Scientific competence during medical education - insights from a cross-sectional study at a German Medical School.

BACKGROUND: Medical knowledge regarding the pathophysiology, diagnosis and treatment of diseases is constantly evolving. To effectively incorporate these findings into professional practice, it is crucial that scientific competencies are a central component of medical education. This study seeks to analyse the current state of scientific education and students' desires for integration into the curriculum. METHODS: From October to December 2022, a survey was distributed at the Medical Faculty Dresden to all medical students from the 1st to 5th academic year (AY). The survey investigates current expectations of applying scientific competencies later in professional life, and the students were asked to self-assess various scientific skills and in relation to the National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education. The self-assessments were objectified through a competence test with ten multiple-choice questions. The desire for curricular teaching was inquired. RESULTS: 860 students completed the survey. This corresponds to a response rate of 64%. In the 5th AY, approximately 80% of the participants stated that they expected to work with scientific literature on a daily to monthly basis in future professional life and to communicate corresponding scientific findings to patients. Only 30-40% of the 5th AY rate their scientific competencies as sufficient to do this appropriately. This corresponds with the self-assessed competencies that only slightly increased over the 5 AYs from 14.1 ± 11.7 to 21.3 ± 13.8 points (max. 52) and is also reflected in the competence test (1st AY 3.6 ± 1.75 vs. 5th AY 5.5 ± 1.68, max. 10 points). Half of the students in the 4th and 5th AYs were dissatisfied with the current teaching of scientific skills. The majority preferred the implementation of a science curriculum (56%), preferably as seminars dealing with topics such as literature research, analysis, and science communication. CONCLUSIONS: The results show discrepancies between expectations of using scientific knowledge in everyday professional life, self-rated and objectively recorded competencies, and the current state of curricular teaching of scientific competencies. There is a strong need for adequate practical training, particularly in critical analyses of scientific literature, which enables the communication of scientific knowledge to patients.

Abdominal Vagal Afferents Modulate the Brain Transcriptome and Behaviors Relevant to Schizophrenia.

Reduced activity of vagal efferents has long been implicated in schizophrenia and appears to be responsible for diminished parasympathetic activity and associated peripheral symptoms such as low heart rate variability and cardiovascular complications in affected individuals. In contrast, only little attention has been paid to the possibility that impaired afferent vagal signaling may be relevant for the disorder's pathophysiology as well. The present study explored this hypothesis using a model of subdiaphragmatic vagal deafferentation (SDA) in male rats. SDA represents the most complete and selective vagal deafferentation method existing to date as it leads to complete disconnection of all abdominal vagal afferents while sparing half of the abdominal vagal efferents. Using next-generation mRNA sequencing, we show that SDA leads to brain transcriptional changes in functional networks annotating with schizophrenia. We further demonstrate that SDA induces a hyperdopaminergic state, which manifests itself as increased sensitivity to acute amphetamine treatment and elevated accumbal levels of dopamine and its major metabolite, 3,4-dihydroxyphenylacetic acid. Our study also shows that SDA impairs sensorimotor gating and the attentional control of associative learning, which were assessed using the paradigms of prepulse inhibition and latent inhibition, respectively. These data provide converging evidence suggesting that the brain transcriptome, dopamine neurochemistry, and behavioral functions implicated in schizophrenia are subject to visceral modulation through abdominal vagal afferents. Our findings may encourage the further establishment and use of therapies for schizophrenia that are based on vagal interventions.SIGNIFICANCE STATEMENT The present work provides a better understanding of how disrupted vagal afferent signaling can contribute to schizophrenia-related brain and behavioral abnormalities. More specifically, it shows that subdiaphragmatic vagal deafferentation (SDA) in rats leads to (1) brain transcriptional changes in functional networks related to schizophrenia, (2) increased sensitivity to dopamine-stimulating drugs and elevated dopamine levels in the nucleus accumbens, and (3) impairments in sensorimotor gating and the attentional control of associative learning. These findings may encourage the further establishment of novel therapies for schizophrenia that are based on vagal interventions.

Impulsivity and Saliva Cortisol in Patients with Suicide Attempt and Controls.

