Argument-based QUalitative Analysis strategy (AQUA) for analyzing free-text responses in health sciences Delphi studies.

Delphi methods are mostly used in the health sciences to reach agreement among experts on unclear issues. Generally, consensus is reached after several rounds of Delphi using standardized items. Additional open-ended questions offer respondents the opportunity to provide reasons for judgments. Although these free-text responses contribute substantially to the steering and result generation of the Delphi process, so far no analytical strategy has been established which takes into account the context and methodological principles of the Delphi procedure. Moreover, in already published Delphi studies the analysis of qualitative data is often not sufficiently disclosed.•We provide an overview of analytical strategies for free-text responses. We critically reflect on them with regard to their use and suitability in the context of Delphi procedures.•Following established qualitative methods of qualitative content analysis according to Mayring and thematic analysis according to Braun & Clarke, we developed the Argument-based QUalitative Analysis strategy (AQUA) for Delphi studies in the health sciences and presented it using a concrete project example.•This newly developed strategy can significantly support the rule-governed and intersubjective evaluation of free-text responses in Delphi processes, the integration of the results into the feedback design, and thereby also the quality of the results.

Final-year information on didactic and organizational issues for students and supervising physicians - project report on the development and implementation of the cross-site website PJ-input.

Objective: Final-year training is becoming increasingly important in medical studies and requires a high degree of personal responsibility from students. It is the task of supervising physicians to make informal learning opportunities available to students when working with and on patients and to gradually transfer responsibility to them. Both students and physicians have a great need for information regarding the contextual conditions and didactic realization of this transfer of responsibility. Up to now, the faculties have only provided information and support in a sporadic manner and with little standardization. With MERLIN, the joint project undertaken by the Competence Network for Teaching Medicine in Baden-Württemberg, a platform for the final year was developed and released on the web. The aim was to bundle information in order to support students and supervising physicians in their teaching-learning process and to improve the quality of teaching in the final year. Project description: The development process of this platform took place in several steps across all faculties. Content and materials were compiled and structured based on a needs assessment. The first draft was evaluated by means of a simulation by students and then revised. A professional internet agency was involved for the technical implementation. The newly designed website PJ-input ("PJ" being the abbreviation for "Praktisches Jahr", the final year) contains areas for students and supervising physicians, as well as faculty-specific and general information about the final year. Faculty-specific content can be entered directly by the respective staff via an input mask and updated at any time. The provision of didactic materials can support competency-oriented teaching and learning in the final year. Here, for example, the concept of the Entrustable Professional Activities (EPA) was taken up, which gives students and supervising physicians orientation for the gradual assumption or transfer of responsibility. The platform was launched in spring 2021. Usage behavior is continuously recorded via the web application. Results and conclusion: The evaluation results show that the website is visited often and perceived as supportive. Increasing usage figures and the high frequency of use by students in the sections "im PJ" (during the final year) and "nach dem PJ" (after the final year) for the faculties involved in the MERLIN project confirm the target group-oriented design and use. The site should be promoted even more to pre-final-year students, as well as across state borders and to the target group of faculties. It is expected that nationwide faculty participation will make a significant contribution to the competency-based shift in teaching and the standardization of training during the final year of study under the new licensing regulations.

Naturopathy, complementary and integrative medicine in medical education - position paper by the GMA Committee Integrative Medicine and Perspective Pluralism.

