crisis is also impressively illustrated. Subsequently, the Heidelberg standards of climate medicine reveals concrete fields of action in the health sector (including the reduction of emissions by means of changing the food supply, energymanagement, and drug supply in hospitals) in order to decisively counter the health crisis stemming from the climate crisis (chapter 6). Afterwards, various health co
{"title":"Christoph Nikendei, Till Johannes Bugaj, Anna Cranz, Alina Herrmann, Julia Tabatabai: Heidelberger Standards der Klimamedizin – Wissen und Handlungsstrategien für den klinischen Alltag und die medizinische Lehre im Klimawandel","authors":"Lorena Morschek","doi":"10.3205/zma001607","DOIUrl":"https://doi.org/10.3205/zma001607","url":null,"abstract":"The climate crisis threatens our natural livelihoods and civilization in many ways. With the steady increase in mean global temperature, the crossing of irreversible climate tipping points is becoming increasingly likely. There is a threat of a massive acceleration of biodiversity loss, acidification of the oceans, more frequent food shortages, an increase in extreme weather events, and climate-related refugee movements. As a compact “pocket book”, the Heidelberg standards of climate medicine provides broad knowledge, as well as practice-oriented recommendations for action on the scientific basics, the (medical) treatment of physical and psychological effects of the climate crisis, and the necessary transformation processes towards a more ecologically sustainable health sector. In 12 chapters with a total of 45 articles, the participating authors summarize the current state of research and information from their (medical) practice and provide useful tips and advice for the everyday professional life of all participants in the health sector. First, the Heidelberg standards of climate medicine provide a brief and concise overview of the scientific basics of the climate crisis (chapter 1) and their impact on natural and social systems (chapter 2). The knowledge of these basics will, on the one hand, help the reader with regard to the following book chapters, and, on the other hand, it should serve as a practical tool in (scientific) discourse. Two comprehensive chapters then highlight the numerous direct and indirect impacts of the climate crisis on human health. In the third chapter on the physical impacts of the climate crisis, it becomes evident how closely environmental changes (e.g., more frequent extreme weather events, heat waves, increased incidence of tropical pathogens) are linked to human health: The occurrence of many diseases, such as heat stroke, COPD, allergies, diabetes, or kidney failure, are influenced by the climate crisis. In addition to explaining this relationship, the chapter presents definitions relevant to clinicians, pathophysiological processes, key recommendations for clinical care, and helpful therapeutic strategies. The psychological effects of climate change are reflected upon in more detail in chapter 4, ranging from trauma in the context of natural disasters, to connections between climate, weather, and suicidality. Additionally, chapter 5 is dedicated to general cognitive processes and biases in psychological perceptions and processing of climate change. The discrepancy between knowledge and action regarding the climate crisis is also impressively illustrated. Subsequently, the Heidelberg standards of climate medicine reveals concrete fields of action in the health sector (including the reduction of emissions by means of changing the food supply, energymanagement, and drug supply in hospitals) in order to decisively counter the health crisis stemming from the climate crisis (chapter 6). Afterwards, various health co","PeriodicalId":45850,"journal":{"name":"GMS Journal for Medical Education","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47829455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The most important statement of this book right at the beginning: “Diagnoses are not found, they are made”. This is likely to come as a bit of a shock to anyone who has enjoyed watching Dr. House or is looking forward to a new episode of Adventure Diagnosis in the media library. However, Norbert Donner-Banzhoff manages the miracle of covering the entire spectrum of medical thought and action, including cognitive psychology and medical history perspectives, in order to explain this statement without once using the term clinical reasoning. Never before have I enjoyed reading about strategies for prevalence enrichment or regression to the mean so much, not tomention the excellent explanations and illustrations of the four-field table, where, after reading it, really no one can claim not to have understood it. And: the fact that tests only modify disease probabilities according to Bayes’ theoremand that the pre-test probability is decisive for this cannot be read often enough – so here also. For this is often forgotten in everyday clinical practice, as the author explains with striking and also somewhat frightening examples. Complete certainty can thus not be achieved in the always tricky contexts of diagnosing. Perhaps it would have been even more useful at these points for a better understanding of this fact not to speak of a disease being “ruled out” but rather of it being made “less likely” by a test. But this is whining on a high level. This book is not just a guide to making a medical diagnosis, it is much more than that. It offers insight into the daily work of physicians in the trickiest task and the greatest professional challenge: making (i.e., “making”) a diagnosis. In doing so, it is devoted to historical perspectives and scientific traditions of different countries that approach the diagnostic process in different ways. This offers an excellent opportunity to reflect on one's own medical work – and teaching – and to open up to sometimes painful insights. The