Lost in translation: Unveiling medical students' untold errors of medical history documentation.

OBJECTIVE: The accurate documentation of a medical history interview is an important goal in medical education. As students' documentation of medical history interviews is mostly decentralised on the wards, a systematic assessment of documentation quality is missing. We therefore evaluated the extent of details missed in students' medical history reports in a standardised setting. METHODS: In this prospective, observational study, 123 of 380 students (32.4%) participated in an Objective Structured Clinical Examination (OSCE) regarding history taking and documentation. Based on the interviews and nine deductively selected main categories, a categorical system was established using a summarising qualitative content analysis. The items in the transcripts (defined as ground truth) and in students' reports were labelled and assigned to the correct subcategory. The ground truth and students' reports were compared to quantify students' documentation completeness. RESULTS: Next to the nine deductively selected main categories, 61 subcategories were defined. A total of 8943 items were labelled in the 123 interview transcripts (ground truth), compared with 5870 items labelled in students' reports (65.6% completeness of students' reports compared with ground truth). The main category personal details overlapped with 94.2% between students' report and ground truth in contrast to the main category with the highest discrepancy, allergy, with 41.1% overlap. Pertinent negative items and non-numerical quantifications were often missed. CONCLUSIONS: Medical students show incomplete documentation of medical history interviews. Therefore, accurate documentation should be taught as an important goal in medical education.

Insights into diagnostic errors in endocrinology: a prospective, case-based, international study.

BACKGROUND: Diagnostic errors in internal medicine are common. While cognitive errors have previously been identified to be the most common contributor to errors, very little is known about errors in specific fields of internal medicine such as endocrinology. This prospective, multicenter study focused on better understanding the causes of diagnostic errors made by general practitioners and internal specialists in the area of endocrinology. METHODS: From August 2019 until January 2020, 24 physicians completed five endocrine cases on an online platform that simulated the diagnostic process. After each case, the participants had to state and explain why they chose their assumed diagnosis. The data gathering process as well as the participants' explanations were quantitatively and qualitatively analyzed to determine the causes of the errors. The diagnostic processes in correctly and incorrectly solved cases were compared. RESULTS: Seven different causes of diagnostic error were identified, the most frequent being misidentification (mistaking one diagnosis with a related one or with more frequent and similar diseases) in 23% of the cases. Other causes were faulty context generation (21%) and premature closure (17%). The diagnostic confidence did not differ between correctly and incorrectly solved cases (median 8 out of 10, p = 0.24). However, in incorrectly solved cases, physicians spent less time on the technical findings (such as lab results, imaging) (median 250 s versus 199 s, p < 0.049). CONCLUSIONS: The causes for errors in endocrine case scenarios are similar to the causes in other fields of internal medicine. Spending more time on technical findings might prevent misdiagnoses in everyday clinical practice.

The role of research competence as an influencing factor for the careers of young academics. Findings and implications from studies on doctorates in medicine and life sciences in Germany.

Background: When viewed internationally, Germany boasts a high rate of doctoral candidates. Fields such as medicine and life sciences have a notably high proportion of doctoral students, a trend rooted in historical factors. Despite this, comprehensive empirical studies concerning the doctoral phase and early-career researchers, especially in relation to the rise of structured doctoral programmes, have only recently gained traction. Methods: We present findings from a project investigating young scientists in medicine and life sciences. Postdoctoral graduates from these disciplines were examined both quantitatively and qualitatively within the E-Prom projects, emphasizing the primary domain of research. Results: Our analysis indicates some benefits of structured doctoral programmes over traditional individual doctorates. However, the disparities between these doctoral approaches are less pronounced than anticipated. We also identified discrepancies between the programme descriptions and their actual execution. Integration into the scientific community and research-related self-efficacy are potential indicators of publication output and inclination towards a scientific career. Physicians exhibited lower research-related self-efficacy and a lesser tendency towards a scientific career than biologists. Notably, we found gender disparities disadvantaging female graduates, with these disparities being more marked in medicine. Conclusions: There is evidence to suggest that official representations of structured doctoral programmes do not always align with their practical applications, limiting their potential effectiveness. Therefore, resources should be allocated to ensure the consistent execution of these programmes. Given the empirical evidence supporting the benefits of community integration for junior researchers, efforts should be made to facilitate their networking. Additionally, our findings emphasize the necessity of providing enhanced support for young female scientists.

