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Introduction Inadequate smoking cessation interventions by physicians have been attributed to lack of training, and it is generally thought that additional education will improve patient care. However, interventions aimed at increasing knowledge and practical skills only address one determinant of behavior (capability). This prospective study assessed how much a teaching session for general practitioner (GP) trainees enrolled in Vocational Training Schemes in England also affected two other determinants (motivation and opportunity) specified by the COM-B theory of behavior. Methods Between October and December 2015, GP trainees were given a 3.5-h training session in the theory and practice of smoking cessation. Questionnaires addressed motivation, capability, and opportunities to provide evidence-based brief advice to smokers at the beginning and end of the session, and 3 months later. They also looked at the recollection of previous teaching as well as knowledge, skills, intervention frequency, and perceived barriers against providing interventions. Results Participants (n = 123) remembered little previous training on the subject and self-reported presession knowledge was minimal. Motivation was high throughout while capability and opportunity increased considerably during the session. No further change in these parameters was noted at 3 months. The proportion of participants stating they provided evidence-based brief advice to >50% of smokers increased from 25.2% before the session to 57.7% at follow-up. Lack of time remained a commonly cited barrier. Conclusions Training elicited an immediate and sustained effect on capability, perceived opportunity, and behavior itself. While perceived barriers referring to capability were greatly reduced, barriers referring to opportunity (eg, lack of time) persisted. Implications This is the first study evaluating a GP training session on smoking cessation with regard to the COM-B model. In a pre-post design with 3-month follow-up, we observed substantial and sustained changes in GP trainees' perceived capability and opportunity to provide evidence-based very brief advice, and these increases were paralleled by favorable changes in practice behavior. [ABSTRACT FROM AUTHOR]

Context Clinical reasoning is an essential skill, the foundations of which should be acquired during undergraduate medical education. Student performance in clinical reasoning can be assessed using key feature examinations. However, within a paradigm of test-enhanced learning, such examinations may also be used to enhance long-term retention of procedural knowledge relevant to clinical reasoning. Objectives This study tested the hypothesis that repeated testing with key feature questions is more effective than repeated case-based learning in fostering clinical reasoning. Methods In this randomised crossover trial, Year 4 medical students attended 10 weekly computer-based seminars during which patient case histories covering general medical conditions were displayed. The presentation format was switched between groups every week. In the control condition, students studied long case narratives. The intervention condition used the same content but augmented case presentation with a sequence of key feature questions. Using a within-subjects design, student performance on intervention and control items was assessed at 13 weeks (exit examination) and 9 months (retention test) after the first day of term. Results A total of 87 of 124 eligible students provided complete data for the longitudinal analysis (response rate: 70.2%). In the retention test, mean ± standard deviation student scores on intervention items were significantly higher than those on control items (56.0 ± 25.8% versus 48.8 ± 24.7%; p < 0.001). The results remained unchanged after accounting for exposure time in a linear regression analysis that also adjusted for sex and general student performance levels. Conclusions This is the first study to demonstrate an effect of test-enhanced learning on clinical reasoning as assessed with key feature questions. In this randomised trial, repeated testing was more effective than repeated case-based learning alone. Curricular implementation of longitudinal key feature testing may considerably enhance student learning outcomes in relevant aspects of clinical medicine. [ABSTRACT FROM AUTHOR]

The article comments on the role of assessments in undergraduate medical education. It references a paper on test-enhanced learning (TEL) in medical education published by D. P. Larsen et al. in 2008. The efficacy of repeated testing in promoting higher-order cognitive functions such as critical thinking is discussed, as well as implementation issues that have a direct bearing on the design of medical school curricula.

Introduction: Smoking cessation is one of the most cost-effective of all health interventions. Physicians are in a strong position to encourage smokers to make a quit attempt and to help them achieve long-term abstinence. Formal teaching on tobacco-related disease, the evidence base of smoking cessation, and practical skills training regarding cessation advice and counseling are therefore important parts of undergraduate medical education. A survey of U.K. medical schools conducted 11 years ago revealed substantial deficits in the curricular coverage of these topics. This study aimed at establishing whether the situation has improved since then. Methods: In 2013, all U.K. medical schools were invited to participate in an online survey of their curricular coverage of tobacco addiction and smoking cessation. Results: Of the 33 medical schools, 22 (67%) schools responded. Health effects of smoking were addressed in more than 90% of curricula, and factual knowledge on nicotine addiction and withdrawal symptoms was covered in 50% of curricula. Only 1 in 3 medical schools offered practical skills training in artificial (i.e., role play) or clinical settings, and 50% of schools did not address smoking in summative assessments. Conclusions: Practical skills training regarding cessation counseling is insufficient at most U.K. medical schools and may have become worse during the last 11 years. Increased curricular coverage—including summative assessments—of these topics would ensure that future physicians are adequately equipped to encourage and support effective evidence-based quit attempts in their patients. [ABSTRACT FROM PUBLISHER]

Aims Lack of adherence to smoking cessation medication regimens is assumed to play a significant role in limiting their effectiveness. This study aimed to assess evidence for this assumption. Methods A systematic search was conducted, supplemented by expert consultation, of papers reporting on randomized trials and observational studies examining the association between adherence to cessation medication and the success of quit attempts. To rule out reverse causality, only studies where adherence was assessed prior to relapse were included. Five studies met the inclusion criteria and results were extracted independently by two researchers. Heterogeneity between studies precluded a pooled analysis of the data. Results Studies varied widely with regard to both the definition of adherence and outcome measures. The included studies only addressed adherence to nicotine replacement therapy. One study of lozenge use found that the amount of medication used between 1 and 2 weeks after the quit date predicted abstinence at 6 weeks [adjusted odds ratio ( OR) for 'high' versus 'low' lozenge use 1.25; 95% confidence interval ( CI) = 1.05-1.50; P < 0.02]. Similarly, one study found a significant impact of oral nicotine consumption during the first week on abstinence at 4 weeks (adjusted OR per additional mg/day = 1.05; CI = 1.01-1.10). Another study found that participants using nicotine replacement therapy for at least 5 weeks were significantly more likely to self-report continuous abstinence at 6 months. The remaining two studies failed to find a significant effect of treatment duration on outcome at 1 and 2 years but had very low power to detect such an effect. Conclusions There is modest evidence to support the assumption that lack of adherence to nicotine replacement therapy regimens undermines effectiveness in clinical studies. [ABSTRACT FROM AUTHOR]

Introduction: In many countries, smoking cessation interventions are not routinely delivered as recommended in national and international guidelines. This may be because of incorrect beliefs about their effectiveness. This study assessed which cessation methods are believed to be effective by medical students in different years of undergraduate education as well as predictors of correct beliefs about effectiveness.Methods: In this cross-sectional study, undergraduate students from 27 German medical schools were invited to complete a survey addressing demographic characteristics, smoking status, self-rated knowledge of health consequences, and treatment options for smoking and beliefs about the effectiveness of 8 different methods to achieve long-term smoking cessation. Predictors of beliefs were identified by means of multilevel modeling.Results: A total of 19,526 students completed the survey. Students greatly overestimated the effectiveness of unaided quitting, and differences between years of undergraduate education were small. In the final year, 51% of students wrongly believed that willpower alone was more effective than a comprehensive group cessation program, including nicotine replacement therapy. Multilevel modeling revealed that having never smoked, supporting public smoking bans, and recalling theoretical training in smoking cessation were associated with correct beliefs.Conclusions: A considerable proportion of German medical students believe that willpower alone is more effective than comprehensive treatment programs to support a quit attempt. [ABSTRACT FROM AUTHOR]

