Reduction of discrepancies between students and instructors in the assessment of practical tasks through structured evaluation sheets and peer feedback.

The aim of this study was to reduce discrepancies between students and instructors in a preclinical dental course by employing structured peer feedback based on a detailed evaluation sheet. In a crossover study of dental students (n = 32), which compared peer feedback using an evaluation sheet (test) with the traditional method (control), participants completed tasks involving cavity and partial crown preparation. The practical tasks were scored numerically on a scale ranging from one (excellent) to six (failure). The amount of feedback provided by the instructor was also recorded. Statistical analysis was conducted using Wilcoxon signed-rank tests (p < 0.05). Regarding cavity preparation, no statistically significant difference was observed (median (25th-75th percentile)) between the grades received by the test (2.00 (1.50-3.00)) and control groups (2.25 (2.00-3.00)). However, the grades pertaining to partial crown preparation exhibited a statistically significant difference between the test (2.25 (2.00-2.50)) and control (2.50 (2.00-3.00)) groups. LimeSurvey and five-finger feedback were used to assess satisfaction with the new method, revealing that most students found the evaluation sheet and peer feedback to be effective. Within the limitations of this study, structured peer feedback using the evaluation sheet positively impacted grades pertaining to partial crown preparation, requiring less instructor feedback.

[ZApprO versus ZÄPrO: results of a first comparative study]. / ZApprO versus ZÄPrO: Ergebnisse einer ersten Vergleichsstudie.

BACKGROUND: More than 60 years after the enactment of the first Licensing Regulations for Dentists (ZÄPrO), a new Licensing Regulations for Dentists, the ZApprO, was implemented in 2020. The aims of this study were to evaluate and compare the "Course in Technical Propaedeutics" (TPK) with the course "Dental Propaedeutics with a Focus on Dental Technology" (ZPDT), which are based on different legal foundations. METHODS: The following parameters were compared after completion of the courses: (1) theoretical and practical knowledge, (2) regular department-internal learner evaluation, and (3) special evaluation of learning conditions by the learners and (4) by the instructors. The theoretical and practical exams and the questionnaires were analyzed in terms of their test-statistical characteristics (difficulty, discrimination index, internal consistency). Group comparisons between TPK and ZPDT were conducted using t­tests for independent groups. RESULTS: Significant differences were only detected in the students' evaluation of their learning conditions, with theoretical and practical knowledge transfer being rated lower in the TPK than in the ZPDT. DISCUSSION: The comparable results of the knowledge assessments and the regular learner evaluation, triangulated with the comprehensive learner and instructor evaluation, allowed a broad assessment of both courses. The significant differences identified provide opportunities for optimization of the newly implemented ZPDT course.

Development of individual competencies and team performance in interprofessional ward rounds: results of a study with multimodal observations at the Heidelberg Interprofessional Training Ward.

Introduction: Interprofessional training wards (IPTW) aim to improve undergraduates' interprofessional collaborative practice of care. Little is known about the effects of the different team tasks on IPTW as measured by external assessment. In Heidelberg, Germany, four nursing and four medical undergraduates (= one cohort) care for up to six patients undergoing general surgery during a four-week placement. They learn both professionally and interprofessionally, working largely on their own responsibility under the supervision of the medical and nursing learning facilitators. Interprofessional ward rounds are a central component of developing individual competencies and team performance. The aim of this study was to evaluate individual competencies and team performance shown in ward rounds. Methods: Observations took place in four cohorts of four nursing and four medical undergraduates each. Undergraduates in one cohort were divided into two teams, which rotated in morning and afternoon shifts. Team 1 was on morning shift during the first (t0) and third (t1) weeks of the IPTW placement, and Team 2 was on morning shift during the second (t0) and fourth (t1) weeks. Within each team, a tandem of one nursing and one medical undergraduate cared for a patient room with three patients. Ward round observations took place with each team and tandem at t0 and t1 using the IP-VITA instrument for individual competencies (16 items) and team performance (11 items). Four hypotheses were formulated for statistical testing with linear mixed models and correlations. Results: A total of 16 nursing and medical undergraduates each were included. There were significant changes in mean values between t0 and t1 in individual competencies (Hypothesis 1). They were statistically significant for all three sum scores: "Roles and Responsibilities", Patient-Centeredness", and "Leadership". In terms of team performance (Hypothesis 2), there was a statistically significant change in mean values in the sum score "Roles and Responsibilities" and positive trends in the sum scores "Patient-Centeredness" and "Decision-Making/Collaborative Clinical Reasoning". Analysis of differences in the development of individual competencies in the groups of nursing and medical undergraduates (Hypothesis 3) showed more significant differences in the mean values of the two groups in t0 than in t1. There were significant correlations between individual competencies and team performance at both t0 and t1 (Hypothesis 4). Discussion: The study has limitations due to the small sample and some sources of bias related to the external assessment by means of observation. Nevertheless, this study offers insights into interprofessional tasks on the IPTW from an external assessment. Results from quantitative and qualitative analysis of learners self-assessment are confirmed in terms of roles and responsibilities and patient-centeredness. It has been observed that medical undergraduates acquired and applied skills in collaborative clinic reasoning and decision-making, whereas nursing undergraduates acquired leadership skills. Within the study sample, only a small group of tandems remained constant over time. In team performance, the group of constant tandems tended to perform better than the group of random tandems. The aim of IPTW should be to prepare healthcare team members for the challenge of changing teams. Therefore, implications for IPTW implementation could be to develop learning support approaches that allow medical and nursing undergraduates to bring interprofessional competencies to team performance, independent of the tandem partner or team.

