332ª Reunião Ordinária - 20 jul. 2022

Brasília Imperial Hotel - Setor Hoteleiro Sul (SHS), quadra 3, bloco H - Asa Sul - Brasília/DF.

Medical Students' Reflections on the Recent Changes to the USMLE Step Exams.

The United States Medical Licensing Examination (USMLE) consists of Step 1, Step 2 Clinical Knowledge, Step 2 Clinical Skills, and Step 3. To be licensed to practice medicine in the United States, medical students must pass all parts of the USMLE. However, in addition to that pass/fail grade, students are currently given a numerical score for Step 1, Step 2 Clinical Knowledge, and Step 3. Residency program directors have come to use the Step 1 score to efficiently screen a growing number of residency applicants. As a result, a deleterious environment in undergraduate medical education has been created, given the importance of Step 1 to medical students matching to their preferred residency program. It was announced in February 2020 that the score-reporting protocol for Step 1 would be changed from a 3-digit numerical score to pass/fail only, beginning no earlier than January 1, 2022. This decision will undoubtedly impact medical students, medical schools, and residency program directors. Here, the authors discuss the impact that the change to Step 1 scoring will have on these key stakeholder groups, from their perspective as students at MD-granting medical schools in the United States. They also call attention to outstanding issues with the USMLE that must be addressed to improve undergraduate medical education for all stakeholders, and they offer advice for further improvements to the residency application process.

Medical Student Interest and Recruitment in Neurosurgery.

OBJECTIVE: Recent years have witnessed an increase in articles describing factors influencing medical student recruitment in neurosurgery, such as undergraduate preparation, impact of research experience, and selection into residency programs. In this study, we provide a comprehensive review of the literature addressing the relationship of medical students within neurosurgery. METHODS: A search of the literature was conducted on the PubMed/MEDLINE database to October 2018 to screen for studies on medical student interest and recruitment in neurosurgery. Articles were screened for eligibility and reviewed for inclusion and their findings critically discussed. RESULTS: Sixty-nine articles were included. Most research on the relationship of medical students with neurosurgery was conducted in the United States and United Kingdom. Data analysis was categorized into 2 groups: educational and noneducational factors. Eight areas of interest were identified: baseline undergraduate education, early research involvement, attitude toward neuroscience, mentoring, existence of a gender gap, residency program requirements, availability of educational resources, and networking opportunities. CONCLUSIONS: Our study bridges the gap of fragmented knowledge on medical student involvement in neurosurgery with the aim of optimizing existing approaches. We suggest that medical institutions outside the United States and United Kingdom should implement university-based interest groups to stimulate student interest, with reinforced participation of faculty for leading educational initiatives and collaborative research. We advocate the creation of national and international associations to support medical students in approaching neurosurgery early in their education.

Challenges and implementation of the German maternity protection act for female medical students in macroscopic anatomical education.

Background: Recent decades have seen controversial discussions on the validity of dissection courses in medical education, with alternative programs tested for various reasons. On April 1, 2015 the classification of formaldehyde as a hazardous substance was upgraded by the EU, leding to some universities precluding the participation of pregnant and breastfeeding students in dissection course. However, the revision to the Maternity Protection Act, implemented in Germany on January 1, 2018, now protects student mothers from being disadvantaged in their studies as a consequence of their pregnancy or breastfeeding. Therefore, universities must offer alternatives to dissection courses using formaldehyde to these female students. Project description: As an alternative to regular dissection courses, which use the abovementioned chemical, the Centre for Anatomy at Charité has opted for developing dedicated courses for student mothers. These new courses use plastinated prosection material instead of formalin-treated cadavers of body donors. As the core of the anatomical education takes place during the third and fourth semester in the current curriculum of human medicine at Charité the alternative courses are limited to those two semesters. Additionally, alternative exams at the end of both semesters had to be developed. The alternative courses were designed to offer pregnant and breastfeeding students a study program as close as possible to the one in which their peers learn human anatomy. Results: For the new courses, plastinates had to be produced and further specimens are still needed. Additionally required sets of bones, models and radiological images were readily available at the Centre for Anatomy. The planning and conceptualization of the courses took half a year of intense preparation. The courses for the third and fourth semester were first running during summer semester 2017. There is a clear demand for courses among pregnant and breastfeeding students. At least 5 student participants per course were registered, corresponding to every fortieth female student in their semester cohorts. The highest number of student participants was 13 in one course so far. The performances of the participants in the anatomical examinations were matching that of students attending the regular courses. Discussion: The alternative macroscopic anatomy courses enable the implementation of the revised Maternity Protection Act. The targeted student group is highly satisfied with the offered alternative courses. Considering the number of participants and their examination performance so far, the Centre for Anatomy regards the efforts involved in planning and implementing the courses as justified. The courses allow pregnant and breastfeeding students to address the same anatomical themes at the same time as their fellow students. However, due to restricted flexibility of plastinates and because students cannot prepare specific anatomical structures independently the scope of topographic learning is limited. That being said, well-produced plastinates can display anatomical structures which often cannot be dissected in regular courses. The alternative macroscopic anatomy courses using plastinates constitute suitable alternatives to the regular dissection courses with formalin-treated cadavers for pregnant and breastfeeding students.

