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Zusammenfassung Hintergrund Im Medizinstudium in Deutschland ist seit 2016 ein gesonderter Leistungsnachweis auf dem Gebiet der Schmerzmedizin zu erwerben. Bislang fehlen Untersuchungen über die Effekte dieser Einführung auf Kompetenzen von Studierenden im Themengebiet Schmerzmedizin. Ziel der Arbeit Ziel war es herauszufinden, inwieweit die Einführung des Fachgebiets Schmerzmedizin als Querschnittsbereich 14 den Kompetenzerwerb der Studierenden im Bereich Schmerzmedizin gemessen über eine Selbsteinschätzung positiv beeinflusst. Material und Methoden Die Entwicklung des longitudinalen Curriculums wurde mithilfe des Kern-Zyklus durchgeführt. Parallel erfolgte die Erstellung eines Fragebogens zur Selbsteinschätzung der Studierenden auf einer 5‑stufigen Likert-Skala bzgl. des eigenen Wissensstands und der Bedeutung schmerzmedizinischer Lehrinhalte. Die Befragungen wurden vor Einführung der Veranstaltungsreihe (2014), nach Abschluss der ersten Kohorte (2016) und 5 Jahre nach Einführung (2019) durchgeführt und mittels Kruskal-Wallis-Tests verglichen. Ergebnisse Die Einführung des Curriculums hat zu einer signifikanten Verbesserung in relevanten Punkten geführt. So fühlen sich die Studierenden insgesamt besser auf die Behandlung von Schmerzpatienten vorbereitet (2,67 im Jahr 2014 vs. 3,18 im Jahr 2019). Teilaspekte wie die Erhebung einer Schmerzanamnese (3,63 vs. 4,10) oder die Erstellung eines Analgesieschemas (3,56 vs. 4,14) werden nun subjektiv deutlich besser beherrscht. Diskussion Trotz erfreulicher Ergebnisse besteht in Teilbereichen noch Verbesserungspotenzial. Beispielsweise ist die Bewertung der Studierenden zur Frage nach der Vorbereitung auf die Behandlung von Schmerzpatienten noch nicht zufriedenstellend. Hier gilt es, das Curriculum mit Fokus auf die Kompetenzorientierung weiterzuentwickeln. Dabei können digitale Lehrformate ebenso integriert werden wie interprofessionelle Einheiten und Simulationspatienten. Zudem sind jedoch gleichzeitig auch die Prüfungsformate hin zu standardisierten praktischen Prüfungen weiterzuentwickeln.

As a part of a major reform of the medical curriculum in Germany, the national catalogue of learning objectives is being revised with the focus shifting from theory-based learning to teaching practical skills. Therefore, we conducted an online survey to answer the question, which practical skills are essential in anesthesia. Participants were asked to rate the relevance of several skills, that medical students should be able to perform at the time of graduation. A total of 2898 questionnaires could be evaluated. The highest ratings were made for “bringing a patient into lateral recumbent position” and “diagnosing a cardiac arrest”. All learning objectives regarding regional anesthesia were rated as irrelevant. Furthermore, learning objectives like “performing a bronchoscopy” or “performing a rapid sequence induction” had low ratings. In the subgroup analysis, physicians with advanced training and those who were working at university hospitals rated most skills with higher relevance compared to others. Our survey provides a good prioritization of practical skills for the development of new curricula and assessment frameworks. The results can also help to establish our discipline as a cross-sectional subject in competency-based medical education, thus further increasing the attractiveness for medical students.

