Do they teach what they need to? An analysis of the impact of curriculum mapping on the learning objectives taught in a lecture series in surgery.

Introduction: Curriculum mapping shows concordances and differences between the intended and the taught curriculum. To our knowledge, no previous studies describe the effects that this mapping has on the curriculum. The aim of the present study is to map the content of a lecture series in surgery to the National Catalogue of Learning Objectives in Surgery and analyze the effects this mapping has on the content of the following lecture series. Methods: All lecturers in the lecture series were directly observed by a minimum of two reviewers and learning objectives and the level of competence were documented. After the lecture series, the results were visualized within the catalog of learning objectives and were sent to the lecturers. In the following lecture series, learning objectives were documented correspondingly. Results: In the first lecture series, 47% of the learning objectives were taught. After the mapping, the number of learning objectives that were taught increased to 59% (p < 0.001). The increase was found in all surgical disciplines and in all levels of competences without any changes in the average duration of the lectures. Conclusions: The presented method for mapping a curriculum effectively increased the number of taught learning objectives without requiring longer lecture durations.

[Train-the-Trainer: Professionalisation of Didactics in Daily Clinical Routine - the Personal Perception of Clinical Teaching Staff with Respect to Didactic Competence and the Framework Conditions of Teaching]. / Train-the-Trainer: Professionalisierung der Lehre im klinischen Alltag ­ Selbsteinschätzung Lehrender zur didaktischen Kompetenz und den Rahmenbedingungen des Unterrichts.

BACKGROUND: Teaching training programs contribute to improving the quality of medical education. In a course of the Train-the-Trainer (TTT) concept of the Surgical Working Group for Teaching, teachers (TN) from different medical professions and career levels were taught together. AIM OF THE WORK: Assessments of teaching activities in everyday clinical practice of residents (AÄ), senior staff (OÄ) and nurses (KP), their perception of teaching obstacles and requirements to improve teaching. MATERIAL AND METHODS: Prior to the beginning of the course, biographical data, previous teaching experiences, teaching obstacles as well as their notions to improve teaching in the daily clinical routine were requested. Upon completion, the participants were asked to rate the course. The answers to the closed and open questions were evaluated quantitatively and qualitatively. RESULTS: From 2014 to 2017, six basic courses (TTT-A) were conducted at three locations. 97 participants participated in the surveys (AÄ n = 44, OÄ n = 19, KP n = 17). More than two-thirds declared previously acquired teaching knowledge. There were no significant differences between medical and nursing staff. While AÄ and KP primarily taught at the bedside, OÄ taught mainly in the context of lectures, electives and seminars. Only a small proportion of all occupational groups felt well prepared for teaching in everyday clinical practice. The main drawbacks were lack of time and staff, too many students per group and too little teaching knowledge. Nearly two-thirds of the AÄ found teaching in general as a strong or moderate burden, compared to about 50% of the OÄ and 60% KP. Aspirations for improvement of teaching included more precise characterisation of the learning objectives, greater appreciation of teaching as a whole, and regular measures to make teaching professional. DISCUSSION: Occupational group-related differences in everyday clinical practice and individual career progression, impact type, implementation and perception of the teaching activity. By focusing on learning objectives and essential teaching methods and examination formats relevant to teaching at the bedside, teacher training programs across professional groups can contribute to knowledge and expertise growth. Indications of a sustainable effect encourage the continuation and further development of the TTT concept.

Conveying practical clinical skills with the help of teaching associates-a randomised trial with focus on the long term learning retention.

