"Corona-Debriefing": concept and pilot testing of a 90-minute workshop for undergraduate-education and specialist-training in family medicine.

Background: The corona pandemic is changing the framework conditions for medical studies and continuing education as well as the work with patients and within teams. Systematic reflection and communication about experiences and ways of dealing with them forms the basis for successful learning in and out of the crisis. Therefore, we designed a 90-minute workshop "Corona-Debriefing" for students and physicians in specialist-training in family medicine (ÄiW) using three successive moderated interaction phases: Questionnaire survey via tele-dialogue voting (TED) with immediate presentation of results and discussion, moderated experience reports on the categories risk/assessment/support/coping and finally moderated group discussions in small groups to collect "best practice" examples of crisis management. Objective: We tested "Corona-Debriefing" as a pilot test with 48 participants (TN) in July 2020 (30 present, 14 online) in order to assess mental stress and risk perception of participants plus formative/brief summative evaluation of the workshop. Methods: The PHQ-4 with its subscales GAD-2 (anxiety) and PHQ-2 (depression) was used to assess mental stress; risk assessments were made by means of self-constructed 5-point Likert-scales for the dimensions person/society/health/economy. A formative evaluation was carried out by means of a questionnaire at the end of the event; the brief summative assessment was asked for by means of a school grading scale. Results: 37 complete TED questionnaires and 22 evaluations were obtained. TN showed a low personal risk assessment, but considerable fears about social and economic developments. Needs are seen mainly in improvements regarding organization, protective equipment and technical communication (e.g. official recommendations for action). The workshop was rated "good" or "very good" in 95% of the evaluations. Criticism was directed at the limited time available, the narrowing of topics by moderators and the desire for (even) more room for the exchange of personal experiences. Conclusion: The workshop "Corona-Debriefing" is a relatively easy way to use crisis experiences for learning processes. "Corona-Debriefing" can be used by changing the focus of moderation in various courses, years or fields of study, whereby the participants' own personal and clinical crisis experiences remain a prerequisite for a meaningful "debriefing".

Financial reimbursement - irrelevant for GPs' readiness to implement brief intervention to reduce alcohol consumption? A cross-sectional vignette study.

BACKGROUND: General Practitioners' (GPs) readiness to implement screening and brief intervention (SBI) to treat patients with excessive alcohol consumption is low. Several studies identified crucial barriers such as insufficient financial reimbursement. In contrast to the barriers-account, we assume that low implementation readiness of GPs may be less attributed to external barriers but rather more so to inherent characteristics of SBI. To test our assumption, we conducted a vignette study assessing the GPs' readiness to implement SBI in comparison to a pharmacological intervention also designed for the treatment of excessive drinkers in relation to standard or above-standard financial reimbursement. According to our hypothesis GPs should be less ready to implement SBI regardless of financial reimbursement. METHODS: A convenience sample of GPs was recruited to answer the questionnaire. To assess the GPs' implementation readiness a 4-item 6-point Likert scale was developed and pretested. RESULTS: One hundred forty GPs completed the questionnaire. GPs were more ready to implement the pharmacological intervention than SBI, F(1,132) = 27.58, p > .001 (main effect). We found no effect for financial reimbursement, F(1,132) = 3.60, ns, and no interaction effect, F(1,132) = 2.20, ns. CONCLUSIONS: Further research should investigate more thoroughly the crucial characteristics of SBI to initiate a modification process finally leading to more effective primary care dependency prevention.

Misclassification of Self-Reported Body Mass Index Categories.

BACKGROUND: Overweight and obesity are an increasingly serious public health problem in Western societies, including Germany. The tendency of overweight and obese people not to classify themselves as such limits the efficacy of information on the health risks of these conditions and lessens the motivation to change behavior accordingly. In this article, we summarize the available study data on the selfperception of weight class. We present and discuss the differences between selfreported body-mass index (BMI) category and the actual category of the BMI when it is calculated from the individual's measured height and weight. METHODS: We systematically searched the Medline, EMBASE, and Cochrane Library databases in August 2017 for pertinent publications. The study protocol was published in the PROSPERO register (CRD42017064230). Meta-analyses were calculable for a number of subgroup analyses. RESULTS: A total of 50 studies from 25 countries were identified that contained findings on self-estimation of weight in a total of 173 971 study participants. The percentage of correct self-categorizations of BMI category varied from 16% to 83%, with marked heterogeneity of the population groups studied. In Europe, women overestimated their BMI category three times as often as men (RR: 3.22; 95% confidence interval: [2.87; 3.62], I2 = 0%). Most erroneous classifications were based on underestimates. Study participants of normal weight were more likely than others to categorize their BMI correctly. In European studies, 50.3-75.8% categorized their BMI correctly. Low socioeconomic status was associated with an incorrect perception of BMI. CONCLUSION: The self-assignment of BMI categories is often erroneous, with underestimates being more common than overestimates. Physicians should take particular care to provide appropriate information to persons belonging to groups in which underestimating one's BMI is common, such as overweight people and men in general.

