How professional and academic pre-qualifications relate to success in medical education: Results of a multicentre study in Germany.

OBJECTIVE: Every year, many applicants want to study medicine. Appropriate selection procedures are needed to identify suitable candidates for the demanding curriculum. Although research on medical school admissions has shown good predictive validity for cognitive selection methods (undergraduate GPA, aptitude tests), the literature on applicants with professional and/or academic experience prior to entering medical school remains slim. In our study, we therefore aimed to examine the association between academic success in medical school and having previously completed vocational training in the medical field, voluntary service (≥11 months) or an academic degree. METHODS: Data were collected in a multicentre, cross-sectional study at five medical schools in Germany (Baden-Wuerttemberg) from students during medical school (i.e. 3rd-, 6th-, and 10th-semester and final-year students). Academic success was assessed according to scores on the first and second state examinations, the total number of examinations repeated and the number of semesters beyond the standard period of study. For the analysis we calculated ordinal logistic regression models for each outcome variable of academic success. RESULTS: A total of N = 2,370 participants (response rate: RR = 47%) participated in the study. Having completed vocational training was associated with a higher amount of repeated examinations (small effect), while having an academic degree was associated with worse scores on the second state examination (medium effect). No significant association emerged between voluntary service and academic success. CONCLUSION: The results indicate that professional and academic pre-qualifications pose no advantage for academic success. Possible associations with the financing of study and living conditions of students with pre-qualifications were analysed and discussed in an exploratory manner. However, the operationalisation of academic success from objective and cognitive data should be critically discussed, as the benefits of prior experience may be captured by personal qualities rather than examination results.

Chest Compression-Related Flail Chest Is Associated with Prolonged Ventilator Weaning in Cardiac Arrest Survivors.

Chest compressions during cardiopulmonary resuscitation (CPR) may be associated with iatrogenic chest wall injuries. The extent to which these CPR-associated chest wall injuries contribute to a delay in the respiratory recovery of cardiac arrest survivors has not been sufficiently explored. In a single-center retrospective cohort study, surviving intensive care unit (ICU) patients, who had undergone CPR due to medical reasons between 1 January 2018 and 30 June 2019, were analyzed regarding CPR-associated chest wall injuries, detected by chest radiography and computed tomography. Among 109 included patients, 38 (34.8%) presented with chest wall injuries, including 10 (9.2%) with flail chest. The multivariable logistic regression analysis identified flail chest to be independently associated with the need for tracheostomy (OR 15.5; 95% CI 2.77−86.27; p = 0.002). The linear regression analysis identified pneumonia (ß 11.34; 95% CI 6.70−15.99; p < 0.001) and the presence of rib fractures (ß 5.97; 95% CI 1.01−10.93; p = 0.019) to be associated with an increase in the length of ICU stay, whereas flail chest (ß 10.45; 95% CI 3.57−17.33; p = 0.003) and pneumonia (ß 6.12; 95% CI 0.94−11.31; p = 0.021) were associated with a prolonged duration of mechanical ventilation. Four patients with flail chest underwent surgical rib stabilization and were successfully weaned from the ventilator. The results of this study suggest that CPR-associated chest wall injuries, flail chest in particular, may impair the respiratory recovery of cardiac arrest survivors in the ICU. A multidisciplinary assessment may help to identify patients who could benefit from a surgical treatment approach.

Malaria Box-Inspired Discovery of N-Aminoalkyl-ß-carboline-3-carboxamides, a Novel Orally Active Class of Antimalarials.

Virtual ligand screening of a publicly available database of antimalarial hits using a pharmacophore derived from antimalarial MMV008138 identified TCMDC-140230, a tetrahydro-ß-carboline amide, as worthy of exploration. All four stereoisomers of this structure were synthesized, but none potently inhibited growth of the malaria parasite Plasmodium falciparum. Interestingly, 7e, a minor byproduct of these syntheses, proved to be potent in vitro against P. falciparum and was orally efficacious (40 mg/kg) in an in vivo mouse model of malaria.

