GMS Journal for Medical Education最新文献

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.

Background: The structures of postgraduate medical education are regulated by the (guideline) regulations on specialty training ((M-)WBO). This formal structure is the result of medical discourse between medical associations, specialist societies and other associations. Various developments can be seen in the WBO. This study examines whether changes at the level of the WBO can contribute to changing and didactically optimizing postgraduate education in hospitals.

Methods: Based on Mayring's theory a document analysis of the MWBO 1992, 2003 and 2018 was carried out with an additional focus on aspects of surgery. For this purpose, texts and contents of the MWBOs were compared and word frequencies were analyzed. In addition, three guided interviews with experts were conducted and analyzed according to Kuckartz using MAXQDA. The experts were selected based on their position and their involvement in the MWBO adaptation process.

Results: The analysis of the WBO shows that efforts are being made to adapt specialty training in hospitals in order to make it more structured and didactically optimized. Concepts are being introduced and, in some cases abolished (e.g. specialist knowledge "Fachkunden") or further developed (e.g. competencies). The word frequency analysis shows the use of the same eight most frequent terms, which seem to define the basic character of postgraduate education. There are also obstacles to communication between the medical self-administration and the clinical stakeholders, which limit the possibilities for change.

Conclusion: For implementation of the WBO in hospitals, clinicians need to be included even more intensively. This should not only take place during the development of the WBO, but especially during its implementation in the hospitals themselves to enable better integration of the new structures and didactic concepts of the WBO.

Introduction: The competency-based catalogue of learning objectives "Principal Relevant Objectives and Framework for Integrative Learning and Education in Switzerland" (PROFILES) based on Entrustable Professional Activities (EPAs) was newly introduced in 2018 in undergraduate medical education in Switzerland. Clerkships provide opportunities for students to train clinical skills and competencies within the curriculum. This study aims to assess the students' experiences during paediatric clerkships and whether they achieve the expected competency level of certain EPAs by the end of their training.

Methods: An online survey was conducted among all 316 students in their last year of medical school (3^rd year master) enrolled at the University of Zurich. A total of 113 students who had completed a clerkship in paediatrics in different hospitals, were asked about their general expectations and experiences, and to rate their achievement of competency levels in 26 selected EPAs. An EPA was considered accomplished if a minimum of 2/3 of all students reached at least level 3.

Results: Paediatric clerkship was generally viewed as positive experience by most students. However, a desire for more integration into clinical teams, increased training in clinical skills, and feedback was expressed. The expected level 3 of competency (indirect supervision) was achieved in 14 out of 26 EPAs by at least 2/3 of students. Level 3 was however not reached for more specific EPAs such as neonatal examination, rating of psychomotor and pubertal development, and clinical reasoning.

Conclusion: Paediatric clerkships are regarded as valuable clinical training opportunities. To enhance the learning of competencies, integration into clinical teams and faculty training is crucial. The implementation of EPAs in the clinical context aligns with these goals.

Objective: In Germany, the rotation into the general practitioner's practice (GPP) as part of postgraduate medical training in general practice traditionally takes place at the end of the training period. The aim of this study was to explore possible subsequent effects of beginning training in the GPP from the perspective of general practitioners (GPs) and GP trainees.

Methods: Nationwide, GPs and GP trainees were recruited who started specialization in GP in the GPP. Semi-structured telephone interviews were conducted between June and October 2022 using a self-developed interview-guide. The results were transcribed verbatim and analyzed using content analysis.

Results: N=15 interviews were conducted, averaging 54 minutes (32-75 minutes) each (9 federal states, 4 GPs, 11 GP trainees). From the participants' perspective, advantages included close supervision, flat hierarchies, more time for preparation and follow-up, self-directed learning as well as higher basic salary and regular working hours. Positive effects mentioned were reinforcement in career choice, early understanding of workflow in GPP, early development of a GP attitude and strengthening of professional self-confidence. Disadvantages included initial uncertainty at the beginning of the profession and limited opportunities for peer exchange. In conclusion, all participants would recommend beginning specialization with a rotation in the GPP.

Discussion: Starting in GGP allows GP trainees to learn about GP in a self-directed, research-oriented manner and based on consultations which enables early professional identity formation. GP trainees should avoid lack of collegial support by participating in a postgraduate training program. In a second step, GP trainers perspectives need to be assessed.

Conclusion: Beginning GP postgraduate training with a rotation in GP is advantageous and should be structurally promoted.

Objective: To aid the shortage of general practitioners (GPs) in Germany, since 2011 medical specialists from other fields may switch specialisation by undergoing a slim-lined training programme (lateral entry) into general practice (GP). Available published qualitative and quantitative data on lateral entrants (LEs) is scarce. Aim of the study was an explorative analysis of LEs in the competence centre for postgraduate medical education Baden-Wuerttemberg (KWBW).

Methods: In 2016, a multicentric cohort study was initiated including all GP trainees entering the KWBW. Data from 2016 to 2022 was included (T0). A follow-up with graduates from the KWBW was performed once in 2023 (T1). Surveys at T0 and T1 were self-developed, piloted, and included questions on social demography, education, qualification, current training, working environment and professional plans. Dataset was analysed exploratively.