BACKGROUND: The SARS-CoV­2 pandemic has been a major challenge for graduate education. Teaching had to be digitalized within a very short time. This also affected the areas of anesthesiology, intensive care, emergency, pain and palliative care at the Department of Anesthesiology and Intensive Care Medicine at the University of Leipzig. OBJECTIVE: The aim of this questionnaire-based survey was to find out which courses can be digitalized from the students' point of view and which forms of teaching are associated with obstacles. In addition, we examined which technical infrastructure supports digitalization best. MATERIAL AND METHODS: In the course of digitalization the lecture series in the areas of palliative care and pain medicine had to be revised but also digital alternatives for seminars, simulation courses and bedside teaching had to be created. Video podcasts, digital learning material, educational films and video conferences were used for the digital implementation of the courses. Depending on the course, different digital methods were combined. In addition, a discussion forum for the exchange between faculty and students was established. An online evaluation was then carried out to assess the content. RESULTS: A total of 82 4th and 5th year medical students took part in the survey. More than 60% of students rated the learning effect of digital courses as "high" or "very high". Video podcasts of the lectures (45.1%) and digital bedside teaching (34.1%) were rated as the most effective ways of imparting knowledge. In particular, 92.7% of the surveyed students believed that the lectures could be replaced digitally on a permanent basis. For bedside teaching (3.7%) and emergency simulation course (1.2%) this is far less the case. In the majority of cases (56.1%), students needed 30-90 min daily for the preparation and post-processing of the contents. Just under 90% gave the digital courses offered by the hospital an overall grade of 1 or 2 (on a scale from 1 = best to 6 = worst). CONCLUSION: The SARS-CoV­2 pandemic posed major challenges for graduate teaching. At the same time, however, it also helped to overcome often long-standing hurdles to the digitalization of teaching. In the course of the digital semester, different teaching formats could be digitalized to varying degrees: Lectures can be digitally reproduced particularly well from the students' perspective, whereas the digitalization of bedside teaching has not been possible in most cases.

Zusammenfassung Hintergrund Das praktische Jahr (PJ) ist an vielen Universitäten der am wenigsten strukturierte und standardisierte Studienabschnitt. Studierende beklagen mangelnde Anleitung, Supervision und Feedback. Häufig übernehmen sie delegationsfähige, nichtmedizinische Aufgaben, obwohl das PJ ein Hauptentscheidungsfaktor für die spätere Facharztwahl ist. Methoden Nach einer Bedarfsanalyse erfolgte die Entwicklung eines Mentoring-basierten Curriculums für Studierende im PJ mithilfe des Kern-Zyklus. Hierzu wurden 10 fachspezifische klinisch-praktische Basiskompetenzen etabliert, die jeder Studierende bis zum Tertialende beherrschen sollte. Eine Überprüfung erfolgte formativ anhand von arbeitsplatzbasierten Prüfungen. Das Tertial wurde durch alle Studierenden abschließend online evaluiert. Ergebnisse Die Priorisierung und Prüfung von klinisch-praktischen Kompetenzen durch Mentoren/Mentorinnen ermöglichten eine bedarfsorientierte und qualitative hochwertige Ausbildung. Das Mentoring und Feedback wurden durchweg positiv beurteilt und unterstützten den Lernerfolg (Note 1,5). Das Prüfungsformat wurde mehrheitlich als unbekannt (64,6 %), aber hilfreich und sinnvoll erlebt (76,7 %). Studierende fühlten sich durch das Curriculum gut auf die Staatsexamensprüfung (81,3 %) und den Berufsbeginn vorbereitet (71,0 %). Dies ging mit einer hohen Zufriedenheit (Note 1,7) einher. Schlussfolgerungen Ein bedarfsgerechtes, Mentoring-basiertes Curriculum mit integrierten arbeitsplatzbasierten Prüfungen geht nicht nur mit einer hohen Ausbildungszufriedenheit einher, sondern fördert effektiv und ressourcenschonend die Ausbildungsqualität.

