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Purpose: In recent years artificial intelligence (AI), as a new segment of computer science, has also become increasingly more important in medicine. The aim of this project was to investigate whether the current version of ChatGPT (ChatGPT 4.0) is able to answer open questions that could be asked in the context of a German board examination in ophthalmology., Methods: After excluding image-based questions, 10 questions from 15 different chapters/topics were selected from the textbook 1000 questions in ophthalmology (1000 Fragen Augenheilkunde 2nd edition, 2014). ChatGPT was instructed by means of a so-called prompt to assume the role of a board certified ophthalmologist and to concentrate on the essentials when answering. A human expert with considerable expertise in the respective topic, evaluated the answers regarding their correctness, relevance and internal coherence. Additionally, the overall performance was rated by school grades and assessed whether the answers would have been sufficient to pass the ophthalmology board examination., Results: The ChatGPT would have passed the board examination in 12 out of 15 topics. The overall performance, however, was limited with only 53.3% completely correct answers. While the correctness of the results in the different topics was highly variable (uveitis and lens/cataract 100%; optics and refraction 20%), the answers always had a high thematic fit (70%) and internal coherence (71%)., Conclusion: The fact that ChatGPT 4.0 would have passed the specialist examination in 12 out of 15 topics is remarkable considering the fact that this AI was not specifically trained for medical questions; however, there is a considerable performance variability between the topics, with some serious shortcomings that currently rule out its safe use in clinical practice., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

After 6 years of development, the amended regulations for medical education were adopted by the German Medical Assembly in May 2018. The aim of the amendment is to move away from a predominantly chronologically standardized further training towards a content standardized further training with simultaneous definition of competence objectives. The level of competence required for admission to the examination should be continuously recorded and documented in an electronic logbook. Failure to achieve the training objective will result in the admission to the examination being refused. These high requirements seem to be attainable only if cognitive and action competences can be acquired before and during training in the real environment of the operating theatre in a standardized setting.

Background: The national competence-based catalogue of learning-goals in surgery (NKLC) defines competence levels for each of its 230 goals, including "competence level in 1: factual knowledge" up to "competence level 3: independent action". Aside from the cumulative examinations influencing the learning behaviour of students, those teaching targets do not affect the second state examination. This study analyses the extent to which the questions of the German second medical licensing examination compiled by the IMPP (central German institute for medical and pharmaceutical examinations) are congruent with the trauma-surgical and orthopaedic learning goals in the NKLC, in which this thematic focus is emphasised., Material and Methods: Exam questions from autumn 2009 to autumn 2014 (n = 11) were retrospectively analysed. Orthopaedic and trauma-surgical teaching targets defined in NKLC were identified by five senior orthopaedic physicians and trauma surgery experts. All questions addressing one of these learning goals were identified and analysed (re: the number of learning goals, the number of questions addressing a trauma-surgical, or orthopaedic goal, as well as different competency levels)., Results: We found 113 learning goals of NKLC (49.1% of the overall NKLC learning goals) identified as orthopaedic or trauma surgery subjects. During the study period, 543 questions included teaching targets referring to orthopaedic or trauma surgery subjects (15.6% of the total of 3480 questions). Per exam, a mean of 49.36 ± 14.1 questions (minimum 30; maximum 80) was identified that addressed a learning goal referring to these issues. For each exam, 13.45 ± 6.39 (minimum 6; maximum 24) questions referred to learning goals of competence level 3a and b, 21.45 ± 9.94 (minimum 9; maximum 39) questions referred to learning goals of competence level 2, and 14.45 ± 6.36 (minimum 6; maximum 25) questions referred to learning goals of competence level 1. Most questions addressed the topic: "disorders of the rheumatic spectrum" (n = 16 questions in autumn 2009)., Conclusion: Questions focusing on orthopaedic and trauma surgery appeared sufficiently often during the second state examination. There is a thematic imbalance, and important clinical learning goals tagged with high competence levels were not addressed in a satisfactory manner. This indicates that a clear adjustment between the state examination and NKLC is necessary., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt vorliegt., (Georg Thieme Verlag KG Stuttgart · New York.)

