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Objective: Competence orientation, often based on the CanMEDS model, has become an important goal for modern curricula in medical education. The National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM) has been adopted in Germany. However, it is currently unknown whether the vision of competence orientation has also reached the licensing examination procedures. Methods: Therefore, a prospective, descriptive, single-centre, exemplary study design was applied to evaluate 4051 questions/tasks (from 28 examiners at 7 two-day licensing oral-practical exams) for undergraduate medical students at the University of Ulm. The oral and practical questions/tasks as well as the real bedside assessment were assigned to specific competence roles (NKLM section I), categories (NKLM section II) and taxonomy levels of learning domains. Results: Numerous questions/tasks were set per candidate (day 1/2: 70±24/86±19 questions) in the licensing oral-practical exam. Competence roles beyond the “medical expert” were scarcely considered. Furthermore, practical and communication skills at the bedside were hardly addressed (less than 3/15 min). Strikingly, there was a significant predominance of questions with a low-level taxonomy. Conclusions: The data indicate a misalignment of competence-oriented frameworks and the “real world” licensing practical-oral medical exam, which needs improvement in both evaluation and education processes., Zielsetzung: Kompetenzorientierung basierend auf dem CanMEDS Model hat sich zu einem wichtigen Bildungsinhalt innerhalb der medizinischen Ausbildung entwickelt. Im Nationalen kompetenzbasierten Lernzielkatalog Medizin (NKLM) wurde diese als Ziel festgeschrieben. Es ist jedoch bisher nicht bekannt, inwiefern in den Prüfungen des medizinischen Staatsexamens tatsächlich kompetenzbasierend geprüft wird. Methoden: In dieser prospektiven, deskriptiven, monozentrischen, exemplarischen Studie wurden 4051 Fragen/Aufgaben (gestellt von 28 Prüfer in n=7 zweitägigen mündlich-praktischen Prüfungen) an Medizinstudierende der Universität Ulm evaluiert. Die mündlichen und praktischen Fragen/Aufgaben wurden, ebenso wie die Prüfung am Patientenbett, auf die spezifischen Kompetenzrollen (gemäß NKLM Abschnitt I), die unterschiedlichen Kategorien (gemäß NKLM Abschnitt II) und die Taxonomielevel der unterschiedlichen Fragen/Aufgaben analysiert. Ergebnisse: Im mündlich-praktischen Prüfungsteil wurden den Kandidaten zahlreiche Fragen/Aufgaben gestellt (Tag 1/2: 70±24/86±19 Fragen). Die Kompetenzrollen außerhalb des “Medizinischen Experten” wurden dabei selten adressiert. Zudem wurden praktische und kommunikative Fertigkeiten in der Prüfung am Patientenbett kaum geprüft (weniger als 3/15 min). Auffallend war die Dominanz an Fragen auf niedrigem taxonomischem Niveau. Schlussfolgerungen: Die Daten zeigen ein deutliches Missverhältnis zwischen den Vorgaben zur Kompetenzorientierung und den tatsächlich geprüften Inhalten der mündlich-praktischen Prüfungen. Diese Diskrepanz sollte zukünftig mit einer verstärkten Prüfer-Schulung und -Evaluation begegnet werden., GMS Journal for Medical Education; 34(2):Doc25

Summary Introduction Peer teaching is widely applied in medical education, anatomists having a notably long tradition in cooperating with student tutors in the dissection course. At Ulm University we established an intensified concomitant didactic training program for student tutors and investigated possible effects on their tutees’ academic performance and tutor evaluation. Methods In winter semester 2012/13 all student tutors of the dissection course were invited to participate in the “Train-the-Tutor” educational program. 1 Test results and failure rates of 149 tutees who had been supervised by program participants (n = 14) and 136 tutees of not participating tutors (n = 13) were analyzed, as well as data on tutor evaluation and learning behavior of 235 (82%) of these tutees. Results Overall, both groups of tutees showed equal learning behavior and evaluated their tutors’ performances similarly. However, tutees of program participants consistently obtained better examination results (median: 1.9 versus 2.2 in overall scores) and lower ultimate failure rates (13.4 versus 17.6% of students failed, respectively). Discussion An intensified didactic training program for student tutors may help their tutees to pass the gross anatomy course. Additional studies are necessary to objectify and further investigate this effect in order to optimize the concept regarding time expenditure and costs.

