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Homberg A, Narciß E, Thiesbonenkamp-Maag J, Heindl F, Schüttpelz-Brauns K. Final-year information on didactic and organizational issues for students and supervising physicians - project report on the development and implementation of the cross-site website PJ-input. GMS J Med Educ 2023; 40:Doc6. [PMID: 36923324 PMCID: PMC10010762 DOI: 10.3205/zma001588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 07/12/2022] [Accepted: 10/31/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Final-year training is becoming increasingly important in medical studies and requires a high degree of personal responsibility from students. It is the task of supervising physicians to make informal learning opportunities available to students when working with and on patients and to gradually transfer responsibility to them. Both students and physicians have a great need for information regarding the contextual conditions and didactic realization of this transfer of responsibility. Up to now, the faculties have only provided information and support in a sporadic manner and with little standardization. With MERLIN, the joint project undertaken by the Competence Network for Teaching Medicine in Baden-Württemberg, a platform for the final year was developed and released on the web. The aim was to bundle information in order to support students and supervising physicians in their teaching-learning process and to improve the quality of teaching in the final year. PROJECT DESCRIPTION The development process of this platform took place in several steps across all faculties. Content and materials were compiled and structured based on a needs assessment. The first draft was evaluated by means of a simulation by students and then revised. A professional internet agency was involved for the technical implementation. The newly designed website PJ-input ("PJ" being the abbreviation for "Praktisches Jahr", the final year) contains areas for students and supervising physicians, as well as faculty-specific and general information about the final year. Faculty-specific content can be entered directly by the respective staff via an input mask and updated at any time. The provision of didactic materials can support competency-oriented teaching and learning in the final year. Here, for example, the concept of the Entrustable Professional Activities (EPA) was taken up, which gives students and supervising physicians orientation for the gradual assumption or transfer of responsibility. The platform was launched in spring 2021. Usage behavior is continuously recorded via the web application. RESULTS AND CONCLUSION The evaluation results show that the website is visited often and perceived as supportive. Increasing usage figures and the high frequency of use by students in the sections "im PJ" (during the final year) and "nach dem PJ" (after the final year) for the faculties involved in the MERLIN project confirm the target group-oriented design and use. The site should be promoted even more to pre-final-year students, as well as across state borders and to the target group of faculties. It is expected that nationwide faculty participation will make a significant contribution to the competency-based shift in teaching and the standardization of training during the final year of study under the new licensing regulations.
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Affiliation(s)
- Angelika Homberg
- Medical Faculty Mannheim, Heidelberg University, Division for Study and Teaching Development, Department of Medical Education Research, Mannheim, Germany
| | - Elisabeth Narciß
- Medical Faculty Mannheim, Heidelberg University, Competence Center for final-year education Baden-Württemberg, Mannheim, Germany
| | - Julia Thiesbonenkamp-Maag
- Medical Faculty Mannheim, Heidelberg University, Division for Study and Teaching Development, Mannheim, Germany
| | - Felix Heindl
- Medical Faculty Ulm, Competence Center eEducation Baden-Württemberg, Ulm, Germany
| | - Katrin Schüttpelz-Brauns
- Medical Faculty Mannheim, Heidelberg University, Division for Study and Teaching Development, Department of Medical Education Research, Mannheim, Germany
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Francischetti I, Holzhausen Y, Peters H. Entrustable professional activities for Junior Brazilian Medical Students in community medicine. BMC Med Educ 2022; 22:737. [PMID: 36284283 PMCID: PMC9598029 DOI: 10.1186/s12909-022-03762-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 09/07/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Entrustable professional activities (EPAs) have been defined to promote the workplace participation of undergraduate medical students, generally in the context of high-income countries with a focus on the secondary and tertiary health care sectors. These EPAs have limited applicability to training and health care contexts in low- to middle-income countries that have a focus on primary health care, for instance, the context of community medicine. The purpose of this article is to report the process and results of defining EPAs for undergraduate medical training in a community health care setting. METHODS A modified Delphi study was performed to develop EPAs for the training of medical students in community medicine during their first and second years of education at the Marília Medical School (FAMEMA), Brazil. The supervision level was operationalized in terms of a student's ability to perform the EPA autonomously in an effective and safe manner with supervision readily available on request. Panellists (9 physicians and 6 nurses) rated the completeness of the proposed list of EPAs and EPA categories on four-point Likert scales. The threshold for consensus among panellists was a mean content validity index of at least 80%. RESULTS Consensus was reached after two Delphi rounds, resulting in 11 EPAs for undergraduate medical education and training in community medicine. These EPAs were organized into three overarching EPA domains: integrality of care for individual health needs in all phases of the life cycle (5 EPAs), integrality of care for family health needs (3 EPAs), and integrality of care for community health needs (3 EPAs). For each EPA, descriptions of the following categories were created: title; specifications and limitations; conditions and implications of the entrustment decision; knowledge, skills, and attitudes; links to competencies; and assessment sources. CONCLUSION The resulting 11 EPAs for training medical students in community medicine expand the application of the EPA framework to both early undergraduate medical education and the context of primary health care. This report can support and guide other medical schools in their attempts to train students in primary health care contexts and to incorporate EPAs into their curricula.