author discusses how reference ranges come about and that biological fluctuations are the greatest source of uncertainty, as well as the overestimation of technical findings in everyday medical practice and the harmful consequences of overdiagnosis and overtreatment. Theoretical, partly philosophical passages explaining important background information on the status quo of medical diagnosis with its problematic consequences (“X-rays and injections are powerful rituals”) alternate with current practical references. These are strikingly accessible to those working in the medical field, students and teachers, and offer good starting points for reflecting on one’s own actions. It is very pleasant to note that, with very few exceptions, English terms have been translated into German. The chosen form of gendering – the female form is used everywhere, except when exclusively men are meant – keeps the text pleasantly readable, even if this principle weakens somewhat in some places toward the
{"title":"Norbert Donner-Banzhoff: Die ärztliche Diagnose: Erfahrung – Evidenz – Ritual","authors":"S. Harendza","doi":"10.3205/zma001596","DOIUrl":"https://doi.org/10.3205/zma001596","url":null,"abstract":"The most important statement of this book right at the beginning: “Diagnoses are not found, they are made”. This is likely to come as a bit of a shock to anyone who has enjoyed watching Dr. House or is looking forward to a new episode of Adventure Diagnosis in the media library. However, Norbert Donner-Banzhoff manages the miracle of covering the entire spectrum of medical thought and action, including cognitive psychology and medical history perspectives, in order to explain this statement without once using the term clinical reasoning. Never before have I enjoyed reading about strategies for prevalence enrichment or regression to the mean so much, not tomention the excellent explanations and illustrations of the four-field table, where, after reading it, really no one can claim not to have understood it. And: the fact that tests only modify disease probabilities according to Bayes’ theoremand that the pre-test probability is decisive for this cannot be read often enough – so here also. For this is often forgotten in everyday clinical practice, as the author explains with striking and also somewhat frightening examples. Complete certainty can thus not be achieved in the always tricky contexts of diagnosing. Perhaps it would have been even more useful at these points for a better understanding of this fact not to speak of a disease being “ruled out” but rather of it being made “less likely” by a test. But this is whining on a high level. This book is not just a guide to making a medical diagnosis, it is much more than that. It offers insight into the daily work of physicians in the trickiest task and the greatest professional challenge: making (i.e., “making”) a diagnosis. In doing so, it is devoted to historical perspectives and scientific traditions of different countries that approach the diagnostic process in different ways. This offers an excellent opportunity to reflect on one's own medical work – and teaching – and to open up to sometimes painful insights. The author discusses how reference ranges come about and that biological fluctuations are the greatest source of uncertainty, as well as the overestimation of technical findings in everyday medical practice and the harmful consequences of overdiagnosis and overtreatment. Theoretical, partly philosophical passages explaining important background information on the status quo of medical diagnosis with its problematic consequences (“X-rays and injections are powerful rituals”) alternate with current practical references. These are strikingly accessible to those working in the medical field, students and teachers, and offer good starting points for reflecting on one’s own actions. It is very pleasant to note that, with very few exceptions, English terms have been translated into German. The chosen form of gendering – the female form is used everywhere, except when exclusively men are meant – keeps the text pleasantly readable, even if this principle weakens somewhat in some places toward the","PeriodicalId":45850,"journal":{"name":"GMS Journal for Medical Education","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42701841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
How does a human being move? Are his actions an expression of his primary motor cerebral cortex or do they reflect the intentions of a human individuality? How do we see? Are we passive recipients or do we have to actively shape our seeing? What results from approaching these questions by bringing together scientific and phenomenological-philosophical insights? Can guiding viewpoints for person-centeredmedicine be gained from this? These questions are illuminated comprehensively and in many ways in the newly published book “Wahrnehmen und Bewegen – Grundlagen einer allgemeinen Bewegungslehre” (Perceiving and Moving Foundations of a General Theory of Movement) by Friedrich Edelhäuser. In doing so, the author takes us to astonishing phenomena, to reflections worth considering, and to profound questions. Using the example of looking at a mountain landscape, the first phenomena of seeing are looked at: our gaze goes inwardly through the picture, searching for various objects and contours and arranging the details into a meaningful overall context. What at first appears to be fixed thus becomes experienceable as a process. In the “objectifying” view of physiology, vision is characterized as a process akin to a camera in which light passes through a lens onto the retina and then leads to electrochemical nervous processes. In this process, the qualitative perceptions melt down into a measurable but qualityless process. Vision thus becomes an example of the stimulus-response sequence, in which an external sensory stimulus becomes