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1.
BMC Med Educ ; 20(1): 132, 2020 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-32345278

RESUMO

BACKGROUND: Physicians have to deal with uncertainty on a daily basis, which requires high tolerance for ambiguity. When medical decisions have to be made in ambiguous situations, low levels of need for cognitive closure and high levels of adaptive perfectionism are beneficial. It might be useful to measure such personality traits during medical school selection processes. In our study, we explored the expression of need for cognitive closure, tolerance for ambiguity, and perfectionism in medical school applicants who participated in a multiple mini-interview selection process with respect to the final decision of admission or rejection. METHODS: After participating in the multiple mini-interview procedure (HAM-Int) at Hamburg Medical School in August 2019, 189 medical school applicants filled out a questionnaire including the Multidimensional Perfectionism Scale by Hewitt and Flett (MPS-H), the Multidimensional Perfectionism Scale by Frost (MPS-F), the Tolerance for Ambiguity Scale (TAS), the 16-Need for Cognitive Closure Scale (16-NCCS), and sociodemographic data. After the final admission decision, the scores of need for cognitive closure, tolerance for ambiguity, and perfectionism of admitted and rejected applicants were compared. We also assessed the predictive power of need for cognitive closure and age for the admission decision in a binary logistic regression model. RESULTS: Compared to the admitted applicants, the rejected applicants showed a significantly higher need for cognitive closure (p = .009). A high need for cognitive closure correlated significantly positively with maladaptive perfectionism (p < .001) and significantly negatively with tolerance for ambiguity (p < .001). Low need for cognitive closure and older age were associated with a positive admission decision. CONCLUSIONS: Regarding the personality traits need for cognitive closure, tolerance for ambiguity, and perfectionism we identified interesting differences and correlations of relevance for physicians' daily work in medical school applicants who were admitted or rejected after participating in a multiple mini-interview selection procedure. Further studies are needed to investigate these characteristics and their development longitudinally in medical students and to correlate them with students' medical performance.

2.
BMC Med Educ ; 20(1): 83, 2020 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-32197608

RESUMO

BACKGROUND: Uncertainty occurs in physicians' daily work in almost every clinical context and is also present in the clinical reasoning process. The way physicians communicate uncertainty in their thinking process during handoffs is crucial for patient safety because uncertainty has diverse effects on individuals involved in patient care. Dealing with uncertainty and expressing uncertainty are important processes in the development of professional identity of undergraduate medical students. Many studies focused on how to deal with uncertainty and whether uncertainty is explicitly expressed. Hardly any research has been done regarding implicit expression of uncertainty. Therefore, we studied the ways in which medical students in the role of beginning residents implicitly express uncertainty during simulated handoffs. METHODS: Sixty-seven advanced undergraduate medical students participated in a simulated first day of residency including a consultation hour, a patient management phase with interprofessional interaction, and a patient handoff. We transcribed the videographed handoffs verbatim and extracted language with respect to expression of uncertainty using a grounded theory approach. Text sequences expressing patient related information were analyzed and coded with respect to language aspects which implicitly modified plain information with respect to increasing or decreasing uncertainty. Concepts and categories were developed and discussed until saturation of all aspects was reached. RESULTS: We discovered a framework of implicit expressions of uncertainty regarding diagnostic and treatment-related decisions within four categories: "Statement", "Assessment", "Consideration", and "Implication". Each category was related to either the subcategory "Actions" or "Results" within the diagnostic or therapeutic decisions. Within each category and subcategory, we found a subset of expressions, which implicitly attenuated or strengthened plain information thereby increasing uncertainty or certainty, respectively. Language that implicitly attenuated plain information belonged to the categories questionable, incomplete, alterable, and unreliable while we could ascribe implicit strengtheners to the categories assertive, adequate, focused, and reliable. CONCLUSIONS: Our suggested framework of implicit expression of uncertainty may help to raise the awareness for expression of uncertainty in the clinical reasoning process and provide support for making uncertainty explicit in the teaching process. This may lead to more transparent communication processes among health care professionals and eventually to improved patient safety.

