[Teaching in Perspective - How Medical Students Assess Their Practical Clinical Training in Surgery]. / Lehre im Fokus ­ Wie beurteilen Studierende ihre praktisch-klinische Ausbildung in der Chirurgie?

Introduction: Practical clinical expertise is a crucial part of medical professionalism. Several studies have shown that medical students are poorly trained in practical skills during their undergraduate training. Even the students rated their own expertise in practical skills as poor. The amendments to the German Regulating Licenses in Practical Medicine are intended to strengthen practical clinical training. The aim of the present study is to use focus groups to analyse practical clinical training with respect to organisation, difficulties and problems from the learners' perspective. Methods: The present qualitative study uses the focus group approach. Each focus group was composed of a maximum of 6 students per group with the same level of training. Using a standardised interview manual, a total of 31 students and four first-year residents participated in the study. Data interpretation was performed using structured qualitative content analysis. Results: The present work demonstrates that students of all levels of training greatly value their training in practical clinical expertise, especially in clinical skills. Due to the lack of defined learning objectives for practical skills, students training in clinical internships and medical registrar positions are highly dependent on the motivation and interest of the individual clinical teacher and the learner himself. Students struggle to estimate their actual level of expertise due to the lack of defined learning objectives. This is exacerbated by the fact that students rarely receive feedback about their expertise. Students complain that many teachers do not know the level of training required of their students. Conclusion: The definition of basic and specific learning objectives and the communication of this between learners and teachers is an essential part of practical clinical training.

["Practical clinical competence" - a joint programme to improve training in surgery]. / "Praktische klinische Kompetenz" - ein Verbundprojekt zur Verbesserung der chirurgischen Lehre.

INTRODUCTION: Practical clinical competence is, as a result of the complexity of the required skills and the immediate consequences of their insufficient mastery, fundamentally important for undergraduate medical education. However, in the daily clinical routine, undergraduate training competes with patient care and experimental research, mostly to the disadvantage of the training of clinical skills and competencies. All students have to spend long periods in compulsory surgical training courses during their undergraduate studies. Thus, surgical undergraduate training is predestined to exemplarily develop, analyse and implement a training concept comprising defined learning objectives, elaborated teaching materials, analysed teaching methods, as well as objective and reliable assessment methods. THE PROJECT: The aim of this project is to improve and strengthen undergraduate training in practical clinical skills and competencies. The project is funded by the German Federal Ministry of Education and Research with almost two million Euro as a joint research project of the medical faculties of the universities of Frankfurt/Main, Gießen and Marburg, in collaboration with the German Society of Surgery, the German Society of Medical Education and the German Medical Students' Association. Nine packages in three pillars are combined in order to improve undergraduate medical training on a methodical, didactic and curricular level in a nation-wide network. Each partner of this network provides a systematic contribution to the project based on individual experience and competence. Based on the learning objectives, which were defined by the working group "Education" of the German Society of Surgery, teaching contents will be analysed with respect to their quality and will be available for both teachers and students as mobile learning tool (first pillar). The existing surgical curricula at the cooperating medical faculties will be analysed and teaching methods as well as assessment methods for clinical skills will be evaluated regarding their methodological quality and evidence. The existing surgical curricula will be revised and adapted on the basis of these results (second pillar). Qualification programmes for physicians will be implemented in order to improve both undergraduate education and the attractiveness of educational research, the required teaching quality will be imparted in a nationwide "train-the-teacher" program for surgical clinical skills (third pillar).

[Evaluation of the Chêneau brace in adolescent idiopathic scoliosis]. / Evaluation du résultat du corset de Chêneau dans la scoliose idiopathique de l'adolescent.

OBJECTIVE: We aimed to evaluate the Chêneau brace in the orthopedic treatment of adolescent idiopathic scoliosis to better determine the indications under which it could be prescribed. MATERIALS AND METHODS: This was a retrospective study including 63 patients treated by Chêneau brace for adolescent idiopathic scoliosis between 1997 and 2006. The Cobb angles of the curves in the frontal and sagittal planes as well as rotations and rib hump were measured at the beginning of treatment, with the brace, at the end of treatment and 2 years after discontinuing the brace. A variation of+/-10 degrees in angle was selected to judge the results. RESULTS: At the end of the treatment, 25.4% of the curves were improved and 60.3% stabilized, with 14.3% aggravated; 5 patients (7.9%) required surgery. At 2 years, the reduction in angle was 1.8 degrees, on average. The best results were obtained for the lumbar and dorsolumbar curves. A significant improvement was noted for the dorsal curves; the major double curves are not as accessible to the treatment. For curves whose initial angle was less than 30 degrees , an initial reduction of higher than 50% with the brace presented the best improvement at the end of the follow-up. We note a significant reduction of the rib hump but not accompanied by a reduction of rotation. Finally, we note a deleterious effect in the sagittal curves, with a slight flatness of the spinal profile. CONCLUSION: The continuous wearing of the Chêneau brace can stabilize the evolution of adolescent idiopathic scoliosis, apart from the forms with major double curves, which are not as accessible to the treatment. However, the improvement comes at the price of a slight flatness of the curves of the spine in the sagittal plane. The loss of the correction after discontinuing the brace is minor. We emphasize, therefore, the necessity to monitor the sagittal aspect of the spine as well as the possibility of early treatment, strict surveillance and prolonged follow-up.