GMS Journal for Medical Education最新文献

Objectives: Advance care planning (ACP) has been conceived to ensure that patients who are unable to consent are treated in consistence with their well-informed, predetermined preferences. At an individual level, standardised conversations are offered by specifically qualified healthcare professionals (ACP facilitators). Internationally, there is considerable variability with regard to ACP qualifications. This article describes how ACP facilitators are trained in role plays employing simulated persons (SPs) in accordance with the standards of two professional societies.

Methods: ACP experts developed ten roles in cooperation with an SP coach (director) based on real ACP conversations. The emotional and mental world of the role, ACP-relevant facts such as previous experience in the medical context, and aids for acting were developed, taking into account the central challenges in ACP conversations. To ensure standardisation, the SPs rehearsed in a structured manner and received feedback training. Microteaching techniques were developed for the facilitator training.

Results: Feedback skills and openness towards the topics of serious illness, dying and death are required for the SP to be suitable. Since 2017, ACP facilitator training has taken place in small groups of four participants, one SP and one qualified ACP coach. The required framework is described in detail.

Conclusion: SP-supported training is a decisive improvement for the teaching and assessment of the highly complex ACP-facilitation skills and attitudes. Planning and implementation place high demands on SP and ACP coaches who also require specific qualifications.

Background: Clerkships for supervised learning of clinical skills are part of modern medical curricula. The availability of clerkship placements in clinics and the provision of competent supervision are essential for effective work-based learning. The scheduling of compulsory and elective work-based learning opportunities for undergraduate medical students (UGMS), especially when their numbers are high, results in varying clerkship sequences, which can influence career plans and examination outcomes. The effect of different clerkship sequences on students' impressions of clinical supervision remains unclear. Therefore, this study describes subject-specific differences in students' perceptions of clinical supervision during surgical (SC) and internal medicine (IMC) clerkships and addresses the impact of varying clerkship sequences and increasing clinical experience thereon.

Method: In this survey, 1,017 final-year students at the Medical University of Vienna (from 2015 to 2019) retrospectively evaluated the quality of supervision they received during the SC and IMC using a newly piloted questionnaire on supervisory roles.

Results: Students described their supervisors as less likely to exercise the roles of gatekeeper/safeguarding, training, and mentoring during the SC than during the IMC. During IMC, the supervisory activities received most often were to ensure patient and trainee safety, whereas during SC, it was to ensure trainee safety and to teach techniques and procedures. Ensuring an appropriate level of clinical duty was the third highest priority in both clerkships. Students' general clinical experience influenced how they perceived the supervision, with students completing SC later in their pathway reporting having received similar levels of supervision in both clerkships.

Conclusions: Supervision experiences during the first clerkship appear to shape students' expectations of subsequent supervision. Providing additional support to foster a strong supervisory relationship, tailored to meet the specific supervision needs of UGMS newly entering year 6, could benefit both supervisors and students.

Objective: A high level of stress and critical burnout values (27-56%) has been identified among medical students in numerous international research and review studies. The aim of this interview study was to gain insights into students' perspectives on stressors, stress amplifiers and reactions, as well as the coping strategies they applied. The results will be used to discuss preventative measures in higher education.

Methods: A total of 22 semi-standardised, semi-narrative interviews were conducted with medical students, students in their practical year and junior doctors to gain retrospective perspectives on their studies. All data were audio-recorded, pseudonymised, fully transcribed as well as structured and analysed using qualitative content analysis, based on Kaluza's stress model.

Results: Study-related causes (e.g. the amount of material), private issues (e.g. social conflicts) and aspects arising during clinical work phases (e.g. complexity of tasks) were named as stressors. Individual stress amplifiers, such as perfectionism, were also described. The respondents showed stress reactions, such as doubts and fears. The coping strategies described were varied, but some were seen to be effective only in the short term.

Conclusion: The ability to cope with stress must be consciously learned and reflected upon across various causative areas. In particular, the discussion of mental strategies for dealing with repeatedly described stress amplifiers, such as one's own perfectionism, appears to be a behavioural prevention measure that is still little used by medical students. In terms of behavioural prevention, discourses on large amounts of learning material, increased support in the transition phase at the start of a degree course and more flexible studying for medical students (e.g. with a family) must be further developed.

