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Postgraduate medical education (PGME) is an essential part of medical education and increasingly shifts into focus of educational stakeholders. Structured postgraduate medical training programs are required in the U.S. through the "American Council for Graduate Medical Education" (ACGME) guidelines with their six core competencies as common program requirements. The basis for this development was provided in Germany with the implementation of the "Standard Framework for Postgraduate Medical Training" (Musterweiterbildungsordnung) issued by the German Medical Association (Bundesärztekammer). However, implementation has been gradual and program development is often conducted in a time consuming, lengthy and top-down approach without that trainee experiences or needs are being assessed or evaluated for their impact on successful medical training. We demonstrate how application of agile working can enable rapid and efficient creation and implementation of a novel postgraduate training program. The postgraduate training program ped.tracks aims to achieve a high-quality, structured and reliable postgraduate training. Moreover, it provides the opportunity to select a priority on scientific or clinical education. The entire process from the first draft to full release of the program was completed within 8 months through agile working. Our team worked using agile working techniques, creating a trainee- customized and -centred program. We anticipate that the quantity of structured postgraduate training programs will significantly increase in Germany and Europe to improve training quality and employee satisfaction. Therefore, the use of agile methods for the creation and implementation of structured training programs represents a useful approach to support program directors rapidly and effectively in this effort. [ABSTRACT FROM AUTHOR]

Objective: Medical training in Switzerland is currently undergoing change. The postgraduate education curricula of all medical specialties are being converted to competency-based medical education (CBME). Entrustable Professional Activities (EPA) are used to assess competencies. EPAs describe specific professional tasks that are assigned to postgraduate trainees once they have achieved sufficient competencies. Methodology and results: The article describes how the didactic building blocks are joined to create competency-based teaching and how the implementation takes place. The project is described using the Kern cycle. The first two steps, problem identification and targeted needs assessment, are presented in the project description section, the other four steps in the results. Concrete details are given using examples from the cardiology curriculum. Conclusion: The conversion of medical training in Switzerland to competency-based teaching is an important step that is urgently needed but complex. The long-term plan of the Swiss Institute for Postgraduate and Continuing Medical Education (SIWF) consists not only of structural steps but also cultural change. The first two years of the conversion were successful. In collaboration with the specialist societies, postgraduate curricula are being converted to EPA-based learning objectives, the didactic training for postgraduate teaching staff adapted accordingly and feedback from learners is continuously gathered. The implementation process has begun. Additional data will be collected as the project proceeds. Using experience already gained internationally and by specialist societies which have already taken this step as benchmarks is critical for other specialties and training centres that are still to follow. [ABSTRACT FROM AUTHOR]

Background: Competency Based Medical Education (CBME) is a global movement in graduate medical training but implementation on a national scale is challenging. One crucial element of fostering CBME is to establish faculty development. We report the design of a national program, the process of implementation, and the results of the first two years. Methods: Following Kern's cycle of curriculum development, a group of medical education experts designed a training program covering the basic skills for teaching in clinical settings. In addition, we outlined a qualification pathway for future educators in the program. Results: The program was built upon 1-day-workshops with the topics: "clinical teaching", "feedback and assessment", "clinical leadership", "supporting trainees in difficulties". More than 30 workshops were delivered in two language regions to more than 500 clinical teachers. The median rating whether participants' expectations were met was 9 (of 10 points, IQR 8-9). The qualification pathway for future educators in the program included a nomination, a 2.5-day introductory workshop, shadowing of workshops, and stepwise acquisition of workshop parts as an educator candidate. Discussion: This faculty development program was well attended and well-received. Using Kern's established model for the design process including an extensive needs assessment helped to serve the goals of the program. Developing future educators for expanding this program proved resource intensive. Conclusion: Implementing a national faculty development program was successful based on a rigorous design process, a highly motivated expert team, and learning content tailored to the needs of the audience. Effects on the implementation of CBME still need to be evaluated. [ABSTRACT FROM AUTHOR]

