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[english] Background: Learning on the ward as a practice-oriented preparation for the future workplace plays a crucial role in the medical education of future physicians. However, students’ ward internship is partially problematic due to condensed workflows on the ward and the high workload of supervising physicians. For the first time in a German-speaking setting, students’ expectations and concerns about their internship on the ward are examined in a qualitative analysis regarding their internal medicine rotation within clinical medical education.Methods: Of a total of 168 medical students in their 6th semester at the Medical Faculty of Heidelberg, 28 students (m=8, f=20, Ø 23.6 years) took part in focus group interviews 3 to 5 days prior to their internship on the internal medicine ward within their clinical internal medicine rotation. Students were divided into four different focus groups. The protocols were transcribed and a content analysis was conducted based on grounded theory.Results: We gathered a total of 489 relevant individual statements. The students hope for a successful integration within the ward team, reliable and supportive supervisors and supervision in small groups. They expect to face the most common diseases, to train the most important medical skills, to assume full responsibility for their own patients and to acquire their own medical identity. The students fear an insufficient time frame to achieve their aims. They are also concerned they will have too little contact with patients and inadequate supervision.Conclusion: For the development and standardization of effective student internships, the greatest relevance should be attributed to guidance and supervision by professionally trained and well-prepared medical teachers, entailing a significant increase in staff and costs. A structural framework is required in order to transfer the responsibility for the treatment of patients to the students at an early stage in medical education and in a longitudinal manner. The data suggest that the development and establishment of guidelines for medical teachers associated with clearly defined learning objectives for the students’ internships are urgently needed. Based on our findings, we provide first recommendations and suggest possible solutions.

The diffusion of cations in organic solvent solutions is important for the performance of metal-ion batteries. In this article, pulsed field gradient nuclear magnetic resonance experiments and fully atomistic molecular dynamic simulations were employed to study the temperature-dependent diffusive behavior of various liquid electrolytes representing 1M propylene carbonate solutions of metal salts with bis(trifluoromethylsulfonyl)imide (TFSI−) or hexafluorophosphate (PF6−) anions commonly used in lithium-ion batteries and beyond. The experimental studies revealed the temperature dependence of the diffusion coefficients for the propylene carbonate (PC) solvent and for the anions following an Arrhenius type of behavior. It was observed that the PC molecules are the faster species. For the monovalent cations (Li+, Na+, K+), the PC solvent diffusion was enhanced as the cation size increased, while for the divalent cations (Mg2+, Ca2+, Sr2+, Ba2+), the opposite trend was observed, i.e., the diffusion coefficients decreased as the cation size increased. The anion diffusion in LiTFSI and NaTFSI solutions was found to be similar, while in electrolytes with divalent cations, a decrease in anion diffusion with increasing cation size was observed. It was shown that non-polarizable charge-scaled force fields could correspond perfectly to the experimental values of the anion and PC solvent diffusion coefficients in salt solutions of both monovalent (Li+, Na+, K+) and divalent (Mg2+, Ca2+, Sr2+, Ba2+) cations at a range of operational temperatures. Finally, after calculating the radial distribution functions between cations, anions, and solvent molecules, the increase in the PC diffusion coefficient established with the increase in cation size for monovalent cations was clearly explained by the large hydration shell of small Li+ cations, due to their strong interaction with the PC solvent. In solutions with larger monovalent cations, such as Na+, and with a smaller solvation shell of PC, the PC diffusion is faster due to more liberated solvent molecules. In the salt solutions with divalent cations, both the anion and the PC diffusion coefficients decreased as the cation size increased due to an enhanced cation–anion coordination, which was accompanied by an increase in the amount of PC in the cation solvation shell due to the presence of anions. [ABSTRACT FROM AUTHOR]

