[The situation of education in ENT-residency-training in Germany]

Hintergrund

Als Ansatzpunkt zur Entwicklung konkreter Optimierungsvorschläge für das HNO-ärztliche Weiterbildungssystem wurde zunächst die Ausbildungssituation an deutschen HNO-Kliniken analysiert, um existierende Schwachstellen der Weiterbildung identifizieren zu können.

Methodik

HNO-Weiterbildungsassistenten an deutschen HNO-Kliniken wurden eingeladen, an einer Online-Befragung teilzunehmen. Der Fragebogen bestand dabei aus 78 Einzelfragen.

Ergebnisse

An der Umfrage nahmen 223 Weiterbildungsassistenten der HNO-Heilkunde teil. Defizite der Ausbildung wie ein fehlendes regelmäßiges Feedback zwischen Weiterbildungsberechtigten und Weiterbildungsassistenten/-innen, eine nur mittelmäßig bewertete Vermittlung von Fachkompetenz sowie eine in den Freitextkommentaren genannte „Willkür“ der Weiterbildungsbeauftragten hinsichtlich der Gestaltung des Weiterbildungsverlaufs sowie Zeit- und Personalmangel treten in den Fokus unserer Auswertung. Einige der verbindlich aufgeführten Empfehlungen der Weiterbildungsordnung wie die Festlegung von konkreten Weiterbildungszielen im Rahmen eines regelmäßigen Gesprächs oder der Einsatz eines Log-Buchs werden bislang nur vereinzelt umgesetzt. Forderungen zum Ausbau von externen Fortbildungsmöglichkeiten (Hospitation/Rotation) und einer externen objektiven Überprüfung der klinikinternen Durchführung der Weiterbildung im Sinne einer Qualitätssicherung beispielsweise durch Fachvertreter der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNOKHC) werden diskutiert.

Schlussfolgerung

Die Umsetzung einer strukturierten und standardisierten Weiterbildung in Deutschland, welche im Sinne einer freiwilligen Eigeninitiative auch durch die DGHNOKHC in ihrer Umsetzung überprüft wird, kann eine Basis für eine effektivere verbindliche Weiterbildung schaffen.

Zusatzmaterial online

Die Online-Version dieses Beitrags (10.1007/s00106-020-00838-9) enthält eine Tabelle, die Ergebnisse einer Fragenauswahl gegliedert nach Themenkomplexen darstellt. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“.

Erratum zu: Die Weiterbildungssituation in der HNO-Heilkunde in Deutschland

Ein Erratum zu dieser Publikation wurde veröffentlicht: 10.1007/s00106-020-00838-9

Cerebellar parcellation in schizophrenia and bipolar disorder

OBJECTIVE

The cerebellum is involved in cognitive processing and emotion control. Cerebellar alterations could explain symptoms of schizophrenia spectrum disorder (SZ) and bipolar disorder (BD). In addition, literature suggests that lithium might influence cerebellar anatomy. Our aim was to study cerebellar anatomy in SZ and BD, and investigate the effect of lithium.

METHODS

Participants from 7 centers worldwide underwent a 3T MRI. We included 182 patients with SZ, 144 patients with BD, and 322 controls. We automatically segmented the cerebellum using the CERES pipeline. All outputs were visually inspected.

RESULTS

Patients with SZ showed a smaller global cerebellar gray matter volume compared to controls, with most of the changes located to the cognitive part of the cerebellum (Crus II and lobule VIIb). This decrease was present in the subgroup of patients with recent-onset SZ. We did not find any alterations in the cerebellum in patients with BD. However, patients medicated with lithium had a larger size of the anterior cerebellum, compared to patients not treated with lithium.

CONCLUSION

Our multicenter study supports a distinct pattern of cerebellar alterations in SZ and BD.

[Peer teaching and peer assessment are appropriate tools in medical education in otorhinolaryngology]

BACKGROUND

The use of student tutors (peers) is an accepted method in medical education. In 2011, final year students of the otorhinolaryngology (ORL) department of the University Hospital in Dresden were appointed as peers for the clinical ORL examination. They assisted in the instruction of the clinical ORL examination (peer teaching, PT) and served as examiners (peer assessment, PA) in the final objective structured clinical examination (OSCE). The effect on the quality of education and examination was examined.

MATERIAL AND METHODS

248 medical students (5(th) year) were divided in 2 groups. They were trained and finally examined in the standardized clinical ORL examination by peers and/or physicians. Group I (n=118) was exclusively trained and examined by physicians and group II (n=130) by peers and physicians. The results of the OSCE were stratified for the 2 groups and in group II for the subgroups according to the instructors' and examiners' qualification (peer or physician). The students evaluated the internship and the instructors' and examiners' quality with a validated questionnaire.

RESULTS

In the OSCE, group I scored in the mean 59.9±4.9 points (max. 65). In group II the mean score was 58.3±4.3 points examined by the peers and 59.5±4.8 points for same performance assessed by the physicians. There were no statistical significant differences in the examination results when stratified for the instructors' and examiners' qualification. The evaluation results were consistently positive and identical when compared to the previous year without use of PT and PA and between the 2 groups and subgroups.

CONCLUSIONS

When using a standardized clinical examination routine peers can be used for PT and PA to appropriate tools in student's medical education without any decrease in the teaching and examination quality.

[Exophytic tumor of the neck]

Malignant melanomas are the most frequent skin tumors and, due to the early tendency to metastasize, are linked with an unfavorable prognosis. In the early stage of illness surgical resection is the treatment of choice. This case shows that even large exulcerated tumors of the neck can originate from a dermal tumor.

