[Show abstract][Hide abstract] ABSTRACT: Already during their studies, medical students should intensively train their clinical thinking and practice skills, enhancing their clinical expertise in theoretical and practical terms.
Based on the findings of educational research, a new curriculum for clinical training was developed at Duesseldorf University, focussing on workplace-based teaching, learning and assessment.
For students in their 3(rd), 4(th) and 5(th) year of study, our curriculum is based on learning with patient complaint items in regard to multidisciplinary areas of outpatient and inpatient care. For this educational format, 123 complaint items were defined and their compatibility with diseases from various disciplines was tested. Based on the complaint of a specific case, students locate the underlying disease pattern, the differential diagnostic and therapeutical procedures and thereby deepen the required knowledge in the basic subjects. Study books have been created by the clinical departments to support this process. Learning is integrated in competence-oriented and workplace-based learning and assessment, offering a close-knit contact between students and doctors.
The concept allows the integration of theory into practice and the integration of knowledge from the basic, clinical-theoretical and clinical subjects into clinical thinking and action.
[Show abstract][Hide abstract] ABSTRACT: Introduction
Core competencies have progressively gained importance in medical education. In other contexts, especially personnel selection and development, assessment centers (ACs) are used to assess competencies, but there is only a limited number of studies on competency-based ACs in medical education. To the best of our knowledge, the present study provides the first data on the criterion-related validity of a competency-based AC in medical education.
We developed an AC tailored to measure core competencies relevant to medical education (social-ethical, communicative, self, and teaching) and tested its validity in n=30 first-year medical students using 3- to 4-year follow-up measures such as (a) objective structured clinical examinations (OSCE) on basic clinical skills (n=26), (b) OSCE on communication skills (n=21), and (c) peer feedback (n=18). The AC contained three elements: interview, group discussion, and role play. Additionally, a self-report questionnaire was provided as a basis for the interview.
Baseline AC average score and teaching competency correlated moderately with the communication OSCE average score (r=0.41, p=0.03, and r=0.38, p=0.04, respectively). Social-ethical competency in the AC showed a very strong convergent association with the communication OSCE average score (r=0.60, p<0.01). The AC total score also showed a moderate correlation with the overall peer feedback score provided in Year 4 (r=0.38, p=0.06). In addition, communicative competency correlated strongly with the overall peer feedback (r=0.50, p=0.02). We found predominantly low and insignificant correlations between the AC and the OSCE on basic clinical skills (r=−0.33 to 0.30, all p's>0.05).
The results showed that competency-based ACs can be used at a very early stage of medical training to successfully predict future performance in core competencies.
Full-text · Article · Sep 2014 · Medical Education Online
[Show abstract][Hide abstract] ABSTRACT: Objective
To evaluate the summative assessment (OSCE) of a communication training program for dealing with challenging doctor-patient encounters in the 4th study year.
Our OSCE consists of 4 stations (breaking bad news, guilt and shame, aggressive patients, shared decision making), using a 4-item global rating (GR) instrument. We calculated reliability coefficients for different levels, discriminability of single items and interrater reliability. Validity was estimated by gender differences and accordance between GR and a checklist.
In a pooled sample of 456 students in 3 OSCEs over 3 terms, total reliability was α = 0.64, reliability coefficients for single stations were >0.80, and discriminability in 3 of 4 stations was within the range of 0.4 to 0.7. Except for one station, interrater reliability was moderate to strong. Reliability on item level was poor and pointed to some problems with the use of the GR.
The application of the GR on regular undergraduate medical education shows moderate reliability in need of improvement and some traits of validity. Ongoing development and evaluation is needed with particular regard to the training of the examiners.
Practice Implications: Our CoMeD-OSCE proved suitable for the summative assessment of communication skills in challenging doctor-patient encounters.
No preview · Article · Jun 2014 · Patient Education and Counseling
[Show abstract][Hide abstract] ABSTRACT: Introduction: There are no uniform specifications for the design of the obligatory course "vocational exploration"in German undergraduate medical education. Consequently, diverse teaching concepts are realized at the medical faculties. One group of concepts gives an overview of possible fields of work for doctors. The other group focuses on a deeper examination of a medical key competence like doctor-patient communication. How do first-year medical students appraise these concepts? Methods: Questionnaire study in 198 first-year medical students at the University of Düsseldorf: Written descriptions of four different teaching concepts (two concepts focussing on possible fields of work and two concepts focussing on a key competence) should to be put into a rank order of their personal preference. Analysis of the mean ranks of the four concepts (Friedman test) and of the relationship between student characteristics and preferred concept (logistic regression). Results: Among the four concepts, a broad overview by means of consultations in several medical settings is the favoured one. An overview in seminars and concepts with focus on competence in communication or chronic illness are significantly ranked lower. There were no significant relationships between student characteristics and concept preference. Discussion: Following the results may imply reassessing the focus on educational goals from general practice like communication or chronic illness. Especially in universities with a minor role of general practice within the curriculum, students' preferences have to be balanced against own purposes of curricular positioning.