Depression and social isolation during the COVID-19 pandemic in a student population: the effects of establishing and relaxing social restrictions.

Introduction: In a quasi-naturalistic study design, we evaluate the change in psychopathological syndromes and general well-being after the alleviation of social restrictions. The aim of this study was to investigate the specific relationship between social isolation and depressive syndromes. Methods: At two timepoints, the first during maximal social restrictions, the second after social restrictions had widely ended for 9 months, depressive and other syndromes were measured in an online survey addressing the total cohort of students registered at Heidelberg University, Germany via e-mail (n = 27,162). The complete Patient Health Questionnaire (PHQ) was used with nine items for depressive syndromes. In addition, well-being was measured by the Well-Being Index WHO-5. In the quantitative and qualitative part of the study psychopathological syndromes and well-being were related to social isolation and feelings of loneliness. Results: After 1.5 years of pandemic-related social restrictions, "major" depressive syndromes were reported by 40.16% of the respondents to the PHQ in a sample of 2,318 university students. 72.52% showed a severely reduced Well-Being-Index. Nine months after the end of social restrictions, "major" depressive syndromes were reported by 28.50% of the participants. Well-being improved after the alleviation of social restrictions, as well: 53.96% showed a Well-Being Index of below 50 vs. 72.52% in the first study. The quantitative and qualitative analysis of the free texts of the respondents suggest that a significant amount of depressive syndromes and reduced well-being are related to social isolation and loneliness. While in the times of the pandemic restrictions the participants mostly reported "loneliness and social isolation" (24.2%) as their main problem, only 7.7% described these as their main problem after social restrictions had been loosened for 9 months. The qualitative analysis hints that at t2 participants were more likely to mention possible ways to actively deal with loneliness than at t1, which might be interpreted along the lines of the decrease in depressive syndromes. Discussion: Keeping the self-selection bias in mind our study results suggest that one third of "major" depressive syndromes and one quarter of severely reduced well-being accompany social restrictions or are even caused by them, with loneliness being an important factor. These results should be taken into account by health policies when coping with future pandemics.

Predictors of Students' Mental Health during the COVID-19 Pandemic: The Impact of Coping Strategies, Sense of Coherence, and Social Support.

Young people and women seem to suffer more from social restrictions due to the COVID-19 pandemic than do others. Findings from pre-pandemic surveys identified students as a specific risk group for developing anxiety and depressive symptoms. Recent studies have indicated that students especially denoted a decrease in mental health during the pandemic. In a sample of n = 1938 university students (67.6% female), we investigated protective factors that are associated with mental health (defined as the absence of any mental disorder) and more specifically, the absence of major depression during the pandemic despite social restrictions. Investigated protective factors were social support, sense of coherence and situational coping strategies. The results of the multiple logistic regression analyses revealed that male gender, high sense of coherence and specific coping strategies could be identified to be associated with mental health in general and the absence of major depression. Protective coping strategies that were related to mental health in general were lower substance use, lower behavioral disengagement, higher positive reframing and lower self-blame. Protective coping strategies that were associated with the absence of major depression specifically were higher use of instrumental support, lower substance use, lower behavioral disengagement, higher positive reframing, higher emotional support, lower self-blame and lower humor. Social support was related to the absence of major depression, but not to mental health in general. Higher age in university students was associated with better mental health, but not with the absence of major depression specifically. These findings indicate that sense of coherence and situational coping strategies can buffer the adverse effect of social restrictions on mental health and thus, can serve as important resilience factors. Moreover, they highlight the political relevance of promoting specific coping strategies to foster mental health in students encompassing adverse events and social restrictions.

