GMS Journal for Medical Education最新文献

Objectives: A strategy-based evaluation of new teaching or examination formats is recommended in order to check their suitability before a possible integration into a medical curriculum. The aim of the project was to evaluate an established formative competence- and simulation-based examination format for medical students in a standardized way.

Project description: In a realistic simulation of a first working day in hospital, medical students at the end of their studies were given the opportunity to test their medical competences and to develop them further on the basis of self-assessment and feedback. In the years 2020 to 2023, a total of 879 students participated. This included 707 students in their final year (PJ) and 172 students before their PJ. The simulation format was evaluated in a standardized manner based on the Stanford criteria for evaluating clinical teaching. The free text comments were analyzed by content using MAXQDA.

Results: The quality of the training, the practical learning content and aspects of the individual training phases are the most important areas of the student evaluation. The learning atmosphere, the leadership and the assessments and feedback received are described positively. There are also clear indications that the simulation format promotes understanding and retention and supports self-directed learning well. Overall, participants gave the teaching format an average school grade of 1.26±.45. Some evaluation results have already been implemented in the adaptation of the simulation.

Conclusion: The integration of the simulation format into medical curricula can be recommended on the basis of this evaluation. Further development of the format is also possible.

Introduction: In the context of the shortage of physicians, the practical year is an important component in the acquisition of future medical talent. Previous studies suggest that PJ students rate several satisfaction parameters significantly lower in the surgical term than in other terms. Poor perceptions of surgical topics may lead to a health care problem. The aim of the current study was to analyse in detail the specific comparison between compulsory surgical and other elective surgical terms.

Methods: 7762 anonymous online PJ evaluations at the Medical Faculty of Münster from 2007-2020 (RR 60.6%) were retrospectively analysed. The elective subjects were divided into operative and conservative subjects. In particular, evaluations and subjective learning gains were compared.

Results: On the one hand, this study confirmed that the mandatory subject surgery was rated significantly worse than the other tertials (M_surg=69,3, M_Int=76,7, M_elec=84,6; p<0,001). Among the elective subjects, the conservative subjects were also preferred and rated better than the operative subjects (30,7% vs. 69,3%; M_op=85,9, M_kons=81,8; p<0,001). A final comparison of the elective operative subjects and the compulsory surgical terms showed that the elective operative subjects were also rated sig. better than the compulsory surgical term (M_surg=69,3, M_op=85,9; p<0,001).

Discussion: The compulsory surgical specialty was found to be deficient in student autonomy and supervision, which may explain the worsening recruitment problem. In order to improve the attractiveness of surgical training, a compulsory surgical elective could be introduced, where students could learn the core competencies in smaller units. This enhancement could increase the interest of future medical professionals in surgical training.

Background: Medical teaching uses medical comics, which are combinations of images and text that depict content from everyday life in the healthcare sector. Over- or under-representation of certain people in certain roles can convey subject-specific role models and stereotypes that can influence individual training pathways. This study examines the proportion of genders and people of colour represented in comic characters, the professional roles to which they can be assigned, and the share of speech they are given.

Method: The analysis included 995 German-language comics from anthologies and textbook series, with 2688 depicted characters from the period between 2002 and 2019. Criteria for categorizing roles, read gender and people of color were developed iteratively. The evaluation was carried out in a descriptive manner.

Results: In the overall evaluation, the quantitatively dominant read gender was male in the roles examined (55%-88%), with especially high representation in the physician's role (88%). Only the nursing staff were predominantly female (75%). The proportion of people of color in the roles analyzed was negligible (0-2%). The share of speech did not differ.

Discussion: Medical comics used in teaching should have a balanced gender ratio, consciously depict people of color and take demographic conditions into account. This should help to create an environment in which students base their career choices on their personal skills and goals rather than on aspects such as gender or identity as people of color.

Background: Due to contact restrictions during the Corona pandemic, teaching at the Center for Physiology and Pathophysiology at the University of Cologne was temporarily offered online for some students and face-to-face for others. As there are different views on the effectiveness of online teaching, this study compared students' examination results between the teaching formats (face-to-face vs. online).

