Publications by authors named "Martin R Fischer"

164 Publications

Development of an Entrustable Professional Activities (EPA) Framework to Inform Surgical Residency Training Programs in Ethiopia: A Three-round National Delphi Method Study.

J Surg Educ 2021 Jul 19. Epub 2021 Jul 19.

Institute of Medical Education, University Hospital, Munich, Germany.

Background: Entrustable Professional Activities (EPAs) have been proposed as a means to translate competencies into clinical practice. Although EPAs for residency training have become available, 1 set of core EPAs cannot automatically be transferred from one context to another due to cultural variability. Further, there is a lack of African- and Asian-based EPA development and implementation studies. We developed an end-of-training EPAs framework to inform surgical residency training programs in the local context of Ethiopian medical education.

Methods: A three-round Delphi method was used to establish consensus about important surgical EPAs among experts. A total of 136 experts representing all surgical residency training institutions in Ethiopia were invited to participate. Round 1 & 2 consisted of senior expert panelists (n = 8) to identify potential EPAs and determine the content validity. Round 3 consisted of a survey (n = 128) to further validate the identified EPAs by attending surgeons who work with them. Each EPA had to achieve at least 80% or higher agreement among experts to be considered having acceptable content validity.

Results: In round 1, a total of 272 EPAs were proposed, reduced, and grouped to 39 consented EPAs. In round 2, the same experts rated each EPA's relevance, resulting in 32 EPAs with a satisfactory item-level content validity index (I-CVI > 0.83). Overall, in the survey in round 3, 29 EPAs met the standard criterion for acceptability (S-CVI/Ave = 0.90) and achieved a high degree of final consensus (ICC = 0.998, 95% CI [0.996, 0.999]; (F = 439.2, p < 0.0001).

Conclusions: The framework of 29 validated and accepted EPAs can guide future surgical residency training programs in the Ethiopian medical education context. The framework allows programs to move from a time-dependent to an outcome-based model and transforms traditional assessment into entrustment decisions. Thus, the use of the framework can improve the quality of training and patient care in Ehtiopia.
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http://dx.doi.org/10.1016/j.jsurg.2021.06.023DOI Listing
July 2021

A structured Endoscopic Ultrasound training program in Germany improves knowledge and competence.

Med Ultrason 2021 Jun 10. Epub 2021 Jun 10.

Institut for Medical Education, University Hospital of LMU Munich, Munich, Germany.

Aims: Limited evidence on how to organize pre-patient training in Endoscopic Ultrasound (EUS) and how to evaluate its effect on knowledge and skills are available. The aim of our study was to assess the impact of a structured multi-site training program on EUS competence in Germany.

Material And Methods: In a prospective study design, evaluation of 64 trainees was conducted during four three-day training courses with equal curricula at three sites. Participants completed a structured pre- and post-test questionnaire consisting of 4 items to evaluate the relevance and acceptance of the training components (theoretical teaching, video sessions, live demonstration, hands-on experience) on a 5-point Likert scale, as well as a Likert scale to judge the self-rated improvement in EUS competence. To assess knowledge, 12 multiple choice (MC) questions had to be answered by all participants in a pre- and a post-test design. Also differences between beginners and advanced learners were analysed.

Results: Overall evaluation on acceptance received above-average results with a median of 4 or 5 (IQR 1-2) on Likert scale (1=completely disagree, 5=completely agree). In the post-test self-rated EUS skills improved from 4 to 2 on the Likert scale (IQR=1, p=0.001, 1=excellent EUS skills, 5=no EUS skills). Results of the MC-test of all trainees showed significant improvement in theoretical knowledge from 7.9±1.9 to 8.8±1.9 points (mean±SD, p=0.001).

Conclusions: Our study provides arguments for the usefulness of a structured EUS training program resulting in a positive acceptance and high self-rated EUS competence by the participants and significant improvements in knowledge.
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http://dx.doi.org/10.11152/mu-2892DOI Listing
June 2021

Doctor-patient communication during the Corona crisis - web-based interactions and structured feedback from standardized patients at the University of Basel and the LMU Munich.

GMS J Med Educ 2021 15;38(4):Doc81. Epub 2021 Apr 15.

LMU Munich, Institute for Medical Education, University Hospital, Munich, Germany.

Due to the pandemic-related restrictions in classroom teaching at the medical faculties of the LMU Munich and the University of Basel, teaching methods with standardized patients (SPs), were shifted to a digital, web-based format at short notice as of April 2020. We report on our experiences with the WebEncounter program, which was used for the first time in German-speaking countries. The program enables one-to-one encounters between SPs and students. Students receive an invitational email with brief instructions and background information on the case. SPs use case-specific criteria that are compliant with the learning objectives for digital evaluation during the encounter. A feedback session takes place immediately following the encounter. The SPs address the didactically relevant sections and can illustrate them with the corresponding video sequences. Finally, the students receive the links to the video recordings of the encounter and the feedback unit by email. The aim of this pilot study was to analyze the practicability of the program and its acceptance by students and SPs. In addition, we examined whether the operationalization of the learning objectives in the form of assessment items has an impact on the content and thematic development of courses in the area of doctor-patient communication. To implement the program, patient cases previously tested in communication seminars in Munich and Basel were rewritten and case-specific evaluation criteria were developed. SPs were trained to use the program, to present their patient figure online and to give feedback. The experience of those involved (faculty, SPs and SP trainers, students) in implementing the program was documented at various levels. The frequency and causes of technical problems were described. Student results on the patient cases and on the feedback items were collected quantitatively and, where possible, supplemented by free-text statements. Data from 218/220 students in Basel and 120/127 students in Munich were collected and evaluated. Students were very satisfied with the patient cases, the encounter with the SPs and their feedback: 3.81±0.42. SPs experienced the training as an increase in their competence and the structured feedback as particularly positive. The training effort per SP was between 2.5 and 4 hours. The results show predominantly normally-distributed, case-specific sum scores of the evaluation criteria. The analysis of the individual assessment items refers to learning objectives that students find difficult to achieve (e.g. explicitly structuring the conversation). Problems in the technical implementation (<10 percent of the encounters) were due mainly to the use of insufficient hardware or internet connection problems. The need to define case-specific evaluation criteria triggered a discussion in the group of study directors about learning objectives and their operationalization. Web-based encounters can be built into the ongoing communication curriculum with reasonable effort. Training the SPs and heeding the technical requirements are of central importance. Practicing the virtual consultation was evaluated very positively by the students - in particular, the immediate feedback in the protected dialogue was appreciated by all involved.
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http://dx.doi.org/10.3205/zma001477DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136343PMC
April 2021

Statistical literacy and scientific reasoning & argumentation in physicians.

