German Physicians and Medical Students Do Not Represent the Population They Serve.

Medical professionals who represent the communities they serve are in a better position to understand patients' social circumstances and communicate in a more patient-centered way. International studies show limited diversity and underrepresentation of certain social groups in the population of physicians and medical students. We designed an observational study to investigate the cultural and socio-economic diversity of physicians and medical applicants in comparison to the general population in Germany. We invited 15,195 physicians in Hamburg and 11,287 medical applicants in Germany to participate in an online survey between June and August 2022. The lower three quintiles of objective socio-economic background (SEB) were vastly underrepresented in all subsamples of the study and in particular amongst applicants and students admitted in Hamburg: 57.9% of physicians and 73.8% of medical students in Hamburg originate from the top quintile of SEB. The Turkish and Polish communities were particularly underrepresented in the group of physicians from Hamburg and medical applicants and students in Germany (p = 0.02; p < 0.001). In line with existing evidence, the vast majority of physicians and medical students come from the most affluent households when entering medical school. Widening participation strategies are needed to facilitate fairer access to the study of medicine in Germany.

Reliability and validity of new online selection tests for midwifery students.

BACKGROUND AND OBJECTIVE: Newly created midwifery bachelor programmes attract an increasing number of applicants. Hence, educators have moved away from traditional non-standardised selection methods and started developing new tools for the admission of students. Researchers have expressed concerns around the validity of such selection measures and their ability to identify the appropriate candidates. The objective of this study was to develop and implement selection procedures for a new midwifery Bachelor of Science degree in Hamburg, Germany, and assess their psychometric properties. DESIGN: This is a mixed-methods longitudinal study on the reliability, validity and acceptability of newly developed selection criteria. SETTING: The newly established midwifery bachelor of science in Hamburg, Germany. PARTICIPANTS: Upon completion of their online application, all midwifery applicants were invited by email to participate in our research project and thereby informed of its purpose and voluntary nature of their participation. The total number of candidates who took the test was 366, of which 309 agreed to take part in this study. Sixty-five applicants were eventually admitted to the midwifery Bachelor programme, of which 59 were included in the study. MEASUREMENTS AND FINDINGS: We developed two tests for cognitive ability (HAM-Mid I and II) and adapted one test for personal and professional characteristics (Casper - Computer-based Assessment for Sampling Personal Characteristics). Due to the Covid pandemic, we implemented the tests online instead of on site as initially planned. HAM-Mid I had the lowest (Cronbach's Alpha = 0.38) whereas Casper had the highest internal consistency (Cronbach's Alpha = 0.77) of all three tests. Age, previous academic achievement and native tongue were significantly associated with applicants' performance on HAM-Mid II and Casper admission tests. HAM-Mid II was associated with students' performance in the first year midwifery exam (r = 0.31, p < 0.05). Overall evaluation of HAM-Mid II and Casper was good while HAM-Mid I received a more negative feedback. KEY CONCLUSIONS: Evidence on the reliability and predictive validity of the newly developed tests suggests that the applied admission criteria are appropriate for an objective selection of bachelor midwifery students. IMPLICATIONS FOR PRACTICE: The interests of university and clinical stakeholders of a midwifery bachelor degree can be represented through the development of tests for the assessment of cognitive ability and personal and professional characteristics.

Attitude and communication skills of German medical students.

OBJECTIVE: While the development of communication competencies in medical schools plays a pivotal role in the curriculum, studies show that students' communication skills and patient-centred attitudes may vary based on gender and ethnicity. The goal of this study was to investigate the socio-demographic factors that influence medical students' communication abilities and, more specifically, to what extent their attitude toward communication skills learning and patient orientation associate with communication abilities. Our population included medical students admitted in 2017. Used tools included a communication score, the patient-provider orientation and communication skills attitudes scales. RESULTS: Three hundred and sixty-five students participated in the study (56.4% female, 85.2% German native speakers, mean age 24.2 ± 3.5 years). Female and German native speaking students had a better communication skills OSCE performance, were more patient-oriented and had more positive attitudes toward communication skills learning than male and non-native speaking students. There was a significant association between gender, native tongue, attitudes towards communication skills learning and communication skills OSCE performance. In conclusion, to support medical students to improve their communication proficiency and attitudes towards the importance of clear communication and patient-oriented care, medical educators should consider teaching and assessment strategies that address socio-cultural aspects of communication.

How good are medical students at communicating risk? An implementation study at three German medical schools.

OBJECTIVE: To assess the objective and subjective risk communication skills of medical students in three universities in Germany METHODS: We developed a risk communication skills Objective Structured Clinical Examination (OSCE) station and implemented it in three medical schools in Germany. 596 students contributed data to a risk communication checklist and a risk communication self-assessment. Multiple linear regression models were used to identify factors associated with the risk communication OSCE performance. RESULTS: Participants in our study achieved on average 73.5% of the total risk communication skills score, which did not differ between locations (F(2-595) = 1.96; p = 0.142). The mean objective performance of students who assessed their skills as poor was significantly worse than the performance of students who assessed their skills as good (t(520) = -5.01, p < 0.001). The risk communication skills score was associated with native language but not with gender nor General Point Average (p < 0.001). CONCLUSIONS: Medical students demonstrated acceptable risk communication skills scores and were able to self-assess their performance. However, selected communication techniques should be re-emphasised in the undergraduate medical curriculum. PRACTICE IMPLICATIONS: Our research identified shortcomings in particular subgroups that can be addressed through tailored curriculum interventions.

The health literacy dyad: the contribution of future GPs in England.

BACKGROUND: Health literacy studies have primarily focused on the cognitive and social skills of individuals needed to gain access to, understand, and use health information. This area of study is undergoing a paradigm shift with increased attention being paid to the skills of practitioners and an examination of their contribution to the link between literacy and health outcomes. The aim of this study was to describe the health literacy related competencies of General Practice (GP) trainees who will soon be responsible for the clinical encounter. METHODS: A cross-sectional survey of a convenience sample of 206 GP trainees was conducted online. Univariate and bivariate analysis methods were used to describe GP trainees' health literacy-related competencies. RESULTS: GP trainees overestimated the numeracy and literacy levels of the English population and did not regard the improvement of patient health literacy as a GP responsibility. GP trainees rated their general communication skills highly but the skills that are important for patients in health decision-making such as coaching skills, explaining risk and using visual aids to clarify were rated low. CONCLUSION: This study demonstrates that health literacy is insufficiently addressed in the undergraduate and postgraduate medical education of GPs to enable them to fulfil the core competence which is part of building an effective partnership with patients.