Effects of a supplementary final year curriculum on students' clinical reasoning skills as assessed by key-feature examination.

BACKGROUND: The final year of medical education is considered crucial in making students 'fit for purpose'. Studies have shown that many students leave medical school without having experienced sufficient preparation for their upcoming professional life. AIM: The aim of this study was to examine the effectiveness of a supplementary internal medicine final year curriculum on clinical reasoning skills. METHOD: Final year internal medicine students from two universities participated in the study which was based on a static-group design. The experimental group (n = 49) took part in a final year student curriculum with interactive case-based seminars and skills training sessions. The comparison group (n = 25) did not receive any additional training beyond working on the ward. Clinical reasoning skills were assessed using a key-feature pre-post test. RESULTS: Prior to their clinical rotation, the two groups did not differ in the key-feature examination (p < 0.924). The experimental group performed significantly better than the comparison group (p < 0.028) in the post-intervention key-feature examination. CONCLUSIONS: Supplementary interactive case-based seminars and skills training sessions are effective and significantly improve the clinical reasoning skills of final year students in internal medicine. Further study is warranted and should look to examine the effectiveness of a final year student curriculum on other performance measures.

Ward rounds: how prepared are future doctors?

INTRODUCTION: Ward rounds are an essential activity for doctors in hospital settings and represent complex tasks requiring not only medical knowledge but also communication skills, clinical technical skills, patient management skills and team-work skills. The present study aimed to identify final year students' deficiencies in conducting ward rounds in order to aid the development of appropriate teaching tools. METHODS: 45 final year students participated in a simulated ward round session with three standardised patient scenarios: (1) myocardial infarction, (2) poorly controlled diabetes, and (3) acute fever in acute myeloid leukaemia. Videotaped sessions were rated by independent raters using binary item checklists which reflected predefined learning goals in five different domains: (I) information gathering, (II) communication with patient, (III) focused physical examination, (IV) chart reviewing/ prescription/ documentation and (V) team communication. RESULTS: For the three patient scenarios, 64.3% of the domain-specific learning goals were attained for the domain "information gathering", 79.4% for "communication with patient", 62.6% for "focused physical examination", 48.9% for "chart reviewing/ prescription/ documentation" and 86.0% for the domain "team communication". CONCLUSION: Final year students' ward round skills appear to be insufficient with a central deficit in reviewing charts and initiating appropriate prescriptions and documentation. Ward round training which eases the transition from observing ward rounds to conducting them on one's own is urgently required.

Integration of role-playing into technical skills training: a randomized controlled trial.

INTRODUCTION: Recently, efforts have been undertaken to enhance the face validity of technical skills training by introducing role-plays and standardised patients. Since little is known about the effects of role-playing with respect to the realism of a training situation and students' objective performance, we performed a randomized controlled trial. METHODS: 36 medical students participated in videotaped small group skills-lab sessions on the topics of Doppler sonography and gastric tube insertion. One half of the students participated in role-plays and the other half practised without role-playing. Realism of the training situation was analysed by means of post-intervention self-selected student survey evaluations. Technical performance and patient-physician communication were assessed by independent ratings of the videotaped sessions. RESULTS: The physician's role was regarded to be significantly more realistic when performing role-plays. Assessment of videotaped sessions showed that practising technical skills by performing role-plays resulted in significantly better patient-physician communication whereas students' technical performance did not differ between groups. CONCLUSION: Introducing role-plays enhances the realism of technical skills training and leads to better patient-physician communication. Students do not seem to be overstrained by practising clinical technical skills using role-plays. We conclude that role-playing is a valuable method in practising technical skills.

An innovative model for teaching complex clinical procedures: integration of standardised patients into ward round training for final year students.

OBJECTIVES: Ward rounds are an essential activity for doctors in hospital settings and represent complex tasks requiring not only medical knowledge but also communication skills, clinical technical skills, patient management skills and team-work skills. However, although the need for ward round training is emphasized in the published literature, there are currently no reports of ward round training in a simulated setting with standardized patients. METHODS: 45 final year students participated in a ward round training session lasting two hours with three standardized patient scenarios and role-plays. Final year students assumed the role of either doctor, nurse or final year student with role-specific instructions and provided each other with peer-feedback during the training session. Training was assessed using final year student focus groups and semi-structured interviews of standardized patients. Written protocols of the focus group as well as the interviews of standardized patients were content analysed. RESULTS: In the course of five focus groups, 204 individual statements were gathered from participating final year students. Ward round training proved to be a feasible tool, well accepted by final year students. It was seen to offer a valuable opportunity for reflection on the processes of ward rounds, important relevant feedback from standardized patients, peer group and tutors. Semi-structured standardized patient interviews yielded 17 central comments indicating that ward rounds are a novel and exciting experience for standardized patients. CONCLUSION: Ward round training with standardized patients is greatly appreciated by final year students and is viewed as an important part of their education, easing the transition from observing ward rounds to conducting them on their own.

