Transfer of learning in histology: Insights from a longitudinal study.

All anatomical educators hope that students apply past training to both similar and new tasks. This two-group longitudinal study investigated the development of such transfer of learning in a histology course. After 0, 10, and 20 sessions of the 10-week-long course, medical students completed theoretical tasks, examined histological slides trained in the course (retention task), and unfamiliar histological slides (transfer task). The results showed that students in the histology group gradually outperformed the control group in all tasks, especially in the second half of the course, η2 = 0.268 (p < 0.001). The best predictor of final transfer performance was students' retention performance after 10 sessions, ß = 0.32 (p = 0.028), and theoretical knowledge after 20 sessions, ß = 0.46 (p = 0.003). Results of eye tracking methodology further revealed that the histology group engaged in greater "visual activity" when solving transfer tasks, as indicated by an increase in the total fixation count, η2 = 0.103 (p = 0.014). This longitudinal study provides evidence that medical students can use what they learn in histology courses to solve unfamiliar problems but cautions that positive transfer effects develop relatively late in the course. Thus, course time and the complex relationship between theory, retention, and transfer holds critical implications for anatomical curricula seeking to foster the transfer of learning.

Artificial Intelligence Supporting the Training of Communication Skills in the Education of Health Care Professions: Scoping Review.

BACKGROUND: Communication is a crucial element of every health care profession, rendering communication skills training in all health care professions as being of great importance. Technological advances such as artificial intelligence (AI) and particularly machine learning (ML) may support this cause: it may provide students with an opportunity for easily accessible and readily available communication training. OBJECTIVE: This scoping review aimed to summarize the status quo regarding the use of AI or ML in the acquisition of communication skills in academic health care professions. METHODS: We conducted a comprehensive literature search across the PubMed, Scopus, Cochrane Library, Web of Science Core Collection, and CINAHL databases to identify articles that covered the use of AI or ML in communication skills training of undergraduate students pursuing health care profession education. Using an inductive approach, the included studies were organized into distinct categories. The specific characteristics of the studies, methods and techniques used by AI or ML applications, and main outcomes of the studies were evaluated. Furthermore, supporting and hindering factors in the use of AI and ML for communication skills training of health care professionals were outlined. RESULTS: The titles and abstracts of 385 studies were identified, of which 29 (7.5%) underwent full-text review. Of the 29 studies, based on the inclusion and exclusion criteria, 12 (3.1%) were included. The studies were organized into 3 distinct categories: studies using AI and ML for text analysis and information extraction, studies using AI and ML and virtual reality, and studies using AI and ML and the simulation of virtual patients, each within the academic training of the communication skills of health care professionals. Within these thematic domains, AI was also used for the provision of feedback. The motivation of the involved agents played a major role in the implementation process. Reported barriers to the use of AI and ML in communication skills training revolved around the lack of authenticity and limited natural flow of language exhibited by the AI- and ML-based virtual patient systems. Furthermore, the use of educational AI- and ML-based systems in communication skills training for health care professionals is currently limited to only a few cases, topics, and clinical domains. CONCLUSIONS: The use of AI and ML in communication skills training for health care professionals is clearly a growing and promising field with a potential to render training more cost-effective and less time-consuming. Furthermore, it may serve learners as an individualized and readily available exercise method. However, in most cases, the outlined applications and technical solutions are limited in terms of access, possible scenarios, the natural flow of a conversation, and authenticity. These issues still stand in the way of any widespread implementation ambitions.

Planetary health as a main topic for the qualification in digital teaching - a project report.