Methods: In winter 2021/22, a total of 198 students in their fourth preclinical semester took part in the physiology course. The students were randomly assigned to 15 practical courses, so that the practical course was completed either traditionally in presence (face-to-face; FtF_group) or as an online practical course via Zoom^® (O_group). The teaching format versus the score achieved per test question were recorded for each examinee. The differences in test scores were calculated using a two-sided t-test. The effect size was determined using Cohen's d. Spearman's rank correlation coefficient was used as a measure of the correlation.

Results: In comparison with the O_group (M=7.02), the FtF_group (M=7.38) achieved a significantly higher test score on average. The effect size was low (Cohen's d=0.135). The FtF_group performed better than the O_group in 14 subject areas. The Spearman's correlation test between the number of FtF participations and the test scores achieved reached a value of r=0.236 (p<.001).

Conclusion: Our study shows that students who have attended traditional face-to-face classes tend to perform better in the written exam. The reasons may be multifactorial. However, online teaching also offers some advantages, such as flexibility in terms of location and time management for students. The choice between online and face-to-face teaching should be based on the specific requirements of the course. Ideally, a hybrid solution that combines the advantages of both formats would be an effective teaching format. It is therefore essential to continuously review educational practices.

Stress-related illnesses are on the rise among medical students and doctors in Germany and internationally. Mind-Body Medicine (MBM) methods are increasingly being used to reduce stress. MBM courses are now being offered to students at medical faculties in Germany, including Charité - Universitätsmedizin Berlin and e.g. at the universities of Magdeburg, Witten-Herdecke, Essen and Ulm. The courses offered in Berlin and Magdeburg are presented as examples in this article. In addition, the Charité course was also conducted with employees (doctors and nurses) of a Charité intensive care unit. The student courses at both medical universities were evaluated at the same time. The results of the analyses showed a reduction in perceived stress and an increase in self-efficacy, mindfulness, self-reflection and empathy in 117 Charité students, and an improvement in mindfulness (Freiburg mindfulness inventory (FFA)) and self-compassion (Self Compassion Scale - German Version (SCS-D)) in 69 students from Magdeburg. In the qualitative focus groups, the students at Charité also reported better abilities to self-regulate stressful experiences, personal growth and new insights into integrative medicine. The further implementation of MBM courses at German-speaking medical universities appears to make sense. In addition, MBM courses should be networked across different locations in order to coordinate their content and carry out a joint evaluation using standardised measurement instruments on a larger group of participants. In addition, the implementation of randomised controlled studies to investigate the effectiveness of MBM courses would be beneficial.

Background: Preparing students for their future roles in preventive medicine is relevant, especially on the subject of nicotine consumption. We implemented a longitudinal smoking cessation counselling course as a part of the subject "prevention and health promotion". Beginning with 6^th semester students were taught the 5A model, a widely used framework to support behavioural change. Four semesters later, we evaluated feasibility of the counselling in the family medicine placement.

Methods: In this evaluative follow-up study, we used online questionnaires with Likert-scales, closed and open questions. Students of the 10^th semester assessed feasibility and obstacles of counselling during placement in a family practice with real patients, their counselling confidence and professional attitudes. For examination of changes since 6^th semester we compared matched data. Data were analysed with t-tests and ANOVAs.

Results: Data of 114 students of the 10^th semester were analysed, 45 data could be matched to the 6^th semester. Results showed that the intervention was feasible under favourable conditions: half of the students did not perform a counselling because of lack of time or opportunity. Performing the counselling during the placement led to a greater increase in felt counselling competences compared to students who did not perform a counselling.

Conclusion: To improve communicative skills in the area of behavioural change, it is important to combine theoretical content and practical implementation. The 5A model has proven due to its simplicity. Promoting good framework conditions in family medicine, such as sufficient time, is essential to give students the opportunity to practice counselling and increase their felt competence.

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.