Well-Being and Mental Health of Students during the COVID-19 Pandemic.

BACKGROUND: During the COVID-19 pandemic, a decrease in well-being and an increase in mental health problems were registered in medical and psychotherapeutic practices, counseling centers, and clinics. According to previous studies, younger people and women seemed to be particularly affected. The aim of this study was to describe mental health problems of students and to draw consequences for the further handling of pandemics and other crises. METHOD: Students at the University of Heidelberg, a typical German "full university," were surveyed online using internationally comparable screening instruments like the Well-Being Index (WHO-5) and the Patient Health Questionnaire (PHQ). In addition, the students had the opportunity to describe in a narrative form their well-being and to make suggestions how to improve their situation. RESULTS: Out of a population of 27,162 students who were contacted by email, 2,137 students completed the questionnaire. The salient finding is that according to the WHO-5 Well-Being Index, 72.2% of the respondents feel seriously impaired in their well-being. This corresponds to the finding that 75.8% of the respondents in the PHQ-D show indications of at least one syndrome diagnosis. Depression was found in 41.8% of the respondents in the PHQ-D. Indications of moderate to severe and severe depressive syndromes were present in 31.8%. Signs of somatoform syndromes are found in 25.4% and of anxiety syndromes in 20.0%. 1,089 students gave narrative reports on how they were feeling and made suggestions for improvement. About 75% reported severely reduced well-being. Their main complaints were loneliness and depression and lack of recognition for their specific academic and life situation during the pandemic. By far, the largest proportion of students supposed that their mental health issues were caused and/or intensified by the pandemic-related social contact restrictions. The vast majority of them made reasonable suggestions for controlled relaxation of contact restrictions. CONCLUSIONS: Students suffer severely from the pandemic-related social restriction. In respect to future pandemic outbreaks or other crises leading to social isolation, the dramatic consequences of social lockdowns should be taken into account. Under pandemic conditions, we especially should support persons lacking social networks.

[Quality assurance of faculty examinations: Optimization of examination management in the Heidelberg Curriculum Medicinale (HeiCuMed)]. / Qualitätssicherung fakultätsinterner Prüfungen ­ Optimierung des Prüfungsmanagements im Heidelberger Curriculum Medicinale (HeiCuMed).

INTRODUCTION: Examinations are a central element of the medical curriculum: they contribute significantly to the quality assurance of medical training and subsequent medical care. In order to meet the high expectations placed on examinations in terms of content, legal and organizational aspects, continuous quality assurance measures are necessary. The aim of this paper was to record and analyze the quality assurance measures implemented at the medical faculty of Heidelberg. METHODS: We investigated quality indicators that are relevant to medical examinations - adequate choice of examination formats, blueprint/validity, reliability and distribution of grades, feedback to students, consequences of examinations - within the faculty examinations in the decentrally organized Heidelberg Curriculum Medicinale (HeiCuMed). In addition, the organizational structures in examination management were examined. For this purpose, interviews were conducted with teaching staff, students and the technical examination administration. RESULTS: The surveys show that the quality indicators in HeiCuMed have already been met in many areas. Optimization work remains to be done concerning the criteria "adequate choice of examination formats", "feedback to students" as well as the documentation of the examination process and the definition of substitution regulations. DISCUSSION: Training courses, statistical analysis and accompanying research are essential for establishing additional innovative, practice-oriented examination formats. In order to improve feedback to students, formative assessments should be more intensively integrated into the curriculum. As a measure for structured quality-oriented examination management, it is also helpful to document the examination procedure and the staff assigned to it using templates. CONCLUSION: Especially with decentralized examination management, the internal coordination of individual departments is of great importance in order to guarantee the quality of examinations. Regular surveys of the parties involved can be of support by collecting best-practice examples and deliver the respective information in handouts encouraging interdisciplinary exchange.

