New horizons in dermatological education: Skin cancer screening with virtual reality.

BACKGROUND: Technological advances in the field of virtual reality (VR) offer new opportunities in many areas of life, including medical education. The University of Münster has been using VR scenarios in the education of medical students for several years, especially for situations that are difficult to reproduce in reality (e.g., brain death). Due to the consistently positive feedback from students, a dermatological VR scenario for skin cancer screening was developed. OBJECTIVES: Presentation and first evaluation of the skin cancer screening VR scenario to determine to what extent the technical implementation of the scenario was evaluated overall by the students and how their subjective competence to perform a skin cancer screening changed over the course of the teaching unit (theory seminar, VR scenario, theoretical debriefing). METHODS: Students (n = 140) participating in the curricular pilot project during the 2023 summer term were surveyed throughout the teaching unit using several established questionnaires (System Usability Scale, Simulation Task-Load-Index, Realism and Presence Questionnaire) as well as additional questions on cybersickness and subjective learning. RESULTS: (i) The use of VR is technically feasible, (ii) students evaluate the VR scenario as a useful curricular supplement, and (iii) from the students' subjective perspective, a good learning outcome is achieved. Although preparation and follow-up appear to be important for overall learning, the greatest increase in subjective competence to perform a skin cancer screening is achieved by the VR scenario. CONCLUSIONS: Technically feasible and positively evaluated by students, VR can already be a useful addition to dermatology education, although costs are still high. As a visual discipline, dermatology offers special opportunities to create VR scenarios that are not always available or comfortable for patients in reality. Additionally, VR scenarios guarantee the same conditions for all students, which is essential for a high-quality education.

Immersive training of clinical decision making with AI driven virtual patients - a new VR platform called medical tr.AI.ning.

Background: Medical students need to be prepared for various situations in clinical decision-making that cannot be systematically trained with real patients without risking their health or integrity. To target system-related limitations of actor-based training, digital learning methods are increasingly used in medical education, with virtual reality (VR)- training seeming to have high potential. Virtually generated training scenarios allow repetitive training of highly relevant clinical skills within a protected, realistic learning environment. Thanks to Artificial Intelligence (AI), face-to-face interaction with virtual agents is feasible. Combining this technology with VR-simulations offers a new way of situated context-based, first-person training for medical students. Project goal and method: The authors' aim is to develop a modular digital training platform for medical education with virtual, interactable agents and to integrate this platform into the medical curriculum. The medical tr.AI.ning platform will provide veridical simulation of clinical scenarios with virtual patients, augmented with highly realistic medical pathologies within a customizable, realistic situational context. Medical tr.AI.ning is scaled to four complementary developmental steps with different scenarios that can be used separately and so each outcome can successively be integrated early within the project. Every step has its own focus (visual, movement, communication, combination) and extends an author toolbox through its modularity. The modules of each step will be specified and designed together with medical didactics experts. Perspective: To ensure constant improvement of user experience, realism, and medical validity, the authors will perform regular iterative evaluation rounds.Furthermore, integration of medical tr.AI.ning into the medical curriculum will enable long-term and large-scale detection of benefits and limitations of this approach, providing enhanced alternative teaching paradigms for VR technology.

Predicting Actual Social Skill Expression from Personality and Skill Self-Concepts.

Social skills are of key importance in everyday and work life. However, the way in which they are typically assessed via self-report questionnaires has one potential downside; self-reports assess individuals' global self-concepts, which do not necessarily reflect individuals' actual social behaviors. In this research, we aimed to investigate how self-concepts assessed via questionnaires relate to skill expression assessed via behavioral observations after short interpersonal simulations. For this, we used an alternative behavior-based skill assessment approach designed to capture expressions of predefined social skills. Self- and observer ratings were collected to assess three different social skills: agency (i.e., getting ahead in social situations), communion (i.e., getting along in social situations), and interpersonal resilience (i.e., staying calm in social situations). We explored how these skills were related to self-concepts by differentiating between a classic personality measure (i.e., Big Five Inventory 2; BFI-2) and a novel skill questionnaire (i.e., Behavioral, Emotional, and Social Skills Inventory; BESSI). The results (N = 137) showed that both personality and skill self-concepts predicted self-rated skill expression, with the BESSI showing incremental validity. For both personality and skills self-concepts, the relationships with observer-rated skill expression were significant for agency but not for communion or interpersonal resilience. We discuss these results and highlight the theoretical and practical importance of differentiating between skill self-concepts and actual skill expression.

