GMS Journal for Medical Education最新文献

Background: Dealing with medical uncertainty is an essential competence of physicians. During handovers, communication of uncertainty is important for patient safety, but is often not explicitly expressed and can hamper medical decisions. This study examines medical students' implicit expression of uncertainty in different sequences of clinical reasoning during simulated patient handovers.

Methods: In 2018, eighty-seven final-year medical students participated in handovers of three simulated patient cases, which were videotaped and transcribed verbatim. Sequences of clinical reasoning and language references to implicit uncertainty that attenuate and strengthen information based on a framework were identified, categorized, and analyzed with chi-square goodness-of-fit tests.

Results: A total of 6358 sequences of clinical reasoning were associated with the four main categories "statement", "assessment", "consideration", and "implication", with statements occurring significantly (p<0.001) most frequently. Attenuated sequences of clinical reasoning occurred significantly (p<0.003) more frequently than strengthened sequences. Implications were significantly more often attenuated than strengthened (p<0.003). Statements regarding results occurred significantly more often plain or strengthened than statements regarding actions (p<0.0025).

Conclusion: Implicit expressions of uncertainty in simulated medical students' handovers occur in different degrees during clinical reasoning. These findings could contribute to courses on clinical case presentations by including linguistic terms and implicit expressions of uncertainty and making them explicit.

Objective: Many patients have undergone visceral surgery. The effects on anatomy and physiology, which can result in further surgical or gastroenterological clinical pictures, are equally significant and require special knowledge. This content should be taught in an interdisciplinary elective course. The draft of the new 2025 approval regulation and the current approval regulation specify that preclinical and clinical content should specifically be combined within the framework of a Z-curriculum and that the new elective course should meet these requirements.

Methodology: Practical and theoretical aspects of recognising and treating patients with postoperative modified anatomy are to be taught and the findings are to be demonstrated using anatomical and artificial preparations. The curriculum of the preclinical course covers anatomy and physiology. The target group of the curriculum is all participating students with a special interest in topics such as anatomy, visceral surgery and gastroenterology. However, the goal is to involve student tutors of the anatomical dissection courses, who, in turn, will pass on knowledge of modified anatomy to the supervised preclinical students.

Results: According to Thomas and Kern, the curriculum development process entails the following six stages: general needs assessment, targeted needs assessment, the formulation of goals and content, the description of strategies, planned implementation and evaluation.

Conclusion: A "modified anatomy" curriculum for an interdisciplinary elective course in surgery, gastroenterology, and anatomy was developed. Through the training of anatomy table tutors, a "dovetailing" with the preclinical stage is to be achieved. In addition, new concepts related to the transfer of knowledge and competencies were introduced and should be evaluated for suitability.

Objective: The acquisition of surgical skills requires motor learning. A special form of this is intermanual transfer by transferring motor skills from the nondominant hand (NDH) to the dominant hand (DH). The purpose of this study was to determine the learning gains that can be achieved for the DH by training with the DH, the NDH, and by non-surgical alternative training (AT).

Methods: 124 preclinical (n=62) and clinical (n=62) dental students completed surgical knot tying and suturing technique training with the DH, with the NDH, and an AT in a controlled randomized trial.

Results: A statistically significant learning gain in knot tying and suture technique with the DH was evident only after training with the DH when compared to training with the NDH (p<0.001 and p=0.004, respectively) and an AT (p=0.001 and p=0.010, respectively). Of those students who achieved a learning gain ≥4 OSATS points, 46.4% (n=32) benefited in their knot tying technique with the DH from training with the DH, 29.0% (n=20) from training with the NDH, and 24.6% (n=17) from an AT while 45.7% (n=32) benefited in their suturing technique with the DH from training with the DH, 31.4% (n=22) from training with the NDH, and 22, 9% (n=16) from an AT.

Conclusions: Training with the DH enabled significantly better learning gains in the surgical knot tying and suturing techniques with the DH.

Objective: Against the backdrop of considerable lack of research, this study provides the first exploration of medical students' perspectives on racism in medicine and healthcare in Germany. The aim is to identify problems and learning needs for medical education. We address the following research questions: - How do medical students perceive racism in medicine and healthcare in Germany? - How do they address, understand, and discuss different aspects of racism in this context? - What are their expectations regarding the role of medical education?