Interprofessional education in medical and physiotherapy studies for future collaboration.

BACKGROUND: Interprofessional education (IPE) for medical and healthcare professions is highly relevant. It increases knowledge and skills, but also helps to foster the development of collaboration, which is essential for optimal patient care. One important aspect of IPE is to better understand profession's individual attitudes and perceptions towards interprofessionalism and the expected roles and skills for future collaboration in the context of patient care. METHODS: We offered IPE workshops using a peer assisted learning approach, with the focus on anatomy in the area of the lower back and hip. The workshops were attended by medical and physiotherapy students and consisted of three consecutive training sessions with the topics anatomical prosections, anatomy in vivo and orthopedics testing. We focused on student's attitudes and perceptions regarding the relevance of IPE and their expected skills in interprofessionalism. An established questionnaire was used as an instrument for self-assessment before and after the interprofessional experience. To evaluate for significance, analysis was carried out for all groups on pre- and post-course item mean differences. RESULTS: Pre-post score comparison for all groups combined demonstrated significant increase in terms of perceptions and attitudes for several items related to interprofessionalism and interprofessional skills. Medical and physiotherapy students rated themselves significantly higher for different questionnaire items. Students, who had obtained a professional qualification prior to their current studies, rated themselves significantly higher on certain items compared to those who had not. CONCLUSIONS: The results from this brief interprofessional anatomy experience are encouraging. The course led to meaningful improvements in competencies that are highly relevant for effective interprofessional collaboration in the future. Furthermore, identification of differences in professional group perceptions can be useful for development of future IPE workshops.

["Closing the Gap": Results of a survey assessing quality assurance in medical education]. / "Closing the Gap": Ergebnisse einer Bestandsaufnahme zu Qualitätssicherungsmaßnahmen der Lehre an medizinischen Fakultäten.

OBJECTIVES: The aim of the present study was to survey the current state of quality assurance of teaching at German-speaking medical faculties. Another aim was to determine whether and how the evaluation loop is closed. METHODS: A questionnaire was sent out to 45 German-speaking faculties in the DACH countries to determine how the faculties ensure quality of teaching. Information was collected on qualification programs offered to faculty, course evaluations (LVE), evaluations during the final year (PJ-E), and on the implementation of graduate surveys (ABS-B). Evaluable data sets are available from 29 of the 40 faculties that responded. RESULTS: At almost all faculties, lecturers can take advantage of various didactic offers. Training programs for (M3) examiners (32%) and PJ supervisors (21%), on the other hand, are offered less frequently. Students at two-thirds of the faculties participate in the planning and implementation of LVEs, which are conducted at all faculties. Almost all faculties conduct PJ-E, and 72% of the faculties report interviewing graduates (ABS-B). However, the responsibility for conducting the ABS-B lies with the faculties themselves in only 48% of the cases. Twenty faculties report various additional teaching evaluations (e.g., evaluation of projects, progress tests). Indicators of teaching quality are mostly student satisfaction (LVE=93%, PJ-E=82%, ABS-B=100%), practical relevance of content (LVE=72%, ABS-B=100%) and quality of supervision (PJ-E=86%). The majority use questionnaires that are often self-developed (LVE=63%, PJ=78%). Surveys are mostly summative and either purely online (LVE=44%, PJ-E=81%, ABS-B=40%) or combined with paper (LVE=56%, ABS-B=60%). The majority of results are reported back to the academic deans in writing and/or as a presentation of results. In addition, faculties conduct results-based interviews with faculty/departments (LVE=79%, PJ=64%) and make binding goal agreements during these interviews (LVE=52%, PJ-E=50%). The survey results are often used to inform curricular development (LVE=79%, PJ-E=89%, ABS-B=80%). However, changes in the curriculum based on these results are not re-evaluated in all cases (LVE=83%, PJ-E=60%, ABS-B=63%). CONCLUSION: This study provides an overview of the evaluation practice at German-speaking medical faculties. The number of evaluations carried out in the various areas related to teaching indicates that quality assurance of teaching is taken very seriously by medical faculties. However, there is still need for optimization in some areas: training programs for examiners and PJ supervisors should be offered more frequently to ensure teaching quality. It should also be examined whether the quality indicators used can be supplemented to include, for example, the indicator "giving appropriate feedback". Very often, self-developed questionnaires are used whose reliability and validity are questionable. The use of standardized questionnaires would be desirable in order to be able to adequately classify the results. In addition, the evaluation cycle is not closed with re-evaluations in all cases after curricular changes have been implemented. This is especially true of changes initiated by the PJ-E and ABS-B. .