Aim: To do justice to the need for planetary health in medical education, these are the aims of the online elective course "Planetary Health in Medical Education" (ME elective):1. Enable students to plan and realize their own course sessions on planetary health;2. Encourage communication among university medical faculties regarding planetary health in medical education;3. Reinforce competency in digital teaching and amplify the expert role as multiplicator among students pursuing a Master's degree in Medicinal Education (MME). Method: The development of the ME elective followed Kern's six-step approach to curriculum development by means of cooperation between the German Medical Students' Association (Bundesvertretung der Medizinstudierenden in Deutschland, abbreviated as bvmd), and the MME study program. Based on general and specific needs analyses, core learning objectives regarding planetary health, medical education and digital education were identified in the National Catalogue of Learning Objectives in Undergraduate Medical Education (NKLM) and the MME study program and relevant teaching methods were selected. Results: The ME elective, consisting of two contact hours per week per semester, was established at 13 medical schools as a four-phase course:1. Introduction to medical education using examples from planetary health;2. Lesson planning on a topic in planetary health under the supervision of MME students;3. Course sessions held by the undergraduate students; and4. Networking with the MME study program through participation in digital courses on planetary health and the pilot OSCE on planetary health.A total of 24 students attended the pilot in the 2022 summer semester. Conclusion: The topic of planetary health combines interests that span many subjects and semester levels. As a collaborative, interdisciplinary and interprofessional subject, it lends itself to training students in a trans-institutional elective course to become multiplicators.

From summative MAAS Global to formative MAAS 2.0 - a workshop report.

Background: The MAAS Global (Maastricht History-taking and Advice Scoring List) is an internationally widely-used instrument in under- and postgraduate medical education. The focus is on the assessment of medical communication and clinical skills. The assessment tool, which has also been used in Germany since 2015, has a high-quality design (e.g. comprehensible structure, appropriate complexity), good psychometric properties and is very user-friendly. An update of MAAS Global, MAAS 2.0, was published in March 2021 with a new and greater focus on context and the formative. Method: The revised version of the MAAS 2.0 assessment sheet was translated into German with the authors' permission. Open questions were discussed with the revision process project manager. Results: The revision was carried out with a view to focusing on the patient's frame of reference, removing ambiguities identified previously while using MAAS Global, and closer alignment with the underlying Calgary-Cambridge model. Furthermore, the scale used for the evaluation was modified and now uses a formative evaluation range without grade-related classification. Conclusion: With the content reorientation of MAAS Global to MAAS 2.0, and the associated focus on frame of reference, context, the formative, the revision presented here sets new priorities for future evaluations in the context of under- and postgraduate medical education and the assessment of medical patient communication in general.

Specifics of and training needs in the inter-professional home care ofpeople with dementia.

Introduction: Successful home care for people living with dementia (PLwD) allows them to live in their own home environment for as long as possible. Current findings indicate a need for further development of medical and nursing knowledge and skills in evidence-based collaborative care for these patients. Aim: To identify specifics of inter-professional care for PLwD and training needs of home care nurses and general practitioners involved in care. Method: A multi-perspective qualitative study was conducted, comprising focus groups as well as individual interviews. Focus groups and interviews followed a semi-structured topic guide. Interview data was digitally recorded and transcribed verbatim, followed by a thematic framework analysis. Results: The sample consisted of nine nurses, one medical assistant, three general practitioners and nine family caregivers of PLwD. Five themes related to inter-professional home care were inductively developed: challenges in outpatient dementia care, challenges in collaboration, insufficient healthcare infrastructure, competencies needed in dementia care, and training requirements. Challenges were a lacking flow of information as well as continuity and organization of care. Home care nurses and family caregivers complained about missing communication skills in health professionals involved in the care of PLwD. Conclusions: The interviews revealed heterogeneous training needs of home care nursing staff and general practitioners that can be addressed by an inter-professional training course.

Bridging the Gap Between Competencies and Uncertainties in Postgraduate Training in Family Medicine: Results and Psychometric Properties of a Self-Assessment Questionnaire.

Purpose: One of the reasons for postgraduate trainees not to choose working in a rural area is uncertainty related to the lack of competencies. The aim of this study was to investigate the concept of uncertainty by measuring competencies and to examine the psychometric properties of an instrument that measures competencies related to uncertainty in the self-assessment of postgraduate trainees in family medicine. Patients and Methods: A questionnaire was created based on pre-existing instruments. It was distributed to participants of postgraduate training seminars in the federal states of Baden-Württemberg and Schleswig-Holstein, Germany in 2016. Descriptive statistics and a partial correlation analysis were calculated for measuring the degree of association between year of postgraduate training and items' responses. Psychometric properties were assessed by calculating descriptive item analysis, factor analysis and internal consistency. Results: The response rate was 85% (105/124). More than one-fifth of the participants stated to show only seldom or sometimes the following skills: ability to balance work and life (N=25, 24%), letting a mild disorder run its own way (N=24, 23%) and ability to conduct interventions that decreased aggression from the patient (N=22, 21%). More than half of the participants felt (very) insecure in performing routine child check-ups, the application of a below elbow backslab and the partial removal of a toenail. Nine out of 21 items showed positive statistically significant correlation between level of competence and progress in training. Factor analysis led to a final instrument with 12 items (Cronbach's α=0.736) and a three-factor-structure: "doctor well-being and resilience", "communication" and "skills". Conclusion: In order to reduce uncertainty with all its consequences, a focus on teaching of competencies regarding the physicians' well-being and resilience, communication and skills has to be continued in postgraduate training.