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Affiliation(s)
- Ieda Francischetti
- Dieter Scheffner Center for Medical Education and Educational Research Charité - Universitätsmedizin Berlin, Dean?s Office of Study Affairs, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
- Marília Medical School (Faculdade de Medicina de Marília - FAMEMA), Marília, São Paulo, Brazil
| | - Ylva Holzhausen
- Dieter Scheffner Center for Medical Education and Educational Research Charité - Universitätsmedizin Berlin, Dean?s Office of Study Affairs, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Harm Peters
- Dieter Scheffner Center for Medical Education and Educational Research Charité - Universitätsmedizin Berlin, Dean?s Office of Study Affairs, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
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Weissenbacher A, Bolz R, Stehr SN, Hempel G. Development and consensus of entrustable professional activities for final-year medical students in anaesthesiology. BMC Anesthesiol 2022; 22:128. [PMID: 35488205 PMCID: PMC9052481 DOI: 10.1186/s12871-022-01668-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background The transfer of classic concepts of competency-based medical education into clinical practice has been proven to be difficult in the past, being described as partially fragmented, misleading and inadequate. At the beginning of training, novice doctors commonly feel overwhelmed, overloaded and exposed to extreme time pressure. The discrepancy between expected and actual clinical competence of doctors at the start of their speciality training jeopardizes patient safety. The framework of Entrustable Professional Activities (EPAs) is a promising instrument to effectively integrate competency-based training into clinical practice and may help to close this gap and consequently to improve patient safety. Methods For anaesthesiology, we developed 5 EPAs for final-year medical students. The EPAs comprised the following seven categories: 1. Title, 2. Specifications, 3. Limitations, 4. Competency domains, 5. Knowledge, abilities and skills, professional attitudes, 6. Assessment and 7. Entrustment. Based on a modified, online-based Delphi study, we further developed and refined these EPAs. Education experts were recruited from the alumni network of the Master of Medical Education (MME) degree course from the University of Heidelberg, Germany. Results 28 data sets were evaluated in three Delphi rounds. 82% of study participants had previous experience with EPAs. Qualitative and quantitative data formed the basis during the iterative process and resulted in complete descriptions of 5 EPAs for final-year medical students in anaesthesiology. Conclusions Our study including the associated description of 5 EPAs represent a further step and starting point for EPA-based curricula in medical training in Germany linking undergraduate training, to residency training and continuous medical education. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01668-8.
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Affiliation(s)
- Andreas Weissenbacher
- Department of Anaesthesiology and Intensive Care, University of Leipzig Medical Centre, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Robert Bolz
- Department of Anaesthesiology and Intensive Care, University of Leipzig Medical Centre, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Sebastian N Stehr
- Department of Anaesthesiology and Intensive Care, University of Leipzig Medical Centre, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Gunther Hempel
- Department of Anaesthesiology and Intensive Care, University of Leipzig Medical Centre, Liebigstrasse 20, 04103, Leipzig, Germany.