3.
BMC Med Educ ; 20(1): 6, 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31910843

RESUMO

BACKGROUND: Assessing competence of advanced undergraduate medical students based on performance in the clinical context is the ultimate, yet challenging goal for medical educators to provide constructive alignment between undergraduate medical training and professional work of physicians. Therefore, we designed and validated a performance-based 360-degree assessment for competences of advanced undergraduate medical students. METHODS: This study was conducted in three steps: 1) Ten facets of competence considered to be most important for beginning residents were determined by a ranking study with 102 internists and 100 surgeons. 2) Based on these facets of competence we developed a 360-degree assessment simulating a first day of residency. Advanced undergraduate medical students (year 5 and 6) participated in the physician's role. Additionally knowledge was assessed by a multiple-choice test. The assessment was performed twice (t1 and t2) and included three phases: a consultation hour, a patient management phase, and a patient handover. Sixty-seven (t1) and eighty-nine (t2) undergraduate medical students participated. 3) The participants completed the Group Assessment of Performance (GAP)-test for flight school applicants to assess medical students' facets of competence in a non-medical context for validation purposes. We aimed to provide a validity argument for our newly designed assessment based on Messick's six aspects of validation: (1) content validity, (2) substantive/cognitive validity, (3) structural validity, (4) generalizability, (5) external validity, and (6) consequential validity. RESULTS: Our assessment proved to be well operationalised to enable undergraduate medical students to show their competences in performance on the higher levels of Bloom's taxonomy. Its generalisability was underscored by its authenticity in respect of workplace reality and its underlying facets of competence relevant for beginning residents. The moderate concordance with facets of competence of the validated GAP-test provides arguments of convergent validity for our assessment. Since five aspects of Messick's validation approach could be defended, our competence-based 360-degree assessment format shows good arguments for its validity. CONCLUSION: According to these validation arguments, our assessment instrument seems to be a good option to assess competence in advanced undergraduate medical students in a summative or formative way. Developments towards assessment of postgraduate medical trainees should be explored.

4.
Patient Educ Couns ; 103(3): 500-504, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31543355

RESUMO

OBJECTIVE: To compare shared decision-making skills of medical students who voluntarily translate medical documents into plain language with students who do not participate in this voluntary task. METHODS: 29 medical students who voluntarily translated medical documents for patients into plain language on the online-platform https://washabich.de (WHI group) and 29 medical students who did not (non-WHI group) participated in a simulated virtual consultation hour. Via skype, participants communicated with six simulated patients. All conversations were transcribed and a blinded rater assessed them with the OPTION scale for shared decision-making. RESULTS: The WHI group received significantly (p < .001) higher total scores for shared decision-making with the OPTION scale than the non-WHI group. The greatest differences in scores were found for the items "The clinician checks that the patient has understood the information." (WHI: 2.98 ±â€¯0.77 vs. non-WHI: 2.61 ±â€¯0.89, p < .001) and "The clinician offers the patient explicit opportunities to ask questions during the decision-making process." (WHI: 2.83 ±â€¯1.00 vs. non-WHI: 2.40 ±â€¯1.07, p < .001). CONCLUSION: Written translation of medical documents is associated with significantly better OPTION scores for shared decision-making in simulated physician-patient encounters. PRACTICE IMPLICATIONS: To use written medial translation exercises in general to improve medical students' shared decision-making skills.