electrochemical processes inside, i.e. in the brain, and is answered with a reaction. Thereby not only the quality of the perceived disappears, but also the perceiving person. In the following, this socalled third-person-perspective as an objectifying approach is supplemented by introspection, the first-personperspective. In chapter 5 “perceiving and moving” the process of seeing is examined more closely. In doing so, one becomes aware of the fact that seeing includes an inner scanning of the contour to be perceived. This unconscious movement of the eyeballs can be represented technically and shows individual movement patterns, similar to gait or handwriting. If this movement is suppressed, the perceived blurs to a gray-in-gray for a short time due to the lack of contrast. During further analysis, it is noticeable that one is not only aligned to the object to be seen with one's eye muscles, but with one's entire head and body posture. Only this self-movementmakes seeing possible. Something similar can be shown for hearing and other sensory modalities. Looking back at the mountain landscape, it becomes clear that there is a circular relationship, the perception of the image and the contours that can be found in it are guiding the scanningmovements of the eye, which in turn are conditions for what is to be seen. Thus, there is no monocausal relationship with temporal succession, but a mutually dependent one. In chapter 6 the Gesta
{"title":"Friedrich Edelhäuser: Wahrnehmen und Bewegen – Grundlagen einer allgemeinen Bewegungslehre","authors":"C. Scheffer","doi":"10.3205/zma001584","DOIUrl":"https://doi.org/10.3205/zma001584","url":null,"abstract":"How does a human being move? Are his actions an expression of his primary motor cerebral cortex or do they reflect the intentions of a human individuality? How do we see? Are we passive recipients or do we have to actively shape our seeing? What results from approaching these questions by bringing together scientific and phenomenological-philosophical insights? Can guiding viewpoints for person-centeredmedicine be gained from this? These questions are illuminated comprehensively and in many ways in the newly published book “Wahrnehmen und Bewegen – Grundlagen einer allgemeinen Bewegungslehre” (Perceiving and Moving Foundations of a General Theory of Movement) by Friedrich Edelhäuser. In doing so, the author takes us to astonishing phenomena, to reflections worth considering, and to profound questions. Using the example of looking at a mountain landscape, the first phenomena of seeing are looked at: our gaze goes inwardly through the picture, searching for various objects and contours and arranging the details into a meaningful overall context. What at first appears to be fixed thus becomes experienceable as a process. In the “objectifying” view of physiology, vision is characterized as a process akin to a camera in which light passes through a lens onto the retina and then leads to electrochemical nervous processes. In this process, the qualitative perceptions melt down into a measurable but qualityless process. Vision thus becomes an example of the stimulus-response sequence, in which an external sensory stimulus becomes electrochemical processes inside, i.e. in the brain, and is answered with a reaction. Thereby not only the quality of the perceived disappears, but also the perceiving person. In the following, this socalled third-person-perspective as an objectifying approach is supplemented by introspection, the first-personperspective. In chapter 5 “perceiving and moving” the process of seeing is examined more closely. In doing so, one becomes aware of the fact that seeing includes an inner scanning of the contour to be perceived. This unconscious movement of the eyeballs can be represented technically and shows individual movement patterns, similar to gait or handwriting. If this movement is suppressed, the perceived blurs to a gray-in-gray for a short time due to the lack of contrast. During further analysis, it is noticeable that one is not only aligned to the object to be seen with one's eye muscles, but with one's entire head and body posture. Only this self-movementmakes seeing possible. Something similar can be shown for hearing and other sensory modalities. Looking back at the mountain landscape, it becomes clear that there is a circular relationship, the perception of the image and the contours that can be found in it are guiding the scanningmovements of the eye, which in turn are conditions for what is to be seen. Thus, there is no monocausal relationship with temporal succession, but a mutually dependent one. In chapter 6 the Gesta","PeriodicalId":45850,"journal":{"name":"GMS Journal for Medical Education","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47795384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angelika Homberg, Elisabeth Narciß, Julia Thiesbonenkamp-Maag, Felix Heindl, Katrin Schüttpelz-Brauns
Objective: Final-year training is becoming increasingly important in medical studies and requires a high degree of personal responsibility from students. It is the task of supervising physicians to make informal learning opportunities available to students when working with and on patients and to gradually transfer responsibility to them. Both students and physicians have a great need for information regarding the contextual conditions and didactic realization of this transfer of responsibility. Up to now, the faculties have only provided information and support in a sporadic manner and with little standardization. With MERLIN, the joint project undertaken by the Competence Network for Teaching Medicine in Baden-Württemberg, a platform for the final year was developed and released on the web. The aim was to bundle information in order to support students and supervising physicians in their teaching-learning process and to improve the quality of teaching in the final year.