[Acute Abdominal Pain: Hospital Admission or Not - And What Happens Then?] / Akuter Bauchschmerz: einweisen oder nicht? Und was dann?

Acute abdominal pain (AAP) is a common symptom and reason for encounter in family practices and emergency rooms. About every tenth hospital emergency room consultation is dealing with AAP, the most important reason is the "suspected acute abdomen". Important diagnostic considerations and clarification steps in family practice and emergency room are presented with the question: in which cases further treatment must be inpatient - or can be done on an outpatient basis. Acute abdominal pain has a complex differential diagnostic spectrum. Early detection of urgent cases is crucial to the outcome. The most important diagnostic means are history ("inductive foraging"), physical examination and sonography. "Yellow flags" provide valuable information for risk groups. Interdisciplinary cooperation is crucial, in doubt: "four eyes principle". If the cause is unclear, follow-up should be planned.

Patient Satisfaction as a Moderator of Risky Alcohol Consumers' Attitude Towards Screening and Brief Intervention: A Cross Sectional Survey.

AIMS: Although shown to be effective, General Practitioners (GPs) tend to refuse the implementation of Screening and Brief Intervention (SBI). Their expectation of negative response by patients seems to contrast with the positive attitude towards SBI of these patients. This discrepancy may be resolved by regarding moderators such as drinking status and patient satisfaction. We hypothesized that the attitude towards SBI will be more positive for abstainers or low-level consumers in comparison to high risk consumers especially in case of low patient satisfaction. METHODS: Ten GP offices in Germany received the questionnaires for a recruitment maximum of 30 patients each. Patient satisfaction was measured by the Koelner Questionnaire of Patient Satisfaction and drinking status was evaluated using the AUDIT-C. To assess the SBI attitude a pretested 8-item Likert scale was used. RESULTS: Questionnaires of 257 patients could be analyzed. Almost a third of patients were risky consumers (N = 78, 29.9%). They showed a more negative attitude towards SBI (M = 3.99, SD = 0.71) than abstainers or low-level consumers (M = 4.20, SD = 0.55). The main analysis revealed main effects for alcohol consumption, F(1, 252) = 4.31, P < 0.05, and patient satisfaction, F(1, 252) = 22.15, P < 0.001, as well as an interaction effect, F(1, 252) = 5.01, P < 0.05, showing that the SBI attitude of risky consumers was more negative than the SBI attitude of abstainers or low-level consumers only in case of low satisfaction. CONCLUSIONS: Risky consumers show a more positive attitude towards SBI when they are satisfied with their GP. Our results thus suggest the use of a supportive consultation style for the intervention of risky consumers. SHORT SUMMARY: SBI attitude of general practice patients depends on their drinking status: abstainers or low-level consumers revealed a more positive attitude towards SBI than risky consumers. This effect is moderated by the patient's satisfaction. Risky consumers show a more positive attitude towards SBI if they are satisfied with their GP.

Fostering needs assessment and access to medical rehabilitation for patients with chronic disease and endangered work ability: protocol of a multilevel evaluation on the effectiveness and efficacy of a CME intervention for general practitioners.

