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Kraus M, Böcker W, Youssef Y, Faber S. [Controversies in promoting young talent in orthopedics and trauma surgery]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:317-323. [PMID: 38634951 DOI: 10.1007/s00132-024-04500-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The field of orthopedics and trauma surgery is facing a serious shortage of new talent due to the increasing average age of active surgeons and a growing need for staff. The appeal of these specialties is declining among medical students. SOLUTIONS This trend could be reversed by introducing practice-oriented curricula, mentoring programs, and early integration into professional societies. The quality of surgical education, especially bedside teaching, needs to be improved, as it is often compromised by a lack of time and insufficient pedagogical training of the educators. The practical year (PY) is crucial to attract students to these specialties, but data indicate that the quality of training in orthopedics and trauma surgery is inferior compared to other fields. Professional societies could enhance junior development through targeted programs. Moreover, the problem of recruitment is compounded by imbalanced gender ratios and working conditions that do not align with modern family models or efficient surgical training. There needs to be a rethinking of work scheduling and task distribution in surgery to make the profession more attractive and to ensure the quality of training.
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Affiliation(s)
- Moritz Kraus
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
- AO Research Institute Davos, Davos, Schweiz.
| | - Wolfgang Böcker
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland
| | - Yasmin Youssef
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum, Bereich für arthroskopische und spezielle Gelenkchirurgie/Sportverletzungen Leipzig, Leipzig, Deutschland
| | - Svea Faber
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland
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Himmels JP, Sterz J, Rüsseler M, Kempf VA, Brandt C. [Case-based learning with practical exercises in the course hygiene and microbiology as a model for the implementation of the new medical licensing regulations]. Dtsch Med Wochenschr 2022; 148:e21-e28. [PMID: 36564018 PMCID: PMC9970697 DOI: 10.1055/a-1973-6533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Within the scope of an educational improvement project, the teaching concept of the course hygiene and microbiology at the Goethe-University in Frankfurt was transferred from an organ system-based teaching concept into a case-based teaching concept. Concomitantly, this transformation was qualitatively reviewed to evaluate self-perceived learning success. METHODS 54 participants were included in this qualitative study. 45 students were interviewed in homogeneous focus groups of up to five. Nine physicians were interviewed individually. Following anonymization and transcription, a structured and qualitative text analysis was conducted. RESULTS Both groups, students and physicians, prefer a case-based teaching concept in hygiene and microbiology, especially in combination with a hands-on approach to learn practical skills. Students taught with the case-based approach were more satisfied and reported better knowledge retention. The practical elements of the course hygiene and microbiology were positively remembered by all participants. Regardless of the teaching concept, the individual lecturer is considered most essential in shaping motivation. CONCLUSIONS Overall, the implementation of a case-based teaching concept with practical elements in the course hygiene and microbiology increases the ability of medical students to understand the relevance of core knowledge and improves self-perceived learning. The fusion of theoretical and clinical contents elements in the course hygiene and microbiology meets the new national medical licensing regulations in Germany and promises to be a sustainable concept for clinical-theoretical subjects like hygiene and microbiology.
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Affiliation(s)
- Jan P.W. Himmels
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Deutschland
| | - Jasmina Sterz
- Frankfurter Interdisziplinäres Simulationszentrum, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Deutschland
| | - Miriam Rüsseler
- Frankfurter Interdisziplinäres Simulationszentrum, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Deutschland
| | - Volkhard A.J. Kempf
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Deutschland
| | - Claudia Brandt
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Deutschland,Korrespondenzadresse Priv.-Doz. Dr. med. Claudia Brandt Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Universitätsklinikum FrankfurtPaul-Ehrlich-Straße 4060596 Frankfurt am Main
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Sterz J, Britz V, Carstensen P, Kollewe T, Voß SH, Stefanescu MC, Schreckenbach T, Verboket RD, Rüsseler M. [The surgeon's balancing act-Teaching in the clinical routine]. Chirurg 2021; 93:286-291. [PMID: 34297149 PMCID: PMC8894151 DOI: 10.1007/s00104-021-01470-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Thus medical students must be inspired to undertake this specialty. Students complain that the teaching is subordinate to patient care and limited by a lack of time and medical personnel. Although there are many studies assessing student perceptions, few exist that focus on the issues that teachers face. OBJECTIVE To analyse student teaching in the daily routine and its potential' problems from the surgeon's perspectives. MATERIAL AND METHODS In this prospective study guidelines for semistructured interviews with formulated, open questions were created, which were specified with further questions. All interviews were conducted using these guidelines and recorded. The number of interviews were a function of the concept of content saturation. RESULTS All 22 participants perceived that the teaching in clinical practice is of paramount importance. Nevertheless, respondents described that learning goals in the clinical routine are not always achieved. The main reason is a lack of time; however, as clinical experience increases other factors will similarly become more important: Consultants and heads of departments complain about deficiencies in students' previous knowledge, including insufficient motivation. Most respondents described that they do not feel appreciated for teaching. Overall, student teaching was perceived as an additional burden but all respondents found the task to be extremely worthwhile. CONCLUSION In addition to the lack of personnel, a lack of appreciation is the most significant obstacle towards effective teaching. It is therefore important to increase the value of teaching by rewarding good achievements and the creation of effective transparency.
