Medical students' preparedness for professional activities in early clerkships.

BACKGROUND: Sufficient preparedness is important for transitions to workplace participation and learning in clinical settings. This study aims to analyse medical students' preparedness for early clerkships using a three-dimensional, socio-cognitive, theory-based model of preparedness anchored in specific professional activities and their supervision level. METHODS: Medical students from a competency-based undergraduate curriculum were surveyed about preparedness for 21 professional activities and level of perceived supervision during their early clerkships via an online questionnaire. Preparedness was operationalized by the three dimensions of confidence to carry out clerkship activities, being prepared through university teaching and coping with failure by seeking support. Factors influencing preparedness and perceived stress as outcomes were analysed through step-wise regression. RESULTS: Professional activities carried out by the students (n = 147; 19.0%) and their supervision levels varied. While most students reported high confidence to perform the tasks, the activity-specific analysis revealed important gaps in preparation through university teaching. Students regularly searched for support in case of difficulty. One quarter of the variance of each preparedness dimension was explained by self-efficacy, supervision quality, amount of prior clerkship experience and nature of professional activities. Preparedness contributed to predicting perceived stress. CONCLUSIONS: The applied three-dimensional concept of preparedness and the task-specific approach provided a detailed and meaningful view on medical students' workplace participation and experiences in early clerkships.

Empowerment for the Digital Transformation: Results of a Structured Blended-Learning On-the-Job Training for Practicing Physicians in Germany.

(1) Background: Practicing physicians have not been in the focus of structured qualifications in basic digital competences so far. However, they are the current gatekeepers to implement digital technologies and need empowerment to proactively take part in the ongoing digital transformation process. The present study investigates if a structured blended-learning training for practicing physicians in Germany enhances both physicians' knowledge about central aspects of the digital transformation (including awareness of personal possibilities to act) and their attitudes towards a more digitally empowered mindset. (2) Methods: Participants (n = 32) self-assessed their knowledge (19 items, 10-point Likert-scale) and attitudes (6 items, 5-point Likert-scale) towards the digital transformation at the beginning and at the end of the training. MANCOVAs were conducted. (3) Results: Participants reported an increase in every knowledge domain, representing large effects (Hedges' g 1.06 to 2.82). Attitudes were partly shifted towards a more empowered mindset with decreased insecurity towards technological, legal, and ethical aspects of the digital transformation (Hedges' g -0.82 to -1.40). However, preparedness for the digital transformation remained low. (4) Conclusions: Generally, the hypotheses were confirmed. The presented on-the-job training had the desired effects on practicing physicians' knowledge and attitudes. Nevertheless, additional empowerment and support are essential.

Development of Entrustable Professional Activities for entry into residency at the Charité Berlin.

Background: Entrustable Professional Activities (EPAs) have emerged as a new approach to operationalise the workplace performance expectations for the transition from under- to postgraduate medical training. However, the transferability of such EPAs from one context to another appears limited. In this article, we report on the results of our approach to define a full set of core EPAs for entry into residency with the expectation to be performed under distant supervision. Methods: The EPA development involved a modified, three round Delphi study, conducted at the Charité - Universitätsmedizin Berlin. The supervision level was operationalised as supervisor being distantly available and findings being reviewed. The threshold for consent was reaching a content validity index of a least 80%. The Delphi study involved experienced physicians (n=45) and resulted in a set of core EPAs with the descriptions of the categories: title, specification/limitations, conditions and implications of entrustment decision, knowledge, skills, and attitude, link to competencies and assessment sources. Results: The response rates were 76-80% in the Delphi rounds. Key to the content validation process for the performance expectation was deciding on "to act under distant supervision". The results are full descriptions of 12 core EPAs, organised into 5 overarching EPA domains. Conclusions: Our systematic approach yielded the definition of 12 core EPAs for entry into residency at the level of "act with distant supervision" according to the practice in our context. This report may support other medical schools who plan to implement EPAs into their curricula.