Implementing community based inclusive development for people with disability in Latin America: a mixed methods perspective on prioritized needs and lessons learned.

BACKGROUND: Research on the needs of people with disability is scarce, which promotes inadequate programs. Community Based Inclusive Development interventions aim to promote rights but demand a high level of community participation. This study aimed to identify prioritized needs as well as lessons learned for successful project implementation in different Latin American communities. METHODS: This study was based on a Community Based Inclusive Development project conducted from 2018 to 2021 led by a Columbian team in Columbia, Brazil and Bolivia. Within a sequential mixed methods design, we first retrospectively analyzed the project baseline data and then conducted Focus Group Discussions, together with ratings of community participation levels. Quantitative descriptive and between group analysis of the baseline survey were used to identify and compare sociodemographic characteristics and prioritized needs of participating communities. We conducted qualitative thematic analysis on Focus Group Discussions, using deductive main categories for triangulation: 1) prioritized needs and 2) lessons learned, with subcategories project impact, facilitators, barriers and community participation. Community participation was assessed via spidergrams. Key findings were compared with triangulation protocols. RESULTS: A total of 348 people with disability from 6 urban settings participated in the baseline survey, with a mean age of 37.6 years (SD 23.8). Out of these, 18 participated within the four Focus Group Discussions. Less than half of the survey participants were able to read and calculate (42.0%) and reported knowledge on health care routes (46.0%). Unemployment (87.9%) and inadequate housing (57.8%) were other prioritized needs across countries. Focus Group Discussions revealed needs within health, education, livelihood, social and empowerment domains. Participants highlighted positive project impact in work inclusion, self-esteem and ability for self-advocacy. Facilitators included individual leadership, community networks and previous reputation of participating organizations. Barriers against successful project implementation were inadequate contextualization, lack of resources and on-site support, mostly due to the COVID-19 pandemic. The overall level of community participation was high (mean score 4.0/5) with lower levels in Brazil (3.8/5) and Bolivia (3.2/5). CONCLUSION: People with disability still face significant needs. Community Based Inclusive Development can initiate positive changes, but adequate contextualization and on-site support should be assured.

Early clinical exposure in undergraduate medical education: A questionnaire survey of 30 European countries.

PURPOSE: Fifteen years ago, a European survey demonstrated widespread adoption of early clinical exposure (ECE) programmes but little emphasis in the curricula of medical schools. We now repeat the survey in light of the ample emerging data suggesting multiple positive outcomes of ECE. METHODS: Online cross-sectional survey in European medical schools conducted by the EURACT Basic Medical Education Committee in 2021. Descriptive quantitative analyses and a thematic analysis approach were used. RESULTS: Eighy-nine (48%) medical schools in 30 European countries responded. ECE was used in 65 (73%) of the medical schools, and 88% of ECE programmes took place in primary care. The median total time spent on the ECE programme was 5 days. Teaching methods covered unstructured learning opportunities such as observation or shadowing doctors, as well as work-based learning whilst seeing real patients or reflecting on own encounters. Learning goals included knowledge, skills, and attitudes. More than half of the respondents expressed barriers to implementing or expanding ECE. CONCLUSIONS: Compared to the previous survey, there was no significant change in the adoption or curricular emphasis of ECE programmes. Institutional attitudes towards certain disciplines and a lack of willingness to experiment with new teaching methods may be partially responsible.

European standards for undergraduate medical education in general practice; a blueprint - for action.

There is compelling evidence that general practice (GP) is the most effective form of healthcare. However, healthcare policy appears independent of evidence and GP is woefully under-resourced in all countries, and this affects recruitment. Recruitment to GP is proportional to the quantity and quality of undergraduate experience and national and transnational guidelines can improve undergraduate experiences by defining both the desired quantity and quality. There is good evidence that these professionally developed guidelines can be effective in changing Government policy if they are used as a touchstone to collaborate with policymakers.EURACT (European Academy of Teachers in General Practice / Family Medicine) have therefore developed transnational guidelines covering the European region. The guidelines cover the desired quantity, quality and support for undergraduate experience. Three main design principles have been used. Firstly, it is democratic. Secondly it is evidence-based, using extensive literature searching, situational analysis and surveys. Finally, it adopts a 'principles-based approach'. Generalist medicine is articulated as a series of interconnected principles that integrate and then re-focus specialist medicine to achieve the enhanced patient-orientated outcomes of primary-care. This way of articulating generalist practice delivers general principles, which can be used as learning outcomes, that are adaptable to a wide range of learning environments. Most clinical learning documents are irrelevant and are destined for dusty drawers or forgotten digital files. We therefore encourage primary care educators to use these guidelines to work with policy-makers at all levels to advocate for change, strengthening primary care education at local, national and international levels.