Introduction: Graduate medical education is being reformed in many countries, with a focus on the principles of competency-based medical education (CBME). A main novel aspect in this context is the implementation of entrustable professional activities (EPAs). The introduction of EPAs aims to better align training curricula with clinical practice, provide individualized supervision, and enhance the quality of feedback. Project description: This project report presents the development of a national strategy and the initial results of implementing entrustable professional activities in the Swiss context. Results: Affiliated with the Swiss Institute of Medical Education (SIME), an EPA-Commission was established with the mandate to develop a strategy and provide guidance to medical specialty societies. To date, 28 out of 45 specialty societies have sought advice from the EPA-Commission and have begun developing EPAs. Concurrently, the Commission has expanded the national faculty development courses, adapted the content, started offering multilingual courses, and has published a series of articles on CBME and EPAs. Selected pilot hospitals are now planning to implement EPA-based graduate medical education curricula. Additionally, the introduction of a nationwide electronic solution (app) for assessing EPAs is planned. Conclusion: The introduction of EPAs in graduate medical education is a multilayered project. In addition to medical education aspects, various social, organizational, and professional-political factors are crucial for the transformation processes. In the Swiss context, such a reform has been successfully initiated. Continuous evaluations of the ongoing projects will provide further insights for competency-based graduate medical education reforms. [ABSTRACT FROM AUTHOR]

Background: A competency-based education approach calls for frequent workplace-based assessments (WBA) of Entrustable Professional Activities (EPAs). While mobile applications increase the efficiency, it is not known how many assessments are required for reliable ratings and whether the concept can be implemented in all sizes of residency programs. Methods: Over 5 months, a mobile app was used to assess 10 different EPAs in daily clinical routine in Swiss anesthesia departments. The data from large residency programs was compared to those from smaller ones. We applied generalizability theory and decision studies to estimate the minimum number of assessments needed for reliable assessments. Results: From 28 residency programs, we included 3936 assessments by 306 supervisors for 295 residents. The median number of assessments per trainee was 8, with a median of 4 different EPAs assessed by 3 different supervisors. We found no statistically significant differences between large and small programs in the number of assessments per trainee, per supervisor, per EPA, the agreement between supervisors and trainees, and the number of feedback processes stimulated. The average "level of supervision" (LoS, scale from 1 to 5) recorded in larger programs was 3.2 (SD 0.5) compared to 2.7 (SD 0.4) (p<0.05). To achieve a g-coefficient >0.7, at least a random set of 3 different EPAs needed to be assessed, with each EPA rated at least 4 times by 4 different supervisors, resulting in a total of 12 assessments. Conclusion: Frequent WBAs of EPAs were feasible in large and small residency programs. We found no significant differences in the number of assessments performed. The minimum number of assessments required for a g-coefficient >0.7 was attainable in large and small residency programs. [ABSTRACT FROM AUTHOR]

Background: Due to the coronavirus pandemic, the medical faculties in the Federal Republic of Germany converted their curricula to digital formats on a large scale and very quickly in spring 2020 as an emer- gency measure. At the same time, a start was made on the nationwide exchange of digital teaching/learning materials via the online platform “LOOOP share” in order to save local resources. Among other things, virtual patient cases (VP) were shared across faculties for case-based learning, through which students can acquire clinical decision-making skills. Objectives: Within the framework of the cooperation project “National Learning Platforms for Digital Patient-Related Learning in Medical Studies” (DigiPaL), the usability of VPs for students and teachers should be improved, and the spectrum of disease patterns that are covered by VPs should be systematically expanded. Results: With the participation of many locations, a total of 150 VPs were developed by 96 case authors from 16 faculties, in addition to the existing 403 VPs. The thematic selection was made on the basis of criteria oriented to the National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM). After completion, these VPs were also made available to all faculties for free use via “LOOOP share” and the CASUS learning platform. Discussion: Even after the pandemic, these developed VPs should be available to the faculties and thus make a lasting contribution to improve medical training in Germany – especially in light of digital teaching formats being expressly advocated on the basis of the adapted current Medical Licensure Act (ÄApprO). A possible application is interdisciplinary learning of clinical decision-making with the help of blended learning formats within the framework of a longitudinal curriculum. The large number of involved colleagues and faculties shows that the nationally coordinated development of VPs across faculties was commonly seen as useful. [ABSTRACT FROM AUTHOR]

