The AaLplus near-peer teaching program in Family Medicine strengthens basic medical skills-A five-year retrospective study.

BACKGROUND: Basic medical skills such as history taking and physical examination are essential components of clinical work profiles, but nevertheless have been neglected by conventional preclinical curricula. The near-peer-teaching program AaLplus [living anatomy plus] teaches basic medical skills, especially history taking, physical examination, and venepuncture, to preclinical students. It is a highly popular compulsory course in the first four semesters (320 students/year, 9h/semester) at Heidelberg University and ends with a formative Objective Structured Clinical Examination (OSCE) during which students receive structured in-depth feedback on their performance. AaLplus is part of the Department of General Practice's longitudinal curriculum for Family Medicine. OBJECTIVES: This study aims to assess whether the AaLplus program has positive effects on students' clinical skill development and subjective confidence in history taking, physical examination and venepuncture. METHODS: From 2015 to 2019, we asked all AaLplus participants to rate the program and self-assess their medical skills on 5-point Likert scales (min 1, max 5). In 4-station OSCEs, trained tutors rated the students' performance in all taught skills using standardized checklists. RESULTS: From 2015 to 2019 n = 1534 questionnaires returned (response rate = 98.6%, 52.7% females). After course completion, students felt able to take a patient's history (mean 3.97, SD = 0.75) and perform physical examinations (means range 3.82-4.36, SDs range 0.74-0.89) as well as venepuncture (mean 4.12, SD = 0.88). A large majority of students claimed they acquired these skills in the AaLplus program. During OSCE, 81.9% passed anamnesis, 93.1% passed physical examination, and 95.4% passed venepuncture (of n = 1556). Students mostly rated the feedback they received during the OSCE as "helpful" or "very helpful" (means for different stations 4.69-4.76, SDs 0.50-0.70). CONCLUSIONS: AaLplus is a positive example of a peer teaching program in the preclinical stage of medical studies. It successfully trains junior students in essential medical abilities and increases their confidence in their skills. A high percentage of students pass the formative OSCE and evaluate it positively. Consistently high ratings indicate the program's routine viability. Further studies are needed to analyze if programs like AaLplus could have an impact on the number of graduates choosing career in Family Medicine.

Peers as OSCE assessors for junior medical students - a review of routine use: a mixed methods study.

BACKGROUND: Peer-assisted learning is well established in medical education; however, peer tutors rarely act as assessors for the OSCE. In the compulsory, near-peer teaching programme covering basic medical skills at the University of Heidelberg, peer tutors serve as assessors on a formative OSCE. This study aimed to investigate the feasibility and acceptance of peer assessors and to survey the perceived advantages and disadvantages of their use. METHODS: In 2016 and 2017 all OSCE peer assessors (third to sixth-year medical students) and all of the peer-assessed students in 2017 (second-year-medical students) were invited to participate in a survey. Both groups were asked to complete a tablet-based questionnaire immediately after the OSCE. Peer assessors were asked to rate eight statements and the peer-assessed students to rate seven statements on a five-point Likert scale. Both were asked to comment on the advantages and disadvantages of peer-assessors. RESULTS: Overall, 74 of 76 peer assessors and 307 of 308 peer-assessed students participated in the study. 94% (67/74) of peer assessors and 90% (276/307) of the peer-assessed group thought that it is important to have peer tutors as assessors. Of the peer assessors, 92% (68/74) felt confident in giving structured feedback during the OSCE and 66% (49/74) felt they had improved their teaching skills. Of the peer-assessed students, 99% (306/307) were satisfied with their peers as OSCE assessors and 96% (292/307) considered the peer feedback during the OSCE as helpful. The participants mentioned structural benefits, such as lower costs, and suggested the quality of the OSCE was higher due to the use of peer assessors. The use of peer assessors was found to be beneficial for the learners in the form of high-quality feedback and an overall reduction in stress. Furthermore, the use of peer assessors was found to be beneficial for the peer assessors (improved teaching and clinical skills). CONCLUSION: From a learner's perspective, the use of peer assessors for a formative OSCE that is part of a near-peer teaching program aimed at junior medical students is favourable for all. A broad implementation of peer assessment in the formative OSCE should be encouraged to investigate effects on quality and stress-reduction.

