A simple approach of applying blended learning to problem-based learning is feasible, accepted and does not affect evaluation and exam results-a just pre-pandemic randomised controlled mixed-method study.

We tested for feasibility, acceptance, and "non-inferiority" of small-group teaching applying blended learning (i.e., the integration of face-to-face and online instruction) to problem-based learning (bPbL) compared to conventional PbL (cPbL). In a just pre-pandemic, randomised controlled trial, 317 students attended either bPbL or cPbL groups. The first meeting of the bPbL groups took place online via written internet chat, while cPbL groups met on site. All groups met on site the second time. All students had the opportunity to attend lectures either on site or as videos on demand. We analysed student evaluation data, results in a final summative exam, attendance of lectures on site and use of lecture videos. Furthermore, we performed a qualitative analysis of student statements made in semi-structured group interviews about pros and cons of the bPbL approach. There was no difference between students of either bPbL or cPbL groups with respect to exam results (score: 14.3 ± 2.8 vs. 13.8 ± 2.7) or course evaluation. However, relatively more bPbL than cPbL students reported having used lecture videos, while the proportion of those attending lectures on-site was higher among cPbL students. Interviews revealed that some of the bPbL students' experiences were unexpected and feared disadvantages seemed to be less severe than expected. Participation in a blended PbL format did not worsen course evaluations or exam results, but seemed to influence lecture attendance. The combination of face-to-face and digital elements could be suitable as a hybrid approach to digital instruction in the post-pandemic era.

The impact of COVID-19 on medical students' practical skills and hygiene behavior regarding venipuncture: a case control study.

BACKGROUND: Despite their importance to current and future patient care, medical students' hygiene behaviors and acquisition of practical skills have rarely been studied in previous observational study. Thus, the aim of this study was to investigate the potential impact of the COVID-19 pandemic on medical student's hygiene and practical skills. METHODS: This case-control study assessed the effect of the COVID-19 pandemic on hygiene behavior by contrasting the practical skills and hygiene adherence of 371 medical students post the pandemic associated lockdown in March 2020 with that of 355 medical students prior to the SARS-CoV-2 outbreak. Students' skills were assessed using an objective structured clinical examination (OSCE). Their skills were then compared based on their results in hygienic venipuncture and the total OSCE score. RESULTS: During the SARS-CoV-2 pandemic, medical students demonstrated an increased level of compliance regarding hand hygiene before (prior COVID-19: 83.7%; during COVID-19: 94.9%; p < 0.001) and after patient contact (prior COVID-19: 19.4%; during COVID-19: 57.2%; p = 0.000) as well as disinfecting the puncture site correctly (prior COVID-19: 83.4%; during COVID-19: 92.7%; p < 0.001). Prior to the pandemic, students were more proficient in practical skills, such as initial venipuncture (prior COVID-19: 47.6%; during COVID-19: 38%; p < 0.041), patient communication (prior COVID-19: 85.9%; during COVID-19: 74.1%; p < 0.001) and structuring their work process (prior COVID-19: 74.4%; during COVID-19: 67.4%; p < 0.024). CONCLUSION: Overall, the COVID-19 pandemic sensitized medical students' attention and adherence to hygiene requirements, while simultaneously reducing the amount of practice opportunities, thus negatively affecting their practical skills. The latter development may have to be addressed by providing additional practice opportunities for students as soon as the pandemic situation allows.

Gender Differences in Attachment Anxiety and Avoidance and Their Association with Psychotherapy Use-Examining Students from a German University.

Attachment anxiety and avoidance might explain gender differences in psychotherapy use, which is generally lower in men. In addition, university students are a particularly vulnerable group for mental health problems, and understanding psychotherapy use, especially among mentally distressed male students, is pivotal. A total of 4894 students completed an online survey answering questions regarding psychotherapy use and completing the PHQ-D identifying psychological syndromes. In addition, the ECR-RD12 was used to measure attachment anxiety and avoidance. Significant gender differences for attachment anxiety and avoidance emerged, showing higher attachment anxiety in female students and higher attachment avoidance in male students. Male students used psychotherapy significantly less than female students. Male students' attachment anxiety and avoidance predicted psychotherapy use, while for female students, only attachment anxiety emerged as a significant predictor. Attachment anxiety is positively associated with psychotherapy use, and lower attachment anxiety in men may explain lower psychotherapy use in male students.