Project description: The development process of this platform took place in several steps across all faculties. Content and materials were compiled and structured based on a needs assessment. The first draft was evaluated by means of a simulation by students and then revised. A professional internet agency was involved for the technical implementation. The newly designed website PJ-input ("PJ" being the abbreviation for "Praktisches Jahr", the final year) contains areas for students and supervising physicians, as well as faculty-specific and general information about the final year. Faculty-specific content can be entered directly by the respective staff via an input mask and updated at any time. The provision of didactic materials can support competency-oriented teaching and learning in the final year. Here, for example, the concept of the Entrustable Professional Activities (EPA) was taken up, which gives students and supervising physicians orientation for the gradual assumption or transfer of responsibility. The platform was launched in spring 2021. Usage behavior is continuously recorded via the web application.
Results and conclusion: The evaluation results show that the website is visited often and perceived as supportive. Increasing usage figures and the high frequency of use by students in the sections "im PJ" (during the final year) and "nach dem PJ" (after the final year) for the faculties involved in the MERLIN project confirm the target group-oriented design and use. The site should be promoted even more to pre-final-year students, as well as across state borders and to the target group of faculties. It is expected that nationwide faculty participation will make a significant contribution to the competency-based shift in teaching and the standardization of training during the final year of study under the new licensing regulations.
目的:最后一年的培训在医学研究中变得越来越重要，要求学生高度的个人责任感。监督医生的任务是为学生提供非正式的学习机会，并逐步将责任转移给他们。学生和医生都非常需要关于这种责任转移的背景条件和教学实现的信息。到目前为止，各院系只是零星地提供信息和支持，缺乏规范化。巴登-符腾堡州医学教学能力网络联合项目MERLIN为最后一年开发了一个平台，并在网上发布。目的是将信息捆绑起来，以便在教学过程中支持学生和监督医生，并提高最后一年的教学质量。项目描述:该平台的开发过程分几个步骤进行，涉及所有院系。内容和材料是根据需求评估汇编和组织的。学生通过模拟的方式对初稿进行评价，然后进行修改。一个专业的互联网机构参与了技术实施。新设计的网站PJ-input(“PJ”是最后一年“Praktisches Jahr”的缩写)包含学生和指导医生的区域，以及关于最后一年的教师特定信息和一般信息。教师特定的内容可以由各自的工作人员通过输入掩码直接输入并随时更新。教学材料的提供可以支持能力导向的教学和学习在最后一年。例如，这里采用了可信赖的专业活动(EPA)的概念，它为学生和指导医生提供了逐渐承担或转移责任的方向。该平台于2021年春季启动。使用行为通过web应用程序持续记录。结果与结论:评价结果显示，该网站经常被访问，并被认为是支持的。在参与MERLIN项目的院系中，学生在“im PJ”(最后一年)和“nach dem PJ”(最后一年之后)部分的使用数字不断增加，使用频率也很高，这证实了面向目标群体的设计和使用。该网站应该更多地推广给即将毕业的学生，以及跨州和目标教师群体。预计全国教师的参与将对在新许可条例下的最后一年学习期间以能力为基础的教学转变和培训标准化做出重大贡献。
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