[Implementation of a competency-based graduate medical education program in a neurology department]. / Einführung eines kompetenzbasierten Facharztweiterbildungsprogramms in einer neurologischen Abteilung.

BACKGROUND: Competency-based programs have long been the basis of graduate medical education in British and North America. Such formally defined program structures are lacking in German graduate medical education. METHODS: The methods and assessment tools used in a curriculum-based program of graduate education in medical specialties are presented. The feasibility of the program was tested in day-to-day use in a pilot study conducted within a neurology department. Experience of it during a 1-year period after implementation has also been collected. RESULTS: It was found that implementation of the program is feasible providing that both the trainers and the students are well motivated, that adequate resources are provided, and that a formal training system is provided for the trainers. This is confirmed by the 1-year experience of the program in routine clinical practice. CONCLUSIONS: The competency-based program presented, which is compatible with many quality management systems, offers management and assessment tools that will make for more satisfactory postgraduate medical education.

Dynamic plantar pressure distribution measurements in hemiparetic patients.

OBJECTIVE: A comparison of plantar pressure distribution of hemiparetic patients with a control group was performed to determine quantitative, objective and reproducible criteria for better assessment of hemiparetic gait. DESIGN: This empirical, descriptive study used a clinical sample of 18 hemiparetic patients and compared the data to previously published data from 111 healthy persons. BACKGROUND: Several biomechanical methods have been used in the past to evaluate and classify hemiplegic gait, for example kinetic, cinematographic, or electromyographic systems, but plantar pressure distribution measurement has not been studied. METHODS: Peak pressures were determined under the feet of 18 hemiparetic patients during stance phase using a capacitive pressure distribution platform (EMED-F01 system, Novel GmbH). RESULTS: Hemiparetic patients showed considerably lower peak pressures under all anatomical structures and an unexpected medial load shift in the forefoot. CONCLUSIONS: The grade of spasticity seems to be the most important cause for expression of the medial load shift. Individual pressure distribution gait analysis, as shown in an example, may improve assessment and therapy of hemiparetic patients. RELEVANCE: Plantar pressure distribution data from hemiparetic patients can be used for an analysis of lower extremity dysfunctions. This method may also be employed to assess objectively the success of drug treatment and/or other rehabilitation processes. In particular, individual plantar pressure data from patients will provide additional clinical information for rehabilitation physicians, therapists, and engineers.