[Peak moments in physician-patient consultations in general practice: A qualitative study among primary care physicians in Germany]. / Peak Moments im Ärzt*innen-Patient*innen-Kontakt der hausärztlichen Praxis­eine qualitative Studie mit Allgemeinmediziner*innen in Deutschland.

BACKGROUND: Successful therapy is influenced by successful communication and a relationship built on trust. Physician empathy and listening skills appear particularly relevant. Based on their empirical experience, general practitioners report special moments in their patients during their medical consultations. Abraham Maslow coined the term "peak experience" for these special moments, which are rare and deeply moving. The present study examines "peak moments" in terms of existence, origin, characterization, doctor perception, and the overall effect on the doctor-patient relationship. METHOD: A qualitative study design was chosen. Interviews with family practitioners were conducted and analyzed using qualitative content analysis by Kuckartz. In order to collect socio-demographic information the participants were asked to complete a short questionnaire. RESULTS: The study participants (n=17) confirmed the existence of peak moments in doctor-patient interactions in their GP practices. These moments came about spontaneously, facilitated by specific communication strategies and intervention measures to support a situation in which peak moments become possible. To bring about a peak moment in patients, specific requirements need to be met on the part of both doctors and patients. Primary care physicians participating agreed that a peak moment led to relaxation and a stronger trust in the relationship between doctor and patient. CONCLUSIONS: Family physicians perceive peak moments to be an important element to build trust between themselves and their patients, for the patients' increased "self-awareness", and to improve the chances of treatment success. To enable peak moment conditions for general practitioners, a framework of health policy measures such as education and training is recommended, along with an assessment of the time needed for doctor-patient interactions.

Determinants of interprofessional collaboration in complementary medicine to develop an educational module "complementary and integrative medicine" for undergraduate students: A mixed-methods study.

As use of complementary medicine (CM) is increasing, health professionals may require proper training in CM to offer evidence-based advice to their patients. The aim of this study was to explore interprofessional collaboration (IPC) in CM in order to gain a comprehensive overview of determinants and to facilitate the definition of objectives for an undergraduate interprofessional educational module. Pursuant to a sequential mixed-methods approach, focus groups and individual interviews with health professionals, who actively use CM in patient care, were conducted. All hospital employees at the University Hospital Lübeck, Germany, were asked to complete an online questionnaire that was based on the previously obtained qualitative results. The interviews with 20 participants revealed four main themes: profession-specific aspects, communication, health care system-associated factors, and the influence of CM on interprofessional dynamics. An analysis of the 157 responses in the online questionnaire showed that team meetings (n = 124, 79%) were most frequently stated as promoting IPC. In binary regression analyses, nursing (OR = 6.17 [2.02-18.84]) and medical professions (OR = 3.77 [1.27-11.18]) predicted evidence-based care as enabler for IPC. Hence, teaching professional competencies and an equal understanding of evidence-based medicine seems necessary to promote IPC within CM.

[Reasons for Encounter in Out-of-Hours Care in Emergency Departments and Emergency Practices - A Mixed Methods Trial]. / Beratungsanlässe in Notaufnahmen und Notfallpraxen außerhalb hausärztlicher Sprechstundenzeiten ­ Eine Mixed-Methods-Studie.