Methods: Semi-structured online focus group discussions were conducted with 32 medical students from 13 different medical schools in Germany. The discussions were transcribed and analyzed using qualitative content analysis.

Results: Based on the analysis of the focus groups, four main hypotheses could be formulated: 1. Medical students perceive racism in medicine and healthcare in Germany as a ubiquitous phenomenon. 2. They have problems to identify racist behaviour and structures due to conceptual knowledge gaps. 3. They are insecure how to deal with racism on a situational level. 4. They hold medical education accountable to tackle racism in medicine and healthcare on various levels.

Conclusion: Our study raises specific learning needs for addressing racism in medicine and healthcare in Germany. Research from the US-context might inspire innovative approaches for German medical education but needs to take national specificities into account. Further research is needed to prepare the implementation of antiracist training in German medical education.

Background: Undergraduate medical students take the licensing exam (M3) as a two-day oral-practical examination. The main requirements are to demonstrate history taking skills and coherent case presentations. The aim of this project was to establish a training in which students can test their communication skills during history taking and their clinical reasoning skills in focused case presentations.

Methods: In the newly developed training, final-year students took four telemedical histories in the role of physicians from simulated patients (SP). They received further findings for two SPs and presented these in a handover, in which they also received a handover of two SPs which they had not seen themselves. Each student presented one of the two received SPs in a case discussion with a senior physician. Feedback was given to the participants on their communication and interpersonal skills by the SPs with the ComCare questionnaire and on the case presentation by the senior physician. Sixty-two students from the universities of Hamburg and Freiburg in their final year participated in September 2022 and evaluated the training.

Results: Participants felt that the training was very appropriate for exam preparation. The SPs' feedback on communication and the senior physician's feedback on clinical reasoning skills received the highest ratings in importance to the students. Participants highly valued the practice opportunity for structured history taking and case presentation and would like to have more such opportunities in the curriculum.

Conclusion: Essential elements of the medical licensing exam can be represented, including feedback, in this telemedical training and it can be offered independent of location.

Objective: Climate change constitutes a major challenge. The higher education sector plays an important role in regard to climate change and the adaptation to its consequences. Various approaches toward the integration of environmental subject areas to higher education teaching have already been described in other studies, but there is a lack of data supporting the effectiveness of these approaches in changing not only the environmental knowledge of students, but also their awareness. To address this, the present study tracked whether student attitudes about the environment could be changed by implicitly addressing medically relevant environmental topics as part of an online seminar.

Methods: Second semester students of molecular medicine attending a mandatory 14-hour online seminar, which was required to obtain additive key qualifications and which consisted of independent study phases as well as online class meetings, were divided into two groups: the intervention group (IG, n=27, thereof 20 in the pretest and 21 in the posttest) was exposed to medically relevant environmental topics, while the comparison group (CG, n=26, thereof 22 in the pretest and 21 in the posttest) was exposed to general, non-environmental medical topics. Surveys were conducted with standardized questionnaires before and after the seminar in order to study the influence on the students' environmental knowledge, awareness and other personal attitudes.

Results: While the seminar did not significantly change the environmental awareness in either group, the environmental knowledge of the IG was significantly increased by the group's exposure to environmental topics. In addition, the IG assessed its own environmental awareness regarding sustainable working methods in a laboratory as significantly higher after the seminar than the CG did, and some students of the IG had become more interested in issues relating to sustainability.

Conclusion: The approach used to communicate environmental content mainly increased the environmental knowledge of students and piqued the interest of some students in climate-related and environmental topics. However, it was not possible to change deeper personal attitudes about environmental awareness, especially everyday behavior.

Background: This project report describes the development and evaluation of an interactive seminar on the topic "medical effects of climate change on children's health".

Objectives: The learning objectives are learning the basics and the direct and indirect connections between climate change and children's health. Future scenarios for affected children, parents and doctors are developed interactively. Subsequently, communication strategies concerning climate change are discussed so that students identify and analyze possibilities to become active.

