Repeated testing improves achievement in a blended learning approach for risk competence training of medical students: results of a randomized controlled trial.

BACKGROUND: Adequate estimation and communication of risks is a critical competence of physicians. Due to an evident lack of these competences, effective training addressing risk competence during medical education is needed. Test-enhanced learning has been shown to produce marked effects on achievements. This study aimed to investigate the effect of repeated tests implemented on top of a blended learning program for risk competence. METHODS: We introduced a blended-learning curriculum for risk estimation and risk communication based on a set of operationalized learning objectives, which was integrated into a mandatory course "Evidence-based Medicine" for third-year students. A randomized controlled trial addressed the effect of repeated testing on achievement as measured by the students' pre- and post-training score (nine multiple-choice items). Basic numeracy and statistical literacy were assessed at baseline. Analysis relied on descriptive statistics (histograms, box plots, scatter plots, and summary of descriptive measures), bootstrapped confidence intervals, analysis of covariance (ANCOVA), and effect sizes (Cohen's d, r) based on adjusted means and standard deviations. RESULTS: All of the 114 students enrolled in the course consented to take part in the study and were assigned to either the intervention or control group (both: n = 57) by balanced randomization. Five participants dropped out due to non-compliance (control: 4, intervention: 1). Both groups profited considerably from the program in general (Cohen's d for overall pre vs. post scores: 2.61). Repeated testing yielded an additional positive effect: while the covariate (baseline score) exhibits no relation to the post-intervention score, F(1, 106) = 2.88, p > .05, there was a significant effect of the intervention (repeated tests scenario) on learning achievement, F(1106) = 12.72, p < .05, d = .94, r = .42 (95% CI: [.26, .57]). However, in the subgroup of participants with a high initial numeracy score no similar effect could be observed. CONCLUSION: Dedicated training can improve relevant components of risk competence of medical students. An already promising overall effect of the blended learning approach can be improved significantly by implementing a test-enhanced learning design, namely repeated testing. As students with a high initial numeracy score did not profit equally from repeated testing, target-group specific opt-out may be offered.

[Current treatment strategies for spondylodiscitis in surgical clinics in Germany]. / Aktuelle Behandlungsstrategien der Spondylodiszitis in deutschen Akutkliniken.

BACKGROUND: Spondylodiscitis is a rare disease which is associated with high mortality. No guidelines for treatment exist and the available studies are not homogeneous. Attempts have been made in recent years to structure therapy using algorithms. Early recognition of the disease is above all important for its later outcome. Therapy takes place in not only orthopaedic/trauma surgery clinics but also in neurosurgical clinics. MATERIAL AND METHOD: We sent an online survey on this subject to orthopaedic clinics, trauma surgery and neurosurgery clinics in Germany. The aim was to ascertain current care strategies in Germany. A further objective was to elicit differences between the specialist fields. RESULTS: A total of 164 clinics responded to the survey. The response rate was 16% of the orthopaedic/trauma surgery clinics and 32% of the neurosurgical clinics. Differences between the two specialist fields can be found particularly in the use of systemic and local antibiotics, in the choice of surgical access to the thoracic spine and the lumbar spine and in post-operative imaging. In both specialist fields, patients with neurological dysfunctions are treated primarily in clinics with high case numbers. In terms of surgery, 2/3 of the responding clinics choose a one-stage operative treatment. Minimally invasive procedures and the use of cages are widespread. The participants estimate that, on the whole, a better outcome and higher patient satisfaction tend to exist after operative treatment. CONCLUSIONS: The lack of homogeneity regarding treatment strategies which is indicated here clearly shows the need for therapy guidelines as an aid to orientation. This will be a challenge for the future due to the low incidence and the situation regarding currently available studies.

[Diagnostic and therapeutic management of primary and recurrent patellar dislocations - analysis of a nationwide survey and the current literature]. / Aktuelle diagnostische und therapeutische Vorgehensweise bei der primären und rezidivierenden Patellaluxation - Analyse einer bundesweiten Umfrage und der aktuellen Literatur.

AIM: Patellar dislocations are a common injury of the knee joint. During patella dislocations injuries of soft-tissue structures can occur that can destabilise the patella and lead to recurrent dislocations. There are also congenital pathologies that predispose to patella dislocations. In the current literature, diagnostics and treatment of patellar dislocations are frequently discussed. Therefore the aim of our survey was to analyse and summarise actual diagnostic and therapeutic strategies regarding primary and recurrent patella dislocations. METHODS: An online questionnaire form was sent to 735 orthopaedic and/or trauma departments in Germany. The departments were invited to participate in an anonymous survey concerning diagnostics and treatment of primary and recurrent patellar dislocations. The questionnaire consisted of multiple choice questions and was divided into three sections. The first section included questions concerning the department structure. The second part contained questions regarding diagnostics and treatment of primary patella dislocations. The third part involved diagnostic and treatment strategies for recurrent patella dislocations. A systematic review of outcome after treatment of patellar dislocation was performed and discussed with the results of the survey. RESULTS: 245 hospitals (33.3 %) returned the questionnaire. Among the participants were 23 % orthopaedic surgery departments, 32 % trauma surgery departments and 45 % combined departments. 12 % were university hospitals and 53 % academic teaching hospitals. Clinical examination was performed by nearly all participants after primary and recurrent patella dislocations. MRI was used as diagnostic tool in 81 % after primary patella dislocation and in 85 % after recurrent patella dislocation. Conventional X-rays were performed in 58 % (primary) and 51 % (recurrent patella dislocations). Computed tomography scans for measurement of the tuberositas tibiae-trochlea groove distance were used in 35 % after recurrent dislocations and in 20 % after primary patella dislocations. 69 % of the participating departments performed non-operative therapies after primary patella dislocations, especially when no associated injuries and no congenital pathologies were observed. Reconstruction of the medial retinaculum was the most frequent surgical therapy (52 %) followed by the reconstruction of the medial patellofemoral ligament (36 %) after primary patella dislocation. Following recurrent patella dislocations reconstruction of the medial patellofemoral ligament (58.5 %) was the most performed surgery and a tuberositas transfer was done in 58 % of participating departments after recurrent patella dislocation. CONCLUSION: The results of our survey showed diagnostic and therapeutic procedures in the participating departments which are in accordance with recommendations in recent publications. The clinical importance of the MPFL reconstruction was observed for primary and recurrent patella dislocation. In addition, conservative treatment is still the most common treatment after primary dislocation of the patella.