German first-year medical students' expectations of their professional life - concerns and hopes: A project report.

Aim: Expectations among medical students towards their future professional life are affected by intrinsic and extrinsic factors which may change during years of medical school. The aim of this study is to gain further insight into students' expectations of their professional life at the beginning of medical school. Findings regarding contextual influences can be used to improve curricula and student guidance. Methods: The project report based on an online survey among three cohorts of first year medical students at the LMU. The questionnaire consisted of six open-ended questions which addressed the student's motivation, expectations, anticipations and concerns of their professional life. Questions were also asked about presumed personal development and influence on private life. An inductive coding was used in this qualitative content analysis. Results: Written responses from 591 participants were coded, categorized and summarized into four main themes: personal life, work, science, personal issue. Despite coming from different cohorts, the occurrence of the main themes showed the same trend in all student groups. Students are worried most about the work-life-balance, and they expect it to be a difficult issue. But many of our first-year students are optimistic that they will be able to establish a good work-life-balance or that the working conditions will have changed to a manageable workload at the time they will enter their first jobs. The majority of our students expect to become more self-confident with enhanced empathy and team-working ability and more patient and stress-resistant in daily challenges. Conclusion: The medical students emphasize the gender-neutral desire for work-life balance. So, they expect improved working conditions for the future - an ongoing challenge for the health care system.

Characteristics and quality assessment of online mentoring profile texts in academic medical mentoring.

BACKGROUND: Mentoring is important for a successful career in academic medicine. In online matching processes, profile texts are decisive for the mentor-selection. We aimed to qualitatively characterize mentoring-profile-texts, identify differences in form and content and thus elements that promote selection. METHODS: In a mixed method study first, quality of texts in 150 selected mentoring profiles was evaluated (10-point Likert scale; 1 = insufficient to 10 = very good). Second, based on a thematic and content analysis approach of profile texts, categories and subcategories were defined. We compared the presence of the assigned categories between the 25% highest ranked profiles with the 25% lowest ranked ones. Finally, additional predefined categories (hot topics) were labelled on the selected texts and their impact on student evaluation was statistically examined. RESULTS: Students rated the quality of texts with a mean of 5.89 ± 1.45. 5 main thematic categories, 21 categories and a total of 74 subcategories were identified. Ten subcategories were significantly associated with high- and four with low-rated profiles. The presence of three or more hot topics in texts significantly correlated with a positive evaluation. CONCLUSION: The introduced classification system helps to understand how mentoring profile texts are composed and which aspects are important for choosing a suited mentor.

FINCA - a conceptual framework to improve interprofessional collaboration in health education and care.

The health care system in Germany and in many other countries is facing fundamental challenges due to demographic change, which require new integrated care concepts and a revision of the collaboration between health care professions in everyday clinical practice. Internationally, several competency framework models have been proposed, but a framework that explicitly conceptualizes collaborative activities to improve interprofessional problem-solving competency in health care is still missing. Such a framework should define contextual, person-related, process-related, and outcome-related variables relevant to interprofessional problem solving in health care. Against this background, we present a conceptual framework to improve interprofessional collaboration in health education and care (FINCA) developed with scientific consideration of empirical data and various theoretical references. FINCA reflects an interprofessional learning and interaction process involving two persons from different health care professions and with different individual learning prerequisites. These two initially identify a problem that is likely to require interprofessional collaboration at some point. FINCA acknowledges the context of interprofessional learning, teaching, and working as well as its action-modifying context factors. We follow the reasoning that individual learning prerequisites interact with the teaching context during learning activities. At the heart of FINCA are observable collaborative activities (information sharing and grounding; negotiating; regulating; executing interprofessional activities; maintaining communication) that can be used to assess individuals' cognitive and social skills. Eventually, the framework envisages an assessment of the outcomes of interprofessional education and collaboration. The proposed conceptual framework provides the basis for analysis and empirical testing of the components and variables it describes and their interactions across studies, educational interventions, and action-modifying contexts. FINCA further provides the basis for fostering the teaching and learning of interprofessional problem-solving skills in various health care settings. It can support faculty and curriculum developers to systematize the implementation and improvement of interprofessional teaching and learning opportunities. From a practical perspective, FINCA can help to better align curricula for different health professions in the future. In principle, we also see potential for transferability of the framework to other areas where different professions collaborate.