[Doctors' strike 2006: psychological and physical distress of striking doctors]. / Arztestreik 2006: Psychische und körperliche Belastungen streikender Arztinnen und Arzte.

BACKGROUND AND OBJECTIVE: From March to June 2006 doctors at university hospitals in Germany went on strike. As they are part of the caring profession, doctors are exposed to extraordinary moral misgivings and ethical conflicts when it comes to striking. Against this background this study investigated for the first time effects of walkout on working relations, individual capacity and mental symptoms among striking doctors. METHODS AND SAMPLE: In a cross-sectional study 42 female and 64 male doctors, average age 33.6 years, at the Tübingen University Hospitals Center were surveyed by questionnaire at the climax of the walkout. They were asked about changes in working relations with superiors and fellow colleagues, their physical and mental burden and symptoms of depression or aggressiveness (modified Symptom Checklist SCL-90-R). RESULTS: 54.8 % of those interviewed described the contact with their superiors during the strike as having been more difficult. This was most notable for doctors in surgical disciplines. 85.5 % thought that solidarity among fellow colleagues had improved. 47.2 % found their mental coping ability and 25.5% their physical capacity to have decreased. Surgeons and female doctors felt most affected. A higher level of aggressiveness was measured in 36 % and 13.6 % showed low-grade depressive symptoms. CONCLUSIONS: This study has demonstrated remarkable changes in working relations and individual capacity during the walkout. Solidarity among doctors of at a corresponding hierarchical (peer) level was noted to have risen, while contact with superiors had become more difficult. A higher level of aggressiveness and lower mental capacity may stem from psychological conflicts arising in strike situations. The burden of the strike is higher in those doctors working in surgical disciplines. It is likely that effects of strike-related changes extend beyond the walkout period. These should be investigated in future studies.

[Practical examinations for neurology. The Tuebingen model]. / Praktische Prüfungen in der Neurologie. Das Tübinger Modell.

Practically orientated examinations represent an important innovation in medical education. In the subject area of neurology, the "Objective Structured Clinical Examination" (OSCE) proved to be a viable form of examination for the subject of neurological anamnesis and a medical examination course at the University of Tuebingen in Germany. A total of 577 students in their sixth semester of study were examined in, to date, four OSCEs and achieved an average of 17.5 of possible 25 points in the subject of neurology. Improvement in point average was observable over the course of time, while the average performance of students across the total OSCE remained constant. Student evaluations regarding form and content of the neurological examinations yielded an average grade of B (in the German system 2.1). Simulation patients were rated with an average grade of A- (German system 1.7). Examination methods are presented together with experience concerning preparation, implementation, and developmental enhancement of neurological OSCE examinations. Implications of this novel form of examination for faculty development and regulating students' learning and study behaviour are discussed.

[Family therapy within the treatment of eating disorders]. / Familientherapie bei Ess-Störungen.

The families of patients suffering from eating disorders such as Anorexia nervosa (AN) und Bulimia nervosa (BN) are, owing to the illness, subject to considerable emotional strain and are furthermore often characterised by significant structures and patterns of interaction within the family. Consequently the inclusion of patients' family members, whose status can be seen as increasingly gaining in scientific approval, plays an important role within both diagnosis and therapy. Of particular importance is the medical informative discussion with both patients and their parents which takes place in a primarily medical context and aims to develop and increase therapy motivation. For this purpose the doctor should possess basic knowledge concerning dialogue management with families, as will be presented in the current article. Within further stages of the therapeutic process the spectrum of interventions at the level of the family ranges from educational and supportive measures to family therapy in a more narrow sense, which is carried out by specialist psychotherapists either as outpatient-treatment or within the framework of therapy with inpatients of a clinic.

An innovative model for final-year students' skills training course in internal medicine: 'essentials from admission to discharge'.

Clerkships are generally seen as a very favourable learning environment for final-year students. However, in recent years the clinical experience of final-year students has been reported to decline progressively. It was decided, therefore, to introduce an innovative skills training model in internal medicine. Sixty final-year students received four consecutive days of training during their first week, consisting of three-hour sessions on each day. The skills training course reflected a patient history from admission to discharge and included all required routine procedures, typical forms/files and computer interactions. Acceptability was measured with self-administered surveys post-intervention and again 16 weeks later; self-assessment was measured pre-/post-intervention. The skills training course was well accepted by the students and led to a significant improvement in self-assessment. It was considered to be very helpful for work on the wards in both the immediate and the long-term retrospective evaluation. The final-year skills training course allows students to learn how to handle specific tools and applications for their work on the ward. It possesses face validity and is easy to integrate.