GMS J Med Educ 2021 15;38(4):Doc77. Epub 2021 Apr 15.

University Hospital, LMU Munich, Institute of Medical Education, Munich, Germany.

Statistical literacy (SL) of physicians, i.e. the ability to use and interpret statistical numbers in the context of science, is an essential prerequisite for risk estimation and communication. Together with scientific reasoning and argumentation (SRA) skills, SL provides the basis for evidence-based practice. Several studies suggest that in medical students both skills are underdeveloped. The aim of the present study was to investigate these skills in practicing physicians and how these skills were acquired. Data collection in =71 physicians was conducted online and as paper pencil. SL was assessed with multiple-choice items. SRA skills evidence evaluation and drawing conclusions were measured with a decision scenario. Study results indicated that physicians have medium levels of SL (=17.58, =6.92, max 30 pts.) and SRA (evidence evaluation: =7.75, =1.85, max 10 pts.; drawing conclusions: =37.20, =5.35, max 60 pts.). Skills development via autodidactic learning activities (=4.78, =1.13, range 1-6) was reported significantly more often than development during formal medical education (=2.31, =1.46), (71)=-9.915, <.001, or in extracurricular activities (=3.34, =1.87), (71)=4.673, <.001. The active involvement in research seemed decisive: The number of publications and time spent in research significantly correlated with SL, (71)=.355, =.002; respectively (71)=.280, =.018. SRA skills were predicted by the type of MD-thesis, =-.380, =.016, and working in research, =3.355, =.008. Active involvement in research activities seems to be a very important factor for the development of both SL and SRA skills. The implementation of systematic fostering of these skills during formal medical education seems warranted.
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http://dx.doi.org/10.3205/zma001473DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136351PMC
April 2021

Simulated ward round training in the medical curriculum Munich.

GMS J Med Educ 2021 15;38(4):Doc75. Epub 2021 Apr 15.

Ludwig-Maximilians-Universität München, LMU Klinikum, Medizinische Klinik und Poliklinik IV, Munich, Germany.

Conducting a ward round in a structured and goal-oriented manner is one of the central competencies of a physician's work. Despite its relevance, ward round competence was only addressed in an unstructured way in the Medical Curriculum Munich (MeCuM) prior to 2011. Therefore, the project's aim was to implement an evidence-based course on medical ward round competence. This project report provides a guideline for developing such a training course. Project planning and development was guided by the steps of the "Kern cycle", beginning with needs assessment, learning objectives definition, and selection of appropriate teaching methods, and ending with implementation and evaluation.
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http://dx.doi.org/10.3205/zma001471DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136345PMC
April 2021

Implementation of self-directed learning within clinical clerkships.

GMS J Med Educ 2021 15;38(2):Doc43. Epub 2021 Feb 15.

Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, Munich, Germany.

The main aim of medical curricula is to prepare students for the first day at the work place. While teaching clinical competence is pivotal, clinical clerkships are often the last chance to close knowledge gaps with the help of clinical teachers. Self-directed learning is a dynamic field for research within medical education, though its curricular implementation is rare. This study focuses on the needs assessment of clinical clerkships using the concept of self-directed learning. The study comprised an educational experience at the Ludwig-Maximilians Universität (LMU) Munich. Medical students (n=1446, 59% female) in their second clinical year were instructed to specify learning objectives (LOs) by Doran`s SMART criteria and to gauge the probability of their fulfilment prior to the mandatory clerkship. In a second questionnaire one week later, the students rated the actual subjective fulfilment of the LOs. Data was coded with regards to the German National Catalogue of Competence-Based Learning Objectives for Undergraduate Medical Education (NKLM) and investigated qualitatively. Factors that determine goal achievement were collected and coded binary (barrier vs. enabler). Univariate analysis was used when appropriate. The acquisition of "clinically practical abilities" (29%), "diagnostic methods" (21%) and "professional communication" (13%) were the LOs mentioned most. Throughout the week, subjective fulfilment diminished. Rich (vs. poor) availability to "practical exercise" (31%), "engagement of the physicians and other medical staff" (27%) and "personal initiative" (23%) resulted in higher subjective fulfilment. The self-chosen LOs reflect the needs of students for which the clinical teacher should be prepared. Considering these findings, it seems possible to close practical training gaps. We support the consideration of establishing curricular anchored self-directed learning in clinical clerkships. Further empirical studies would be beneficial in revealing its positive effects on the learning progress.
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http://dx.doi.org/10.3205/zma001439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7958912PMC
February 2021

Global e-Learning in Early Nutrition and Lifestyle for International Healthcare Professionals: Design and Evaluation of the Early Nutrition Specialist Programme (ENS).

Nutrients 2021 Feb 27;13(3). Epub 2021 Feb 27.

Department of Paediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU-Ludwig-Maximilians-Universität München, 80377 Munich, Germany.

Background: Every encounter a healthcare professional has with new or expecting parents offers an opportunity for addressing improved early nutrition and lifestyle. Evidence-based qualification programmes via e-learning offer valuable tools for attenuating the world's huge double burden of both under- and overnutrition in early childhood. We evaluated use and learner satisfaction of a global e-learning programme on early nutrition and lifestyle addressing international healthcare professionals.

Methods: We implemented the Early Nutrition Specialist Programme (ENS) with six interactive e-learning courses on early nutrition building on more than ten years of experience with global e-learning platforms, expert knowledge and an international network in the subject field. We collected descriptive and explorative evaluation data on usage and learner satisfaction with a questionnaire and log data over three years among 4003 learners from 48 countries.