Introduction: In many countries, smoking cessation interventions are not routinely delivered as recommended in national and international guidelines. This may be because of incorrect beliefs about their effectiveness. This study assessed which cessation methods are believed to be effective by medical students in different years of undergraduate education as well as predictors of correct beliefs about effectiveness. Methods: In this cross-sectional study, undergraduate students from 27 German medical schools were invited to complete a survey addressing demographic characteristics, smoking status, self-rated knowledge of health consequences, and treatment options for smoking and beliefs about the effectiveness of 8 different methods to achieve long-term smoking cessation. Predictors of beliefs were identified by means of multilevel modeling. Results: A total of 19,526 students completed the survey. Students greatly overestimated the effectiveness of unaided quitting, and differences between years of undergraduate education were small. In the final year, 51% of students wrongly believed that willpower alone was more effective than a comprehensive group cessation program, including nicotine replacement therapy. Multilevel modeling revealed that having never smoked, supporting public smoking bans, and recalling theoretical training in smoking cessation were associated with correct beliefs. Conclusions: A considerable proportion of German medical students believe that willpower alone is more effective than comprehensive treatment programs to support a quit attempt. [ABSTRACT FROM PUBLISHER]

Background: Financial incentives are effective in moderating physician and patient behaviour, but they have not been studied in the context of medical education. Aim: This study assessed whether financial incentives can motivate students to acquire electrocardiogram (ECG) interpretation skills. Methods: Students enrolled for a cardio-respiratory teaching module ( n = 121) were randomised to an intervention (financial incentive) or a control (book voucher raffle) condition. All students took three validated exams of ECG interpretation skills (at module entry, module exit and seven weeks later). Only the exit exam was financially incentivised in the intervention group. The primary outcome was the proportion of students who correctly identified ≥60% of clinically important diagnoses in the exit exam. Results: Financial incentives more than doubled the odds of correctly identifying ≥60% of diagnoses in the exit exam (adjusted odds ratio 2.44, 95% confidence interval 1.05-5.67) and significantly increased student learning time. However, there was no significant effect on performance levels in the retention exam. Conclusions: Financial incentives increase reported learning time and examination results in the short-term. The lack of a sustained effect on performance suggests that financial incentives may foster a superficial or strategic rather than a deep approach to learning. [ABSTRACT FROM AUTHOR]

Aims: In Germany, the final year of undergraduate medical education ('practice year') consists of three 16-week clinical attachments, two of which are internal medicine and surgery. Students can choose a specific specialty for their third 16-week attachment. Practice year students do not receive specific teachingto prepare them forthe National Licensing Examination. It is unknown whether knowledge levels increase during this year. This study aimed at assessing knowledge at the beginning and the end of the final year of medical school. Methods: Three hundred pre-selected United States Medical Licensing Examination type items from ten medical disciplines were reviewed by ten recent medical graduates from the Netherlands and Germany. The resulting test included 150 items and was taken by 77 and 79 final year medical students from Göttingen and Hamburg at the beginning and the end of their practice year, respectively. Results: Cronbach's a of the pre-and post-test was 0.75 and 0.68, respectively. Mean percentscores in the pre-and post-test were 63.9±6.9 and 69.4±5.7, respectively (p<0.001; effectsize calculated as Cohen's d: 0.87). In individual students, post-test scores were particularly high for items related to their specific chosen specialty. Conclusion: The knowledge test used in this study provides a suitable external tool to assess progress of undergraduate medical students in their knowledge duringthe practice year. The pre-test may be used to guide individual learning behaviour duringthis final year of undergraduate education. [ABSTRACT FROM AUTHOR]

Background: Electrocardiogram (ECG) interpretation is a core clinical skill that needs to be acquired during undergraduate medical education. Intensive teaching is generally assumed to produce more favorable learning outcomes, but recent research suggests that examinations are more powerful drivers of student learning than instructional format. This study assessed the differential contribution of teaching format and examination consequences to learning outcome regarding ECG interpretation skills in undergraduate medical students. Methods: A total of 534 fourth-year medical students participated in a six-group (two sets of three), partially randomized trial. Students received three levels of teaching intensity: self-directed learning (two groups), lectures (two groups) or small-group peer teaching facilitated by more advanced students (two groups). One of the two groups on each level of teaching intensity was assessed in a formative, the other in a summative written ECG examination, which provided a maximum of 1% credit points of the total curriculum. The formative examination provided individual feedback without credit points. Main outcome was the correct identification of ⩾3 out of 5 diagnoses in original ECG tracings. Secondary outcome measures were time spent on independent study and use of additional study material. Results: Compared with formative assessments, summative assessments increased the odds of correctly identifying at least three out of five ECG diagnoses (OR 5.14; 95% CI 3.26 to 8.09), of spending at least 2 h/week extra on ECG self-study (OR 4.02; 95% CI 2.65 to 6.12) and of using additional learning material (OR 2.86; 95% CI 1.92 to 4.24). Lectures and peer teaching were associated with increased learning effort only, but did not augment examination performance. Conclusions: Medical educators need to be aware of the paramount role of summative assessments in promoting student learning. Consequently, examinations within medical schools need to be closely matched to the desired learning outcomes. Shifting resources from implementing innovative and costly teaching formats to designing more high-quality summative examinations warrants further investigation. [ABSTRACT FROM AUTHOR]

