Chirurgie (Heidelberg, Germany)最新文献

Background: Curriculum mapping describes the process indexing a curriculum to identify academic gaps. The first version of the National Competence-based Catalogue of Learning Objectives in Medicine (NKLM 1.0) was created to catalogue the content of medical studies and to promote the implementation of competence-oriented learning objectives. It is unclear and not transparent to what extent learning objectives are achieved in existing courses, particularly in clinical internships that cannot be standardized.

Objective: The aim of the work was to map the achieved learning objectives of the NKLM 1.0. within a surgical internship from the students' perspectives.

Material and methods: Medical students mapped their achieved learning objectives after a 2-week internship with an online questionnaire. In addition, sociodemographic data, the type of teaching hospital and the surgical specialty were recorded.

Results: A total of 81 students participated in the mapping. After the internship 8.78 ± 5.10% (min. = 1.01%; max. = 29.84%) of all learning objectives were achieved by the students. Most of the learning objectives come from section 1 "medical roles" with 29.92 ± 15.22% (min. = 0.00%; max. = 63.10%). From section 2 "medical knowledge, clinical skills and professional attitudes", learning objectives from chapters 14b "clinical practical skills" (15.49 ± 7.78%, min. = 0.00%; max. = 41.30%) and 14c "medical counseling technique" (22.98 ± 16.47%, min. = 0.00%; max. = 70.69%) were primarily named. There were no significant differences between the sexes, the surgical specialty or the size of the teaching hospital.

Conclusion: Students state that they mainly achieve learning objectives in the area of medical roles and clinical practical skills during an internship. Additional teaching formats seem to be necessary to teach specific surgical skills, diagnostics and treatment.

Background: Since 2023 the law in Germany has required that working times are recorded in the field of surgery.

Objectives: The consequences of recording of the working hours in surgery are the main topic of this study. The search for ways of harmonization in the team to counteract a limited availability of personnel requires knowledge of the position of surgeons on the issue in question.

Material and methods: The study design is based on the situational approach of organizational research and encompasses 20 qualitative interviews and 186 datasets of an online questionnaire with 24 questions. For the evaluation group comparisons were carried out using the ANOVA analysis. The target groups were surgeons working in German hospitals. The study has an explorative character due to the targeted selection of samples.

Results: The results of the online survey showed a strong support for working time recording among surgeons with a general agreement of 82% and a consensus at all levels from residents to medical directors. Less than 50% of the assistants and medical specialists saw an improvement via an in-house dialogue, in comparison to senior physicians and medical directors. The right to compensatory time off by other employees represents a greater burden for senior physicians and chief physicians.

Discussion: The decisive result shows that there is a preference for transponder-based systems, especially among surgeons with long working hours. The problems of transparency and the right to compensatory time off, often associated with a lack of personnel, demonstrate the necessity for an improved communication and strategic personnel planning in hospitals. Surgeons have differentiated views on the transparent exchange on the topic of the working hours performed.

The treatment of multimorbid patients in oncological surgery of the upper gastrointestinal tract requires a differentiated consideration of every single risk factor in order to provide a holistic assessment. This article focuses on pre-existing diseases that are particularly relevant for elective esophageal and gastric surgery and have practical clinical consequences. In this way a differtiation is made between metabolic, vascular, cardiopulmonary and organ-specific risks. The aim of this work is to provide practical guidelines for complex and multimorbid cases. Given the multifactorial interrelationships, the importance of a thorough preoperative evaluation and interdisciplinary management cannot be overemphasized.