The field of pain medicine was established as an obligatory subject area of medical schools in Germany in 2016. No prior study has evaluated the effects of this curricular change on students' competences in the field of pain medicine.The aim of this study was to find out to what extent the introduction of the additional subject "pain medicine" positively influenced the students' acquisition of competences measured via a self-assessment.A longitudinal and interdisciplinary curriculum for pain medicine was developed according to the current recommendations for curriculum development for medical education. In parallel, a questionnaire was created for the students' self-assessment of their own level of knowledge and the importance of pain medicine teaching content on a 5-stage Likert scale. The surveys were conducted before the implementation of the curriculum (2014), directly after the first cohort finished (2016) and 5 years after the implementation (2019) and compared by Kruskal-Wallis test.The implementation of the curriculum has led to significant improvement in relevant aspects. For example, students now feel better prepared overall for the treatment of pain patients (2.67 in 2014 vs. 3.18 in 2019). Individual sub-aspects such as taking a pain history (3.63 vs. 4.10) or drawing up an analgesia scheme (3.56 vs. 4.14) are now also subjectively better mastered.Even though the results are encouraging, there is further potential for improvement in some sub-areas. For example, the students' rating regarding the question about their preparation for treating patients in pain is not yet satisfactory. Therefore, the curriculum should be developed further with a focus on competence orientation. Digital teaching formats can be integrated as well as interprofessional units and simulated patients. Additionally, the examination formats should be further developed towards standardized practical examinations.HINTERGRUND: Im Medizinstudium in Deutschland ist seit 2016 ein gesonderter Leistungsnachweis auf dem Gebiet der Schmerzmedizin zu erwerben. Bislang fehlen Untersuchungen über die Effekte dieser Einführung auf Kompetenzen von Studierenden im Themengebiet Schmerzmedizin.Ziel war es herauszufinden, inwieweit die Einführung des Fachgebiets Schmerzmedizin als Querschnittsbereich 14 den Kompetenzerwerb der Studierenden im Bereich Schmerzmedizin gemessen über eine Selbsteinschätzung positiv beeinflusst.Die Entwicklung des longitudinalen Curriculums wurde mithilfe des Kern-Zyklus durchgeführt. Parallel erfolgte die Erstellung eines Fragebogens zur Selbsteinschätzung der Studierenden auf einer 5‑stufigen Likert-Skala bzgl. des eigenen Wissensstands und der Bedeutung schmerzmedizinischer Lehrinhalte. Die Befragungen wurden vor Einführung der Veranstaltungsreihe (2014), nach Abschluss der ersten Kohorte (2016) und 5 Jahre nach Einführung (2019) durchgeführt und mittels Kruskal-Wallis-Tests verglichen.Die Einführung des Curriculums hat zu einer signifikanten Verbesserung in relevanten Punkten geführt. So fühlen sich die Studierenden insgesamt besser auf die Behandlung von Schmerzpatienten vorbereitet (2,67 im Jahr 2014 vs. 3,18 im Jahr 2019). Teilaspekte wie die Erhebung einer Schmerzanamnese (3,63 vs. 4,10) oder die Erstellung eines Analgesieschemas (3,56 vs. 4,14) werden nun subjektiv deutlich besser beherrscht.Trotz erfreulicher Ergebnisse besteht in Teilbereichen noch Verbesserungspotenzial. Beispielsweise ist die Bewertung der Studierenden zur Frage nach der Vorbereitung auf die Behandlung von Schmerzpatienten noch nicht zufriedenstellend. Hier gilt es, das Curriculum mit Fokus auf die Kompetenzorientierung weiterzuentwickeln. Dabei können digitale Lehrformate ebenso integriert werden wie interprofessionelle Einheiten und Simulationspatienten. Zudem sind jedoch gleichzeitig auch die Prüfungsformate hin zu standardisierten praktischen Prüfungen weiterzuentwickeln.

Learning strategies are typically tested in rather conventional test settings, using questionnaires or observation as a method of information acquisition. However, such conventional test settings are far from the test taker's everyday life situation and might therefore evoke stress. Embedding a learning strategies test into an educational computer game, provides several advantages over the conventional testing procedure: The test takers can stay in their familiar learning environment and even learn something during the process of being tested. We conducted an explorative study by testing 24 pupils, comparing the outcome of a conventional learning strategies test conducted by a psychologist with the results obtained by our GETOLS method. The high similarity of results strongly supports our approach.

