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ABSTRACT: Anorexia nervosa (AN), at the stage of starvation and emaciation, is characterized by abnormalities in cognitive function, including memory performance. It is unclear whether memory impairment persists or is reversible following weight restoration, and whether memory function differs between AN subtypes. The aim of the present study was to investigate general memory performance in currently ill and fully weight-restored patients of different AN subtypes.
Memory performance was assessed using the Wechsler Memory Scale-Revised (WMS-R) in a total of 99 participants, including 34 restricting-type AN patients (AN-RESTR), 19 binge-eating/purging-type AN patients (AN-PURGE), 16 weight-restored AN patients (AN-W-R) and 30 healthy controls (CONTROL). Cognitive evaluation included a battery of standardized neuropsychological tasks for validating the findings on memory function.
Deficits were found with respect to immediate and delayed story recall in currently ill AN patients irrespective of AN subtype. These deficits persisted in weight-restored AN patients. Currently ill and weight-restored AN patients did not differ significantly from healthy controls with respect to working memory or other measures of neuropsychological functioning.
The findings suggest that impaired memory performance is either a stable trait characteristic or a scar effect of chronic starvation that may play a role in the development and/or persistence of the disorder.
Psychological Medicine 04/2011; 41(4):829-38. · 6.16 Impact Factor
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Christoph Nikendei,
Hans Martin Bosse,
Katja Hoffmann,
Andreas Möltner,
Rabea Hancke,
Corinna Conrad,
Soeren Huwendiek,
Georg F Hoffmann,
Wolfgang Herzog,
Jana Jünger,
Jobst-Hendrik Schultz
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ABSTRACT: communication skills represent an essential component of clinical competence. In the field of pediatrics, communication between physicians and patients' parents is characterized by particular difficulties. To investigate the effects of a parent-physician communication skills training program on OSCE performance and self-efficacy in a group control design.
parallel to their daily work in the outpatient department, intervention-group experienced clinicians in practice (n=14) participated in a communication training with standardized parents. Control-group physicians (n=14) did not receive any training beyond their daily work. Performance was assessed by independent video ratings of an OSCE. Both groups rated their self-efficacy prior to and following training.
regarding OSCE performance, the intervention group demonstrated superior skills in building relationships with parents (p<.024) and tended to perform better in exploring parents' problems (p<.081). The communication training program led to significant improvement in self-efficacy with respect to the specific training objectives in the intervention group (p<.046).
even in physicians with considerable experience, structured communication training with standardized parents leads to significant improvement in OSCE performance and self-efficacy. PRACTISE IMPLICATIONS: briefness and tight structure make the presented communication training program applicable even for experienced physicians in daily clinical practice.
Patient Education and Counseling 02/2010; 82(1):94-9. · 2.31 Impact Factor
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ABSTRACT: An innovative model for the structured on-ward supervision of final year students Dear Sir Clerkships are generally viewed as a favourable learning environment for final year students. During this period, it is necessary to completely integrate final year students into ward procedures in order to improve their proficiency in indepen-dent patient management. Since on-ward supervision has been shown to be rare (Howley & Wilson 2004), we introduced an innovative model of a supplementary, structured, on-ward supervision for final year students, with experienced physi-cians who were not simultaneously the current ward physician serving as supervisors. Learning goals were defined based on a search of the literature (Schrauth et al. 2009) and comprised patient history taking and clinical examination, conducting ward rounds including chart documentation, the presentation of patient cases, and writing medical reports. A cohort of final year students (n ¼ 16; 9 female; mean age 25.0 years) agreed to participate in the on-ward supervision programme during their clinical rotation. Final-year-student supervisors (n ¼ 2; 1 female) were third-year internal medicine residents and received intensive training in teaching metho-dology as well as in providing qualified feedback. Evaluation of the programme included post-intervention ratings on a seven-point Likert-scale ranging from 6 (very good) to 1 (unsatisfactory) and a focus group analysis. Quantitative analysis revealed that final year students considered the programme to be extremely helpful (5.75; AE0.44), to improve their clinical skills (4.90; AE1.40), and to support independent working (4.80; AE1.01). They expressed the wish for the programme to be expanded (5.62; AE0.62). Final-year-student supervisors were seen as good teachers (5.81; AE0.40) that were sufficiently qualified (5.87; AE0.50) and were considered to represent an important attachment figure (5.80; AE0.30). A supplementary focus-group analysis based on a sub-sample of participants (n ¼ 4) affirmed that delegated medical tasks normally remain unsupervised, and that final-year-students benefited enormously from the programme, mainly due to the close one-to-one monitoring by the supervisors. In conclusion, an on-ward supervision programme is a feasible and well-accepted tool in final year medical education which assures supervision and conveys skills in independent patient management.