Background: A large part of the population in Germany makes use of naturopathic, complementary and integrative medical treatments. There are now numerous scientific studies that provide evidence of efficacy for certain indications. At German medical faculties, selected procedures and their application are taught within the cross-sectoral unit called QB 12 and some elective courses, with a focus on specific aspects are offered. So far, however, there has been no structured curriculum that longitudinally anchors teaching across medical studies and enables all students to consider naturopathic and complementary medical options for patient care later on and to integrate them effectively into the diagnostic and treatment process. Objective: The aim of this position paper is to show the relevance of this topic for medical education, to clarify terminology and to present core competencies and possible implementation options for training. Method: The Integrative Medicine and Perspective Pluralism Committee of the German Association for Medical Education developed this position paper in a multi-stage consensual process, in cooperation with the Forum of University Work Groups on Naturopathic Treatment and Complementary Medicine. Results: First, different umbrella terms were discussed and an existing definition of integrative medicine and health was chosen for subsequent use. Building on this step, the status of education and its scientific foundation in Germany was considered in an international context. In the next step, a competency profile for medical training, consisting of seven areas of competency, was developed and described in detail with regard to naturopathic, complementary and integrative medicine. Implementation options were identified using possible starting points in the curriculum and using established examples of best practice. Conclusion: Despite different priorities at each faculty, it was possible to find an agreement on the development of competencies and anchoring them in medical education on the basis of a common definition of terms. Currently, the implementation in the mandatory and elective areas is very heterogeneous. As part of the current revision of the Medical Licensure Act, there are many possible starting points for the integration of naturopathic and complementary medical teaching content, especially in interprofessional and general practice courses. The implementation and accompanying research of targeted teaching settings should lay the foundations for a long-term and binding integration into medical education. Overall, it is clear that medical education in the field of naturopathy and complementary and integrative medicine has the potential to develop comprehensive core medical competencies.

Reporting guidelines for Delphi techniques in health sciences: A methodological review.

BACKGROUND: Delphi techniques are conducted across different subfields in the health sciences. The reporting practices of studies using Delphi techniques vary, and current reporting guidelines for Delphi techniques focus on individual subfields of the health sciences or on different aspects of research and are therefore of limited applicability. The aim of this article was to identify similarities, differences, and possible shortcomings of existing Delphi reporting guidelines and to draft an initial proposal for a comprehensively applicable reporting guideline. METHODS: A systematic literature search for reporting guidelines on Delphi studies was performed in existing data resources based on databases in the health sciences (Scopus, MEDLINE, CINAHL, Epistemonikos) including publications from 2016 to 2021. In June 2021, we conducted an additional search in PubMed and included further studies by contacting experts of the scientific Delphi expert network (DeWiss). Title and abstract screening of articles was performed, followed by a full-text screening of the articles included. We qualitatively and quantitatively evaluated, compared and contrasted the reporting guidelines identified using content analysis and discussed the results among the members of the Delphi expert network. RESULTS: We retrieved ten health science articles with reporting guidelines for Delphi studies. In analyzing them, we identified nine main categories (Justification, Expert panel, Questionnaire, Survey design, Process regulation, Analyses, Results, Discussion, Methods reflection & Ethics). The current reporting guidelines vary significantly, with only the aspect of consensus appearing in all of them. Frequency distributions show that most of the subcategories are only addressed in individual articles (e.g., meeting of participants, proceeding with the survey method, transfer of the results, validation, prevention of bias) and that epistemological foundations of the Delphi technique are rarely mentioned or reflected on. We drafted an initial proposal for Delphi reporting guidelines for the health science sector. DISCUSSION: A well-justified position concerning epistemological foundations of Delphi studies is necessary to make the quality of the process assessable and, along with the reporting of the process, to classify and compare study results. This will increase the acceptance of both the method in the health science sector and the results in medical practice. A Delphi reporting guideline must, above all, take into account the diversity of variants, subfield-related objectives and application areas, and their modifications of the Delphi technique in order to be comprehensively applicable in the health sciences. CONCLUSION: The results of our methodological review do not provide a final reporting guideline. The newly developed proposal is intended to encourage discussion and agreement in further analyses.

Consensus views on competencies and teaching methods for an interprofessional curriculum on complementary and integrative medicine: A Delphi study.