No preview · Article · Jan 2014 · ZFA. Zeitschrift fur Allgemeinmedizin
[Show abstract][Hide abstract] ABSTRACT: Background
A mission statement (MS) sets out the long-term goals of an institution and is supposed to be suited for studying learning environments. Yet, hardly any study has tested this issue so far. The aim of the present study was the development and psychometric evaluation of an MS-Questionnaire (MSQ) focusing on explicit competencies. We investigated to what extent the MSQ captures the construct of learning environment and how well a faculty is following - in its perception - a competency orientation in a competency-based curriculum.
A questionnaire was derived from the MS “teaching” (Medical Faculty, Heinrich-Heine University Düsseldorf) which was based on (inter-) nationally accepted goals and recommendations for a competency based medical education. The MSQ was administered together with the Dundee Ready Education Environment Measure (DREEM) to 1119 students and 258 teachers. Cronbach’s alpha was used to analyze the internal consistency of the items. Explorative factor analyses were performed to analyze homogeneity of the items within subscales and factorial validity of the MSQ. Item discrimination was assessed by means of part-whole corrected discrimination indices, and convergent validity was analyzed with respect to DREEM. Demographic variations of the respondents were used to analyze the inter-group variations in their responses.
Students and teachers perceived the MS implementation as “moderate” and on average, students differed significantly in their perception of the MS. They thought implementation of the MS was less successful than faculty did. Women had a more positive perception of educational climate than their male colleagues and clinical students perceived the implementation of the MS on all dimensions significantly worse than preclinical students. The psychometric properties of the MSQ were very satisfactory: Item discrimination was high. Similarly to DREEM, the MSQ was highly reliable among students (α = 0.92) and teachers (α = 0.93). In both groups, the MSQ correlated highly positively with DREEM (r = 0.79 and 0.80, p < 0.001 each). Factor analyses did not reproduce the three areas of the MS perfectly. The subscales, however, could be identified as such both among teachers and students.
The perceived implementation of faculty-specific goals can be measured in an institution to some considerable extent by means of a questionnaire developed on the basis of the institution’s MS. Our MSQ provides a reliable instrument to measure the learning climate with a strong focus on competencies which are increasingly considered crucial in medical education. The questionnaire thus offers additional information beyond the DREEM. Our site-specific results imply that our own faculty is not yet fully living up to its competency-based MS. In general, the MSQ might prove useful for faculty development to the increasing number of faculties seeking to measure their perceived competency orientation in a competency-based curriculum.
Full-text · Article · Nov 2012 · BMC Medical Education
[Show abstract][Hide abstract] ABSTRACT: The educational climate in which future doctors are trained is an important aspect of medical education. In contrast to human medicine, it has been rather neglected in dental educational research. The aim of the study was to supplement this lack by applying and validating the Dundee Ready Education Environment Measure (DREEM) for the first time in a German-speaking sample of dental students.
All dental students at the Medical Faculty of Heinrich-Heine-University Düsseldorf were asked to complete a German adaptation of the DREEM and the Düsseldorf Mission Statement Questionnaire (DMSQ) in a paper-pencil survey. Data from 205 participants were analysed. Psychometric validation included analysis of item homogeneity and discrimination, test reliability, criterion and construct validity (convergent, factorial).
DREEM item parameters were satisfactory, reliability (α = 0.87) and convergent validity (r = 0.66 with DMSQ) were also high. Factor analyses, however, yielded dimensions which did not fully correspond to the original DREEM subscales. Overall perception of the educational environment was positive (DREEM total score = 122.95 ± 15.52). Students in the clinical part of course rated the atmosphere more negatively, but their academic self-perception more positively than preclinical students.
Showing satisfactory psychometric properties, DREEM proved suitable for assessing educational environments among dental students. Given the right circumstances, e.g., small and early clinically oriented classes, traditional curricula can generate positive environments.
