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Objective: A competency-based training of medical students that is adapted to the realities of care is required internationally and is being intended in Germany with the Master Plan for Medical Studies 2020. In order to test these competencies, the German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy (IMPP) has developed a concept for the redesign of the final part of the medical licensing examination in Germany. It focuses on general and interprofessional healthcare in the examination with outpatients. The aim of this work is to assess the feasibility of the new final examination on the basis of pilot examinations in family practices and to derive further steps for the national implementation.Methods: Fourteen medical students in their internship year completed a full examination with patients aged 42 to 84 years. Examiners evaluated the examination performance using standardised evaluation forms. Feasibility was qualitatively assessed in terms of compliance with content and time limits, examination results, patient reflections, and implementation in the practice. Results: Students were able to complete all tasks within the given time frame. Based on the evaluation forms, the examiners assessed the performance of the students. Patients appreciated the structured course of the examination in the familiar location of their family practice. For the nationwide implementation of the examination, 2,500 examination practices are required for about 10,000 examinees per year. Four students can then be examined on two days per year in each practice.Conclusions: Oral-practical examinations with outpatients in general medical practices can be carried out successfully throughout the nation. An implementation of the examinations throughout Germany requires that medical studies are restructured and that this new curriculum is implemented as intended by the Master Plan for Medical Studies 2020. Furthermore, training and remuneration of examiners together with a legal framework for the new examination must be established.

Aim: The Masterplan Medizinstudium 2020 (Masterplan for Medical Studies 2020) focuses on practice-oriented undergraduate training with increased involvement of rural teaching practices. The demand for teaching practices for the final year will increase at all medical faculties in Germany. The project medPJplus at the University Medical Center Göttingen (UMG) presents an approach for successfully acquiring general medical teaching practices in local rural areas.Project outline: The project medPJplus implemented eight measures in cooperation with medical students, interested general practitioners, and regional players in the surrounding districts to attract new teaching practices: we established public relations, accredited practices, organized the didactic training of participating general practitioners, created a digital platform for students that is linked to the nationwide PJ-Portal, and organized information events, workshops, and feedback reports to regional actors.Results: Within one year, a total of 40 new teaching practices with 57 new teachers in the local rural area joined the project in southern Lower Saxony. A three-stage didactic training concept for general practitioners was established at the UMG. A digital platform enhances the visibility of general practitioners and their activities for students. The teaching practices can now be found on the nationwide PJ-Portal. Fourteen students have currently completed their period of the final year in family medicine there.Conclusions: It is possible to acquire rural general medical teaching practices for the final year. This depends on four core elements: addressing and didactic training of interested general practitioners, networking of medical students with teaching physicians and regional actors, digitally presenting teaching practices, and developing solutions for mobility and living space during the final year.

Background: Treatment data from general practitioners (GP) in private practice have great potential for research into diagnostics, therapy and quality of care. The quality of these data influences not only the primary research results, but also the results of later secondary data analyses, but then for other research questions. Completeness and availability of data at the time of data collection are important quality characteristics that depend on medical documentation and technical data export. Using GP treatment data as an example, we examine these quality characteristics and propose a procedure for continuous quality assurance.Methods: A fictitious patient was defined with 22 treatment characteristics of routine general practitioners treatment (e.g. age, gender, medication, diagnoses, risk factors, inability to work, therapies, hospitalization, etc.). Without prior training, the data of the fictitious patient were electronically documented and exported by general practitioners. Comparisons between fictitious patient data, data documented electronically by general practitioners and exported data enabled the assessment of data completeness and availability.Results: Approximately 80% of the tasks could be completed without medical training. Exemplary studies with six practice software systems show that without software adaptation and medical training, only approx. 37% of the treatment data entered is available for secondary research in data export. An increase to 83.4% availability would be possible through software adaptations. If, in addition, medical training were carried out, a data availability of approx. 95% could be achieved.Discussion: Missing or incorrectly mapped data must be reckoned with in the data export prior to secondary research. The completeness and availability of the data must be tested individually for each practice software during the primary data collection and documented in the metadata of the research data. Fictitious patient data with defined characteristics can also be used for continuous quality assurance in quarterly software updates.Conclusions: Independent, continuous quality assurance of the data interfaces, medical training and investigations into the completeness of routine and treatment data can considerably improve the quality of subsequent secondary data research.

Abstract: Axonal degeneration is now recognized as an important pathological feature of multiple sclerosis (MS). Acute axonal damage happens early in the disease course, and therefore early changes might occur in markers in body fluids, such as cerebrospinal fluid (CSF) and blood. In our study we investigated the relevance of serum and CSF markers for axonal damage in patients with clinically isolated syndrome indicative for MS. We measured the concentration of tau, phospho-tau, S100B, Amyloid beta and neuron specific enolase (NSE) in CSF and serum. Interestingly, the NSE concentration in CSF and serum was decreased in clinically isolated syndrome (CIS)-patients in comparison to the control group indicating reduced neuronal metabolic activity in the early stage of the disease. Concerning other biomarkers, we did not observe any changes in the concentrations between groups. Moreover, we did not detect any correlation between Expanded Disability Status Scale (EDSS) and the concentration of investigated proteins. [Copyright &y& Elsevier]

Purpose: To assess the use of visual evoked potentials (VEPs) for the in vivo detection of impaired visual function in a marmoset model of multiple sclerosis. The sensitivity of the VEP recordings was determined by comparison with magnetic resonance imaging (MRI) and histopathology., Methods: Baseline VEPs were recorded in six healthy marmoset monkeys in response to light-flash stimulation. Experimental autoimmune encephalomyelitis (EAE) was induced in four of the six monkeys. Clinical scores were assessed daily, and VEPs were recorded every second week. In vivo MRI and subsequent histopathology of the brains and optic nerves were performed at the end of the study., Results: After induction of EAE, all four marmosets exhibited clinical signs between day 26 and 38 after immunization. VEPs were normal during the induction phase of the disease, but deteriorated in amplitude with the occurrence of clinical symptoms in all animals. MRI revealed bilateral optic neuritis and signal alterations in the optic tracts and occipital subcortical white matter in two of the animals. In the remaining two animals, MRI detected signal alterations in the occipital subcortical white matter. Histopathologic results were concordant with the MRI findings., Conclusions: VEPs are an easily accessible noninvasive tool for measuring visual function and diagnosing impairment of the visual pathway in a marmoset EAE model.