OBJECTIVE: Since 2006, with the opening of emergency practices (EP) in Germany, out-of-hours patient care has been carried out by general practitioners. Additionally, emergency departments (ED) of the hospitals ensure acute care. Thus, optimal coordination of care is a much discussed subject. The aim of this study was to provide reasons for encounter and subjective reasons to visit each of these institutions. METHODS: In a mixed method trial, patients with non-urgent conditions (Manchester Triage System level 4 and 5) were interviewed in 2 ED in Schleswig-Holstein and 2 EP in Baden-Württemberg regarding their reasons for encounter from July 2015 to August 2016 during the out of hours primary care practices. Data collection was carried out using a paper-based questionnaire and a semi-structured interview. The statistical program SPSS was used for descriptive analysis, text data analysis was carried out with the method of qualitative content analysis. RESULTS: In total, 398 patients were interviewed. Most frequently, reasons for encounter in ED and EP were related to musculoskeletal complaints (39%, n=116 and 23%, n=23, respectively). Within technical examination services, the laboratory diagnostics were used as a priority in ED (59%, n=175). In the EP, one patient (2%) underwent laboratory diagnostics. The main reasons for encounter in both facilities were increasing complaints (50%, n=147 in ED; 70%, n=70 in EP) and a desire for quick diagnosis (73%, n=217 in ED; 48%, n=48 in EP). In total, 112 patients (28%) had a medication plan, and 67 (60%) brought it into the facility. Two-thirds of ED patients (n=197) were handed over to outpatient care. In EP, 89% (n=89) continued as outpatient. Qualitative content analysis revealed similar complaint categories in both facilities, but with significant differences in the severity and experienced urgency. In both facilities, patients expected to have their symptoms clarified. In ED, the desire for a rapid and specific diagnosis was expressed more frequently. CONCLUSION: Indications for medical treatment were seen in most consultations in both care facilities. There was a distinction between the ED and EP in the urgency of the consultations.

Evaluation of attitudes towards telemedicine as a basis for successful implementation: A cross-sectional survey among postgraduate trainees in family medicine in Germany.

BACKGROUND: By comparison with other countries of the European Union Germany is only middle-ranking in terms of telemedicine usage. There is a relevant gap between the legal framework and the actual state of implementation. Healthcare providers play an important role in this implementation process as they are increasingly confronted with the application of telemedical scenarios. Therefore, the aim of this survey was to determine attitudes towards telemedicine of postgraduate trainees in Family Medicine (FM) in Germany. METHODS: A cross-sectional survey was conducted between July and October 2016 among postgraduate trainees in FM throughout Germany. The questionnaire covered four topics: attitudes towards telemedicine, barriers for the implementation of telemedicine, assessment of useful telemedical applications and telemedicine scenarios. A descriptive approach was used to analyze the data in order to derive determinants for the implementation of telemedicine. RESULTS: In total, 388 postgraduate trainees from 13 of the 16 federal states in Germany answered the survey. Seventy-eight percent were female. Participants' mean age was 36 years. The majority of participants believed that only a fraction of the already existing technology in telemedicine is being used (70 %). The largest perceived barrier to telemedicine was data safety concerns. More than half of the participants (54 %) believed that telemedicine would change the doctor-patient relationship. 51 % of the participants were interested in training in telemedicine. In this respect, it is important to note that 27 % of the postgraduate trainees said their willingness to practice in rural areas might be facilitated through the availability of telemedical backup for family physicians. CONCLUSIONS: Participating trainees in FM in Germany think that the potential for telemedicine is not yet fully exploited. Based on the results of this survey the next steps to be taken for the implementation of telemedicine applications can be addressed.

[Hyponatremia in older persons (II)-A clear treatment : How to detect tricks and avoid pitfalls]. / Hyponatriämie im Alter (II) ­ eine klare Therapie : Tücken erkennen und Fallstricke umgehen.

The aim of this continuing medical education (CME) article (part II) is to describe the particular challenge of the treatment of hyponatremia, which occurs in older patients. This part II follows on from part I concerning the diagnosis in the previous volume. A staged approach is necessary. The best treatment is always when the underlying cause can be eliminated. Hyponatremia in older patients is mainly induced by the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. The authors use a concept for the first, second and third line strategy: (1) changing or discontinuation of drugs, (2) fluid restriction and (3) tolvaptan medication. The algorithm for treatment should be simple. It also contains recommendations for the correction rate. Caution is also needed in order to avoid the occurrence of an osmotic demyelination syndrome (ODS).