Methodology: The seminar was offered as an obligatory seminar for a total of 128 third-year medical students with one appointment of 45 minutes per course group as part of the interdisciplinary seminar series "Environmental Medicine". A course group consisted of 14 to 18 students. The seminar for the 2020 summer semester was developed as part of the interdisciplinary field of environmental medicine with the special feature of an interactive role play. The role play intends to give the students the opportunity to put themselves in the situation of affected children, parents and doctors of the future in order to develop detailed solution strategies. From 2020 to 2021, the seminar took place as online self-study due to the lockdown requirements. Since winter semester 2021/22, the seminar was held as an attendance event for the first time, although the switch to an online presence seminar with obligatory attendance had to take place after four seminar dates due to renewed lockdown requirements, which also took place four times. The evaluated results here refer to a total of eight dates in the winter semester 2021/22 and were carried out using a specially developed questionnaire, which was filled out voluntarily and anonymously by the students immediately after the respective seminar date. An overall grade as well as the appropriateness of the time and content of lectures and role play were asked for. Free text answers were possible for each question.

Results: A total of 83 questionnaires were evaluated, 54 of which were from the four seminars in attendance, 15 were from the four online presence seminars that took place as an online live stream. The evaluation of the seminar resulted in an average grade of 1.7 for the face-to-face seminars and 1.9 for the online seminars. Content-related comments in the free-text answers addressed the desire for concrete solution strategies, more time for discussions and a more in-depth study of the topic. Numerous positive responses described the seminar as "very exciting", "good food for thought", "interesting and important topic".

Conclusion: There is a very high interest on the topic of "climate change & health" among students There is an obvious need to integrate the topic on a larger scale into medical education. Ideally, the focus on children's health should

Objectives: Changes in academic conditions due to the COVID-19 pandemic are potential stressors for medical students and can make them vulnerable for the development of psychiatric disorders.Previous pandemics had a negative impairment on well-being due to social isolation and the perceived threat, an increase in fear, anger and frustration and an increase in post-traumatic stress disorder among health professionals. Therefore, this study examines the impact of the COVID-19 pandemic on medical students' mental health and possible psychological consequences.

Methods: In this anonymous online survey (online 12/01/2021-03/31/2022), we examined the impact of COVID-19 pandemic on mental health of 561 German medical students aged between 18 und 45 years. Perceived anxiety and burden were assessed retrospectively from spring 2020 to autumn 2021. Changes in symptoms of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), quality of life was assessed using the WHO Quality of Life Questionnaire (WHOQOL BREF).

Results: Anxiety and burden showed wavelike courses with higher scores in autumn, winter and spring. The scores for depression and anxiety increased after the outbreak of the COVID-19 pandemic compared to the time before (p<.001). Results of a multifactorial ANOVA showed, that previous psychiatric illness (p<.001), being in the first two years of studies (p=.006), higher burden (p=.013) and greater differences in symptoms of depression (p<.001) were associated with a decreased quality of life in medical students.

Conclusion: The COVID-19 pandemic has a negative impact on mental health of medical students and their actual quality of life. Therefore, medical faculties should establish specific support to prevent the development of psychiatric sequelae probably resulting in long-term medical leaves.

Objective: The consequences of climate change on health care systems as well as the individual involvement in climate change has not been a focus of the study of human medicine. Therefore, the lecture and practical course medical ecology have been reorganized to reflect the increasing importance of this topic. In order to be available to all students, this course was included in the core curriculum of the first year of study in human medicine.

Methodology: The teaching concept is based on the method "multidimensional learning". The theoretical examination of environmental changes, especially climate change, is placed at the starting point within the framework of a lecture, followed by the translation of theoretical principles into practical knowledge by calculating the ecological footprint and subsequent reflection on the newly learned content. The project was evaluated by means of a self-constructed course evaluation instrument (three feedback questions) and an internal university online tool.

Results: 656 students (100%) described the most important knowledge they gained in the course. One third of the students (N=218) indicate that they would like to participate in a more advanced seminar. 137 students comment on specific aspects. Overall, students express great interest in the topic of medical ecology. They reflect in a remarkably (self-)critical way on the individual contribution to climate change and can clearly name the health consequences of climate change. The contents should be expanded in a more in-depth seminar.

Conclusion: The concept of the course has proven to be purposeful in order to prepare relevant and complex contents of medical ecology in an understandable way. Both lecture and practical course should be further developed accordingly.