A project report on the switch from in-class to online tuition in the preparatory course for the knowledge examination for foreign physicians - guidelines for the organization of the online summer semester 2020 at the faculty of medicine of the Westfälische Wilhelms-Universität of Münster.

Introduction: In Germany, foreign physicians are a fixed component of the medical profession. According to the German Medical Licensure Act, physicians having completed their qualification in another country are required to pass a knowledge examination which falls within the competence of examination offices or the regional governments. Project outline: The preparatory course consists of 10 modules. On Fridays, individual cases are discussed in small groups and specific examination techniques are trained. On Saturdays, illnesses are simulated by simulated patients. After each encounter, faculty experts, psychologists and peer group members provide the participants with 360° feedback. Due to the COVID-19 pandemic, the course which had been established 2 years beforehand has now been switched to an online class within one week. Friday units were visualized in power-point presentations and tutorial videos were discussed. On Saturdays, the cases were simulated by simulated patients and transmitted via a telemedicine platform. Results: The course could be conducted without interruptions (75 hours of in-class tuition and 75 hours of online tuition). In the oral evaluation the participants criticized telemedicine as a medium for imparting of practical skills. 7/22 (32%) of the participants underwent the knowledge examination and 6/7 (86%) of them passed it (versus 18/19 of the participants of in-class tuition (95%)). Discussion: There was a clear preference for in-class tuition. It was noted that the telemedical setting entailed some restrictions. However, the switch to online classes did not affect the pass rate. Conclusion: The switch from in-class to online units was feasible. The gained insights were taken into account when conceiving the online semester at our faculty and especially the tuition with the support of simulated patients.

Medical education too: sexual harassment within the educational context of medicine - insights of undergraduates.

BACKGROUND: Assessment of the presence and characteristics of sexual harassment in academic medicine is a global issue. Only limited international data are available so far. METHODS: Aim: To assess the extent of sexual harassment and identify the perpetrators in the student population of the medical school of Münster, Germany. A survey was undertaken, using the Medical Women's International Association sexual harassment questionnaire translated into German. The anonymous online questionnaire was sent as a link to all medical undergraduates at Münster Medical School via a mailing list between 1 October and 30 November 2018. Identifying or potentially identifying data were not collected. Data were analysed by descriptive statistical methods such as categorical variables. Baseline characteristics, e.g. answers by male or female medical students, were correlated with their individual sexual harassment experiences and perpetrator groups by means of univariate analysis. RESULTS: A total of 2162 medical students were asked to participate, with 623 (28.8%) completing the survey. Sexual harassment is a significant issue among medical students at Münster Medical School with over half (58.9%) of all undergraduates being exposed to sexually harassing behaviour. In total, 31.8% of all participants reported having experienced unwanted physical sexual contact such as unwanted physical touching, with 87.6% of the victims being female. Overall, 41.3% personally experienced verbal sexual harassment of which 87.4% were female. Furthermore, 8.5% of undergraduates faced forced sexual contact such as oral, anal or vaginal penetration, intercourse and rape, with all victims being female. Perpetrators in these cases were mostly male medical superiors (7.0%) and male patients (18.3%). In general, most perpetrators were patients, followed by medical superiors and educators, and less frequently by colleagues. CONCLUSIONS: Sexual harassment in medical education and the medical workplace is a significant problem in a German medical school. Most students experiencing sexual harassment are females. Female students also experience the more serious forms of sexual harassment more often.