Digitalization within the MME study program - teaching and assessment of communicative and interprofessional skills in the Heidelberg module via video conference together with a virtual OSCE course.

Background: Due to the corona pandemic, we conducted the Heidelberg module of the Master of Medical Education (MME) study program, which focuses on teaching and assessment of communicative and interpofessional skills, digitally for the first time. Method: We outsourced the teaching to a pre-module phase in the weeks upfront. During the module week, the lecturers picked up again and deepened the topics and the participants created, revised and simulated a virtual OSCE course. Results/Conclusion: Evaluation and reflection of the module showed that the digital implementation including an OSCE examination can be an appropriate alternative to a classroom-based training. However, important elements of the MME program that provide networking possibilities and personal exchange can only be replicated in the digital environment to a limited extent. In the future, sensibly applied digital components can be used to enrich the study program.

Formative assessment of practical skills with peer-assessors: quality features of an OSCE in general medicine at the Heidelberg Medical Faculty.

Background: Objective Structured Clinical Examinations (OSCEs) have become an established examination format at German medical faculties. Medical experts routinely use a summative assessment to evaluate practical and communicative skills, while the use of the OSCE format by student examiners, as a formative examination, remains rather limited. Objective: The formative OSCE program of the Department of General Practice and Implementation Research at the Heidelberg Medical Faculty, which is conducted and evaluated by peer tutors, is examined with regard to its quality criteria and compared with summative OSCEs from other departments. Methods: Difficulties and discriminatory power of individual testing stations were determined for the summative, as well as the formative OSCE, and compared with each other. To assess the reliability of the measurements, an analysis of the data was carried out using the Generalizability theory. In addition, a comparison is made between the assessments of student examiners and second assessments by medical experts. Results: The stations of the formative OSCE show similar difficulties as those of the summative comparison OSCEs (Pform=0.882; Psum=0.845 - 0.902). With respect to measurement reliability, there are no differences between the OSCE in General Medicine and the other subjects. The assessments of student examiners and medical experts correlate highly (r=0.888). Conclusion: The formative OSCE in General Medicine is comparable to the summative comparison formats in terms of its quality criteria. The use of student examiners can be a reliable alternative to medical experts in formative OSCEs.

Adaptation and validation of the Berlin questionnaire of competence in evidence-based dentistry for dental students: a pilot study.

BACKGROUND: The purpose of this pilot study was to create a valid and reliable set of assessment questions for examining Evidence-based Dentistry (EbD) knowledge. For this reason, we adapted and validated for dental students the Berlin Questionnaire (BQ), which assesses Evidence-based Medicine (EbM) abilities. METHODS: The Berlin Questionnaire was validated with medical residents. We adapted it for use in a dentistry setting. An expert panel reviewed the adapted BQ for content validity. A cross-sectional cohort representing four training levels (EbD-novice dental students, EbD-trained dental students, dentists, and EbM-/EbD-expert faculty) completed the questionnaire. A total of 140 participants comprised the validation set. Internal reliability, item difficulty and item discrimination were assessed. Construct validity was assessed by comparing the mean total scores of students to faculty and comparing proportions of students and faculty who passed each item. RESULTS: Among the 133 participants (52 EbD-novice dental students, 53 EbD-trained dental students, 12 dentists, and 16 EbM-/ EbD-expert faculty), a statistically significant (p < 0.001) difference was evident in the total score corresponding to the training level. The total score reliability and psychometric properties of items modified for discipline-specific content were acceptable. Cronbach's alpha was 0.648. CONCLUSION: The adapted Berlin Questionnaire is a reliable and valid instrument to assess competence in Evidence-based Dentistry in dental students. Future research will focus on refining the instrument further.

Measuring competency-relevant knowledge in the competency-oriented student progress test.