Medical Teacher 01/2010; 32(2):181-185. · 1.22 Impact Factor
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C. Nikendei
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ABSTRACT: Background: The final year of medical education is considered crucial in making students ‘fit for purpose’. Studies have shown that many students leave medical school without having experienced sufficient preparation for their upcoming professional life. Aim: The aim of this study was to examine the effectiveness of a supplementary internal medicine final year curriculum on clinical reasoning skills. Method: Final year internal medicine students from two universities participated in the study which was based on a static-group design. The experimental group (n = 49) took part in a final year student curriculum with interactive case-based seminars and skills training sessions. The comparison group (n = 25) did not receive any additional training beyond working on the ward. Clinical reasoning skills were assessed using a key-feature pre-post test. Results: Prior to their clinical rotation, the two groups did not differ in the key-feature examination (p < 0.924). The experimental group performed significantly better than the comparison group (p < 0.028) in the post-intervention key-feature examination. Conclusions: Supplementary interactive case-based seminars and skills training sessions are effective and significantly improve the clinical reasoning skills of final year students in internal medicine. Further study is warranted and should look to examine the effectiveness of a final year student curriculum on other performance measures.
09/2009; 31(9):e438-e442.
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ABSTRACT: The final year of medical education is considered crucial in making students 'fit for purpose'. Studies have shown that many students leave medical school without having experienced sufficient preparation for their upcoming professional life.
The aim of this study was to examine the effectiveness of a supplementary internal medicine final year curriculum on clinical reasoning skills.
Final year internal medicine students from two universities participated in the study which was based on a static-group design. The experimental group (n = 49) took part in a final year student curriculum with interactive case-based seminars and skills training sessions. The comparison group (n = 25) did not receive any additional training beyond working on the ward. Clinical reasoning skills were assessed using a key-feature pre-post test.
Prior to their clinical rotation, the two groups did not differ in the key-feature examination (p < 0.924). The experimental group performed significantly better than the comparison group (p < 0.028) in the post-intervention key-feature examination.
Supplementary interactive case-based seminars and skills training sessions are effective and significantly improve the clinical reasoning skills of final year students in internal medicine. Further study is warranted and should look to examine the effectiveness of a final year student curriculum on other performance measures.
Medical Teacher 09/2009; 31(9):e438-42. · 1.22 Impact Factor
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ABSTRACT: Following amendment to the German medical licensing regulations in April 2002, the training and examination of clinical-technical competencies within university medical education has gained in importance. To date, the implementation of new and innovative teaching and assessment methods at medical faculties in the Federal Republic of Germany has not been subject to exhaustive and detailed evaluation.
Using structured telephone interviews, all 36 medical faculties were questioned concerning their curricula, application of skills laboratory training, standardised patients (SPs), problem-based learning (PBL), computer-based training (CBT), and the implementation of objective structured clinical examinations (OSCE).
All 36 faculties (100 %) took part in the survey. 34 faculties (94 %) reported providing training in a skills laboratory and 30 (83 %) faculties reported working with standardised patients. PBL is employed at 33 faculties (92 %) and CBT at 32 (89 %). Practical clinical assessments in the form of OSCEs are conducted at 28 faculties and are currently being installed at two further universities.
New and innovative teaching and examination methods have been implemented in almost all medical universities in the Federal Republic of Germany. Further studies are needed in order to assess the extent to which individual specialist fields are involved in these developments.
DMW - Deutsche Medizinische Wochenschrift 03/2009; 134(8):371-2. · 0.53 Impact Factor
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ABSTRACT: Peer-assisted learning (PAL) has become a well-accepted teaching method within medical education. However, descriptions of on-ward PAL programmes are rare. We introduced a PAL programme with a focus on clinical competencies on internal medicine wards.
To assess the effects of an on-ward PAL programme on self-assessed clinical competencies.