5.
GMS J Med Educ ; 36(6): Doc83, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31844655

RESUMO

Background: Clinical reasoning refers to a thinking process including medical problem solving and medical decision making skills. Several studies have shown that the clinical reasoning process can be influenced by a number of factors, e.g. context or personality traits, and the results of this thinking process are expressed in case presentation. The aim of this study was to identify factors, which predict the quality of case summary statements as an indicator of clinical reasoning of undergraduate medical students in an assessment simulating the first day of residency. Methods: To investigate factors predicting aspects of clinical reasoning 67 advanced undergraduate medical students participated in the role of a beginning resident in our competence-based assessment, which included a consultation hour, a patient management phase, and a handover. Participants filled out a Post Encounter Form (PEF) to document their case summary statements and other aspects of clinical reasoning. After each phase, they filled out the Strain Perception Questionnaire (STRAIPER) to measure their situation dependent mental strain. To assess medical knowledge the participants completed a 100 questions multiple choice test. To measure stress resistance, adherence to procedures, and teamwork students took part in the Group Assessment of Performance (GAP) test for flight school applicants. These factors were included in a multiple linear regression analysis. Results: Medical knowledge and teamwork predicted the quality of case summary statements as an indicator of clinical reasoning of undergraduate medical students and explained approximately 20.3% of the variance. Neither age, gender, undergraduate curriculum, academic advancement nor high school grade point average of the medical students of our sample had an effect on their clinical reasoning skills. Conclusion: The quality of case summary statements as an indicator of clinical reasoning can be predicted in undergraduate medical students by their medical knowledge and teamwork. Students should be supported in developing abilities to work in a team and to acquire long term knowledge for good case summary statements as an important aspect of clinical reasoning.


Assuntos
Tomada de Decisão Clínica , Educação de Graduação em Medicina/métodos , Resolução de Problemas , Adulto , Competência Clínica , Educação Baseada em Competências/métodos , Comportamento Cooperativo , Feminino , Humanos , Internato e Residência , Masculino , Estudantes de Medicina/psicologia , Inquéritos e Questionários
6.
BMC Med Educ ; 19(1): 370, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615496

RESUMO

BACKGROUND: The association between perfectionism and depression in the medical profession can ultimately influence physicians' performance negatively. In medical students, especially maladaptive perfectionism is connected with distress and lower academic performance. The expression of perfectionism and symptoms of depression at the time of medical school application is not known. Therefore, we explored perfectionism and symptoms of depression in participants of multiple mini-interviews for medical school admission and investigated possible differences between applicants who were eventually admitted or rejected. METHODS: After the multiple mini-interviews admission procedure at Hamburg Medical School in August 2018, 146 applicants filled out a questionnaire including sociodemographic data and the following validated instruments: Multidimensional Perfectionism Scale by Hewitt and Flett (MPS-H), Multidimensional Perfectionism Scale by Frost (MPS-F), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and a 10-item version of the Big Five Inventory (BFI-10). The two groups of admitted and rejected applicants were compared and the correlation between symptoms of depression and perfectionism further explored. RESULTS: The admitted applicants were significantly more extrovert and had lower depression scores compared to the rejected applicants. In both groups, the composite scales of Adaptive Perfectionism (r = .21, p = .011) and Maladaptive Perfectionism (r = .43, p < .001) as well as their components correlated significantly with the PHQ-9 results. Maladaptive Perfectionism accounted for about 18% of variance in the PHQ-9 score. CONCLUSIONS: Rejected medical school applicants who participated in a multiple mini-interviews admission procedure showed higher levels of depression symptoms than admitted applicants. The degree of depressive symptoms can be partly explained by Maladaptive Perfectionism scores. Since coping in medical school and in postgraduate medical education require robust mental health, perfectionism questionnaires could be an additional tool in medical school selection processes.


Assuntos
Depressão/psicologia , Educação de Graduação em Medicina , Critérios de Admissão Escolar/estatística & dados numéricos , Estudantes de Medicina/psicologia , Feminino , Humanos , Masculino , Perfeccionismo , Determinação da Personalidade , Faculdades de Medicina
7.
GMS J Med Educ ; 36(4): Doc44, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31544144