["Critical discussion should be encouraged!" - a qualitative analysis of medical students' evaluation of a complementary medicine course]. / "Kritische Diskussion sollte mehr gefördert werden!"­ Eine qualitative Auswertung der Lehrevaluation von Medizinstudierenden zur komplementärmedizinischen Lehre.

BACKGROUND: In 2002, the new version of the German Medical Licensure Act integrated Naturopathy and Complementary Medicine into the cross-sectoral unit 12 "Rehabilitation, Physical Medicine and Naturopathy" (QB12) of the medical undergraduate course. At the University of Heidelberg, Complementary Medicine (CAM) is an obligatory clinical subject of the medical undergraduate curriculum and is delivered in the form of lectures and small group work. As a central educational objective, medical students should be able to explain the principles of classical Naturopathy and the most commonly used CAM procedures. The aim was to explore the attitudes, learning needs and interests of medical students with regard to Naturopathy and CAM, and thus establish the teaching requirements. METHODS: The lectures and internships were evaluated using a faculty-based teaching evaluation form. The free-text of the evaluation forms between winter semester 2011/2012 and summer semester 2013 were assessed using Mayring qualitative content analysis. RESULTS: The free-texts were divided into three deductive main categories (Attitudes, Learning Needs and Interests) and further subcategories. A central topic was the polarization of views in medical students regarding CAM; it ranged from lively resistance to great enthusiasm. Strikingly, comments often showed that students had significant reservations with respect to CAM and would require further evidence from the teachers in order to embrace this concept. This was particularly prominent in the use of non-pharmaceutical methods. DISCUSSION: Our results show that evidence-based teaching, combined with practical experience, contributes positively to the critical appraisal of CAM amongst medical students. These findings can serve as the basis for planning, implementation and realization of CAM teaching within mainstream undergraduate medical education.

[Five-year experience with Train-the-Trainer courses for general practice trainers - a qualitative and quantitative analysis]. / Fünf Jahre Train-the-Trainer-Kurs für weiterbildungsbefugte Hausärzte - qualitativ-quantitative Analyse der Begleitevaluation.

BACKGROUND: A Train-The-Trainer course (TTT course) for general practice trainers was developed as part of the program Verbundweiterbildungplus Baden-Württemberg. The course included aspects of training such as organizational and legal knowledge as well as didactic skills for trainers in 9.5 teaching units (45minutes each). The present article analyzes the evaluation of the course and considers possible future developments for TTT courses in Germany. METHODS: An evaluation tool was used covering aspects such as information, relevance for daily work, opportunities for participant engagement in the seminars and working environment as well as didactic competencies among teachers. Within five years, 256 trainers participated in a TTT course and received an evaluation sheet. Data were analyzed descriptively. RESULTS: 249 evaluation sheets were included (response rate 97 %). Overall, the participants were (very) satisfied with the course in general, its organization, the exchange with colleagues and the teaching units. The participants used the free text mode to give positive feedback; in particular, teaching units in organizational and legal regulations as well as practical feedback training to strengthen professionalism were evaluated positively. Suggestions for improvements included follow-up courses or a deepening of understanding of course contents. CONCLUSION: The participants gave a very positive overall rating and claimed to have benefited from the course contents. Future projects should address further qualifications of general practice trainers and facilitate the exchange with colleagues on an ongoing basis.

[Integrated Peer Teaching of Communication and Clinical Skills: How to Train Student Tutors?]. / Integriertes Peer Teaching klinischer und kommunikativer Kompetenzen: Wie bereiten wir studentische Tutoren darauf vor?

AIM: This paper describes the theory-based development of a standardized training model for peer tutors. The aim is to qualify tutors to teach communication skills integrated with practical clinical skills, to medical students in the pre-clinical curriculum. As a result, students are encouraged to form a basic understanding of the biopsychosocial model of diseases early in their studies. METHOD: The training model's design is based on the Kern model for curriculum development as adapted by McLean et al., who outlined the following steps: planning, implementation, and evaluation/feedback. Our focus is on development, review of feasibility, and evaluation as measured by the subjectively perceived effectiveness of the implemented training model. 2 target groups were considered: the peer tutors and the student tutees. RESULTS: In 2009, a 3-step training model consisting of 12 units was developed, based on the theory of patient-centered communication and the biopsychosocial model. The training was rated very positively on a 5-point Likert scale by all tutors at 2 points in time: t1 (directly after training) and t2 (after conducting 2 tutorials) (t1: M=1.67; SD=±0.86; t2: M=1.75; SD=±0.71). On a 6-point Likert scale, the tutees also evaluated their communication and clinical skills as being significantly better after completing the 10 tutorials (t2: scale for interaction and communication: M=4.81; SD: 1.09; scale for clinical examination: M=4.99; SD: 0.85) than before the tutorials (t0: scale for communication and interaction: M=3.18; SD=1.15; scale for clinical examination: M=2.88; SD: 1.09). CONCLUSIONS: By implementing a standardized tutor training model, one can qualify peer tutors to teach communication skills integrated with practical clinical skills during the pre-clinical phase. Practice teaching of the curricular material via role playing, tutorial simulation and an extensive feedback session, along with the definition of clinical standards for recording case histories and performing examinations, have proven themselves to be core elements of effective tutor training.