Background: Since 2013 a competency-oriented student progress test (SKPT) has been administered at a number of German medical schools. The questions are generated on the basis of a two-dimensional blueprint, on which one axis contains the five competency domains - communicative competence (CO), practical clinical competence (CP), theoretical clinical competence (CT), scientific competence (SC), and professional decision-making competence (PR) - that form part of the competency model of the National Competency-based Catalogue of Learning Objectives for Undergraduate Medicine (NKLM). The feedback for students is structured in part according to these domains. The aim of our study is to examine if the results differentiated by competency domain show adequate measurement accuracy and if the results for the different domains also contain different information. Methods: The SKPTs for the years 2013 to 2017, taken by a total of 3,027 students, were examined. The measurement accuracy was determined using the coefficient glb (greatest bound to reliability) and the standard error of measurement; discriminant analysis of the principal components was carried out to demonstrate differentiation between the competency domains. Results: The reliability of the competency domains was above 0.8 for all SKPTs; exceptions to this were seen in two of the tests for CO and PR that had a reliability of 0.7-0.8. The results for all of the individual competency domains differed in their informational content compared to the overall of the other domains; the same applies for all pairwise comparisons, with the exceptions of CP and CT. Discussion: The SKPT feedback for students that is differentiated by competency domains basically fulfills the requirements for measurement reliability and distinctness. An improvement of the measurement quality for CO and PR and a better differentiation between CP and CT is desirable.

Acceptability of an orodispersible film compared to syrup in neonates and infants: A randomized controlled trial.

OBJECTIVES: Reliable pediatric pharmacotherapy in all age groups requires the availability of age-appropriate drug administration. Orodispersible films (ODF) are a promising pediatric oral dosage form. ODFs would meet relevant targets: one dosage form matching the full range of pediatric patients, a minimum of non-toxic excipients, a stable drug formulation easily to be produced. However, there is a lack of reliable data on ODFs' acceptability, swallowability and palatability, especially in young children. The primary objective was to demonstrate non-inferiority in acceptability of a drug-free ODF in comparison to glucose syrup in children aged below one year. Secondary objectives were swallowability and palatability of the two formulations. STUDY DESIGN: The study was performed in an open, randomized, two-way cross-over design with three age groups: 2-28 days, 29 days-5 months, 6-12 months. 150 children (N = 50 per age group) were randomized to the order of receiving the ODF (2 × 3 cm) and age-adapted amounts of glucose syrup (0.5-3 mL). Deglutition and swallowing were assessed according to predefined evaluation criteria. The application of the formulations was documented by video to evaluate the palatability. RESULTS: The primary objective was confirmed: Non-inferiority of the acceptability of an ODF compared to syrup was demonstrated, even superiority of the ODF was shown (p < 0.0001). The secondary endpoints demonstrated positive results including the superior swallowability of the ODF in comparison to syrup (p < 0.0001). The palatability assessments were in favor of the ODF. CONCLUSION: ODFs are a promising and safe alternative to liquid formulations, even for children of very young ages.

Individual and institutional influencing factors on completion rates in a medical education master's program in Germany.

Background: The increasing significance of didactic aspects in medical education has also led to the development of special postgraduate programs. Completion rates represent an important outcome criterion for these programs of study. Up to today, detailed studies on what factors influence these completion rates have been lacking. Methods: Within the framework of outcomes research, a semi-structured online survey of students was conducted in the Master of Medical Education Germany program. Of the 90 items, 21 referred to the master's thesis that is required for graduation. Results: 157 out of 246 (63.8%) of students from classes 1-10 of the program (study period 2004-2014) participated in the survey. 109 participants had submitted a master's thesis, whereas 45 participants had not completed their studies by submitting a master's thesis. Influencing factors of successful completion were, among other things, little difficulty in choosing the topic, retention of the originally chosen topic, general support by the program administration in the modules and ensuring timely feedback from the advisor, and the provision of temporal, staff and financial resources by the home faculty. The failure to turn in the project report and a lengthy interruption of master thesi's work could be identified as critical parameters. Conclusion: Taking into account these results can contribute to increasing completion rates in medical education graduate programs. Systematic outcomes research leads, moreover, to quality assurance. Such studies should be conducted in a standardized manner in the future, in order to facilitate comparisons between medical education programs.

"Princess and the pea" - an assessment tool for palpation skills in postgraduate education.