Results: Results show high completion of the ENS programme, with 85.5% of learners finalizing the programme after enrollment into the first of six courses. Very good results were provided for learner satisfaction with the courses (96.7% of users), for increasing understanding of the topic (97.4%) and matching the indicated time investment (94.4%). Most predominant themes in the open text fields of user feedback questionnaires were "Increase interactivity or number of audio-visuals", "Content suggestions or more examples" and "Technical (quality) issues or navigation problems".

Conclusions: The ENS programme evaluation shows high completion rates and level of satisfaction by learners from numerous countries. The different needs for Continuing Medical Education (CME) of healthcare professionals in diverse healthcare system settings can be met by a joint e-learning qualification programme. Further optimizations will be implemented based on user feedback. More research with a learning analytics approach may help to further identify the most effective and efficient didactic and pedagogic elements of e-learning.
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http://dx.doi.org/10.3390/nu13030775DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997315PMC
February 2021

Assessment of Diagnostic Competences With Standardized Patients Versus Virtual Patients: Experimental Study in the Context of History Taking.

J Med Internet Res 2021 Mar 4;23(3):e21196. Epub 2021 Mar 4.

Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany.

Background: Standardized patients (SPs) have been one of the popular assessment methods in clinical teaching for decades, although they are resource intensive. Nowadays, simulated virtual patients (VPs) are increasingly used because they are permanently available and fully scalable to a large audience. However, empirical studies comparing the differential effects of these assessment methods are lacking. Similarly, the relationships between key variables associated with diagnostic competences (ie, diagnostic accuracy and evidence generation) in these assessment methods still require further research.

Objective: The aim of this study is to compare perceived authenticity, cognitive load, and diagnostic competences in performance-based assessment using SPs and VPs. This study also aims to examine the relationships of perceived authenticity, cognitive load, and quality of evidence generation with diagnostic accuracy.

Methods: We conducted an experimental study with 86 medical students (mean 26.03 years, SD 4.71) focusing on history taking in dyspnea cases. Participants solved three cases with SPs and three cases with VPs in this repeated measures study. After each case, students provided a diagnosis and rated perceived authenticity and cognitive load. The provided diagnosis was scored in terms of diagnostic accuracy; the questions asked by the medical students were rated with respect to their quality of evidence generation. In addition to regular null hypothesis testing, this study used equivalence testing to investigate the absence of meaningful effects.

Results: Perceived authenticity (1-tailed t=11.12; P<.001) was higher for SPs than for VPs. The correlation between diagnostic accuracy and perceived authenticity was very small (r=0.05) and neither equivalent (P=.09) nor statistically significant (P=.32). Cognitive load was equivalent in both assessment methods (t=2.81; P=.003). Intrinsic cognitive load (1-tailed r=-0.30; P=.003) and extraneous load (1-tailed r=-0.29; P=.003) correlated negatively with the combined score for diagnostic accuracy. The quality of evidence generation was positively related to diagnostic accuracy for VPs (1-tailed r=0.38; P<.001); this finding did not hold for SPs (1-tailed r=0.05; P=.32). Comparing both assessment methods with each other, diagnostic accuracy was higher for SPs than for VPs (2-tailed t=2.49; P=.01).

Conclusions: The results on perceived authenticity demonstrate that learners experience SPs as more authentic than VPs. As higher amounts of intrinsic and extraneous cognitive loads are detrimental to performance, both types of cognitive load must be monitored and manipulated systematically in the assessment. Diagnostic accuracy was higher for SPs than for VPs, which could potentially negatively affect students' grades with VPs. We identify and discuss possible reasons for this performance difference between both assessment methods.
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http://dx.doi.org/10.2196/21196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7974754PMC
March 2021

The use of the online Inverted Classroom Model for digital teaching with gamification in medical studies.

GMS J Med Educ 2021;38(1):Doc3. Epub 2021 Jan 28.

LMU Klinikum München, Institut für Didaktik und Ausbildungsforschung in der Medizin, Munich, Germany.

In 2014, a newly designed, case-based seminar was successfully implemented in the subjects of health systems, health economics and public health care (GGG). The seminar "The Lonely Patient" is based on a real patient case and deals with the German health care system from the perspective of a patient. In order to create more space for discussion and exchange among students, the seminar was redesigned on the basis of the Inverted Classroom Method (ICM). Due to the COVID-19 pandemic, new, purely digital teaching formats had to be developed quickly in the sense of Emergency Remote Teaching. Therefore, the Inverted Classroom concept of the seminar was transformed into an online ICM. In order to promote active learning based on the ICAP model (Interactive, Constructive, Active, Passive), the online face-to-face part was designed as a synchronous interactive learner-centered course using the gamified audience response system Kahoot! Evaluation results to date and feedback rounds with students indicate that the online ICM-version of the seminar leads to at least as good evaluation results as the previous face-to-face course. In particular, the students positively emphasize the use of Kahoot! as an activating digital medium. Through the use of the ICM and the gamified audience response system Kahoot!, students could be activated in meaningful ways. The resulting discussions about the patient case and teaching content of the quiz questions in the synchronous online course could be implemented just as well as in the classroom-based course of previous semesters. The application of the online ICM, along with the consideration of the ICAP Model, has led to the successful implementation of a digital course within the context of the increased difficulty surrounding the emergency remote teaching. Additionally, students' learning success has remained at a similar level as during traditional classroom-based courses of previous semesters.
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http://dx.doi.org/10.3205/zma001399DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899094PMC
March 2021

"I just stand around and look friendly" - Comparing medical students' and physicians' ward round scripts.

Med Teach 2021 05 11;43(5):560-566. Epub 2021 Feb 11.

Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany.

Background: Even though ward rounds are important learning opportunities for medical students, unfavourable ward round scripts of students and physicians may hinder learning in such situations. We investigated medical students' and physicians' ward round scripts with respect to (a) the content focus of ward round activities, and (b) the potential of these activities for knowledge construction.

Methods: We conducted standardized interviews with 50 medical students and physicians in internal medicine at different expertise stages. Activities participants labelled as typical for ward rounds were coded with respect to their content focus and their potential with regard to knowledge construction.