Risk literacy assessment of general practitioners and medical students using the Berlin Numeracy Test.

BACKGROUND: The responsibility for helping patients understand potential health benefits and risks, especially regarding screening tests, falls largely to general practitioners (GPs). The Berlin Numeracy Test (BNT) specifically measures risk literacy (i.e., the ability to understand different aspects of statistical numeracy associated with accurate interpretation of information about risks). This study explored the association between risk literacy levels and clinical experience in GPs vs. medical students. Additionally, the effect of GP risk literacy on evaluation of the predictive value of screening tests was examined. METHODS: The participants were 84 GPs and 92 third-year medical students who completed the BNT (total score range 0-4 points). The GPs received an additional case scenario on mammography screening as a simple measure of performance in applying numeracy skills. RESULTS: Despite having an average of 25.9 years of clinical experience, GPs scored no better than medical students on risk literacy (GPs: 2.33 points, 95% confidence interval [CI] 2.08-2.59; students: 2.34, 95% CI 2.07-2.61; P = .983). Of all GPs, 71.6% (n = 58) greatly overestimated the real predictive value. CONCLUSIONS: In this study, we found no difference in risk literacy between current students and current GPs. GPs lack risk literacy and consequently do not fully understand numeric estimates of probability in routine screening procedures.

[Generation Y in surgery-the competition battle for talent in times of talent shortage]. / Generation Y in der Chirurgie ­ der Konkurrenzkampf um Talente in Zeiten des Nachwuchsmangels.

BACKGROUND: Surgical disciplines are fighting with a critical and escalating shortage of recruits. Potential young professionals belong to the Generation Y, a generation that is constantly challenging senior consultants and human resources departments. The aim of this study was the analysis of various measures of personnel acquisition with respect to motivating factors of young medical students. MATERIAL AND METHODS: A survey was carried out among students of the first and ninth semesters of a medical faculty on individual motivating factors, aspiration for medical specialist training and professional experience gained in surgery. RESULTS: Results from 179 out of 269 medical students were available for analysis (66.5% response rate). The interest in a specialist training in surgery was high in the first semester of medical school (21%) but dropped noticeably up to the ninth semester (13%, p = 0.23). Medical students in the ninth semester, who favored professional advancement and appreciation over flexible working hours showed a significantly higher interest in a specialist training in surgery (p = 0.022). Surgical experience gained was valued with an average grade of 2+ (1 = best, 6 = worst). CONCLUSION: The high fundamental interest in a surgical residency during the beginning of medical studies is a competitive advantage of surgical disciplines; however, the diverse recruiting efforts are mainly aimed at later stages of studies. Timely hands-on courses in the core working area of surgery, the operating theatre, have proven to be particularly successful for the long-term acquisition and retention of junior doctors.

Construct validity of multiple mini interviews - Investigating the role of stations, skills, and raters using Bayesian G-theory.

Background: One popular procedure in the medical student selection process are multiple mini-interviews (MMIs), which are designed to assess social skills (e.g., empathy) by means of brief interview and role-play stations. However, it remains unclear whether MMIs reliably measure desired social skills or rather general performance differences that do not depend on specific social skills. Here, we provide a detailed investigation into the construct validity of MMIs, including the identification and quantification of performance facets (social skill-specific performance, station-specific performance, general performance) and their relations with other selection measures.Methods: We used data from three MMI samples (N = 376 applicants, 144 raters) that included six interview and role-play stations and multiple assessed social skills.Results: Bayesian generalizability analyses show that, the largest amount of reliable MMI variance was accounted for by station-specific and general performance differences between applicants. Furthermore, there were low or no correlations with other selection measures.Discussion: Our findings suggest that MMI ratings are less social skill-specific than originally conceptualized and are due more to general performance differences (across and within-stations). Future research should focus on the development of skill-specific MMI stations and on behavioral analyses on the extents to which performance differences are based on desirable skills versus undesired aspects.