Tobacco smoking causes cardiovascular, respiratory and malignant disease, and stopping smoking is among the key medical interventions to lower the worldwide burden of these disorders. However, the addictive properties of cigarette smoking, including nicotine inhalation, render most quit attempts unsuccessful. Recommended therapies, including combinations of counselling and medication, produce long-term continuous abstinence rates of no more than 30%. Thus, more effective treatment options are needed. An intriguing novel therapeutic concept is vaccination against nicotine. The basic principle of this approach is that, after entering the systemic circulation, a substantial proportion of nicotine can be bound by antibodies. Once bound to antibodies, nicotine is no longer able to cross the blood-brain barrier. As a consequence, the rewarding effects of nicotine are diminished, and relapse to smoking is less likely to occur. Animal studies indicate that antibodies profoundly change the pharmacokinetics of the drug and can interfere with nicotine self-administration and impact on the severity of withdrawal symptoms. To date, five phase I/II clinical trials using vaccines against nicotine have been published. Results have been disappointing in that an increase in quit rates was only observed in small groups of smokers displaying particularly high antibody titres. The failure of encouraging preclinical data to completely translate to clinical studies may be partially explained by shortcomings of animal models of addiction and an incomplete understanding of the complex physiological and behavioural processes contributing to tobacco addiction. This review summarizes the current status of research and suggests some directions for the future development of vaccines against nicotine. Ideally, these vaccines could one day become part of a multifaceted approach to treating tobacco addiction that includes counselling and pharmacotherapy. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: COPD with emphysema causes marked neurohumoral activation. Angiotensin II receptors are highly expressed within the lung and interfere with mechanisms involved in the progression of emphysema. This study examined the effects of an angiotensin II receptor blocker (ARB) on pulmonary and systemic manifestations of emphysema in a mouse model. Methods: Female NMRI mice received five intratracheal instillations of porcine pancreatic elastase (emphysema; n = 11) or phosphate-buffered saline (PBS; n = 4). Emphysema severity was quantified histologically by mean linear intercept, exercise tolerance by treadmill running distance, and lung biomechanics by compliance. Following emphysema induction, 6 mice were treated with the ARB irbesartan for 8 weeks, while 5 mice receiving standard food served as controls. Results: Following emphysema induction, mean linear intercept was higher in elastase-treated than in PBS-treated lungs (103.0 ± 6.2 μm vs. 35.0 ± 0.6 μm; p = 0.043) while running distance was shorter in emphysema mice (418.6 ± 83.5 m vs. 906.6 ± 244.6 m, p = 0.028). Irbesartan-treated emphysema mice showed a lower mean linear intercept (90.8 ± 3.8 μm vs. 121.5 ± 8.1 μm; p = 0.005), improved compliance (163.6 ± 55.9 μl/cmH2O vs. 354.4 ± 72.5 μl/cmH2O; p = 0.063) and greater running distance (p ANOVA = 0.015) compared to emphysema mice receiving standard food. Conclusions: The ARB irbesartan elicits encouraging beneficial effects on emphysema severity, lung biomechanics and exercise capacity in an emphysema mouse model. These findings might help to understand the corresponding positive effects of angiotensin II receptor blockade noticed in patients with COPD. [Copyright &y& Elsevier]

Medical Education 2010: 44: 731–740 Objectives Interpretation of the electrocardiogram (ECG) is a core clinical skill that should be developed in undergraduate medical education. This study assessed whether small-group peer teaching is more effective than lectures in enhancing medical students’ ECG interpretation skills. In addition, the impact of assessment format on study outcome was analysed. Methods Two consecutive cohorts of Year 4 medical students ( n = 335) were randomised to receive either traditional ECG lectures or the same amount of small-group, near-peer teaching during a 6-week cardiorespiratory course. Before and after the course, written assessments of ECG interpretation skills were undertaken. Whereas this final assessment yielded a considerable amount of credit points for students in the first cohort, it was merely formative in nature for the second cohort. An unannounced retention test was applied 8 weeks after the end of the cardiovascular course. Results A significant advantage of near-peer teaching over lectures (effect size 0.33) was noted only in the second cohort, whereas, in the setting of a summative assessment, both teaching formats appeared to be equally effective. A summative instead of a formative assessment doubled the performance increase (Cohen’s d 4.9 versus 2.4), mitigating any difference between teaching formats. Within the second cohort, the significant difference between the two teaching formats was maintained in the retention test (p = 0.017). However, in both cohorts, a significant decrease in student performance was detected during the 8 weeks following the cardiovascular course. Conclusions Assessment format appeared to be more powerful than choice of instructional method in enhancing student learning. The effect observed in the second cohort was masked by an overriding incentive generated by the summative assessment in the first cohort. This masking effect should be considered in studies assessing the effectiveness of different teaching methods. [ABSTRACT FROM AUTHOR]

This historical cohort study conducted in a University Hospital between 2004 and 2006 included 322 smokers willing to quit and assessed whether adding a teaching session on nicotine addiction to a smoking cessation program could increase the proportion of participants using pharmacotherapy. The control cohort received the standard course while two short talks were added to the course for a consecutive intervention cohort. These talks used the metaphor of a pizza delivery service to explain neural mechanisms underlying nicotine addiction. Medication use was significantly more common in the intervention than control cohort (82.1% vs. 51.2%; adjusted odds ratio 4.0; 2.34–6.83). [ABSTRACT FROM AUTHOR]

Background: Bedside teaching is an important element of undergraduate medical education. However, the impact of curricular course structure on student outcome needs to be determined. Aims: This study assessed changes in fourth-year medical students' evaluations of clinical teaching sessions before and after the introduction of a new course format. Method: The curricular structure of bedside teaching sessions in cardiology was modified without changing the amount of teaching time. Clinical teachers were instructed about the new teaching format and learning objectives. The new format implemented for adult but not paediatric cardiology sessions was piloted with 143 students in winter 2007/08. By computing effect sizes, evaluation results were compared to data obtained from 185 students before the intervention. Results: Significant rating increases were observed for adult cardiology teaching sessions (Cohen's d = 0.66) but not paediatric cardiology sessions (d = 0.22). In addition to improving the structure and organization of the course, the intervention significantly impacted on students' perceptions of their learning outcome regarding practical skills (d = 0.69). Conclusions: Minimal curricular changes combined with basic faculty development measures significantly increase students' perception of learning outcome. Curricular structure needs to be considered when planning bedside teaching sessions in medical undergraduate training. [ABSTRACT FROM AUTHOR]

Introduction:: Prevention of smoking-related disease is a major challenge to medicine. Although interventions delivered by clinicians can reduce smoking rates, the teaching of smoking cessation methods is not a top priority in most medical curricula. [ABSTRACT FROM PUBLISHER]

Background: Systemic effects of chronic obstructive pulmonary disease (COPD) significantly contribute to severity and mortality of the disease. We aimed to develop a COPD/emphysema model exhibiting systemic manifestations of the disease. Methods: Female NMRI mice were treated 5 times intratracheally with porcine pancreatic elastase (emphysema) or phosphate-buffered saline (control). Emphysema severity was quantified histologically by mean linear intercept, exercise tolerance by treadmill running distance, diaphragm dysfunction using isolated muscle strips, pulmonary hypertension by measuring right ventricular pressure, and neurohumoral activation by determining urinary norepinephrine concentration. Results: Mean linear intercept was higher in emphysema (260.7 ± 26.8 μm) than in control lungs (24.7 ± 1.7 μm). Emphysema mice lost body weight, controls gained weight. Running distance was shorter in emphysema than in controls. Diaphragm muscle length was shorter in controls compared to emphysema. Fatigue tests of muscle strips revealed impaired relaxation in emphysema diaphragms. Maximum right ventricular pressure and norepinephrine were elevated in emphysema compared to controls. Linear correlations were observed between running distance changes and intercept, right ventricular weight, norepinephrine, and diaphragm length. Conclusion: The elastase mouse model exhibited severe emphysema with consecutive exercise limitation, and neurohumoral activation. The model may deepen our understanding of systemic aspects of COPD. [ABSTRACT FROM AUTHOR]