[Hyponatremia in older persons (part I)-keep diagnosis simple : How to detect tricks and avoid pitfalls]. / Hyponatriämie im Alter (Teil I) ­ Diagnose leicht gemacht : Tücken erkennen und Fallstricke umgehen.

Old age is a strong independent risk factor for hyponatremia. Dizziness, fatigue, reduced vigilance, cognitive impairment, gait deficits, nausea, vomiting, headache, falls, osteoporosis and fractures, coma and seizures are more frequent and severe than in middle-aged patients. Hyponatremia is mainly caused by the syndrome of inappropriate antidiuretic hormone (SIADH) secretion and also including drugs. Hyponatremia is multifactorial in a significant proportion of older patients. Hyponatremia requires a staged diagnostic approach to identify the underlying cause. The aim of this continuing medical education (CME) report (part I) is to emphasize the special challenges in the diagnostics of hyponatremia, which occur in older patients. Diagnostics should be kept simple. A special algorithm is presented. Part II concerning treatment will follow.

[Determinants of Setting up a General Practice - a Qualitative Study]. / Determinanten der Niederlassung als Allgemeinmediziner ­ eine qualitative Studie.

BACKGROUND: In recent years, the motivation of the new generation of general practitioners to set up their own practice is decreasing. Knowledge of factors that promote and inhibit the process of setting up a practice can enable developing strategies to support this process. The aim of this study was to explore these determinants. METHODS: Between April and October 2016, self-employed general practitioners from Baden-Württemberg were invited to participate in a qualitative interview study. Stratification of 553 physicians, who participated in a general practice support program between 2008 and 2011 and set up a practice in 2008 to 2014, was based on the agglomeration in rural areas, the peripheral zones around the agglomeration and the urban agglomerations themselves. The transcripts of the interviews were analyzed by two authors with the content analysis according to Mayring and summarized. In a second step, a consensus version was elaborated. RESULTS: A total of 23 general practitioners were recruited, 57% female and 42 years on average, and mostly working in group practices. The main motivation to set up a practice was the desire to improve the situation in relation to the daily clinical routine. These included a lower duty load and more family-friendly working hours. Relevant supportive factors during setting up a practice were family support, participation in a postgraduate training rotation network program and professional counseling. Inhibiting factors were fears of recourse and indebtedness, a complicated accounting system and a bureaucratic process of admission. CONCLUSIONS: On the one hand, the study shows that the many advantages of working as a general practitioner, such as its being family friendly, need to be better communicated to the doctors and their financial concerns alleviated. On the other hand, the need for courses on management of one's practice has also become clear. A standardized and optimized process of setting up a practice with an improved overview and a collegial contact person can facilitate the decision for and implementing the setting up a medical practice as a general practitioner.

[Regional differences between general practitioners and general internal medicine physicians in primary care]. / Regionale Unterschiede zwischen Fachärztinnen und Fachärzten für Allgemeinmedizin und hausärztlich tätigen Internistinnen und Internisten in der hausärztlichen Versorgung.

OBJECTIVE: In many places in Germany, the need for primary care physicians has been steadily increasing for several years, especially in rural areas. It is hypothesized that physicians are more likely to practice in rural areas if they have received a broad education and vocational training. Differences between general practitioners (GPs) and physicians in general internal medicine (GIM) in the breadth of their vocational training are created by the underlying distinct training schemes. The aim of the analysis was to test whether GPs and GIM physicians differ in their distribution between urban and rural regions of Schleswig-Holstein and whether there are differences in the rate and frequency of performing home visits. METHODS: Based on invoicing data of the Association of Statutory Health Insurance Physicians in the federal state of Schleswig-Holstein (Northern Germany) covering the years 2015 up to the third quarter (Q3) of 2018, we analysed differences between GPs and GIM physicians in their regional distribution. Furthermore, we looked at differences between both specialties regarding the application rate and the number of home visits performed and unforeseen physician visits. In addition to bivariate approaches, we also used multivariate regression analysis. RESULTS: Between 2017 (Q4) and 2018 (Q3), 1,378 GPs and 585 GIM physicians provided medical services in Schleswig-Holstein. While 27.5 % of the GPs had practices in rural areas, the share of GIM physicians was 14.5 % (p < 0.001). Home visits were performed by 97.8 % of the GPs and 93.2 % of the GIM physicians (p < 0.001). This difference was even more pronounced in rural areas (99.5 % vs. 94.1 % (p = 0.002)). Significant differences have also been found in the number of billed home visits. GPs made 36 % more home visits than GIM physicians. In rural areas, the difference was 60 %. CONCLUSION: The analysis revealed significant differences between GPs and GIM physicians regarding the type of region where they work, the application rate and the number of performed home visits. The findings could foster a discussion about how GIM physicians can be better prepared to provide primary care, especially in rural areas.