Principles of oncology taught in a one-week course.

BACKGROUND: Growing challenges in oncology require evolving educational methods and content. International efforts to reform oncology education are underway. Hands-on, interdisciplinary, and compact course formats have shown great effectiveness in the education of medical students. Our aim was to establish a new interdisciplinary one-week course on the principles of oncology using state-of-the-art teaching methods. METHODS: In an initial survey, medical students of LMU Munich were questioned about their current level of knowledge on the principles of oncology. In a second two-stage survey, the increase in knowledge resulting from our recently established interdisciplinary one-week course was determined. RESULTS: The medical students' knowledge of clinically important oncological topics, such as the diagnostic workup and interdisciplinary treatment options, showed a need for improvement. Knowledge of the major oncological entities was also in an expandable state. By attending the one-week course on the principles of oncology, students improved their expertise in all areas of the clinical workup in oncology and had the opportunity to close previous knowledge gaps. In addition, students were able to gain more in-depth clinical knowledge on the most common oncological entities. CONCLUSION: The interdisciplinary one-week course on the principles of oncology proved to be an effective teaching method to expand the knowledge of the future physicians to an appropriate level. With its innovative and interdisciplinary approach, the one-week course could be used as a showcase project for the ongoing development of medical education in Germany.

Objective and subjective consequences of pandemic-related study program changes for the perception of the practical year - a comparison of medical students in Germany with and without a second national board examination.

Background: Due to SARS-CoV-2, the Bavarian Ministry of Health decided in April 2020 to postpone the second national board examination in human medicine and to bring forward the start of the practical year (in German: Praktisches Jahr, further abbreviated with PJ) from May to April 2020. The different tertial times made it necessary for affected students to reorganise the PJ and rendered the preparation for the national board examination that had already taken place obsolete. As a result, students had to prepare for it again after the PJ and take it together with the third national board examination. Research question: How do students affected by the early PJ differ in their perception of the practical year and in their psychological well-being from the comparison groups with a regular PJ schedule? Methodology: The study is based on quantitative data from the Dean of Studies Office of the Medical Faculty of Ludwig-Maximilians-Universität München (LMU) and an online survey. The sample consists of LMU students who started the early PJ in April 2020 (n=86) and two comparison groups: The cohort of LMU students who started their PJ regularly in May 2019 (n=50), and students from other German universities who started their PJ regularly in May 2020 (n=98) and took the second national board examination in human medicine in spring 2020. Results: For students affected by the early PJ, there were measurable negative effects on the choice of training institutions, the quality of the PJ content, preparation for the national board examinations, and career planning. Compared to regular students from other federal states, affected students reported higher psychological stress, with comparable resilience. Conclusion: It can be assumed that the insights gained apply to the entirety of medical students in the affected federal states of Bavaria and Baden-Württemberg. As a conclusion, we make the recommendation to include the position of the students in decisions of great consequence.

Bayesian versus diagnostic information in physician-patient communication: Effects of direction of statistical information and presentation of visualization.