Objective: This study assessed a newly set-up, hospital-based smoking cessation clinic with regard to continuous abstinence rates and the effectiveness of concomittant nicotine replacement therapy. Methods: Smoking status of 369 participants of this 8-week cognitive-behavioural smoking cessation group programme was obtained using exhaled carbon monoxide at the end of the course as well as self-report 6 months after the course. In addition to demographic data, FTND score, SDS score, and usage of nicotine replacement products were recorded. Results: Overall, 29.8% of all participants reported to have been continuously abstinent for 6 months after the course. Success rates increased significantly during the first year after initiation of the programme (from 15 to 35%, p <0.001), indicating a learning process of the staff running the course. Nicotine replacement therapy was used by 51.3% of participants, but 58% of these discontinued its use within 5 weeks. Nicotine substitution for more than 5 weeks was associated with a 50% success rate after 6 months. Conclusions: Our data indicate a learning effect of smoking cessation course staff and a possible minimum duration required for nicotine replacement to be effective. Practice implications: The observed learning effect in smoking cessation programmes should be considered when evaluating newly established interventions of this kind. Patients tend to stop nicotine replacement therapy too early, thereby decreasing their chances of middle-term abstinence. [Copyright &y& Elsevier]

Intracellular pH (pHi) is an important factor for understanding cellular processes associated with the response of central neurons to metabolic disturbances such as anoxia or ischemia. In the present study, pHi was fluorometrically measured in 2′7′-bis(carboxyethyl)-5(6)-carboxyfluorescin (BCECF)-filled, voltage-clamped dorsal vagal neurons (DVN) of brainstem slices from rats during metabolic disturbances activating ATP-sensitive K+ (KATP) channels. Chemical anoxia induced by cyanide, rotenone or p-trifluoromethoxy-phenylhydrazone (FCCP) decreased pHi by >0.4 pH units. Untreated neurons with normal pHi baseline (7.2) responded to glucose-free superfusate after a delay of 7–16 min with a progressive fall of pHi. In contrast, pHi increased by >0.2 pH units after ∼10 min in cells that had a mean pHi of 6.8 due to incomplete recovery from a CN–induced acid load prior to glucose depletion. Metabolic arrest, induced by cyanide in glucose-free solution after 30 min preincubation in glucose-free saline, caused a progressive glutamate-mediated inward current with no change of pHi. Upon metabolic arrest, depolarization-evoked pHi decreases (∼0.2 pH units) were abolished, whereas glucose-free superfusate slightly delayed their recovery without major effects on amplitude. The glucose-dependent pHi fall coincided with activation of the KATP channel-mediated outward current, while KATP currents due to anoxia or metabolic arrest could reach their maximum in the absence of a major pHi change. The results indicate that the anoxic pHi decrease is due to enhanced glycolysis and lactate formation with often no obvious effect on KATP channel activity. The origin of glucose-dependent acidosis and its relation to KATP channel activity remain to be determined. [Copyright &y& Elsevier]

The evaluation of teaching can be an essential driver for curriculum development. Instruments for teaching evaluation are not only used for the purpose of quality assurance but also in the context of medical education research. Therefore, they must meet the common requirements for reliability and validity. This position paper from the GMA Teaching Evaluation Committee discusses strategic and methodological aspects of evaluation in the context of undergraduate medical education and related courses; and formulates recommendations for the further development of evaluation. First, a four-step approach to the design and implementation of evaluations is presented, then methodological and practical aspects are discussed in more detail. The focus here is on target and confounding variables, survey instruments as well as aspects of implementation and data protection. Finally, possible consequences from evaluation data for the four dimensions of teaching quality (structural and procedural aspects, teachers and outcomes) are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Inadequate smoking cessation interventions by physicians have been attributed to lack of training, and it is generally thought that additional education will improve patient care. However, interventions aimed at increasing knowledge and practical skills only address one determinant of behavior (capability). This prospective study assessed how much a teaching session for general practitioner (GP) trainees enrolled in Vocational Training Schemes in England also affected two other determinants (motivation and opportunity) specified by the COM-B theory of behavior.Methods: Between October and December 2015, GP trainees were given a 3.5-h training session in the theory and practice of smoking cessation. Questionnaires addressed motivation, capability, and opportunities to provide evidence-based brief advice to smokers at the beginning and end of the session, and 3 months later. They also looked at the recollection of previous teaching as well as knowledge, skills, intervention frequency, and perceived barriers against providing interventions.Results: Participants (n = 123) remembered little previous training on the subject and self-reported presession knowledge was minimal. Motivation was high throughout while capability and opportunity increased considerably during the session. No further change in these parameters was noted at 3 months. The proportion of participants stating they provided evidence-based brief advice to >50% of smokers increased from 25.2% before the session to 57.7% at follow-up. Lack of time remained a commonly cited barrier.Conclusions: Training elicited an immediate and sustained effect on capability, perceived opportunity, and behavior itself. While perceived barriers referring to capability were greatly reduced, barriers referring to opportunity (eg, lack of time) persisted.Implications: This is the first study evaluating a GP training session on smoking cessation with regard to the COM-B model. In a pre-post design with 3-month follow-up, we observed substantial and sustained changes in GP trainees' perceived capability and opportunity to provide evidence-based very brief advice, and these increases were paralleled by favorable changes in practice behavior. [ABSTRACT FROM AUTHOR]

Background: Professional and consistent smoking prevention and cessation may avoid many smoking-associated deaths worldwide. Dentists can exert a decisive influence on smoking behavior, as most people regularly visit a dentist. However, only if dentists have been trained sufficiently about the consequences of smoking and of smoking cessation methods might they fulfill this task appropriately. Objectives: The aim of our study was therefore to examine the prevalence of smokers among dental students in Germany, their attitude toward smoking in general, and their knowledge about tobacco-related diseases and smoking cessation programs. Methods: A cross-sectional survey among dental students in Germany was conducted in 2016. Students of the first and tenth semesters were asked to participate in this anonymous survey. The questionnaire included items concerning their own smoking habits, their knowledge about effects of smoking on health, and their attitude toward prevention and cessation in a dental setting. Results: Seven hundred and thirty dental students participated in this survey; 21% of the participating students were smokers. Their knowledge about smoking-related diseases was widespread. Some diseases were rarely known (only in 34% of students) and others were well known (in 99% of the students). Knowledge about health risks of e-cigarettes was low. About 30% of the participating students felt competent to encourage and support patients in cessation strategies; 2 out of 3 students were willing to improve their knowledge in that area. More than 85% confirmed that advice for smoking cessation should be one of the tasks of a dentist. Conclusions: Smoking is common among dental students, their knowledge about smoking-related health risks is moderate, and self-perceived smoking cessation skills are poor. More emphasis should be placed on education regarding smoking prevention and cessation methods. [ABSTRACT FROM AUTHOR]

