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Having teaching staff with didactic qualifications in university teaching leads to a measurable improvement in academic skills among students. Previous recommendations on the type and scope of medical didactic qualification measures primarily apply to teaching staff at university and in-patient settings. The situation of primary care medicine, which often employs external lecturers and whose teaching takes place to a considerable extent in decentralized training facilities (teaching practices) is not adequately addressed.Taking into account a survey on the status quo at higher education institutions for General Practice in Germany, recommendations for minimum standards are made, based on national and international recommendations on the content and scope of medical didactic qualification measures.These recommendations include preliminary work by the Personnel and Organizational Development in Teaching (POiL) Committee of the Society for Medical Education (GMA), the MedicalTeachingNetwork (MDN), the Society of University Teaching Staff in General Medicine (GHA) as well as the experiences of the committee members, who hail from the field of general medicine, internal medicine and pediatrics amongst others.

Objective: Training in the final year (FY) of undergraduate medical training currently does not adequately prepare students for the independent performance of medical professional activities after graduation. The concept of Entrustable Professional Activities (EPA) offers the opportunity for a competency-based FY training with the focus on medical professional activities.Methodology: In regular meetings, the FY sub-working group of the German Medical Faculty Association (MFT), which includes representatives with clinical and didactic expertise of the Associations of Internal Medicine, Surgery and General Medicine, developed a concept for the competecy-orientated, EPA-based, FY model logbook 2.0. The selection of the units of practice was made in a cross-disciplinary, consensus-orientated discussion process based on the question which medical professional activities a young professional has to master in the inpatient or outpatient working environment.Results: For the FY electives internal medicine, surgery and general medicine, a blueprint of a total of 18 comprehensive, partially interdisciplinary EPAs relating to inpatient and outpatient care contexts were developed. Each EPA was operationalised by a short description, supervision levels were attributed, and the process of transparent entrustment was determined.Conclusions: The concept for a new FY model logbook 2.0 focuses on the interdisciplinary core medical professional activities in an inpatient and outpatient care context, in order to facilitate transition from undergraduate training to professional practice, and to help avoid overload, thus increasing patient safety.

Objectives: The final year of undergraduate medical education (practical year) should foster the transition from undergraduate medical education to graduate medical education. Medical students in the practical year should be able to assume professional tasks, and supervisors should assign these tasks to them. In this pilot study, a curriculum based on the concept of entrustable professional activities (EPAs) was implemented and evaluated in the disciplines of internal medicine, surgery and general practice at four university hospitals.Methods: =37 medical students and =17 supervising physicians at four German university hospitals participated in the implementation study for one trimester. For evaluation purposes, we conducted focus group discussions and telephone interviews and analyzed them following qualitative content analysis.Results: We identified five different aspects as important for implementing the EPA curriculum in undergraduate medical education in the German context: Conclusion: The study presents a practical implementation of the EPA curriculum in Germany’s undergraduate medical education. Besides the need for time and resources, the concept shows good feasibility and fosters a competence-oriented undergraduate medical education in the practical year.

Awareness of one’s own strengths and weaknesses is a key qualification for the specialist physician. We examined how physicians undergoing specialist training in general medicine rate themselves in different areas.For this purpose, 139 participants receiving post-graduate training in general practice offered by the Medical Association of Westfalen-Lippe assessed themselves regarding their subjective confidence in 20 core competencies and 47 situations involving patient counseling in general practice. Their self-assessments were recorded on a five-point Likert scale. The study questions addressed acceptance and practicability of self-assessment, mean values, reliability, stratification and plausibility of the results in group comparison.On average participants rated their subjective confidence with 3.4 out of 5 points. The results are self-consistent (Cronbach’s alpha >0.8), although there are considerable differences among competencies and among participants. The latter can be explained partly by biographical data, which supports the plausibility of the data.Participants stated that regularly gathering data on subjective learning needs and the discussion of these needs with mentors and trainers contributes to improving their specialist training.Elements for self-assessment are suitable for integration into a postgraduate training portfolio. These should be supplemented by formative assessment procedures.