A National, Palliative Care Competency Framework for Undergraduate Medical Curricula.

As nearly all doctors deal with patients requiring palliative care, it is imperative that palliative care education starts early. This study aimed to validate a national, palliative care competency framework for undergraduate medical curricula. We conducted a Delphi study with five groups of stakeholders (palliative care experts, physicians, nurses, curriculum coordinators, and junior doctors), inviting them to rate a competency list. The list was organized around six key competencies. For each competency, participants indicated the level to which students should have mastered the skill at the end of undergraduate training. Stability was reached after two rating rounds (N = 82 round 1, N = 54 round 2). The results showed high levels of agreement within and between stakeholder groups. Participants agreed that theoretical knowledge is not enough: Students must practice palliative care competencies, albeit to varying degrees. Overall, communication and personal development and well-being scored the highest: Junior doctors should be able to perform these in the workplace under close supervision. Advance care planning scored the lowest, indicating performance in a simulated setting. A wide range of stakeholders validated a palliative care competency framework for undergraduate medical curricula. This framework can be used to guide teaching about palliative care.

Fifteen years of the cologne medical model study course: has the expectation of increasing student interest in general practice specialization been fulfilled?

Background: The 2002 Medical Licensure Act gave German universities certain freedoms for reforming their medical degree courses. The Medical Faculty of the University of Cologne took advantage of this opportunity and introduced a model study course in the winter semester 2003/04 through §41 of the Medical Licensure Act. One of the main reasons for this was that back then there was an increasing shortage of doctors in clinical curative medicine and GP primary care. This study investigates whether the introduction of the Cologne Model Study Course (MSG) can show stronger interest in curative medical work (especially General Practice) compared to students of the standard degree course (RSG). Methodology: The proof of added value was examined through graduate surveys conducted at the University of Cologne and through the proportion of students who completed the PY elective rotation "General Practice". The students of the standard degree course (start of studies prior to winter semester 2003/2004) were compared with students of the model study course (start of studies from winter semester 2003/04 onwards). Measurements were carried out using descriptive frequency tables and correlation analyzes according to Spearman. Results: The students' interest in curative medicine was already high (91%) even before the model study course was introduced and increased only slightly (to 91.9%). There is also only a slight increase in specialization in General Practice (RSG=5.9% vs. MSG=9.2%). However, selection of rotations in General Practice was significantly increased (RSG=1.9% vs. MSG=3.4%, r=0.046 **, p<0.005). Conclusion: The Cologne Model Study Course in Human Medicine has increased awareness of the subject of General Practice among students through a large number of curricular changes. The fact that only marginal effects can be demonstrated shows once more the strong dependence of choosing General Medicine as a career path on other factors (such as gender or the presence of positive role models) and emphasizes the necessity of promoting General Practice student education not only through increased curricular mapping but by additional innovative concepts to maximize the status of General Practice from the perspective of students.

Institutional differences in USMLE Step 1 and 2 CK performance: Cross-sectional study of 89 US allopathic medical schools.