[Implementation and evaluation of a revised curriculum for psychiatry and psychotherapy]. / Einführung und Evaluation eines neuen Kurrikulums Psychiatrie und Psychotherapie.

BACKGROUND: Medical education in the discipline of psychiatry and psychotherapy at the University of Münster was traditionally focused on the transfer of knowledge via lectures. According to the current guidelines, the medical curriculum was modified as from the winter semester 2016/2017 to be more competency-based and the changes were evaluated. OBJECTIVE: Lectures and seminars were reduced to achieve a better linkage between theoretical and practical knowledge. Moreover, learning goals were formulated based on the German National Competence-based Catalogue of Learning Objectives in Medicine (NKLM) and entrustable professional activities (EPAs). MATERIAL AND METHODS: Almost all previous lectures are now replaced by an inverted classroom concept with e­learning. Theoretical knowledge is deepened by immediate multiple choice (MC) examinations and a seminar, which now focusses on specific practical EPAs. At the end of the semester, the students now undergo a practical, formative examination with simulated patients (actors) in addition to the former MC test. For evaluation, a representative sample of a semester cohort which took part in the previous curriculum and a similar cohort which attended the revised curriculum were investigated. Moreover, variables which might have an impact on the results were assessed, e. g. pre-existing psychiatric knowledge and motivation. RESULTS: Students taught by the modified curriculum showed a significantly better practical performance and no reduction of theoretical knowledge. Relevant influencing factors were not identified. CONCLUSION: The results show that a competency-based modification of the curriculum in the discipline of psychiatry and psychotherapy leads to more practical abilities and thus helps future physicians to be more self-determined.

Simulation-based mastery learning in medical students: Skill retention at 1-year follow up.

Context: Deficits in basic skill performance and long-term skill retention among medical students and novice doctors are a persistent problem. This controlled study tested whether the addition of a mastery learning component to simulation-based teaching is associated with long-term retention and performance of peripheral venous catheter insertion. Methods: Fourth-year medical students were assigned to receive either the control (simulation without mastery learning, n = 131) or the intervention (simulation + mastery learning, n = 133) instruction in peripheral venous catheter insertion. Performance was assessed at one year post-instruction. Eighty-four students from the control group and 71 from the intervention group participated in the assessment. Results: Students who received the mastery learning instruction achieved higher overall test scores than did controls (median mastery learning score: 20.0, IQR 2.0; median control score 19.0, IQR 3.0; Mann-Whitney U test, p < 0.001, effect size d = 0.82). Pass rates also differed significantly between the groups, with 74.5% (n = 53) of the intervention group passing compared with 33% (n = 28) of the control group (p < 0.001). Conclusions: Mastery learning is an effective means of teaching practical skills to medical students, and is associated with higher scores at a 1-year follow up.

Medical doctors' job specification analysis: A qualitative inquiry.

Purpose: A qualitative inquiry was conducted to investigate the qualification requirements of medical doctors in different professional fields and from different perspectives. The inquiry was part of an empirical workplace analysis. Methods: Seventy-four structured interviews were conducted and analyzed to examine critical incidents and behaviors of medical doctors working in different professional fields (clinical theory, clinical practice, practitioner) and disciplines, and from three different perspectives (medical doctors, non-medical staff, and patients). In addition, the National Competency-based Catalogue of Learning Objectives for Medical Education (Nationaler Kompetenzbasierter Lernzielkatalog Medizin / NKLM) was used. Results: The results revealed eleven relevant competencies, which could be categorized into three superordinate competence clusters: interpersonal, work-related, and self-related. The perspectives of medical doctors and non-medical staff included all eleven competencies. However, the perspective of patients did not include one interpersonal and two self-related competencies. Nearly all of the critical behaviors mentioned are included in the NKLM. However, the NKLM also includes behaviors that were not mentioned in the interviews. Conclusions: The behavior-oriented interviews resulted in a requirement profile that is very similar in structure to other competency models in occupational contexts. Comparisons of the different perspectives predominantly revealed similarities. However, the patient perspective also revealed interesting differences compared to the perspectives of medical doctors and non-medical staff. The behavior-related results of the interviews can be directly used for the development of exercises in selection and personnel development contexts and for potential appraisals specific to different medical disciplines. In future steps, the results of this initial qualitative step are to be replicated and extended using quantitative studies and a representative sample. The main overall objective is the definition of relevant competencies both for the selection and development of medical students and for the design of potential appraisals as part of personnel development programs in different medical disciplines.