A total of 168 medical students were randomly assigned to one of the seven intervention wards or one of the seven control wards. During their 5-week ward-placement, the intervention group (IG; n = 88) received 10 patient-centred tutorials lead by final year tutors: (I) history taking, (II) physical examination, (III) blood withdrawal, (IV) infusion, (V) patient files, (VI and VII) ECG, (VIII-X) chart rounds. The control group (CG; n = 80) did not take part in the PAL programme. Clinical competencies were self-assessed pre- and post-intervention. Results: For five of the ten assessed clinical competencies, increases in self-confidence ratings were significantly higher in the IG as compared to CG.
Results provide preliminary evidence to suggest that PAL programmes on internal medicine wards and with final year students as peer tutors may represent a valuable additional tool within medical clerkships. However, the findings must be confirmed and clarified in further research.
Medical Teacher 03/2009; 31(2):e32-5. · 1.22 Impact Factor
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ABSTRACT: Maladaptive processing of food cues is considered pivotal in the psychopathology of anorexia nervosa. However, the influence of hunger and differences in processing because of the type of stimuli remain largely unclear.
Memory bias for food-related pictorial and semantic stimuli was assessed in a recognition and a free recall test in 16 anorexia nervosa (AN) patients, 16 control participants with food intake prior to the study (CG-FI) and 16 control participants with a fasting period prior to the study (CG-NF).
Compared with CG-FI participants, both AN and CG-NF participants responded faster to food-related as compared with neutral words (p < .001) in the recognition test. Differences were found for word but not for pictorial stimuli. No group differences were observed with respect to the number of correct retrievals in either the recognition or the free recall test.
The present study found behavioral indications of abnormal processing of food-related and neutral stimuli in anorectic patients similar to those found in fasted healthy controls. Results are discussed in terms of self-schemata in eating disorders, competitive interference, and levels of processing.
International Journal of Eating Disorders 07/2008; 41(5):439-47. · 2.95 Impact Factor
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C. Nikendei MD,
M. Weisbrod MD,
S. Schild PhD,
S. Bender MD,
S. Walther PhD,
W. Herzog MD,
S. Zipfel MD,
H.C. Friederich MD, C. Nikendei,
M. Weisbrod,
S. Schild,
S. Bender,
S. Walther,
W. Herzog,
S. Zipfel,
H.C. Friederich
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ABSTRACT: Objective:Maladaptive processing of food cues is considered pivotal in the psychopathology of anorexia nervosa. However, the influence of hunger and differences in processing because of the type of stimuli remain largely unclear.Method:Memory bias for food-related pictorial and semantic stimuli was assessed in a recognition and a free recall test in 16 anorexia nervosa (AN) patients, 16 control participants with food intake prior to the study (CG-FI) and 16 control participants with a fasting period prior to the study (CG-NF).Results:Compared with CG-FI participants, both AN and CG-NF participants responded faster to food-related as compared with neutral words (p < .001) in the recognition test. Differences were found for word but not for pictorial stimuli. No group differences were observed with respect to the number of correct retrievals in either the recognition or the free recall test.Conclusion:The present study found behavioral indications of abnormal processing of food-related and neutral stimuli in anorectic patients similar to those found in fasted healthy controls. Results are discussed in terms of self-schemata in eating disorders, competitive interference, and levels of processing. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2008
International Journal of Eating Disorders 06/2008; 41(5):439 - 447. · 2.95 Impact Factor
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ABSTRACT: Ward rounds are an essential activity for doctors in hospital settings and represent complex tasks requiring not only medical knowledge but also communication skills, clinical technical skills, patient management skills and team-work skills. The present study aimed to identify final year students' deficiencies in conducting ward rounds in order to aid the development of appropriate teaching tools.
45 final year students participated in a simulated ward round session with three standardised patient scenarios: (1) myocardial infarction, (2) poorly controlled diabetes, and (3) acute fever in acute myeloid leukaemia. Videotaped sessions were rated by independent raters using binary item checklists which reflected predefined learning goals in five different domains: (I) information gathering, (II) communication with patient, (III) focused physical examination, (IV) chart reviewing/ prescription/ documentation and (V) team communication.
For the three patient scenarios, 64.3% of the domain-specific learning goals were attained for the domain "information gathering", 79.4% for "communication with patient", 62.6% for "focused physical examination", 48.9% for "chart reviewing/ prescription/ documentation" and 86.0% for the domain "team communication".