Prescription of antibiotics in the medical care of newly arrived refugees and migrants.

PURPOSE: Unnecessary and inappropriate use of antibiotics is a widespread problem in primary care. However, current data on the care of refugees and migrants in initial reception centers is pending. This article provides data on prescription frequencies of various antibiotics and associated diagnoses. METHODS: In this retrospective observational study, patient data of 3255 patients with 6376 medical contacts in two initial reception centers in Germany were analyzed. Patient data, collected by chart review, included sociodemographic characteristics, diagnoses, and prescriptions. Antibiotic prescription behavior and corresponding physician-coded diagnoses were analyzed. RESULTS: Nineteen percent of all patients in our study received systemic antibiotics during the observation period, with children below the age of 10 years receiving antibiotics most frequently (24%). The most commonly prescribed antibiotics were penicillins (65%), macrolides (12%), and cephalosporins (7%). The most frequent diagnoses associated with antibiotic prescription were acute tonsillitis (26%), bronchitis (21%), infections of the upper respiratory tract (14%), and urinary tract infections (10%). In case of acute bronchitis 74% of the antibiotic prescriptions were probably not indicated. In addition, we found a significant number of inappropriate prescriptions such as amoxicillin for tonsillitis (67%), and ciprofloxacin and cotrimoxazol for urinary tract infections (49%). CONCLUSION: Regarding inappropriate prescription of antibiotics in refugee healthcare, this study shows a rate ranging from 8% for upper respiratory tract infections to 75% for acute bronchitis. Unnecessary use of antibiotics is a global problem contributing to gratuitous costs, side effects, and antimicrobial resistance. This research contributes to the development of stringent antibiotic stewardship regiments in the particularly vulnerable population of migrants and refugees.

[Usability and Efficiency of a Digital Communication Assistance Tool to Obtain Medical History from Non-German-Speaking Patients]. / Nutzbarkeit digitaler Anamnesehilfen für nicht-deutschsprachige Patienten in der allgemeinärztlichen Sprechstunde.

AIM: In the DICTUM-Friedland study, a medical history-taking app was implemented in an initial reception facility for refugees and asylum seekers. This app can be used to obtain from patients information about the most frequent general medical complaints and risk factors in 13 different languages or dialects. A report (synopsis) is generated, based on each patient's given data, in the German language. Usability and efficiency of obtaining medical history were the criteria evaluated in order to test and optimize the app for use in a broader general medical setting. METHODS: From May to December 2018, the app was tested in the waiting room of the general medical ward in the refugee camp in Friedland in southern Lower Saxony, Germany. Patients were asked to complete a short digital questionnaire about the usability of the app immediately after finishing the query. Sociodemographic data were partly collected with the same questionnaire and partly extracted from patient records. The efficiency was evaluated on the basis of the correspondence between the entered complaints (ICPC-2) and the diagnoses of the doctors (ICD-10). RESULTS: In total, the app was used 353 times, and based on these, 283 medical histories were taken. The median time for entering the complaints was 10:27 minutes. The use of the audio output (60% of patients used this option) did not influence the usability. The majority of the users (76%) rated the app as easy to use and 65% of the users stated that they were able to enter their main complaints. Both assessments were independent of the age and sex of the users, but the educational level had a slightly more positive influence. The efficiency test showed that 51% (n=144) of the synopses matched fully and 28% (n=79) of the synopses matched partially with the medical diagnoses. CONCLUSION: The systematic survey of the most frequent general medical complaints enables a more precise medical history taking in patients with whom a normal interview is not possible due to language barriers. Thus it serves as a support for the medical history taking. The app is easy to use and not prone to the errors of online translations.