BACKGROUND: Studies show that endangered work ability (EWA) can be maintained or restored through medical rehabilitation (MR). For patients, general practitioners (GP) represent an important point of access to MR in outpatient care. However, many different barriers and shortcomings hinder GPs in both timely detection of the need for MR and the recognition of its potentials for their EWA-patients. These are necessary if GPs are to adequately inform patients about MR options and successfully support applications for MR. This study describes the evaluation of a continuing medical education (CME) module designed to improve rehabilitation-related practical performance of GPs regarding a) subjective satisfaction of GPs with the CME module, b) stability of attitudes and knowledge over time regarding rehabilitation, and c) subjective and objective changes in MR-related competencies needed to support MR applications. METHODS: This study is an open, non-randomised, pre-post-intervention study. The intervention involves a CME module for GPs (n = 1365) in the German state of Saxony-Anhalt on the topic of medical rehabilitation in connection with the federal German pension fund (Deutsche Rentenversicherung). The module will be initially held as regularly scheduled meetings in moderated GP quality circles (QC), and then offered as a written self-study unit. At the end it will be evaluated by the GPs. The study's primary focus is on the organizational practice as measured by the number of approved MR applications supported by medical reports submitted by the participating GPs in the 6 months before and 6 months after the CME module. Other study aims involve measuring self-perceived competencies of GPs, as well as their attitudes towards and knowledge of rehabilitation (both upon completing the CME and 6 months later). In addition, the level of satisfaction with the CME module will be analysed among participating GPs and QC moderators (as CME facilitators). DISCUSSION: Implementing targeted CME on complex topics such as those involving barriers is possible, even promising, when using QCs and their moderators. Of particular importance is how aware moderating physicians are of the relevance of MR need detection and access. ETHICS AND DISSEMINATION: The ethics committee of the Martin-Luther-Universität Halle-Wittenberg has registered this study under the number 2014-13. The study will be reported on in peer-reviewed journals and at national and international conferences. The results will be available to current and future initiatives aiming to improve detection of MR need and making MR accessible to EWEC patients needing such support to minimize the effects of chronic disease on their livess. TRIAL REGISTRATION NUMBER: German Clinical Trials Register (ID number DRKS00006188) and WHO International Clinical Trials Registry Platform, Universal Trial Number (UTN) U1111-1158-8334.

Pilot phase evaluation of the elective general practice class: results of student surveys of the first two years.

Background: Primary health care in rural regions is currently undergoing a global crisis in respect of the next generation of practitioners. National and international recommendations advise placing greater emphasis upon practical skills and competences in medical studies. It is also in the interest of training the next generation to include mentoring and longitudinal integration of contact to teaching practices for general medicine in an early stage. Consequently, the General Practice Class (KAM) was introduced in Halle in 2011 as an elective with 20 individually mentored students per year, beginning with the first subject-related semester. We are now reporting on the results of the evaluation for the first two years. Method: A standardised online survey was carried out with all students who took part in the KAM in the two years 2011 and 2012 (N=38). For both years the survey was made at the end of the first summer semester on the basis of an adapted version of the Heidelberger Inventar zur Lehrevaluation (Heidelberg Inventory for the Evaluation of Teaching, HILVE-II) and the Berliner Evaluationsinstrument für selbsteingeschätzte, studentische Kompetenzen (Berlin Evaluation Instrument for the self-assessment of student competences, BEvaKomp). Furthermore, each year the preference for the choice of specialty and location of a medical practice was queried. Predictors for the preference of the chosen specialty and the location of a medical practice were estimated by binary logistic regression analysis. Via univariate evaluations the number of students who reported an increase in knowledge in different areas of competence as a result of the KAM was counted. Correlations between the intention to remain in the KAM and the quality of teaching were evaluated on the basis of bivariate correlations. Results: 48% of the students agreed partly or fully that the KAM seminars enhanced their specialist competence. This individual acquiring of competence in the model project represented a significant predictor for the preferred choice of the area (OR 7.98; 95% CI [1.27-50.27], p=0.027). Students who assessed the commitment (r=0.504), support (r=0.526) and interaction management (r=0.529) of the mentors positively were more likely inclined to continue their participation in the KAM. Conclusion: The successful conveyance of care-relevant competences to students proved to be an important predictor in our project for the preference of the specialty general practice. This requires that the medical mentors are suitably trained and that the students are specifically prepared for practical experience.

Methamphetamine use in Central Germany: protocol for a qualitative study exploring requirements and challenges in healthcare from the professionals' perspective.