BACKGROUND: Ensuring that all medical students achieve adequate clinical skills remains a challenge, yet the correct performance of clinical skills is critical for all fields of medicine. This study analyzes the influence of receiving feedback by teaching associates in the context of achieving and maintaining a level of expertise in complex head and skull examination. METHODS: All third year students at a German university who completed the obligatory surgical skills lab training and surgical clerkship participated in this study. The students were randomized into two groups. CONTROL GROUP: lessons by an instructor and peer-based practical skills training. Intervention group: training by teaching associates who are examined as simulation patients and provided direct feedback on student performance. Their competency in short- and long-term competence (directly after intervention and at 4 months after the training) of head and skull examination was measured. Statistical analyses were performed using SPSS Statistics version 19 (IBM, Armonk, USA). Parametric and non-parametric test methods were applied. As a measurement of correlation, Pearson correlations and correlations via Kendall's-Tau-b were calculated and Cohen's d effect size was calculated. RESULTS: A total of 181 students were included (90 intervention, 91 control). Out of those 181 students 81 agreed to be videotaped (32 in the control group and 49 in the TA group) and examined at time point 1. At both time points, the intervention group performed the examination significantly better (time point 1, p = <.001; time point 2 (rater 1 p = .009, rater 2 p = .015), than the control group. The effect size (Cohens d) was up to 1.422. CONCLUSIONS: The use of teaching associates for teaching complex practical skills is effective for short- and long-term retention. We anticipate the method could be easily translated to nearly every patient-based clinical skill, particularly with regards to a competence-based education of future doctors.

[The Medical Examination - Between Desire and Reality - Analysis of Consensus Between the Second Part of the Medical Licensing Exam (IMPP) and the National Catalogue of Expertise-based Learning Goals in Surgery (NKLC)]. / Medizinische Prüfung zwischen Wunsch und Wirklichkeit ­ Analyse der Übereinstimmung zwischen dem 2. Abschnitt der ärztlichen Prüfung und dem Nationalen Kompetenzbasierten Lernzielkatalog Chirurgie.

Background The working party of the German Society for Surgery (DGCH) on undergraduate surgical education has developed a national expertise-based catalogue of learning goals in surgery (NKLC). This study analyses the extent to which the questions of the German second medical licensing examination compiled by the IMPP are congruent with the NKLC and which thematic focus is emphasised. Materials and Methods Firstly, a guideline and evaluation sheet were developed in order to achieve documentation of the individual examination questions of the second licensing examination with respect to the learning goals of the NKLC. In a retrospective analysis from autumn 2009 to autumn 2014, eleven licensing examinations in human medicine were screened independently by three different reviewers. In accordance with the guideline, the surgical questions were identified and subsequently matched to the learning goals of the NKLC. The analysis included the number of surgical learning goals as well as the number of surgical questions for each examination, learning goal, and different levels of expertise (LE). Results Thirteen reviewers from six surgical disciplines participated in the analysis. On average, reviewers agreed on the differentiation between surgical and non-surgical questions in 79.1% of all 3480 questions from 11 licensing examinations. For each examination (n = 320 questions), 98.8 ± 22.6 questions (min.: 69, max.: 150) were rated as surgical. For each surgical learning goal addressed, 2.2 ± 0.3 questions (min.: 1, max.: 16) were asked. For each examination, 23.5 ± 6.3 questions (min.: 11; max.: 31) referred to learning goals of LE 3, 52.5 ± 16.7 questions (min.: 34; max.: 94) addressed learning goals of LE 2 and 22.8 ± 7.7 questions (min.: 9; max.: 34) were related to learning goals of LE 1. 64 learning goals (27.8% of all learning goals of the NKLC) were not reflected in the examinations. With a total of 70 questions, the most frequently examined surgical topic was "disorders of the rheumatic spectrum". Conclusion The number of surgical examination questions in the German second medical licensing examination seems to be sufficient. However, the questions seem to be unevenly distributed between different surgical areas of undergraduate education. In order to achieve a more homogenous representation of relevant surgical topics, improved alignment is needed between the state examination with existing catalogues of learning goals by the IMPP.

The Use of Teaching Associates for Knee and Shoulder Examination: A Comparative Effectiveness Analysis.