Introduction: Almost half of smoking quit attempts are “spontaneous” (initiated as soon as the decision to quit has been made) and are associated with increased success rates. This study aimed to assess to what extent other factors may account for this association. Methods: Data were used from respondents to a survey representative of the adult population in England from 2006 to 2016. We included 2018 respondents who were current smokers at baseline and had attempted to quit between baseline and 6-month follow-up. Logistic regression models assessed the association between quit success and spontaneous quit attempts while adjusting for smoking, sociodemographic, and quit attempt characteristics. Results: Spontaneous quit attempts were associated with greater odds of quit success (OR = 1.31, 95% CI = 1.07 to 1.60) but the association was not significant in the fully adjusted model (ORadj = 1.19, 95% CI = 0.95 to 1.49). In this adjusted model, those who attempted to quit without cutting down first (ORadj = 3.08, 95% CI = 2.46 to 3.88) and were male (ORadj = 1.44, 95% CI = 1.16 to 1.80) had greater odds of success; although a greater number of attempts in the past 6 months, stronger urges to smoke (strong vs. none), higher daily cigarette consumption, and lower social grade (E vs. AB) were associated with lower odds of success (ORadj range = 0.32–0.98, p < .030). Quit attempts made without cutting down first were correlated with spontaneous quit attempts (r = .150, p < .001) and appeared to account for the diminished association between spontaneous quitting and success (ORadj = 1.18, 95% CI = 0.96 to 1.46). Conclusions: The increased success rate of spontaneous quit attempts appears to be because spontaneous quit attempts are more likely to be made without cutting down first. [ABSTRACT FROM AUTHOR]

The authors reflect on the implementation of an effective clinical interventions against problem drinking and smoking by the World Health Organization (WHO). They state that the World Health Assembly (WHA) has supported the execution of therapy programmes for patients with alcohol use disorders to reduce the harmful use of alcohol. The authors highlight the importance of medical journals and information to the development of clinical medicine in healthcare professionals.

Re-establishment of rigor mortis following mechanical loosening is used as part of the complex method for the forensic estimation of the time since death in human bodies and has formerly been reported to occur up to 8-12 h post-mortem (hpm). We recently described our observation of the phenomenon in up to 19 hpm in cases with in-hospital death. Due to the case selection (preceding illness, immobilisation), transfer of these results to forensic cases might be limited. We therefore examined 67 out-of-hospital cases of sudden death with known time points of death. Re-establishment of rigor mortis was positive in 52.2% of cases and was observed up to 20 hpm. In contrast to the current doctrine that a recurrence of rigor mortis is always of a lesser degree than its first manifestation in a given patient, muscular rigidity at re-establishment equalled or even exceeded the degree observed before dissolving in 21 joints. Furthermore, this is the first study to describe that the phenomenon appears to be independent of body or ambient temperature. [ABSTRACT FROM AUTHOR]

Serious games (computer-based learning games) are increasingly used in medical education at various levels, as user access is independent of location and time and promotes non-linear learning. In legal medicine, interactive digital media are still scarce. The freely accessible online serious game "Adventure Legal Medicine" was developed as part of the "Hamburg Open Online University". The goal was to teach the basics of forensic casework in a point-and-click adventure setting consisting of five cases. During development, 40 medical students were asked to evaluate the game anonymously. The System Usability Scale (SUS) resulted in a mean score of 86.7 (SD 8.3), which corresponds to above-average usability. Further specific evaluations revealed a good to very good rating of the game with no differences in terms of gender (p = 0.214), first-year versus advanced students (p = 0.393) and students who never/rarely or sometimes/often played computer games (p = 0.780). Since there are only a few digital media so far that allow curricular integration into undergraduate teaching in legal medicine, this serious game represents a possibility to integrate digital media into both face-to-face teaching and distance learning and to use it as a supplement to the medical school's own teaching offer, encouraging users to actively engage with the subject. [ABSTRACT FROM AUTHOR]

Background: Electrocardiogram (ECG) interpretation is a core clinical skill that needs to be acquired during undergraduate medical education. Intensive teaching is generally assumed to produce more favorable learning outcomes, but recent research suggests that examinations are more powerful drivers of student learning than instructional format. This study assessed the differential contribution of teaching format and examination consequences to learning outcome regarding ECG interpretation skills in undergraduate medical students.Methods: A total of 534 fourth-year medical students participated in a six-group (two sets of three), partially randomized trial. Students received three levels of teaching intensity: self-directed learning (two groups), lectures (two groups) or small-group peer teaching facilitated by more advanced students (two groups). One of the two groups on each level of teaching intensity was assessed in a formative, the other in a summative written ECG examination, which provided a maximum of 1% credit points of the total curriculum. The formative examination provided individual feedback without credit points. Main outcome was the correct identification of ≥3 out of 5 diagnoses in original ECG tracings. Secondary outcome measures were time spent on independent study and use of additional study material.Results: Compared with formative assessments, summative assessments increased the odds of correctly identifying at least three out of five ECG diagnoses (OR 5.14; 95% CI 3.26 to 8.09), of spending at least 2 h/week extra on ECG self-study (OR 4.02; 95% CI 2.65 to 6.12) and of using additional learning material (OR 2.86; 95% CI 1.92 to 4.24). Lectures and peer teaching were associated with increased learning effort only, but did not augment examination performance.Conclusions: Medical educators need to be aware of the paramount role of summative assessments in promoting student learning. Consequently, examinations within medical schools need to be closely matched to the desired learning outcomes. Shifting resources from implementing innovative and costly teaching formats to designing more high-quality summative examinations warrants further investigation. [ABSTRACT FROM AUTHOR]

Objective: Clinical reasoning is an essential skill, the foundations of which should be acquired during medical school. Within the format of test-based learning, such examinations can also be used to support the long-term retention of procedural knowledge necessary for clinical reasoning. The aim was to investigate whether repeated exposure to clinical cases in obstetrics and gynecology (OBGYN) with built-in questions leads to higher learning outcome than pure reading cases and what influence the delay between the intervention and the final test has on the retention of the respective content.Methods: In this non-randomised crossover study, 5th-year medical students (duration of the study is 6 years) taking a 1-week clinical attachment in OBGYN participated in computer-based case seminars in winter term 2020/2021, in which different case histories on gynecological-obstetric diseases were presented. Case content was identical for all groups, but the presentation format (cases with key feature questions vs read-only cases) of individual case vignettes changed weekly. The also intervention was repeated after 2 weeks for each group. Knowledge was assessed in an entry and an exit exam consisting of 40 short-answer questions.Results: A total of 94 out of 118 eligible students participated in the study (response rate: 79.7%). Learning outcome was significantly higher for items presented in the key feature format compared to items presented as read-only cases (74.2 ± 8.6% vs. 71.0 ± 9.2%; p = 0.017). Furthermore, the analysis showed that the temporal distance of the intervention package from the final examination had no influence on retention.Conclusion: This is the first study to demonstrate an effect of test-enhanced learning on clinical reasoning in the subject of OGBYN. In this cross-over study, repeated testing was more effective than repeated case-based learning alone. Curricular implementation of longitudinal key feature testing can thus improve learning outcomes for OBGYN. [ABSTRACT FROM AUTHOR]