Introduction Peer teaching is a well-established teaching method in medical education. During the 2012/13 winter term, the Institute of Anatomy and Cell Biology in Ulm, Germany, introduced a longitudinal didactics program (“Train the Tutor”: TtT) to train student tutors as near-peer teachers (NPT) in the dissection course (DC). Twenty-three of 38 tutors participated in the programme. Our study describes the educational concept and the NPTs’ activities in the dissection course. Methods NPTs documented their activities on a daily basis in the form of semi-structured reports. A total of 575 reports were quantitatively and qualitatively analysed. Free-text analysis was performed using Grounded Theory followed by code quantification of all indications (n = 1868). Results NPTs spend 61% of their time dissecting by themselves or supervising the tutee’s dissection process. Organisational tasks had a larger share at the beginning of the course. Just before examinations the proportion of time spent giving feedback rose. Of all positive indications, 45% described experiences working with the tutees. In contrast, 68% of all negative indications were characterized by a self-critical reflection on their own activities. NPTs included all learning domains in their teaching, substantially functioning as teachers and role models to convey particular attitudes. Conclusion TtT-Trained Tutors (NPT) clearly met the requirements of a practical course and adjusted their activities in response to the course’s progress. NPTs were concerned about their tutees’ attitudes and may need more professional support within the TtT program regarding this.

One of the major functional properties of the mature motoneuron is its ability to generate and conduct signals from the central nervous system (CNS) to the peripheral muscle cell in order to induce and control muscle contraction [1]. The molecular composition of the neuromuscular junction (NMj) is crucial for its function and maintenance whereas dysregulation of endplate physiology is considered to be involved in denervation of the muscle cells and subsequent motoneuron degeneration [2, 3]. At early developmental stages of the neuron-to-muscle synaptogenesis, a large number of spinal motoneurons die, presumably because they fail to form adequate connections with the target muscle. In fact, if the limb bud (the precursor of limb muscles) is removed before the formation of neuromuscular connections all the corresponding motoneurons eventually degenerate [4]. In vitro, various cell systems are utilized to search for developmental and functional characteristics of the motoneuron system. Both, primary cultures and stem cellderived motoneurons are used for various questions. Pluripotent embryonic stem cells [5] from mouse and human origin [6] had been shown to be able to generate motoneurons in vitro. Since the first discovery and invention of the induced pluripotent stem cell (iPSC) technology by Takahashi and Yamanaka [7], it is now possible to analyze and study cell development and differentiation on the basis of a gene defect in patient specific settings [8, 9]. For comparison all these studies are crucially dependent upon the analysis of human cell differentiation, morphology and protein expression under

The dissection course (DC) is an essential part of the preclinical medical curriculum that mediates professionalism. The process of dissecting, however, has an inherent additional stress potential. Our study determined student mental stress, their need of psychological support and factors influencing this need. A quantitative longitudinal query before, during and after the DC was performed including the Brief Symptom Inventory (BSI) as well as self-formulated questions used a 5-point Likert scale. Half of the students who anticipated dissection to be a stress factor reported that this declined significantly over time. Instead, student fear of not being able to cope with the work load increased significantly. As many as 64% of the students favored psychological support on the first course day, while 75% rejected this during the period of dissection and 39% appreciated this after the course. Moreover, 42% emphasized the importance of the funeral ceremony. Additionally, 75% documented their need for support in coping with stress and learning strategies. Gender, previous medical training, and BSI levels were identified as psychosocial influence factors. A majority of students named friends, members of their family or workmates as partners with whom they could talk about mental stress. Our results document the need to develop an optimum support during the DC taking into account the ascertained indicators. Exemplarily the Institute of Anatomy and Cell Biology at Ulm University suggests several options like a step by step approach for optimization. These measures reduce mental stress and help students to cope with it by the development of "detached concern" towards their "first patient" as this will decisively influence their future professional behavior.

Summary Because of a new legislation concerning fees for study in Germany, novel financial opportunities for improvement of medical education have been provided. Some of these additional funds were invested at Ulm University in the Institute of Anatomy and Cell Biology to realize a teaching operating theatre similar to the ancient anatomical theatre in an amazingly short period of time. The anatomical theatre is a unique teaching facility in Germany, a direct implementation of joint preclinical and clinical education in the medical curriculum as required by the new Federal Medical Licensing Regulations (Approbationsordnung). It was set up in January of 2008. In this teaching operating theatre students and doctors will meet to study anatomical structures. In a simulated operating setting, surgeons will demonstrate invasive procedures and operative techniques on donated bodies. About 50 students can be positioned on a grandstand at a short distance to the operating table to follow the “operation” or anatomical demonstrations. Students can also learn how to behave in a sterile environment before they are actually confronted with this new situation during their first clinical clerkship. The anatomical theatre is supposed to be integrated in preclinical and clinical medical education as well as in advanced professional education for suitable sub-specialties. We are confident that the anatomical theatre will further improve students’ motivation and their efforts in gaining knowledge in the field of gross anatomy because of its clinical relevance.