BACKGROUND: Communicating well with patients is a competence central to everyday clinical practice, and communicating statistical information, especially in Bayesian reasoning tasks, can be challenging. In Bayesian reasoning tasks, information can be communicated in two different ways (which we call directions of information): The direction of Bayesian information (e.g., proportion of people tested positive among those with the disease) and the direction of diagnostic information (e.g., the proportion of people having the disease among those tested positive). The purpose of this study was to analyze the impact of both the direction of the information presented and whether a visualization (frequency net) is presented with it on patient's ability to quantify a positive predictive value. MATERIAL AND METHODS: 109 participants completed four different medical cases (2⨯2⨯4 design) that were presented in a video; a physician communicated frequencies using different directions of information (Bayesian information vs. diagnostic information). In half of the cases for each direction, participants were given a frequency net. After watching the video, participants stated a positive predictive value. Accuracy and speed of response were analyzed. RESULTS: Communicating with Bayesian information led to participant performance of only 10% (without frequency net) and 37% (with frequency net) accuracy. The tasks communicated with diagnostic information but without a frequency net were correctly solved by 72% of participants, but accuracy rate decreased to 61% when participants were given a frequency net. Participants with correct responses in the Bayesian information version without visualization took longest to complete the tasks (median of 106 seconds; median of 13.5, 14.0, and 14.5 seconds in other versions). DISCUSSION: Communicating with diagnostic information rather than Bayesian information helps patients to understand specific information better and more quickly. Patients' understanding of the relevance of test results is strongly dependent on the way the information is presented.

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.

Diagnosing virtual patients: the interplay between knowledge and diagnostic activities.

Clinical reasoning theories agree that knowledge and the diagnostic process are associated with diagnostic success. However, the exact contributions of these components of clinical reasoning to diagnostic success remain unclear. This is particularly the case when operationalizing the diagnostic process with diagnostic activities (i.e., teachable practices that generate knowledge). Therefore, we conducted a study investigating to what extent knowledge and diagnostic activities uniquely explain variance in diagnostic success with virtual patients among medical students. The sample consisted of N = 106 medical students in their third to fifth year of university studies in Germany (6-years curriculum). Participants completed professional knowledge tests before diagnosing virtual patients. Diagnostic success with the virtual patients was assessed with diagnostic accuracy as well as a comprehensive diagnostic score to answer the call for more extensive measurement of clinical reasoning outcomes. The three diagnostic activities hypothesis generation, evidence generation, and evidence evaluation were tracked. Professional knowledge predicted performance in terms of the comprehensive diagnostic score and displayed a small association with diagnostic accuracy. Diagnostic activities predicted comprehensive diagnostic score and diagnostic accuracy. Hierarchical regressions showed that the diagnostic activities made a unique contribution to diagnostic success, even when knowledge was taken into account. Our results support the argument that the diagnostic process is more than an embodiment of knowledge and explains variance in diagnostic success over and above knowledge. We discuss possible mechanisms explaining this finding.

Overconfidence effects and learning motivation refreshing BLS: An observational questionnaire study.

Aim of the study: Regular refresher skill courses are necessary to maintain competence in basic life support. The utilization of these training programs strongly depends on the motivation to learn. Learning motivation may be affected by overconfidence and clinical tribalism, as they both imply a higher competence compared to others, and therefore, a lower demand for training. This study aimed to assess how overconfidence in basic life support competencies affects learning motivation. Methods: We conducted a cross-sectional, observational, multicenter, anonymous online questionnaire survey using validated psychometric tests for healthcare professionals in Germany. Further, we tested participants' knowledge and attitude regarding international basic life support guidelines. The study was conducted between March and April 2022, and healthcare providers from 22 German emergency medical services and hospitals at all levels were assessed. Results: Of 2,000 healthcare professionals assessed, 407 completed the assessment (response rate, 20.4%). We confirmed the presence of overconfidence and clinical tribalism (identity differentiation between social groups) among the 407 physicians, nurses, and emergency medical service providers who completed the survey. Three different learning-motivation groups emerged from cluster analysis: "experts" (confident and motivated), "recruitables" (overconfident and motivated), and "unawares" (overconfident and unmotivated). The three groups were present in all professional groups, independent of the frequency of exposure to cardiac arrest and educational level. Conclusions: These findings showed the presence of overconfidence effects and different learning motivation types in individuals learning basic life support, even in instructors.