Deterioration in hygiene behavior among fifth-year medical students during the placement of intravenous catheters: a prospective cohort comparison of practical skills.

BACKGROUND: The American Association of Medical Colleges has defined peripheral intravenous cannulation as one of the eight practical skills that a medical student should possess upon graduation. Since following a standard hygiene protocol can reduce the rate of complications such as bloodstream infections, the medical student's compliance to hygienic standards is highly relevant. METHODS: This unicentric longitudinal cohort study included 177 medical students undergoing OSCE 1 in the winter semesters 2016/2017 and 2017/2018 as well as OSCE 2 during the winter semesters 2018/2019 and 2019/2020 at the University of Cologne. Their performance in peripheral intravenous cannulation was rated by trained student supervisors using a scaled 13-item questionnaire and compared between OSCE 1 and OSCE 2. RESULTS: Overall, a decline in the correct placement of peripheral intravenous catheters was observed among advanced medical students during OSCE 2 (mean total score: 6.27 ± 1.84) in comparison to their results in OSCE 1 (mean total score: 7.67 ± 1.7). During OSCE 2, the students were more negligent in regard to hygienic behavior, such as disinfection of the puncture site as well as hand disinfection before and after venipuncture. Their patients were also less likely to be informed about the procedure as compared to OSCE 1. CONCLUSIONS: An unsatisfying performance in regard to peripheral intravenous cannulation was observed in medical students with hygiene compliance deteriorating between the third and fifth year of their study. Thus, we promote an extension of practical hygiene and stress management training in medical school to reduce complications associated with intravenous catheters, such as bloodstream infections.

Studies on acceptance, evaluation and impact of the Cologne program "Research and Medical Studies".

Introduction: The curricular implementation of events (or programs) for science-related training in human medicine has been on the agenda of the medical faculties since the publication of the Federal-State Working Group [1]. The Medical Faculty of the University of Cologne developed and established a systematic, longitudinal science curriculum together with the start of the model curriculum in human medicine in 2003. Here, we investigate the questions of whether the described (para-) curricular elements are accepted by students and lecturers and how they are evaluated, especially by students. In addition, we investigate whether selected parameters can be used to demonstrate changes in the students' scientific activities. Project description: The program "Research and Medical Studies" (RaMS) consists of several components: these elements of the mandatory curricular (Scientific Projects, SP) and optional components (Research in Medical Studies (RiMS), Research Track (RT), Research Fair Cologne (RFC)) are described here. Results were recorded at various levels: Likert Scale evaluation of the event's elements were collected as satisfaction parameters from the studentsProcess data on participation in the voluntary events were collected and evaluated as absolute and relational figures (WS 12/13-SS 17). Data on the outcome of the RaMS program were collected: Type of scientific projects in the academic years 2011/12-2014/15), number and type of available projects offered at the RFC (in the years 2011-18) and number of student research funding applications in a comparison of the periods 2010-13 vs. 2014-17). Results: The students' acceptance of mandatory and paracurricular courses of the RaMS program is pleasingly high, which is not surprising, at least in the case of the voluntary courses. The participation of students in RiMS, RT and RFC is satisfactory for voluntary courses. In the case of the RT, with certified participation of approximately 47% of all registrations (corresponding to 10% of the total cohort), this is comparable to similar programs. It can be shown that the number of experimental science projects has more than doubled over time in parallel with the development of RaMS. The average number of provided projects according to the RFC is 42 (which corresponds to a placement rate of approx. 1:4). The number of successful student applications for a research support grant during the period the measures were implemented has doubled. Discussion and conclusion: The RaMS program shows a route for the implementation of the SP required by the next licensing regulations in medical education, which was initially supported and expanded solitarily, later by further elements (RiMS), also in the sense of a science-based career development (RT, RFC). The student acceptance and the measured success, in the form of successful participation in the Research Track, increased choice of experimental projects, significant increase of submitted as well as approved research grants and the high project placement rate of the Research Fair, encourage the further development of the program, which is indicated in the conclusion.