Implementing a digital communication assistance tool to collect the medical history of refugee patients: DICTUM Friedland - an action-oriented mixed methods study protocol.

BACKGROUND: Language barriers play a decisive role in determining the outcomes of medical consultations between healthcare providers and their foreign patients. This issue is a significant challenge to the German healthcare system, especially with the rising number of refugees in recent years. The communication gap between healthcare professionals and their non-German speaking patients sometimes leads to unnecessary medical re-admission, insufficient medical history, incorrect diagnosis, and treatment plans. In this study, we aim to assess the usability and accuracy of a novel digital translation tool in collecting medical history from patients in their native language and to check its effects on healthcare outcomes. METHODS: The study aims to monitor the implementation of a new digital communication assistance tool (DCAT) and to investigate its impact on the mutual understanding between refugee patients and their German general practitioners (GPs). In the first study phase, an action-oriented approach is used to implement DCAT. In the second study phase, DCAT use will be evaluated with a mixed methods design. The main outcome assesses the re-consultation rates of patients before and after using DCAT. Secondary outcomes include the usability of the tool, its acceptance and perceived quality by patients, the accuracy of the information collected as determined from analysing the reasons for the consultation (ICPC-2 codes), and diagnosis (ICD-10 codes). The acceptance by patients, socio-demographic factors and native language are also taken into account. The research designs for both study phases include questionnaires, semi-structured interviews, non-participant observation and analysis of collected patients' data. All the collected data is pseudonymised. DISCUSSION: The DCAT study is one of the new research projects in primary healthcare investigating the usability, accuracy, and acceptance of digital translation tools during medical encounters. We aim to eliminate significant communication errors and misunderstandings in medical consultations, thereby improving the quality of healthcare outcomes. By applying an action research design, we will attain a more comprehensive evaluation of DCAT scopes and limits. The results of this study are expected to give an in-depth understanding of possible applications and benefits of digital translation tools for patient care. TRIAL REGISTRATION: German Clinical Trials Register DRKS00013076 , 29/09/2017.

Neuroenhancement and mental health in students from four faculties - a cross-sectional questionnaire study.

Background: Students face great challenges at the beginning of and during their studies. Competitive experience, exam anxiety, and especially the new performance requirements often cause test anxiety and stressful experiences. The extent of substance use in terms of neuroenhancement (NE) is unclear. Evidence shows associations between NE, increased stress levels, and mental health. Objectives: We aim to determine the prevalence of NE and alcohol and tobacco use among college students. We also investigate the associations between NE and ADHD, anxiety, depression, and stress experience. Methods: In spring 2021, an anonymous online cross-sectional survey was conducted among students of medicine, dentistry, business economics, and business informatics in Würzburg. The survey included the instruments ASRS (ADHD), PSS-10 (stress), PHQ-4 (depression and anxiety), and AUDIT-C (alcohol comsumption), as well as questions about consumption patterns, prior knowledge, and reasons for NE. Results: Of the 5564 students who were invited to participate, 1010 completed the questionnaire (18.2%). Of these, 12.4% indicated NE for the studied period. NE was used in particular during preparations for exams, to enhance performance, and/or to regulate emotions, most commonly through caffeine tablets, cannabis, and methylphenidate. NE was associated with risky use of alcohol or tobacco, and to a lesser extent with ADHD symptoms and stress experience.Conclusions: Students are at risk of substance abuse and NE. Effective stress management and prevention approaches as well as low-threshold services are needed to identify and support students with risk profiles.

Pre-post evaluation of the emotions and motivations for transformative action of medical students in Germany after two different planetary health educational interventions.

