[Quality assurance of faculty examinations: Optimization of examination management in the Heidelberg Curriculum Medicinale (HeiCuMed)]. / Qualitätssicherung fakultätsinterner Prüfungen ­ Optimierung des Prüfungsmanagements im Heidelberger Curriculum Medicinale (HeiCuMed).

INTRODUCTION: Examinations are a central element of the medical curriculum: they contribute significantly to the quality assurance of medical training and subsequent medical care. In order to meet the high expectations placed on examinations in terms of content, legal and organizational aspects, continuous quality assurance measures are necessary. The aim of this paper was to record and analyze the quality assurance measures implemented at the medical faculty of Heidelberg. METHODS: We investigated quality indicators that are relevant to medical examinations - adequate choice of examination formats, blueprint/validity, reliability and distribution of grades, feedback to students, consequences of examinations - within the faculty examinations in the decentrally organized Heidelberg Curriculum Medicinale (HeiCuMed). In addition, the organizational structures in examination management were examined. For this purpose, interviews were conducted with teaching staff, students and the technical examination administration. RESULTS: The surveys show that the quality indicators in HeiCuMed have already been met in many areas. Optimization work remains to be done concerning the criteria "adequate choice of examination formats", "feedback to students" as well as the documentation of the examination process and the definition of substitution regulations. DISCUSSION: Training courses, statistical analysis and accompanying research are essential for establishing additional innovative, practice-oriented examination formats. In order to improve feedback to students, formative assessments should be more intensively integrated into the curriculum. As a measure for structured quality-oriented examination management, it is also helpful to document the examination procedure and the staff assigned to it using templates. CONCLUSION: Especially with decentralized examination management, the internal coordination of individual departments is of great importance in order to guarantee the quality of examinations. Regular surveys of the parties involved can be of support by collecting best-practice examples and deliver the respective information in handouts encouraging interdisciplinary exchange.

Predictive value of the school-leaving grade and prognosis of different admission groups for academic performance and continuity in the medical course - a longitudinal study.

BACKGROUND: The school-leaving GPA and the time since completion of secondary education are the major criteria for admission to German medical schools. However, the predictive value of the school-leaving grade and the admission delay have not been thoroughly examined since the amendment of the Medical Licensing Regulations and the introduction of reformed curricula in 2002. Detailed information on the prognosis of the different admission groups is also missing. AIM: To examine the predictive values of the school-leaving grade and the age at enrolment for academic performance and continuity throughout the reformed medical course. METHODS: The study includes the central admission groups "GPA-best" and "delayed admission" as well as the primary and secondary local admission groups of three consecutive cohorts. The relationship between the criteria academic performance and continuity and the predictors school-leaving GPA, enrolment age, and admission group affiliation were examined up to the beginning of the final clerkship year. RESULTS: The academic performance and the prolongation of the pre-clinical part of undergraduate training were significantly related to the school-leaving GPA. Conversely, the dropout rate was related to age at enrolment. The students of the GPA-best group and the primary local admission group performed best and had the lowest dropout rates. The students of the delayed admission group and secondary local admission group performed significantly worse. More than 20% of these students dropped out within the pre-clinical course, half of them due to poor academic performance. However, the academic performance of all of the admission groups was highly variable and only about 35% of the students of each group reached the final clerkship year within the regular time. DISCUSSION: The school-leaving grade and age appear to have different prognostic implications for academic performance and continuity. Both factors have consequences for the delayed admission group. The academic prognosis of the secondary local admission group is as problematic as that of the delayed admission group. Additional admission instruments would be necessary, in order to recognise potentially able applicants independently of their school-leaving grade and to avoid the secondary admission procedure.

The Ulm Study and the implications for the advisory services of the Dean of Studies at the Medical Faculty of Heidelberg.