Fifteen years of the cologne medical model study course: has the expectation of increasing student interest in general practice specialization been fulfilled?

Background: The 2002 Medical Licensure Act gave German universities certain freedoms for reforming their medical degree courses. The Medical Faculty of the University of Cologne took advantage of this opportunity and introduced a model study course in the winter semester 2003/04 through §41 of the Medical Licensure Act. One of the main reasons for this was that back then there was an increasing shortage of doctors in clinical curative medicine and GP primary care. This study investigates whether the introduction of the Cologne Model Study Course (MSG) can show stronger interest in curative medical work (especially General Practice) compared to students of the standard degree course (RSG). Methodology: The proof of added value was examined through graduate surveys conducted at the University of Cologne and through the proportion of students who completed the PY elective rotation "General Practice". The students of the standard degree course (start of studies prior to winter semester 2003/2004) were compared with students of the model study course (start of studies from winter semester 2003/04 onwards). Measurements were carried out using descriptive frequency tables and correlation analyzes according to Spearman. Results: The students' interest in curative medicine was already high (91%) even before the model study course was introduced and increased only slightly (to 91.9%). There is also only a slight increase in specialization in General Practice (RSG=5.9% vs. MSG=9.2%). However, selection of rotations in General Practice was significantly increased (RSG=1.9% vs. MSG=3.4%, r=0.046 **, p<0.005). Conclusion: The Cologne Model Study Course in Human Medicine has increased awareness of the subject of General Practice among students through a large number of curricular changes. The fact that only marginal effects can be demonstrated shows once more the strong dependence of choosing General Medicine as a career path on other factors (such as gender or the presence of positive role models) and emphasizes the necessity of promoting General Practice student education not only through increased curricular mapping but by additional innovative concepts to maximize the status of General Practice from the perspective of students.

Research into finding a stable prognosis parameter for the detection of students in need of guidance - Realization of equal opportunities through a diversity-oriented study guidance.

Objective: The internationalization of teaching and studying as well as increasing numbers of students with increasingly heterogeneous educational biographies and lifestyles require universities to develop awareness of this diversity and the need for adequate diversity management. For some diversity criteria at least it has been proven that they can influence the individual study success of students. The Dean's Office of the Medical Faculty of the University of Cologne has empirically determined a stable prognosis parameter for study progression on the basis of selected criteria in order to enable early detection of students in need of guidance. This will then be used for targeted, diversity-oriented study guidance. On the one hand a correspondingly adapted guidance offer should take into account individual study progressions. On the other hand, measures to improve the equal opportunities of students with regard to their academic success can be discussed. Methodology: With the help of study progression analyses, study progress of cohorts can be recorded longitudinally. The study progression analysis implemented in the control of faculty teaching serves as a central forecasting and steering tool for the forthcoming concept of diversity-oriented study guidance. The significance measurement of the various features is determined using binary logistic regression analyses. Results: As part of the study progression analyses, the study success rate after the first semester has the strongest influence on the concordance with the minimum duration of study in the pre-clinical phase, followed by the characteristics age at commencement of studies and place of university entrance qualification. The school leaving grade only just misses the required significance level of p <0.05. As a predictor gender provides no explanatory contribution in the considered model. Conclusion: In order to do justice to the heterogeneity among the students, university administrators and lecturers should understand the recognition of diversity as a cross-cutting task and keep an eye on diversity-related aspects and discrimination-critical topics for different target groups as well as individual guidance services in the context of individual study guidance. Within the scope of this study, we were able to empirically prove the stable prognosis parameter study success rate after the first semester allows reliable detection of students in need of guidance. The explanatory contribution is larger than any of the individual criteria examined in this study. The specific causes that led to a delay in studying will be analyzed in the context of downstream and diversity-oriented study guidance. A follow-up study will deal with the question of whether the success of students requiring study guidance can be significantly improved by subsequent study guidance.