Background: Patient-centredness (PCN) is an increasingly demanded objective in health care and has gained importance for the care situation, for research, and the education of healthcare professions. The literature shows that the term PCN is not uniformly defined. Key aspects for the concept of PCN can be found in the integrative model and its dimensions by Scholl and colleagues (2014), which are incorporated into the acquisition of competencies in Objective Structured Clinical Examination (OSCE) examination formats. The inclusion of subjective experiences of persons directly affected in health-related situations is recognized as an important factor for continuous improvement in health care. In the interprofessional education of healthcare professions, subjective experiences serve as a starting point in relation to OSCE exams. In this context, the project "DIPEx" "Database of Individual Patients' Experiences" stands for the systematic collection and evaluation of subjective experiences of illness using scientific methods. Aim: The aim of this interprofessional training workshop was to show how PCN can support the writing of case vignettes based on real experiences from systematically collected narratives within the DIPEx project, as well as the preparation of simulation subjects for OSCE examinations in the healthcare professions. Methods: Interactive, moderated workshop with two theory-based input presentations on the systematic development of interprofessional case vignettes based on four steps, group work with synthesis in the form of statements, and a concluding outlook. Results: With regard to the aims of the workshop, the synthesis included results at two levels: exemplary results on aims not explicitly addressed: Interprofessional teaching is full of presuppositions and requires clarification of four different perspectives in advance to be included in case development; exemplary results on explicitly addressed aims: Listening to and incorporating the real-life experiences and narratives of persons directly affected in health-related situations and their families was seen as an important learning aspect for PCN in relation to the practitioner-patient relationship. Five key statements on explicit aims for case development involving PCN emerged from the group work. Conclusion: Competency-based interprofessional education of health professionals and PCN can benefit from real patient narratives of health and illness as simulated patients can portray roles in OSCE formats in a realistic and convincing manner. [ABSTRACT FROM AUTHOR]

Since October 2018, a longitudinal communication curriculum for medical students has been implemented at Witten/Herdecke University. In the summer semester 2020, the concept for the 4th preclinical semester included a practical training on "sharing information", which consisted of three two-hour face-to-face sessions with simulated patients (SP). Due to the Covid 19 pandemic, teaching was changed to an inverted classroom concept combining asynchronous and synchronous teaching. The students worked at the beginning of the semester on an e-learning module of the learning platform docCom.deutsch on the topic "sharing information" using reflection and processing tasks. In two digital sessions, the students then were able to practice discharge interviews and discussions about risk communication illustrated by the example of screening methods for cancer prevention. In the first zoom session, students practiced in role-plays among themselves. In the second zoom session, they practiced with SP. The evaluation results revealed that 76% of the responding students considered working with the e-learning module as a good preparation for the interviews. According to the evaluation results, satisfaction with the Zoom meeting including SP contact was slightly higher than those with role-plays among themselves. Although the group atmosphere was rated by all responding students as conducive to learning, almost half of them confirmed that using Zoom significantly impaired the atmosphere (47%). In retrospect, the conversion of the communication training to a digital format worked better than expected from both the perspective of teachers and students. The students explicitly appreciated working with SP. From the teachers' perspective, some specific aspects of successful communication were difficult to reflect on, e.g. non-verbal communication. The use of e-learning as a preparation for practical exercises has proven successful and will be continued in the future. [ABSTRACT FROM AUTHOR]