BACKGROUND: Climate change is the greatest threat to human health. Medical students, as future health-care workers, are important in promoting sustainable behaviours, which are strongly associated with individuals' emotional responses to climate change. At Würzburg University Hospital (Würzburg, Germany), a one-term optional course (40 learning units) about planetary health and two lectures within the curricular course Environmental Medicine were introduced in 2021. We aimed to examine the effects of these courses on the emotions and motivations of students in acting against climate change. METHODS: We surveyed medical students from both courses during four consecutive terms during 2021-23 with a pre-post design using an anonymous online questionnaire on EvaSys. The survey consisted of 20 closed questions based on a 5-point Likert scale and six open questions. Quantitative data were analysed with SPSS version 28.0.1.1. Qualitative data were analysed with Kuckartz' qualitative content analysis. FINDINGS: 458 students were initially involved (349 [76%] in the lectures and 109 [24%] in the optional course) and 396 students were involved until the final date (288 [73%] in the lectures and 108 [27%] in the optional course). Mean response rate was 389 (85%) of 458 students pre-survey and 315 (80%) of 396 post-survey. The most frequently reported initial emotions of medical students from both cohorts were "helplessness" (220 [57%] of 389), "fear" (197 [51%]), and "disappointment" (171 [44%]). Only 82 (21%) of 389 students reported having "motivation to act" and 45 (12%) reported having "confidence". When comparing 176 matched pre-lecture and post-lecture Likert scale values of reported emotions, we observed a significant decrease in "helplessness" (mean difference -0·37, 95% CI -0·2 to -0·53; p<0·0001; d=0·34) and "disappointment" (-0·35, -0·2 to -0·49; p<0·0001; d=0·36) and a significant increase in "confidence" (0·67, 0·82 to 0·51; p<0·0001; d=0·65 and "motivation to act" (0·4, 0·53 to 0·27; p<0·0001; d=0·46). Students associated these changes with options for action offered in the lecture. INTERPRETATION: This pre-post evaluation provides evidence for a positive effect of planetary health education at the university level. Educators should focus on options for action and create space for improving emotional resilience within courses. FUNDING: None.

[The elective planetary health: Climate, environment and health at the faculty of medicine in Würzburg: Concept, didactic methods and evaluation results]. / Das Wahlpflichtfach Planetare Gesundheit: Klima.Umwelt.Gesundheit an der Medizinischen Fakultät Würzburg ­ Konzeption, didaktische Methoden und Evaluationsergebnisse.

BACKGROUND: The connections between climate, environment, and health as well as the concept of planetary health need to be integrated into the education of health professionals, as is increasingly demanded both internationally and nationally. Planetary health education should also aim to foster transformative action for climate protection and sustainability. In recent years, innovative teaching formats and objective catalogues have emerged internationally. In Germany, these topics have not yet been integrated into medical education everywhere. Since 2021, the Faculty of Medicine in Würzburg has offered an elective course as a first step of a longitudinal curriculum currently in development. The design, content, structure, and results of the evaluation are discussed in this article and will be used for quality assurance as well as the (further) development of this kind of educational interventions elsewhere. METHODOLOGY: We developed an elective course for students in their second to tenth semester with 30 onsite and online face-to-face teaching units and an additional project phase. We used an innovative mix of didactic methods with online simulations, training in climate-sensitive health counselling, and interdisciplinary climate communication as well as local sustainability projects in small groups, with a large amount of peer-teaching. A quantitative and qualitative evaluation was done immediately after the teaching units through feedback rounds and online with the evaluation software Evasys®, using closed and open-ended questions exploring learning progress (summer semester) and achievement of learning objectives (winter semester), motivation to participate, acceptance of teaching methods, attitudes, relevance, and further interest. The evaluation questionnaire was slightly modified for the winter semester. RESULTS: In the summer and winter semester of 2021/2022, a total of 34 students (17 per semester) participated in the elective course; of these, 33 participated in the written evaluation. The evaluation in the summer semester (n = 17) showed a significant increase in self-assessed learning gain, the evaluation in the winter semester (n = 16) indicated a substantial achievement of learning objectives (mean = 3.96 of a 5-point Likert scale). Participants of both semesters (n = 33) regarded peer-teaching as a suitable method (mean = 4.2) and well-implemented (mean = 4.3). The topics were considered highly relevant but not adequately integrated into the main curriculum. There was a high level of interest in local impacts of climate and environmental changes and local measures for climate protection and sustainability. The specific projects in small groups may serve as examples of how transformative action can be promoted in education. DISCUSSION: In the current dynamic development of the widely demanded integration of planetary health education into curricula, this elective course shows a possible and well-accepted example with a combination of various innovative didactic methods aiming at the levels of knowledge, attitudes, skills, and self-efficacy (or confidence) alike. The positive evaluation by the students and the high interest in local sustainability projects show the potential for future integration into the main curriculum. CONCLUSION: The elective can serve as an inspiration to tackle the challenge of taking the steps from knowledge to action in planetary health education. While an elective cannot replace the integration of all relevant aspects of planetary health into the main curriculum, it can serve as a space for piloting of future curricular educational interventions and offer opportunities for developing transformative competencies.