No preview · Article · May 2012 · European Journal Of Dental Education
[Show abstract][Hide abstract] ABSTRACT: Implementation of a longitudinal curriculum for training in advanced communications skills represents an unmet need in most German medical faculties, especially in the 4rth and 5th years of medical studies. The CoMeD project (communication in medical education Düsseldorf) attempted to establish an interdisciplinary program to teach and to assess communicative competence in the 4th academic year. In this paper, we describe the development of the project and report results of its evaluation by medical students.
Teaching objectives and lesson formats were developed in a multistage process. A teaching program for simulated patients (SP) was built up and continuous lecturer trainings were estabilshed. Several clinical disciplines co-operated for the purpose of integrating the communication training into the pre-existing clinical teaching curriculum. The CoMeD project was evaluated using feedback-forms after each course.
Until now, six training units for especially challenging communication tasks like "dealing with aggression" or "breaking bad news" were implemented, each unit connected with a preliminary tutorial or e-learning course. An OSCE (objective structured clinical examination) with 4 stations was introduced. The students' evaluation of the six CoMeD training units showed the top or second-best rating in more than 80% of the answers.
Introducing an interdisciplinary communication training and a corresponding OSCE into the 4th year medical curriculum is feasible. Embedding communication teaching in a clinical context and involvement of clinicians as lecturers seem to be important factors for ensuring practical relevance and achieving high acceptance by medical students.
Full-text · Article · Feb 2012 · GMS Zeitschrift fü medizinische Ausbildung
[Show abstract][Hide abstract] ABSTRACT: The teachers' perspectives of the educational environment have as yet only been sparsely considered. This study aimed at validating the first German version of the Dundee Ready Education Environment Measure (DREEM) from the points of view of both students and teachers.
Data from 1119 students and 258 teachers were available for analysis. Psychometric validation included the analysis of homogeneity and discrimination at item level as well as reliability (Cronbach's α), criterion and construct validity at test level. Effect sizes were calculated and the independent samples t-test was used for statistical inference testing of mean differences between two groups.
Item characteristics were satisfactory in both samples. Reliability was high with α = 0.92 (students) and 0.94 (teachers), respectively. Factor analyses revealed five dimensions which slightly diverged from the five subscales postulated by the DREEM authors though. The environment was evaluated significantly (p < 0.001) more positively by teachers (M = 117.63) than by students (M = 109.75). Further significant differences were observed with regard to gender, mother language, stage of studies and previous professional training among others.
With convincing psychometric properties at item and test levels, the suitability of DREEM not only for students but also for teachers to assess the educational environment has been demonstrated.
[Show abstract][Hide abstract] ABSTRACT: Background: Doctor-patient communication and patient-centeredness are of increasing importance to both doctors and the public. Within a qualitative study we focussed on 4th year medical students' selfperception of their own communicative competences, attitudes and their experiences during basic medical education. Methods: We conducted in-depth interviews with nine students. After verbatim transcription the interviews were analysed according to grounded theory. Results: Medical students define "good" doctor-patient- communication in terms of "efficacy" and "control". Medical students are concerned about the "right distance" to patients, which they perceive as a sign of professionalism. The results of our analysis show a discrepancy between students' acknowledgement of the importance of doctor-patient communication and a mostly emotional rejection of such educational content in the medical curriculum. Overwhelmed by the complexity of medicine, 4th year students have nothing more in need as gaining control on their performance. Thus a patient-centred attitude to communication, which allows a certain amount of uncertainness, seems unfavourable for medical students at this stage of their professional development. Conclusions: Accepting this phenomenon may help to develop more student-centred approaches in education on medical communication.
No preview · Article · Mar 2011 · ZFA. Zeitschrift fur Allgemeinmedizin
[Show abstract][Hide abstract] ABSTRACT: Question arises as to what extent communication skills are considered in continuing medical education (CME).
Analysis for CME-courses in communication skills in the area of the Chamber of Physicians North Rhine (ÄkNo), Germany. Supply Arm(A): CME events (n = 19,320) certified in 2007 were evaluated. Demand Arm(B): course participation of 850 family physicians in the period 2002-2007 was analyzed (n = 37,724). Tests were calculated to the level 0.05 using Mann-Whitney U-test.