Validation of examinations is usually based on classical test theory. In this study, we analysed a key feature examination according to item response theory and compared the results with those of a classical test theory approach. Over the course of five years, 805 fourth-year undergraduate students took a key feature examination on general medicine consisting of 30 items. Analyses were run according to a classical test theory approach as well as using item response theory. Classical test theory analyses are reported as item difficulty, discriminatory power, and Cronbach's alpha while item response theory analyses are presented as item characteristics curves, item information curves and a test information function. According to classical test theory findings, the examination was labelled as easy. Analyses according to item response theory more specifically indicated that the examination was most suited to identify struggling students. Furthermore, the analysis allowed for adapting the examination to specific ability ranges by removing items, as well as comparing multiple samples with varying ability ranges. Item response theory analyses revealed results not yielded by classical test theory. Thus, both approaches should be routinely combined to increase the information yield of examination data. [ABSTRACT FROM AUTHOR]

Aims and objectives: Digital teaching, learning and assessment have been part of medical education and continuing education for decades. The objective of this review paper is to highlight developments and perspectives in these areas in the GMS Journal for Medical Education (GMS JME). Methodology: In the spring of 2020, we conducted a systematic literature search of the Journal for Medical Education (JME) and analysed the articles with regard to different categories such as article type, digital tools used or mode of data collection. Results: Of the 132 articles analysed, 78 were digital interventions (53 of which were exploratory-descriptive), 28 were project descriptions, 16 were surveys of needs or equipment and 10 were concept papers. About one-third of the studies and project reports each dealt with virtual patients or case-based learning, whereas no articles were published on trends such as serious games or virtual reality. Overall, our analysis shows that in many respects, the studies on digital teaching were more broadly based, especially between 2006 and 2010, after which this trend tended to decline again. Conclusions: Our analysis shows that publications in the JME consider some key aspects of digital teaching in medical education and continuing education, such as educational videos or virtual patients. The variability of information and methods of presentation advocate the use of guidelines to optimise the quality of scientific papers. Furthermore, clues for future research topics and experimental study designs are identified. [ABSTRACT FROM AUTHOR]

Background: Due to the coronavirus pandemic, the medical faculties in the Federal Republic of Germany converted their curricula to digital formats on a large scale and very quickly in spring 2020 as an emer- gency measure. At the same time, a start was made on the nationwide exchange of digital teaching/learning materials via the online platform “LOOOP share” in order to save local resources. Among other things, virtual patient cases (VP) were shared across faculties for case-based learning, through which students can acquire clinical decision-making skills. Objectives: Within the framework of the cooperation project “National Learning Platforms for Digital Patient-Related Learning in Medical Studies” (DigiPaL), the usability of VPs for students and teachers should be improved, and the spectrum of disease patterns that are covered by VPs should be systematically expanded. Results: With the participation of many locations, a total of 150 VPs were developed by 96 case authors from 16 faculties, in addition to the existing 403 VPs. The thematic selection was made on the basis of criteria oriented to the National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM). After completion, these VPs were also made available to all faculties for free use via “LOOOP share” and the CASUS learning platform. Discussion: Even after the pandemic, these developed VPs should be available to the faculties and thus make a lasting contribution to improve medical training in Germany – especially in light of digital teaching formats being expressly advocated on the basis of the adapted current Medical Licensure Act (ÄApprO). A possible application is interdisciplinary learning of clinical decision-making with the help of blended learning formats within the framework of a longitudinal curriculum. The large number of involved colleagues and faculties shows that the nationally coordinated development of VPs across faculties was commonly seen as useful. [ABSTRACT FROM AUTHOR]

In describing the inverted classroom model (ICM), the following paper is meant to provide an introduction to the subject matter and to serve as a practical guide for those wishing to employ its methods in basic and advanced medical training and education. The ICM is a blended-learning method in which a self-directed learning phase (individual phase) precedes the classroom-instruction phase. During the online phase, factual knowledge is imparted that serves as a basis for the classroom phase. The classroom phase should subsequently be used to assimilate and implement the previously gained knowledge. In contrast, traditional course concepts impart factual knowledge in lectures, for example, or in other face-to-face teachingformats and are followed by the students' self-instruction in order to assimilate this knowledge. The goal of the ICM is the shift from passive learning to accelerated learning in order to foster learning at cognitively demanding levels such as analysis, synthesis and evaluation. The concurrent increase in production and use of screencasts and educational videos, the Open Educational Resources "movement" and the widespread use of Massive Open Online Courses (MOOCS) have contributed to the increased dissemination of the inverted-classroom method. The intention of the present paper is to provide an introduction to the subject matter and simultaneously to offer a short overview of important projects and research results in the field of medical education and other health professions. Furthermore, an outline is given of the advantages and disadvantages of the model as well as its potential benefit to the future of medical education and training. [ABSTRACT FROM AUTHOR]

Dieser Artikel beschreibt die Inverted-Classroom-Methode (ICM) im Sinne einer Einführung in die Thematik und soll als Praxisleitleitfaden für diejenigen dienen, die diese Methode in der medizinischen Aus-, Fort- und Weiterbildungeinsetzen möchten. Es handeltsich bei der ICM um einen Blended-Learning-Methode, bei dem eine Selbstlernphase (individuelle Phase) vor die Präsenzunterrichtsphase gesetzt wird. In der Online-Phase wird Faktenwissen vermittelt, das als Grundlage für die Präsenzphase dient. Die Präsenzphase soll anschließend dafür genutzt werden, das erlernte Wissen zu vertiefen und anzuwenden. Dem gegenüber stehen die traditionellen Kurskonzepte, in denen das Faktenwissen beispielsweise in Vorlesungen oder in anderen Präsenzunterricht-Formaten vermittelt wird und die Vertiefung dieses Wissens durch die Studierenden im Anschluss daran im Selbststudium stattfinden soll. Das Ziel der ICM ist die Verschiebung des passiven Lernens hin zum aktivierenden Lernen, um das Lernen auf kognitiv anspruchvollen Ebenen wie Analyse, Synthese und Evaluation zu unterstützen. Dabei haben die gestiegene Produktion und Nutzung von Screencasts und Lernvideos, die „Bewegung” der „Open Educational Resources” und die verbreitete Nutzung von „Massive Open Online Courses” (MOOCs) zu einer gestiegenen Verbreitung der Inverted-Classroom-Methode beigetragen. Der Artikel soll als Einführung in die Thematik dienen und dabei eine kurze Übersicht über wichtige Projekte und Forschungsergebnisse in der medizinischen Ausbildung und in weiteren Gesundheitsberufen geben. Außerdem werden die Vor- und Nachteile der Methode und ihr potentieller Nutzen für die zukünftige medizinische Aus- und Weiterbildung dargestellt. [ABSTRACT FROM AUTHOR]

