How are social determinants of health represented in German medical education?: a qualitative content analysis of key-curricular documents.

OBJECTIVE: The WHO Commission on Social Determinants of Health (SDH) has called for a health workforce trained in recognising, understanding and acting on the SDH. However, little is known about how current medical education prepares graduates for this challenge. This study analyses the extent to which the German medical education incorporates content on SDH. DESIGN: Following a published protocol, in 2018, we conducted a qualitative and quantitative content analysis of three key document groups, defining and guiding what medical schools are expected to teach and what medical students are expected to know when graduating in Germany. We developed the coding system in a mixed inductive and deductive approach based on key WHO documents. SETTING: Medical schools and the medical education system in Germany. RESULTS: Important gaps exist in the representation of SDH in medical education in Germany. Between 3% and 27% of the analysed document-elements made reference to SDH and only 0%-3% of those document elements made explicit references to SDH. While some aspects were covered widely (eg, topics of occupational health, early childhood development and hygiene), other topics such as health inequalities or determinants outside of the healthcare system were not or hardly represented. CONCLUSIONS: A stronger and more explicit representation of SDH in German medical education is needed to prepare the new health workforce for current and future challenges in our globalised world and for medical schools to be socially accountable.

Adverse effects of non-steroidal anti-inflammatory drugs in patients with viral respiratory infections: rapid systematic review.

OBJECTIVES: To assess the effects of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with viral respiratory infections on acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival. DESIGN: Rapid systematic review. PARTICIPANTS: Humans with viral respiratory infections, exposed to systemic NSAIDs. PRIMARY OUTCOMES: Acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival. RESULTS: We screened 10 999 titles and abstracts and 738 full texts, including 87 studies. No studies addressed COVID-19, Severe Acute Respiratory Syndrome or Middle East Respiratory Syndrome; none examined inpatient healthcare utilisation, quality of life or long-term survival. Effects of NSAIDs on mortality and cardiovascular events in adults with viral respiratory infections are unclear (three observational studies; very low certainty). Children with empyema and gastrointestinal bleeding may be more likely to have taken NSAIDs than children without these conditions (two observational studies; very low certainty). In patients aged 3 years and older with acute respiratory infections, ibuprofen is associated with a higher rate of reconsultations with general practitioners than paracetamol (one randomised controlled trial (RCT); low certainty). The difference in death from all causes and hospitalisation for renal failure and anaphylaxis between children with fever receiving ibuprofen versus paracetamol is likely to be less than 1 per 10 000 (1 RCT; moderate/high certainty). Twenty-eight studies in adults and 42 studies in children report adverse event counts. Most report that no severe adverse events occurred. Due to methodological limitations of adverse event counts, this evidence should be interpreted with caution. CONCLUSIONS: It is unclear whether the use of NSAIDs increases the risk of severe adverse outcomes in patients with viral respiratory infections. This absence of evidence should not be interpreted as evidence for the absence of such risk. This is a rapid review with a number of limitations. PROSPERO REGISTRATION NUMBER: CRD42020176056.

[Representation of Social Determinants of Health in German Medical Education]. / Soziale Determinanten von Gesundheit als Lehr- und Prüfungsinhalte im Medizinstudium.

OBJECTIVE: The World Health Organization (WHO) has emphasized the need for a health workforce trained in recognising, understanding and acting on the social determinants of health (SDH). However, little is known about how current medical education prepares graduates to meet this challenge. This study analyses the extent to which content on SDH is incorporated in the German medical curriculum. METHOD: This work is based on a qualitative and quantitative content analysis of 3 key document groups, outlining what medical schools are expected to teach and defining what medical students are expected to know on graduation. RESULTS: The assessment reveals important gaps in the representation of SDH in key frameworks for German medical education. Only between 4 and 27% of the analysed document-elements contained reference to any SDH-related issues, with 0-3% of those elements containing explicit references to SDH. While some aspects were widely covered (e. g. topics of occupational health), other topics such as health inequalities or determinants outside of the health care system were not or hardly represented. CONCLUSIONS: A stronger and more explicit representation of SDH during medical education could help to prepare the new health workforce for current and future challenges in our globalised world. The current reform process of the National Competency-Based Catalogue of Learning Objectives for Medicine should strive to fill the gaps, e. g. by putting more emphasis on aspects of poverty and health, health inequalities and issues of access to healthcare.

The scientific term paper at the Charité: a project report on concept, implementation, and students' evaluation and learning.