INTRODUCTION: The synthetic drug methamphetamine with its high addiction potential is associated with substantial adverse health effects. In Germany, especially Central Germany, the increase in the consumption of methamphetamine has exceeded that of other illegal drugs. The treatment system and service providers are facing new challenges due to this rise in consumption. This qualitative study will explore the demand created by the increasing healthcare needs of methamphetamine-addicted persons in Central Germany, and the difficulty of rehabilitating addicted people. METHODS AND ANALYSIS: The collection of empirical data will take place in a consecutive, two-stage process. In the first part of data collection, the experiences and perspectives of 40 professionals from numerous healthcare sectors for methamphetamine-addicted persons will be explored with the help of semistructured face-to-face interviews and probed by the research team. These findings will be discussed in 2 focus groups consisting of the participants of the face-to-face interviews; these group discussions comprise the second part of the data collection process. The interviews will be audio recorded, transcribed, and then subjected to qualitative content analysis. ETHICS AND DISSEMINATION: All interviewees will receive comprehensive written information about the study, and sign a declaration of consent prior to the interview. The study will comply rigorously with data protection legislation. The research team has obtained the approval of the Ethical Review Committee at the Martin Luther University Halle-Wittenberg, Germany. The results of the study will be published in high-quality, peer-reviewed international journals, presented at several congresses and used to design follow-up research projects. TRIAL REGISTRATION NUMBER: VfD_METH_MD_15_003600.

[General practitioners' commitment to treating excessive alcohol consumption: A question of role security in treating affected patients?]. / Hausärztliche Bereitschaft zur Intervention bei zu hohem Alkoholkonsum: Eine Frage der Sicherheit im Umgang mit betroffenen Patienten?

Only a few general practitioners (GPs) are committed to screen their patients for alcohol consumption and, in case of excessive alcohol consumption conduct by a brief intervention according to WHO recommendations. Apart from inadequate compensation and work load, another barrier identified by the GPs was their uncertainty about how to deal with affected patients. Most German universities presently spend no more than 90minutes lecture time on addiction medicine teaching. Our research aims to investigate the question whether medical studies and advanced medical education increases the role security of medical students and physicians and their commitment to implementing alcohol screening and brief intervention. Moreover, we will explore whether lack of therapeutic commitment can be related to lack of role security. Questionnaires were administered to pre-clinical and clinical medical students as well as senior house officers. Role security and therapeutic commitment of students and senior house officers were assessed using the Alcohol and Alcohol Problems Questionnaire (SAAPPQ) subscales "Role Security" and "Therapeutic Commitment". Analysis was based on 367 questionnaires. As expected, senior house officers reported more Role Security than clinical medical students who showed a higher level of Role Security than pre-clinical medical students. No differences could be found for Therapeutic Commitment. An association between Role Security and Therapeutic Commitment was only revealed for clinical medical students. Medical studies and advanced medical education can increase students' and senior house officers' Role Security to treat patients with excessive alcohol consumption, but not Therapeutic Commitment. Moreover, no association between Role Security and Therapeutic Commitment could be found for senior house officers. Hence, it may be assumed that educational activities aiming to increase Role Security do not promote the development of motivational aspects such as Therapeutic Commitment to the management of patients with excessive alcohol intake.

[(Expected) Consultation length, mental (co-)morbidity and patient satisfaction in the family practice encounter]. / (Erwartete) Konsultationsdauer, psychische (Ko-)Morbidität und Zufriedenheit mit dem ärztlichen Gespräch in der Hausarztpraxis.

INTRODUCTION: Mental disorders are common in family practice, but their meaning for variables of consultation is rarely considered. Thus, we examined the influence of mental disorders on patients' expectations regarding time, openness and seriousness as well as ratings of satisfaction with the consultation. METHODS: Prior to consultation for 219 patients a screening for anxiety (GAD-7), depression (PHQ-9) and hypochondriasis (WI-7) was performed. Before and after the consultation patient expectations and ratings were recorded. Subgroup analysis was based on Mann-Whitney U tests. RESULTS: Almost half of the sample were screen-positive. Prior the consultation, screen positive patients had higher ratings for expectations compared with screen negative patients, but did not differ in their experiences after the consultation. There was no association between consultation length and ratings for satisfaction. DISCUSSION: Patients screened positive for mental disorders do not necessarily require longer consultation length, if their expectations regarding openness and seriousness are met. This is underlines the importance of communication skills in undergraduate medical education and specialist training for future GPs.

Clerkship in primary care: a cross-sectional study about expectations and experiences of undergraduates in medicine.