"Assistant physician light?" - Feedback from graduates on the practical year.

Background: As the final and longest practical phase of undergraduate medical study in Germany, the final year is essential for the acquisition and development of core medical competencies. However, studies show that the educational conditions are often not optimal. The aim of this study was to learn more about the educational conditions connected with the final year and to find out how it can be improved. To do this, written comments from graduate evaluation surveys were analyzed. Methods: Using the data from the survey of Freiburg medical students in the graduating classes of 2015/16 and 2016/17, we investigated which potential improvements were identified by students who had completed the final year and which aspects these students felt they especially benefited from in terms of beginning their medical careers. The written responses by the Freiburg graduating classes of 2015/16 (n=88; response rate: 28%) and 2016/17 (n=112; response rate: 36%) to the questions about beneficial aspects of the final year and potential improvements were qualitatively analyzed for content. As a comparison condition, the written comments of medical students graduating in the same years from the other medical schools in Baden-Württemberg were analyzed. Results: The written responses of the Freiburg graduates to these two questions could be classified according to five main categories. Comments were most frequently assigned either to the category "(more) autonomous work, like an assistant physician" or "(increased) mentoring of the final-year students as learners". In hindsight, the Freiburg medical graduates felt that they had already benefited in terms of beginning their careers from working independently under supervision during the final year, but they also saw room for improvement and wished that they had been perceived more strongly as learners and encouraged as such. The analysis of the written comments made by students in the same graduating classes at other medical schools in Baden-Württemberg showed corroborating results. Conclusion: The results of this study show how the educational conditions of final year can be optimized. For instance, more opportunities should be created for final-year students to work independently and care for patients, and the course offerings should be expanded and adjusted, if needed, to match the needs of the students. Furthermore, those teaching final year students should be better trained and released from other duties so that they can focus on teaching.

Addiction Psychiatry and Addiction Medicine: The Evolution of Addiction Physician Specialists.

Addiction Psychiatry and Addiction Medicine are two physician subspecialities recognized by the American Board of Medical Specialties (ABMS) that focus on providing care for patients with substance use disorders. Their shared and distinct historical roots are reviewed, and their respective ABMS board examination content areas and Accreditation Council on Graduate Medical Education (ACGME) fellowship training program requirements are compared. Addiction Psychiatry, a subspecialty under the American Board of Psychiatry and Neurology, began certifying diplomates in 1993, currently has 1202 active diplomates, and certifies around 150 diplomates every 2 years through 50 ACGME-accredited fellowships. Addiction Medicine, a subspecialty under the American Board of Preventive Medicine, began certifying diplomates in 2018, has 2604 diplomates with more expected before the practice pathway closes (anticipated in 2021), after which a fellowship training becomes required. Currently there are 78 accredited Addiction Medicine fellowships and more under development. The fields display substantial overlap between their respective examination content areas and fellowship training requirements, covering similar knowledge and skills for evaluation and treatment of substance use disorders and psychiatric and medical comorbidities across the full range of clinical settings, from general medical to addiction specialty settings. Key differences include that Addiction Psychiatry is open only to Board-certified psychiatrists and places extra emphasis on psychotherapeutic and psychopharmacological management strategies. Addiction Medicine is open to any ABMS primary specialty, including psychiatry. Opportunities for collaboration are discussed as both fields pursue the common goal of providing a well-trained workforce of physicians to meet the public health challenge presented by addiction. (Am J Addict 2020;00:00-00).