(A) 388 (2.0%) events were concerned with the topic communications. 59.3% involved active cooperation of the participants. 0.5% events devoted more than 50% of their duration to the topic communication. Proportions in the subjects of internal medicine, general medicine and pediatrics amounted to 0.2%. (B) 803 (2.1%) events with a focus on communication were identified. Women took part in significantly more events than men (p<0.002) and selected more interactive courses.
Content on communication training was small. Increasing experience does not automatically improve communication skills but an extent of deliberate praxis seems to be necessary and must be sought and developed.
Communication skills are still insufficiently provided in CME-courses and should be more directed to focus as treatment strategies and scientifically investigated for outcome improvements.
No preview · Article · Sep 2010 · Patient Education and Counseling
[Show abstract][Hide abstract] ABSTRACT: the study analyses the supply and the demand for Continuing Medical Education (CME) in the area served by the "Ärztekammer Nordrhein (ÄkNo)", which is one of the biggest regional Chambers of Physicians in Germany. Both the supply of all CME events certified by the ÄkNo in 2007 (n=18,932) and the participation of physicians in CME activities - using the example of family doctors (n=850), ophthalmologists (n=122) and orthopaedists (n=38) in the university towns of Cologne, Bonn and Aachen - was analysed for the period of 2002 to 2007 (n=44,760 events).
differences between groups were tested by the nonparametric Kruskal-Wallis method; adjustment for other factors was performed using Cochran-Mantel-Haenszel tests. The significance level was chosen to be 0.05.
half of the accredited CME activities had been provided in the form of lectures accompanied by discussion. This didactic focus is reflected by the CME choices of the analysed physicians, although interactive, multimedia materials and case based formats have been demonstrated to be advantageous. Family physicians and ophthalmologists participated twice as often in CME events as orthopaedists (p<0.001). Across all the disciplines investigated, female physicians participated significantly more often in CME events than their male colleagues (p<0.03).
our results show individual, group and gender specific differences in Continuing Medical Education which so far have not been adequately recognised and which warrants more research on CME.
No preview · Article · Jan 2010 · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen
[Show abstract][Hide abstract] ABSTRACT: Continuing medical education (CME) increasingly focuses on measurable patient outcomes. Nevertheless, international data on this issue are insufficient, and in Germany the measurable effects of CME in terms of its efficacy and utility for patient care have hardly been subjected to scientific examination. Advanced medical education as a continuation of university education is always based on scientific standards and research-oriented learning. Advanced medical training in Germany therefore requires the implementation of a kind of learning and teaching research that should be geared toward individual training needs, personal motivation and the outcomes of medical care. In addition, the definition of educational goals and the advancement of CME in terms of continuing professional development (CPD) should be considered an important component for a reevaluation of CME.
No preview · Article · Feb 2009 · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen
[Show abstract][Hide abstract] ABSTRACT: Continuing medical education (CME) increasingly focuses on measurable patient outcomes. Nevertheless, international data on this issue are insufficient, and in Germany the measurable effects of CME in terms of its efficacy and utility for patient care have hardly been subjected to scientific examination. Advanced medical education as a continuation of university education is always based on scientific standards and research-oriented learning. Advanced medical training in Germany therefore requires the implementation of a kind of learning and teaching research that should be geared toward individual training needs, personal motivation and the outcomes of medical care. In addition, the definition of educational goals and the advancement of CME in terms of continuing professional development (CPD) should be considered an important component for a re-evaluation of CME.
No preview · Article · Jan 2009 · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen
[Show abstract][Hide abstract] ABSTRACT: Mit der Änderung der ärztlichen Fortbildungsverpflichtungen ist ein deutlicher Anstieg an zertifizierten Fortbildungsangeboten (CME) zu verzeichnen. Eine Möglichkeit, Fortbildungspunkte zu erlangen, ist die strukturierte Fortbildung über Printmedien mit Erfolgskontrolle. International wird CME zunehmend auf den messbaren Nutzen für den Patienten ausgerichtet. Eine vergleichende Bewertung der Qualität und Praxisorientierung von Fortbildungsangeboten ist notwendig.
No preview · Article · Jan 2008 · Zeitschrift fü Arztliche Fortbildung und Qualitatssicherung
[Show abstract][Hide abstract] ABSTRACT: Changes in physician-training requirements have led to a significant increase in continuing medical education (CME) courses. Structured CME courses based on print media in combination with outcome evaluation offers one opportunity for earning credit points. On the international stage, CME courses are increasingly directed towards measurable patient benefit. Comparative assessment of quality and practical orientation in training courses is required.