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Affiliation(s)
- J. Sterz
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklink Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590 Frankfurt, Deutschland
- Frankfurter Interdisziplinären Simulationstraining, Fachbereich 16, Goethe-Universität, Frankfurt am Main, Deutschland
| | - V. Britz
- Frankfurter Interdisziplinären Simulationstraining, Fachbereich 16, Goethe-Universität, Frankfurt am Main, Deutschland
| | - P. Carstensen
- Frankfurter Interdisziplinären Simulationstraining, Fachbereich 16, Goethe-Universität, Frankfurt am Main, Deutschland
| | - T. Kollewe
- Frankfurter Arbeitsstelle für Medizindidaktik, Fachbereich Medizin, Goethe-Universität, Frankfurt am Main, Deutschland
| | - S. H. Voß
- MVZ VOSS, Aschaffenburg, Deutschland
| | - M. C. Stefanescu
- Frankfurter Interdisziplinären Simulationstraining, Fachbereich 16, Goethe-Universität, Frankfurt am Main, Deutschland
| | - T. Schreckenbach
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt am Main, Deutschland
| | - R. D. Verboket
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklink Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590 Frankfurt, Deutschland
| | - Miriam Rüsseler
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklink Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590 Frankfurt, Deutschland
- Frankfurter Interdisziplinären Simulationstraining, Fachbereich 16, Goethe-Universität, Frankfurt am Main, Deutschland
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Sterz J, Linßen S, Stefanescu MC, Schreckenbach T, Seifert LB, Ruesseler M. Implementation of written structured feedback into a surgical OSCE. BMC MEDICAL EDUCATION 2021; 21:192. [PMID: 33823844 PMCID: PMC8022414 DOI: 10.1186/s12909-021-02581-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 02/26/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND Feedback is an essential element of learning. Despite this, students complain about receiving too little feedback in medical examinations, e.g., in an objective structured clinical examination (OSCE). This study aims to implement a written structured feedback tool for use in OSCEs and to analyse the attitudes of students and examiners towards this kind of feedback. METHODS The participants were OSCE examiners and third-year medical students. This prospective study was conducted using a multistage design. In the first step, an unstructured interrogation of the examiners formed the basis for developing a feedback tool, which was evaluated and then adopted in the next steps. RESULTS In total, 351 students and 51 examiners participated in this study. A baseline was created for each category of OSCE station and was supplemented with station-specific items. Each of these items was rated on a three-point scale. In addition to the preformulated answer options, each domain had space for individual comments. A total of 87.5% of the students and 91.6% of the examiners agreed or rather agreed that written feedback should continue to be used in upcoming OSCEs. CONCLUSION The implementation of structured, written feedback in a curricular, summative examination is possible, and examiners and students would like the feedback to be constant.