[english] Introduction: Communicative competence is essential for daily medical routine. The usefulness of communication-trainings for physicians is described in various publications. However, specific trainings in paediatrics are rarely found. A characteristic for paediatric work is that the primary communication is not only with the patient – the child – but also with the parents. Beside self-assessment external assessment by parents can be used for evaluation of paediatrician’s communicative skills.Methods: 28 paediatric residents (intervention group n = 14; control group n = 14) of the University Children’s Hospital of Heidelberg took part in a communication training using standardised parents and -patients (SP), video recording and feedback by peers, SPs and supervisors. Data of self-evaluated communicative competence in contact with parents was collected from all participants before and after the training of the intervention group. In addition there was an assessment of parents’ satisfaction with the paediatricians-parents communication concerning their children’s treatment nine weeks before and nine weeks after the training (n = 248). A follow-up survey to record the transfer into clinical practice was conducted with the participants after six months.Results: After the training participants of the intervention group showed an increased feeling of communicative competence in reference to communicative situations that were explicitly practiced in the training. The external assessment by parents generally showed a positive evaluation of paediatricians’ communication skills. However, a group effect was not found. In the follow-up survey participants reported an improved self-perception and specific elements of the training that facilitated the daily clinical practice with parents and their children. Discussion: The training of specific relevant clinical situations lead to an increase in perceived communicative competence and competence in handling difficult encounters with parents. Communication trainings should be integrated not only into the medical student education but also into post-graduate education curricula. [german] Einführung: Kommunikative Kompetenzen sind wesentlich für den ärztlichen Alltag. In der Literatur wird vielfach der Nutzen von Kommunikationsschulungen für Ärzte beschrieben, über gezielte Schulungen für den Fachbereich Pädiatrie finden sich nur vereinzelt Berichte. Die Besonderheit der pädiatrischen Versorgung besteht dabei im Wesentlichen darin, dass nicht nur die Kommunikation zum Patienten – dem Kind –, sondern auch zu dessen Eltern oder Bezugspersonen eine entscheidende Rolle spielt. Zur Überprüfung kommunikativer Fähigkeiten von Pädiatern können neben Selbsteinschätzungen auch Fremdeinschätzungen durch Eltern dienen.Methode: 28 Assistenzärzte (Interventionsgruppe n = 14; Kontrollgruppe n = 14) der Universitätsklinik für Kinder- und Jugendmedizin in Heidelberg nahmen an einer Kommunikationsschulung teil. Diese beinhaltete Übungsgespräche mit standardisierten Eltern und -Patienten (SP), Videoaufzeichnungen sowie Feedback von SPs, Peers und Supervisoren. Daten zur Selbsteinschätzung der eigenen kommunikativen Kompetenz wurden vor und nach der Schulung der Interventionsgruppe von allen Teilnehmern erhoben. Weiterhin wurde neun Wochen vor und neun Wochen nach Abschluss der Schulung eine Elternbefragung bei n = 248 Eltern durchgeführt, in der die Zufriedenheit mit dem Arztkontakt hinsichtlich der Arzt-Eltern Kommunikation erfasst wurde. Nach 6 Monaten schloss sich eine Nachbefragung bei den Teilnehmern zum Transfer in den Klinikalltag an.Ergebnis: Bei den Teilnehmern der Interventionsgruppe zeigte sich im Gegensatz zur Kontrollgruppe nach Abschluss der Schulung eine signifikante Steigerung der subjektiven Kompetenzeinschätzung in Bezug auf die kommunikativen Situationen, die speziell in der Schulung trainiert wurden. Die Fremdeinschätzung durch die Eltern ergab eine generell sehr positive Bewertung der Ärzte, es ließ sich jedoch kein Gruppeneffekt nachweisen. Im Langezeitverlauf berichteten die Teilnehmer von einer verbesserten Selbstwahrnehmung und benannten konkrete Elemente der Schulung, die ihnen die tägliche klinische Arbeit im Kontakt mit Eltern erkrankter Kinder erleichterten.Diskussion: Das Training von spezifischen, für den klinischen Alltag typischen Situationen führt zu einer Verbesserung der Selbsteinschätzung kommunikativer Kompetenzen bezüglich des Umgangs mit schwierigen Situationen im Elternkontakt. Eine Integration von Kommunikationsschulungen nicht nur in das Medizinstudium, sondern auch in postgraduierte Ausbildungs-Curricula erscheint daher sinnvoll.