Results: Regarding content focus, especially residents mainly named activities bound to patient care. Teaching- and learning-related activities were very rare, but more frequently mentioned by students and more experienced physicians. With respect to potential for knowledge construction, students regarded significantly more passive activities (= low potential for knowledge construction) as typical for ward rounds, especially when they described their own role.

Conclusions: Medical students should be supported in their development of conceiving ward rounds as valuable learning opportunities. Residents should be asked to take their teaching responsibility seriously, for example by demanding an active engagement of the students during ward rounds.
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http://dx.doi.org/10.1080/0142159X.2021.1877267DOI Listing
May 2021

Isn't here just there without a "t" - to what extent can digital Clinical Case Discussions compensate for the absence of face-to-face teaching?

GMS J Med Educ 2020 3;37(7):Doc99. Epub 2020 Dec 3.

LMU Munich, University Hospital, Institute for Medical Education, Munich, Germany.

COVID-19 challenges curriculum managers worldwide to create digital substitutes for classroom teaching. Case-based teaching formats under expert supervision can be used as a substitute for practical bedside teaching, where the focus is on teaching clinical reasoning skills. For medical students of LMU and TU Munich, the interactive, case-based, and supervised teaching format of Clinical Case Discussion (CCD) was digitised and implemented as dCCD in their respective curricula. Case discussions were realised as videoconferences, led by a student moderator, and took place under the supervision of a board-certified clinician. To prevent passive participation, additional cognitive activations were implemented. Acceptance, usability, and subjective learning outcomes were assessed in dCCDs by means of a special evaluation concept. With regard to acceptance, students were of the opinion that they had learned effectively by participating in dCCDs (M=4.31; SD=1.37). The majority of students also stated that they would recommend the course to others (M=4.23; SD=1.62). The technical implementation of the teaching format was judged positively overall, but findings for usability were heterogeneous. Students rated their clinical reasoning skills at the end of the dCCDs (M=4.43; SD=0.66) as being significantly higher than at the beginning (M=4.33; SD=0.69), with low effect size, t(181)=-2.352, p=.020, d=0.15. Our evaluation data shows that the dCCD format is well-accepted by students as a substitute for face-to-face teaching. In the next step, we plan to examine the extent to which participation in dCCDs leads to an increase in objectively measured clinical reasoning skills, analogous to a face-to-face CCD with on-site attendance.
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http://dx.doi.org/10.3205/zma001392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7740012PMC
January 2021

Impact of a Heutagogical, Multimedia-Based Teaching Concept to Promote Self-Determined, Cooperative Student Learning in Clinical Radiology.

Rofo 2021 Jun 16;193(6):701-711. Epub 2020 Dec 16.

Institute for Medical Education, University Hospital of LMU Munich, Munich, Germany.

Purpose:  To date, didactic lecturing is a common method of university medical training. However, higher levels of competence to solve complex issues are hardly to be achieved with a largely passive learning style. We established and evaluated a heutagogical blended learning concept to investigate self-determined learning with a multimedia-based, interactive approach in the lecture room to teach clinical radiology.

Materials And Methods:  In the 2019/2020 winter semester, we included 266 medical students in their fourth academic year in our prospective, observational study. Students participated in a series of 11 radiological lectures given by 10 lecturers. They were requested to prepare for lectures by watching learning videos. During the lecture, students had to answer key-feature questions (KFQ) in small groups and to jointly submit their answers by means of an audience response system (ARS). After each lecture and the exam, we conducted surveys and compared results with a historical control group. A focus group interview with lecturers was performed after conclusion of the lecture series.

Results:  The students' overall impression of the "flipped classroom" concept and their examination grades were superior to historical controls (overall impression: 1.5 [95 % CI 1.4-1.6] vs. 2.7 [95 % CI 2.5-2.9] rated on a scale from 1 to 6, p < 0.001; examination grades: 1.8 [95 % CI 1.7-1.9] vs. 2.0 [95 % CI 1.9-2.0] rated on a scale from 1 to 5, p < 0.001). Most students agreed that learning videos (76.6 %), ARS (88.5 %), KFQ (76.5 %), and solution-oriented small group discussions (83.7 %) were useful. Lecturers stated an improved convergence of demands on learning and clinical competence. However, they also emphasized an increased initial effort for implementation.

Conclusion:  Students rated the overall benefit from the heutagogical "flipped classroom" concept as high. Examination grades improved. According to lecturers, the "flipped classroom" concept better matched later professional demands than traditional lectures.

Key Points:   · The benefit of the "flipped classroom" concept for radiological lectures was rated high by students.. · Most students were satisfied with the multimedia and interactive elements of lectures.. · Lecturers considered heutagogical learning demands as appropriate for later clinical requirements..

Citation Format: · Teichgräber U, Ingwersen M, Mentzel H et al. Impact of a Heutagogical, Multimedia-Based Teaching Concept to Promote Self-Determined, Cooperative Student Learning in Clinical Radiology. Fortschr Röntgenstr 2021; 193: 701 - 711.
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http://dx.doi.org/10.1055/a-1313-7924DOI Listing
June 2021

Diagnostic Activities and Diagnostic Practices in Medical Education and Teacher Education: An Interdisciplinary Comparison.

Front Psychol 2020 20;11:562665. Epub 2020 Oct 20.

Education and Educational Psychology, Department Psychology, LMU University of Munich, Munich, Germany.

In this article, we investigate diagnostic activities and diagnostic practices in medical education and teacher education. Previous studies have tended to focus on comparing knowledge between disciplines, but such an approach is complicated due to the content specificity of knowledge. We compared 142 learners from medical education and 122 learners from teacher education who were asked to (a) diagnose eight simulated cases from their respective discipline in a simulation-based learning environment and (b) write a justificatory report for each simulated case. We coded all justificatory reports regarding four diagnostic activities: , , , and Moreover, using the method of Epistemic Network Analysis, we operationalized diagnostic practices as the relative frequencies of co-occurring diagnostic activities. We found significant differences between learners from medical education and teacher education with respect to both their diagnostic activities and diagnostic practices. Learners from medical education put relatively more emphasis on generating hypotheses and drawing conclusions, therefore applying a more hypothesis-driven approach. By contrast, learners in teacher education had a stronger focus on generating and evaluating evidence, indicating a more data-driven approach. The results may be explained by different epistemic ideals and standards taught in higher education. Further research on the issue of epistemic ideals and standards in diagnosing is needed. Moreover, we recommend that educators think beyond individuals' knowledge and implement measures to systematically teach and increase the awareness of disciplinary standards.
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http://dx.doi.org/10.3389/fpsyg.2020.562665DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606905PMC
October 2020

Alteration of physical activity during COVID-19 pandemic lockdown in young adults.