Differences in perceptions of capability, autonomy, and expectations between residents and surgical team members in executing EPAs in Ethiopian medical education.

Background: Entrustable Professional Activities (EPAs) are units of professional practice that are defined as tasks or responsibilities that are entrusted to an unsupervised execution by a trainee. In 2021, a framework of 29 EPAs was developed for surgical residency training programs in Ethiopia, with the goal of residents being able to perform independently by the time they graduate. However, studies show that surgical residents lack confidence and are unable to execute EPAs autonomously upon graduation, and concerns have been raised about graduate competencies in EPA execution. The goal of this research is to assess how surgical team members judge/perceive residents' performance in executing these EPAs autonomously at the time of graduation and how residents rate their own capability and autonomy in executing EPAs in order to systematically introduce and implement EPAs in Ethiopian medical education. Methods: A survey was conducted in the Departments of Surgery at four residency training institutions in Ethiopia. All eligible surgical team members and final-year general surgery residents were invited to participate. Surgical team members were asked to rate the observed performance of a group of graduating surgical residents in each of the 29 EPAs, and residents were asked to rate their own capability in executing EPAs. The analysis focused on variations in performance ratings between surgical team members and residents, as well as across surgical team members. Results: A total of 125 surgical team members and 49 residents participated in this study. Residents rate their competence in performing these EPAs higher than surgical team members, mean 4.2 (SD = 0.63) vs. 3.7 (SD = 0.9). A statistically significant difference in perceptions of capability, autonomy, and expectations in executing EPAs was observed between the two groups of study (p = 0.03, CI: 0.51-0.95), as well as within surgical team members (p < 0.001). Conclusions: Differences in perceptions of capability, autonomy, and expectations between residents and surgical team members, as well as within faculty members, were seen in executing EPAs. There were concerns about graduate surgical residents' competence to execute EPAs autonomously at the time of graduation. Surgical team members perceived that a set of graduating surgical residents are not yet safe to perform these EPAs independently (without supervision) and still requires distant supervision.

Effects of tablet-based drawing and paper-based methods on medical students' learning of gross anatomy.

The way medical students learn anatomy is constantly evolving. Nowadays, technologies such as tablets support established learning methods like drawing. In this study, the effect of drawing on a tablet on medical students' anatomy learning was investigated compared to drawing or summarizing on paper. The quality of drawings or summaries was assessed as a measure of the quality of strategy implementation. Learning outcome was measured with an anatomy test, both immediately afterward and after 4-6 weeks to assess its sustainability. There were no significant group differences in learning outcome at both measurement points. For all groups, there was a significant medium strength correlation between the quality of the drawings or summaries and the learning outcome (p < 0.05). Further analysis revealed that the quality of strategy implementation moderated outcomes in the delayed test: When poorly implemented, drawing on a tablet (M = 48.81) was associated with lower learning outcome than drawing on paper (M = 58.95); The latter (M = 58.89) was related to higher learning outcome than writing summaries (M = 45.59). In case of high-quality strategy implementation, drawing on a tablet (M = 60.98) outperformed drawing on paper (M = 52.67), which in turn was outperformed by writing summaries (M = 62.62). To conclude, drawing on a tablet serves as a viable alternative to paper-based methods for learning anatomy if students can make adequate use of this strategy. Future research needs to identify how to support student drawing, for instance, by offering scaffolds with adaptive feedback to enhance learning.

Digital patient-centred learning in medical education: A national learning platform with virtual patients as part of the DigiPaL project.