Does teaching social and communicative competences influence dental students' attitudes towards learning communication skills? A comparison between two dental schools in Germany.

Introduction: Teaching social and communicative competences has become an important part of undergraduate dental education. The aim of this study was to explore the influence of a longitudinal curriculum, addressing social and communication skills, on dental students' attitudes towards learning these skills. Material and methods: Data on the attitudes towards learning communication skills were collected at two German universities and compared in a cross-sectional survey. 397 dental students were included, 175 students attended a longitudinal curriculum addressing social and communicative competences while 222 students did not. The dental students' attitude towards learning communication skills was measured by a German version of the Communication Skills Attitude Scale (CSAS-D). Results: Dental students who participated in a longitudinal communication curriculum had significantly lower negative attitudes towards learning communication skills than students who did not attend such courses. Differences in positive attitudes could not be found. Significant interaction effects were found for the factors gender and section of study: female students in the clinical section of their study who participated in the longitudinal curriculum reported higher positive attitudes and lower negative attitudes compared to female students in the preclinical section of study. Conclusion: The results of this study indicate that a longitudinal curriculum addressing communication skills can enhance positive and reduce negative attitudes towards learning communication skills. More longitudinal data is needed to explore to what extent gender affects development of communication skills and how students' attitudes towards learning communication change in the long run.

Peyton's 4-Steps-Approach in comparison: Medium-term effects on learning external chest compression - a pilot study.

INTRODUCTION: The external chest compression is a very important skill required to maintain a minimum of circulation during cardiac arrest until further medical procedures can be taken. Peyton's 4-Steps-Approach is one method of skill training, the four steps being: Demonstration, Deconstruction, Comprehension and Execution. Based on CPR skill training, this method is widely, allegedly predominantly used, although there are insufficient studies on Peyton's 4-Steps-Approach for skill training in CPR in comparison with other methods of skill training. In our study, we compared the medium- term effects on learning external chest compression with a CPR training device in three different groups: PEY (Peyton's 4-Steps-Approach), PMOD (Peyton's 4-Steps-Approach without Step 3) and STDM, the standard model, according to the widely spread method "see one, do one" (this is equal to Peyton's step 1 and 3). MATERIAL AND METHODS: This prospective and randomised pilot study took place during the summer semester of 2009 at the SkillsLab and Simulation Centre of the University of Cologne (Kölner interprofessionelles Skills Lab und Simulationszentrum - KISS). The subjects were medical students (2(nd) and 3(rd) semester). They volunteered for the study and were randomised in three parallel groups, each receiving one of the teaching methods mentioned above. One week and 5/6 months after the intervention, an objective, structured single assessment was taken. Compression rate, compression depth, correct compressions, and the sum of correct checklist items were recorded. Additionally, we compared cumulative percentages between the groups based on the correct implementation of the resuscitation guidelines during that time. RESULTS: The examined sample consisted of 134 subjects (68% female; age 22±4; PEY: n=62; PMOD: n=31; STDM: n=41). There was no difference between the groups concerning age, gender, pre-existing experience in CPR or time of last CPR course. The only significant difference between the groups was the mean compression rate (bpm): Group 1 (PEY) with 99±17 bpm, Group 2 (PMOD) with 101±16 bpm and Group 3 (STDM) with 90±16 bpm (p=0,007 for Group 3 vs. Group 1 and Group 3 vs. Group 2, Mann-Whitney- U-Test). We observed no significant differences between the groups after the second assessment. CONCLUSION: Our study showed that there are no essential differences in external chest compression during CPR performed by medical students dependent on the teaching method (Peyton vs. "Non-Peyton") implemented with regard to the medium-term effects. The absence of benefits could possibly be due to the simplicity of external chest compression.