Objective: The AIXTRA Competence Center for Training and Patient Safety at RWTH Aachen University has developed a concept to enable learning of communication skills with simulated persons (SP) digitally. Methodology: Existing SP cases in curricular teaching were checked for digital applicability and modified. Digital seminars with the methodology of simulated conversations with SP, for planned 690 students for the courses "history taking", 6th semester, conversations in psychiatry, 8th semester, and in the clinical competence course, 10th semester, were conducted via video conferencing software. The structure is similar to SP-seminars in classroom teaching with a case presentation, a doctor/patient dialogue and a feedback session. In the 6th and 10th semester, the seminars were evaluated anonymously by the students using an online questionnaire. SP were asked by e-mail for their assessment. The lecturers were asked about their experience with the digital seminars by means of qualitative interviews. Results: The survey of students with 92 completed questionnaires indicates a high level of acceptance. Digital teaching with SP was rated "very good" by 63% of the students and "good" by 37% as an overall mark for the course. The digital implementation is well practicable, the retention and accessibility of all learning goals is rated as given. Conclusion: Digital teaching with SP can be well realized with appropriate preparation. Specific aspects of digital implementation (e.g. role and data protection) must be taken into account. The differentiated evaluation of the surveys will bring further results and deductive questions. [ABSTRACT FROM AUTHOR]

Background: Today's medical students are growing up in a digital age in which the use of smartphones and smart devices is now irrevocably part of professional life. However, the abilities to use these devices that have become so ubiquitous in private life can only be partially transferred to work with patients and the medical setting. Since little is known about digitalization in medical education, the aim of this paper is to gain an overview of the current training in digital competencies at Swiss universities. Methods: The medical deans at all Swiss universities were contacted by telephone and informed about an online survey. The invitation to fill out the Survey Monkey questionnaire was subsequently sent by email to the specific contacts at each university. The survey consisted of questions to be answered using a defined scale and open-ended questions. The survey's focus, topics involving digital competencies, is based on the content in the Principal Relevant Objectives and Framework for Integrative Learning and Education in Switzerland (PROFILES) and the National Competency-based Catalogue of Learning Objective in Undergraduate Medicine (NKLM). Results: All of the dean's offices that were contacted participated in the survey. The topics on digitalization were all rated as relevant or very relevant. Our survey shows a heterogeneous picture in terms of implementing PROFILE and NKLM content. A few universities have well-established educational approaches or even implemented curricula, but often these are still in development. Participants also mentioned factors that are necessary for successfully setting up and implementing curricula dealing with digitalization and factors that can impede such efforts. Conclusion: The importance of acquiring digital competencies during medical study is known and recognized by all Swiss medical schools. Curricular integration varies in its progress and represents major challenges for the medical faculties. It is precisely the inclusion of students in such efforts that may be a potential response to this challenge. [ABSTRACT FROM AUTHOR]

Introduction: To date, hardly any reports exist that outline the reforms in medical studies in Switzerland from the first partial reforms in the 1970s until today.Methods: This article outlines the recent history of medical curricula, their reforms in the early 1970s and, based on these, the key reasons for the major curricular reforms of the 2000s from the perspective of the authors. Results: The various projects, initiatives and legislative elements at the national level include the introduction of new quality control instruments – federal examination and programme accreditation, the introduction of a national catalogue of learning objectives and its two follow-up editions, as well as the implementation of the Bologna reform in undergraduate medical curricula. Examples of the key new elements found in all medical training in Switzerland include: the interdisciplinary orientation of learning content in organ and functional system-oriented subject areas or modules, the enhanced valorisation of practical clinical training, as well as the introduction of problem-oriented formats and the integration of partly formative, partly summative exams according to the format of the objective structured practical examination (OSCE). Characteristics unique to the four medical faculties and their medical training programme are also highlighted.Discussion: The described projects, initiatives and legislative elements have led to a dynamic, continuous development of medical curricula in Switzerland. The close cooperation between the faculties and the Federal Office of Public Health (FOPH) has also resulted in a redefinition of the roles and responsibilities of universities and the Federal Government according to the new Law on Medical Professions. This guarantees the medical faculties a great deal of autonomy, without neglecting quality assurance.