Background: The coronavirus pandemic has led to increased use of digital teaching formats in medical education. A number of studies have assessed student satisfaction with these resources. However, there is a lack of studies investigating changes in student performance following the switch from contact to virtual teaching. Specifically, there are no studies linking student use of digital resources to learning outcome and examining predictors of failure. Methods: Student performance before (winter term 2019/20: contact teaching) and during (summer term 2020: no contact teaching) the pandemic was compared prospectively in a cohort of 162 medical students enrolled in the clinical phase of a five-year undergraduate curriculum. Use of and performance in various digital resources (case-based teaching in a modified flipped classroom approach; formative key feature examinations of clinical reasoning; daily multiple choice quizzes) was recorded in summer 2020. Student scores in summative examinations were compared to examination scores in the previous term. Associations between student characteristics, resource use and summative examination results were used to identify predictors of performance. Results: Not all students made complete use of the digital learning resources provided. Timely completion of tasks was associated with superior performance compared to delayed completion. Female students scored significantly fewer points in formative key feature examinations and digital quizzes. Overall, higher rankings within the student cohort (according to summative exams) in winter term 2019/20 as well as male gender predicted summative exam performance in summer 2020. Scores achieved in the first formative key feature examination predicted summative end-of-module exam scores. Conclusions: The association between timely completion of tasks as well as early performance in a module and summative exams might help to identify students at risk and offering help early on. The unexpected gender difference requires further study to determine whether the shift to a digital-only curriculum disadvantages female students. [ABSTRACT FROM AUTHOR]

Introduction: Observational and trial evidence conflict on the efficacy of two contrasting behavioral approaches to quitting smoking-gradual and abrupt. Observational data suggest an abrupt approach to quitting is superior to a gradual approach, whilst trials show no difference. One potential explanation is self-selection in observational data, whereby people can choose their quit approach, and those who find it harder to quit may be more likely to choose a gradual quit approach. This study aims to investigate potential explanations for these conflicting findings.Aims and Methods: This study aims to investigate potential explanations for these conflicting findings. We used observational data from a nationally representative sample of adults in England from November 2006 to February 2020 who reported smoking and had made at least one quit attempt in the past year (n = 21 542). We used logistic regression models to assess the association between abrupt versus gradual quit attempts and quit success, adjusting for sociodemographic, smoking, and quit attempt characteristics.Findings: Abrupt, versus gradual, attempts were associated with improved quit success in an unadjusted model (odds ratio = 2.02, 95% CI = 1.86 to 2.19). This association remained after adjusting for a broad range of relevant confounders (odds ratio = 1.75, 95% CI = 1.59 to 1.93).Conclusions: Among a representative sample of adults who had smoked and made a quit attempt in the past year, there was evidence of an association between abrupt attempts and quit success before and after adjusting for relevant confounders. This suggests that the differences in quit success seen between abrupt and gradual quit attempt types are not completely driven by self-selection in observational data.Implications: We investigated explanations for conflicting findings on the efficacy of gradual versus abrupt approaches to quitting smoking between trial and observational data. Despite adjusting observational data for sociodemographic, smoking, and quit attempt characteristics, an association between abrupt quitting and quit success remained. Therefore, differences in quit success were not completely driven by the self-selection of a gradual approach by people who found it especially difficult to quit or differences in the use of quitting aids. However, characteristics adjusted for were limited by the data available, and future research should continue to investigate the difference in findings across study types to inform cessation support. [ABSTRACT FROM AUTHOR]

The mechanically stimulated idiomuscular contraction of skeletal muscles is part of the widely used compound method for death time estimation and therefore represents an item of high relevance and practicability in forensic case work. However, data on the topic are scarce and inconsistent and the currently reported maximum time span for the occurrence of the phenomenon until 13 h post-mortem (hpm) is based on a single case report from the beginning of the twentieth century. Therefore, idiomuscular contraction following mechanical stimulation has been investigated in skeletal muscles of 270 cases with assured time of death at defined post-mortem time points between 7 and 15 hpm. Of all investigated cases, 45 (16.7%) showed a positive reaction with a preponderance of cases of sudden death. Our investigations confirmed the upper time limit of 13 hpm up until idiomuscular contraction could be stimulated. With every hour of the post-mortem interval, a 0.61-fold decrease of the phenomenon's occurrence was observed (95%CI, 0.52-0.72; p < 0.001). Furthermore, several parameters showed significant correlations with the likelihood of the phenomenon's occurrence, namely stimulation of upper arm as opposed to the thigh ( p < 0.001), gender ( p = 0.017), and BMI ( p < 0.001). These findings for the first time give reliable evidence of a post-mortem time limit of mechanically stimulated idiomuscular contraction and therefore contribute to the future application of the method in forensic case work. [ABSTRACT FROM AUTHOR]

Promoting smoking cessation is among the key medical interventions aimed at reducing worldwide morbidity and mortality in this century. Both behavioural counselling and pharmacotherapy have been shown to significantly increase long-term abstinence rates, and combining the two treatment modalities is recommended. This article provides an update on pharmacotherapy for smoking cessation in the general population. Current first-line agents used to support quit attempts are nicotine replacement therapy (NRT), bupropion and varenicline. Research suggests that abstinence rates can be increased by combining different forms of NRT or simultaneously administering NRT and non-nicotine medications. New treatments targeting the nicotinic acetylcholine receptor as well as other pathophysiological pathways involved in nicotine addiction are being developed, with nicotine vaccines now being tested in phase III clinical trials. Among the numerous research topics currently addressed, pharmacogenetics and tailoring therapy to specific groups of smokers look most promising. However, substantial progress is unlikely to be made unless social gradients impeding effective treatment of all smokers are overcome. In addition, public smoking bans and reimbursement of medication costs are crucial in reducing the future burden of disease caused by smoking on a global level. [ABSTRACT FROM AUTHOR]

Low response rates threaten the reliability and validity of student evaluations of teaching. Previous research has shown that asking students to predict how satisfied their fellow students were with a course produces reliable results at lower response rates. The aim of this study was to investigate whether this prediction-based method can also be used to evaluate student learning outcome. Before and after a cardiorespiratory module, 128 fourth-year medical students provided self-assessments and predictions of performance on 27 specific learning objectives and took formative tests on the respective contents. Pre-post performance gain was compared across all three modalities. Formative exam results indicated a performance gain of 63.0%. Self-assessed and prediction-based performance gains were identical (67.8%) but both slightly overestimated actual performance gain. Irrespective of the method used, a response rate of 20% was sufficient to produce reliable results. Compared to male students, females greatly overestimated their peers' performance which led to inflated performance gain values. Student self-assessments and predictions are equally valid sources of learning outcome measures, and low response rates are sufficient to produce stable results. When using a prediction-based approach, a tendency to overestimate learning outcome in female students needs to be taken into account. [ABSTRACT FROM AUTHOR]