Implementation of an innovative hands-on training to improve adherence to hygiene rules: A feasibility Study.

BACKGROUND: Hospital-acquired infections (HAI) still pose a major problem in inpatient care. The single most important measure for preventing HAIs is to improve adherence to hand hygiene among health care professionals. OBJECTIVE: To assess the feasibility of an innovative hands-on training to improve adherence to hygiene rules under standardized and under real life conditions. DESIGN: Before-after controlled cohort trial to assess the feasibility of implementing an innovative hands-on training to improve hand hygiene adherence. SETTING: Large university hospital in Germany. PARTICIPANTS: Fifty trained nurses from three wards with an average age of 32years (±10.22years) and an average vocational experience of 6.85years (±7.54years). METHODS: The intervention consisted of a hands-on training in the skills lab of the University of Cologne complemented by a 12-week observation period before and after the training on participating wards. The training comprised important skills with respect to hand hygiene, venipuncture, dressing changes of central venous catheters, preparation of IV infusions, and donning of gloves using sterile technique. A communication training was included to enable nurses to enforce hygiene rules in their collaboration with peers and physicians. The intervention was taught in small groups with a wide array of interactive teaching methods. It was evaluated using the objective structured clinical examination (OSCE) format. Observations were conducted by a trained infection control nurse. RESULTS: Before (after) the intervention 622 (612) occasions of hand hygiene were documented. A highly significant improvement in hygiene compliance was observed pre- and post-intervention (64.3% vs. 79.2%; p≤0.0001). The OSCE evaluation showed significant improvements in all subscales. CONCLUSION: The developed and conducted hands-on training seems feasible and is successful in significantly improving adherence to hygiene rules under standardized and real life conditions. Whether the effect is stable over time is subject to further investigation.

"May I help you?" - Evaluation of the new student service at the reception desk during the clinical courses at the Department of Operative Dentistry and Periodontology as a part of a longitudinal curriculum of social and communicative competences for dental students.

OBJECTIVES: Since 2009, the University of Cologne has been developing a longitudinal curriculum for teaching social and communicative skills to dental students (LSK-Dent) based on the recommendations of the Association for Dental Education in Europe (ADEE). As a part of this curriculum it was considered to develop a reception service in the undergraduate treatment courses of the Department of Operative Dentistry and Periodontology involving the organizational and administrative handling of the patients by the students. Students should gain an insight into everyday practice and the reception service should function as a learning environment for social und communicative competences. This article introduces the LSK-Dent project, the implementation of the reception service and presents initial evaluation results. METHODS: Patients (n=575) and students (n=53) filled out a questionnaire. Additionally, four semi-structured interviews with students were conducted. RESULTS: The reception service was successfully implemented and endorsed by the students. First indications suggest that the reception service was well received by students as a learning environment for social und communicative competences and viewed as an opportunity to gain an insight into everyday practice. CONCLUSION: The reception service is an innovative addition to the treatment courses and an example for transforming an already existing reality in a course into a new learning environment for students. To what extent the implementation of reflexive elements can increase the subjectively perceived additional benefit by students, has to be addressed in further studies.

Computer versus paper--does it make any difference in test performance?