RESUMO

Objective: The concept of perfectionism comprises high standards of performance as needed in medicine, but also concerns about making mistakes and dealing with social reactions about not being perfect. Perfectionism is associated with motivation and deep learning strategies but high expression of perfectionism has been found to be associated with symptoms of stress and anxiety in students. We aim to gain insights into the longitudinal development of different dimensions of perfectionism in medical students with respect to their way of medical school admission. Methods: At the Medical Faculty of Hamburg University, 167 undergraduate medical students completed validated questionnaires (MPS-H and MPS-F) of different dimensions of perfectionism and sociodemographic data including medical school admission procedures, personality traits (BSI-10 and GSE), and symptoms of depression and anxiety (PHQ-9 and GAD-7) at the start of their first year and at half term of their second year. Results: On average, after controlling for baseline and age, a significant decrease (p≤0.05) in Self-Oriented Perfectionism was found during the first two years in students who were admitted after a waiting period (M: -12.57; 95% CI: [-21.94 - -3.35]), by other ways of medical school entrance (M: -6.36; 95% CI: [-12.71 - -0.02]), by multiple mini-interviews (HAM-Int) (M: -5.52; 95% CI: [-9.90 - -1.14]), and by a natural science test (HAM-Nat) (M: -3.41; 95% CI: [-6.71 - -0.11]. Waiting period students also showed a significant longitudinal decline in the scale Personal Standards (M: -4.62; 95% CI: [-8.04 - -1.21]. Conclusions: Since medical students from all admission groups except from the high school degree group showed a significant longitudinal decrease in Self-Oriented Perfectionism, high levels of aspects of perfectionism associated with intrinsic motivation or deep learning strategies could be included medical school admission processes. Additionally, particular attention needs to be paid not to induce a loss of intrinsic motivation or deep learning strategies during undergraduate medical education.


Assuntos
Motivação , Perfeccionismo , Critérios de Admissão Escolar , Estudantes de Medicina/psicologia , Adulto , Educação de Graduação em Medicina , Feminino , Humanos , Estudos Longitudinais , Masculino , Personalidade , Adulto Jovem
9.
PLoS One ; 14(9): e0221293, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31498806

RESUMO

BACKGROUND: Membranous nephropathy (MN) is an autoimmune disease induced by circulating antibodies against the podocyte protein phospholipase A2 receptor 1 (PLA2R1-ab) in 80% of patients and represents the leading cause of nephrotic syndrome in adults. PLA2R1-ab levels correlate with disease activity and treatment response. However, their predictive role for long-term renal outcome is not clear. METHODS: The aim of this prospective observational multicenter study was to investigate the predictive role of PLA2R1-ab levels at the time of diagnosis for long-term outcome in a cohort of 243 patients with newly diagnosed biopsy-proven PLA2R1-associated MN. Statistical analyses included Cox proportional hazard models. The primary study endpoint was defined prior to data collection as doubling of serum creatinine or development of end-stage renal disease. RESULTS: During the median follow-up time of 48 months, 36 (15%) patients reached the study endpoint. Independent predictors for reaching the study endpoint were baseline PLA2R1-ab levels (HR = 1.36, 95%CI 1.11-1.66, p = 0.01), percentage of tubular atrophy and interstitial fibrosis (HR = 1.32, 95%CI 1.03-1.68, p = 0.03), PLA2R1-ab relapse during follow-up (HR = 3.22, 95%CI 1.36-7.60, p = 0.01), and relapse of proteinuria (HR = 2.60, 95%CI 1.17-5.79, p = 0.02). Fifty-four (22%) patients received no immunosuppressive treatment during the study, in 41 (76%) of them PLA2R1-ab spontaneously disappeared during follow-up, 29 (54%) patients had a complete remission of proteinuria, and 19 (35%) had a partial remission. Patients not treated with immunosuppression were more often females and had lower PLA2R1-ab levels, proteinuria, and serum creatinine at baseline compared to patients receiving immunosuppression. However, no conclusion on the efficacy of immunosuppressive therapies can be made, since this was not a randomized controlled study and treatment decisions were not made per-protocol. CONCLUSIONS: PLA2R1-ab levels are, in addition to pre-existing renal damage, predictive factors for long-term outcome and should therefore be considered when deciding the treatment of patients with MN.


Assuntos
Anticorpos/sangue , Anticorpos/imunologia , Glomerulonefrite Membranosa/diagnóstico , Glomerulonefrite Membranosa/imunologia , Receptores da Fosfolipase A2/imunologia , Adulto , Feminino , Glomerulonefrite Membranosa/sangue , Glomerulonefrite Membranosa/tratamento farmacológico , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Prognóstico
10.
BMC Med Educ ; 19(1): 177, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31146715

RESUMO

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.