Background: An important prerequisite for collaborative learning is the integration of learners into a community. This supports individual learning processes and creates a common learning culture. The "sense of community" construct includes feelings of belonging and socio-emotional bonds with key elements including interdependence, trust, interactivity, and shared values. "Learning communities" in educational environments consist of two components: a sense of connectedness among members and shared learning expectations. The "Classroom Community Scale (CCS)" was developed to capture sense of community in collaborative learning environments. So far, this instrument is not available in German. Aim of this work is the translation and internal construct validation of a German form of the Classroom Community Scale (CCS-D).

Methods: The questionnaire was administered to N=334 first semester students in the programs of human medicine, dentistry, and molecular medicine at the Eberhard Karls University of Tuebingen, Germany. Descriptive analysis, as well as a confirmatory and principal component analysis were performed.

Results: Cronbach's α=.87 could be recorded for the overall questionnaire, with reliabilities of α=.85 for the subscale Connectedness and α=.76 for the subscale Learning. In confirmatory factor analysis, the model achieves moderate (CFI=.85; TLI=.83) to acceptable (χ² [169, n=334]=455.368, p<.000; χ²/df=2.694; RMSEA=.071; SRMR=.0605) model fit.

Discussion: The reliability of the CCS-D demonstrates results similar to those found in existing literature. The two-factor structure of the model could be confirmed, with moderate to acceptable model-fit.Therefore, the CCS-D is a usable instrument to measure sense of community in learning environments.

Background: The rise of antimicrobial resistance as leading infection-related cause of death will necessitate trans-sectoral efforts on a global level. While many antimicrobial stewardship (AMS) incentives target healthcare workers, addressing undergraduates offers new and hitherto neglected opportunities.

Methods: We describe the pilot phase of a novel undergraduate elective ("stewards for future", SFF) for medical students at the Saarland University, Germany, between 2021 and 2023. We focused on knowledge and attitudes relevant to AMS. To allow for full immersion, we applied case-based learning, problem-based learning, and peer teaching in a small group teaching format spanning 15 hours, including AMS ward rounds. We obtained students' pre- and post-course self-assessment regarding AMS topics using 5-point Likert scales modified from the previously published ASSURE elective, as well as their subjective experience using the German short intrinsic motivation inventory.

Results: Over four terms, 23 undergraduate medical students from the clinical phase participated in the elective. Participants reported an increase in their ability to explain the concept of AMS (mean and standard deviation, pre 3.26±0.94 vs. post 4.74±0.44, p<0.0001), their confidence in choosing the appropriate antibiotic (pre 2.22±0.78 vs. post 3.57±0.58, p<0.0001), their ability to judge potential drug side effects (pre 2.09±0.72 vs. post 3.43±0.71, p<0.0001), their confidence in communicating with colleagues about antibiotics (pre 2.30±0.86 vs. post 3.52±0.83, p<0.0001), their understanding of diagnostics as an AMS tool (pre 4.22±0.41 vs. post 4.91±0.28, p<0.0001), and their ability to evaluate the roles of all AMS team members including their own (pre 2.52±0.77 vs. post 4.13±0.68, p<0.0001). Participants reported having enjoyed the course (4.6±0.5), while they were moderately satisfied with their performance (3.8±1.0). Pressure and anxiety levels were reported to be low (1.8±0.9 and 2.0±1.0 each).

Conclusions: Student participants of the elective SFF reported increased competencies relevant to AMS, while enjoying the course format. Sustainability and scalability will ultimately depend on the implementation into the core curriculum.

Importance and objective: All medical students are confronted with death during their medical curriculum. Despite this, too few qualitative studies have examined this reality's impact, the support provided by clinical supervisors and the theoretical instruction dedicated to this theme in the university curriculum. This study explores these issues and gives students an opportunity to express themselves, to improve their training and well-being during their pre-graduate.