J Transl Med 2020 11 2;18(1):410. Epub 2020 Nov 2.

Department of Medicine I, Ludwig-Maximilians-University Munich, University Hospital Munich - Campus Innenstadt, Ziemssenstrasse 1, 80336, Munich, Germany.

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http://dx.doi.org/10.1186/s12967-020-02591-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605130PMC
November 2020

Learning to diagnose collaboratively: validating a simulation for medical students.

GMS J Med Educ 2020 15;37(5):Doc51. Epub 2020 Sep 15.

Ludwig-Maximilians-Universität München, Munich Center of the Learning Sciences, München, Germany.

Physicians with different professional backgrounds often diagnose a patients' problem collaboratively. In this article, we first introduce a process model for collaborative diagnosing (CDR model), describe the development of a simulation used to empirically examine the facilitation of collaborative diagnostic reasoning. Based on a contemporary validity framework [1], we further suggest indicators for validity and collect initial evidence with respect to the scoring, generalization, extrapolation, and implication inferences to assess the validity of the simulation when used to assess effects of learning interventions. In a quasi-experimental study, we assessed objectivity and reliability of the simulation and compared medical students with low and advanced prior knowledge to practitioners with high prior knowledge with respect to their diagnostic accuracy, diagnostic efficiency, information sharing skills, and their intrinsic cognitive load. Additionally, we obtained authenticity ratings from practitioners with high prior knowledge. The results yielded satisfying initial evidence for the validity of the scoring and the extrapolation inferences as ratings are objective, and the simulation and the collaborative process is perceived as rather authentic. Additionally, participants on different levels of prior knowledge differ with respect to their diagnostic accuracy, diagnostic efficiency, information sharing skills, and their reported intrinsic cognitive load. With one exception (information sharing skills), the generalization inference seems to be valid as well. We conclude that collecting validity evidence for the simulation was an important step towards a better interpretation of the simulation. We found that the simulation is an authentic and valid representation of the chosen collaborative situation and that the collected validity evidence offers sufficient evidence for an initial validation of the simulation. Nevertheless, the validation process highlighted some important gaps that need further consideration. We further conclude that applying a validation model to the context of empirical research is promising and encourage other researchers to follow the example.
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http://dx.doi.org/10.3205/zma001344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499460PMC
September 2020

Spontaneously retrievable knowledge of German general practitioners depending on time since graduation, measured with the progress test medicine.

GMS J Med Educ 2020 15;37(5):Doc49. Epub 2020 Sep 15.

LMU Munich, University Hospital, Institute for Medical Education, Munich, Germany.

General practitioners and general internists occupy a key position in German and Austrian healthcare systems. They provide primary care and act as gatekeepers between medical disciplines and sectors of care. Their explicit medical knowledge levels, however, can be quite disparate. This study analyses whether general practitioners' performances on a standardised knowledge test changes with four relevant socio-demographic variables. The survey was based on the Progress Test Medicine (PTM), a standardised 200 item knowledge test on graduate level. After formal blueprinting and item analysis, 60 items of PTM were selected ("PTM-GP") for our study. PTM-GP was presented ad hoc to general practitioners and internists from Germany and Austria at a number of professional meetings in 2011. 161 volunteers completed the survey. For evaluation, correlation analysis (Spearman), Kruskal Wallis-tests for non-parametric data and an analysis of covariance (ANCOVA) were calculated. Overall, four indicators turned out to be slightly significant for the performance on the PTM-GP, namely: time passed since graduation, the grade received in the licensing examination, the type of institution for postgraduate training, and the medical specialisation. Recent graduates performed better in the PTM-GP; a doctor's licensing examination grade as well as training at a university hospital correlated positively with PTM-GP performance. A general doctor's knowledge level is moderately influenced by exam grades, time since graduation, the institutional affiliation of postgraduate training and medical specialisation. Individual changes in knowledge over time have to be deliberately considered in lifelong learning. In consequence, the on-going teaching of medical knowledge should be integrated mandatory and verifiable into general doctors' everyday practices, e.g. through repetitive knowledge tests with individual feedback and recommendations for further continuing medical education (CME).
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http://dx.doi.org/10.3205/zma001342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499467PMC
September 2020

Clinical Case Discussions - a novel, supervised peer-teaching format to promote clinical reasoning in medical students.

GMS J Med Educ 2020 15;37(5):Doc48. Epub 2020 Sep 15.

LMU Munich, University Hospital, Institute for Medical Education, Munich, Germany.

Clinical reasoning (CR) is a clinical core competence for medical students to acquire. While the necessity for CR teaching has been recognized since the early 20 century, to this day no consensus on how to best educate students in CR exists. Hence, few universities have incorporated dedicated CR teaching formats into their medical curriculum. We propose a novel case-based, peer-taught and physician-supervised collaborative learning format, dubbed "Clinical Case Discussions" (CCDs) to foster CR in medical students. We present the curricular concept of CCDs and its development according to a six-step approach (problem identification and general needs assessment; targeted needs assessment; goals and objectives; educational strategies; implementation; evaluation and feedback). Our goal is to strengthen the physician roles (CanMEDS/NKLM) and CR competence of medical students. CCDs are offered at our institution as an elective course and students work on real-life, complex medical cases through a structured approach. Over the course of five years we evaluated various aspects of the course and trained student teachers to optimize our course concept according to the feedback of our participants. We also obtained intro and exit self-assessments of CR competence using an established CR questionnaire. We found an unmet need for CR teaching, as medical students in their clinical years view CR as highly important for later practice, but only 50% have ever heard of CR within the curriculum. Acceptance of CCDs was consistently high with over 85% of participants strongly agreeing that they would re-participate in the course and recommend it to a friend. Additionally, we observed significant improvements in CR self-assessments of participants. CCDs are a feasible teaching format to improve students' CR competence, have a high acceptance and involve students in medical education through peer-teaching.
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http://dx.doi.org/10.3205/zma001341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499459PMC
September 2020

International mobility of students in the medical disciplines from a comparative perspective.