[english] During their studies to become medical professionals, all students are obliged to become familiar with various aspects of primary care. The aim is to provide all students with a high quality training which ensures the best possible cooperation across all sectors of the medical system. Primary care comprises the primary use of the medical service by an unfiltered set of patients as well as continued patient care – including home-care.This position paper was developed together with representatives of the German Society of University Teachers of General Practice (GHA), the German Society for Ambulatory General Paediatrics (DGAAP), the German Society of General Practice and Family Medicine (DEGAM) and the German Society for Internal Medicine (DGIM).It includes recommendations for teaching in the field of primary care in four different types of internships such as preclinical work experience (“Hospitation”), 4-week clinical traineeships of a casual nature (“Famulatur”) and 2-week courses of structured and assessed clinical training (“Blockpraktikum”) as well as a broad-based 4-month elective clinical placement in the final year (known as a practical year, “PJ”).The recommendations encompass structural and process criteria for internships in different general practices.In addition, for the first time recommendations for teaching on campus – in the fields of general medicine, paediatrics, numerous cross-sectional areas and other clinical fields, but also for clinical skills training – are set down here. In this position paper the intention is to demonstrate the possible ways in which more aspects of primary care could be integrated into undergraduate medical training.

[english] Objectives: It was investigated how students judge the teaching of medical ethics and the history of medicine at the start and during their studies, and the influence which subject-specific teaching of the history, theory and ethics of medicine (GTE) - or the lack thereof - has on the judgement of these subjects.Methods: From a total of 533 students who were in their first and 5 semester of the Bochum Model curriculum (GTE teaching from the first semester onwards) or followed the traditional curriculum (GTE teaching in the 5/6 semester), questionnaires were requested in the winter semester 2005/06 and in the summer semester 2006. They were asked both before and after the 1 and 5 (model curriculum) or 6 semester (traditional curriculum). We asked students to judge the importance of teaching medical ethics and the history of medicine, the significance of these subjects for physicians and about teachability and testability (Likert scale from -2 (do not agree at all) to +2 (agree completely)).Results: 331 questionnaire pairs were included in the study. There were no significant differences between the students of the two curricula at the start of the 1 semester.The views on medical ethics and the history of medicine, in contrast, were significantly different at the start of undergraduate studies: The importance of medical ethics for the individual and the physician was considered very high but their teachability and testability were rated considerably worse. For the history of medicine, the results were exactly opposite. GTE teaching led to a more positive assessment of items previously ranked less favourably in both curricula. A lack of teaching led to a drop in the assessment of both subjects which had previously been rated well.Conclusion: Consistent with the literature, our results support the hypothesis that the teaching of GTE has a positive impact on the views towards the history and ethics of medicine, with a lack of teaching having a negative impact. Therefore the teaching of GTE should already begin in the 1 semester. The teaching of GTE must take into account that even right at the start of their studies, students judge medical ethics and the history of medicine differently.[german] Zielsetzung: Es wurde untersucht, wie Studierende zu Beginn und im Verlauf ihres Studiums den Unterricht in Medizinethik und Medizingeschichte einschätzen und welchen Einfluss der durchgeführte bzw. fehlende fachspezifische Unterricht in Geschichte, Theorie und Ethik der Medizin (GTE) auf die Wertschätzung der Fächer hat.Methodik: Befragt wurden im WS 2005/6 insgesamt 533 Studierende des 1. und 5. Fachsemesters aus dem Bochumer Modell- (GTE-Unterricht ab dem 1. Fachsemester) und Regelstudiengang (GTE-Unterricht im 5./6. Fachsemester). Befragt wurde jeweils vor und nach dem 1. bzw. 5. oder 6. Semester. Wir fragten nach der Einschätzung der Bedeutung der Lehre in Medizinethik und Medizingeschichte für die Studierenden, nach der Bedeutung der Fächer für den Arzt sowie nach ihrer Lehr- und Prüfbarkeit (Likert Skala von -2 (stimme überhaupt nicht zu) bis +2 (stimme völlig zu)).Ergebnisse: 331 Fragebogenpaare wurden in die Studie einbezogen. Zwischen den Studierenden der beiden Studiengänge fanden sich zu Beginn des 1. Semesters keine signifikanten Unterschiede. Die Einschätzungen der Medizinethik und der Medizingeschichte unterschieden sich zu Beginn des Studiums jedoch signifikant: Die Bedeutung der Medizinethik für die eigene Person und für den Arzt wurde als sehr hoch eingeschätzt, deutlich schlechter ihre Lehr- und Prüfbarkeit. Für die Medizingeschichte waren die Ergebnisse genau entgegengesetzt.Durch den GTE-Unterricht verbesserten sich dann in beiden Studiengängen die Einschätzungen in den vorher weniger gut bewerteten Items. Fehlender Unterricht führte zur Verschlechterung der Einschätzung beider Fächer in den vorher gut bewerteten Items.Schlussfolgerung: Im Einklang mit der Literatur unterstützen unsere Ergebnisse die Hypothese, dass der GTE-Unterricht auf die Einschätzung von Geschichte und Ethik der Medizin positiv wirkt, fehlender Fachunterricht hingegen negativ. Deshalb sollte der GTE-Unterricht bereits im 1. Fachsemester beginnen und in beiden Studienabschnitten angeboten werden. Der GTE-Unterricht muss auf jeden Fall berücksichtigen, dass die Studierenden die Medizinethik und die Medizingeschichte schon zum Studienbeginn in ihrer Bedeutung unterschiedlich einschätzen.