Purpose: A qualitative inquiry was conducted to investigate the qualification requirements of medical doctors in different professional fields and from different perspectives. The inquiry was part of an empirical workplace analysis. Methods: Seventy-four structured interviews were conducted and analyzed to examine critical incidents and behaviors of medical doctors working in different professional fields (clinical theory, clinical practice, practitioner) and disciplines, and from three different perspectives (medical doctors, non-medical staff, and patients). In addition, the National Competency-based Catalogue of Learning Objectives for Medical Education (Nationaler Kompetenzbasierter Lernzielkatalog Medizin / NKLM) was used. Results: The results revealed eleven relevant competencies, which could be categorized into three superordinate competence clusters: interpersonal, work-related, and self-related. The perspectives of medical doctors and non-medical staff included all eleven competencies. However, the perspective of patients did not include one interpersonal and two self-related competencies. Nearly all of the critical behaviors mentioned are included in the NKLM. However, the NKLM also includes behaviors that were not mentioned in the interviews. Conclusions: The behavior-oriented interviews resulted in a requirement profile that is very similar in structure to other competency models in occupational contexts. Comparisons of the different perspectives predominantly revealed similarities. However, the patient perspective also revealed interesting differences compared to the perspectives of medical doctors and non-medical staff. The behavior-related results of the interviews can be directly used for the development of exercises in selection and personnel development contexts and for potential appraisals specific to different medical disciplines. In future steps, the results of this initial qualitative step are to be replicated and extended using quantitative studies and a representative sample. The main overall objective is the definition of relevant competencies both for the selection and development of medical students and for the design of potential appraisals as part of personnel development programs in different medical disciplines. [ABSTRACT FROM AUTHOR]

Objective: The aim of the Medical Academy Waldbreitbach is to connect individual and organisational requirements in order to promote an appropriate and multi-locational development of medical competency in the face of the continuously evolving challenges of clinical practice. Integral processes in this are the reduction of organisational learning barriers and thesuccessive integration of competency-oriented learning events in the structures of personnel and organisational development. The modularsystem for the further development of doctors' skills serves here as a supplementary and recommendation system for both existing curricula and those defined by regulatory organisations and professional associations. Methods: The Medical Academy's modularsystem has a two-dimensional structure. In addition to the axis of biography orientation, the model orients itself around issues relatingto the needs of a doctor in any individual professional position, as well as with whom he comes into contact and where his primary challenges lie. In order to achieve better integration in day-to-day routine and a needs-specific orientation of content, the modular system provides a combination of "one, two or three day and two- three- or four-hour training units" depending upon the topic. The transfer of experiential knowledge with the aid of practical exercises is a central element of the didactic model. Results: Through the combined use of summative and formative assessment, the significance of a dialogue-orientated approach in both planning and in the organisational process was highlighted. In feedback discussions and quantitative evaluation sheets, participants identified in particular cross-generational knowledge sharing as a central element for the development of personal values alongside the interdisciplinary transfer of knowledge. The combination of specialist and interdisciplinary topics, for example on team processes or communication, is frequently emphasised, indicatingthatthis had been taught insufficiently and impractically duringmedical school. Longitudinal evaluations of continuous course units support this, sothatthe reinforcement of informal learning processes through feedback and exchange of experience is established as an effective and integral learning pattern within the modularsystem. Conclusion: The of the modularsystem of the Medical Academy Waldbreitbach - as an institution of the Marienhaus Hospitals Ltd. - is to develop the knowledge, ability and motivation of doctors both individually and professionally. Here, an equally high demand is placed upon the advancement of individual dispositions, attitudes and values, as well as on specialised topics, in order to promote/develop solutions-based and overall medical activity. [ABSTRACT FROM AUTHOR]