INTRODUCTION: With the amendment of the medical licensure act (Approbationsordnung) in 2012, a four-week clerkship in primary care (FHV) became mandatory. We investigated the expectations with which students begin the FHV, which criteria are relevant in selecting the location for the FHV, and the experiences the students had during the FHV. METHOD: In a cross-sectional study, all third-year students at both medical schools in Saxony-Anhalt were surveyed in 2013 about their expectations and experiences regarding the FHV. This is the last cohort for which the FHV is optional. Questions were asked about 29 items addressing six topics (personal information, selection of FHV location, selection of FHV medical practice, expectations, experiences, and specialty selection). RESULTS: Out of a student body of 446, responses were received from N=424 (response rate 95.1%; of which 61.8% female). Of these students, 71 (16.7%) had completed the FHV and 70 (16.5%) were planning to; another 267 students (63%) had not (yet) planned to participate in an FHV. Where a student's parents lived, personal recommendations of a particular medical practice and the attractiveness of the region were the most important criteria for selecting the clerkship site. After completing the FHV, the learning objectives reflected themselves in the experiences of the students in a similar order and significance as in the expectations of students who planned or had not (as of yet) planned to complete the FHV. A relevant influence of the FHV confirming the choice to specialize in general practice or outpatient care was not indicated by those who had completed the FHV. CONCLUSION: After location and practice, the FHV is selected according to personal criteria and in connection with prioritized learning objectives. From the students' perspective, the most frequently named learning objectives are also identified as acquired experience after completing the FHV. However, the FHV does not have a reinforcing effect on the selection of general practice as a specialty.

Meta-regression analyses to explain statistical heterogeneity in a systematic review of strategies for guideline implementation in primary health care.

This study is an in-depth-analysis to explain statistical heterogeneity in a systematic review of implementation strategies to improve guideline adherence of primary care physicians in the treatment of patients with cardiovascular diseases. The systematic review included randomized controlled trials from a systematic search in MEDLINE, EMBASE, CENTRAL, conference proceedings and registers of ongoing studies. Implementation strategies were shown to be effective with substantial heterogeneity of treatment effects across all investigated strategies. Primary aim of this study was to explain different effects of eligible trials and to identify methodological and clinical effect modifiers. Random effects meta-regression models were used to simultaneously assess the influence of multimodal implementation strategies and effect modifiers on physician adherence. Effect modifiers included the staff responsible for implementation, level of prevention and definition pf the primary outcome, unit of randomization, duration of follow-up and risk of bias. Six clinical and methodological factors were investigated as potential effect modifiers of the efficacy of different implementation strategies on guideline adherence in primary care practices on the basis of information from 75 eligible trials. Five effect modifiers were able to explain a substantial amount of statistical heterogeneity. Physician adherence was improved by 62% (95% confidence interval (95% CI) 29 to 104%) or 29% (95% CI 5 to 60%) in trials where other non-medical professionals or nurses were included in the implementation process. Improvement of physician adherence was more successful in primary and secondary prevention of cardiovascular diseases by around 30% (30%; 95% CI -2 to 71% and 31%; 95% CI 9 to 57%, respectively) compared to tertiary prevention. This study aimed to identify effect modifiers of implementation strategies on physician adherence. Especially the cooperation of different health professionals in primary care practices might increase efficacy and guideline implementation seems to be more difficult in tertiary prevention of cardiovascular diseases.

Gaining information about home visits in primary care: methodological issues from a feasibility study.

BACKGROUND: Home visits are part of general practice work in Germany. Within the context of an expanding elderly population and a decreasing number of general practitioner (GPs), open questions regarding the organisation and adequacy of GPs' care in immobile patients remain. To answer these questions, we will conduct a representative primary data collection concerning contents and organisation of GPs' home visits in 2014. Because this study will require considerable efforts for documentation and thus substantial involvement by participating GPs, we conducted a pilot study to see whether such a study design was feasible. METHODS: We used a mixed methods design with two study arms in a sample of teaching GPs of the University Halle. The quantitative arm evaluates participating GPs and documentation of home visits. The qualitative arm focuses on reasons for non-participation for GPs who declined to take part in the pilot study. RESULTS: Our study confirms previously observed reasons for non-response of GPs in the particular setting of home visits including lack of time and/or interest. In contrast to previous findings, monetary incentives were not crucial for GPs participation. Several factors influenced the documentation rate of home visits and resulted in a discrepancy between the numbers of home visits documented versus those actually conducted. The most frequently reported problem was related to obtaining patient consent, especially when patients were unable to provide informed consent due to cognitive deficits. CONCLUSIONS: The results of our feasibility study provide evidence for improvement of the study design and study instruments to effectively conduct a documentation-intensive study of GPs doing home visits. Improvement of instructions and questionnaire regarding time variables and assessment of the need for home visits will be carried out to increase the reliability of future data. One particularly important methodological issue yet to be resolved is how to increase the representativeness of home visit care by including the homebound patient population that is unable to provide informed consent.