INTRODUCTION: The United States Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) are important for trainee medical knowledge assessment and licensure, medical school program assessment, and residency program applicant screening. Little is known about how USMLE performance varies between institutions. This observational study attempts to identify institutions with above-predicted USMLE performance, which may indicate educational programs successful at promoting students' medical knowledge. METHODS: Self-reported institution-level data was tabulated from publicly available US News and World Report and Association of American Medical Colleges publications for 131 US allopathic medical schools from 2012-2014. Bivariate and multiple linear regression were performed. The primary outcome was institutional mean USMLE Step 1 and Step 2 CK scores outside a 95% prediction interval (≥2 standard deviations above or below predicted) based on multiple regression accounting for students' prior academic performance. RESULTS: Eighty-nine US medical schools (54 public, 35 private) reported complete USMLE scores over the three-year study period, representing over 39,000 examinees. Institutional mean grade point average (GPA) and Medical College Admission Test score (MCAT) achieved an adjusted R2 of 72% for Step 1 (standardized ßMCAT 0.7, ßGPA 0.2) and 41% for Step 2 CK (standardized ßMCAT 0.5, ßGPA 0.3) in multiple regression. Using this regression model, 5 institutions were identified with above-predicted institutional USMLE performance, while 3 institutions had below-predicted performance. CONCLUSIONS: This exploratory study identified several US allopathic medical schools with significant above- or below-predicted USMLE performance. Although limited by self-reported data, the findings raise questions about inter-institutional USMLE performance parity, and thus, educational parity. Additional work is needed to determine the etiology and robustness of the observed performance differences.

A Multi-Institution Collaboration to Define Core Content and Design Flexible Curricular Components for a Foundational Medical School Course: Implications for National Curriculum Reform.

Medical educators have not reached widespread agreement on core content for a U.S. medical school curriculum. As a first step toward addressing this, five U.S. medical schools formed the Robert Wood Johnson Foundation Reimagining Medical Education collaborative to define, create, implement, and freely share core content for a foundational medical school course on microbiology and immunology. This proof-of-concept project involved delivery of core content to preclinical medical students through online videos and class-time interactions between students and facilitators. A flexible, modular design allowed four of the medical schools to successfully implement the content modules in diverse curricular settings. Compared with the prior year, student satisfaction ratings after implementation were comparable or showed a statistically significant improvement. Students who took this course at a time point in their training similar to when the USMLE Step 1 reference group took Step 1 earned equivalent scores on National Board of Medical Examiners-Customized Assessment Services microbiology exam items. Exam scores for three schools ranged from 0.82 to 0.84, compared with 0.81 for the national reference group; exam scores were 0.70 at the fourth school, where students took the exam in their first quarter, two years earlier than the reference group. This project demonstrates that core content for a foundational medical school course can be defined, created, and used by multiple medical schools without compromising student satisfaction or knowledge. This project offers one approach to collaboratively defining core content and designing curricular resources for preclinical medical school education that can be shared.

Making Progress: The University of Hawai'i at Manoa's (UHM) Department of Surgery's Cross-Cultural Health Care Efforts from 2008-2018.

In 2008 the University of Hawai'i at Manoa's (UHM) Department of Surgery introduced the concept of cross-cultural health care (aka cultural competency) to its faculty and trainees. Much work remains before the cultural efforts wellknown outside the department are embraced within, but it has been prioritized for curriculum development and research. An example of the department's efforts include the Cross-Cultural Health Care Research Collaborative, which was created as a forum for faculty who have an interest in cultural issues related to healthcare and healthcare delivery. Participants from 14 UHM departments and other organizations developed projects and mentored students, resulting in over ten peer-reviewed publications. A related effort is the JABSOM Cultural Competency Resource Guide, which is in its 7th edition and reflects JABSOM activities and those of its collaborators. Another highlight is the Biennial Cross-Cultural Health Care Conference: Collaborative and Multidisciplinary Interventions, with six conferences held since 2010, hosting attendees from 28 US Mainland states and 11 countries. Additionally, the department has been recognized as one of the first to develop a cultural standardized patient exam for surgical residents. These nationally-recognized efforts resulted in invitations to serve on the very first cultural competency panel at the American College of Surgeons Clinical Congress and as a consultant on the development of Brigham and Women's Hospital's Center for Surgery and Public Health's Provider Awareness and Cultural dexterity Toolkit for Surgeons (PACTS), a standardized curriculum for surgical residents. The department plans to continue its work on these projects and document outcomes.

[Responsibilities and concepts for undergraduate and postgraduate medical education in Germany : A plea for a reorientation]. / Zuständigkeiten und Konzepte zur ärztlichen Ausbildung und Weiterbildung : Ein Plädoyer für eine Neuorientierung.