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Affiliation(s)
- J Sterz
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - S Linßen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - M C Stefanescu
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - T Schreckenbach
- Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - L B Seifert
- Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - M Ruesseler
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
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Gottlob K, Joos S, Haumann H. The teaching and learning environment of a primary care medical student clinical attachment ("Famulatur") - a qualitative study on experiences of students and primary care physicians in Germany. GMS JOURNAL FOR MEDICAL EDUCATION 2019; 36:Doc28. [PMID: 31211223 PMCID: PMC6545615 DOI: 10.3205/zma001236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 01/10/2019] [Accepted: 02/01/2019] [Indexed: 05/23/2023]
Abstract
Aim: Following changes in licensing regulations for doctors ("Approbationsordnung") in 2012, a 4-week clinical attachment ("Famulatur") in primary care is now mandatory for all medical students in Germany. To date, it has not been studied how the Famulatur in primary care is perceived by the learner or the teacher. The aim of this study was to explore the experiences of both medical students and primary care physicians (PCPs) with regard to the teaching and learning situation in the Famulatur in primary care. Methods: A qualitative analysis of semi-structured interviews with 12 students from the medical faculty in Tübingen, Germany, and 17 PCPs from this region, was performed. Interview material was analyzed following content analysis according to Mayring. Results: In addition to considering the variety of tasks expected of the students and the optimal time for the Famulatur during the medical curriculum, the main themes of the interviews were the strengths, weaknesses and suggestions for improvement of the Famulatur. The Famulatur was predominantly perceived positively, although it being obligatory was criticized. In particular, the 1:1 supervision and the extended duration (compared to the first curricular primary care placement ("Blockpraktikum")) were positively evaluated. PCPs and students were critical of the lack of a learning and educational Famulatur framework, which would have enabled earlier orientation and alignment of each party. Conclusion: The Famulatur offers good learning opportunities for medical students and provides an insight into primary care, which is typically seen positively; it appears to heighten enthusiasm for primary care within budding doctors. Even if the obligation should cease in "The Master Plan for Medical Studies 2020" (Masterplan Medizinstudium 2020), it would be beneficial to optimize the primary care Famulatur; the development of a student logbook and learning objectives could be helpful, for example in the form of portfolios.
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Affiliation(s)
- Kirsten Gottlob
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Tübingen, Germany
| | - Stefanie Joos
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Tübingen, Germany
| | - Hannah Haumann
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Tübingen, Germany
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Berberat PO, Rotthoff T, Baerwald C, Ehrhardt M, Huenges B, Johannink J, Narciss E, Obertacke U, Peters H, Kadmon M. Entrustable Professional Activities in final year undergraduate medical training - advancement of the final year training logbook in Germany. GMS JOURNAL FOR MEDICAL EDUCATION 2019; 36:Doc70. [PMID: 31844642 PMCID: PMC6905355 DOI: 10.3205/zma001278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/16/2019] [Accepted: 09/24/2019] [Indexed: 05/09/2023]
Abstract
Objective: Training in the final year (FY) of undergraduate medical training currently does not adequately prepare students for the independent performance of medical professional activities after graduation. The concept of Entrustable Professional Activities (EPA) offers the opportunity for a competency-based FY training with the focus on medical professional activities. Methodology: In regular meetings, the FY sub-working group of the German Medical Faculty Association (MFT), which includes representatives with clinical and didactic expertise of the Associations of Internal Medicine, Surgery and General Medicine, developed a concept for the competecy-orientated, EPA-based, FY model logbook 2.0. The selection of the units of practice was made in a cross-disciplinary, consensus-orientated discussion process based on the question which medical professional activities a young professional has to master in the inpatient or outpatient working environment. Results: For the FY electives internal medicine, surgery and general medicine, a blueprint of a total of 18 comprehensive, partially interdisciplinary EPAs relating to inpatient and outpatient care contexts were developed. Each EPA was operationalised by a short description, supervision levels were attributed, and the process of transparent entrustment was determined. Conclusions: The concept for a new FY model logbook 2.0 focuses on the interdisciplinary core medical professional activities in an inpatient and outpatient care context, in order to facilitate transition from undergraduate training to professional practice, and to help avoid overload, thus increasing patient safety.
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Affiliation(s)
- Pascal O. Berberat
- Technical University of Munich, Faculty of Medicine, TUM Medical Education Centre, Munich, Germany
| | | | | | - Maren Ehrhardt
- Hamburg University Medical School, Department of General Practice/Primary Care, Hamburg, Germany
| | - Bert Huenges
- Ruhr-University Bochum, Medical Faculty, Department of General Medicine, Bochum, Germany
| | - Jonas Johannink
- University Hospital Tübingen, University Department of General, Visceral and Transplant Surgery, Tübingen, Germany
| | - Elisabeth Narciss
- Medical Faculty Mannheim of Heidelberg University, Competence Center for Final Year Medical Education, Mannheim, Germany
- University Medical Center Mannheim, Orthopaedic and Trauma Surgery Center, Mannheim, Germany
| | - Udo Obertacke
- Medical Faculty Mannheim of Heidelberg University, Competence Center for Final Year Medical Education, Mannheim, Germany
- University Medical Center Mannheim, Orthopaedic and Trauma Surgery Center, Mannheim, Germany
| | - Harm Peters