OBJECTIVE: A collaborative team is necessary to help patients achieve their healthcare goals using complementary medicine. At present, healthcare professionals do not feel sufficiently qualified to provide this service. This study sought to identify competencies and teaching methods for interprofessional training on complementary and integrative medicine at medical schools. METHODS: Sixty-five German-speaking experts with various professional backgrounds were invited to take part in a three-round Delphi study. In the first round, predefined competencies were assessed on a seven-point Likert scale, and participants were invited to propose additional competencies that would be evaluated in the subsequent rounds. The competencies were ranked based on the participant assessments and were assigned to four relevance groups. In the second and third rounds, suitable teaching methods were identified using free-text fields and multiple-choice questions. In a final workshop, participants synthesized the outcomes of the previous sessions and derived key competencies that would be a benefit to undergraduate interprofessional training in complementary and integrative medicine at medical schools. RESULTS: The three rounds plus final worksop were attended by 50, 40, 36 and 11 experts. The competencies that these experts determined to be highly relevant to teaching complementary and integrative medicine emphasized, in particular, the respectful treatment of patients and the importance of taking a medical history. From these highly relevant competencies, three key targets were agreed upon in the final workshop: students are able to 1) classify and assess complementary medical terms and methods; 2) work collaboratively and integrate patients into the interprofessional team; 3) involve patients and their relatives respectfully and empathetically in all healthcare processes. To achieve these competency goals, the following teaching methods were highlighted: students discuss therapy options based on authentic patient cases with each other and practice empathic patient communication incorporating complementary medicine. Further, the theoretical background of complementary medicines could be provided as online-training, to use the class sessions for hands-on exercises and interprofessional exchange and discussion. CONCLUSION: Despite the heterogeneous panel of experts, a consensus was reached on the competency orientation and teaching approaches. The results can promote the implementation of interprofessional training for complementary medicine in undergraduate education.

Interprofessional Education on Complementary and Integrative Medicine.

BACKGROUND: Interprofessional education and complementary and integrative medicine (CIM) strive for patient-centred medical care. Combining both concepts in education seems promising to prepare students for future health care. This article explores the question of what should be considered in undergraduate interprofessional training on complementary and integrative medicine for students of medicine and other health care professions and what benefits can be expected. METHODS: A three-round Delphi study was conducted with experts from varied professional backgrounds who have experience in teaching and patient care to address CIM training in the above-mentioned setting. Presented here are the results of the third round, in which 40 experts were asked open questions about what benefits/opportunities and what barriers/challenges they expect when such training programmes are offered. The statements were inductively evaluated by content analysis, to develop categories and subcategories. RESULTS: The response rate was 90% (n = 36). The categories (and most frequently mentioned subcategories) were as follows: Regarding benefits: patient care (strengthening holistic and patient-centred care); teaching and learning (learning together); faculty development (opening up new perspectives); and regarding barriers: teaching and learning (uncritical teaching); faculty development (lack of acceptance); implementation (difficult scheduling). CONCLUSION: Experts expect interprofessional teaching on CIM to have positive effects not only on holistic and team-oriented patient care but also on faculty development. It might be challenging to teach the topics in a critical manner and on a scientific basis to ensure high-quality teaching. The results of this study can be used to promote an appropriate implementation of such training programmes.

Findings from a three-round Delphi study: essential topics for interprofessional training on complementary and integrative medicine.

BACKGROUND: Integrating complementary medicine into medical care promotes patient-oriented care. A well-informed and collaborative professional healthcare team is essential for effective and patient-safe implementation of these methods. At present, the skills for patient counseling, therapy and care regarding complementary medicine vary among the professional groups involved. Professionals generally feel that they are not sufficiently qualified in this area. Curricular concepts for Complementary and Integrative Medicine (CIM) are virtually non-existent in undergraduate interprofessional training. The aim of this study is to initiate a consensus-building process between various experts (professionals, students, patient and faculty representatives) in order to identify which topics should be the focus of such a curriculum. METHODS: A three-round Delphi study was carried out from March 2018 to March 2019 to compile the experience and knowledge of experts in the field of integrative patient care and interprofessional education. Sixty-five experts from Germany and German-speaking Switzerland with various professional backgrounds and experiences were asked to name general content, therapy methods and treatment reasons which should be addressed in interprofessional seminars. In the subsequent rounds these were rated on a seven-point Likert scale. The ratings were assigned to relevance groups and discussed in a final workshop in July 2019. RESULTS: The response rates for the three rounds were 76% (n = 50), 80% (n = 40) 90% (n = 36); and 21% (n = 11) for the final workshop. The experts suggested that topics could be aligned along the most common treatment reasons such as insomnia, generalized pain, fatigue and back pain. However, it is important that students also receive an overview of the evidence base for different therapeutic concepts, especially in the field of classical natural medicine, acupuncture and mind-body medicine, and that they get an overview of the effects and interactions of frequently used procedures. CONCLUSION: Consensus was reached among the various experts on the most important topics for an interprofessional CIM curriculum. The systematic evaluation of the topics in this study can help to create a curriculum that achieves a high level of acceptance among teachers, lecturers and students, and thus facilitates implementation at universities and medical faculties.