Assuntos
Competência Clínica , Educação Médica Continuada/normas , Palpação , Adulto , Competência Clínica/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Palpação/métodos , Palpação/normas , Reprodutibilidade dos Testes
11.
BMC Med Educ ; 19(1): 46, 2019 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-30728006

RESUMO

BACKGROUND: Physicians need a set of specific competences to perform well in interprofessional teams in their first year of residency. These competences should be achieved with graduation from medical school. Assessments during undergraduate medical studies are mostly rated by supervisors only. The aim of our study was to compare the rating of core facets of competence of medical students late in their undergraduate training as well as the rating confidence between three different groups of assessors (supervisors, residents, and nurses) in an assessment simulating the first day of residency. METHODS: Sixty-seven advanced medical students from three different medical schools (Hamburg, Oldenburg and Munich) participated in a 360-degree assessment simulating the first working day of a resident. Each participant was rated by three assessors - a supervisor, a resident and a nurse - in seven facets of competence relevant for the first year of residency: (1) responsibility, (2) teamwork and collegiality, (3) knowing and maintaining own personal bounds and possibilities, (4) structure, work planning and priorities, (5) coping with mistakes, (6) scientifically and empirically grounded method of working, and (7) verbal communication with colleagues and supervisors. Means of all assessed competences and confidences of judgement of the three rating groups were compared. Additionally, correlations between assessed competences and confidence of judgement within each group of raters were computed. RESULTS: All rating groups showed consistent assessment decisions (Cronbach's α: supervisors = .90, residents = .80, nurses = .78). Nurses assessed the participants significantly higher in all competences compared to supervisors and residents (all p ≤ .05) with moderate and high effect sizes (d = .667-1.068). While supervisors' and residents' ratings were highest for "teamwork and collegiality", participants received the highest rating by nurses for "responsibility". Competences assessed by nurses were strongly positively correlated with their confidence of judgment while supervisors' assessments correlated only moderately with their confidence of judgment in two competences. CONCLUSIONS: Different professional perspectives provide differentiated competence ratings for medical students in the role of a beginning resident. Rating confidence should be enhanced by empirically derived behavior checklists with anchors, which need to be included in rater training to decrease raters' subjectivity.


Assuntos
Competência Clínica/normas , Internato e Residência , Estudantes de Medicina , Desempenho Acadêmico , Atitude do Pessoal de Saúde , Lista de Checagem , Comportamento Cooperativo , Humanos , Relações Interprofissionais , Faculdades de Medicina
12.
BMC Med Educ ; 19(1): 9, 2019 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-30616684

RESUMO

BACKGROUND: Important competences of physicians regarding patient safety include communication, leadership, stress resistance, adherence to procedures, awareness, and teamwork. Similarly, while selected, prospective flight school applicants are tested for the same set of skills. The aim of our study was to assess these core competences in advanced undergraduate medical students from different medical schools. METHODS: In 2017, 67 medical students (year 5 and 6) from the universities of Hamburg, Oldenburg, and TU Munich, Germany, participated in the verified Group Assessment Performance (GAP)-Test at the German Aerospace Center (DLR) in Hamburg. All participants were rated by DLR assessment observers with a set of empirically derived behavioural checklists. This lists consisted of 6-point rating scales (1: very low occurrence to 6: very high occurrence) and included the competences leadership, teamwork, stress resistance, communication, awareness, and adherence to procedures. Medical students' scores were compared with the results of 117 admitted flight school applicants. RESULTS: Medical students showed significantly higher scores than admitted flight school applicants for adherence to procedures (p < .001, d = .63) and communication (p < .01, d = .62). They reached significantly lower ratings for teamwork (p < .001, d = .77), stress resistance (p < 0.001, d = .70), and awareness (p < .001, d = 1.31). Students in semester 10 showed significantly (p < .02, d = .58) higher scores in domain awareness compared to the final year students. On average, flight school entrance level was not reached by either group for this domain. CONCLUSIONS: Advanced medical students' low results for awareness are alarming as awareness is essential and integrative for clinical reasoning and patient safety. Further studies should elucidate and discuss whether awareness needs to be included in medical student selection or integrated into the curriculum in training units.