Increasing the flexibility of medical degree courses as well as individual advice and curriculum planning are essential needs of pregnant students and student parents. The results of the Ulm Study gave the academic advisers in the Dean of Studies' office in Heidelberg a large number of suggestions on how to offer sensitive, competent and needs-based advice to this target group. Comprehensive reflection on many years of experience in giving advice and recent survey results leads to a series of concrete measures which will contribute to more family-friendliness in Heidelberg's medical school.

[What is the purpose of the German Aptitude Test for Medical Studies (TMS)?]. / Warum der Test für Medizinische Studiengänge (TMS)?

The German Aptitude Test for Medical Studies (TMS) was implemented in 2007. 12,194 persons registered for this test in 2011, which represents a 91% increase over 2007. The male/female ratio remained constant at 38:62. Its reliability among applicants to Heidelberg Medical Faculty was confirmed by Cronbach's α (≥ 0.75) and inter-item correlation (≥ 0.25, p < 10(-7)). The TMS contains nine items; using factor analysis these were allocated to the two components verbal-mathematical and spatial-figural ability. The verbal-mathematical items moderately correlate with the German Baccalaureate GPA (r = 0.33), while the spatial-figural items do not correlate (r = 0.07). Thus, the TMS is an admission instrument that appraise different cognitive abilities than the GPA. For the admission of students to our faculty their TMS scores are weighted at 39%, which has resulted in a diversification of our student cohorts.

Increased densities of monocarboxylate transport protein MCT1 after chronic administration of nicotine in rat brain.

Chronic administration of nicotine is followed by a general stimulation of brain metabolism that results in a distinct increase of glucose transport protein densities for Glut1 and Glu3, and local cerebral glucose utilization (LCGU). This increase of LCGU might be paralleled by an enhanced production of lactate. Therefore, the question arose as to whether chronic nicotine infusion is accompanied by increased local densities of monocarboxylate transporter MCT1 in the brain. Secondly, we inquired whether LCGU might be correlated with local densities of MCT1 during normal conditions and after chronic nicotine infusion. Nicotine was given subcutaneously for 1 week by osmotic mini-pumps and local densities of MCT1 were measured by immunoautoradiographic methods in cryosections of rat brains. MCT1 density was significantly increased in 21 of 32 brain structures investigated (median increase 15.0+/-3.6%). Immunohistochemical stainings of these substructures revealed an over-expression of MCT1 within endothelial cells and astrocytes of treated animals. A comparison of 23 MCT1 densities with LCGU measured in the same structures in a previous study revealed a partial correlation between both parameters under control conditions and after chronic nicotine infusion. 10 out of 23 brain areas, which showed a significant increase of MCT1 density due to chronic nicotine infusion, also showed a significant increase of LCGU. In summary, our data show that chronic nicotine infusion induces a moderate increase of local and global density of MCT1 in defined brain structures. However, in terms of brain topologies and substructures this phenomenon did partially match with increased LCGU. It is concluded that MCT1 transporters were upregulated during chronic nicotine infusion at the level of brain substructures and, at least partially, independently of LCGU.

Increased densities of monocarboxylate transporter MCT1 after chronic hyperglycemia in rat brain.