Mastery learning improves students skills in inserting intravenous access: a pre-post-study.

OBJECTIVE: Inserting peripheral venous catheters (PVCs) has been identified as a core competency for medical students. Because the performance - even of hygienic standards - of both students and novice physicians is frequently inadequate, medical faculties must focus on competence-based learning objectives and deliberate practice, features that are combined in mastery learning. Our aim was to determine the competency of students in inserting PVCs before and after an educational intervention. DESIGN: This study comprised a skills assessment with pre- and post-tests of a group of third-year students who received a simulation-based intervention. A newly established curriculum involved one hour of practice at inserting PVCs on simulators. Students were required to pass a test (total 21 points, pass mark 20 points) developed on the concept of mastery learning. An unannounced follow-up test was performed one week (8 days) after the intervention. SETTING: The simulation center of the medical faculty in Muenster. PARTICIPANTS: Third-year students who received the intervention. RESULTS: One hundred and nine complete data sets were obtained from 133 students (82.5%). Most students (97.2%) passed the test after the intervention (mean score increase from 15.56 to 20.50, P<0.001). There was a significant decrease in students' performance after one week (8 days): only 74.5% of participants passed this retest (mean score reduction from 20.50 to 20.06, P<0.001). CONCLUSION: Mastery learning is an effective form of teaching practical skills to medical students, allowing a thorough preparation for the challenges of daily clinical practice.

Practicing evidence based medicine at the bedside: a randomized controlled pilot study in undergraduate medical students assessing the practicality of tablets, smartphones, and computers in clinical life.

BACKGROUND: Practicing evidence-based medicine is an important aspect of providing good medical care. Accessing external information through literature searches on computer-based systems can effectively achieve integration in clinical care. We conducted a pilot study using smartphones, tablets, and stationary computers as search devices at the bedside. The objective was to determine possible differences between the various devices and assess students' internet use habits. METHODS: In a randomized controlled pilot study, 120 students were divided in three groups. One control group solved clinical problems on a computer and two intervention groups used mobile devices at the bedside. In a questionnaire, students were asked to report their internet use habits as well as their satisfaction with their respective search tool using a 5-point Likert scale. RESULTS: Of 120 surveys, 94 (78.3%) complete data sets were analyzed. The mobility of the tablet (3.90) and the smartphone (4.39) was seen as a significant advantage over the computer (2.38, p < .001). However, for performing an effective literature search at the bedside, the computer (3.22) was rated superior to both tablet computers (2.13) and smartphones (1.68). No significant differences were detected between tablets and smartphones except satisfaction with screen size (tablet 4.10, smartphone 2.00, p < .001). CONCLUSIONS: Using a mobile device at the bedside to perform an extensive search is not suitable for students who prefer using computers. However, mobility is regarded as a substantial advantage, and therefore future applications might facilitate quick and simple searches at the bedside.

Combining simulated patients and simulators: pilot study of hybrid simulation in teaching cardiac auscultation.