BACKGROUND: In osteopathic medicine, palpation is considered to be the key skill to be acquired during training. Whether palpation skills are adequately acquired during undergraduate or postgraduate training is difficult to assess. The aim of our study was to test a palpation assessment tool developed for undergraduate medical education in a postgraduate medical education (PME) setting. METHODS: We modified and standardized an assessment tool, where a coin has to be palpated under different layers of copy paper. For every layer depth we randomized the hiding positions with a random generator. The task was to palpate the coin or to determine that no coin was hidden in the stack. We recruited three groups of participants: 22 physicians with no training in osteopathic medicine, 25 participants in a PME course of osteopathic techniques before and after a palpation training program, 31 physicians from an osteopathic expert group with at least 700 h of osteopathic skills training. These experts ran the test twice to check for test-retest-reliability. Inferential statistical analyzes were performed using generalized linear mixed models with the dichotomous variable "coin detected / not detected" as the dependent variable. RESULTS: We measured a test-retest reliability of the assessment tool as a whole with 56 stations in the expert group of 0.67 (p <  0.001). For different paper layers, we found good retest reliabilities up to 300 sheets. The control group detected a coin significantly better in a depth of 150 sheets (p = 0.01) than the pre-training group. The osteopathic training group showed significantly more correct coin localizations after the training in layer depths of 200 (p = 0.03) and 300 sheets (p = 0.05). This group also had significantly better palpation results than the expert group in the depth of 300 sheets (p = 0.001). When there was no coin hidden, the expert group showed significantly better results than the post-training group (p = 0.01). CONCLUSIONS: Our tool can be used with reliable results to test palpation course achievements with 200 and 300 sheets of paper. Further refinements of this tool will be needed to use it in complex assessment designs for the evaluation of more sophisticated palpatory skills in postgraduate medical settings.

Students' self-assessment of competencies in the phantom course of operative dentistry.

INTRODUCTION: The aim was to assess the competencies of undergraduate students in their roles of dental expert, scholar, communicator, collaborator, health advocate, manager and professional. MATERIALS AND METHODS: For this retrospective, pseudonymised observational study (pre-/post-testing), students in two cohorts in their first clinical semester in operative dentistry were asked to judge their competencies (1 = very good to 6 = insufficient) with a learning objective catalogue designed at the Goethe University Frankfurt (modelled after the National Competency-Based Learning Objective Catalogue Dentistry), at the beginning and end of their phantom course. In order to relate the students' subjective competency judgements to objective evidence of their skills, at the end of the semester their marks from the summative Objective Structured Practical Examination (OSPE) were compared with the subjective judgement of their exam performance before the final results were known. RESULTS: The reliability of the evaluation sheet was evaluated with Cronbach's alpha 0.98. The students judged their competencies as "sufficient" (4.23 ± 0.51) at the beginning and "satisfactory" (2.82 ± 0.43) at the end. A significant improvement in competencies was observed within all roles. The students' subjective judgement of the exam results (3.66 ± 0.62) was significantly correlated with the actual marks (3.69 ± 0.83) in the OSPE at 0.3547 (P = 0.0015). CONCLUSION: The evaluation instrument showed excellent reliability. The students judged that their competencies significantly increased during the semester. The triangulation with the actual marks in the context of an OSPE demonstrated a significant correlation with the students' exam judgements.

A Comparison of Stress Perception in International and Local First Semester Medical Students Using Psychometric, Psychophysiological, and Humoral Methods.

(1) Medical doctors and medical students show increased psychological stress levels. International medical students seem to be particularly vulnerable. (2) We compared different methods of assessing stress levels in international and local first year medical students. First, study participants completed questionnaires related to stress, depression, empathy, and self-efficacy (MBI, PSQ, PHQ-9, JSPE-S, and GSE) at three separate points in time (T1 to T3). Second, their heart rate variabilities (HRVs) were recorded in an oral examination, a seminar, and in a relaxing situation. Third, hair samples were collected at the beginning and at the end of the semester to assess the cortisol concentration. (3) Included were 20 international and 20 local first semester medical students. At T1, we found considerable differences between international and local students in the JSPE-S; at T2 in the MBI factor "professional efficacy", the PHQ-9, and in the JSPE-S; and at T3 in the MBI factors "cynicism" and "professional efficacy", the PHQ-9, and in the JSPE-S. International and local students also differed concerning their HRVs during relaxation. Over the course of the semester, international students showed changes in the MBI factors "emotional exhaustion" and "professional efficacy", the PHQ-9, and the GSE. Local students showed changes in the GSE. No effects were found for students' hair cortisol concentrations. (4) All participants showed low levels of stress. However, while international students experienced their stress levels to decrease over the course of the semester, local students found their stress levels to increase.

Dealing with flawed items in examinations: Using the compensation of disadvantage as used in German state examinations in items with partial credit scoring.