The brain is capable of taking up monocarboxylates as energy substrates. Under physiological conditions, plasma levels of monocarboxylates are very low and glucose is the primary energy substrate in brain metabolism. However, given conditions such as hyperglycemia and ketosis, levels of circulating monocarboxylates such as lactate and pyruvate are elevated. Previous studies reported an increased expression of monocarboxylate transporter MCT1 in brain following ketotic diet. The major aim of the present study was to answer the question whether chronic hyperglycemia is likewise sufficient to change local densities of MCT1 in the brain. Moreover, chronic hyperglycemia increases local cerebral glucose utilization (LCGU) in particular brain areas. Glucose hereby enters the brain parenchyma via glucose transporters and is partially metabolised by astrocytes, which then release lactate to meet the energetic demands of surrounding neurons. Streptozotocin was given intravenously to induce chronic hyperglycemia and local densities of MCT1 were measured by immunoautoradiographic methods in cryosections of rat brains. The density of monocarboxylate transporter MCT1 was significantly increased in 10 of 24 brain structures investigated (median increase 11.7+/-3.4 %). Immunocytochemical stainings of these substructures revealed an expression of MCT1 within endothelial cells and astrocytes. A comparison of MCT1 densities with LCGU measured in a previous study under normo- and hyperglycemic conditions revealed a partial correlation between both parameters and under both conditions. Four out of 10 brain areas, which showed a significant increase in MCT1 density due to hyperglycemia, also showed a significant increase in LCGU. In summary, our data show that chronic hyperglycemia induces a moderate increase of local and global density of MCT1 in several brain structures. However, in terms of brain topologies and substructures this phenomenon did only partially match with increased LCGU. It is concluded that MCT1 transporters were up-regulated during chronic hyperglycemia at the level of brain substructures and independently of LCGU.

[Concept, implementation and evaluation of an interfaculty Master of Medical Education Programme]. / Konzeption, Implementierung und Evaluation eines interfakultären Master of Medical Education Programms.

The implementation of new medical licensing regulations (AAppO 2003) was the starting point for radical curricular changes in all German medical schools. In 2004, the postgraduate and interfaculty Master of Medical Education (MME) degree programme was established at the University of Heidelberg under the auspices of the Medical Faculty Association (Medizinischer Fakultätentag, MFT) and supported by the Association for the Promotion of Science and Humanities in Germany (Stifterverband für die Deutsche Wissenschaft). This new degree programme is intended to train multipliers and leaders in medical education, to build a German-speaking network and to strengthen educational research. The eight one-week MME modules are organised by seven locations in Germany (Munich, Tuebingen, Muenster/Essen, Berlin, Heidelberg, Cologne, Dresden) and an annually changing international faculty. The instructor teams are composed of national and international experts. Major focal points include: curriculum development, education theory, teaching and exam methods, evaluations, team building and group dynamics, project management, leadership, and faculty development, as well as educational research. The modules are connected with each other longitudinally: each participant conducts a project to improve teaching in his or her own faculty and writes a master's thesis about an educational research project. Overall, the participants earn 60 ECTS (European Credit Transfer System) in the course of two years while working. So far 100 participants (25 per year) from 33 of 34 medical faculties have started the program and 19 participants (50% of the participants from Cohort 1, 29% of the participants from Cohort 2) completed the program. The evaluation of the individual modules showed a very high level of participant satisfaction. In two modules, the evaluation results demonstrated a need for change. In 2006, an external evaluation conducted by international experts positively highlighted the MME Programme structure as a leading example emphasizing all aspects of modern medical education, including relevant managerial skills. The MME Programme as a contribution to the professionalization of medical education in the German-speaking area has become firmly established. The impact of the MME Programme on the career development of its participants and the institutional development of the medical faculties still remains to be evaluated.

Correlation between local monocarboxylate transporter 1 (MCT1) and glucose transporter 1 (GLUT1) densities in the adult rat brain.

Monocarboxylate transporters type 1 (MCT1) facilitate the transport of monocarboxylates across cell membranes of the blood-brain barrier and brain parenchymal cells. The present study had two aims: (1) to determine the local distribution of MCT1 in the brain; and (2) to compare the local densities of MCT1 with the local densities of the main nutritional transporters, glucose transporter GLUT1. Using immunoautoradiography of cryosections from rat brain, 32 brain structures were analyzed. (1) A heterogenous distribution pattern of MCT1 densities was observed throughout the brain. Compared to brain homogenate (100%), MCT1 densities ranged from 43 to 164% in the brain structures investigated. Local GLUT1 densities showed a comparable range (35-145%). (2) A close correlation was found between local MCT1 and local GLUT1 densities. As local GLUT1 densities reflect local glucose metabolism in the brain, we conclude that local MCT1 densities are adjusted to local glucose metabolism and transport.