Role competencies in interprofessional undergraduate education in complementary and integrative medicine: A Delphi study.

OBJECTIVES: Physicians and other health professionals like nurses, physiotherapists and midwives should be prepared to work in a patient-centred and team-based manner through appropriate interprofessional training. This includes consideration of patients' preferences for complementary treatment methods, as well as reflection of one's own professional role and that of the others. The CanMEDS Physician Competency Framework is an established instrument that describes the competencies of health professionals in seven roles. We investigated which role competencies should be addressed in an undergraduate interprofessional curriculum on Complementary and Integrative Medicine. DESIGN: In a Delphi study, an interprofessional expert group evaluated the relevance of the CanMEDS role competencies (n = 49) and the respective individual competencies (n = 30) on a seven-point Likert scale. For analysis, we assigned the competencies according to the ratings, to four groups of relevance (consensus: >80 %) and compared the proportions of individual competencies classified as relevant within the seven role competencies. RESULTS: The role Medical Expert was rated as highly relevant for all individual competencies. For the roles Professional, Collaborator, Communicator and Scholar, all or most individual competencies were rated at least as relevant. For the roles Leader or Health Advocate all individual competencies were rated as not relevant. CONCLUSIONS: In order to improve healthcare including complementary treatment options, it is initially of great importance to impart expert and communication skills in undergraduate interprofessional training in addition to improving teamwork. The acquisition of management and consulting skills could only be given priority in a later phase of training.

[The effect of tailored training courses in preanalytical procedures on the quality of laboratory results]. / Einfluss einer maßgeschneiderten Präanalytik-Fortbildung auf die Qualität der Laboruntersuchungen.

INTRODUCTION: In 31 to 75 percent of cases, errors in laboratory medicine have preanalytical causes such as erroneous blood sampling. Erroneous blood sampling may lead to false test results and additional laboratory cost; it may increase analyzing time and endanger the health of patients and employees. In particular, under- and overfilling of blood sampling tubes can considerably distort laboratory values. So far there has been a lack of studies investigating the effect of a tailored training for ward staff to improve preanalytical procedures on blood sampling. ISSUE: Can a tailored preanalytical training significantly reduce the number of commented under- and overfilled coagulation samples, reduce the number of hemolytic serum and lithium heparin samples and increase the number of standards-compliant blood sampling? METHODS: In an intervention study we compared the number of commented under- and overfilled coagulation tubes and the number of hemolytic serum and lithium heparin samples on the basis of laboratory data and, using participant observation, compared the blood sampling quality on a surgical ward before and after participation in a training course. Based on prior results of participant observation, a 20-minute training was conceptualized and conducted. Target criteria were a) the number of commented under- and overfilled coagulation tubes and b) the number of hemolytic serum and lithium heparin samples in a before/after comparison (Oct-Dec 2017 and Jan-Mar 2018 compared with Jun-Aug 2018) and an annual comparison (Jun-Aug 2017 compared to Jun-Aug 2018), and c) a standards-compliant performance of blood sampling in a before/after comparison (Apr 2018 and Jun 2018). The number of commented under- and overfilled coagulation tubes in the annual comparison was compared using the Chi-square test. RESULTS: After the training (Jun-Aug 2018) the number of commented under- and overfilled coagulation tubes decreased significantly in annual comparison to Jun-Aug 2017 (-68.07%, p < 0.001). The number of commented under- and overfilled coagulation tubes and of hemolytic serum and lithium heparin samples decreased in the before/after and in the annual comparison, and the number of standards-compliant blood samplings increased in the before/after comparison. CONCLUSION: The training contributed significantly to reducing the number of commented coagulation samples and hemolytic serum and lithium heparin samples and to increasing standards-compliant blood sampling. There is a need to investigate to what extent this concept can be transferred to other wards, and in which intervals further trainings should be conducted in order to maintain these positive effects.

Clinical reasoning - an approach for decision-making in education and training for biomedical scientists.