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Wijnen-Meijer M, Brandhuber T, Schneider A, Berberat P. Implementing Kolb´s Experiential Learning Cycle by Linking Real Experience, Case-Based Discussion and Simulation. J Med Educ Curric Dev 2022; 9:23821205221091511. [PMID: 35592131 PMCID: PMC9112303 DOI: 10.1177/23821205221091511] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Background: To prepare medical students for their future, they must become acquainted with clinical practice, for example by means of simulations, clerkships and discussing patient cases. By connecting these different approaches, according to Kolb´s experiential learning cycle, the learning effect can be strengthened. METHODOLOGY In the development of a didactical program for students who are being prepared for their role as general practitioners, we have adopted a new didactic approach, in which educational formats are interlinked, according to Kolb´s experiential learning cycle. The content of these courses is determined by the Entrustable Professional Activities (EPAs) for the clerkship in family medicine, combined with the most common chief complaints of patients in the GP's practice. In 2019, the first course was implemented at the Technical University of Munich, Germany, with 6 medical students. A first seminar discusses patients who the students have seen for themselves during their clerkship in family medicine. In addition, matching theory is discussed and skills are practiced. In the next seminar, students apply the acquired knowledge and skills in scenarios with standardized patients. Students evaluated the courses as positive. The evaluations show they find discussing personally experienced patient cases and the opportunity to practice very valuable. CONCLUSIONS A course design according to Kolb's Experiential learning cycle, which integrates experience, theory and simulation, is a valuable addition to existing forms of teaching in medical education. Students appreciated both discussing personally experienced patient cases and the opportunity to re-practice similar cases in a simulated environment. To gain more insight into the learning effects, it is recommended to further explore this approach in a different context.
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Affiliation(s)
- M. Wijnen-Meijer
- Technical University of Munich, School of Medicine, TUM Medical
Education Center, Munich, Germany
| | - T. Brandhuber
- Technical University of Munich, School of Medicine, Institute of
General Practice and Health Services Research, Munich, Germany
| | - A. Schneider
- Technical University of Munich, School of Medicine, Institute of
General Practice and Health Services Research, Munich, Germany
| | - P.O. Berberat
- Technical University of Munich, School of Medicine, TUM Medical
Education Center, Munich, Germany
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Rotthoff T, Kadmon M, Harendza S. It does not have to be either or! Assessing competence in medicine should be a continuum between an analytic and a holistic approach. Adv Health Sci Educ Theory Pract 2021; 26:1659-1673. [PMID: 33779895 PMCID: PMC8610945 DOI: 10.1007/s10459-021-10043-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 03/07/2021] [Indexed: 06/12/2023]
Abstract
Assessing competence is a tremendous challenge in medical education. There are two contrasting approaches in competence assessment: an analytic approach that aims to precisely measure observable constituents and facets of competence and a holistic approach that focuses on a comprehensive assessment of competences in complex real situations reflecting actual performance. We would like to contribute to the existing discourse about medical competence and its assessment by proposing an approach that can provide orientation for the development of competence-based assessment concepts in undergraduate and postgraduate medical education. The approach follows Kane's framework of an "argument-based approach" to validity and is based on insights into task complexity, testing and learning theories as well as the importance of the learning environment. It describes a continuum from analytic to holistic approaches to assess the constituents and facets of competence to performance. We conclude that the complexity of a task should determine the selection of the assessment and suggest to use this approach to reorganize and adapt competence assessment.
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Affiliation(s)
- Thomas Rotthoff
- Medical Didactics and Educational Research, DEMEDA, Medical Faculty, University of Augsburg, Universitätsstrasse 2, 86159, Augsburg, Germany.
| | - Martina Kadmon
- Medical Education Sciences, DEMEDA, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Sigrid Harendza
- III. Department of Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Sopka S, Hahn F, Vogt L, Pears KH, Rossaint R, Rudolph J, Klasen M. Peer video feedback builds basic life support skills: A randomized controlled non-inferiority trial. PLoS One 2021; 16:e0254923. [PMID: 34293034 PMCID: PMC8297748 DOI: 10.1371/journal.pone.0254923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/06/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction Training Basic Life Support saves lives. However, current BLS training approaches are time-consuming and costly. Alternative cost-efficient and effective training methods are highly needed. The present study evaluated whether a video-feedback supported peer-guided Basic Life Support training approach achieves similar practical performance as a standard instructor-guided training in laypersons. Methods In a randomized controlled non-inferiority trial, 288 first-year medical students were randomized to two study arms with different Basic Life Support training methods: 1) Standard Instructor Feedback (SIF) or 2) a Peer Video Feedback (PVF). Outcome parameters were objective data for Basic Life Support performance (compression depth and rate) from a resuscitation manikin with recording software as well as overall Basic Life Support performance and subjective confidence. Non-inferiority margins (Δ) for these outcome parameters and sample size calculation were based on previous studies with Standard Instructor Feedback. Two-sided 95% confidence intervals were employed to determine significance of non-inferiority. Results Results confirmed non-inferiority of Peer Video Feedback to Standard Instructor Feedback for compression depth (proportion difference PVF–SIF = 2.9%; 95% CI: -8.2% to 14.1%; Δ = -19%), overall Basic Life Support performance (proportion difference PVF–SIF = 6.7%; 95% CI: 0.0% to 14.3%; Δ = -27%) and subjective confidence for CPR performance (proportion difference PVF–SIF = -0.01; 95% CI: -0.18–0.17; Δ = -0.5) and emergency situations (proportion difference PVF–SIF = -0.02; 95% CI: -0.21–0.18; Δ = -0.5). Results for compression rate were inconclusive. Discussion Peer Video Feedback achieves comparable results as standard instructor-based training methods. It is an easy-to-apply and cost-efficient alternative to standard Basic Life Support training methods. To improve performance with respect to compression rate, additional implementation of a metronome is recommended.