Auscultation torsos are widely used to teach position-dependent heart sounds and murmurs. To provide a more realistic teaching experience, both whole body auscultation mannequins and torsos have been used in clinical examination skills training at the Medical Faculty of the University of Muenster since the winter term of 2008-2009. This training has since been extended by simulated patients, which are normal, healthy subjects who have undergone attachment of the electronic components of the auscultation mannequins to their chests to mimic pathophysiological conditions ("hybrid models"). The acceptance of this new learning method was examined in the present pilot study. In total, 143 students in their second preclinical year who were participating in auscultation training were randomized into an intervention group (hybrid models) and a control group (auscultation mannequins). One hundred forty-two (99.3%) of these students completed a self-assessment Likert-scale questionnaire regarding different teaching approaches (where 1 = "very poor" to 100 = "very good"). The questionnaire focused on the "value of learning" of different teaching approaches. Direct comparison showed that students evaluated the hybrid models to be significantly more effective than the auscultation mannequins (median: 83 vs. 64, P < 0.001). The cardiac auscultation training was generally assessed positively (median: 88). Additionally, verbal feedback was obtained from simulated patients and tutors (trained students who had successfully passed the course a few semesters earlier). Personal feedback showed high satisfaction from student tutors and simulated patients. Hybrid simulators for teaching cardiac auscultation elucidated positive responses from students, tutors, and simulated patients.

Measuring the ambiguity tolerance of medical students: a cross-sectional study from the first to sixth academic years.

BACKGROUND: Tolerance of ambiguity, or the extent to which ambiguous situations are perceived as desirable, is an important component of the attitudes and behaviors of medical students. However, few studies have compared this trait across the years of medical school. General practitioners are considered to have a higher ambiguity tolerance than specialists. We compared ambiguity tolerance between general practitioners and medical students. METHODS: We designed a cross-sectional study to evaluate the ambiguity tolerance of 622 medical students in the first to sixth academic years. We compared this with the ambiguity tolerance of 30 general practitioners. We used the inventory for measuring ambiguity tolerance (IMA) developed by Reis (1997), which includes three measures of ambiguity tolerance: openness to new experiences, social conflicts, and perception of insoluble problems. RESULTS: We obtained a total of 564 complete data sets (return rate 90.1%) from medical students and 29 questionnaires (return rate 96.7%) from general practitioners. In relation to the reference groups defined by Reis (1997), medical students had poor ambiguity tolerance on all three scales. No differences were found between those in the first and the sixth academic years, although we did observe gender-specific differences in ambiguity tolerance. We found no differences in ambiguity tolerance between general practitioners and medical students. CONCLUSIONS: The ambiguity tolerance of the students that we assessed was below average, and appeared to be stable throughout the course of their studies. In contrast to our expectations, the general practitioners did not have a higher level of ambiguity tolerance than the students did.

Teaching ultrasound in a curricular course according to certified EFSUMB standards during undergraduate medical education: a prospective study.

BACKGROUND: As a non-invasive and readily available diagnostic tool, ultrasound is one of the most important imaging techniques in medicine. Ultrasound is usually trained during residency preferable according to German Society of Ultrasound in Medicine (DEGUM) standards. Our curriculum calls for undergraduate training in ultrasound of medical students in their 4th year of undergraduate education. An explorative pilot study evaluated the acceptance of this teaching method, and compared it to other practical activities in medical education at Muenster University. METHODS: 240 medical students in their 4th year of undergraduate medical education participated in the training and completed a pre- and post-questionnaire for self-assessment of technical knowledge, self-assurance of the procedure, and motivation in performing ultrasound using a Likert scale. Moreover, students were asked about their interest in pursuing a career in internal medicine. To compare this training to other educational activities a standardized online evaluation tool was used. A direct observation of procedural skills assessment (DOPS) for the first time applied on ultrasound aimed to independently assess the success of our teaching method. RESULTS: There was a significant increase in technical knowledge and self-assurance (p < 0.001) of the students' self-assessments. The clinical relevance and self-motivation of the teaching were evaluated positively. The students' DOPS results demonstrated proficiency in the understanding of anatomic structures shown in ultrasonographic images, including terminology, machine settings, and transducer frequencies. CONCLUSIONS: Training ultrasound according to certified DEGUM standards was successful and should be offered in undergraduate medical education. The evaluation of the course affirmed the necessity, quality and clinical relevance of the course with a top ranking score of hands-on training courses within the educational activities of the Medical Faculty of Muenster.