[english] The aim of this paper, written by the committee of educational research methodology of the “Society for Medical Education” of the German-speaking countries, will give recommendations for the review process of scientific papers in medical education. The recommendations are based on the results of a workshop in 2007 and on a survey among reviewers of the journal GMS Z Med Ausbild. It reflects on international standards and research in medical education in Germany. The paper describes reviewer’s function concerning the journal of GMS Z Med Ausbild and specifies criteria for the review process with regard to the editors and reviewers; it also gives proposals for a feedback to the author. The catalogue of criteria for the reviewers is pictured in a checklist. The present recommendations shall help to increase the quality of the review process and to improve the national and international acceptance of the journal GMS Z Med Ausbild. Additionally, transparency of the review processes will support authors to submit a scientific article of high quality. [german] Ziel des vorliegenden Artikels des „Ausschusses für Methodik der Ausbildungsforschung“ der Gesellschaft für Medizinische Ausbildung ist, Empfehlungen für die Begutachtung von Manuskripten in der medizinischen Ausbildungsforschung vorzustellen. Die Empfehlungen basieren auf den Ergebnissen eines Workshops 2007 und einer Befragung von Gutachtern. Sie berücksichtigen darüber hinaus sowohl internationale Standards als auch die Situation der medizinischen Ausbildungsforschung in Deutschland. Es werden die Aufgaben eines Gutachters der GMS Z Med Ausbild dargelegt und Kriterien für den Begutachtungsprozess sowohl für die Herausgeber als auch für die Gutachter beschrieben. Sie enthalten außerdem Vorschläge für ein Autoren-Feedback. Der Kriterienkatalog für die Gutachter wird darüberhinaus in einer Checkliste abgebildet. Die vorliegenden Empfehlungen sollen dazu beitragen, die Qualität des Begutachtungsprozesses zu steigern und das nationale und internationale Ansehen der Fachzeitschrift GMS Z Med Ausbild zu verbessern. Die Transparenz des Begutachtungsprozesses dient den Autoren, einen qualitativ hochwertigen und anspruchsvollen Beitrag einzureichen.