GMS J Med Educ 2020 15;37(3):Doc34. Epub 2020 Apr 15.

Technical University of Munich, Faculty of Medicine, Hospital rechts der Isar, TUM Medical Education Center, Munich, Germany.

We analyze the extent to which students of human, veterinary and dental medicine complete study-related stays abroad (frequency, type and duration of stays abroad and countries visited). Furthermore, we investigate the possible correlations between completed stays abroad and the duration of studies, the completion of a doctorate and entering professional life. The data come from a written cross-sectional survey of 742 graduates of their respective study programs at Bavarian universities. The evaluation was carried out using descriptive and inferential statistical methods. Slightly more than half of the surveyed students completed study-associated stays abroad, with notable differences between the three study programs. The students most frequently completed internships abroad lasting an average of nine weeks. Switzerland was the most common country of destination for the stays abroad. Furthermore, there were no or only weak correlations between stays abroad, the duration of studies and progress towards a doctorate or the commencement of professional employment abroad. There were no correlations with the stress experienced as part of initial employment after graduation. The results clearly indicate that stays abroad are quite usual for students in the medical disciplines and are almost standard in the study of human medicine. The selection of the countries visited indicates that the primary goal of the students' stays abroad is to deepen their competence with a view to later employment in their home country.
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http://dx.doi.org/10.3205/zma001327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291386PMC
July 2021

Do it together! Conception and long-term results of the trans-institutional Master of Medical Education (MME) program in Germany.

GMS J Med Educ 2020 15;37(3):Doc33. Epub 2020 Apr 15.

University Hospital, LMU Munich, Institute for Medical Education, Munich, Germany.

Medical education has the responsibility to react to developments and changing demands in healthcare. This implies the need for experts in the area of medical education as well as nationally coordinated initiatives. An innovative model based on trans-institutional cooperation and nationwide consensus for establishing a master's degree course in Medical Education (MME) and long-term results are presented here to other countries and other programs, facing similar challenges. A MME program with the following goals was implemented at the Medical Faculty of Heidelberg University, Germany, in 2004: Qualification of leaders in medical faculties, professionalization and improvement of teaching quality, promotion of nationwide and international exchange, and stimulation of research in medical education. Since then, 15 cohorts with a total of 380 participants have started their studies, 179 participants have graduated and 90 publications resulted from the master's theses (as at November 2018). Evaluation and survey data revealed a very high degree of satisfaction among the participants and a lasting development to medical education experts. Our concept shows that the bundling of regional expertise into a clearly structured trans-institutional network can be a driving force for nationwide comprehensive changes, in order to address changing demands in healthcare systems and transfer it into medical education programs.
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http://dx.doi.org/10.3205/zma001326DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291385PMC
July 2021

Measurement precision at the cut score in medical multiple choice exams: Theory matters.

Perspect Med Educ 2020 08;9(4):220-228

Institute for Medical Education, University of Bern, Bern, Switzerland.

Introduction: In high-stakes assessment, the measurement precision of pass-fail decisions is of great importance. A concept for analyzing the measurement precision at the cut score is conditional reliability, which describes measurement precision for every score achieved in an exam. We compared conditional reliabilities in Classical Test Theory (CTT) and Item Response Theory (IRT) with a special focus on the cut score and potential factors influencing conditional reliability at the cut score.

Methods: We analyzed 32 multiple-choice exams from three Swiss medical schools comparing conditional reliability at the cut score in IRT and CCT. Additionally, we analyzed potential influencing factors such as the range of examinees' performance, year of study, and number of items using multiple regression.

Results: In CTT, conditional reliability was highest for very low and very high scores, whereas examinees with medium scores showed low conditional reliabilities. In IRT, the maximum conditional reliability was in the middle of the scale. Therefore, conditional reliability at the cut score was significantly higher in IRT compared with CTT. It was influenced by the range of examinees' performance and number of items. This influence was more pronounced in CTT.

Discussion: We found that conditional reliability shows inverse distributions and conclusions regarding the measurement precision at the cut score depending on the theory used. As the use of IRT seems to be more appropriate for criterion-oriented standard setting in the framework of competency-based medical education, our findings might have practical implications for the design and quality assurance of medical education assessments.
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http://dx.doi.org/10.1007/s40037-020-00586-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7459012PMC
August 2020

Development and piloting of a Situational Judgement Test for emotion-handling skills using the Verona Coding Definitions of Emotional Sequences (VR-CoDES).

Patient Educ Couns 2020 09 6;103(9):1839-1845. Epub 2020 May 6.

Lehrstuhl für die Ausbildung personaler und interpersonaler Kompetenzen im Gesundheitswesen, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany.

Objective: Emotion-handling skills are key components for interpersonal communication by medical professionals. The Verona Coding Definitions of Emotional Sequences (VR-CoDES) appears useful to develop a Situational Judgment Test (SJT) for assessing emotion-handling skills.

Methods: In phase 1 we used a multi-stage process with expert panels (n = 16; n = 8; n = 20) to develop 12 case vignettes. Each vignette includes (1) video representing a critical incident containing concern(s) and/or cue(s), (2) standardized lead-in-question, (3) five response alternatives. In phase 2 we piloted the SJT to assess validity via an experimental study with medical students (n = 88).

Results: Experts and students rated most of the 'Reduce space' responses as inappropriate and preferred 'Explicit' responses. Women scored higher than men and there was no decline of empathy according to students' year of study. There were medium correlations with self-assessment instruments. The students' acceptance of the SJT was high.

Conclusion: The use of VR-CoDES, authentic vignettes, videos and expert panels contributed to the development and validity of the SJT.

Practice Implications: Development costs were high but could be made up over time. The agreement on a proper score and the implementation of an adequate feedback structure seem to be useful.
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http://dx.doi.org/10.1016/j.pec.2020.04.001DOI Listing
September 2020

The influence of prompts on final year medical students' learning process and achievement in ECG interpretation.