Introduction: Interprofessional learning is a critical pre-requisite for future interprofessional work. Structural adaptations in education offer possibilities to introduce new concepts. Rheumatic and musculoskeletal diseases (RMD) are both prevented and treated by physicians and physiotherapists but the development of interprofessional roles is seldom part of curricula. Project description: A complex, longitudinal interprofessional educational approach for future doctors and physiotherapists was designed and implanted at various stages (anatomy, physical examination, pathology, therapy). Most segments of the RMD curriculum are now based on interprofessional classes. Student satisfaction with learning is continually and comparatively evaluated. Learning success is assessed with practical and written exams. Results: Interprofessional teaching was first introduced in 2013 for 420 first-year and 360 fourth-year medical students, along with 40 first- and third-year physiotherapy majors. The satisfaction with teaching and learning is high and distinctly above average for all teaching areas (satisfaction RMD rated as 2.4; average for all is 3.3). The percentage of those who pass the final exam is 94%. 100% of the students surveyed support the continuation of this interprofessional unit. Conclusion: Interprofessional teaching of RMD can be successfully implemented for future physicians and physiotherapists at different learning levels. [ABSTRACT FROM AUTHOR]

The author shares her thoughts on the present state of interprofessional education (IPE) from her perspective on evaluation and what has to be done to ensure sustainability of initiatives in the future. She suggests taking into account standards of national accreditation bodies for each health profession at pre-certification level and use these to help define outcomes. She cites the need for educators and clinical academics to build high quality evaluation and research in their courses.

Introduction: This project report describes the development, "piloting" and evaluation of an interprofessional seminar on team communication bringing together medical students and Interprofessional Health Care B.Sc. students at the Medical Faculty of Heidelberg University, Germany. Project Description: A five-member interprofessional team collaborated together on this project. Kolb's experiential learning concept formed the theoretical foundation for the seminar, which explored three interprofessional competency areas: team work, communication and values/ ethics. Evaluation for the purposes of quality assurance and future curricula development was conducted using two quantitative measures: 1. descriptive analysis of a standardized course evaluation tool (EvaSys) 2. ANOVA analysis of the German translation of the University of the West of England Interprofessional Questionnaire (UWE-IP-D). Results: The key finding from the standardized course evaluation was that the interprofessional seminars were rated more positively [M=2.11 (1 most positive and 5 most negative), SD=1, n=27] than the monoprofessional seminars [M=2.55, SD=0.98, n=90]. The key finding from the UWE-IP-D survey, comparing pre and post scores of the interprofessional (IP) (n=40) and monoprofessional (MP) groups (n=34), was that significant positive changes in mean scores for both groups towards communication, teamwork and interprofessional learning occurred. Conclusions: Lessons learnt included: a) recognising the benefit of being pragmatic when introducing interprofessional education initiatives, which enabled various logistical and attitudinal barriers to be overcome; b) quantitative evaluation of learning outcomes alone could not explain positive responses or potential influences of interprofessional aspects, which highlighted the need for a mixed methods approach, including qualitative methods, to enrich judgment formation on interprofessional educational outcomes. [ABSTRACT FROM AUTHOR]

Aim: Interprofessional teaching and learning is gaining significance in the health professions. At the same time, the development and implementation of such educational courses is demanding. Focusing on factors critical to success, the aim of this paper is to evaluate the experience gathered by eight grant projects in which interprofessional courses were designed. Emphasis is placed on the level of cooperation between the participating educational institutions, course content, the operative implementation of the course units and their permanent integration into curricula. Method: Data was collected in semi-structured, guideline-based interviews with project leaders and team members (n=43). University and vocational students who had attended the evaluated courses were also included in the survey (n=7) as a means to triangulate data. Analysis was carried out based on qualitative content analysis. Results: A participatory, dialogue-centered model of cooperation appears to be most suited for developing and implementing courses. Belonging to the factors critical to success are the time when courses are offered, the conditions for attendance, the different teaching and learning cultures of the professions involved, preparation and deployment of instructors, and the role played by project coordination. Permanently integrating interprofessional units into medical curricula revealed itself to be difficult. Conclusion: While the development and realization of interprofessional courses can be achieved easily enough in projects, curricular integration of the new course units is challenging. In respect to the latter, not only a large amount of staffing resources and time are required, but also the creation of the necessary system-level structures, not just within the educational institutions (organizational development) but also in the frameworks governing the professions. [ABSTRACT FROM AUTHOR]