Visions and reality: the idea of competence-oriented assessment for German medical students is not yet realised in licensing examinations.

Objective: Competence orientation, often based on the CanMEDS model, has become an important goal for modern curricula in medical education. The National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM) has been adopted in Germany. However, it is currently unknown whether the vision of competence orientation has also reached the licensing examination procedures. Methods: Therefore, a prospective, descriptive, single-centre, exemplary study design was applied to evaluate 4051 questions/tasks (from 28 examiners at 7 two-day licensing oral-practical exams) for undergraduate medical students at the University of Ulm. The oral and practical questions/tasks as well as the real bedside assessment were assigned to specific competence roles (NKLM section I), categories (NKLM section II) and taxonomy levels of learning domains. Results: Numerous questions/tasks were set per candidate (day 1/2: 70±24/86±19 questions) in the licensing oral-practical exam. Competence roles beyond the "medical expert" were scarcely considered. Furthermore, practical and communication skills at the bedside were hardly addressed (less than 3/15 min). Strikingly, there was a significant predominance of questions with a low-level taxonomy. Conclusions: The data indicate a misalignment of competence-oriented frameworks and the "real world" licensing practical-oral medical exam, which needs improvement in both evaluation and education processes.

How can we deal with mental distress in the dissection room?-An evaluation of the need for psychological support.

The dissection course (DC) is an essential part of the preclinical medical curriculum that mediates professionalism. The process of dissecting, however, has an inherent additional stress potential. Our study determined student mental stress, their need of psychological support and factors influencing this need. A quantitative longitudinal query before, during and after the DC was performed including the Brief Symptom Inventory (BSI) as well as self-formulated questions used a 5-point Likert scale. Half of the students who anticipated dissection to be a stress factor reported that this declined significantly over time. Instead, student fear of not being able to cope with the work load increased significantly. As many as 64% of the students favored psychological support on the first course day, while 75% rejected this during the period of dissection and 39% appreciated this after the course. Moreover, 42% emphasized the importance of the funeral ceremony. Additionally, 75% documented their need for support in coping with stress and learning strategies. Gender, previous medical training, and BSI levels were identified as psychosocial influence factors. A majority of students named friends, members of their family or workmates as partners with whom they could talk about mental stress. Our results document the need to develop an optimum support during the DC taking into account the ascertained indicators. Exemplarily the Institute of Anatomy and Cell Biology at Ulm University suggests several options like a step by step approach for optimization. These measures reduce mental stress and help students to cope with it by the development of "detached concern" towards their "first patient" as this will decisively influence their future professional behavior.

"Theatrum anatomicum" -- a revived teaching facility in gross anatomy.

Because of a new legislation concerning fees for study in Germany, novel financial opportunities for improvement of medical education have been provided. Some of these additional funds were invested at Ulm University in the Institute of Anatomy and Cell Biology to realize a teaching operating theatre similar to the ancient anatomical theatre in an amazingly short period of time. The anatomical theatre is a unique teaching facility in Germany, a direct implementation of joint preclinical and clinical education in the medical curriculum as required by the new Federal Medical Licensing Regulations (Approbationsordnung). It was set up in January of 2008. In this teaching operating theatre students and doctors will meet to study anatomical structures. In a simulated operating setting, surgeons will demonstrate invasive procedures and operative techniques on donated bodies. About 50 students can be positioned on a grandstand at a short distance to the operating table to follow the "operation" or anatomical demonstrations. Students can also learn how to behave in a sterile environment before they are actually confronted with this new situation during their first clinical clerkship. The anatomical theatre is supposed to be integrated in preclinical and clinical medical education as well as in advanced professional education for suitable sub-specialties. We are confident that the anatomical theatre will further improve students' motivation and their efforts in gaining knowledge in the field of gross anatomy because of its clinical relevance.