Evaluation of a newly developed flipped-classroom course on interprofessional practice in health care for medical students.

Interprofessional education is expected to promote collaborative practice and should therefore be included in health professionals' curricula. Reports on interprofessional curricular development and its evaluation are rare. We therefore undertook a comprehensive quantitative and qualitative evaluation of a new, mandatory course on interprofessional collaboration for medical students during their third year of the Bachelor of Medicine study programme. The newly developed and implemented course spans over six weeks and was designed in a hybrid, flipped-classroom format. It incorporates experience- and case-based learning as well as interactions with other health professionals. Each student completes an eLearning and a clinical workshadowing individually before attending the - due to the pandemic - virtual live lectures. To assess quality and usefulness of teaching-learning formats and course structure to learn about interprofessional collaboration and to develop interprofessional competencies and identity, a quantitative and qualitative evaluation was performed with more than 280 medical students and 26 nurse educators from teaching hospitals using online surveys (open & closed-ended format). Data were analyzed descriptively and using content analysis processes. Students appreciated the flipped-classroom concept, the real-world case-based learning scenarios with interprofessional lecturer teams, and the possibility of an experience-based learning opportunity in the clinical setting including interaction with students and professionals from other health professions. Interprofessional identity did not change during the course. Evaluation data showed that the course is a promising approach for teaching-learning interprofessional competencies to medical students. The evaluation revealed three factors that determined the success of this course, namely, a flipped-classroom concept, the individual workshadowing of medical students with another health professional, mainly nurses, and live sessions with interprofessional teaching-learning teams. The course structure and teaching-learning methods showed potential and could serve as a template for interprofessional course development in other institutions and on other course topics.

Development, Implementation, and Evaluation of an e-Learning in Integrative Oncology for Physicians and Students Involving Experts and Learners: Experiences and Recommendations.

In this project, an e-Learning program for complementary and integrative medicine in oncology was systematically developed, implemented, and evaluated in a stepwise procedure. Learning objectives and content were defined within the KOKON project network, considering the educational competencies for integrative oncology. To design a valuable e-Learning, experts were involved in all relevant steps of the process, as well as stakeholders from various target groups (undergraduates: medicine students, postgraduates: oncology physicians). We used mixed methods including quantitative surveys, progress tests, and qualitative focus groups. The developed e-Learning program led to a significant measurable knowledge gain about complementary and integrative medicine. In parallel, physicians and students were subjectively satisfied with the training. For the majority of e-Learning elements, the needs of both target groups are comparable. Furthermore, both groups emphasized the value of formative assessment tools for gaining knowledge. From the various surveys and experiences collected in this project, we derive recommendations for others developing e-Learning programs.

Training oncology physicians to advise their patients on complementary and integrative medicine: An implementation study for a manual-guided consultation.

BACKGROUND: The unmonitored use of complementary medicine in patients with cancer can be associated with an increased risk of safety-related issues, such as lower adherence to conventional cancer therapies. Training oncology physicians to advise their patients about the effectiveness and safety of these therapies could improve this situation. METHODS: The objective of this study was to develop and pretest a consultation framework that has high potential to be widely implemented. The framework comprises: 1) a systematically developed and tested, manualized, guided consultation; and 2) blended learning training (e-learning and communication skills training workshop) to upskill oncology physicians in advising their patients on complementary and integrative medicine (CIM). For this implementation study, mixed methods were used to develop the manual (literature review, consensus procedure, pilot testing) and the training (questionnaires and interviews with oncology physicians and patients with cancer and an examination of the skills in a setting with standardized patients). RESULTS: The training was tested with 47 oncology physicians from across Germany. The manual-guided consultation (context: general information on the setting and communication techniques; inform: consultation duration and content; capture: previous CIM use; prioritize: focus on consultation; advise: evidence-based CIM recommendations; discuss, advise, accept, or advise against other CIM; concretize advice: summary and implementation; and monitor: documentation) was considered suitable. The structure and time frame (maximum, 20 minutes) of the consultation as well as the training were feasible and well accepted. CONCLUSIONS: The current study demonstrates that the KOKON-KTO framework (a German acronym for Competence Network for Complementary Medicine - Consultation Training for Oncology Physicians) is suitable for training oncology physicians. Its implementation can lead to better physician-patient communication about CIM in cancer.