Aim: Better training in scientific skills, such as the ability to conduct research independently, has been one of the main drivers of reform in medical education. The aim of this article is to report on the scientific term paper module in the modular curriculum of medicine (MCM) at the Charité. This module is an established example of undergraduate medical students conducting their own scientific investigations. Project outline: A faculty-wide, outcome-oriented process resulted in a four-week module for writing a scientific term paper in the 6th semester of the MCM as part of a longitudinal science curriculum. Acquired competencies were assessed through a written term paper and an oral presentation. Two student cohorts (winter terms 2013 and 2014) were surveyed on how they rated the module concept, organizational aspects and the quality of support. We further analysed the chosen topics of the papers as well as student assessment results. Results: The student evaluation (return rates of 193 and 197, 71% and 77%) showed high overall satisfaction with the module. This result was evident in the high rating of the module concept and organizational aspects, a positive attitude towards scientific research, and strong motivation to pursue further scientific research. There was a wide spectrum of term paper topics with a focus on literature reviews. Most of the student work was assessed as good or very good. Conclusion: The scientific term paper module has proven itself as a curricular concept for students to perform own scientific research in the MCM, with strong acceptance and good performance by students. This project report can serve as basis and guidance for development and further improvements to promote scientific competencies in undergraduate medical education in other faculties.

Student engagement in medical education: A mixed-method study on medical students as module co-directors in curriculum development.

Introduction: Beyond participation in evaluation of teaching, there is sparse research available on more active roles of medical students in curriculum development. We report on a model of student engagement where medical students function as module co-directors, and how this is experienced by faculty and student module directors. Methods: Student engage in co-development of their curriculum with a high level of autonomy in organizing their activities. We conducted a mixed-methods, convergent design study based on surveys with faculty and student module co-directors and a student co-director focus group. Quantitative data were analyzed descriptively. Qualitative analysis was performed inductively. Results: Quantitatively, the majority of both faculty and student module directors report that the curriculum benefits from the students' work (95 and 94%). Both groups see each other as equal partners (80 and 87%). Qualitatively, this is related to students' competencies such as "bringing in broad and unique knowledge of the curriculum", "giving the students' perspective a voice," and "contributing ideas for improvement". Key strategies and challenges of the student co-module directors are illuminated. Conclusions: Student module co-directors represent a well-accepted practice model for curriculum development. This report may stimulate other faculties to engage their students more actively in medical education.

[Public Health in Germany From The Perspective of Young Professionals]. / Öffentliche Gesundheit in Deutschland: Eine Perspektive des Nachwuchses.

The current reform process of Germany's public health system has opened a window of opportunity for strengthening this field in research, policy and practice in Germany. The present article discusses challenges and necessary measures from the perspective of young professionals. The authors argue that public health education and training in Germany needs to be strengthened and reformed. Moreover, Germany's public health community must create and strengthen structures and processes needed to make its voice heard more strongly in politics and society, including an effective professional organization. Discussions on these challenges have begun in a number of fora and should be translated into concrete actions soon.

Crisis on the game board - a novel approach to teach medical students about disaster medicine.

Introduction: Every year, natural and other disasters cause significant loss of life around the world. This calls for an improved response from, among others, the health professions to strengthen disaster medicine, whether relating to prevention, emergency response or recovery. It includes both knowledge and competencies, such as planning, coordination, and communication. Simulations can be used to acquire these competencies. Project description: In 2016, the German Medical Students' Association founded the project "Disaster Medicine" with the goal of educating and connecting medical students interested in the topic. AFTERSHOCK, a board game simulating early disaster response after an earthquake, was utilized for workshops. It highlights the need for interagency cooperation and the challenges of responding to disasters in dynamic and highly complex settings. Seven workshops were facilitated between October 2016 and December 2017. A survey was conducted to assess participant satisfaction and the design of the workshop. Results: 89 German medical students participated and 74 (83 %) responded with written evaluation. Students generally reported moderate to low levels of previous knowledge. The event produced very positive feedback, with participants overwhelmingly finding the simulation to be a useful or very useful way to learn about the challenges of humanitarian assistance and disaster relief. Qualitative feedback included requests for more theoretical background information and highlighted the need for small group sizes. Discussion and Conclusion: Board games such as AFTERSHOCK are well-suited for medical education and enjoy high rates of acceptance among students. To ensure deeper and longer-term learning, they should be accompanied by theoretical coursework.

Representation of social determinants of health in German medical education: protocol of a content analysis study.

