[The National Competency-Based Catalogue of Learning Objectives for Medicine 2.0 for the subject Physical and Rehabilitative Medicine, Naturopathic Medicine. Consensus of Scientific Medical Societies]. / Der Nationale Kompetenzbasierte Lernzielkatalog 2.0 für das Fach "Physikalische und Rehabilitative Medizin, Naturheilverfahren". Konsentierte Ergebnisse beteiligter Fachgesellschaften der AWMF.

BACKGROUND: The learning objectives in the current cross-sectional subject "Rehabilitation, Physical Medicine, Naturopathic Medicine" have been revised as part of the further development of the National Competency-Based Catalogue of Learning Objectives for Medicine (NKLM) to its new version 2.0. Since the NKLM is designed as an interdisciplinary catalogue, a subject assignment seemed necessary from the point of view of various stakeholders. Thus, the German Association of Scientific Medical Societies (AWMF) and the German medical faculties initiated a subject assignment process. The assignment process for the subject "Physical and Rehabilitative Medicine, Naturopathic Medicine" (PRM-NHV; according to the subject list of the first draft of the planned novel medical license regulations from 2020) is presented in this paper. MATERIAL AND METHODS: The AWMF invited its member societies to participate in the assignment of learning objectives of chapters VI, VII, and VIII of the NKLM 2.0 to the individual subjects to which they consider to contribute in teaching. For "PRM-NHV", representatives of the societies for rehabilitation sciences (DGRW), physical and rehabilitation medicine (DGPRM), orthopaedics and traumatology (DGOU), as well as for naturopathy (DGNHK) participated. In a structured consensus process according to the DELPHI methodology, the learning objectives were selected and consented. Subsequently, subject recommendations were made by the AWMF for each learning objective. RESULTS: From the NKLM 2.0, a total of 100 competency-based learning objectives of chapters VII and VIII for the subject "PRM-NHV" were consented by the representatives of the involved societies for presentation on the NKLM 2.0 online platform. CONCLUSIONS: In the context of the revision process of medical studies in Germany and under the umbrella of the AWMF and the German medical faculties, a broad consensus of competency-based learning objectives in the subject "PRM-NHV" could be achieved. This provides an important orientation for all medical faculties both for the further development of teaching in the cross-sectional subject "Rehabilitation, Physical Medicine, Naturopathic Medicine" according to the 9th revision of the medical license regulations, which has been valid for twenty years, and for the preparation of the corresponding subjects in the draft bill of the novel license regulations.

[The new medical licensing regulations (ÄApprO) : Status and expected challenges]. / Die neue Ärztliche Approbationsordnung ÄApprO : Aktueller Stand und zu erwartende Herausforderungen.

BackgroundThe amendment to the medical licensing regulations (ÄApprO) was decided at the federal level in the version of the "Master Plan for Medical Studies 2020" passed in 2017. In addition to the organizational effort involved in redesigning the curricular teaching, the expected costs associated with the implementation of the new licensing regulations due to the necessary additional time and, therefore, personnel expenditure are of particular importance. Taking into account the different forms of study and the 20% scope for study-design provided to the individual faculties, the process of transferring the teaching content to the new modules confronts us with an enormous organizational challenge.Significance of O&UDiseases of the musculoskeletal system are of particular medical, social and economic importance. Therefore, the training of future physicians in the field of orthopedics and traumatology must be taken into account. The visibility of the field of orthopedics and traumatology must not be lost with the introduction of the new medical licensing regulations (ÄApprO).ImplementationThe implementation of the new medical licensing regulations at German universities will be costly and necessitates an increased number of staff. However, there is a great opportunity to position orthopedics and traumatology as a "central player" in the modular, interdisciplinary and interprofessional course landscape. It is, therefore, important to take on concrete responsibility for the design of the new teaching programs and to bring in our specialist and interdisciplinary skills wherever sensible and possible.

US Medical Licensing Exam Performance and American Board of Surgery Qualifying and Certifying Examinations.