[english] Handling strong emotions like sorrow, anger, shame, and fear in patients with somatic disease in an adequate way is a key issue for the future physician. Up to now, this aspect of the doctor?patient relationship has played a minor role in medical studies. To address this shortcoming, the handling of emotions is the focus of the third semester in the “Medical Interaction” course of the Modellstudiengang Medizin, the problem-based track of the medical faculty in Bochum, Germany. The course presented is given by the Department of General Medicine.The main objective is the recognition and correct interpretation of patients’ emotional expressions. The course is composed of six modules (one introductory and one for each leading affect). The main teaching methods are realistic role plays in a small group setting with video feedback, whereby one main requirement is that each student plays the role of both the patient and the doctor. Each session is introduced and analyzed by a general practitioner experienced in psychosomatic medicine. Evaluation of the course has shown a high acceptance among students. This motivates us to conduct a public discussion on the possibilities of applying this concept in other medical studies as well. [german] Der adäquate Umgang mit Emotionen wie Trauer, Wut, Scham und Angst bei Patienten mit körperlichen Erkrankungen spielt für den werdenden Arzt eine Schlüsselrolle. Dieser Aspekt der Arzt-Patient-Beziehung wird allerdings im Medizinstudium bislang wenig berücksichtigt. Aus diesem Grunde wird der Umgang mit Emotionen im dritten Semester des Stranges „ärztliche Interaktion“ im Modellstudiengang Medizin der Ruhr-Universität Bochum thematisiert. Der vorgestellte Kurs wird von der Abteilung für Allgemeinmedizin durchgeführt.Zielsetzung ist die Verbesserung der emotionalen und kommunikativen Kompetenz des Studierenden. Um dies zu erreichen soll dem eigenen emotionalen Erleben in der Arzt-Patient-Beziehung Raum gegeben werden. Der Kurs gliedert sich in 6 Module in dem realistische Patientenszenarien in Rollenspielen gespielt und aufgezeichnet werden. Ein zentrales Ziel ist, dass jeder Studierende eine Arzt- und eine Patientenrolle selber gespielt hat. Jedes Rollenspiel wird von einem in der psychosomatischen Medizin erfahrenen Allgemeinmediziner eingeleitet und ausgewertet. Die Evaluation spricht für eine hohe Akzeptanz der Lehrveranstaltung von Seiten der Studierenden die uns dazu ermutigt, öffentlich darüber nachzudenken, in wie fern ein solches Konzept in andere Medizinstudiengänge übertragen werden könnte.