Social anxiety disorder patients suffer from excessive anxious responses in social interaction leading to avoidance behavior and social impairment. Although the amygdala has a central role in perception and processing of threatening cues, little is known about the involved networks and corresponding dysfunctions in social anxiety. Therefore, this study aims to investigate the functional connectivity network of the amygdala in patients with social anxiety disorder and to identify regions that might influence amygdalar reactivity via modulatory pathways. Ten patients with anxiety disorders (social and/or panic) and 27 healthy controls underwent a facial emotion processing task as well as 6-min functional MRI at resting state. Individual voxel-wise functional connectivity maps were calculated using the amygdala as seed region. Group comparisons were done by random-effects analysis in SPM. Patients exhibited an amygdala hyperactivation during the emotional task and decreased functional coupling of the left amygdala with the medial orbitofrontal cortex and the posterior cingulate cortex/precuneus. The strength of this functional connectivity showed a negative association with the severity of state anxiety. In addition, an exploratory analysis revealed further reduced functional connectivity and a marked functional separation between the medial orbitofrontal and anterior cingulate cortices in the patient group. Our results suggest alterations within the amygdalar functional connectivity network in social anxiety disorder. Combined with the amygdalar hyperactivation our findings corroborate the proposed dysfunction of the fronto-amygdalar inhibition in anxiety disorders and indicate a modulatory influence of the anterior and posterior cingulate cortices on threat perception and processing.

Currently, most studies that employ dynamic causal modeling (DCM) use random-effects (RFX) analysis to make group inferences, applying a second-level frequentist test to subjects' parameter estimates. In some instances, however, fixed-effects (FFX) analysis can be more appropriate. Such analyses can be implemented by combining the subjects' posterior densities according to Bayes' theorem either on a multivariate (Bayesian parameter averaging or BPA) or univariate basis (posterior variance weighted averaging or PVWA), or by applying DCM to time-series averaged across subjects beforehand (temporal averaging or TA). While all these FFX approaches have the advantage of allowing for Bayesian inferences on parameters a systematic comparison of their statistical properties has been lacking so far. Based on simulated data generated from a two-region network we examined the effects of signal-to-noise ratio (SNR) and population heterogeneity on group-level parameter estimates. Data sets were simulated assuming either a homogeneous large population (N=60) with constant connectivities across subjects or a heterogeneous population with varying parameters. TA showed advantages at lower SNR but is limited in its applicability. Because BPA and PVWA take into account posterior (co)variance structure, they can yield non-intuitive results when only considering posterior means. This problem is relevant for high SNR data, pronounced parameter interdependencies and when FFX assumptions are violated (i.e. inhomogeneous groups). It diminishes with decreasing SNR and is absent for models with independent parameters or when FFX assumptions are appropriate. Group results obtained with these FFX approaches should therefore be interpreted carefully by considering estimates of dependencies among model parameters.

Resting-state data sets contain coherent fluctuations unrelated to neural processes originating from residual motion artefacts, respiration and cardiac action. Such confounding effects may introduce correlations and cause an overestimation of functional connectivity strengths. In this study we applied several multidimensional linear regression approaches to remove artificial coherencies and examined the impact of preprocessing on sensitivity and specificity of functional connectivity results in simulated data and resting-state data sets from 40 subjects. Furthermore, we aimed at clarifying possible causes of anticorrelations and test the hypothesis that anticorrelations are introduced via certain preprocessing approaches, with particular focus on the effects of regression against the global signal. Our results show that preprocessing in general greatly increased connection specificity, in particular correction for global signal fluctuations almost doubled connection specificity. However, widespread anticorrelated networks were only found when regression against the global signal was applied. Results in simulated data sets compared with result of human data strongly suggest that anticorrelations are indeed introduced by global signal regression and should therefore be interpreted very carefully. In addition, global signal regression may also reduce the sensitivity for detecting true correlations, i.e. increase the number of false negatives. Concluding from our results we suggest that is highly recommended to apply correction against realignment parameters, white matter and ventricular time courses, as well as the global signal to maximize the specificity of positive resting-state correlations.