BACKGROUND: Undergraduate medical education in Germany takes place in the medical faculties of universities, whereas postgraduate medical education takes place in nearly all hospitals under the aegis of medical associations. Both phases of the medical qualification process live on their own; the communication between the two responsible bodies is negligible. Previous reforms have always tackled undergraduate education only, whereas postgraduate education takes place without public attention. OBJECTIVE: This position paper discusses the origins and consequences of the complete separation between undergraduate and postgraduate medical education in Germany with regard to responsible bodies, learning objectives, and didactical concepts. On the basis of this critical analysis, proposals are presented to narrow the gap between the two phases. MATERIALS AND METHODS: This paper is based on several sources: data from historical documents, information retrieved from the internet on educational concepts in other OECD countries as well as intensive discussions among the authors. RESULTS AND DISCUSSION: The dissociation between under- and postgraduate education has historical reasons. Over a longer period of time the German Federal States reduced their responsibility for postgraduate education in favor of medical associations. The authors propose steps towards a better integration of both sequences, towards seeing the educational process as a continuum. In such a concept, medical associations would have a greater influence on undergraduate education and - vice versa - medical faculties on the postgraduate phase.

Accreditation of Medical Education Programs: Moving From Student Outcomes to Continuous Quality Improvement Measures.

Accreditation of undergraduate medical education programs aims to ensure the quality of medical education and promote quality improvement, with the ultimate goal of providing optimal patient care. Direct linkages between accreditation and education quality are, however, difficult to establish. The literature examining the impact of accreditation predominantly focuses on student outcomes, such as performances on national examinations. However, student outcomes present challenges with regard to data availability, comparability, and contamination.The true impact of accreditation may well rest in its ability to promote continuous quality improvement (CQI) within medical education programs. The conceptual model grounding this paper suggests accreditation leads medical schools to commit resources to and engage in self-assessment activities that represent best practices of CQI, leading to the development within schools of a culture of CQI. In line with this model, measures of the impact of accreditation on medical schools need to include CQI-related markers. The CQI orientation of organizations can be measured using validated instruments from the business and management fields. Repeated determinations of medical schools' CQI orientation at various points throughout their accreditation cycles could provide additional evidence of the impact of accreditation on medical education. Strong CQI orientation should lead to high-quality medical education and would serve as a proxy marker for the quality of graduates and possibly for the quality of care they provide.It is time to move away from a focus on student outcomes as measures of the impact of accreditation and embrace additional markers, such as indicators of organizational CQI orientation.

Visions and reality: the idea of competence-oriented assessment for German medical students is not yet realised in licensing examinations.

Objective: Competence orientation, often based on the CanMEDS model, has become an important goal for modern curricula in medical education. The National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM) has been adopted in Germany. However, it is currently unknown whether the vision of competence orientation has also reached the licensing examination procedures. Methods: Therefore, a prospective, descriptive, single-centre, exemplary study design was applied to evaluate 4051 questions/tasks (from 28 examiners at 7 two-day licensing oral-practical exams) for undergraduate medical students at the University of Ulm. The oral and practical questions/tasks as well as the real bedside assessment were assigned to specific competence roles (NKLM section I), categories (NKLM section II) and taxonomy levels of learning domains. Results: Numerous questions/tasks were set per candidate (day 1/2: 70±24/86±19 questions) in the licensing oral-practical exam. Competence roles beyond the "medical expert" were scarcely considered. Furthermore, practical and communication skills at the bedside were hardly addressed (less than 3/15 min). Strikingly, there was a significant predominance of questions with a low-level taxonomy. Conclusions: The data indicate a misalignment of competence-oriented frameworks and the "real world" licensing practical-oral medical exam, which needs improvement in both evaluation and education processes.

Reformas na educação médica no Brasil: estudo comparativo entre as diretrizes curriculares nacionais dos cursos de graduação em medicina de 2001 e 2014 / Reforms in medical education in Brazil: a comparative study between the national curricular guidelines of undergraduate medical courses in 2001 and 2014