[english] The German Regulation on the Licensing of Doctors (Approbationsordnung für Ärzte, ÄAppO) demands: “…the medical education is supposed to promote interdisciplinary thinking and should – as far as practicable – aim at the learning objectives in a problem-based way” (ÄAppO §2 (2)). We have put this into action in the Medical Reformed Curriculum at the Ruhr-University Bochum by the implementation of a standardized planning procedure, which covers the entire teaching effort. The planning takes place in three meetings of theme-based planning groups based on the preparatory work of a curriculum draft and a catalogue of learning objectives. These are the concrete planning steps: 1. Screening, revisal and completion of the suggested learning objectives, concentration of the main topics and its thematical arrangements; phrasing of concrete learning objectives, coordination of topics among the disciplines. 2. Planning of the sequence of scientifical and clinical topics and of joint lessons; development of clinical paper cases, specification of the teaching lessons. 3. Discussion of the paper cases, coordination of individual lessons and of the schedule, planning of exam cases and of the evaluation strategy. We look back on a four-year experience on the planning of interdisciplinary teaching, including students’ evaluations and academic achievements. This standardized procedure makes it possible to calculate the necessary effort of this complex process of coordination and planning for all persons involved. [german] Der Forderung der Approbationsordnung, „… der Unterricht im Studium soll fächerübergreifendes Denken fördern und soweit zweckmäßig problemorientiert am Lehrgegenstand ausgerichtet sein“ (ÄAppO §2 (2)), wurde im Modellstudiengang Medizin an der Ruhr-Universität Rechnung getragen, indem ein standardisiertes Planungsverfahren für den gesamten Unterricht entwickelt und angewendet wurde. Das Verfahren erfolgt in 3 Treffen einer themenorientierten Planungsgruppe und läuft – aufbauend auf Vorarbeiten eines Curriculumentwurfs und der Erstellung eines Lehrinhaltekatalogs durch die jeweiligen Fachvertreter in folgenden Schritten ab: 1. Sichtung, Revision und Ergänzung der vorgeschlagenen Lehrinhalte, Schwerpunktbildung und thematische Sortierung. Operationalisierung der Lehrinhalte in konkrete Lehrziele, Absprache der Inhalte unter den Fächern. 2. Planung der Abfolge grundlagenwissenschaftlicher, klinisch-theoretischer und klinischer Inhalte und gemeinsamer Lehrveranstaltungen, Entwicklung von Fallgeschichten, Festlegung der Details zu den Unterrichtsveranstaltungen. 3. Diskussion der Fallgeschichten, Abstimmung der Lehrveranstaltungen und des Stundenplans, Planung der Prüfungsfragen und der Evaluation. Über die inhaltliche, zeitliche und räumliche Verknüpfung des interdisziplinären Unterrichts liegen nun Erfahrungen, Evaluationen und Prüfungsergebnisse aus acht Semestern vor. Dank des standardisierten Vorgehens wurde der erforderliche Arbeitsaufwand für den komplexen Abstimmungs- und Planungsprozess für alle Beteiligten kalkulierbar.

[english] Background: In view of the continuously increasing number of beginners of medical students at the Ludwig-Maximilians-University (LMU), the traditional kind of the practically oral tests on the cadaver for the assessment in tests of anatomy has become no longer reliably and practically realisable. Material and Methods: As an alternative was an exam-course established, where the students have to pass in turn different stations with preparations and to work on relating tasks. We investigated the practicability, reliability and the students' acceptance of this form of testing. Results: In 7 parallel prepaired exam-courses, 930 students can be testet within 155 minutes with time and effort of 2 academic teachers and 32 student co-workers. The results show an adequate selectivity high reliability and apropriate difficulty. Results of a written evaluation of 442 students (49%) show a high acceptance of this kind of testing. Summary: This kind of test represents an alternative, which has to be taken seriously, to the traditional form of anatomical tests. [german] Hintergrund: Angesichts der stetig steigenden Zahl (WS 06/07 n=930) an Studienanfängern der Medizin in München ist im Fach Anatomie die traditionelle Prüfungsform der praktischen, mündlichen Prüfung am Präparat für die Bewertung in den Testaten nicht mehr zuverlässig und praktikabel durchführbar. Material & Methoden: Als Alternative wurde ein Prüfungsparcours etabliert, in dem die Studierenden der Reihe nach unterschiedliche Stationen mit ausgelegten Präparaten durchlaufen und entsprechende Aufgaben bearbeiten. Wir untersuchten die Praktikabilität, Zuverlässigkeit und studentische Akzeptanz des Prüfungsformates. Ergebnisse: Durch sieben parallel aufgebaute Prüfungsparcours können 930 Studierende in 155 Minuten mit einem Betreuungsaufwand von zwei akademischen und 32 studentischen Mitarbeitern geprüft werden. Die Ergebnisse zeigen eine adäquate Trennschärfe, hohe Zuverlässigkeit und angemessene Schwierigkeit der Prüfung. Ergebnisse einer schriftlichen Evaluation von 442 Studierenden (49%) sprechen für eine hohe Akzeptanz des Prüfungsformates. Schlussfolgerung: Wir halten diese Form der Prüfung als ernst zu nehmende Alternative zur bisher in den anatomischen Testaten traditionellen Form der mündlichen Prüfung am Präparat.

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