Final year students' ward round skills appear to be insufficient with a central deficit in reviewing charts and initiating appropriate prescriptions and documentation. Ward round training which eases the transition from observing ward rounds to conducting them on one's own is urgently required.
Medical Teacher 03/2008; 30(1):88-91. · 1.22 Impact Factor
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Medical Teacher 02/2008; 30(4):442-3. · 1.22 Impact Factor
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Medical Teacher 02/2008; 30(4):444-5. · 1.22 Impact Factor
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ABSTRACT: Recently, efforts have been undertaken to enhance the face validity of technical skills training by introducing role-plays and standardised patients. Since little is known about the effects of role-playing with respect to the realism of a training situation and students' objective performance, we performed a randomized controlled trial.
36 medical students participated in videotaped small group skills-lab sessions on the topics of Doppler sonography and gastric tube insertion. One half of the students participated in role-plays and the other half practised without role-playing. Realism of the training situation was analysed by means of post-intervention self-selected student survey evaluations. Technical performance and patient-physician communication were assessed by independent ratings of the videotaped sessions.
The physician's role was regarded to be significantly more realistic when performing role-plays. Assessment of videotaped sessions showed that practising technical skills by performing role-plays resulted in significantly better patient-physician communication whereas students' technical performance did not differ between groups.
Introducing role-plays enhances the realism of technical skills training and leads to better patient-physician communication. Students do not seem to be overstrained by practising clinical technical skills using role-plays. We conclude that role-playing is a valuable method in practising technical skills.
Medical Teacher 12/2007; 29(9):956-60. · 1.22 Impact Factor
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ABSTRACT: Ward rounds are an essential activity for doctors in hospital settings and represent complex tasks requiring not only medical knowledge but also communication skills, clinical technical skills, patient management skills and team-work skills. However, although the need for ward round training is emphasized in the published literature, there are currently no reports of ward round training in a simulated setting with standardized patients.
45 final year students participated in a ward round training session lasting two hours with three standardized patient scenarios and role-plays. Final year students assumed the role of either doctor, nurse or final year student with role-specific instructions and provided each other with peer-feedback during the training session. Training was assessed using final year student focus groups and semi-structured interviews of standardized patients. Written protocols of the focus group as well as the interviews of standardized patients were content analysed.
In the course of five focus groups, 204 individual statements were gathered from participating final year students. Ward round training proved to be a feasible tool, well accepted by final year students. It was seen to offer a valuable opportunity for reflection on the processes of ward rounds, important relevant feedback from standardized patients, peer group and tutors. Semi-structured standardized patient interviews yielded 17 central comments indicating that ward rounds are a novel and exciting experience for standardized patients.
Ward round training with standardized patients is greatly appreciated by final year students and is viewed as an important part of their education, easing the transition from observing ward rounds to conducting them on their own.
Medical Teacher 04/2007; 29(2-3):246-52. · 1.22 Impact Factor
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ABSTRACT: Clerkships are generally seen as a very favourable learning environment for final-year students. However, in recent years the clinical experience of final-year students has been reported to decline progressively. It was decided, therefore, to introduce an innovative skills training model in internal medicine. Sixty final-year students received four consecutive days of training during their first week, consisting of three-hour sessions on each day. The skills training course reflected a patient history from admission to discharge and included all required routine procedures, typical forms/files and computer interactions. Acceptability was measured with self-administered surveys post-intervention and again 16 weeks later; self-assessment was measured pre-/post-intervention. The skills training course was well accepted by the students and led to a significant improvement in self-assessment. It was considered to be very helpful for work on the wards in both the immediate and the long-term retrospective evaluation. The final-year skills training course allows students to learn how to handle specific tools and applications for their work on the ward. It possesses face validity and is easy to integrate.
Medical Teacher 12/2006; 28(7):648-51. · 1.22 Impact Factor
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ABSTRACT: The families of patients suffering from eating disorders such as Anorexia nervosa (AN) und Bulimia nervosa (BN) are, owing to the illness, subject to considerable emotional strain and are furthermore often characterised by significant structures and patterns of interaction within the family. Consequently the inclusion of patients' family members, whose status can be seen as increasingly gaining in scientific approval, plays an important role within both diagnosis and therapy. Of particular importance is the medical informative discussion with both patients and their parents which takes place in a primarily medical context and aims to develop and increase therapy motivation. For this purpose the doctor should possess basic knowledge concerning dialogue management with families, as will be presented in the current article. Within further stages of the therapeutic process the spectrum of interventions at the level of the family ranges from educational and supportive measures to family therapy in a more narrow sense, which is carried out by specialist psychotherapists either as outpatient-treatment or within the framework of therapy with inpatients of a clinic.