Design/method: Qualitative study conducted via semi-structured interviews with 4^th year medical students at the University of Fribourg engaged in clinical rotations in all the main medical specialties, with in-depth exploration of their experience with death, the support provided by their supervisors and the preparation provided by the university curriculum. A thematic analysis was conducted.

Findings: Five themes emerged: fantasies about death before the encounter, first encounters with death, need for a global approach, impact of clinical supervisors' skills and denial of death during training. Whether positive or negative, confronting death is often an intense experience for students. They value clinical supervisors who care about how they're feeling, which is all too rare. According to students, the curriculum absolutely needs to be improved to better prepare them for the reality on the ground.

Conclusion: This study highlights the intensity of students' experiences with death and enables us to propose necessary improvements to their support and training. We believe that students would benefit from a space in which to explore their experiences with death. This would enable them to develop better skills for supporting end-of-life patients and their loved ones, while enhancing their own resources.

Introduction: Simulation-based teaching and assessment are integral to education in the health professions, with simulated patients (SP) being a widely accepted strategy. Ensuring high-quality SP role-portrayal is crucial for the authenticity and standardization of assessments, particularly in high-stakes exams like the Swiss Federal Licensing Examination (FLE).The study assesses the quality of SP role-portrayal over consecutive instances of the Swiss FLE. We hypothesized that the quality of role-portrayal improves over time.

Methods: The study employed the FAIR OSCE instrument to assess SP role-portrayal in five consecutive FLE exams from 2016 to 2021. The instrument, developed between 2011 and 2014, includes four categories: introduction, delivery of information, portrayal, and others. Data analysis involved retrospective examination of FAIR OSCE ratings, calculating item scores, and overall mean scores for each exam year.

Results: The study involved 37 SP educators observing 1803 SP-candidate interactions across five exam sites. Results demonstrated a continuous improvement in SP role-portrayal over the five-year period, with significant differences between 2016 and subsequent years. The overall mean scores of SP role-play ratings increased steadily, indicating a positive trend in SP performance.

Discussion: The findings supported the hypothesis of continuous improvement of SP role-portrayal within the Swiss FLE. The quality of role portrayal not only improved consistently but also maintained a very high level, with no items on the FAIR OSCE instrument rated "do not agree" more than 5% of the time. This suggests that SPs role play aligned well with case scripts, reflecting the intended authenticity and standardization of assessments.Limitations were acknowledged, including potential bias in local SP educators rating their own SPs and the study's sole focus on SP role-portrayal. While the findings contribute to understanding SP effectiveness in standardized, high-stakes clinical exams, the study did not scrutinize other potential sources of variance.

Conclusion: In conclusion, the research demonstrated a continuous improvement and high quality of SP role-portrayal in the Swiss FLE over five years. Well-trained SPs, assessed using the FAIR OSCE instrument, play a crucial role in maintaining the standardized and high-quality nature of clinical skills exams in a high-stakes context. Further research could explore additional factors influencing overall exam quality and address potential biases in SP educator ratings.

Objective: Medical training in Switzerland is currently undergoing change. The postgraduate education curricula of all medical specialties are being converted to competency-based medical education (CBME). Entrustable Professional Activities (EPA) are used to assess competencies. EPAs describe specific professional tasks that are assigned to postgraduate trainees once they have achieved sufficient competencies.

Methodology and results: The article describes how the didactic building blocks are joined to create competency-based teaching and how the implementation takes place.The project is described using the Kern cycle. The first two steps, problem identification and targeted needs assessment, are presented in the project description section, the other four steps in the results. Concrete details are given using examples from the cardiology curriculum.

Conclusion: The conversion of medical training in Switzerland to competency-based teaching is an important step that is urgently needed but complex. The long-term plan of the Swiss Institute for Postgraduate and Continuing Medical Education (SIWF) consists not only of structural steps but also cultural change. The first two years of the conversion were successful. In collaboration with the specialist societies, postgraduate curricula are being converted to EPA-based learning objectives, the didactic training for postgraduate teaching staff adapted accordingly and feedback from learners is continuously gathered. The implementation process has begun. Additional data will be collected as the project proceeds. Using experience already gained internationally and by specialist societies which have already taken this step as benchmarks is critical for other specialties and training centres that are still to follow.