Continued multidisciplinary project-based learning - implementation in health informatics.

OBJECTIVES: Problem- and project-based learning are approved methods to train students, graduates and post-graduates in scientific and other professional skills. The students are trained on realistic scenarios in a broader context. For students specializing in health informatics we introduced continued multidisciplinary project-based learning (CM-PBL) at a department of medical informatics. The training approach addresses both students of medicine and students of computer science. METHODS: The students are full members of an ongoing research project and develop a project-related application or module, or explore or evaluate a sub-project. Two teachers guide and review the students' work. The training on scientific work follows a workflow with defined milestones. The team acts as peer group. By participating in the research team's work the students are trained on professional skills. RESULTS: A research project on a web-based information system on hospitals built the scenario for the realistic context. The research team consisted of up to 14 active members at a time, who were scientists and students of computer science and medicine. The well communicated educational approach and team policy fostered the participation of the students. Formative assessment and evaluation showed a considerable improvement of the students' skills and a high participant satisfaction. CONCLUSIONS: Alternative education approaches such as project-based learning empower students to acquire scientific knowledge and professional skills, especially the ability of life-long learning, multidisciplinary team work and social responsibility.

Implementing software development guidelines in a medical informatics research project.

OBJECTIVES: Due to the non-commercial, research-oriented context, software in medical informatics research projects is often developed by researchers as a proof-of-concept without applying structured software development process models. A guideline for software development can bring sufficient structure to the development process while avoiding the complexity of industry-standard methods. METHODS: We adapted the common evidence-based guideline development process from medicine to build a guideline for software development in our medical informatics teaching and research project. RESULTS: Our guideline development used the six steps of problem identification, first proposal, review, revision, gaining consensus and periodic guideline review. Since the developers had taken part in guideline development, our guideline clearly states the consensus of the development team over critical topics. The guideline improved the quality of our source code in structure and understandability. CONCLUSIONS: A software development guideline that is developed following a consensus panel approach is a good instrument for basic software quality assurance in domains where complex, industry-standard software development methods cannot be applied. This is especially the case in non-commercial, research-oriented medical informatics projects where mainly non-software engineers like students do the development work.

Formalising and acquiring model-based hypertext in medicine: an integrative approach.

Combining a knowledge acquisition methodology with a powerful data model we present an approach to the acquisition, maintenance and browsing of scientific medical hypertext. The hypergraph-based data model supports the consistent treatment of cyclic data structures, the nesting of complex object and provides an elegant way of path declaration to represent time-dependent medical processes or large hypertext tours. It encourages a stepwise schema design and therefore supports a spiral-shaped acquisition process. We formally define view mechanisms on the basis of a rule-based query and modification language. The views enable a context-sensitive presentation of medical knowledge according to the informational needs of the physician. Our approach has been applied to the implementation of an authoring and tutoring environment for a computer-based hypermedia reference book for cerebrovascular diseases (NeuroN). During the acquisition process the expressive power and flexibility of the representational formats have been evaluated.

Programs, databases, and expert systems for human geneticists--a survey.

We present an overview of the variety of databases and programs that offer substantial aid to medical and molecular geneticists. Databases and expert systems for genetic diseases and birth defects, programs for segregation and linkage analysis, certain DNA and protein sequence databases, and information resources in general for molecular biology are addressed. These systems cannot be used effectively without the newly developed techniques of information exchange based on international computer networks. A short introduction is given to the Internet and to European institutions and organizations that offer help with the acquisition and use of bioinformatic resources.

Responses of retinal and tectal neurons in non-paralyzed toads Bufo bufo and B. marinus to the real size versus angular size of objects moved at variable distance.

Toads judge the real size of moving visual objects during prey-catching. But neither ganglion cells of the retinotectal projection nor tectal neurons showed a comparable phenomenon in muscle paralyzed toads. In non-paralyzed toads, however, tectal neurons, unlike neurons, displayed a sensitivity to the real size of an object moving at variable distance to the animal. Interestingly, this property was obtained both in monocular T5 smallfield neurons and in most of the investigated T4 widefield neurons.