- Charité-Medical University Berlin, Dieter Scheffner Center for Medical Education and Education Research, Dean's Office of Student Affairs, Berlin, Germany
| | - Martina Kadmon
- Augsburg University, Faculty of Medicine, Augsburg, Germany
- *To whom correspondence should be addressed: Martina Kadmon, Augsburg University, Faculty of Medicine, Universitätsstr. 2, D-86159 Augsburg, Germany, Phone: +49 (0)821/598-2710, Fax: +49 (0)821/598-5116, E-mail:
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Stefanescu MC, Sterz J, Hoefer SH, Ruesseler M. Young surgeons' challenges at the start of their clinical residency: a semi-qualitative study. Innov Surg Sci 2018; 3:235-243. [PMID: 31579787 PMCID: PMC6604589 DOI: 10.1515/iss-2018-0015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/24/2018] [Indexed: 12/30/2022] Open
Abstract
Introduction According to German regulations on licensing to practice medicine, the aim of undergraduate medical training is to produce a scientifically and practically trained physician who is able to work independently. More precisely, medical training has to impart the required knowledge and skills in diagnostics, therapy, health promotion, prevention, and rehabilitation. From the young residents’ point of view, this aim is not achieved, and they do not feel prepared to be a doctor. However, the literature on this subject relies mostly on data based on surveys, and there is a lack of deep analysis of the specific details of the topic. The aim of this study was to analyze in depth how junior doctors in their first and second years felt about their preparation for clinical practice as a doctor from their undergraduate training, as well as which teaching formats and factors influence their preparedness. Methods This semi-qualitative study is based on recorded interviews conducted using a structured interview manual. This serves to limit the subject matter of the interview and to target the topics. The study participants were 35 residents of general and visceral surgery, trauma surgery, and urology in their first and second years of medical specialty training. The number of participants was defined by the concept of saturation of the content. Basic data regarding age and the location and length of study were collected using a questionnaire. The audio recordings were transcribed word by word and analyzed with structured qualitative content analysis techniques. Results Only 43% (n=15) of the 35 participating residents stated they were sufficiently prepared to be a doctor from undergraduate medical training, and 22.9% stated that they were not prepared for their work as a resident (8/35). However, 34.3% of the residents stated that undergraduate medical training did prepare them for some of the parts they were expected to master in daily clinical practice, but not other parts. Most of the participants described their first weeks as doctors as particularly stressful and exhausting. As major hurdles during their daily clinical work, participants described knowledge gaps regarding organizational and administrative pathways (71%), deficits in linking knowledge to clinical reasoning (71%), decision making (54%), and therapy planning (51%). Most participants stated that the practical placements during the semester, the clinical clerkships, and the last year internship were most effective as preparation for clinical residency. To be better prepared for clinical practice, participants suggested providing a clearer structure and that the course subjects bear better relations to each other. Nearly all participants proposed increasing patient encounters directly from the beginning of medical training as a longitudinal approach. Discussion Even though we were able to demonstrate an increase in residents’ preparedness, 57% of the study participants still felt unprepared for their job to some extent. One might argue that starting a new profession will always result in a feeling of being unprepared to some extent. However, this unpreparedness can increase the risk for patients’ well being due to medical errors, which actually represents the third leading cause of death in the US after malignant tumors and cardiovascular diseases. Structured on-the-job adjustment, structured qualification training, and guided professional training are becoming increasingly important for future doctors as selection criteria for career choice and choice of employer. Thus, the surgical disciplines that are struggling with new young residents have to improve their concepts.
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Affiliation(s)
- Maria-Christina Stefanescu
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Jasmina Sterz
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Sebastian Herbert Hoefer
- Department of Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Miriam Ruesseler
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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A nationwide survey of undergraduate training in oral and maxillofacial surgery. Oral Maxillofac Surg 2018; 22:289-296. [PMID: 29797106 DOI: 10.1007/s10006-018-0703-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/17/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE To investigate the current status of undergraduate training in oral and maxillofacial (OMF) surgery in Germany using a nationwide survey and hence contribute to an educational improvement in the field. METHODS A 39-item questionnaire was sent to all university clinics with an OMF surgery chair in Germany (n = 34). RESULTS Ninety-two percent of OMF clinics are involved in the curricular training in medicine and 100% in dentistry. Eighty-one percent of OMF clinics perform curricular examinations and, respectively, 86% in dentistry. Examinations are mainly performed written with multiple-choice tests (62% medicine, 76% dentistry) and using non-structured oral examinations (57% medicine, 86% dentistry). Objective structured clinical examinations (OSCEs) are only used in 19% of all faculties. CONCLUSION OMF surgery with its involvement both in medical and dental education has a special position as a surgical discipline. Our results show that OMF as a specialty is underrepresented in dental and especially in medical education considering the numerical and health economic importance of OMF consultations. Enhancing curricular integration and developing more structured examination forms is necessary to guarantee a high quality of OMF education.
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