[The "National Aeronautics and Space Administration-Task Load Index" (NASA-TLX) - an instrument for measuring consultation workload within general practice: evaluation of psychometric properties]. / Der "National Aeronautics and Space Administration-Task Load Index" (NASA-TLX) ­ ein Instrument zur Erfassung der Arbeitsbelastung in der hausärztlichen Sprechstunde: Bestimmung der psychometrischen Eigenschaften.

OBJECTIVE: The aims of the study were the translation and a first reflection of the psychometric properties of the Aeronautics and Space Administration-Task Load Index (NASA-TLX), a multidimensional instrument to measure workload in general practice. METHODS: During April and September 2015, the NASA-TLX was translated and evaluated. For this purpose, a questionnaire composed of the NASA-TLX items and others items related to demographic data, was developed. Postgraduate family medicine trainees and family physicians were then asked to assess patient consultations by applying the questionnaire. The psychometric properties of the NASA-TLX were identified using explorative and confirmatory factor analysis. Reliability was assessed using Cronbach's α. RESULTS: Overall, 16 participants completed 769 surveys after a single patient consultation. The highest average was observed for the item 'mental demand' (mean 6.9 ± 5.4), followed by the item 'effort' (mean 6.6 ± 5.5). Factor analysis revealed a one-factor solution with an explained variance of 56.9 %. The German version of NASA-TLX demonstrated a high internal consistency (Cronbach's α = 0.84). Confirmatory factor analysis showed that there was an acceptable consistency between the expected unidimensional structure and the data. CONCLUSIONS: The German version of NASA-TLX provides preliminary indications of psychometric properties and presents an important tool to evaluate family physicians' workload in direct patient contact.

Mobility concepts and access to health care in a rural district in Germany: a mixed methods approach.

BACKGROUND: Western countries are facing the challenges of an imminent shortage of physicians, especially general practitioners. As a consequence longer travel times to doctors' practices may arise. This study aimed to investigate the mobility behavior of a rural population in terms of medical consultations. METHODS: An exploratory mixed-methods design was conducted in the Waldshut district of the federal state Baden-Württemberg in Germany. Focus groups and a single telephone-interview with representatives, occupationally affiliated with mobility in the district (e.g. representatives of public transport, nursing-services or the District Office Waldshut), were performed in 2016 and analyzed using Mayring's structuring content analysis. A questionnaire based on the collected qualitative data was subsequently distributed to a random sample of 1000 adult inhabitants living in the Waldshut district. Quantitative data were analyzed employing descriptive statistics. RESULTS: Qualitatively, four focus groups and one single telephone-interview with a total of 20 participants were performed. Therein the necessity of reaching a nearby general practitioner and the importance of individual motor traffic was emphasized. Novel mobility modes of ride sharing and telemedicine were controversially discussed as future transport and consultation options, respectively. Quantitatively, 277 questionnaires (27.7%) were valid and included in our analysis. Mean age was 51 years (SD = 18.5) and 58% (n = 160) were female. Irrespective of the mode of transport 60% (n = 166) expected to reach their general practitioner within 15 min. Using the possibility of multiple answers 47% (n = 192) stated to use a car in order to reach their general practitioner, public transport was used by 5% (n = 19). Nearly 80% (n = 220) could imagine sharing a car with well-known persons for consultations. Turning to a general practitioner via telemedicine was imaginable for 32% (n = 91). CONCLUSIONS: Individual motor car traffic seems to be an important factor in providing accessibility to rural medical care. As a supplementation, web based ride sharing has economic and structural potential for reaching a doctor's practice. However, familiarity and trustworthiness need to be guaranteed within this flexible transport mode. Furthermore, telemedicine may be a future approach in order to reduce travel time to a doctor's practice.