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Affiliation(s)
- Saša Sopka
- Medical Faculty, AIXTRA–Competency Center for Training and Patient Safety, RWTH Aachen University, Aachen, Germany
- Medical Faculty, Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
- * E-mail:
| | - Fabian Hahn
- Medical Faculty, AIXTRA–Competency Center for Training and Patient Safety, RWTH Aachen University, Aachen, Germany
| | - Lina Vogt
- Medical Faculty, AIXTRA–Competency Center for Training and Patient Safety, RWTH Aachen University, Aachen, Germany
- Medical Faculty, Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Kim Hannah Pears
- Medical Faculty, AIXTRA–Competency Center for Training and Patient Safety, RWTH Aachen University, Aachen, Germany
| | - Rolf Rossaint
- Medical Faculty, Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Jenny Rudolph
- Center for Medical Simulation, Boston, MA, United States of America
| | - Martin Klasen
- Medical Faculty, AIXTRA–Competency Center for Training and Patient Safety, RWTH Aachen University, Aachen, Germany
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Demmer I, Selgert L, Altiner A, Baum E, Becker A, Schmittdiel L, Streitlein-Böhme I, Michiels-Corsten M, Zutz S, Hummers E, Jünger J. Implementation of a uniform nationwide medical licensing examination in general practice. A feasibility study. GMS J Med Educ 2021; 38:Doc96. [PMID: 34286076 PMCID: PMC8256129 DOI: 10.3205/zma001492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/09/2021] [Accepted: 05/31/2021] [Indexed: 06/13/2023]
Abstract
Objective: A competency-based training of medical students that is adapted to the realities of care is required internationally and is being intended in Germany with the Master Plan for Medical Studies 2020. In order to test these competencies, the German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy (IMPP) has developed a concept for the redesign of the final part of the medical licensing examination in Germany. It focuses on general and interprofessional healthcare in the examination with outpatients. The aim of this work is to assess the feasibility of the new final examination on the basis of pilot examinations in family practices and to derive further steps for the national implementation. Methods: Fourteen medical students in their internship year completed a full examination with patients aged 42 to 84 years. Examiners evaluated the examination performance using standardised evaluation forms. Feasibility was qualitatively assessed in terms of compliance with content and time limits, examination results, patient reflections, and implementation in the practice. Results: Students were able to complete all tasks within the given time frame. Based on the evaluation forms, the examiners assessed the performance of the students. Patients appreciated the structured course of the examination in the familiar location of their family practice. For the nationwide implementation of the examination, 2,500 examination practices are required for about 10,000 examinees per year. Four students can then be examined on two days per year in each practice. Conclusions: Oral-practical examinations with outpatients in general medical practices can be carried out successfully throughout the nation. An implementation of the examinations throughout Germany requires that medical studies are restructured and that this new curriculum is implemented as intended by the Master Plan for Medical Studies 2020. Furthermore, training and remuneration of examiners together with a legal framework for the new examination must be established.