O presente trabalho trata de pesquisa qualitativa, de cunho documental, abordando análise comparativa entre a Resolução CNE/CES nº 4, de 7 de Novembro de 2001 e a Resolução Nº 3, de 20 de Junho de 2014, que versam sobre as Diretrizes Curriculares Nacionais (DCN) dos Cursos de Graduação em Medicina. Tais documentos são responsáveis pelo caráter oficial que as reformas na educação médica do país vêm ocorrendo desde o início dos anos 2000, no sentido de aprofundar a relação da formação médica com o Sistema Único de Saúde (SUS). A DCN 2014 surgiu sob o advento do Programa Mais Médicos, a partir das determinações da Lei 12.871, de 22 de outubro de 2013. Esta lei, alvo de polêmicas e ataques por diversos setores da sociedade política, meios de comunicação e corporação médica, busca atualizar a formação médica do país às mudanças que ocorreram nas políticas públicas de saúde e educação do Brasil nos últimos 15 anos, no sentido das pautas que envolvem acesso a direitos sociais, equidade, qualificação dos serviços públicos, mudanças nas políticas de assistência à saúde, inclusão social e democratização do ensino superior. Assim o trabalho tem por objetivo 1 ­ Analisar, sob as bases do referencial teórico estabelecido, as relações entre as DCN 2001 e as de 2014, levando em consideração suas continuidades, diferenças, inovações e mudanças estabelecidas; 2- Refletir sobre as significações que conceitos similares ou conexos, da educação médica, utilizados em épocas distintas, tomam frente a contextos históricos marcados por temporalidades diferentes; 3- Elaborar apontamentos sobre o potencial de inovação/mudança/transformação das propostas apresentadas pelas DCN 2014. Para tal intuito se utilizou como métodos de análise a Análise de Conteúdo, com referencial em Bardin e Franco; e a História dos Conceitos, com referencial em Koselleck e Marçal Brandão. Como conclusão o trabalho mostra um esforço conceitual e normativo importante da nova DCN 2014, que busca induzir que as escolas médicas brasileiras avancem de um patamar de inovações para mudanças, no sentido reformista que este novo dispositivo se apresenta. Contudo o sucesso de tal política dependerá de diversas condições objetivas, que envolvem os riscos de retrocessos nas políticas sociais a partir da aprovação da Emenda Constitucional 55/2016, e a eventual estagnação das políticas sociais do país, inclusive nos setores saúde e educação, bem como a interferência que as relações externas dos setores de oposição ao Programa Mais Médicos conseguirão ter no âmbito das escolas médicas no país. Conseqüentemente, o trabalho aponta para a importância da continuidade de pesquisas que avaliem a implementação concreta das novas DCNs, no sentido da materialização daquilo que ela preconiza em seu escopo, bem como problematiza a necessidade de uma compreensão crítica na incorporação da pedagogia das competências como elemento estruturante da formação médica em cada curso, visto que a mesma, sem mediações, pode reproduzir uma lógica individualista de construção do aprendizado, potencialmente "capturável" pela lógica liberal que permeia a ideologia hegemônica nos processos organização corporativa da prática médica no Brasil. Ou seja, assim não se produzirão mudanças e nem transformação.(AU)

This paper deals with a qualitative research, of a documentary nature, addressing a comparative analysis between Resolution CNE / CES nº 4 of November 7, 2001 and Resolution No. 3 of June 20, 2014, which deal with the National Curricular Guidelines (DCN) of the Undergraduate Medical Courses. These documents are responsible for the official character that reforms in medical education in the country have been occurring since the beginning of the 2000s, in order to deepen the relationship between medical education and the Unified Health System (SUS). The DCN 2014 arose under the advent of the More Doctors Program, based on the provisions of Law 12,871, of October 22, 2013. This law, which is the target of controversy and attacks by various sectors of political society, media and medical corporation, seeks Update the country's medical education to the changes that have occurred in Brazil's health and education public policies in the last 15 years, in the sense of guidelines that include access to social rights, equity, qualification of public services, changes in health care policies, social inclusion and Democratization of higher education. Thus, the objective of the study is to analyze the relationships between the DCN 2001 and the 2014, taking into account their continuities, differences, innovations and established changes; 2- Reflect on the meanings that similar or related concepts of medical education used in different epochs take on historical contexts marked by different temporalities; 3- To elaborate notes on the potential of innovation / change / transformation of the proposals presented by the DCN 2014. For this purpose the Content Analysis was used as analysis methods, with reference in Bardin and Franco; And the History of Concepts, with a reference in Koselleck and Marçal Brandão. As conclusion, the work shows an important conceptual and normative effort of the new DCN 2014, which seeks to induce Brazilian medical schools to move from a level of innovations to changes, in the reformist sense that this new device presents itself. However, the success of such a policy will depend on a number of objective conditions, which involve the risk of retrogression in social policies after the approval of Constitutional Amendment 55/2016, and the eventual stagnation of the country's social policies, including in the health and education sectors, As well as the interference that the external relations of the sectors of opposition to the Mais Médicos Program will be able to have in the scope of the medical schools in the country. Consequently, the work points to the importance of the continuity of research that evaluates the concrete implementation of the new DCNs, in the sense of materializing what it advocates in its scope, as well as problematizes the need for a critical understanding in the incorporation of the pedagogy of competences as element Structuring of medical training in each course, since it can reproduce an individualistic logic of learning construction, potentially "capable" by the liberal logic that permeates hegemonic ideology in the corporate organization processes of medical practice in Brazil. That is, there will be no change or transformation.(AU)