UNLABELLED: CONSTRUCT: In this study, we examine the differences in test performance between the paper-based and the computer-based version of the Berlin formative Progress Test. In this context it is the first study that allows controlling for students' prior performance. BACKGROUND: Computer-based tests make possible a more efficient examination procedure for test administration and review. Although university staff will benefit largely from computer-based tests, the question arises if computer-based tests influence students' test performance. APPROACH: A total of 266 German students from the 9th and 10th semester of medicine (comparable with the 4th-year North American medical school schedule) participated in the study (paper = 132, computer = 134). The allocation of the test format was conducted as a randomized matched-pair design in which students were first sorted according to their prior test results. The organizational procedure, the examination conditions, the room, and seating arrangements, as well as the order of questions and answers, were identical in both groups. RESULTS: The sociodemographic variables and pretest scores of both groups were comparable. The test results from the paper and computer versions did not differ. The groups remained within the allotted time, but students using the computer version (particularly the high performers) needed significantly less time to complete the test. In addition, we found significant differences in guessing behavior. Low performers using the computer version guess significantly more than low-performing students in the paper-pencil version. CONCLUSIONS: Participants in computer-based tests are not at a disadvantage in terms of their test results. The computer-based test required less processing time. The reason for the longer processing time when using the paper-pencil version might be due to the time needed to write the answer down, controlling for transferring the answer correctly. It is still not known why students using the computer version (particularly low-performing students) guess at a higher rate. Further studies are necessary to understand this finding.

Do different medical curricula influence self-assessed clinical thinking of students?

OBJECTIVES: As a fundamental element of medical practice, clinical reasoning should be cultivated in courses of study in human medicine. To date, however, no conclusive evidence has been offered as to what forms of teaching and learning are most effective in achieving this goal. The Diagnostic Thinking Inventory (DTI) was developed as a means of measuring knowledge-unrelated components of clinical reasoning. The present pilot study examines the adequacy of this instrument in measuring differences in the clinical reasoning of students in varying stages of education in three curricula of medical studies. METHODS: The Diagnostic Thinking Inventory (DTI) comprises 41 items in two subscales ("Flexibility in Thinking" and "Structure of Knowledge in Memory"). Each item contains a statement or finding concerning clinical reasoning in the form of a stem under which a 6-point scale presents opposing conclusions. The subjects are asked to assess their clinical thinking within this range. The German-language version of the DTI was completed by 247 student volunteers from three schools and varying clinical semesters. In a quasi-experimental design, 219 subjects from traditional and model courses of study in the German state of North Rhine-Westphalia took part. Specifically, these were 5(th), 6(th) and 8(th) semester students from the model course of study at Witten/Herdecke University (W/HU), from the model (7(th) and 9(th) semester) and traditional (7(th) semester) courses of study at the Ruhr University Bochum (RUB) and from the model course of study (9(th) semester) at the University of Cologne (UoC). The data retrieved were quantitatively assessed. RESULTS: The reliability of the questionnaire in its entirety was good (Cronbach's alpha between 0.71 and 0.83); the reliability of the subscales ranged between 0.49 and 0.75. The different groups were compared using the Mann-Whitney test, revealing significant differences among semester cohorts within a school as well as between students from similar academic years in different schools. Among the participants from the model course of study at the W/HU, scores increased from the 5(th) to the 6(th) semester and from the 5(th) to the 9(th) semester. Among individual cohorts at RUB, no differences could be established between model and traditional courses of study or between 7(th) and 9(th) semester students in model courses of study. Comparing all participating highest semester students, the 8(th) semester participants from the W/HU achieved the highest scores - significantly higher than those of 9(th) semester RUB students or 9(th) semester UoC students. Scores from the RUB 9(th) semester participants were significantly higher than those of the 9(th) semester UoC participants. DISCUSSION: The German-language version of the DTI measures self-assessed differences in diagnostic reasoning among students from various semesters and different model and traditional courses of study with satisfactory reliability. The results can be used for discussion in the context of diverse curricula. The DTI is therefore appropriate for further research that can then be correlated with the different teaching method characteristics and outcomes of various curricula.

Simulator Network project report: a tool for improvement of teaching materials and targeted resource usage in Skills Labs.

During the last decade, medical education in the German-speaking world has been striving to become more practice-oriented. This is currently being achieved in many schools through the implementation of simulation-based instruction in Skills Labs. Simulators are thus an essential part of this type of medical training, and their acquisition and operation by a Skills Lab require a large outlay of resources. Therefore, the Practical Skills Committee of the Medical Education Society (GMA) introduced a new project, which aims to improve the flow of information between the Skills Labs and enable a transparent assessment of the simulators via an online database (the Simulator Network).