Addiction Medicine Training Fellowships in North America: A Recent Assessment of Progress and Needs.

OBJECTIVES: Although unhealthy substance use and addiction contribute to 1 in 4 deaths and are estimated to cost the US more than $740 billion annually, fewer than 12 hours of physician education over the 7 years of medical school and primary residency training specifically address alcohol and other drug-related issues. Addiction Medicine was formally recognized as a medical subspecialty in 2016 to address the need for physicians trained in prevention, treatment, and management of substance use. This study examines the characteristics of the Addiction Medicine fellowships in operation during this critical period in the subspecialty's development to identify needs and potential. METHODS: This study is a cross-sectional survey of Addiction Medicine Fellowship Directors from 46 fellowships accredited as of 2017 (43 in the United States and 3 in Canada). The response rate was 100%. RESULTS: Directors estimated significant growth in available fellowship slots between 2016 to 2017 and 2017 to 2018 (F = 49.584, P < .001). The majority of Directors reported that demand for their graduates was high (79.5%). Fellow training in screening, brief intervention, and referral to treatment spanned many substances and age groups, although fewer programs focused on nicotine and on adolescent populations. Notably, most directors reported that graduates completed waiver training to prescribe buprenorphine-naloxone (77.5%) and gained clinical experience in an opioid treatment setting (89.1%). Funding was the #1 need among 56.8% of Directors. CONCLUSIONS: Despite significant growth in Addiction Medicine fellowships over the past 6 years, meeting future workforce demands for Addiction Medicine specialists depends on access to funding to support fellowships.

The frequency of using certain feedback methods in the teaching of medicine: a survey of teachers at the medical faculties in Baden-Wurttemberg.

Objectives: Feedback is one of the most important methods for competency-based teaching. A survey was conducted to learn more about the use of feedback methods at five medical faculties. Methods: In the 2017 summer semester, teachers at Baden-Wurttemberg's medical schools in Freiburg, Heidelberg, Mannheim, Tuebingen and Ulm were invited to participate in the survey. The link to the questionnaire was sent to the teaching coordinators at the various departments at each of the five medical schools. The teaching coordinators were asked to forward the link to the questionnaire to all instructors in their department. At one location, all instructors were directly addressed. The data were collected online. Results: A total of 464 instructors participated in the survey. Most consider feedback in medical education as important (23%) or very important (72%). However, some feedback methods are hardly used. The reason for this is, in particular, that some of the feedback methods are unfamiliar, e.g. checklists (56%), or not considered necessary by the instructors, e.g. written feedback (31%). Fifty-five percent of the instructors would like to receive further education or information on feedback. Conclusion: The results show that the use of feedback methods in medical teaching is expandable and that teachers find feedback to be important. Accordingly, nothing should stand in the way of a greater use of feedback methods in teaching. However, in order for this to happen, it is important that instructors are made more familiar with feedback methods.

Integrating addiction medicine into rural primary care: Strategies and initial outcomes.