Dipsticks and point-of-care Microscopy to reduce antibiotic use in women with an uncomplicated Urinary Tract Infection (MicUTI): protocol of a randomised controlled pilot trial in primary care.

INTRODUCTION: Uncomplicated urinary tract infections (uUTIs) in women are common infections encountered in primary care. Evidence suggests that rapid point-of-care tests (POCTs) to detect bacteria and erythrocytes in urine at presentation may help primary care clinicians to identify women with uUTIs in whom antibiotics can be withheld without influencing clinical outcomes. This pilot study aims to provide preliminary evidence on whether a POCT informed management of uUTI in women can safely reduce antibiotic use. METHODS AND ANALYSIS: This is an open-label two-arm parallel cluster-randomised controlled pilot trial. 20 general practices affiliated with the Bavarian Practice-Based Research Network (BayFoNet) in Germany were randomly assigned to deliver patient management based on POCTs or to provide usual care. POCTs consist of phase-contrast microscopy to detect bacteria and urinary dipsticks to detect erythrocytes in urine samples. In both arms, urine samples will be obtained at presentation for POCTs (intervention arm only) and microbiological analysis. Women will be followed-up for 28 days from enrolment using self-reported symptom diaries, telephone follow-up and a review of the electronic medical record. Primary outcomes are feasibility of patient enrolment and retention rates per site, which will be summarised by means and SDs, with corresponding confidence and prediction intervals. Secondary outcomes include antibiotic use for UTI at day 28, time to symptom resolution, symptom burden, number of recurrent and upper UTIs and re-consultations and diagnostic accuracy of POCTs versus urine culture as the reference standard. These outcomes will be explored at cluster-levels and individual-levels using descriptive statistics, two-sample hypothesis tests and mixed effects models or generalised estimation equations. ETHICS AND DISSEMINATION: The University of Würzburg institutional review board approved MicUTI on 16 December 2022 (protocol n. 109/22-sc). Study findings will be disseminated through peer-reviewed publications, conferences, reports addressed to clinicians and the local citizen's forums. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT05667207.

Ten characteristics of high-quality planetary health education-Results from a qualitative study with educators, students as educators and study deans at medical schools in Germany.

Aim: The climate and ecological crises are considered fundamental threats to human health. Healthcare workers in general and doctors in particular can contribute as change agents in mitigation and adaptation. Planetary health education (PHE) aims to harness this potential. This study explores perspectives among stakeholders involved in PHE at German medical schools on the characteristics of high-quality PHE and compares them to existing PHE frameworks. Methods: In 2021, we conducted a qualitative interview study with stakeholders from German medical schools involved in PHE. Three different groups were eligible: faculty members, medical students actively involved in PHE, and study deans of medical schools. Recruitment was performed through national PHE networks and snowball sampling. Thematic qualitative text analysis according to Kuckartz was used for the analysis. Results were systematically compared to three existing PHE frameworks. Results: A total of 20 participants (13 female) from 15 different medical schools were interviewed. Participants covered a wide range of professional backgrounds and experience in PHE education. The analysis revealed ten key themes: (1) Complexity and systems thinking, (2) inter- and transdisciplinarity, (3) ethical dimension, (4) responsibility of health professionals, (5) transformative competencies including practical skills, (6) space for reflection and resilience building, (7) special role of students, (8) need for curricular integration, (9) innovative and proven didactic methods, and (10) education as a driver of innovation. Six of our themes showed substantial overlap with existing PHE frameworks. Two of our themes were only mentioned in one of the frameworks, and two others were not explicitly mentioned. Few important elements of the frameworks did not emerge from our data. Conclusions: In the light of increased attention regarding the connections of the climate and ecological crises and health, our results can be useful for anyone working toward the integration of planetary health into medical schools' and any health professions' curricula and should be considered when designing and implementing new educational activities.

"And how am I going to ask about this?" - introducing the course "sexual anamnesis" in peer teaching for medical students in Würzburg.