The "Joint Commission of BDA and DGAI for Graduate Medical Education and Further Education" presents a concept for postgraduate training in anesthesiology. Aiming at a different and demanding generation of young physicians it proposes a new approach to an attractive training in anesthesiology e. g. by simulation as one key concept. It is also intended to meet the guidelines of the German Medical Association of competency based rather than time based or procedure based graduate medical education. A clear structure and the competency based approach shall facilitate a process of professional teaching. The article describes the new concept of graduate medical education by the German Medical Association and the respective aims and objectives of the Scientific Medical Societies in Germany. An existing implementation in a hospital is given as an example of feasibility., (© Georg Thieme Verlag Stuttgart · New York.)

Time spent for research activities can count as time spent in GMA (graduate medical education) as long as requirements according to EU directive 2005/36 concerning minimum time in GMA are fulfilled and the necessary knowledge, experience and competencies have been acquired. First results from a project in Westfalia-Lippe are positive., (© Georg Thieme Verlag Stuttgart · New York.)

Introduction: The number of foreign doctors in Germany has increased steadily in recent years. To obtain the German medical license, sufficient language competence is mandatory. Nevertheless, in practice, foreign doctors have considerable difficulties in their communication with patients, medical colleagues and other health professionals. This can lead to misunderstandings and thus impair patient safety. To overcome this problem, the "patient communication test" was developed and piloted as an additional requirement to be granted license to practice medicine in Germany. The aim of this study is to present our results in the development and piloting of this test., Methods: 3 OSCE stations (Objective Structured Clinical Examination) were designed, which evaluate communication skills in 3 medical competences: history taking, case presentation and explaining to patients before obtaining informed consent. After extensive instruction of actors as patients and raters on the basis of the evaluation criteria, the communication test was subjected to pilot studies in 6 different cities (Freiburg, Jena, Mainz, Mannheim, Tübingen, and Ulm)., Results: In 2013, 639 foreign doctors participated in the test; 461 (72.14%) of these doctors passed the test on their first try, 51 (7.98%) on their second attempt and 6 (0.93%) on their third try., Conclusion: The patient communication test evaluates the communication skills of foreign doctors in OSCE-setting using standardized actor-patients. This improves the communication skills and enhances patient safety in the German health care system by smooth inter-professional and patient-centered communication., (© Georg Thieme Verlag KG Stuttgart · New York.)

Organisational development is crucial to health promotion in schools. The intervention "Learning to Live Healthy" is a new school health promotion strategy designed to develop schools into healthy environments for all those who work and study there. The aim of the study "School Development by using Health Management" is to introduce the management instrument balanced scorecard and to develop an indicator toolbox. This allows schools to evaluate the achievement of objectives, the implementation level of the measures and the changes in their organisation regarding health management., (© Georg Thieme Verlag KG Stuttgart · New York.)

The provision of high-quality health-services is only possible if it is based on vocational education of corresponding quality. To promote the quality of vocational education in speech therapy, a quality assurance programme was developed in a scientifically supervised multi-step process. The main goals of the quality assurance programme include: (i) external review of the quality of education by means of well-defined criteria, (ii) certification of schools that meet the requirements, and (iii) provision of feedback to schools about their results. A total of 208 quality indicators cover the essential aspects of vocational education in speech therapy, and apply to the structural, process and outcome quality. These indicators are based on a literature survey as well as on expert opinion, and are calibrated by data. The data are collected by using questionnaires (school management, teachers in speech therapy, students, consecutive patient sample) and are validated by specific document analyses and telephone audits. Each school receives an individual quality report of its achieved results benchmarked to other schools. Since the initial implementation in 2008, a total of 50 schools participated in the quality assurance programme and 41 achieved certification. Therefore, the defined set of quality criteria has been disseminated and utilized by about half of all German schools for vocational education in speech therapy. The evaluation of the data on quality collected across all schools highlights the strengths and weaknesses of vocational education as well as the demands for quality improvement., (© Georg Thieme Verlag KG Stuttgart · New York.)

The European training curriculum for radiology of the European Society of Radiology (ESR) aims to harmonize training in radiology in Europe. Levels I and II constitute the centerpiece of the curriculum. The ESR recommends a 5-year training period in radiology with 3 years of level I and 2 years of level II training. The undergraduate (U) level curriculum is conceived as a basis for teaching radiology in medical schools and consists of a modality-oriented U1 level and an organ-based U2 level. Level III curricula provide contents for subspecialty and fellowship training after board certification in radiology. The curricular contents of all parts of the European Training Curriculum are divided into the sections knowledge, skills as well as competences and attitudes. The European training curriculum is meant to be a recommendation and a basis for the development of national curricula, but is not meant to replace existing national regulations.