[english] Introduction: “Standardised patients” are finding increased application within medical training and have become an indispensable component of communication training for medical students. In the Anglo-American world, “standardised patients” are also employed in the postgraduate curriculum for resident physicians. In the German-speaking realm, however, there are currently no publications indicating the use of “standardised parents” in the specialist field of paediatrics. The basic recurring question concerning the extent to which training with “standardised parents” can be considered adequately realistic - a question which has already been raised in connection with the use of “standardised patients” - is of particular relevance in the case of highly experienced clinical staff. The degree to which feedback from “standardised parents” proves helpful in everyday clinical life also remains to be ascertained. Methods: In the current project, a communication training course involving “standardised patients”, who simulated the parents and caregivers of ill children, was carried out with residents of Heidelberg University Clinic for Paediatric and Adolescent Medicine. 28 Accident and Emergency were trained in dealing with problems and difficult situations arising in communication with parents. Following the physician-parent dialogue, the respective physician received feedback from the actors, fellow medical peers and supervisors. The authenticity of the cases and their relevance in the context of a realistic training course for communication skills was assessed by means of a questionnaire for participants. Additionally, participants evaluated the quality of the feedback received following the physician-parent dialogue. Results: Physicians considered the training cases to be extremely authentic and of relevance regarding both the improvement of communication skills and confidence in dealing with the parents of ill children. Feedback from actors (Likert scale: M = 1.08; SD = 0.28), from supervisors (M = 1.25; SD = 0.68) and medical peers (M =1.29; SD = 0.55) received very high ratings. Discussion: In the project presented here, the application of “standardised parents” represents a valuable tool which can be considered a suitable and obligatory component within a structured communication training course for paediatric residents. Furthermore, the employment of “standardised parents” could prove of interest in the context of graduate medical education. [german] Einführung: "Standardisierte Patienten“ (SP) sind simulierte Patienten, die sorgfältig und gewissenhaft trainiert wurden, um ihre erlernte Erkrankung in einer standardisierten und gleich bleibenden Art und Weise für didaktische Lehrzwecke zu präsentieren. SP werden in der Medizinischen Ausbildung zunehmend eingesetzt und sind inzwischen ein unverzichtbarer Bestandteil eines Kommunikationstrainings von Medizinstudenten. Auch für die Ausbildungscurricula von Assistenzärzten auf dem Weg zum Facharzt werden im angloamerikanischen Raum inzwischen SP eingesetzt. In der Pädiatrie wird die Verwendung von Schauspielern zu Schulungszwecken bisher nur vereinzelt beschrieben. Die wiederkehrende Frage nach einer ausreichenden Realitätsnähe und nach dem Nutzen ihres Feedbacks, wie sie bereits hinsichtlich des Einsatzes von SP aufgeworfen wurde, bleibt auch bei Schulungen mit "standardisierten Eltern“, bei denen der Patient - das Kind - gar nicht oder nur teilweise anwesend ist, bestehen. Methode: In dem vorliegenden Projekt wurde für 28 Ärzte der Universitätsklinik für Kinder- und Jugendmedizin Heidelberg mit einer mittleren Berufserfahrung von 4,2 Jahren ein Kommunikationstraining mit "standardisierten Eltern“ durchgeführt. Dazu wurden 13 Schauspieler anhand ausführlicher Rollenskripte für den Einsatz als „standardisierte Eltern“ trainiert. Die Auswahl der Schauspieler erfolgte aus einem umfangreichen Pool an erfahrenen Schauspieler, die bereits Vorerfahrung im Einsatz als "standardisierte Patienten“ hatten. Berufserfahrene pädiatrische Dienstärzte wurden anhand neun klinischer Szenarien im Umgang mit Problemen und schwierigen Gesprächssituationen im Kontakt mit Eltern erkrankter Kinder geschult. Im Anschluss an das Arzt-Eltern-Gespräch erhielten die trainierten Ärzte ein Feedback von den Schauspielern selbst, den teilnehmenden ärztlichen Kollegen ("peers“) sowie den Supervisoren der Unterrichtsveranstaltungen. Mittels einer schriftlichen Evaluation der Teilnehmer wurde die Authentizität der "standardisierten Eltern“ sowie die Relevanz der Fälle für eine praxisnahe Schulung hinsichtlich kommunikativer Fähigkeiten erfasst. Darüber hinaus wurde eine Einschätzung der Teilnehmer hinsichtlich der Qualität der nach dem Arzt-Eltern-Gespräch erhaltenen Feedbacks eingeholt. Ergebnis: Die Fälle der Schulungen wurden von den Ärzten als äußerst authentisch und relevant hinsichtlich der Verbesserung der eigenen kommunikativen Fertigkeiten und der Sicherheit im Umgang mit Eltern erkrankter Kinder gewertet. Die Teilnehmer bewerteten (sechsstufige Likert Skala:1 = und 6 = ) das Feedback der Schauspieler (Mittelwert (M) = 1,08; Standardabweichung (SD) = 0,28), der Supervisoren (M = 1,25; SD = 0,68) und der „peers“ (M =1,29; SD = 0,55) als etwa gleich relevant und nützlich. Diskussion: "Standardisierte Eltern“ werden von angehenden Fachärzten der Pädiatrie als sehr authentisch eingeschätzt. Das Feedback der "standardisierten Eltern“ wird als sehr hochwertig angesehen. Die Grundlage für diese Einschätzungen bildet eine fundierte Vorbereitung und Konzeption der Schulungsfälle sowie ein umfassendes Training der "standardisierten Eltern“ hinsichtlich der Feedbackgabe. Ein weitreichender Einsatz von "standardisierten Eltern“ wäre auch für die Ausbildung von angehenden Ärzten im Fachbereich Pädiatrie wünschenswert.