OBJECTIVE: Musculoskeletal diseases and injuries are the most common cause of long-term pain and physical disability. Thus, every medical graduate should be able to perform a structured examination of the musculoskeletal system. Besides the see-one-do-one principle, other teaching methods have been proposed to be effective. The use of teaching associates offers an established, proven pathway for teaching examination skills in urology and gynecology. During the patient experience method, students are examined first, thus giving them an opportunity to feel the examination before performing it themselves. The objective of this study was to compare the efficiency of 3 distinct teaching methods for both knee and shoulder examination. DESIGN: The study took place during obligatory knee and shoulder examination training. Participants received basic training, including a demonstration of the structured examination by a specialist in trauma surgery. Afterward, group 1 examined each other under professional supervision; group 2 students examined the teaching associates, followed by mutual examinations; and group 3 students were each examined by the instructor, followed by mutual examinations. The acquired competence was assessed in 5-minute practical assessments directly after training and again 5 weeks later. SETTING: The study was conducted at the medical faculty of Goethe University, Frankfurt, Germany. PARTICIPANTS: Study participants were third-year undergraduate medical students completing their obligatory 3-week surgical training. RESULTS: One hundred and forty-four students [group 1 (N = 53), group 2 (N = 46), and group 3 (N = 45)] participated in the first measurement, 92 students in the second measurement of the study. Directly after the training, group 2 and group 3 performed significantly better than group 1 regarding overall score (p < 0.001) and all 4 checklist parts (p < 0.001). At the second measurement, group 2 performed significantly better than group 1 regarding shoulder examination (p = 0.003) and significantly better than group 3 (p = 0.025) regarding knee examination. CONCLUSIONS: The use of a teaching associate and the patient perspective can increase students' performance in knee and shoulder examinations.

Young surgeons' challenges at the start of their clinical residency: a semi-qualitative study.

INTRODUCTION: According to German regulations on licensing to practice medicine, the aim of undergraduate medical training is to produce a scientifically and practically trained physician who is able to work independently. More precisely, medical training has to impart the required knowledge and skills in diagnostics, therapy, health promotion, prevention, and rehabilitation. From the young residents' point of view, this aim is not achieved, and they do not feel prepared to be a doctor. However, the literature on this subject relies mostly on data based on surveys, and there is a lack of deep analysis of the specific details of the topic. The aim of this study was to analyze in depth how junior doctors in their first and second years felt about their preparation for clinical practice as a doctor from their undergraduate training, as well as which teaching formats and factors influence their preparedness. METHODS: This semi-qualitative study is based on recorded interviews conducted using a structured interview manual. This serves to limit the subject matter of the interview and to target the topics. The study participants were 35 residents of general and visceral surgery, trauma surgery, and urology in their first and second years of medical specialty training. The number of participants was defined by the concept of saturation of the content. Basic data regarding age and the location and length of study were collected using a questionnaire. The audio recordings were transcribed word by word and analyzed with structured qualitative content analysis techniques. RESULTS: Only 43% (n=15) of the 35 participating residents stated they were sufficiently prepared to be a doctor from undergraduate medical training, and 22.9% stated that they were not prepared for their work as a resident (8/35). However, 34.3% of the residents stated that undergraduate medical training did prepare them for some of the parts they were expected to master in daily clinical practice, but not other parts. Most of the participants described their first weeks as doctors as particularly stressful and exhausting. As major hurdles during their daily clinical work, participants described knowledge gaps regarding organizational and administrative pathways (71%), deficits in linking knowledge to clinical reasoning (71%), decision making (54%), and therapy planning (51%). Most participants stated that the practical placements during the semester, the clinical clerkships, and the last year internship were most effective as preparation for clinical residency. To be better prepared for clinical practice, participants suggested providing a clearer structure and that the course subjects bear better relations to each other. Nearly all participants proposed increasing patient encounters directly from the beginning of medical training as a longitudinal approach. DISCUSSION: Even though we were able to demonstrate an increase in residents' preparedness, 57% of the study participants still felt unprepared for their job to some extent. One might argue that starting a new profession will always result in a feeling of being unprepared to some extent. However, this unpreparedness can increase the risk for patients' well being due to medical errors, which actually represents the third leading cause of death in the US after malignant tumors and cardiovascular diseases. Structured on-the-job adjustment, structured qualification training, and guided professional training are becoming increasingly important for future doctors as selection criteria for career choice and choice of employer. Thus, the surgical disciplines that are struggling with new young residents have to improve their concepts.

A nationwide survey of undergraduate training in oral and maxillofacial surgery.

PURPOSE: To investigate the current status of undergraduate training in oral and maxillofacial (OMF) surgery in Germany using a nationwide survey and hence contribute to an educational improvement in the field. METHODS: A 39-item questionnaire was sent to all university clinics with an OMF surgery chair in Germany (n = 34). RESULTS: Ninety-two percent of OMF clinics are involved in the curricular training in medicine and 100% in dentistry. Eighty-one percent of OMF clinics perform curricular examinations and, respectively, 86% in dentistry. Examinations are mainly performed written with multiple-choice tests (62% medicine, 76% dentistry) and using non-structured oral examinations (57% medicine, 86% dentistry). Objective structured clinical examinations (OSCEs) are only used in 19% of all faculties. CONCLUSION: OMF surgery with its involvement both in medical and dental education has a special position as a surgical discipline. Our results show that OMF as a specialty is underrepresented in dental and especially in medical education considering the numerical and health economic importance of OMF consultations. Enhancing curricular integration and developing more structured examination forms is necessary to guarantee a high quality of OMF education.