Introduction: Recent years have seen an increasing number of foreign doctors starting to practice medicine in German hospitals (or more rarely, in surgeries). In order to be granted the German license to practice medicine, doctors with a medical degree from outside the European Union have to undergo an equivalency examination. The supervisory authority for this is the examination office of the relevant federal state, which is why different procedures are being applied in the individual states. The aim of this paper is to point out the problems that frequently arise when conducting this specialist exam and to make suggestions as to how to improve the quality of the procedure., Method: 6 senior professors from the examination boards of the 4 medical schools in Baden-Wuerttemberg formed a focus group and discussed the difficulties associated with the exam, recorded problems in its actual implementation and then analysed the minutes of the meeting in a results-based manner in order to compile proposals for optimisation., Results: In view of the deficits in subject knowledge, general communication skills and specific communication skills, the difficulties of the current recognition procedure and the existing equivalency exam fall into 3 categories: structure and content of the exam, examiners and exam candidates., Conclusions: In consultation with the State Examination Office Stuttgart, some processes for optimisation have been devised, e. g., to develop a special curriculum which could be used for guidance and to recruit more examiners. The recommendations of the focus group from Baden-Wuerttemberg are an important step towards more transparency and possibly towards a Germany-wide standardisation of this exam., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: University teaching in ophthalmology has tended to focus on imparting knowledge rather than practical skills. The new skills laboratory at the University Medical Center in Göttingen enables practical skills to be taught. The focus is on basic skills that could help all physicians. The learning goals set are techniques considered basic in ophthalmology that can be mastered without requiring any physician to operate major equipment., Methods: The design and results from four semesters of an ophthalmological objective structured clinical examination (OSCE) following students engaged in peer-teaching, as well as feedback from a student questionnaire are described., Results: Practical skills can successfully be taught and mastered within 1 week and 68-100 % of all students achieved the maximum scores in the individual tests. The OSCE and peer- eaching were well received by the students., Conclusions: Practical skills and peer teaching fulfill student educational goals in ophthalmology and are well accepted by undergraduates.

Background: According to the approval system for medical doctors, practical courses such as block practical training must be graded. The grading of the surgical block practical training at the Klinikum rechts der Isar, Technische Universität of Munich (TUM), was changed from single grades of each day to a final objective structured clinical examination (OSCE). We report about the experiences in the past 12 months with this relatively new form of examination., Methods: An OSCE was established as a practical exam with seven stations about suture techniques, internal fixation, first-aid education, hygiene and sterility, clinical examination and perioperative management. The feasibility of a comprehensive OSCE with the necessary modifications was studied and the grades had been compared., Results: In the past 12 months four surgical block placements for over three weeks had been organised with a total of 326 students. 309 students were admitted for the OSCE at the end of block practical training. The average score was 1.75. The medical student raters graded either equally or more stringently compared to the medical doctors. The transcript revealed in all OSCEs a normal distribution of grading with high validity. However, an adaptation of the evaluation forms and an extension of the stations with modified content was required to obtain the same test conditions for all students. The implementation of the OSCE on this scale is possible with adequate preparation time and sufficient financial support. The evaluation of the specimens after completion of the test were all positive., Conclusion: The new medical approval system calls for restructuring, not only in teaching but also in the form of examination of the courses. Through this practical test, those skills of a student will be assessed that cannot be tested by the IMPP exam. Moreover, this examination form provides an excellent preparation for the practical part of the oral state examination. This OSCE is even feasible with high numbers of students and offers with appropriate adaptation of the evaluation forms and test stations, a normal distribution of grading., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Many clinicians, particularly those from university hospitals and associated teaching hospitals, use multiple-choice questions in different professional roles: as examiners for student assessment and as life-long learners in respect to the CME programmes of medical journals. For this group of physicians it might thus be desirable that medical journals serve as implicit role models for formulating high-quality multiple-choice questions., Method: 370 multiple-choice questions taken from the 2011 volumes of three different medical journals were reviewed. A checklist consisting of 11 formal quality criteria, 5 quality categories and one global criterion, taken from the literature and from the German Item Management System, was used., Results: High-quality questions were found in the categories "language", "structure", and "signposting the question type." However, "application to cases or problems" and "analysis, interpretation, problem solving" were realised in less than 20 %, and "cues" were detected in almost half of the questions. A subgroup analysis showed different quality levels between the journals., Conclusions: To serve as role models for high-quality multiple-choice questions (MCQ) German medical journals should deliver formal quality criteria and good writing examples to their MCQ authors and ensure strict adherence to these criteria. The development of journal-independent formal standards might prove worthwhile., (Copyright © 2013. Published by Elsevier GmbH.)