Aim: Explicitly addressing clinical reasoning (CR) is seen as a promising opportunity in the teaching of the biomedical sciences to enable students to acquire the skills to meet the challenges posed by ever more complex health care processes. The quality of diagnostic decisions plays an essential role here. Our aim is to examine if biomedical scientists recognize the practical relevance of CR and are able to apply it as a reflective framework for their professional practice. Method: In two different educational settings, biomedical science students were asked to look closely at CR in the context of the degree program and to indentify the different forms of reasoning used in their internships and professional practice. The written descriptions were analyzed for content and discussed in the seminars. Results: In both scenarios, the analyses of the students' descriptions and discussions showed that examining the different forms of CR helped to raise conscious awareness of thought and decision-making processes, encouraging students to think critically about them and to articulate insights about them, as well as recognize the importance of different reasoning strategies when making specific medical decisions. Conclusion: CR for biomedical scientists could help make decision-making processes visible for other occupational groups and thus advantageously integrate specific professional expertise into health care. Over the long term, an interdisciplinary focus on CR could foster and promote the development of a shared discourse and interprofessional collaboration.

What reasons do final-year medical students give for choosing the hospitals for their clinical training phases? A quantitative content analysis.

Aim: In the final (practical) year (PY), students have the opportunity to become familiar with their potential future place of work. At the same time, university hospitals and teaching hospitals compete to recruit the best junior staff from this pool. The aim of this study is to present students' selection criteria for the location of the final year in detail. Methods: On the formal evaluation of the final year at the Mannheim Medical Faculty, students were asked after each training period which reasons led to the selection of the location. Thirty-one subcategories were formed from the free-text responses, sorted according to their controllability and then grouped into 11 main categories. The Mannheim University Hospital introduced an expense allowance in November 2015. The data from the period before and after its introduction, the reasons given for choosing the location for the compulsory and elective subjects, and the reasons given for choosing a teaching hospital or university hospital were evaluated and compared separately. Results: A total of 1,164 questionnaires were evaluated from the period before the introduction of the expense allowance, and 1,120 questionnaires were evaluated from the period after the introduction. Overall, Proximity (19%), Financial incentives (18%) and Subject (18%) were the most frequently cited reasons. The Financial incentives subcategory was the most frequent in period 1 (32%), but lost relevance in period 2 (6%). In contrast, Recommendation gained in importance (from 8% to 15%). A comparison of the lead categories shows that teaching hospitals benefit more from their public image and university hospitals more from the subjects they offer. Conclusion: Students primarily choose the location for their final year for pragmatic reasons, such as Incentives and Living environment, but the Public image of the hospitals also plays a significant role. The frequency of the reasons given differs between compulsory and elective subjects, as well as between university hospitals and teaching hospitals. The results can help to improve the attractiveness of the location in a targeted manner and to present a specific image to the public.

Promoting medical competencies through a didactic tutor qualification programme - a qualitative study based on the CanMEDS Physician Competency Framework.

BACKGROUND: In peer-led tutorial courses, qualified medical students ("tutors") provide their peers with opportunities to deepen their theoretical knowledge effectively and to practice clinical skills already in preclinical semesters. At the Medical Faculty of Heidelberg University, a structured medical didactic qualification programme prepares and trains future tutors for their responsibilities. This programme consists of four modules: 1. medical didactics and group leadership, 2. subject-specific training, 3. performance of tutorial courses as well as 4. collegial advice and reflection on the tutors' activities. The aim of this study is to systematically analyse and present the development of role competencies for medical tutors based on the CanMEDS Physician Competency Framework through the didactic qualification programme. METHODS: We applied a qualitative research approach to detect CanMEDS role competencies acquisition within the tutor qualification programme. The CanMEDS framework describes key competencies, grouped thematically under seven professional roles. Two tutors and three training coordinators independently assigned the individual modules of the tutor qualification programme to the key competencies of the CanMEDS framework. Tutors and training coordinators compared and discussed the allocations within the groups in a consensus finding process. All authors analysed the findings in order to find out the so-called "hidden curriculum". The views of both groups are presented separately. RESULTS: The training programme promotes the acquisition of competencies in all seven CanMEDS roles. The roles of the scholar and the leader are promoted in all modules. In addition, the first and fourth module focus predominately on the role of the collaborator, the second on the role of the medical expert and communicator, and the fourth on the role of the professional. CONCLUSIONS: The systematic analysis through assignment of the CanMEDS roles to the individual modules of the tutor qualification programme documents the comprehensive acquisition of competencies, not only with regard to the tutor activity, but generally with regard to the later role of the physician. The reflection on one's own competency acquisition can support the promotion of corresponding competencies in the qualification programme and their transfer into the professional practice later.