Aim: A course on sexual anamnesis based on peer teaching was developed, piloted, and evaluated at the medical school of the University of Würzburg. The course is part of the expansion of the communication curriculum and in order to close existing gaps in medical education. An implementation of the course in the curriculum is meant to give all students the opportunity to acquire professional skills in this area. Method: The course consists of knowledge transfer, interactive exercises, role plays with structured feedback, and an exchange with practitioners. A standardized online evaluation of the course took place in regard to teaching quality, subjective learning success, and acceptance. The voluntary course was conducted online in the summer semester of 2021 and in person in the winter semester of 2021/22. A total of 68 students participated. The training of the tutors was realized in cooperation with the "Deutsche Aidshilfe" (DAH). Results: The course was successfully conducted online and in person. A total of 60 students participated in the evaluation. More than 80% of the students rated the course as structured. They assessed an adequate mix of knowledge transfer and practical exercises. More than half of the students reported that they were more confident in performing sexual anamnesis after they participated in the course. There was an open exchange among the students. More than 90% of the students found the peer teaching by the tutors helpful. Conclusion: The implementation of the course closes a relevant gap of the curriculum in Würzburg. Sexual anamnesis will be a regular part of the curriculum starting in the winter semester 2022/23. The concept can also be transferred to other universities.

Initiatives promoting planetary health education in Germany: An overview.

Planetary health education focuses on the climate and ecological crises and their adverse health effects. Given the acceleration of these crises, nationwide integration of planetary health education into undergraduate and graduate education, postgraduate training and continuing education for all health professionals has repeatedly been called for. Since 2019, planetary health education has been promoted by several national initiatives in Germany that are summarized in this commentary: 1. National Working Group Planetary Health Education, 2. Manual for planetary health education, 3. Catalog of National Planetary Health Learning Objectives in the National Competency-Based Catalog of Learning Objectives for Medical Education, 4. Working Group Climate, Environment and Health Impact Assessment at the Institute for Medical and Pharmaceutical Examinations, 5. Planetary Health Report Card, and 6. PlanetMedEd study: planetary health education in medical schools in Germany. We hope these initiatives promote collaboration across institutions involved in educating and training health professionals, inter-professional cooperation as well as rapid implementation of planetary health education.

The "Seminartage Weiterbildung Allgemeinmedizin" (SemiWAM®) - development, implementation and evaluation of a five-year, competence-based postgraduate programme in Bavaria.

Introduction: Starting in 2013, a five-year, competence-based postgraduate programme, the "Seminartage Weiterbildung Allgemeinmedizin" (SemiWAM®) for continuing education in general practice, was developed and offered in Bavaria. This evaluation reports on the experiences of SemiWAM® after a first cycle. Material and methods: Process reflection based on the cycle of Kern: In addition to qualitative findings, results of the evaluation forms (mean values with standard deviation) are presented. The evaluation form contained questions on organisational issues, content of presentation, didactic preparation of the supervisor, transfer to real life practice as well as demographic variables. All questions were voted on a six-point Likert scale from "1=very satisfied" to "6=very dissatisfied". Results: The reflection showed three crucial entry points: Choosing "reason for encounter" as a content precondition to ensure target audience needs, the close didactic supervision of supervisor, and the continuous growth of supervisor team with newly qualified GP. The evaluation results for the overall assessment (MW 1.11-1.60), the didactic concept (MW 1.30-1.87), as well as the transfer into daily life practice (MW 1.48-2.35) reflect the high quality of the SemiWAM®. Discussion: The SemiWAM® curriculum presented can be easily transferred to comparable structures in Germany that accompany specialty training, such as the competence centres for residency training in general practice. The process evaluation based on the core cycle also provides important support for the agile implementation of these or similar programmes.

[Structured Individual Mentoring as Part of Continuing Education in Family Medicine in Bavaria - a Multicenter Evaluation]. / Strukturiertes Einzelmentoring im Rahmen der Weiterbildung Allgemeinmedizin in Bayern ­ eine multizentrische Evaluation.