GMS J Med Educ 2020 17;37(1):Doc11. Epub 2020 Feb 17.

University Hospital, LMU Munich, Institute for Medical Education, Munich, Germany.

ECG interpretation is prone to errors that can lead to relevant misdiagnoses and incorrect treatment. Prompts are one way in lectures to encourage learning from one's own mistakes and to reduce error rates. Prompts are measures such as questions, hints, and suggestions of content-related or metacognitive nature, which can lead to self-explanation in the learner and thus to a deeper understanding of an issue. The aim of the study was therefore to investigate whether the use of prompts can reduce the error rate in ECG interpretation among students. In a 2x2 experimental test and control group design, =100 final year medical students carried out ECG interpretation tasks in the form of online case vignettes in CASUS. In these tasks, justification prompts (B) and error analysis prompts (F) were systematically varied in four groups and the learning success was measured using a knowledge test. In addition, prior knowledge in ECG interpretation, motivation, interest in the topic, subjective confidence in ECG interpretation, and cognitive load was collected. Neither error analysis prompts nor justification prompts had a significant effect on the correct ECG interpretation by students, (1,96)=1.03, =.31. Justification prompts seemed to have a positive effect on the confidence of answering the questions, (1,96)=10.15, =.002, =.10; and a negative effect on student motivation, (1,96)=8.13 , =.005, =.08; but both with comparable diagnostic accuracy. The present study could not confirm the positive effects of prompts on the error rate in ECG interpretation reported in the literature but showed significant effects on subjective confidence and motivation which should be investigated in further studies.
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http://dx.doi.org/10.3205/zma001304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7105760PMC
October 2020

Learning clinical reasoning: how virtual patient case format and prior knowledge interact.

BMC Med Educ 2020 Mar 14;20(1):73. Epub 2020 Mar 14.

Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany.

Introduction: Clinical reasoning has been fostered with varying case formats including the use of virtual patients. Existing literature points to different conclusions regarding which format is most beneficial for learners with diverse levels of prior knowledge. We designed our study to better understand which case format affects clinical reasoning outcomes and cognitive load, dependent on medical students' prior knowledge.

Methods: Overall, 142 medical students (3 rd to 6 th year) were randomly assigned to either a whole case or serial cue case format. Participants worked on eight virtual patients in their respective case format. Outcomes included diagnostic accuracy, knowledge, and cognitive load.

Results: We found no effect of case format on strategic knowledge scores pre- vs post-test (whole case learning gain = 3, 95% CI. -.01 to .01, serial cue learning gain = 3, 95% CI. -.06 to .00 p = .50). In both case formats, students with high baseline knowledge (determined by median split on the pre-test in conceptual knowledge) benefitted from learning with virtual patients (learning gain in strategic knowledge = 5, 95% CI .03 to .09, p = .01) while students with low prior knowledge did not (learning gain = 0, 95%CI -.02 to .02). We found no difference in diagnostic accuracy between experimental conditions (difference = .44, 95% CI -.96 to .08, p = .22), but diagnostic accuracy was higher for students with high prior knowledge compared to those with low prior knowledge (difference = .8, 95% CI 0.31 to 1.35, p < .01). Students with low prior knowledge experienced higher extraneous cognitive load than students with high prior knowledge (multiple measurements, p < .01).

Conclusions: The whole case and serial cue case formats alone did not affect students' knowledge gain or diagnostic accuracy. Students with lower knowledge experienced increased cognitive load and appear to have learned less from their interaction with virtual patients. Cognitive load should be taken into account when attempting to help students learn clinical reasoning with virtual patients, especially for students with lower knowledge.
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http://dx.doi.org/10.1186/s12909-020-1987-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071577PMC
March 2020

What works best in a general practice specific OSCE for medical students: Mini-CEX or content-related checklists?

Med Teach 2020 05 5;42(5):578-584. Epub 2020 Feb 5.

Lehrstuhl für die Ausbildung Personaler und Interpersonaler Kompetenzen im Gesundheitswesen, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany.

To develop and pilot a General Practice (GPr) OSCE assessing medical students dealing with patient encounters, which are typical for GPr and to compare different measurement instruments (global ratings, content-specific checklists). A blueprint based on Entrusted Professional Activities was used to develop prototypical OSCE stations. Four stations were tested with voluntary medical students. Students were videotaped and assessed with self-developed content-specific checklists, a global rating for communication skills, and mini-CEX. Results were compared according to students' phases of studies. All three measurements were able to discriminate between clinical and pre-clinical students. Clearest results were achieved by using mini-CEX. Content-specific checklists were not able to differentiate between those groups for the more difficult stations. Inter-station reliability for the global ratings was sufficient for high-stakes exams. Students enjoyed the OSCE-setting simulating GPr consultation hours. They would prefer feedback from GPs after the OSCE and from simulated patients after each encounter. Although the OSCE was short, results indicate advantages for using a global rating instead of checklists. Further research should include validating these results with a larger group of students and to find the threshold during the phases of education for switching from checklists to global ratings.
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http://dx.doi.org/10.1080/0142159X.2020.1721449DOI Listing
May 2020

Guessing right - whether and how medical students give incorrect reasons for their correct diagnoses.

GMS J Med Educ 2019 15;36(6):Doc85. Epub 2019 Nov 15.

Ludwig-Maximilians-University (LMU) Munich, Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, München, Germany.

Clinical reasoning is one of the central competencies in everyday clinical practice. Diagnostic competence is often measured based on diagnostic accuracy. It is implicitly assumed that a correct diagnosis is based on a proper diagnostic process, although this has never been empirically tested. The frequency and nature of errors in students' diagnostic processes in correctly solved cases was analyzed in this study. 148 medical students processed 15 virtual patient cases in internal medicine. After each case, they were asked to state their final diagnosis and justify it. These explanations were qualitatively analyzed and assigned to one of the following three categories: correct explanation, incorrect explanation and diagnosis guessed right. The correct diagnosis was made 1,135 times out of 2,080 diagnostic processes. The analysis of the associated diagnostic explanations showed that 92% (1,042) reasoning processes were correct, 7% (80) were incorrect, and 1% (13) of the diagnoses were guessed right. Causes of incorrect diagnostic processes were primarily a lack of pathophysiological knowledge (50%) and a lack of diagnostic skills (30%). Generally, if the diagnosis is correct, the diagnostic process is also correct. The rate of guessed diagnoses is quite low at 1%. Nevertheless, about every 14th correct diagnosis is based on a false diagnostic explanation and thus, a wrong diagnostic process. To assess the diagnostic competence, both the diagnosis result and the diagnostic process should be recorded.
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http://dx.doi.org/10.3205/zma001293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6905369PMC
May 2020

Complexity of clinical cases in simulated learning environments: proposal for a scoring system.