Two hundred items in twenty training units from four established German medical journals were analysed for comparison-based evaluation. The criteria applied were training goals, as well as item construction, authors' requirements and question quality. The items were analyzed independently by two persons trained and experienced in preparing and reviewing items. The analyses from the two assessors were then compared, and any deviations were subjected to mutual consultation.
Question formulation showed weaknesses in all the training units. In 52% of the items a clear question was lacking, and all of the training units contained items with concealed hints indicating the correct answer. Only 10% of the questions were preceded by a cameo case study presenting a clinical scenario, and only 14.5% of the items asked for a correct clinical decision.
The CME questions from the medical journals selected show weaknesses in formulation, and mostly tested factual knowledge. Differences were revealed between publishing houses yielding insights into the requirements made of the authors by the publishers. The question preparation process is still deficient. Adherence to international standards in item construction may lead to an improvement in quality, which would also enhance the implicit transferability of content learned to actual clinical situations, thus improving the practical usefulness of training courses.
No preview · Article · Feb 2007 · Zeitschrift fü Arztliche Fortbildung und Qualitatssicherung
[Show abstract][Hide abstract] ABSTRACT: Long-term success in obesity therapy is difficult to obtain, therefore drug therapy appears to be helpful. Until today, end-point studies for obesity drugs beyond the improvement of individual surrogate parameters are still missing. For all available drugs, medical treatment can be recommended only for a limited period of time due to the data of the studies and under consideration of side effects. Although a weight reduction leads to an improvement of cardiovascular risk factors and hence a reduction of cardiovascular morbidity and mortality should be expected, no study could prove it so far. Despite the positive influence on individual surrogate parameters, the use of the present available therapies appears underwhelming. In this overview the approved substances and perspectives of new therapeutic concepts are represented.
No preview · Article · Jan 2007 · Medizinische Monatsschrift für Pharmazeuten
[Show abstract][Hide abstract] ABSTRACT: Long-menu questions (LMQs) are viewed as an alternative method for answering open-ended questions (OEQs) in computerized assessment. So far this question type and its influence on examination scores have not been studied sufficiently. However, the increasing use of computerized assessments will also lead to an increasing use of this question type. Using a summative online key feature (KF) examination we evaluated whether LMQs can be compared with OEQs in regard to the level of difficulty, performance and response times. We also evaluated the content for its suitability for LMQs.
We randomized 146 fourth year medical students into two groups. For the purpose of this study we created 7 peer-reviewed KF-cases with a total of 25 questions. All questions had the same content in both groups, but nine questions had a different answer type. Group A answered 9 questions with an LM type, group B with an OE type. In addition to the LM answer, group A could give an OE answer if the appropriate answer was not included in the list.
The average number of correct answers for LMQs and OEQs showed no significant difference (p = 0.93). Among all 630 LM answers only one correct term (0.32%) was not included in the list of answers. The response time for LMQs did not significantly differ from that of OEQs (p = 0.65).
LMQs and OEQs do not differ significantly. Compared to standard multiple-choice questions (MCQs), the response time for LMQs and OEQs is longer. This is probably due to the fact that they require active problem solving skills and more practice. LMQs correspond more suitable to Short answer questions (SAQ) then to OEQ and should only be used when the answers can be clearly phrased, using only a few, precise synonyms.LMQs can decrease cueing effects and significantly simplify the scoring in computerized assessment.
Full-text · Article · Feb 2006 · BMC Medical Education
[Show abstract][Hide abstract] ABSTRACT: Medical students often lack the ability to develop strategies for problem solving based on adequate diagnostic and therapeutic measures. Case studies are an appropriate learning as well as examining tool for this purpose. For in-house examinations new computer based examinations are playing an important role, because they permit a chronological approach to clinical cases. At the same time this method allows the use of new question and answer formats. Based on this background CASUS was introduced at the Heinrich-Heine-University of Duesseldorf as a mandatory case and computer-based learning system including an online computer-based exam for the first time in Germany. About 140 students participated in the examination which was held at the university’s computer centre. The introduction of the online examination led to a significant increase in the use of the CASUS study cases during the term. The study cases as well as the online examination were accepted very well among the students. Despite the cost-effective use of this multimedia method and its didactic advantages it currently requires more administrative efforts and is more interference-prone than traditional paper based examinations with multiple choice questions. Problems of justiciability and technological safety have to be solved first before a routine use in summative evaluation of learning. Therefore, at present online examinations can serve for the formative evaluation of learning.