Therapeutische Umschau 09/2006; 63(8):551-4.
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ABSTRACT: The metabolic syndrome is defined as a constellation of metabolic abnormalities, including glucose intolerance, obesity, dyslipidaemia, and hypertension. It is associated with an elevated risk for cardiovascular disease and type 2 diabetes. Over the past 20 years, a worldwide increase of the metabolic syndrome has taken place. In the USA, 21% to 39% of the general population suffer from metabolic syndrome; in Europe prevalence rates are lower. At the same time, depressive disorders, which are associated with a 1.5 to 2.5 fold risk for cardiovascular events, are increasing. The combination of metabolic syndrome and depression multiplies the risk for severe complications: Due to behavioural, physiological, genetic, and treatment-induced factors, depression stimulates the development of a metabolic syndrome. In reverse, the metabolic syndrome favours development and maintenance of the metabolic syndrome. Consequently, in patients suffering from metabolic syndrome and depression, both disorders must be treated simultaneously. The treatment plan includes weight reduction, physical activity, psychoeducation, family interventions, the patient's subjective explanatory and treatment models, cognitive techniques, and problem solving techniques. Weight, blood pressure, fastening glucose, haemoglobin A1c, and lipids must be controlled in order to monitor treatment progress. Additional drug treatment can be appropriate for hypertension, dyslipidaemia, hyperglycaemia, and depression. Under these conditions, sustained improvements of individual well-being, psychosocial risk-factors, functional limitations, glycemic control, hypertension, and obesity are possible.
Therapeutische Umschau 09/2006; 63(8):521-7.
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C Nikendei,
T Schilling,
P Nawroth,
M Hensel,
A D Ho,
V Schwenger,
M Zeier,
W Herzog,
D Schellberg,
H A Katus,
T Dengler,
W Stremmel,
M Müller,
J Jünger
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ABSTRACT: An amendment to the German medical curriculum in April 2002 will place basic practical skills at the centre of medical training. We report here on the implementation and evaluation of an obligatory, tutor-guided, and integrated skills laboratory concept in the field of internal medicine.
To test the effectiveness of a skills laboratory training on OSCE performance a pilot study was carried out. The experimental group, of 77 students, participated in seven sessions of communication training, skills laboratory training, and bedside teaching, each lasting one and a half hours. The control group of 66 students had as many sessions but was only offered bedside-teaching. The evaluation of acceptance of skills' training as well as the related increase in individual competence is on-going (summer term 2004: n = 176 students).
The integrated skills laboratory concept was rated at 3.5 (SD = 1.2) on a 5-point scale and was acknowledged as practice-oriented (M = 4.2; SD = 1.0) and relevant for doctors' everyday lives (M = 3.6; SD = 1.1). Increased levels of competence according to individual self-evaluations proved to be highly significant (p<.001), and results of the pilot study showed that the experimental group had a significantly better OSCE performance than the control group (p<.001).
This pilot study shows that curriculum changes promoting basic clinical skills are effective and lead to an improved practical education of tomorrow's physicians. The integrated skills laboratory concept is well accepted and leads to a relevant increase in competence in the practice of internal medical. The presented skills laboratory concept in internal medicine is proving to be a viable and efficient learning tool.
DMW - Deutsche Medizinische Wochenschrift 06/2005; 130(18):1133-8. · 0.53 Impact Factor
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ABSTRACT: Clinical skills are an important and necessary part of clinical competence. Simulation plays an important role in many fields of medical education. Although role-playing is common in communication training, there are no reports about the use of student role-plays in the training of technical clinical skills. This article describes an educational intervention with analysis of pre- and post-intervention self-selected student survey evaluations. After one term of skills training, a thorough evaluation showed that the skills-lab training did not seem very realistic nor was it very demanding for trainees. To create a more realistic training situation and to enhance students' involvement, case studies and role-plays with defined roles for students (i.e. intern, senior consultant) were introduced into half of the sessions. Results of the evaluation in the second term showed that sessions with role-playing were rated significantly higher than sessions without role-playing.
Medical Teacher 04/2005; 27(2):122-6. · 1.22 Impact Factor