[Job Satisfaction of Young Professionals in Health Care]. / Die Arbeitszufriedenheit von Berufseinsteigern in den Gesundheitsberufen.

BACKGROUND: Job satisfaction in health care is currently important in view of workforce shortage in the health care area. The purpose of this study was to evaluate job satisfaction in young health professionals and to identify factors possibly influencing overall job satisfaction. METHODS: About one year after graduating from vocational training, a total of 579 graduates from various health care professions [Nursing (N), Nursing and Geriatric Nursing; Therapy (TP), Physical therapy and Logopaedics; Diagnostics (D), Diagnostic Radiography and Biomedical Science], were invited to participate in an online-survey. Job satisfaction was assessed with the 10-item Warr-Cook-Wall (WCW) job satisfaction questionnaire. Descriptive analysis of the WCW was performed, and the impact of various factors on job satisfaction was determined by stepwise linear regression analysis. RESULTS: In total, 189 graduates (N, n=121; TP, n=32; D, n=36) were included in data analysis (32.6% response rate). Overall job satisfaction in all young professionals was 4.9±1.6 (mean±SD) and was slightly higher in TP (5.4±1.4) compared with N (4.7±1.6) and D (5.0±1.5), respectively. Highest satisfaction was identified with "colleagues" and lowest satisfaction with "income" was identified in all professional groups. Colleagues and fellow workers showed the highest score of association regarding overall job satisfaction in regression analysis. CONCLUSIONS: As a whole, our data suggest good to very good satisfaction in various WCW items of job satisfaction. "Colleagues" were shown to have a high impact on job satisfaction. To improve the attractiveness of job profiles in health care, the presented results may provide a valuable input regarding workforce shortage.

Practice Report / Bericht aus der Praxis: Tutor training for a peer-assisted interprofessional communication seminar: A work in progress.

A novel peer-led communication seminar for medical students and for students of the Interprofessional Health Care B.Sc. degree programme at the Medical Faculty of Heidelberg is currently being developed to address the increasing need for interprofessional collaborative competencies in health care professionals. The core elements of this course include role plays in interprofessional communication situations, patient-centred professional practice, and reflections on underlying attitudes. Each seminar will be conducted by a team of two senior students from both undergraduate programmes, practising their new roles as interprofessional tutors and, at the same time, serving as competent role models for interprofessional collaboration. To provide tutors with the necessary didactic preparation, an interprofessional tutor training was developed and implemented. It was positively evaluated and well accepted by participants. The seminar and tutor training concept presented in this paper aims to foster (inter-)professional ethics and communication competency development in medical students.

Addressing holistic healthcare needs of oncology patients: Implementation and evaluation of a complementary and alternative medicine (CAM) course within an elective module designed for healthcare professionals.

BACKGROUND: Patients, and especially oncology patients, increasingly demand information and application of complementary therapies to supplement their conventional medical treatment and follow-up care. Due to the widespread interest in holistic treatment opportunities in oncology populations, healthcare professionals need to be prepared in differentiating evidence-based methods of the complementary and alternative medicine (CAM) spectrum and how to consult with patients about it. OBJECTIVE: This paper reports on the implementation and evaluation of a newly designed module "Complementary and Alternative Medicine in oncological healthcare" in the bachelor degree program Interprofessional Health Care (B.Sc.). DESIGN: The study applied a developed evaluation questionnaire to capture students' perspectives on the CAM contents. This assessment instrument was administered pre and post the CAM teaching unit. SETTING: Interprofessional medical education, University Hospital Heidelberg, Germany. RESULTS: The integration of the CAM elective module was possible and was met by positive response. Students' interest was reflected in an increase of their self-reported knowledge gain and positive CAM attitude. Comparison of pre and post evaluation data demonstrate that, particularly, students' expectations on developing their own opinion about CAM, and getting an overview of the evidence-base of different CAM methods have been met. CONCLUSIONS: Evaluation results indicate that the module content was in line with the students' expectations and may have positively impacted on their general CAM attitude. The results support us in continuing to offer this CAM course within the elective module to prepare today's healthcare professionals for patient-oriented healthcare delivery.