Assuntos
Medicina Aeroespacial , Competência Clínica , Liderança , Critérios de Admissão Escolar , Currículo , Avaliação Educacional , Alemanha , Humanos , Estudos Prospectivos
14.
BMC Med Educ ; 18(1): 322, 2018 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-30594177

RESUMO

BACKGROUND: Residents face demanding situations on the job and have been found to perceive high levels of strain. Medical students also reported a high degree of strain and even depressive tendencies when entering their clinical rotations. The aim of this study was to explore the perceived strain of medical students from different undergraduate curricula and at different stages of academic advancement during different phases of an assessment simulating a resident's first day in hospital. METHODS: Sixty-seven undergraduate medical students participated in the following three phases of the assessment in the role of a resident: a consultation hour with five simulated patients, a management phase with interprofessional contact, and a patient handover with a colleague. They completed the Strain Perception Questionnaire (STRAIPER) after each phase. Students from different undergraduate curricula (VI: vertically integrated, n = 35 versus non-VI: not vertically integrated, n = 26) and different academic advancement (semester 10, n = 26 versus final year, n = 41) were compared. RESULTS: All students showed the highest strain level after the management phase compared to the consultation hour and the handover. Medical students from a non-VI curriculum felt significantly more strain in the dimension of agitation (p < .05) after the consultation hour compared to students from a VI curriculum and compared to the management phase and the handover. No significant difference in perceived strain was found between students from semester 10 compared to final year students. CONCLUSIONS: During the consultation hour and the handover with a colleague medical students faced tasks which are familiar to them from undergraduate education. Their higher strain levels during the management phase might occur because they are confronted with unfamiliar tasks and decisions. Feeling responsible for the right actions in this phase of multitasking and professional interaction might have added to the strain students perceived during this phase. Patient management should be emphasized more in any type of undergraduate medical curriculum.


Assuntos
Estágio Clínico , Competência Clínica , Internato e Residência , Estresse Psicológico , Estudantes de Medicina/psicologia , Currículo , Alemanha , Humanos , Relações Interprofissionais , Transferência da Responsabilidade pelo Paciente , Simulação de Paciente , Encaminhamento e Consulta , Inquéritos e Questionários
15.
GMS J Med Educ ; 35(3): Doc39, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30186949

RESUMO

Background: The Medical Licensure Act prescribes a total of four months of clinical electives in which the medical students are to work in a self-organized manner in outpatient and inpatient care. Since no specific learning objectives or learning content are given and students come into contact with different structures of outpatient and inpatient care, the learning success in a clinical elective is often rather random. In order to make self-organized learning (SOL) in clinical electives as effective as possible, we identified factors in the area of inpatient care that have an influence on SOL and thus the learning success during a clinical elective. Methods: To investigate this question a qualitative and explorative approach was chosen. In 2015, a total of 21 students from semester 1 to 11 participated in six semi-structured focus group discussions at Hamburg Medical Faculty. In these, the students were asked about their experiences and expectations with regard to SOL in clinical electives. The interviews were transcribed literally and analyzed using Grounded Theory in parallel to further data collection. Results: Three main categories were identified, which had an impact on SOL in clinical electives, each with two sub-categories: People (elective students and physicians), learning itself (learning content and learning process) and the framework (local conditions and organizational structure). For example, elective students exhibiting openness and self-initiative as well as a good working atmosphere and few hierarchical structures were conducive to SOL, while shyness and lack of integration into the ward's medical team inhibited SOL. A mentor formally assigned to the student can promote SOL through guidance, supervision and the transfer of responsibility. Continuous feedback from mentors or peers promotes SOL. Framework conditions, such as a smooth administrative organization, also affect SOL, but elective students have limited influence over these. Conclusion: The creation of suitable framework conditions and considering the needs of the people involved in clinical electives and the requirements of learning itself are necessary steps in order to enable successful SOL during clinical electives. Suitable framework conditions could be compiled and widely disseminated on an empirical basis. Training for teachers and elective students on various aspects of clinical electives, from professional behavior to practical skills, could be a suitable preparatory measure to promote SOL in clinical electives and contribute to a better learning success of the elective students.