In the written part of German state exams, multiple choice questions which inherit a flaw are not always excluded but taken into consideration when awarding a grade to any individual candidate, if this is advantageous to the candidate. This process of elimination and compensation of disadvantage in flawed questions, as applied by the Institut für medizinische und pharmazeutische Prüfungsfragen (IMPP), can lead to differentitems being taken into consideration in the grading in individual cases and to the application of different pass and grade boundaries in individual cases. This procedure is applied here to examinations containing items with partial credit scoring. A simple numerical rule can be applied which can be used to decide whether a flawed item has be taken into account in the grading procedure in order to achieve a pass or a particular grade for a candidate. This rule - as in the state examinations - must take account of the individual number of scores achieved in the flawed item and, if the relative pass threshold ("automatic adjustment clause") is applied, the average score achieved in the item by all candidates. In addition, however, it also includes the grade boundaries.

Ready to run the wards? - A descriptive follow-up study assessing future doctors' clinical skills.

BACKGROUND: Recent studies have shown that clinical tasks only represent a small percentage in the scope of final-year medical students' activities and often lack sufficient supervision. It appears that final-year medical students are frequently deployed to perform "routine tasks" and show deficits in the performance of more complex activities. This study aimed to evaluate final-year students' clinical performance in multiple impromptu clinical scenarios using video-based assessment. METHODS: We assessed final-year medical students' clinical performance in a prospective, descriptive, clinical follow-up study with 24 final-year medical students during their Internal Medicine rotation. Participating students were videotaped while practicing history taking, physical examination, IV cannulation, and case presentation at the beginning and end of their rotation. Clinical performance was rated by two independent, blinded video assessors using binary checklists, activity specific rating scales and a five-point global rating scale for clinical competence. RESULTS: Students' performance, assessed by the global rating scale for clinical competence, improved significantly during their rotation. However, their task performance was not rated as sufficient for independent practice in most cases. Analysis of average scores revealed that overall performance levels differed significantly, whereby average performance was better for less complex and more frequently performed activities. CONCLUSIONS: We were able to show that students' performance levels differ significantly depending on the frequency and complexity of activities. Hence, to ensure adequate job preparedness for clinical practice, students need sufficiently supervised and comprehensive on-ward medical training.

Study on the Interrater Reliability of an OSPE (Objective Structured Practical Examination) - Subject to the Evaluation Mode in the Phantom Course of Operative Dentistry.

INTRODUCTION: The aim of the study presented here was to evaluate the reliability of an OSPE end-of-semester exam in the phantom course for operative dentistry in Frankfurt am Main taking into consideration different modes of evaluation (examiner's checklist versus instructor's manual) and number of examiners (three versus four). METHODS: In an historic, monocentric, comparative study, two different methods of evaluation were examined in a real end-of-semester setting held in OSPE form (Group I: exclusive use of an examiner's checklist versus Group II: use of an examiner's checklist including an instructor's manual). For the analysis of interrater reliability, the generalisability theory was applied that contains a generalisation of the concept of internal consistency (Cronbach's alpha). RESULTS: The results show that the exclusive use of the examiner's checklist led to higher interrater reliability values than the in-depth instructor's manual used in addition to the list. CONCLUSION: In summary it can be said that the examiner's checklists used in the present study, without the instructor's manual, resulted in the highest interrater reliability in combination with three evaluators within the context of the completed OSPE.

Improving patient-centered communication: Results of a randomized controlled trial.

OBJECTIVE: Patient-centered communication is a key element for improving the quality of care in terms of therapeutic relationship, patient participation, and treatment process. Postgraduate trainings provide an essential way of promoting patient centeredness on the job where learning opportunities are often limited by time, patient volume, and economic pressure. In the present study, changes in patient centeredness during clinical routines of postgraduate physicians (internal medicine) after a three-day communication training were assessed. METHODS: A randomized controlled trial was conducted in a primary care clinic. The intervention consisted of a communication training that aimed to enhance patient centeredness in postgraduate physicians. The training was based on a need assessment and the principles of deliberate practice. Workplace-based assessment of physicians' communication behavior was obtained using the Roter Interaction Analysis System. RESULTS: Three months after the intervention, trained physicians showed significantly increased patient centeredness (F=5.36, p=.04; d=0.42). CONCLUSION: The communication training significantly improved patient centeredness during routine clinical practice. Thus, this training provides a structured and theory-based concept to foster patient centeredness. PRACTICE IMPLICATIONS: The results support the implementation of communication trainings as a part of faculty development and medical specialization training.