[Systematic aspects of problem-based, case-related, practice-oriented, professional continuing education]. / Systematik des problemorientierten, fallbezogenen, praxisgebundenen, professionellen Weiterlernens.

Traditional CME using lectures has not been shown to improve patient care, which is the purpose of all learning in medicine. As knowledge taught mainly by lecturing is not useful for dealing with clinical problems, problem-based courses were developed to integrate general principles of basic and clinical sciences in undergraduate education. Case-based teaching is used for effective teaching of patient care. Six components were defined as a case system for clinical education: 1. Demonstration of patients; 2. free access to patients or data of patients, 3. responsible care of the patients, 4. acquisition of basic knowledge integrated in clinical problem-solving, 5. evaluation of documented work and 6. participation in patient related research. Surveys of general physicians showed that they regard a multitude of the components of the case system as desirable for learning in quality circles. Small group work can be implemented using computer supported work.

Lifelong learning of physicians: contributions of different educational phases to practice performance.

This pilot study was designed to find out where and when in their education physicians thought they had acquired the competencies they used in their daily practices five years after completion of their formal training. Specifically, the study sought physicians' views about the relative contributions of seven major phases of medical education (i.e., preclinical, clinical, "practice phases 1 and 2," specialty training, formal continuing education, and independent learning) to their practice performances. In 1991, the authors distributed a questionnaire to 330 physicians participating in a continuing medical education course in Germany, asking them about the relative contributions of these educational phases to their practice performances. A total of 141 (43%) returned questionnaires, of which 114 were suitable for evaluation. Specialty education was believed to have contributed most to the physicians' daily practices, with a median contribution of 20%. Practice-based independent learning, in which 38% participated in groups, contributed, with a median of 18%, and was superior to formal continuing education, with a median of 5%, and to university education, 15%. The frequency distribution of the percentages allotted to the seven phases showed great variation. Thirty-four respondents stated that they had not gained appreciably from preclinical education or formal continuing education but that the other five phases had contributed 50% to 90% of the knowledge and skills they used in their practices.

[Methods in continuing professional education. Results of a pilot survey of physicians]. / Methoden für professionelles Weiterlernen. Ergebnis orientierender Umfragen bei Arzten.

There is not enough evidence, that formal continuing education can improve the quality of patient care. A model to support the work of quality circles by improving the acquisition of new knowledge and skills through problem-based learning in small groups was suggested in 1991. The results of a pilot survey carried out in three different groups of physicians and professional health care workers gave evidence that the model is acceptable in Germany, where problem-based learning is virtually unknown. Attributes of study groups like inclusion of nonphysicians, who would also be accepted as moderators, were indicated by a great majority. Topics and groups should be chosen by the individual and not be imposed by a central organization. Of the four methods suggested for problem-solving-presentation of the solution by an expert, solving the problem in group work, advice from an external expert, use of electronic publications--at least three were selected by 62, 65 and 96% of the responders in the three different groups. 30% of the total of 108 responders favor all four methods. Three of the four tasks of organizations responsible for continuing education are accepted: 1. support of local study groups, 2. provision of consulting experts, 3. instillation of information centers using modern information technology. Production and application of case simulations to be used in the study groups were only accepted by 23%. The differences between groups could have been caused by external influence such as experience with case presentations. The results justify a survey with improved and extended methodology in a sample of doctors representative for the physicians working within the frame work of social insurance.

[Rational continuing medical education]. / Rationale ärztliche Fortbildung.

The goal of continuing medical education is to enhance quality and effectiveness of patient care and the health of the public. Everything helping to reach this goal is continuing education. Knowledge and principles needed to improve practice can only be acquired to a small extent by attending conventional lectures. Results of a survey, which are in good agreement with American studies show that literature and personal advice from colleagues are the most important sources for improving practice (35 resp 30%). With the introduction of electronic publishing and full text databases becoming available publications can be retrieved and downloaded anywhere and any time. Study groups for practice-based learning can prepare themselves for discussions of their problems or of simulated cases systematically provided by central organizations with experts using information technology. A pilot study showed great interest in the application of information technology: 80% of the responding colleagues showed interest in occasional or regular use of medical or non-medical full text database, preferably using their own computers. Competence depends on the kind and number of patients cared for. Physicians working for a long time in their specialty often concentrate on a restricted number of diseases. In order to keep up competence in the whole certified specialty, organizations issuing the certificates have to provide simulated cases exemplifying all aspects of their specialty. German medicine was the last to transfer clinical teaching from the ward to the lecture theatre compared to predecessors at Leiden, Edinburgh, Philadelphia and Paris. It is also the last still believing in its efficacy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of medical education at the McMaster University, Canada, based on the case method concept]. / Bewertung der ärztlichen Ausbildung an der McMaster Universität, Kanada, anhand des Konzepts der "Fallmethode".

Students of three different levels and the chairman of the MD-Program evaluated the educational system of McMaster University, Canada, using the six criteria of the case method as defined by Renschler. This analysis provided a very differentiated evaluation of the McMaster curriculum, demonstrating a systematic progress of learning methods from the second to the last phase. The instrument showed differences in the ratings of the demonstrative lectures between the chairman and the students. Free access to patients and responsibility, gradually growing during the 3-year program, are important features of the educational system. The problem-based system provides a unique integration of acquiring theoretical knowledge in the basic sciences through clinical problem solving which was highly rated in all analysed phases. Ratings given by the interviewed students for evaluation of documented work were lower than expected by the chairman and the authors. The results are discussed in relationship to the McMaster Philosophy and to the conditions of studying medicine in America and in Germany.

[Quantitative determination of glia-specific proteins in the cerebrospinal fluid of patients with MS (author's transl)]. / Nachweis Glia-spezifischen Proteins im Liquor bei multipler Sklerose

150 cerebrospinal fluids from MS patients (85 cases) and patients with different neurological diseases (65 cases) were investigated for their glia-specific content. The demonstration was made quantitatively by means of modified passive hemagglutination tests. The brain-specific glycoprotein was examined for its possible endogenous antigen and/or antibody properties in the cerebrospinal fluid (csf). It could only be demonstrated in the CSF as antigen. CSF with a quantitatively detectable glia-specific protein content- recognizable by a significant increase in titer - were set in relation to other CSF parameters such as cell count, total protein and globulin ratio, and investigated for possible relationships to the clinical syndromes mentioned and their development. A firm correlation was found between the glia-specific protein content and the total protein content of the CSF with retained equivalence.