OBJECTIVES: The objective of this study was to prove concepts in the characterization of suicidal patients and the possible usefulness of those markers to potentially identify patients with a higher risk for suicidality. METHODS: Patients with a recent suicide attempt were compared with patients suffering from depression, adjustment disorder, anxiety, or eating disorders without suicidality, healthy controls and remitted patients with a history of at least 1 suicide attempt (≥1 year). We analyzed impulsivity (Barratt Impulsivity Scale, BIS) and saliva cortisol concentrations. RESULTS: Independently of suicidality and disease state patients display higher BIS scores than healthy controls. Saliva cortisol levels tend to be higher in patients in the acute disease state than in remitted patients and healthy controls. CONCLUSIONS: Saliva cortisol may be a useful marker that reveals alterations in nonsuicidal patients suffering from depression, adjustment disorder, anxiety, or eating disorders who might be at risk.

Gut vagal afferents differentially modulate innate anxiety and learned fear.

Vagal afferents are an important neuronal component of the gut-brain axis allowing bottom-up information flow from the viscera to the CNS. In addition to its role in ingestive behavior, vagal afferent signaling has been implicated modulating mood and affect, including distinct forms of anxiety and fear. Here, we used a rat model of subdiaphragmatic vagal deafferentation (SDA), the most complete and selective vagal deafferentation method existing to date, to study the consequences of complete disconnection of abdominal vagal afferents on innate anxiety, conditioned fear, and neurochemical parameters in the limbic system. We found that compared with Sham controls, SDA rats consistently displayed reduced innate anxiety-like behavior in three procedures commonly used in preclinical rodent models of anxiety, namely the elevated plus maze test, open field test, and food neophobia test. On the other hand, SDA rats exhibited increased expression of auditory-cued fear conditioning, which specifically emerged as attenuated extinction of conditioned fear during the tone re-exposure test. The behavioral manifestations in SDA rats were associated with region-dependent changes in noradrenaline and GABA levels in key areas of the limbic system, but not with functional alterations in the hypothalamus-pituitary-adrenal grand stress. Our study demonstrates that innate anxiety and learned fear are both subjected to visceral modulation through abdominal vagal afferents, possibly via changing limbic neurotransmitter systems. These data add further weight to theories emphasizing an important role of afferent visceral signals in the regulation of emotional behavior.

Digital competence using the example of executives in residential care facilities in Germany-a comparison.

Background: Change and progress through digitalisation is also becoming increasingly important in the field of professional care and the associated increasing demands on the skills of nursing staff. The European Union considers digital skills to be one of the eight key competences for lifelong learning. At present, few reliable statements can be made about the status of digital skills in professional nursing care in Germany. The aim of this study was to map the current status of digital competences of executives in full inpatient care facilities in Germany and to identify possible differences to reference values of academics. Methodology: This survey is based on a Germany-wide cross-sectional survey in full inpatient care facilities (N = 8,727). The survey instrument Digital Competences Framework (DigComp 2.2) according to the European Union's reference framework was used as the basis for recording the digital competence characteristics. The statistical analysis was descriptive and inferential (t-test, two-sided, p < 0.05). Results: Out of 15 items across five dimensions, significant differences for nine items can be determined. The competence levels of the participating managers from the full inpatient care facilities were lower compared to the reference sample. Discussion: In order to be able to counter the skills discrepancy shown by the study in the future, it is of central importance to deepen knowledge and skills in the area of digitalisation in the care context.

Curricular representation of neurogastroenterology: A survey among medical students in Germany.

BACKGROUND: Neurogastroenterological disorders (NGDs) are highly prevalent and substantially impact patients' quality of life. Effective treatment of NGDs depends on the competence and training of medical caregivers. Students' perceived competence in neurogastroenterology and its place in medical school curricula are assessed in this study. METHODS: A multi-center digital survey among medical students was conducted at five universities. Self-ratings of competence regarding basic mechanisms, diagnosis, and treatment of six chronic medical conditions were assessed. These included irritable bowel syndrome (IBS), gastroesophageal reflux disease, and achalasia. Ulcerative colitis, hypertension, and migraine were included as references. KEY RESULTS: Of 231 participants, 38% remembered that neurogastroenterology was covered in their curriculum. Highest competence ratings were stated for hypertension and the lowest for IBS. These findings were identical for all institutions irrespective of their curricular model and demographic parameters. Students who remembered neurogastroenterology as a part of their curriculum reported higher competence ratings. According to 72% of students, NGDs should be highlighted more prominently in the curriculum. CONCLUSIONS & INFERENCES: Despite its epidemiological relevance, neurogastroenterology is only weakly represented in medical curricula. Students report low levels of subjective competence in handling NGDs. In general, assessing the learners' perspective on an empirical basis may enrichen the process of national standardization of medical school curricula.