OBJECTIVE: This retrospective study describes the role of behavioral health in an addiction medicine program integrated in a primary care clinic, and evaluates retention, substance use, and mental health symptoms for patients in a rural underserved community. METHOD: Data were abstracted from records of patients referred for buprenorphine treatment of opioid use disorder (N = 101; 45% female, 23% Native Hawaiian or Pacific Islander, Mage = 42.5, SD = 12.75). Among patients prescribed buprenorphine (n = 61), most had comorbid substance-related diagnoses (72% with tobacco use, 75% with at least one other substance use disorder) and non-substance-related mental health diagnoses (77%), most commonly depression and anxiety. Integrated sessions with a behavioral health provider and a buprenorphine-waivered prescriber occurred weekly to monthly. Participants completed depression and anxiety questionnaires (Patient Health Questionnaire-9 and Generalized Anxiety Disorder Scale-7) and provided urine samples at each visit. RESULTS: Most patients (72%) were retained for at least 3 months, with early dropout associated with higher initial depression and anxiety scores. Inconsistent urine drug tests (i.e., those positive for illicit/nonprescribed substances) were significantly more common at treatment initiation (74%) than during the most recent visit (43%, p < .001), and were associated with baseline substance and other mental health factors, as well as shorter treatment duration. Generalized estimating equations models suggested time-based improvements in depression and anxiety symptoms, especially for patients retained for at least 3 months. CONCLUSIONS: Integrating wraparound addiction treatment within a rural primary care setting is feasible and associated with improved mental health and retention outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Deazidoalkoxylation: Sequential Nucleophilic Substitutions with Diazidated Diethyl Malonate.

Diazidated malonamides derived from amines and diazidated diethyl malonate react with lithiated alcohols through nucleophilic substitution reactions where azide acts as an unconventional leaving group. This deazidoalkoxylation leads to the formal construction of N, O-acetals, and the remaining azide functionality is a useful entry point for further functionalizations through, for example, standard cycloaddition chemistry. Thus, the presented chemistry provides an easy route toward densely functionalized molecules: Amines, alcohols, and alkynes can be attached onto the small malonate core unit in a sequential manner.

Thermolysis of Geminal Diazides: Reagent-Free Synthesis of 3-Hydroxypyridines.

An operationally simple protocol for the rapid and efficient construction of highly substituted 3-hydroxypyridines is presented. The thermally induced cyclization of easily constructed geminal diazides derived from ß-ketoesters having an additional olefin moiety affords the title compounds in yields up to 97% under reagent-free conditions. The new method allows for the synthesis of preparative quantities of material. Additionally, the synthetic utility of the pyridine products for the synthesis of valuable heterocycles is described.

Addiction Medicine: Current Status of Certification, Maintenance of Certification, Training, and Practice.

Addiction medicine (ADM) is an emerging medical field. It will soon be recognized by the American Board of Medical Specialties as a multispecialty subspecialty, sponsored by the American Board of Preventive Medicine. Certification and maintenance of certification in ADM are available currently through the American Board of Addiction Medicine (ABAM). There is an urgent need for trained and certified ADM physicians to serve the needs of patients and society. Thirty-seven addiction medicine fellowships of 12 months duration are now available, and their number is increasing. Physicians specializing in medical toxicology have educational, training, and practice overlap with addiction medicine. Medical toxicology physicians usually meet ADM examination eligibility requirements, based on clinical practice experience and continuing medical education activities. Those with fellowship training or in a fellowship bring training experience which has commonalities to ADM fellowship training, and therefore are particularly prepared for examination and practice in ADM. There are opportunities for partnerships in training, practice, and leadership between addiction medicine and medical toxicology.

Specialized training on addictions for physicians in the United States.

In the United States accredited residency programs in addiction exist only for psychiatrists specializing in addiction psychiatry (ADP); nonpsychiatrists seeking training in addiction medicine (ADM) can train in nonaccredited "fellowships," or can receive training in some ADP programs, only to not be granted a certificate of completion of accredited training. Information about ADP residency programs has been tabulated, but it is not available for ADM fellowships. The authors conducted a national survey to compile information about the location, structure, curriculum, and other characteristics of active ADM fellowships. Of the 40 accredited ADP residency programs, 7 offered training in addiction to nonpsychiatrists. The authors identified 14 nonaccredited ADM fellowships. In 2009 and 2010, there were approximately 15 nonpsychiatrists in ADP programs and 25 in ADM fellowships. Clinical experiences included inpatient services, outpatient treatment services such as methadone maintenance or buprenorphine maintenance, and providing addiction consult services. The most common academic activities included weekly lectures and the teaching of medical students.