Background: Multiple choice questions play an important role in training and continuing education. Der Nervenarzt has been publishing articles for continuing medical education (CME) since 2002 which usually have ten multiple choice questions. Studies from other fields have shown that CME questions are often formulated awkwardly from a didactic standpoint. In this study we analyzed the CME questions contained in Der Nervenarzt to assess their instructional quality., Materials and Methods: The standardized evaluation was performed by semiskilled nonprofessionals. The setup permitted differentiation of 15 known quality criteria for multiple choice questions from the educational medical literature., Results: Of the 796 questions studied that had been posed in 2002-2008 (370 neurology, 346 psychiatry, and 80 interdisciplinary), 518 questions had an awkward construction for didactic purposes. A negative wording of the stem, followed by unintentional cues and obsolete combination formats were most frequently observed. The proportion of precisely phrased questions has increased significantly since 2006., Conclusion: The CME questions in the German medical journal Der Nervenarzt have improved regarding their instructional quality since the beginning of the program.

Quality management of assessment in medical education plays a key role in Germany--owing to, among other factors, the new medical licensing regulations ("Approbationsordnung"). OSCE (Objective Structured Clinical Examination) is a widespread tool to assess clinical competencies. However, the quality of OSCE in terms of reliability as a criterion of a good test is highly debated in the current literature. To improve the reliability of the OSCE three accompanying measures have been implemented at the Faculty of Medicine of the University of Heidelberg since the summer of 2006: 1. the application of a checklist for pre- and post-reviews of OSCEs, 2. a specific training of OSCE examiners, 3. an advanced psychometric OSCE test report giving feedback to the item developer. The reliability of the Internal Medicine OSCE at the University of Heidelberg has increased since. Currently Cronbach's alpha of the final OSCE in the summer of 2007 was 0.829.

Introduction: Changes in physician-training requirements have led to a significant increase in continuing medical education (CME) courses. Structured CME courses based on print media in combination with outcome evaluation offers one opportunity for earning credit points. On the international stage, CME courses are increasingly directed towards measurable patient benefit. Comparative assessment of quality and practical orientation in training courses is required., Method: Two hundred items in twenty training units from four established German medical journals were analysed for comparison-based evaluation. The criteria applied were training goals, as well as item construction, authors' requirements and question quality. The items were analyzed independently by two persons trained and experienced in preparing and reviewing items. The analyses from the two assessors were then compared, and any deviations were subjected to mutual consultation., Results: Question formulation showed weaknesses in all the training units. In 52% of the items a clear question was lacking, and all of the training units contained items with concealed hints indicating the correct answer. Only 10% of the questions were preceded by a cameo case study presenting a clinical scenario, and only 14.5% of the items asked for a correct clinical decision., Conclusion: The CME questions from the medical journals selected show weaknesses in formulation, and mostly tested factual knowledge. Differences were revealed between publishing houses yielding insights into the requirements made of the authors by the publishers. The question preparation process is still deficient. Adherence to international standards in item construction may lead to an improvement in quality, which would also enhance the implicit transferability of content learned to actual clinical situations, thus improving the practical usefulness of training courses.

A novel Federal Regulation for Basic Medical Education was issued in Germany, which requires an end of course assessment. General Practice (GP) in Duesseldorf has introduced a written examination. An accompanying study was carried out to understand whether different methods of performance evaluation would show equivalent results intraindividually. Out of the GP class 21 students were randomised to undergo an oral examination on top of the regular written examination. Furthermore their teaching practitioners have appraised these students performance in small group teaching. Finally, the students have been rated following a practical term. At the end the students have been interviewed in a focus group to investigate their preferred method of assessment. The survey of the average grades showed comparable results for the written test, the oral examination and small group teaching while the appraisal at the end of the practical term happened to be significantly higher in grade. The comparison of the individual results, however, showed a statistical spreading in all directions. For example, a poor performance in the written test can come along with excellent results in the oral examination and vice versa. The intra-class correlation across all classes has been as low as 0.1. These results support the conclusion that apparently each method can appropriately evaluate only a very specific part of the complex contents of the GP education and of students' performance. In order to properly examine the performance of GP students a combination of different evaluation methods needs to be applied. As an alternative, different skills can be examined in different practical and theoretical test situations in an OSCE.