Recurrent stress across life may improve cognitive performance in individual rats, suggesting the induction of resilience.

Depressive symptoms are often accompanied by cognitive impairments and recurrent depressive episodes are discussed as a potential risk for dementia. Especially, stressful life events are considered a potent risk factor for depression. Here, we induced recurrent stress-induced depressive episodes over the life span of rats, followed by cognitive assessment in the symptom-free period. Rats exposed to stress-induced depressive episodes learned faster than control rats. A high degree of stress-induced depressive-like behavior early in the paradigm was a predictor of improved cognitive performance, suggesting induction of resilience. Subsequently, exposure to lorazepam prior to stress-induced depressive episodes and cognitive testing in a nonaversive environment prevented the positive effect. This indicates a beneficial effect of the stress-associated situation, with the existence of individual coping abilities. Altogether, stress may in some have a beneficial effect, yet for those individuals unable to tackle these aversive events, consecutive unpleasant episodes may lead to worse cognitive performance later in life.

Effects of chronic citalopram treatment on 5-HT1A and 5-HT2A receptors in group- and isolation-housed mice.

Selective serotonin reuptake inhibitors (SSRI) are characterized by high clinical effectiveness and good tolerability. A 2-3 week delay in the onset of effects is caused by adaptive mechanisms, probably at the serotonergic (5-HT) receptor level. To analyze this in detail, we measured 5-HT(1A) and 5-HT(2A) receptor bindings in vitro after 3 weeks of citalopram treatment (20 mg/kg i.p. daily) in group-housed as well as isolation-housed mice, reflecting neurobiological aspects seen in psychiatric patients. Isolation housing increased somatodendritic (+52%) and postsynaptic (+30-95%) 5-HT(1A) as well as postsynaptic 5-HT(2A) receptor binding (+25-34%), which confirms previous findings. Chronic citalopram treatment did not induce alterations in raphe 5-HT(1A) autoreceptor binding, independent of housing conditions. Housing-dependent citalopram effects on postsynaptic 5-HT(1A) receptor binding were found with increases in group- (+11-42%) but decreases in isolation-housed (-11 to 35%) mice. Forebrain 5-HT(2A) receptor binding decreased between 11 and 38% after chronic citalopram administration, independent of housing conditions. Citalopram's long-term action comprises alterations at the postsynaptic 5-HT(1A) and 5-HT(2A) receptor binding levels. Housing conditions interact with citalopram effects, especially on 5-HT(1A) receptor binding, and should be more strongly considered in pharmacological studies. In general, SSRI-induced alterations were more pronounced and affected more brain regions in isolates, supporting the concept of a higher responsiveness in "stressed" animals. Isolation-induced receptor binding changes were partly normalized by chronic citalopram treatment, suggesting the isolation housing model for further analyses of SSRI effects, especially at the behavioral level.

A novel approach to investigate neuronal network activity patterns affected by deep brain stimulation in rats.

The establishment of new therapeutic indications for deep brain stimulation (DBS) is ambitiously promoted though the underlying mechanisms remain contested. Here, we report that PET-imaging and subsequent c-Fos-immunostaining in rats constitute a new translational approach to further understand DBS-mechanisms and -effectiveness.

5-HT(1A)-receptor over-expressing mice: genotype and sex dependent responses to antidepressants in the forced swim-test.