Background: Since 2019, the competence center for specialist training in family medicine Bavaria (KWAB) offers an individual mentoring program to accompany specialist training in family medicine. The mentors are confidants for matters of specialist training, private practice, career development and compatibility of work and family life. The training takes place after registration via an online portal. Methods: The evaluation was conducted 24 months after the start of KWAB mentoring (06/30/2021-08/01/2021). All active participants were interviewed via online survey. In each case, separate questionnaires were developed, which inquire on the one hand about the content-related aspects of the mentoring, such as topics discussed, and on the other hand about the individual mentoring relationship, such as the interpersonal relationship. The mentees received 39 questions (34 closed, 5 open) and the mentors received 26 questions (21 closed, 5 open), which were subsequently analyzed using descriptive statistics. Results: N = 30 mentors and N = 72 mentees were invited to participate in the evaluation (25 (83 %) mentors and 32 (44 %) mentees participated). More than half of the participants met each other at least twice. The main methods of communication were telephone, face-to-face meetings, and email contacts. The individual time commitment in each case was judged to be appropriate. According to the mentors, the mentees showed interest in the content of the program and demonstrated availability and commitment. All respondents indicated a high level of satisfaction with one-on-one mentoring and would recommend it to others. Conclusions: Mentors and mentees in family medicine residency reported a great benefit from the one-on-one mentoring offered and a will to continue their mentoring relationships even after the project period.

Teaching alcohol and smoking counselling in times of COVID-19 to 6th-semester medical students: experiences with a digital-only and a blended learning teaching approach using role-play and feedback.

Objectives: Digital teaching formats have seen increased use, and not just since the beginning of the pandemic. They can also be used to teach cognitive, practical and communicative learning objectives effectively. We describe the implementation of an online-only course on alcohol/smoking counselling in the COVID-19 summer semester (SS) 2020 and an inverted classroom (IC) concept in the winter semester (WS) 2020/21 at the University Hospital of Würzburg. Methodology: The interdisciplinary subject of "prevention" teaches students about high-risk alcohol consumption/smoking and how to conduct a brief verbal intervention. All 143 (SS) and 131 (WS) 6th-semester medical students completed a 90-minute course: module 1 included a Prezi® presentation on alcohol/smoking basics. Module 2 introduced a counselling concept (alcohol or smoking) online or classroom-based (WS only), depending on the participants' choice. In the online practical component, each student created a counselling video and reflections at home, and later received written feedback from lecturers/tutors. Supervised role-playing was used in the classroom-based format in the WS. There were 2 exam questions on module 1 at the end of each semester. Results: The students surveyed (11%) were satisfied with module 1. Practical exercises and feedback received praise in the evaluation of the classroom-based format (response: 97%). It was not possible for all students to perform counselling due to time constraints. A majority of participants filmed live role-playing in the online practical component. The exam questions were answered correctly by 31% (SS) and 36% (WS) respectively. Conclusions: Counselling can also be taught digitally: creating one's own videos with delayed written feedback is an innovative form of teaching. We are now aiming for a mix of both aspects as an IC with 90 minutes of classroom-based practical exercises.

Can smoking cessation be taught online? A prospective study comparing e-learning and role-playing in medical education.

OBJECTIVES: We compared the effect of different didactic formats - e - learning and role-playing - on medical students' knowledge and counselling skills in smoking cessation training. METHODS: At a German medical school, 145 third-year students were randomly allocated to attend an online course with video examples or an attendance course with role-playing. Students were trained in smoking cessation counselling according to the 5A's (ask, advise, assess, assist, arrange) for approximately 90 minutes. Practical skills were measured in an objective structured clinical examination (OSCE) and represent the primary endpoint of this prospective comparative study. Additionally, changes in theoretic knowledge were assessed by pre - and post - interventional questionnaires and a final written exam. RESULTS: In the OSCE, overall scores were higher in the attendance group (Mdn=70.8 % vs. 62.8 %; U=119; p=.087, n=36), but a statistical advantage was only found in one single counselling sequence ("Assist": Mdn=66.7 % vs. 51.4 %; p = .049) and the rating of the standardised patients (M=4.7 vs. 4.2 out of 5 points, t(27.836)=2.0, p=.028). Students' results (n=130) from self-assessment and written exams suggest that both approaches are equally well suited to increase theoretical knowledge. The online course was more time efficient (90 vs. 73 minutes). CONCLUSIONS: Seminar and web-based training seem equally well suited for transferring knowledge and skills on tobacco cessation counselling. Considering their particular strengths, these two teaching approaches could be combined.