Background: Due to the coronavirus pandemic, the medical faculties in the Federal Republic of Germany converted their curricula to digital formats on a large scale and very quickly in spring 2020 as an emergency measure. At the same time, a start was made on the nationwide exchange of digital teaching/learning materials via the online platform "LOOOP share" in order to save local resources. Among other things, virtual patient cases (VP) were shared across faculties for case-based learning, through which students can acquire clinical decision-making skills. Objectives: Within the framework of the cooperation project "National Learning Platforms for Digital Patient-Related Learning in Medical Studies" (DigiPaL), the usability of VPs for students and teachers should be improved, and the spectrum of disease patterns that are covered by VPs should be systematically expanded. Results: With the participation of many locations, a total of 150 VPs were developed by 96 case authors from 16 faculties, in addition to the existing 403 VPs. The thematic selection was made on the basis of criteria oriented to the National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM). After completion, these VPs were also made available to all faculties for free use via "LOOOP share" and the CASUS learning platform. Discussion: Even after the pandemic, these developed VPs should be available to the faculties and thus make a lasting contribution to improve medical training in Germany - especially in light of digital teaching formats being expressly advocated on the basis of the adapted current Medical Licensure Act (ÄApprO). A possible application is interdisciplinary learning of clinical decision-making with the help of blended learning formats within the framework of a longitudinal curriculum. The large number of involved colleagues and faculties shows that the nationally coordinated development of VPs across faculties was commonly seen as useful.

A Mixed Methods Assessment of the Management Role of Physicians.

Introduction: Physicians are increasingly confronted with new requirements in their daily job, which go beyond the mere treatment of patients. The aim of this Mixed-Method-Study is to better understand management as it relates to physicians' daily work, to clarify the physicians' perception of their management role and to examine physician's self-assessed competence in these functions. Methods: We used three different instruments: Semi-structured interviews, a self-assessment survey and direct observations to evaluate managerial activities performed by residents. Both latter were based on instruments established for management research. Results: Interviewed residents were familiar with the term "Management" but had difficulties in defining it. Concerning managerial functions in context of their daily work, we identified three main categories: Self-management, Patient-management and Management of the ward. In this context, physicians named numerous examples of management tasks and for which they felt ill prepared. Eighty-eight residents participated in the self-assessment survey and rated the majority of the management tasks as necessary for the residents' work. Although physicians estimated the proportion of managerial work to comprise only 40.6%, a much higher number of mere management tasks could be identified through direct observations (n = 12). Activities related to management were more often observed than genuine physician tasks. Discussion: This study illustrates the prominent role of management activities in context of the residents' work, while at the same time showing that residents do not feel sufficiently educated, prepared nor competent in management tasks.

Does a sense of gratitude protect against empathy loss in medical students? An exploratory study.

Introduction: The promotion of physicians' empathy (PE) skills in medical school plays a central role in physician-patient communication. However, a significant decline in empathy among medical students during their training has been repeatedly reported. Gratitude could be a possible protective factor for PE. However, as some students do not seem to be affected by this empathy loss, this study explores the relationship between gratitude and PE. Methods: Using validated questionnaires (JSPE-S, IRI and GQ-6), 88 medical students at LMU München evaluated their self-assessed PE and gratitude. In addition, they went through four OSCE stations focusing on general medicine, in which their empathy and communication skills were assessed by simulated patients (SP) and by an assessor using the Berlin Global Rating. Correlations were analysed using Pearson's correlation coefficient and gender differences were analysed using Mann-Whitney U-tests. Results: In the self-assessment, there was a significant, moderate correlation between students' attitude towards empathy (JSPE-S) and their gratitude (GQ-6) and a weak correlation between the IRI subscale "Empathy" and the GQ-6. In terms of the performance-based assessment, there were also weak correlations between PE or communication skills and gratitude. There were no gender-specific differences in the gratitude of the students. Conclusion: We were able to demonstrate a correlational relationship between gratitude and empathy in medical students. Whether gratitude acts causally as a protective or supportive factor for empathy remains open. A causal relationship of gratitude to empathy should therefore be examined in a prospective study design.

Online medical history taking course: Opportunities and limitations in comparison to traditional bedside teaching.