Deficiencies in serotonergic neurotransmission are involved in the pathophysiology of depression. Due to its modulatory effect on serotonin (5-HT) release, the 5-HT(1A)-receptor is thought to play a decisive role in the therapy of this mood disorder. However, it is not fully understood how antidepressant effects are mediated by pre- and postsynaptic receptor sites. In this study we examined the impact of postsynaptic 5-HT(1A)-receptor over-expression in corticolimbic areas of male and female mice on the performance in the forced swim-test (FST). Furthermore, we investigated their response to the serotonin selective reuptake inhibitor (SSRI) citalopram in comparison to the selective noradrenaline reuptake inhibitor reboxetine, as well as the partial 5-HT(1A)-receptor agonists, buspirone and S 15535. Additionally, these drugs were evaluated in the open field-test in order to observe effects on motor activity. The density of 5-HT(1A)-receptors in discrete corticolimbic regions was determined in detail by quantitative autoradiography with [(3)H]8-OH-DPAT to investigate genotype as well as sex dependent differences in the expression pattern. [(3)H]8-OH-DPAT binding differed depending on sex with female mice of both genotypes displaying higher receptor binding in distinct brain areas. In the FST untreated male but not female over-expressing (OE) mice showed an antidepressant-like behaviour compared to wild-type (WT) mice. Citalopram yielded an antidepressant effect without influencing locomotor activity in OE mice but not in WT mice. Reboxetine had no antidepressant-like effect in OE mice, but sex-dependently in WT mice. The two partial agonists, buspirone and S 15535 produced no antidepressant-like activity in both genotypes and sexes, but aberrant motor effects. The antidepressant-like phenotype of male transgenic mice accounts for an involvement of postsynaptic 5-HT(1A)-receptors in the FST behaviour. In addition, the selective over-expression of postsynaptic 5-HT(1A)-receptors in mice contributes to the antidepressant response to citalopram in the FST. Although further pharmacological analysis is required, the data provide novel support for a role of postsynaptic 5-HT(1A)-receptors in the effects of SSRIs.

A diverse development of 5-HT1A receptor binding is relevant to behavioral differences observed in adult mice of two genetically closely related inbred strains.

Only few genetic loci were supposed to be crucial for strong behavioral differences, especially in locomotion and aggression, in two closely related mice inbred strains: AB/Halle (ABH) and AB/Gatersleben (ABG). Previously we reported remarkable strain differences in 5-HT1A receptor binding in adult mice. In the present study, we were interested if the strain-specific 5-HT1A receptor binding pattern is already present very early in ontogeny which could indirectly hint at a gene that is differentially regulated in these 2 mouse strains. Since the 5-HT1A receptor is involved in the regulation of locomotion and aggression, one genetic determinate for the behavioral differences in ABH and ABG mice would have been found. Therefore, we measured [³H]8-OH-DPAT specific binding at postnatal day (PND) 1 and 21 (weanlings) using in vitro autoradiography. 5-HT1A receptor binding was not significantly different at PND 1 between strains. However, in weanlings the same 5-HT1A receptor binding pattern was observed as in adults, i.e. ABH mice display a higher forebrain 5-HT1A receptor binding compared to ABG mice. So the strain-specific forebrain 5-HT1A receptor binding pattern develops during the first 3 postnatal weeks and genetically driven mechanisms seem to be crucial. However, early environmental influences, e.g. differences in maternal care, can't be excluded.

Higher BDNF concentrations in the hippocampus and cortex of an aggressive mouse strain.

Although genetically closely related AB-Halle (ABH) and AB-Gatersleben (ABG) mice inbred strains differ in activity and aggressive behaviour. These behavioural traits have been observed especially in response to social challenges, where ABH mice develop a highly aggressive and active behaviour, which cannot be observed in their ABG counterparts. In contrast to ABG mice, basal brain serotonin, dopamine and noradrenaline concentrations in ABH mice are low but highly stimulated by social challenges. Since brain-derived neurotrophic factor (BDNF) modulates central neurotransmitter systems and has been involved in aggressive and activity behaviour, we studied specific concentrations of BDNF and NGF protein in several brain regions of ABG and ABH mice. A significant higher concentration of BDNF protein was found in the hippocampus of 5 weeks and 5 months old ABH mice, when compared to ABG mice. BDNF was also higher in the cortex of 5 weeks and 5 months old ABH mice. Moreover BDNF concentrations were higher in the striatum of 5 months old ABH mice when compared to ABG mice. NGF concentrations in ABH mice were not changed in all measured brain regions but higher in older age in the hippocampus of ABG mice as compared to ABH mice. We hypothesize, that BDNF might be involved in the behavioural and neurochemical mechanisms of aggressive behaviour.