Structured evaluation and need-based restructuring of the cranio-maxillofacial surgery module within surgical clerkship.

BACKGROUND: Evaluations are important for teaching courses and contribute to educational quality assurance. CMF surgery provides a module in the skills-lab week in preparation for surgical clerkship. Even though the CMF module receives positive evaluations, the students report deviating content. Subsequently, exams skills were often not mastered correctly. The aim of this study is to gather the contents taught within the course and to revise the module accordingly. METHODS: A structured evaluation sheet was used to evaluate the CMF modules. The detailed time frame used, teaching methods integrated, and learning objectives taught were documented. Based on the results, the module was restructured and re-evaluated twice. RESULTS: There were substantial fluctuations among the taught learning objectives in the first evaluation (21%-47% of the objectives were totally covered). The deployed time (160.50 ± 32.55 min) for the module was much shorter than scheduled (210 min). After restructuring, more learning objectives were totally covered (44%-100%), which corresponds to a significant gain (p = .024). The deployed teaching time for the modules was used more efficiently (183.65 ± 21.10 min/p = .005), and the additional time (51.89 ± 21.23 min vs. 37.55 ± 16.06 min before/p = .011) was used mainly for practical exercises. CONCLUSION: Structured evaluations are a meaningful tool for gaining valuable insights regarding the contents and quality of teaching courses and pinpointing potential for improvement. Key factors for the improvement of an educational module are the definition of learning goals within the context of a transparent and structured module.

Undergraduate medical students need more training in craniomaxillofacial surgery: a comparative study between medical and dental students.

PURPOSE: To compare the performance in oral, craniomaxillofacial, and facial plastic surgery (CMF)-specific surgical skills between medical students (MS) and dental students (DS) and hence adjust the current CMF training to student-specific needs. The investigators hypothesized that there would be no performance differences between MS and DS. METHODS: The investigators implemented a comparative retrospective item-based analysis of student performance in a CMF-specific objective structured clinical examination (OSCE) from 2008 to 2015. The sample was composed of 1010 MS and 225 DS who completed a standardized CMF training and OSCE. Three OSCE scenarios [management mandible fracture (MMF), management zygomatic fracture (MZF), and structured facial examination (SFE)] were included in the study because learning objectives were equal. Descriptive and bivariate statistics were computed and the p value was set at 0.05. RESULTS: In all of the analyzed OSCE scenarios, DS significantly outperformed MS (MMF p<0.001; MZF p=0.013; SFE p<0.001). DS especially appeared to be better in the correct interpretation of radiological findings (five of seven items, MMF) and the correct allocation of anatomical structures (four of five items, MZF) as well as the symptom-oriented examination of the eye (three of three items, SFE). DISCUSSION AND CONCLUSION: DS overall seem to be perform better in typical CMF skills. The reasons for this performance gap could be a more profound knowledge of the facial anatomy as well as a higher awareness for CMF as a related specialty to dentistry. CMF should be included in medical curricula in a larger scale, and possible career paths should be highlighted to MS and DS to raise attraction for the specialty. Further studies should focus on the implementation of modern teaching methods in CMF education.

The reliability and predictive validity of a sixth-semester OSPE in conservative dentistry regarding performance on the state examination.