Which teaching method is more effective in a communication course - role-playing versus simulated patients, taught by tutors or faculty staff? A randomized trial.

Aim: Communicative skills can be taught and trained as part of medical training. In these courses, lecturers or tutors serve as instructors, and students perform interviews with simulated patients (SP) or role-play (RP) with fellow students. The present study was conducted to identify the combination of applied teaching methods that is most effective. Method: n=144 third-year (5th semester) medical students attended a medical history-taking course that consisted of three separate sessions (90 minutes each). Students were randomized into three groups. Groups 1 and 2 received training with SP in sessions one and two, followed by RP training in session three; (teaching by lecturer = SP-Lecturer group vs. teaching by tutor = SP-Tutor group). Group 3 received two sessions of RP training and a SP-based training in session three (teaching by tutor = RP-Tutor group). After completing the course, students had to rate their learning success using a short questionnaire, pass an SP-OSCE station and were supposed to answer exam questions. Results: The OSCE performance of both the SP-Lecturer group (n=28) and the RP-Tutor group (n=44) was significantly better than that of the SP-Tutor group (n=26; p=.018 and p=.041, respectively). All groups reported an increase in self-rated history-taking skills (p<.001). There was no difference between groups in the results achieved on the final exam. Conclusions: Students receiving SP-based teaching benefit more from a lecturer-taught course, while students instructed by tutors benefit more from RP-based teaching. The significant learning progress highlights the great advantage of taking the course as part of medical studies. Further research should aim to determine at which time each teaching method improves learning progress most effectively.

Acute respiratory infections in an adult refugee population: an observational study.

The presence of acute infectious respiratory diseases (ARD) is one of the main reasons why recently arrived refugees seek medical help. This paper investigates the incidence rates of acute respiratory diseases in an adult refugee population as well as associated sociodemographic factors and drug treatments. We conducted a retrospective observational study of deidentified medical records. The data were collected between 2015 and 2019 in the health care centers of two large German initial reception centers for refugees. Multivariable analyses controlling for sociodemographics were carried out using generalized estimating equations. Out of 10,431 eligible residents, 6965 medical encounters of 2840 adult patients were recorded over 30 months. Of all the adult patients, 34.4% sought medical help for a respiratory symptom or diagnosis at least once. Older patients and patients from Sub-Saharan Africa sought help less often. The occurrence of ARD showed a typical distribution over the course of the year. Facility occupancy was not associated with ARD occurrence. Acute respiratory symptoms are a leading cause for adult refugee patients to seek medical care. The doctor contact rates due to ARD were consistently two to three times higher among refugees than among German residents.

Disease burden in a large cohort of asylum seekers and refugees in Germany.

BACKGROUND: Currently, health care systems worldwide are challenged with providing care to an increasing number of migrants, refugees, and displaced persons. In this article, we report on disease burden and drug prescription patterns in a large refugee cohort in Germany. METHODS: We conducted a cross-sectional study of anonymized medical records including demographic data, diagnoses, and drug prescriptions in two refugee reception centres between 2015 and 2019. Refugees and migrants received medical assistance exclusively through the on-site clinics. Thus, this study represents all medical visits of the housed residents. RESULTS: In total, n = 15531 diagnoses from n = 4858 patients in a cohort of n = 10431 accommodated refugees were recorded. N = 11898 medications were prescribed. Overall, 29.8% of all refugees sought medical attention. Half of the patients were female (49.6%), the average age was 23.8 years (SD [standard deviation] 17.0, min 0, max 81), and 41.5% were minors (<18 years). Most patients had Middle Eastern or Northern African origin (63.9%). The largest proportion of diagnoses belonged to the ICD (International Statistical Classification of Diseases and Related Health Problems) category "R" (miscellaneous, 33.5%), followed by diseases of the respiratory system (category "J", 16.5%), or the musculoskeletal system (category "M", 7.1%). Non-steroidal anti-inflammatory drugs were most frequently prescribed. CONCLUSIONS: This analysis in two large refugee centres in Germany shows that about one third of refugees seek medical attention upon initial arrival. Complaints are manifold, with a high prevalence of respiratory infections.