GMS J Med Educ 2019 15;36(6):Doc80. Epub 2019 Nov 15.

Ludwig-Maximilians-University (LMU) Munich, Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, Munich, Germany.

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http://dx.doi.org/10.3205/zma001288DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6905356PMC
May 2020

Assessment methods in medical specialist assessments in the DACH region - overview, critical examination and recommendations for further development.

GMS J Med Educ 2019 15;36(6):Doc78. Epub 2019 Nov 15.

Universität Bern, Institut für Medizinische Lehre, Abteilung für Assessment und Evaluation, Bern, Switzerland.

Specialist medical assessments fulfil the task of ensuring that physicians have the clinical competence to independently represent their field and provide the best possible care to patients, taking into account the current state of knowledge. To date, there are no comprehensive reports on the status of specialist assessments in the German-speaking countries (DACH). For that reason, the assessment methods used in the DACH region are compiled and critically evaluated in this article, and recommendations for further development are described. The websites of the following institutions were searched for information regarding testing methods used and the organisation of specialist examinations: Homepage of the Swiss Institute for Medical Continuing Education (SIWF), Homepage of the Academy of Physicians (Austria) and Homepage of the German Federal Medical Association (BAEK). Further links were considered and the results were presented in tabular form. The assessment methods used in the specialist assessments are critically examined with regard to established quality criteria and recommendations for the further development of the specialist assessments are derived from these. The following assessment methods are already used in Switzerland and Austria: written examinations with multiple choice and short answer questions, structured oral examinations, the Script Concordance Test (SCT) and the Objective Structured Clinical Examination (OSCE). In some cases, these assessment methods are combined (triangulation). In Germany, on the other hand, the oral examination has so far been conducted in an unstructured manner in the form of a 'collegial content discussion'. In order to test knowledge, practical and communicative competences equally, it is recommended to implement a triangulation of methods and follow the further recommendations described in this article. While there are already accepted approaches for quality-assured and competence-based specialist assessments in Switzerland and Austria at present, there is still a long way to go in Germany. Following the recommendations presented in this article, a contribution could be made to improving the specialist assessments in the DACH region according to the specialist assessments objectives.
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http://dx.doi.org/10.3205/zma001286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6905366PMC
May 2020

Individual and institutional influencing factors on completion rates in a medical education master's program in Germany.

GMS J Med Educ 2019 15;36(6):Doc75. Epub 2019 Nov 15.

Heidelberg University, Medical Faculty, MME program, Heidelberg, Germany.

The increasing significance of didactic aspects in medical education has also led to the development of special postgraduate programs. Completion rates represent an important outcome criterion for these programs of study. Up to today, detailed studies on what factors influence these completion rates have been lacking. Within the framework of outcomes research, a semi-structured online survey of students was conducted in the Master of Medical Education Germany program. Of the 90 items, 21 referred to the master's thesis that is required for graduation. 157 out of 246 (63.8%) of students from classes 1-10 of the program (study period 2004-2014) participated in the survey. 109 participants had submitted a master's thesis, whereas 45 participants had not completed their studies by submitting a master's thesis. Influencing factors of successful completion were, among other things, little difficulty in choosing the topic, retention of the originally chosen topic, general support by the program administration in the modules and ensuring timely feedback from the advisor, and the provision of temporal, staff and financial resources by the home faculty. The failure to turn in the project report and a lengthy interruption of master thesi's work could be identified as critical parameters. Taking into account these results can contribute to increasing completion rates in medical education graduate programs. Systematic outcomes research leads, moreover, to quality assurance. Such studies should be conducted in a standardized manner in the future, in order to facilitate comparisons between medical education programs.
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http://dx.doi.org/10.3205/zma001283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6905360PMC
May 2020

[The specialist examination in internal medicine: a qualitative and quantitative analysis of minutes from memory].

Dtsch Med Wochenschr 2020 01 23;145(2):e10-e17. Epub 2019 Sep 23.

Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-University (LMU) Munich, Germany.

Background: The specialist examination entitles to independent professional conduct and is therefore of great significance for the quality of medical care. It should cover the contents of the continuing education regulations. So far, little is known about the actual content of the exam. In this study, the question was, which content and which structural characteristics do specialist examinations in internal medicine in Germany contain.

Methods: 100 randomly selected protocols from nationwide specialist examinations from the years 2013-2016 were quantitatively recorded and descriptively evaluated with regards to their main content as well as the various types of questions. The results were compared with the blueprints of the medical examinations in Switzerland and the USA.

Results: In each exam, an average of 27 (SD = 10) questions are asked. The questions can be categorized into three categories: (1) subject-specific questions, (2) case-related questions, and (3) diagnostic-oriented questions with visual material. Cardiology and Gastroenterology, each with 17 %, and Endocrinology with 11 % are the most frequently requested internal medical topics. For 50 % of the questions, the examinee must reproduce knowledge, while for the other 50 %, concepts and procedures must be understood and used. In comparison with the American and Swiss blueprints, a similar percentual distribution of question contents was found. With regards to the American blueprint, it is noticeable that there are more questions from other specialist areas such as Urology, Neurology and Psychiatry in comparison to Germany. The Swiss blueprint covers a wide range of interdisciplinary aspects such as ethics, prevention and economics which are not subject to examination in the German specialist examination.

Conclusion: In the oral specialist examination in internal medicine in Germany as many topics as in foreign specialist examinations are examined. However, the variance between the individual exams is relatively large. A standardization of the exam is important to create equal exam conditions for all candidates.
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http://dx.doi.org/10.1055/a-0970-6348DOI Listing
January 2020
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