Lipid-bilayer permeation of drug-like compounds.

Lipid-bilayer permeation is determinant for the disposition of xenobiotics in the body. It controls the pharmacokinetic behavior of drugs and is, in many cases, a prerequisite for intracellular targeting. Permeation of in vivo barriers is in general predicted from lipophilicity and related parameters. This article goes beyond the empirical correlations, and elucidates the processes and their interplay determining bilayer permeation. A flip-flop model for bilayer permeation, which considers the partitioning rate constants beside the translocation rate constants, is compared with the diffusion model based on Fick's first law. According to the flip-flop model, the ratios of aqueous volumes to barrier area can determine whether partitioning or translocation is rate-limiting. The flip-flop model allows permeation of anions and cations, and expands our understanding of pH-dependent permeation kinetics. Some experimental evidences for ion-controlled permeation at pH 7 are also included in this work.

Comparing the lipid membrane affinity and permeation of drug-like acids: the intriguing effects of cholesterol and charged lipids.

PURPOSE: Lipid bilayers regulate the passage of solutes into and between cellular compartments. A general prerequisite for this passage is the partitioning of the solute into the bilayer. We investigated the relationship between bilayer partitioning and permeation of three drug-like acids in liposomal systems consisting of phosphatidylcholine alone or mixed with cholesterol or charged lipids. MATERIALS AND METHODS: Bilayer partitioning was determined by equilibrium dialysis. Bilayer permeation was studied with a luminescence assay which is based on the energy transfer of the permeant to intraliposomal terbium(III). RESULTS: The influence of the lipid composition on the pH-dependent membrane affinity was in accordance with the membrane rigidity and possible electrostatic interactions between the acids and the lipids. However, there was no direct relationship between membrane affinity and permeation. This seeming discrepancy was closer analyzed with numerical simulations of the permeation process based on the single rate constants for partitioning and translocation. The simulations were in line with our experimental findings. CONCLUSIONS: Depending on the single rate constants and on the geometry of the system, lipid bilayer permeation may positively, negatively or not correlate with the bilayer affinity of the permeant.

Comparison of permeation through phosphatidylcholine bilayers of N-dipicolinyl-alpha- and -beta-oligopeptides.

Cell-membrane permeation of small therapeutic peptides and peptidomimetics is a fundamental issue in pharmaceutical research. Using a Tb(3+)-based permeation assay, we have examined the ability of alpha- and beta-peptides, bearing proteinogenic side chains and an N-terminal dipicolinic acid (DPA) monoamide group, to enter liposomes composed of egg phosphatidylcholine bilayers. A series of 12 DPA-peptides of increasing chain length was prepared and characterized by CD and NMR analysis. An interesting destabilizing effect of the N-terminal DPA group on the helical structure of a beta-hexapeptide was discovered. Significant differences in permeation were observed between the DPA-alpha- and the DPA-beta-peptides, with all beta-peptidic compounds permeating better than their alpha-analogs. Thus, beta-peptides have been shown to interact with lipid bilayers in a manner that is distinctly different from that of alpha-peptides. Together with the fact that beta-peptides are proteolytically stable in mammalian organisms, and that they fold to form helices and hairpin turns with short chain lengths, the new results further emphasize the biomedical potential of beta-peptides.

Permeation of aromatic carboxylic acids across lipid bilayers: the pH-partition hypothesis revisited.

According to the pH-partition hypothesis the charged species of organic compounds do not contribute to lipid bilayer permeation as they generally show negligible partitioning into n-octanol. With this assumption, membrane permeation is related to the molar fraction of the neutral species at a particular pH. A recently developed permeation assay permits us to directly determine pH-dependent permeation of aromatic carboxylic acids. Tb(3+)-loaded liposomes are incubated with aromatic carboxylic acids and upon excitation at the absorption wavelength of the acid, permeation kinetics can be measured as an increase in Tb(3+) luminescence. The anions of the tested acids permeated egg phosphatidylcholine membranes only 12 (2-hydroxynicotinic acid), 66 (salicylic acid), and 155 (dipicolinic acid) times slower than the net neutral species. The anions, therefore, controlled the total permeation already at 1-2 pH units above their pK(a). These results indicate that in contrast to the expectations of the pH-partition hypothesis, lipid bilayer permeation of an acidic compound can be completely controlled by the anion at physiological pH.