Train the Trainer for general practice trainer - a report of the pilot within the programme Verbundweiterbildung plus.

BACKGROUND: Since 2008 the Verbundweiterbildung(plus) programme of the Competence Centre General Practice Baden-Wuerttemberg offers continual improvement with regards to content and structure of general practice training. The programme uses the didactical concept of the CanMEDs competencies, which were developed in Canada, as a postgraduate medical training framework. Train the trainer (TTT)-programmes are an additional important element of these contentual optimisations of postgraduate training. Within this article we describe the conception and evaluation of the first TTT-workshop within the programme Verbundweiterbildung(plus). METHODS: The conception of the first TTT-workshop was influenced by results of a survey of general practitioner (GP) trainers and by experiences with teaching GP trainers involved in medical undergraduate teaching. A questionnaire was designed to get a self-assessment about organisational and didactic aspects oriented on the CanMEDs competencies of postgraduate medical training. In addition, the workshop was evaluated by the participants. RESULTS: The workshop lasted 12 teaching units and included the following elements: introduction into the CanMEDs competencies, feedback training, fault management, legal and organisational aspects of post graduate training. From the 29 participating trainers 76% were male and on average 57 years old. The evaluation showed a good to very good acceptance of the workshop. Initial self-rating showed the need of improving in the fields of determining learning objectives, providing formative feedback and incorporation of a trainee. Most trainers rated themselves as very good in procure CanMEDs competencies with the exclusion of the competencies "Manager" and "Scholar". CONCLUSION: A TTT-programme is an important method to improve GP training which has not been used in Germany so far. Such a GP TTT-programme should highlight especially training in providing feedback and teaching in management aspects. Results of this article add information that can be used for developing TTT-programmes also in other specialties.

[Development and implementation of a 'curriculum complementary and alternative medicine' at the Heidelberg Medical School]. / Entwicklung, Implementierung und Evaluation eines "Curriculums Naturheilverfahren" an der Universität Heidelberg.

BACKGROUND: The 9th revision of the Medical Training Regulations for Physicians (AAppO) in October 2003 included the new compulsory interdisciplinary subject 'Rehabilitation, Physical Medicine and Complementary and Alternative Medicine (CAM)' (QB 12). The present article describes the development of a 'CAM curriculum' for undergraduate education, its implementation in the QB 12 at the Heidelberg Medical School and its evaluation. METHODS: According to the 6-step approach by Kern, the following aspects are presented: requirements, experiences/interests of students, learning targets, development of practical training courses and lectures, implementation, and evaluation. Experiences/interests of students were assessed by a self-developed questionnaire. Practical training courses and lectures were evaluated by school marks (1 through 6) and by a modified version of the HILVE-I. RESULTS: A selection of CAM methods to be included in the curriculum was made by the participating lecturers based on the criteria 'evidence' and 'prevalence in health care'. Learning targets were defined in terms of knowledge, skills and attitudes. On this basis, practical training courses/lectures comprising classical naturopathy, acupuncture/ traditional Chinese medicine and neural therapy were developed and integrated in the QB 12. Regular evaluations of the practical training courses/lectures constantly reveal good results. 69% of the 219 students questioned indicated to be interested in CAM, 27% already had gained experience with CAM themselves. DISCUSSION: The well-evaluated CAM courses/lectures indicate a successful development and implementation of the 'CAM curriculum' in the QB 12 at the Heidelberg Medical School. Thus, the requirements of the AAppO are met. Moreover, implementation of CAM in undergraduate education allows for the importance CAM has in every-day care of patients in Germany.