Motives of former interns in general practice for speciality-choice--results of a cross-sectional study among graduates 2007 to 2012.

BACKGROUND: The influence of a final-year elective internship in general practice (IGP) on motives affecting graduates' choice of specialty is the object of great public interest, yet still insufficiently evaluated. Longitudinal studies show the influence of numerous motives (e.g., work-life balance), but not following the IGP experience itself. Thus, we performed a cross-sectional questionnaire study of all graduates who completed the IGP in Saxony-Anhalt during 2007-2012 regarding their motives for choosing a speciality. METHOD: A standardized questionnaire was sent to 109 former interns in general practice. The questionnaire contained 29 items addressing three topics (personal attitudes, concept of personal and professional life, motives for speciality choice) and used single-choice and multiple-choice answers, as well as Likert scales. Correlation analysis was carried out by means of Kendall's tau. RESULTS: The questionnaire reached 97 former interns, of which 45 (46%) responded. In the overall ranking of motives for speciality choice, family (71%), leisure time (66%) and job opportunities (48%) rated as more important than income (36%), mentoring (20%), status or scientific work (20%). Only 29% of the respondents stated that their speciality choice was changed by the IGP. If the speciality choice was already established before the IGP, the influence of the IGP on speciality choice was significantly low (r = -.5; p < .01). However, if the IGP had an influence on speciality choice, it was correlated with a new perception of general practice (r = .36; p<.01). This new perception was associated with a positive influence of the medical teacher during the IGP. CONCLUSION: The final-year IGP is an opportunity to change the perception of general practice in students who are still undecided. This can lead to different speciality choices in a subgroup. Personal attitudes and concepts of personal life and career were also important factors affecting speciality choice. The aspects of the positive influence exerted by medical teachers on those students who are still undecided during the IGP should be carefully evaluated.

Strategies for guideline implementation in primary care focusing on patients with cardiovascular disease: a systematic review.

BACKGROUND: Guidelines should reduce inappropriate practice and improve the efficiency of treatment. Not only methodological quality but also acceptance and successful implementation in daily practice are crucial for the benefit on patients. Focusing on cardiovascular diseases (CVD), it is still unclear which implementation strategy can improve physician adherence to the recommendations of guidelines in primary care. METHODS: We conducted a systematic review on randomized controlled trials about guideline implementation strategies on CVD. Medline, Embase, CENTRAL, conference proceedings and registers of ongoing studies were searched. RESULTS: Eighty-four trials met our predefined inclusion criteria, of them 54 trials compared unimodal strategies and 30 multimodal strategies to usual care. Concerning unimodal strategies, 15 trials investigated provider reminder systems, 3 audit and feedback, 15 provider education, 4 patient education, 5 promotion of self-management and 14 organizational change. The strongest benefit of a unimodal implementation strategy was found due to organizational change (odds ratio 1.96; 95% CI 1.4 to 2.75), followed by patient education, provider education and provider reminder systems. Trials on the efficacy of audit and feedback and patient self-management showed differing results or small advantages in terms of physician adherence. Multimodal interventions showed almost similar effect measures and ranking of strategies. CONCLUSION: The use of implementation strategies for the distribution of guidelines on CVD can be convincingly effective on physician adherence, regardless whether based on a unimodal or multimodal design. Three distinct strategies should be well considered in such an attempt: organizational changes in the primary care team, patient education and provider education.

The "general practice class"--an eligible compulsory course in undergraduate medical education: didactical structure, teaching targets and implementation.

Undergraduate medical education in the field of general practice currently faces two considerable challenges: enhancing the attractiveness of general practice for all students and contributing to the necessary future rural physician workforce in primary care. Thus, we introduce a curriculum-based concept called the "General Practice Class" (Klasse Allgemeinmedizin) as an elective compulsory course to be taken during preclinical study. The aim of this concept is to strengthen the program focus on primary care in rural areas for interested students at an early stage.Since October 2011, the "General Practice Class" in Halle-Wittenberg offers learning experiences in regard to GP professional culture and a practice-oriented learning environment for 10% (n=20) of the freshman students. Each participating student is assigned to an individual GP mentor, who acts as a "professional example" and accompanies the student during the entire course of study. The concept of the "General Practice Class" is considered to be an innovative project due to the close connection between practical experience, problem-oriented skills training, early patient contact, and the accompanying face-to-face mentorship, starting from the beginning of preclinical study.