Assuntos
Comunicação , Aprendizagem , Estudantes de Medicina , Educação de Graduação em Medicina , Grupos Focais , Humanos
16.
BMC Med Educ ; 18(1): 157, 2018 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-29970069

RESUMO

BACKGROUND: Verbal and non-verbal aspects of communication as well as empathy are known to have an important impact on the medical encounter. The aim of the study was to analyze how well final year undergraduate medical students use skills of verbal and non-verbal communication during history-taking and whether these aspects of communication correlate with empathy and gender. METHODS: During a three steps performance assessment simulating the first day of a resident 30 medical final year students took histories of five simulated patients resulting in 150 videos of physician-patient encounters. These videos were analyzed by external rating with a newly developed observation scale for the verbal and non-verbal communication and with the validated CARE-questionnaire for empathy. One-way ANOVA, t-tests and bivariate correlations were used for statistical analyses. RESULTS: Female students showed signicantly higher scores for verbal communication in the case of a female patient with abdominal pain (p < 0.05), while male students started the conversations significantly more often with an open question (p < 0.05) and interrupted the patients significantly later in two cases than female students (p < 0.05). The number of W-questions asked by all students was significantly higher in the case of the female patient with abdominal pain (p < 0.05) and this patient was interrupted after the beginning of the interview significantly earlier than the patients in the other four cases (p < 0.001). Female students reached significantly higher scores for non-verbal communication in two cases (p < 0.05) and showed significantly more empathy than male students in the case of the female patient with abdominal pain (p < 0.05). In general, non-verbal communication correlated significantly with verbal communication and with empathy while verbal communication showed no significant correlation with empathy. CONCLUSIONS: Undergraduate medical students display differentiated communication behaviour with respect to verbal and non-verbal aspects of communication and empathy in a performance assessment and special differences could be detected between male and female students. These results suggest that explicit communication training and feedback might be necessary to raise students' awareness for the different aspects of communication and their interaction.


Assuntos
Comunicação , Educação de Graduação em Medicina , Empatia , Anamnese , Comunicação não Verbal , Relações Médico-Paciente , Estudantes de Medicina/psicologia , Gravação em Vídeo , Adulto , Idoso , Análise de Variância , Pré-Escolar , Competência Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Simulação de Paciente , Fatores Sexuais , Comportamento Verbal
17.
BMC Med Educ ; 18(1): 149, 2018 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-29929497

RESUMO

BACKGROUND: The number of internal diseases, disorders and syndromes (IMDDSs) encountered in dental practice is increasing. Dentists report to feel ill prepared by their undergraduate dental training for the management of IMDDSs. To increase the effectiveness of internal medicine training at dental school it might be necessary to focus on IMDDs encountered by dental students. The aim of our study was to identify IMDDSs dental students come across while treating dental patients during the clinical years of their undergraduate training. METHODS: All dental patients treated between April and July 2015 by 116 dental students enrolled at the Medical Faculty of Hamburg University in the semesters 7 to 10 were anonymously analysed retrospectively with respect to age, gender, smoking habits, drinking habits, current or previous diseases, allergies, current medication, dental diagnoses, and dental treatment in the current semester. Identified IMDDSs were clustered and evaluated. RESULTS: The 116 dental students treated 511 patients with 559 IMDDSs with a median of one IMDDS per patient. The IMDDSs encountered most frequently could be assigned to the subspecialties cardiology, endocrinology/diabetology, and rheumatology. Arterial hypertension occurred most frequently in dental patients, followed by diabetes mellitus type 2, and chronic bronchitis. CONCLUSIONS: We identified the spectrum of IMDDSs encountered by dental students in the clinical years of their undergraduate dental education. Further studies are needed to test the effects of learning internal medicine with an internal medicine course based on the IMDDSs encountered by dental students and including additional IMDDSs specific relevance for dentists.