BACKGROUND: Program directors use US Medical Licensing Exam (USMLE) scores as criteria for ranking applicants. First-time pass rates of the American Board of Surgery (ABS) Qualifying (QE) and Certifying (CE) Examinations have become important measures of residency program quality. USMLE Step 1 will become pass/fail in 2022. STUDY DESIGN: American Board of Surgery QE and CE success rates were assessed considering multiple characteristics of highly ranked (top 20) applicants to 22 general surgery programs in 2011. Chi-square, t-test, Wilcoxon Rank sum, linear and logistic regression were used, as appropriate. RESULTS: The QE and CE first attempt pass rates were 96% (235/244) and 86% (190/221), respectively. QE/CE success was not significantly associated with sex, race, research experience, or publications. Alpha Omega Alpha (AΩA) status was associated with success on the index CE (98% vs 83%; p = 0.008). Step 1 and Step 2 Clinical Knowledge (CK) scores of surgeons who passed QE on their first attempt were higher than scores of those who failed (Step 1: 233 vs 218; p = 0.016); (Step 2CK: 244 vs 228, p = 0.009). For every 10-point increase in Step 1 and 2CK scores, the odds of passing CE on the first attempt increased 1.5 times (95% CI 1.12, 2.0; p = 0.006) and 1.5 times (95% CI 1.11, 2.02, p = 0.008), respectively. For every 10-point increase in Steps 1 and 2CK scores, the odds of passing the QE on the first attempt increased 1.85 times (95% CI 1.11, 3.09; p = 0.018) and 1.86 times (95% CI 1.14, 3.06, p = 0.013), respectively. CONCLUSIONS: USMLE Step 1 and Step 2 CK examination scores correlate with American Board of Surgery QE and CE performance and success. The USMLE decision to transition Step 1 to a pass/fail examination will require program directors to identify other factors that predict ABS performance for ranking applicants.

The outcome of applications for restoration to the Medical Register following disciplinary erasure.

In the period 1 January 2012 to 30 June 2020, 76 doctors whose names/entries had been erased from the UK Medical Register by a disciplinary tribunal applied for restoration, and 23 out of 76 (30.3%) applications granted. In 5 of the 53 of those refused restoration, the tribunal suspended indefinitely the right to make further applications. The most frequent reasons for refusal were failure to demonstrate insight (seen in 96%), failure to demonstrate remediation (seen in 79%), and failure to demonstrate that knowledge and skills were up to date (24.5%). Success was more common in UK graduate applications (14/29 - 48.3%) than non-UK graduate applications (9/37 - 24.3%), and in those legally represented (16/29 - 55.2%) than in those without legal representation (7/29 - 24.1%), but the data does not indicate the reasons for these differences. Disciplinary erasure need not necessarily be for life as doctors who learn from their experience, change their ways, and provide evidence of genuine insight and remediation along with up to date knowledge and skills can successfully be reinstated on the register.

Medical Students' Reflections on the Recent Changes to the USMLE Step Exams.

The United States Medical Licensing Examination (USMLE) consists of Step 1, Step 2 Clinical Knowledge, Step 2 Clinical Skills, and Step 3. To be licensed to practice medicine in the United States, medical students must pass all parts of the USMLE. However, in addition to that pass/fail grade, students are currently given a numerical score for Step 1, Step 2 Clinical Knowledge, and Step 3. Residency program directors have come to use the Step 1 score to efficiently screen a growing number of residency applicants. As a result, a deleterious environment in undergraduate medical education has been created, given the importance of Step 1 to medical students matching to their preferred residency program. It was announced in February 2020 that the score-reporting protocol for Step 1 would be changed from a 3-digit numerical score to pass/fail only, beginning no earlier than January 1, 2022. This decision will undoubtedly impact medical students, medical schools, and residency program directors. Here, the authors discuss the impact that the change to Step 1 scoring will have on these key stakeholder groups, from their perspective as students at MD-granting medical schools in the United States. They also call attention to outstanding issues with the USMLE that must be addressed to improve undergraduate medical education for all stakeholders, and they offer advice for further improvements to the residency application process.

Admissions Is Not Enough: The Racial Achievement Gap in Medical Education.

The achievement gap is a disparity in academic and standardized test performance that exists between White and underrepresented minority (URM) students that begins as early as preschool and worsens as students progress through the educational system. Medical education is not immune to this inequality. URM medical students are more likely to experience delayed graduation and course failure, even after accounting for science grade point average and Medical College Admission Test performance. Moreover, URM students are more likely to earn lower scores on licensing examinations, which can have a significant impact on their career trajectory, including specialty choice and residency competitiveness. After the release of preliminary recommendations from the Invitational Conference on USMLE Scoring (InCUS) and public commentary on these recommendations, the National Board of Medical Examiners and Federation of State Medical Boards announced that the United States Medical Licensing Examination (USMLE) Step 1 would transition from a 3-digit numeric score to pass/fail scoring. Given that another of InCUS's recommendations was to "minimize racial demographic differences that exist in USMLE performance," it is paramount to consider the impact of this scoring change on URM medical students specifically. Holistic admissions are a step in the right direction of acknowledging that URM students often travel a further distance to reach medical school. However, when residency programs emphasize USMLE performance (or any standardized test score) despite persistent test score gaps, medical education contributes to the disproportionate harm URM students face and bolsters segregation across medical specialties. This Perspective provides a brief explanation of the achievement gap, its psychological consequences, and its consequences in medical education; discusses the potential effect of the Step 1 scoring change on URM medical students; and provides a review of strategies to redress this disparity.