Undergraduate education in palliative medicine in Germany: a longitudinal perspective on curricular and infrastructural development.

BACKGROUND: In 2009, palliative medicine became an integrated and compulsory part of undergraduate training in Germany by legislation. After a transitional period, all medical faculties were required to provide adequate teaching with an according examination and certification procedure. In parallel, we conducted bi-annual surveys on all medical faculties in Germany to examine for potential discrepancies between the implementation process and their intended consequences on teaching time and content. METHODS: Four consecutive bi-annual surveys (2006, 2008, 2010, 2012) of all 36 medical faculties in Germany were performed, using purposively for this study developed questionnaires. Likert scales and closed questions were analyzed descriptively. RESULTS: Medical Faculty response rate increased from 50 % in 2006 to 88.9 % in 2012. Teaching coordinators in palliative medicine primarily had an anesthesiology or internal medicine background. There was a noted increase over time of the involvement of specialized palliative care units (PCUs) as providing the setting for education. The number of faculties that were able to offer a complete 16 weeks of training in palliative medicine during the "final year" rose steadily. In addition, increased patient-centered teaching formats have been implemented over time. The faculties which offered innovative teaching formats with actors as patients (standardized patient interaction) increased, as did the total number of mandatory examinations. The number of faculties that provided compulsory teaching in a condensed manner within a single academic year increased sharply from 3 of 31 responding faculties in 2010 to 19 of 32 responding faculties in 2012. CONCLUSIONS: Until now, teaching conditions and structures in palliative medicine in Germany have proven to be extraordinarily heterogeneous. Although professorships ("Chairs") in palliative medicine proved to be particularly beneficial and supportive in curricular and structural development, only a minority of faculties provide leading academic positions in palliative medicine.

Medical education for "Dreamers": Barriers and opportunities for undocumented immigrants.

Medical schools should amend their admissions policies to welcome applications from qualified undocumented immigrants, often called "Dreamers." The recent creation of the Deferred Action for Childhood Arrivals (DACA) program of the U.S. Citizenship and Immigration Service removes the key obstacles to securing a license and residency eligibility for such medical school graduates. As a result, to deny application to Dreamers of DACA status represents a kind of unjustified discrimination and violates the basic ethical principle of the equality of human beings. In addition, the medical profession's duty of beneficence to patients compels medical schools to develop the talents of any and all qualified applicants so as to produce the most competent, diverse physician workforce that best represents contemporary U.S. society. Furthermore, social justice calls for medical schools to produce physicians inclined to serve populations that have traditionally been underserved, including some minority and immigrant populations. An examination of the characteristics of those granted DACA status suggests that they are a potential source of future physicians likely to be helpful in addressing these needs. The authors of this Perspective discuss the remaining challenges facing Dreamers who want to attend medical school in the United States and possible means of overcoming these hurdles. The authors' views are based on principles of social justice, their recognition of the duty to treat Dreamer applicants fairly and justly, and their belief that physicians have an obligation primarily to the patients they serve that entails developing the best health care workforce possible.

[The competent surgeon. Bridging the gap between undergraduate final year and postgraduate surgery training]. / Der kompetente Chirurg. Brückenschlag zwischen der Ausbildung im Praktischen Jahr und der chirurgischen Weiterbildung.

Competency-based frameworks rely on relevant professional competency rather than formal regulations. The transitional phase between final year undergraduate and common trunk postgraduate medical training is characterized by an increase of professional responsibility whereby previously acquired knowledge, skills and abilities have to be merged and applied to patients. Undergraduate and postgraduate training programs should ensure a successive transfer of responsibility for medical practice to final year students and young residents depending on individual competence. The concept of entrustable professional activities (EPA) represents a curricular concept based on concrete medical tasks which may be assigned to the responsibility of the trainee.