Objective: Obtaining a systematic medical history (MH) from a patient is a core competency in medical education and plays a vital role in the diagnosis of diseases. At the Faculty of Medicine at LMU Munich, students have their first course in MH taking during their second year. Due to the COVID-19 pandemic, the traditional bedside MH taking course had to be transformed into an online course (OC). Our objectives were to implement an online MH taking course, to evaluate its feasibility and to compare the evaluation results to a historic cohort that had undertaken the traditional bedside teaching course (BTC). Methods: 874 second-year students participated in the OC (BTC=827). After teaching the theoretical background via asynchronous online lectures, students participated in a practical exercise with fellow students using the video communication platform Zoom where they were able to practice taking a MH on the basis of fictitious, text-based patient cases. Students were then asked to evaluate the course through a standardized online survey with 31 questions on teaching quality and self-perceived learning success, which had also been used in previous years. The survey results were compared to the results of the historic cohort using the Mann-Whitney U test. Results: A total of n=162 students (18.5%) evaluated the OC. In the historic cohort, n=252 (30.5%) completed the survey. 85.3% of the OC respondents thought that the atmosphere during the practical exercise was productive and 83.0% greatly appreciated the flexibility in terms of time management. Moreover, they appreciated the online resources as well as having the opportunity to undertake a MH taking course during the COVID-19 pandemic. 27.7% of the respondents thought that traditional BTCs should be supplemented through more online activities in the future. With respect to the ability of independently taking a MH upon completion of the course, the OC was rated significantly lower relative to the BTC (mean OC=2.4, SD=±1.1 vs. mean BTC=1.9, SD=±1.1 (1=strongly agree; 5=strongly disagree); p<0.0001). Conclusion: OCs are a feasible format and seem to convey the theory and practical implementation in a peer-exercise format of MH taking to medical students. The theoretical background can be acquired with great flexibility. Nevertheless, the students' self-appraisal suggested that the traditional teaching format was more effective at teaching MH taking skills. Thus, we propose a blended learning concept, combining elements of both formats. In this context, we suggest prospective, randomized trials to evaluate blended learning approaches.

The role of the emotive, moral, and cognitive components for the prediction of medical students' empathic behavior in an Objective Structured Clinical Examination (OSCE).

OBJECTIVES: Investigate whether medical students' emotive abilities, attitudes, and cognitive empathic professional abilities predict empathic behavior in an Objective Structured Clinical Examination (OSCE). METHODS: Linear and multiple regressions were used to test concurrent validity between Interpersonal Reactivity Index (IRI), Jefferson Scale of Physician Empathy (JSPE-S), Situational Judgement Test (SJT-expert-based score (SJT-ES), SJT-theory-based score (SJT-TS)) and empathic behavior in an OSCE measured by Berlin Global Rating (BGR) and Verona Coding Definitions for Emotion Sequences (VR-CoDES). RESULTS: Highest amounts of explained variance of empathic behavior measured by VR-CoDES were found for the SJT-ES (R2 = 0.125) and SJT-TS (R2 = 0.131). JSPE-S (R2 = 0.11) and SJT-ES (R2 = 0.10) explained the highest amount of variance in empathic behavior as measured by BGR. Stepwise multiple regression improved the model for BGR by including SJT-ES and JSPE-S, explaining 16.2% of variance. CONCLUSIONS: The instrument measuring the emotive component (IRI) did not significantly predict empathic behavior, whereas instruments measuring moral (JSPE-S) and cognitive components (SJT) significantly predicted empathic behavior. However, the explained variance was small. PRACTICE IMPLICATIONS: The instrument measuring the emotive component (IRI) did not significantly predict empathic behavior, whereas instruments measuring moral (JSPE-S) and cognitive components (SJT) significantly predicted empathic behavior. However, the explained variance was small. In a longitudinal assessment program, triangulation of different instruments assessing empathy offers a rich perspective of learner's empathic abilities. Empathy training should include the acquisition of knowledge, attitudes, and behavior to support learner's empathic behaviors.