Results: At T0, 884 GP trainees participated (response 95.2%). 23.8% of participants were LEs (N=210). Most LEs were specialists from anaesthesiology (34.8%), internal medicine (28.5%) and surgery (20.6%). LEs had been working in their previous specialty for a median of 3 years before starting GP-training. At T0, LEs were seven years older than their colleagues (p<0,001). The proportion of men among LEs was higher (34.3% vs 25.1%, p=0,009). LEs were more decisive to open their own GP practice (p=0,009). At T1, 48 LEs participated of which 92% were practising GPs (N=36). 64,5% considered themselves rural GPs and work in communities <20.000 people (N=36). LEs mainly choose GP because of its specific way of working, job dissatisfaction and personal motives such as opportunity to start a practice. Most LEs strongly agreed that they would switch to GP again.

Discussion: LEs are a relevant party among GP trainees. Many LEs become self-employed and contribute essentially to providing primary care. Lateral entry attracts specialists, also from rural areas, seeking for professional satisfaction. This is why LEs should follow their new path within a regional competence centre providing GP specific courses, mentoring and a professional network.

Conclusions: LEs graduating from KWBW have become an important pillar of primary care in Baden-Wuerttemberg.

Introduction: Graduate medical education is being reformed in many countries, with a focus on the principles of competency-based medical education (CBME). A main novel aspect in this context is the implementation of entrustable professional activities (EPAs). The introduction of EPAs aims to better align training curricula with clinical practice, provide individualized supervision, and enhance the quality of feedback.

Project description: This project report presents the development of a national strategy and the initial results of implementing entrustable professional activities in the Swiss context.

Results: Affiliated with the Swiss Institute of Medical Education (SIME), an EPA-Commission was established with the mandate to develop a strategy and provide guidance to medical specialty societies. To date, 28 out of 45 specialty societies have sought advice from the EPA-Commission and have begun developing EPAs. Concurrently, the Commission has expanded the national faculty development courses, adapted the content, started offering multilingual courses, and has published a series of articles on CBME and EPAs. Selected pilot hospitals are now planning to implement EPA-based graduate medical education curricula. Additionally, the introduction of a nationwide electronic solution (app) for assessing EPAs is planned.

Conclusion: The introduction of EPAs in graduate medical education is a multilayered project. In addition to medical education aspects, various social, organizational, and professional-political factors are crucial for the transformation processes. In the Swiss context, such a reform has been successfully initiated. Continuous evaluations of the ongoing projects will provide further insights for competency-based graduate medical education reforms.

Objective: The Halle continuum (HaKom) is a course for doctors undergoing postgraduate medical training in southern Saxony-Anhalt. It revises the skills and knowledge acquired during undergraduate medical training and develops them on an individual and needs-driven basis. The development and establishment of the three-day ready for (resident on-call) duty (Fit für den Dienst) course, which has been held four times a year since 2020, will be used as an example to present the overall HaKom curriculum.

Methodology: The HaKom comprises a total of eight courses already established and four further courses still being planned, the order of which can be adapted individually. One of the HaKom courses is the ready for duty course, the structure and development of which will be explained below. The course content was developed in line with the KERN model using a questionnaire-based needs assessment conducted between 2019 and 2020 among 77 participants from ten different specialty areas.

Results: In the in-person ready for duty course, 16 participants learn relevant content for their first (on-call) duty using simulations, communication training and practical skills stations at the learning centre of Halle University Hospital. Participants can study theoretical content in detail in a blended-learning approach. Evaluations of the curriculum taught to the first 12 cohorts - comprising a total of 205 participants - were conducted with a response rate of 65% and the course content was adapted on the basis of these evaluations. All of the respondents (100%) said that the course was useful in preparing them at the beginning of their medical career.

Conclusion: As part of the overall HaKom curriculum, the ready for duty course builds on and goes beyond undergraduate medical training. By improving the quality of postgraduate medical training, it is designed to guarantee adequate patient care and can also promote local networking among the participants.

Objectives: Current research increasingly describes physicians' health as endangered. Interventions to improve physicians' health show inconsistent results. In order to investigate possible causes for weak long-term effects, we examined senior physicians' perceptions about the relevance of their own health and analyzed whether and how these might affect the difficulty to improve physicians' health.

Method: The authors conducted 19 semi-structured interviews with senior physicians from different medical disciplines, analyzed the data and developed theory using the grounded theory method.

Results: Based on the interviews, we developed a conceptual model which identifies reinforcing factors for physicians' hesitancy in self-care as well as barriers to change. Participants regarded their own health needs as low and equated health with performance. These perceptions were described as being part of their professional identity and mirrored by the hospital culture they work in. Mechanisms as part of the collective professional identity (CPI) of physicians help to stabilize the status quo through early socialization and pride in exceptional performance. In addition, the tabooing of weakness and illness among colleagues, and dissociation from patients as well as sick doctors were identified as stabilizing mechanisms.

Conclusion: Findings support the assumption that one cause of physicians' health problems might lie in a CPI that includes tendencies to rate one's health as secondary or irrelevant. Identified mechanisms against change are, according to Social Identity Theory, typical group strategies which ensure the stability of CPI and make existing attitudes and beliefs difficult to change. However, barriers against change could possibly be overcome by addressing these underlying mechanisms and by a change process that is supported by experienced and competent members of the in-group for the benefit of both physicians and patients.