Assuntos
Educação em Odontologia/estatística & dados numéricos , Medicina Interna/educação , Medicina Interna/estatística & dados numéricos , Estudantes de Odontologia/estatística & dados numéricos , Bronquite/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Alemanha/epidemiologia , Humanos , Hipertensão/epidemiologia , Hipotireoidismo/epidemiologia , Artropatias/epidemiologia , Masculino , Estudos Retrospectivos , Faculdades de Odontologia/estatística & dados numéricos , Síndrome
18.
Kidney Blood Press Res ; 43(2): 360-366, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29539619

RESUMO

BACKGROUND/AIMS: IgA nephropathy (IgAN) is the most common form of primary glomerulonephritis and still constitutes one of the most important causes of end-stage renal disease. Abnormal T cell responses may play a role in IgAN pathogenesis. Co-stimulatory molecules such as cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) are important for naive T cells to initiate and terminate immune responses. Single nucleotide polymorphisms (SNPs) in the CTLA4 gene locus are associated with several autoimmune diseases. METHODS: We aimed to investigate the occurrence of the SNPs -318C/T, +49A/G and CT60 G/A within the CTLA4 locus in healthy blood donors (n=455) and IgAN patients (n=252) recruited from the recently published STOP-IgAN trial. The presence of these SNPs was then associated with baseline proteinuria in IgAN patients. RESULTS: We observed a significantly increased frequency of the CTLA4 -318C/T genotype in IgAN patients as compared to controls (CC vs. CT+TT: OR 1.65, 95%-CI 1.03-2.65, p=0.035). No significant associations, neither with the +49A/G nor for the CT60 G/A SNP, were detected. However, when we stratified for proteinuria at time of inclusion into the STOP-IgAN trial (<1 g/day vs. >1 g/day), we observed significant differences in the frequencies of the CT60 G/A genotype, i.e. a significantly increased risk for higher proteinuria in patients carrying the G allele (OR 2.81, 95%-CI 1.03-7.64, p=0.042). CONCLUSION: The CTLA4 -318/C/T SNP was associated with an increased risk to develop IgAN, while the CT60 G/A genotype significantly associated with the risk for higher proteinuria suggesting a possible role for CTLA-4 in IgAN.


Assuntos
Antígeno CTLA-4/genética , Glomerulonefrite por IGA/genética , Polimorfismo de Nucleotídeo Único , Proteinúria/genética , Estudos de Casos e Controles , Predisposição Genética para Doença , Genótipo , Humanos
19.
GMS J Med Educ ; 34(5): Doc66, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29226234

RESUMO

Background: Clinical reasoning, comprising the processes of clinical thinking, which form the basis of medical decisions, constitutes a central competence in the clinical routine on which diagnostic and therapeutic steps are based. In medical curricula in Germany, clinical reasoning is currently taught explicitly only to a small extend. Therefore, the aim of this project was to develop and implement a clinical reasoning course in the final year of undergraduate medical training. Project description: A clinical reasoning course with six learning units and 18 learning objectives was developed, which was taught by two to four instructors on the basis of 32 paper cases from the clinical practice of the instructors. In the years 2011 to 2013, the course of eight weeks with two hours per week was taught seven times. Before the first and after the last seminar, the participating students filled out a self-assessment questionnaire with a 6-point Likert scale regarding eight different clinical reasoning skills. At the same times, they received a patient case with the assignment to prepare a case presentation and differential diagnoses. Results: From 128 participating students altogether, 42 complete data sets were available. After the course, participants assessed themselves significantly better than before the course in all eight clinical reasoning skills, for example in "Summarizing and presentation of a paper case" or in the "Skill to enumerate differential diagnoses" (p<0.05). The greatest increase occurred in the skill to recognize typical cognitive errors in medicine and to identify risk situations for their occurrence (pre: 2.98±0.92 and retro-pre: 2.64±1.01, respectively, versus post: 4.38±0.88). Based on the ratio of number of words used per keywords used the problem presentation of the paper case was significantly more focused after the course (p=0.011). A significant increase in the number of gathered differential diagnoses was not detected after the course. Conclusion: The newly developed and established Clinical Reasoning Course leads to a gain in the desired skills from the students' self-assessment perspective and to a more structured case presentation. To establish better options to exercise clinical reasoning, a longitudinal implementation in the medical curriculum seems to be desirable. Faculty training would be useful to implement the concept as standardized as possible.


Assuntos
Currículo , Resolução de Problemas , Estudantes de Medicina , Competência Clínica , Educação de Graduação em Medicina , Alemanha , Humanos , Estudos Retrospectivos
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