Introduction: The aim of this study was to ascertain whether the testing format of an OSPE (Objective Structured Practical Examination) in conservative dentistry (sixth semester) predicts the scores on the practical section of the state examination (11th semester) in the same subject. Taking general student profiles into consideration (score on the school-leaving exam [Abitur], score on the preliminary exam in dental medicine [Physikum], length of university study, cohorts, and sex), we also investigated if any correlations or differences exist in regard to the total and partial scores on the OSPE and the corresponding state examination. Methods: Within the scope of this longitudinal retrospective study, exam-specific data spanning 11 semesters for dental students (N=223) in Frankfurt am Main were collected and analyzed. Statistical analysis was carried out by calculating Spearman rank correlations, partial correlations, Pearson's correlation coefficients, and multiple regressions (SPSS Statistics 21, IBM Corporation, New York). Results: The results show that the OSPE (Cronbach's α=.87) correlates with level of success on the practical section of the state exam in conservative dentistry (p=.01, r=.17). Length of university study also emerged to correlate significantly with the state exam score (p=.001, r=.23). Together, these two variables contribute significantly to predicting the state exam score (p=.001, R2 =.076). This was seen extensively among female students. It was also discovered that these female students had higher school-leaving exam scores than male students (F=6.09, p=.01, η2 =.027), and that a significant correlation between scores on the Physikum (preliminary exam in dental medicine) and OSPE scores existed only for male students (r=.17, p=.01). Conclusion: This study was able to demonstrate the predictive effect of a clinical OSPE regarding scores achieved on the state exam. Taking the limitations of this study into account, we are able to recommend using the OSPE testing format in the sixth semester during the clinical phase of dental study.

Perspectives of patients about bioabsorbable internal fixation for maxillofacial fractures.

PURPOSE: Resorbable/bioabsorbable internal fixation provides effective treatment for maxillofacial fractures and avoids the need for metal hardware removal. We evaluated the initial knowledge, attitudes, subjective demand, and treatment satisfaction of patients concerning bioabsorbable osteofixation for maxillofacial trauma. MATERIALS AND METHODS: From May 2007 to October 2009, there were 71 patients (63 males and 8 females; mean age: 35 ± 15 years) included in this prospective study. The patients completed preoperative and postoperative (4-6 weeks and 1 year) questionnaires. RESULTS: After receiving information, 70 patients (99%) preferred resorbable/bioabsorbable bone fixation, usually because they preferred to avoid a second operation to remove metal hardware (67 patients [94%]). The higher cost of resorbable/bioabsorbable bone fixation was believed and justified by 41 patients (58%) and not justified by 30 patients (42%). No adverse events were reported by 27 of 34 patients (79%) at 4-6 weeks and by 14 of 21 patients (67%) at 1 year after surgery. Most patients were very satisfied with the outcome of surgery. CONCLUSION: Patients who have maxillofacial trauma have a high frequency of preference and high satisfaction with resorbable/bioabsorbable than metal osteofixation. Literature review showed increased activity in research and publication worldwide about resorbable bone fixation, suggesting that there may be increased patient demand for resorbable bone fixation in the future.

Long-term prospective teaching effectivity of practical skills training and a first OSCE in cranio maxillofacial surgery for dental students.

Basic skills in oral/CMF surgery should be taught effectively to dental students as surgical skills training is traditionally under-represented in the dental curriculum compared to its later need in daily clinical practice. Rigid curricular time frames and prospectively condensed professional education foster new effective teaching and examination formats. Transmitting and assessing clinical competence objectively (independent of subjective bias), reliably (repeatable, inter-rater consistency) and valid (representative, structured task selection) was intended and evaluated in oral/CMF surgery skills acquisition starting in summer 2009. A small-group practical skills training (PST) day initiated a one-week practical training course, covering previously formulated learning objectives. An objective structured clinical evaluation (OSCE) was held at the end of each semester. Theoretical background knowledge and clinical skills should have to be memorized within a representative number of practical tasks (test stations). A first semester (26 students) used classical practical training alone as controls, the following semesters (171 students) had PST, considered as a study group. All 197 students were assessed with OSCE's over a 3-year period. An instructor held PST based on presentations, videos and practical training, including mannequins, with pairs of students. This included history taking, communication and interpretation of laboratory/image diagnostics, structured clinical facial examination, fracture diagnosis, venipuncture, suturing, biopsy and wire loops on pig jaws for manual and clinical skills, which were later incorporated in OSCE stations. OSCE average results increased from 63.3 ± 9.7% before and to 75.5 ± 10% after the inclusion of PST (p < 0.05). Knowledge diffusion between sittings on the same test date and between consecutive semesters was insignificant. Students and faculty rated their learning/teaching experience "very good" to "good". PST was effective in optimizing clinical skills as evaluated by OSCE.