Introduction: Seamless interoperability of ophthalmic clinical data is beneficial for improving patient care and advancing research through the integration of data from various sources. Such consolidation increases the amount of data available, leading to more robust statistical analyses, and improving the accuracy and reliability of artificial intelligence models. However, the lack of consistent, harmonized data formats and meanings (syntactic and semantic interoperability) poses a significant challenge in sharing ophthalmic data. Methods: The Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR), a standard for the exchange of healthcare data, emerges as a promising solution. To facilitate crosssite data exchange in research, the German Medical Informatics Initiative (MII) has developed a core data set (CDS) based on FHIR. Results: This work investigates the suitability of the MII CDS specifications for exchanging ophthalmic clinical data necessary to train and validate a specific machine learning model designed for predicting visual acuity. In interdisciplinary collaborations, we identified and categorized the required ophthalmic clinical data and explored the possibility of its mapping to FHIR using the MII CDS specifications. Discussion: We found that the current FHIR MII CDS specifications do not completely accommodate the ophthalmic clinical data we investigated, indicating that the creation of an extension module is essential. [ABSTRACT FROM AUTHOR]

Introduction: The Medical Informatics Initiative (MII) in Germany has pioneered platforms such as the National Portal for Medical Research Data (FDPG) to enhance the accessibility of data from clinical routine care for research across both university and non-university healthcare settings. This study explores the efficacy of the Medical Informatics Hub in Saxony (MiHUBx) services by integrating Klinikum Chemnitz gGmbH (KC) with the FDPG, leveraging the Fast Healthcare Interoperability Resources Core Data Set of the MII to standardize and harmonize data from disparate source systems. Methods: The employed procedures include deploying installation packages to convert data into FHIR format and utilizing the Research Data Repository for structured data storage and exchange within the clinical infrastructure of KC. Result: Our results demonstrate successful integration, the development of a comprehensive deployment diagram, additionally, it was demonstrated that the non-university site can report clinical data to the FDPG. Discussion: The discussion reflects on the practical application of this integration, highlighting its potential scalability to even smaller healthcare facilities and to pave the way to access to more medical data for research. This exemplary demonstration of the interplay of different tools provides valuable insights into technical and operational challenges, setting a precedent for future expansions and contributing to the democratization of medical data access. [ABSTRACT FROM AUTHOR]

This study advances the utility of synthetic study data in hematology, particularly for Acute Myeloid Leukemia (AML), by facilitating its integration into healthcare systems and research platforms through standardization into the Observational Medical Outcomes Partnership (OMOP) and Fast Healthcare Interoperability Resources (FHIR) formats. In our previous work, we addressed the need for high-quality patient data and used CTAB-GAN+ and Normalizing Flow (NFlow) to synthesize data from 1606 patients across four multicenter AML clinical trials. We published the generated synthetic cohorts, that accurately replicate the distributions of key demographic, laboratory, molecular, and cytogenetic variables, alongside patient outcomes, demonstrating high fidelity and usability. The conversion to the OMOP format opens avenues for comparative observational multi-center research by enabling seamless combination with related OMOP datasets, thereby broadening the scope of AML research. Similarly, standardization into FHIR facilitates further developments of applications, e.g. via the SMART-onFHIR platform, offering realistic test data. This effort aims to foster a more collaborative research environment and facilitate the development of innovative tools and applications in AML care and research. [ABSTRACT FROM AUTHOR]