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Affiliation(s)
- Iris Demmer
- University Medical Center Göttingen, Department of General Practice, Göttingen, Germany
| | - L. Selgert
- German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy (IMPP), Mainz, Germany
| | - A. Altiner
- University Medical Center Rostock, Department of General Practice, Rostock, Germany
| | - E. Baum
- University of Marburg, Department of General Practice/Family Medicine, Marburg, Germany
| | - A. Becker
- University of Marburg, Department of General Practice/Family Medicine, Marburg, Germany
| | | | - I. Streitlein-Böhme
- Ruhr-University Bochum, Department of General Practice/Family Medicine, Bochum, Germany
| | - M. Michiels-Corsten
- University of Marburg, Department of General Practice/Family Medicine, Marburg, Germany
| | - S. Zutz
- Practice for general and family medicine, Neubukow, Germany
| | - E. Hummers
- University Medical Center Göttingen, Department of General Practice, Göttingen, Germany
| | - J. Jünger
- German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy (IMPP), Mainz, Germany
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Holzhausen Y, Maaz A, Roa-Romero Y, Peters H. What can we expect from medical graduates? Empirical survey on the performance of Core EPAs in the first days of residency. BMC Med Educ 2020; 20:452. [PMID: 33228704 PMCID: PMC7685603 DOI: 10.1186/s12909-020-02376-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/10/2020] [Indexed: 06/01/2023]
Abstract
BACKGROUND Core Entrustable Professional Activities (EPAs) have been defined to specify the performance expectations for entering residents worldwide. The content of these EPAs was elaborated and validated primarily via medical expert consent approaches. The present study aims to collect empirical information on the actual task performance and supervision level of entering residents as a complementary methodological approach to enhance the content validity of a set of institutional EPAs. METHODS In the summers of 2017 and 2018, Charité medical graduates (n = 720) received a post-graduation survey by mail. The questionnaire covered the performance of Core EPAs, Core procedures and more advanced EPAs. Graduates were asked how frequently they had performed the respective EPAs since the start of residency and under what level of supervision. We expected the large majority of graduates (> 75%) to have performed the Core EPAs and procedures under at least indirect supervision. RESULTS In total, 215 graduates (30%) returned the questionnaire, and 131 (18%) surveys could be included in the data analysis. The majority of participants were female (63%) and worked in hospitals (50%) or in university medical centres (30%) across various medical disciplines. Among the Core EPAs, 10 out of 11 tasks had been performed by more than 75% of graduates since the start of residency, 9 under indirect supervision. Regarding the Core procedures, only 3 out of 13 procedures had been performed by the large majority of graduates under indirect supervision, and 10 procedures had not been carried out by at least one-third of participants. Among the 5 advanced EPAs, none of 5 had been performed by more than 75% of the participants since the start of residency, and 4 had been carried out by 50% under indirect supervision. CONCLUSIONS The results of this study largely and complementarily confirm the validity of the defined Core EPAs representing realistic expectations for entry into residence at our institution. The low actual performance rate of Core procedures serves to stimulate an institutional discussion on their adjustment to better match the workplace reality.
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Affiliation(s)
- Ylva Holzhausen
- Dieter Scheffner Centre for Medical Education and Educational Research, Dean’s Office of Study Affairs, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Asja Maaz
- Dieter Scheffner Centre for Medical Education and Educational Research, Dean’s Office of Study Affairs, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Yadira Roa-Romero
- Department of Quality Management (QM) Teaching and Learning, Dean’s Office of Study Affairs, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Harm Peters
- Dieter Scheffner Centre for Medical Education and Educational Research, Dean’s Office of Study Affairs, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Jud SM, Cupisti S, Frobenius W, Benn S, Winkler A, Antoniadis S, Beckmann MW, Heindl F. Logbooks alone are not enough: initial experience with implementing a logbook for medical students in a clinical internship in gynecology and obstetrics. Eur J Med Res 2020; 25:15. [PMID: 32384922 PMCID: PMC7206670 DOI: 10.1186/s40001-020-00413-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Logbooks are being increasingly widely used as a means of improving medical education and further training. They will in all probability continue to be mandatory in the Practical Year (PJ) in Germany even after the upcoming amendment of the Medical Licensing Regulations (ÄAppO). However, there are different approaches to their design and use, and these are also currently undergoing considerable change. This study for the first time examines and discusses the influence of logbooks on students' evaluation of a gynecology internship. METHODS The study was based on a well-established two-part 1-week internship course, with initially unstructured morning classes on wards and duty areas, along with precisely planned afternoon classes with skills training by peer teachers and seminars supervised by duty-exempted physicians. The postgraduate lecturers were prepared for the introduction of the logbook in a special course, and the aim was to optimize morning classes by introducing learning objectives adapted to the respective locations. The effects over 38 weeks of practical training were examined in evaluations by 235 prospectively group-randomized students with and without logbooks (n = 166 and n = 66, respectively; three datasets were not evaluable). RESULTS In the cohort comparison, the logbook group responded significantly more positively toward the internship at the start of the course (P = 0.046). In the final evaluation, however, medical supervision during the entire internship was rated significantly more poorly (P = 0.007). The logbook cohort also considered that guidance based on learning objectives was significantly worse, as was the extent to which wards and duty areas were prepared for the students (P = 0.001 and P = 0.029). CONCLUSIONS Introducing a logbook to optimize clinical teaching in internships may raise expectations that cannot always be met. In addition to adapting the learning objectives to a general framework that is less favorable in comparison with the Practical Year, the least that is required appears to be simultaneous and continuous mentoring of the lecturers, as well as an increase in staffing resources.