INTRODUCTION: Action on the social determinants of health has been key for improving health and prolonging life in the past, and remains so today. Against this background, WHO's Commission on Social Determinants of Health has called for increased efforts to create health workforces trained in recognising, understanding and acting on the social determinants of health. However, little is known about the extent to which current medical education systems prepare graduates for this challenge. We, therefore, aim to analyse the extent to which the medical curriculum in Germany incorporates content on the social determinants of health. METHODS AND ANALYSIS: We will conduct a qualitative and quantitative content analysis of four key document groups which influence medical education in Germany: the national medical catalogue of learning objectives; examination content outlines provided by the German Institute for Medical and Pharmaceutical Examination Questions; the online textbook most widely used for final examination preparation and the full set of questions from two national medical licensing examinations. We will analyse these documents based on a coding system, which we derived deductively from the report of WHO's Commission on Social Determinants of Health as well as other key publications of WHO. We will report quantitative indicators, such as the percentage of text related to social determinants of health for each document type. Moreover, we will conduct a semiqualitative analysis of relevant content. ETHICS AND DISSEMINATION: This study is based on the analysis of existing documents which do not contain personal or otherwise sensitive information. Results from the study will be published in a scientific peer-reviewed journal.

[Disease Prevention and Health Promotion in Germany: A Qualitative Analysis of the Federal Goverment's Coalition Agreement]. / Prävention und Gesundheitsförderung im Koalitionsvertrag: Eine qualitative Analyse.

BACKGROUND: The creation of healthful living conditions has contributed to improving health and prolonging life in Germany and worldwide. Despite this progress, avoidable behavioural, occupational and environmental risk factors still contribute considerably to the burden of disease in Germany. Many of these risk factors are strongly influenced by political determinants. The coalition agreement outlining the agenda of Germany's federal government for 2018-2022 provides insights regarding relevant political priorities and plans. METHODS: We performed qualitative content analysis of the coalition agreement signed on March 12, 2018 by Germany's governing parties with regard to content related to disease prevention and health promotion. We present results in tables and narratively and discuss them against the background of evidence-based scientific recommendations and in the national and international political context. RESULTS: The coalition agreement discusses various measures to strengthen disease prevention in and health promotion in general, to support the prevention of specific disease groups, and to reduce the burden of a number of behavioural, occupational and environmental risk factors. This includes an evaluation and reform of Germany's Law for Health Promotion and Prevention, a strengthening of relevant research capacities, the development of a national obesity strategy, and measures to increase vaccination rates. DISCUSSION: The extensive discussion of health promotion and disease prevention in the coalition agreement is laudable. However, the agreements fail to mention a number of important approaches, such as the regulation of tobacco and alcohol marketing and food and beverage taxation. Moreover, many statements remain vague. Adoption and implementation of effective measures will therefore require the attention and political pressure from the scientific community, civil society, the media, and members of the parliament from both government and opposition parties. The mid-term evaluation of the coalition agreement will be an opportunity to critically examine the government's achievement to date.

The importance of scientific competencies in German medical curricula - the student perspective.

BACKGROUND: Scientific competencies are of great importance for physicians; not only for conducting reliable research, but also for patient care. However, there is growing concern that a lack of scientific competencies among physicians may lead to a deterioration in the quality on biomedical research. This study aims at assessing medical students' perspectives on the implementation of scientific competency training in German medical curricula. METHODS: An online survey was conducted in order to collect German medical students' opinions on the importance of acquiring scientific competencies during their medical studies and to provide us with an assessment of their current levels of basic scientific competencies by having them conduct a self-evaluation. Moreover, we wanted to understand their perceptions of current curricular content and to receive suggestions for improving scientific competency training. Participants were reached via the mailing lists of the German Medical Students' Association, as well as of local medical student committees, and the German Medical Students' Associations social media channel on Facebook. RESULTS: In total, 2380 medical students from across all 37 German medical faculties participated in the survey. The majority of students agreed that the ability to critically evaluate the relevant literature is an important competency for physicians, and that every student should conduct a research project during their medical studies. However, the students evaluated their scientific competencies as unsatisfactory, especially with regard to statistics and scientific writing. They were strongly in favor of receiving extended research training. CONCLUSION: Our study provides insight into German medical students' self-perception in relation to both patient care and biomedical research, and makes recommendations for potential improvements in scientific training. The study demonstrates that scientific competencies are of great importance to medical students in Germany. Students are not lacking motivation for scientific practice and have numerous ideas for enhancing scientific teaching opportunities. Scientific training should follow a holistic approach based on three pillars: (i) a scientific core curriculum, (ii) intracurricular research projects, and (iii) special research programs for students strongly interested in medical research.