[APC resistance due to factor V Leiden mutation presenting as acute hemorrhagic jejunal infarction--case report]

We report on a 43-year-old patient presenting to the emergency department with acute abdominal pain the source of which turned out to be acute hemorrhagic jejunal infarction due to portal and mesenteric vein occlusion with no apparent cause. In spite of a lacking history of hereditary thrombophilic risk factors, further diagnostic procedures revealed heterozygous factor V Leiden mutation. Diagnosis, therapy and clinical course are described. An overview on acute mesenteric venous occlusion with special reference to genetically determined thrombophilic disorders is given.

Optimised surgery (so-called TME surgery) and high-resolution MRI in the planning of treatment of rectal carcinoma

BACKGROUND

Since November 1998, we have applied the concept of total mesorectal excision (TME) to rectal carcinoma together with a standardised pathological quality assessment. Participation in the European MERCURY study [The MERCURY Study Group Radiology (in press), 2006] required us to establish the indication for neoadjuvant radiochemotherapy on the basis of an magnetic resonance imaging (MRI) scan. The aim of the present retrospective study is to evaluate the quality of the surgery, the efficacy of the MRI and the oncological outcomes achieved.

MATERIALS AND METHODS

Between November 2001 and October 2005, 68 out of 109 patients with carcinoma of the rectum were submitted to radical surgery in curative intent and 23/68 (34%) were given neoadjuvant therapy. In an interdisciplinary study group, each patient was evaluated pre-operatively and post-operatively using standardised MRI and histopathological methods.

RESULTS

The quality of surgery was established on the basis of the pathological examination of the surgical specimen. The rates of incomplete mesorectal excision, intra-operative tumour cell dissemination and positive circumferential margins were all low at 4%, 7% and 3%, respectively. The effectiveness of MRI proved to be greatest in predicting the tumour status at the circumferential resection margin: in the admittedly limited number of patients it proved possible to correctly predict the tumour status for every patient. The assessment of the anatomic extent of the primary tumour and of the regional lymph node metastasis according to the TNM system, in contrast, was considerably less successful at 73% and 75%, and 37% and 57%, respectively.

CONCLUSION

By applying the TME concept and MRI-based therapy planning, excellent results can be achieved and, at the same time, the number of patients requiring neoadjuvant treatment is considerably reduced.

[Regression of germ cell tumors after chemotherapy]

Today the treatment of gonadal germ cell tumors is standardized. The cisplatin containing chemotherapy and the multi-modal therapy strategies have increased the rate of successful treatment enormously. Germ cell tumors are almost always treated surgically. Following the rare, primary chemotherapy, the residual tumor must be classified according to the WHO as accurately as possible. A binding system for the documentation of tumor regression does not exist. The diagnostic retroperitoneal lymphadenectomy is also rare. Here as well, the classification is performed according to the WHO and the TNM classification. The examination of the tissue samples from a retroperitoneal lymphadenectomy after chemotherapy is problematic. The morphology is often bizarre, preparatory and terminological standards do not exist. Is there still vital tumor present then it can most often be diagnosed as a teratoma. In that case a classification takes place as to whether it is "mature" or "immature". If a tissue sample contains other differentiations, the classification is performed in detail according to the WHO classification of germ cell tumors. Sarcomas or carcinomas must be reliably distinguished and classified, as they lead to different therapeutic consequences. The terminology must be defined in a binding manner between both the pathology and the clinic, due to the lack of global definitions.

[Endocrine tumors of the testis]

The most characteristic endocrine tumours of the testis are germ cell tumours and sex cord/gonadal stromal tumours. They include the primary carcinoid, the relation of which to teratomas is still unclear. In general, gonadal stromal tumours are rare, however, endocrine activity occurs in at least 10%-20%. Among gonadal stromal tumours, only Leydig cell tumours and Sertoli cell tumours are of practical importance. Endocrine disorders are mostly related to Leydig cell tumours (gynaecomastia, pubertas praecox). Although less frequent than the other gonadal stromal tumours, they can, in principle, occur. The large cell calcifying Sertoli cell tumour occurs in association with other complex disorders (i.e. Peutz-Jeghers syndrome). Valuable markers are: inhibin, calretinin, cytokeratin, melan-A, CD-99, Ki-67, androgen receptor and p53. As the conventional morphology and immunohistological markers frequently overlap, unclear cases should be referred to specialised centres.

Seabirds at risk around offshore oil platforms in the north-west Atlantic

Seabirds aggregate around oil drilling platforms and rigs in above average numbers due to night lighting, flaring, food and other visual cues. Bird mortality has been documented due to impact on the structure, oiling and incineration by the flare. The environmental circumstances for offshore hydrocarbon development in North-west Atlantic are unique because of the harsh climate, cold waters and because enormous seabird concentrations inhabit and move through the Grand Banks in autumn (storm-petrels, Oceanodroma spp), winter (dovekies, Alle alle, murres, Uria spp), spring and summer (shearwaters, Puffinus spp). Many species are planktivorous and attracted to artificial light sources. Most of the seabirds in the region are long-distance migrants, and hydrocarbon development in the North-west Atlantic could affect both regional and global breeding populations. Regulators need to take responsibility for these circumstances. It is essential to implement comprehensive, independent arm's length monitoring of potential avian impacts of offshore hydrocarbon platforms in the North-west Atlantic. This should include quantifying and determining the nature, timing and extent of bird mortality caused by these structures. Based on existing evidence of potential impacts of offshore hydrocarbon platforms on seabirds, it is difficult to understand why this has not been, and is not being, systematically implemented.