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Affiliation(s)
- Sebastian M Jud
- Department of Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Susanne Cupisti
- Department of Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Wolfgang Frobenius
- Department of Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Sigrid Benn
- Department of Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Andrea Winkler
- Department of Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Sophia Antoniadis
- Department of Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
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Wijnen-Meijer M. Integration in the light of curriculum design. GMS J Med Educ 2019; 36:Doc79. [PMID: 31844651 PMCID: PMC6905371 DOI: 10.3205/zma001287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Marjo Wijnen-Meijer
- Technical University of Munich, School of Medicine, TUM Medical Education Center, Munich, Germany
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11
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Schick K, Eissner A, Wijnen-Meijer M, Johannink J, Huenges B, Ehrhardt M, Kadmon M, Berberat PO, Rotthoff T. Implementing a logbook on entrustable professional activities in the final year of undergraduate medical education in Germany - a multicentric pilot study. GMS J Med Educ 2019; 36:Doc69. [PMID: 31844641 PMCID: PMC6905372 DOI: 10.3205/zma001277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 06/10/2023]
Abstract
Objectives: The final year of undergraduate medical education (practical year) should foster the transition from undergraduate medical education to graduate medical education. Medical students in the practical year should be able to assume professional tasks, and supervisors should assign these tasks to them. In this pilot study, a curriculum based on the concept of entrustable professional activities (EPAs) was implemented and evaluated in the disciplines of internal medicine, surgery and general practice at four university hospitals. Methods:n=37 medical students and n=17 supervising physicians at four German university hospitals participated in the implementation study for one trimester. For evaluation purposes, we conducted focus group discussions and telephone interviews and analyzed them following qualitative content analysis. Results: We identified five different aspects as important for implementing the EPA curriculum in undergraduate medical education in the German context: Implementation process of the EPA curriculum and required resources, Entrustment process, Feedback sessions with supervisors, Students' and supervisors' role perceptionOverall impact of EPAs on training conditions in the practical year. Conclusion: The study presents a practical implementation of the EPA curriculum in Germany's undergraduate medical education. Besides the need for time and resources, the concept shows good feasibility and fosters a competence-oriented undergraduate medical education in the practical year.
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Affiliation(s)
- Kristina Schick
- Technical University of Munich, School of Medicine, Medical Education Center, Munich, Germany
| | - Alexander Eissner
- Heinrich Heine University Düsseldorf, Medical Faculty, Dean's Office, Düsseldorf, Germany
| | - Marjo Wijnen-Meijer
- Technical University of Munich, School of Medicine, Medical Education Center, Munich, Germany
| | - Jonas Johannink
- Eberhard Karls University of Tübingen, University Department of General, Visceral and Transplant Surgery, Tübingen, Germany
| | - Bert Huenges
- RUB, Faculty of Medicine, Institute of General Practice and Family Medicine, Bochum, Germany
| | - Maren Ehrhardt
- Hamburg University Medical School, Department of General Practice/Primary Care, Hamburg, Germany
| | - Martina Kadmon
- Augsburg University, Faculty of Medicine, Dean, Augsburg, Germany
| | - Pascal O. Berberat
- Technical University of Munich, School of Medicine, Medical Education Center, Munich, Germany
| | - Thomas Rotthoff
- Augsburg University, Faculty of Medicine, Department for Medical Education and Educational Research, Augsburg, Germany
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