Introduction: In summer term 2020, the clinical phase of the undergraduate medical curriculum at University Medical Center Göttingen was restructured since distance teaching had to be used predominantly due to contact restrictions during the COVID-19 pandemic. This paper investigates the impact of restructuring the clinical curriculum on medical students' satisfaction and learning outcomes. Methods: In each cohort, the 13-week curriculum was divided into two parts: During the first 9 weeks, factual knowledge was imparted using distance teaching by means of a modified inverted classroom approach. This was followed by a 4-week period of adapted classroom teaching involving both real and virtual patients in order to train students' practical skills. The evaluation of the 21 clinical modules comprised students' satisfaction with distance teaching as well as students' learning outcome. The latter was assessed by means of comparative self-assessment (CSA) gain and the results of the module exams, respectively. Data of summer term 2020 (= distance teaching, DT) were compared with respective data of winter term 2019/20 (= classroom teaching, CT) and analysed for differences and correlations. Results: Response rates of evaluations were 51.3% in CT and 19.3% in DT. There was no significant difference between mean scores in module exams in CT and DT, respectively. However, CSA gain was significantly lower in DT (p=0.047) compared with CT. Further analyses revealed that CSA gain depended on the time point of data collection: CSA gain was lower the more time had passed since the end of a specific module. Moreover, we found positive correlations between CSA gain and students' satisfaction with various aspects of distance teaching, particularly with "communication between teachers and students" (rho=0.674; p=0.002). Discussion and conclusions: Although some limitations and confounding factors have to be taken into account (such as evaluation response rates, assessment time points, and proportion of familiar items in module exams), the following recommendations can be derived from our findings: A valid assessment of students' learning outcome by means of exam results requires that as few exam items as possible are familiar to the students. CSA gain seems to be valid if assessment time points are standardised and not contaminated by students' learning activities for other modules. Good communication between teachers and students may contribute to increase students' satisfaction with distance teaching. [ABSTRACT FROM AUTHOR]

The objective of the present study was to investigate the association between angiotensin-converting enzyme (ACE) inhibitor use and cancer incidence (overall, and breast, prostate, and colorectal cancers specifically) in a large representative sample of US adults. Cross-sectional data on cancer diagnosis, timing of cancer diagnosis, ACE inhibitor use, and other characteristics were extracted from 49 512 adults aged ≥ 20 years participating in the National Health and Nutrition Examination Survey (1999–2016). Multivariable-logistic and propensity score matching (PSM) regressions examined the relationship between pre-diagnosis use of ACE inhibitors and diagnosis of all cancers, and breast, prostate, and colorectal cancers specifically. Overall, we observed an increased likelihood of cancer diagnosis [odds ratio (OR) 1.269, 95% confidence interval (CI) 1.088–1.480] among those who used ACE inhibitors compared to non-ACE inhibitor use, and for prostate cancer diagnosis (OR 1.438, 95% CI 1.090–1.897), after adjusting for age, sex, body mass index, race/ethnicity, educational attainment, physical activity, alcohol drinking status, smoking status, and high blood pressure. PSM regression retrieved more conservative estimates such that the increased likelihood of cancer diagnosis was only observed when comparing ACE inhibitor users with non-drug users (OR 1.022, 95% CI 1.016–1.027). Compared with non-ACE inhibitor use, ACE inhibitor use was associated with an increased risk of prostate cancer. In conclusion, in this large representative sample of US adults, it was found that ACE inhibitor use may have a marginal influence on some cancers. [ABSTRACT FROM AUTHOR]

Introduction: Verifying self-reports of smoking abstinence is challenging in studies that involve remote data collection. Resting heart rate (HR) decreases during smoking abstinence. This study assessed whether a decrease in resting HR measured using freely available smartphone apps could potentially be used to verify smoking abstinence.Methods: This study involved a repeated measures experimental design, with data collection in natural setting. Participants were 18 adult, daily smokers. They recorded resting HR in beats per minute (bpm) using freely available smartphone apps during five timepoints (two in the morning and three postnoon) on each of 3 days. The outcome measure was the mean of the postnoon HR recordings. The experimental condition for each of the 3 days (counterbalanced order) was as follows: (1) smoking as usual, (2) not smoking without nicotine replacement therapy (NRT), or (3) not smoking but using NRT. Abstinence was verified using expired-air carbon monoxide (CO) concentration.Results: Compared with the smoking as usual condition, mean HR was 13.4 bpm lower (95% confidence interval [CI] = 5.4 to 21.4, p = .001) in the not smoking without NRT condition and 10.4 bpm lower (95% CI = 3.1 to 17.8, p = 0.004) in the not smoking with NRT condition. There was no statistically significant difference in HR between the two not smoking conditions (p = .39). Abstinence during not smoking days without and with NRT was CO-verified in 18/18 and in 16/18 cases, respectively.Conclusions: Self-recording of resting HR in natural setting using smartphone apps shows a reliable decrease in response to smoking abstinence and may provide a basis for remote verification in smoking cessation studies.Implications: Remote verification of self-reported abstinence in smoking cessation studies remains challenging. Smoking abstinence has been shown to decrease resting HR under laboratory conditions. This study demonstrated that self-recording using freely available smartphone apps shows reliable decreases in resting HR during smoking abstinence and may provide a basis for inexpensive remote verification of smoking abstinence. [ABSTRACT FROM AUTHOR]

Background: Smoking is one of the world's major health problems and dental professionals are in a unique position to promote smoking cessation. However, according to the current literature, neither dental students nor dentists feel adequately prepared to counsel smokers. The purpose of this study was to develop and implement a teaching intervention on smoking cessation for fourth‐year dental students and assess its effectiveness in terms of learning outcome on knowledge, communication skills and attitudes. Materials and Methods: In this prospective intervention study, students in the intervention group (n = 28) participated in a teaching module consisting of a podcast, an interactive lecture, a seminar, and small‐group sessions with role‐play interactions. Knowledge, communication skills and attitudes were measured using written examinations and an objective structured clinical examination (OSCE) at the end of the module and 6 months later. Results were compared with data from a historical control group (n = 27) receiving standard teaching. Results: Compared with the control group, students in the intervention group had higher scores in the knowledge test (67.1% vs 41.8%; P <.001; d = 2.8) as well as in the OSCE (74.9% vs 44.7%; P <.001; d = 2.3) and also retained more knowledge (52.7% vs 36.5%; P <.001; d = 2.0) and skills (71.8% vs 47.6%; P <.001; d = 2.5) over a period of 6 months. Attitudes were similar across groups and time‐points. Conclusion: The teaching intervention equipped dental students with specific knowledge and skills required to effectively counsel smoking patients. Further research is required to assess the transfer of these skills to the clinical setting. [ABSTRACT FROM AUTHOR]

Background: Little is known about evaluation practices as well as performance-oriented allocation of resources according to teaching quality at German medical schools. For this reason, the Association of the Scientific Medical Societies in Germany and the German Association of Medical Faculties aimed to analyse current practices at German medical schools. Methods: Data were collected by a questionnaire which was sent to all medical schools in Germany. Results: 30 medical schools with 33 undergraduate medical programs participated in the survey (response rate: 83%). The evaluation tools used at these schools mainly assessed structural and procedural aspects of teaching and were designed to obtain overall student ratings of teaching quality. Evaluation tools were quite heterogeneous across the sample, and some uncertainty remained with regard to the psychometric properties of these tools and whether they meet international quality standards. Various algorithms underlying resource allocation for teaching are being used, but most focus on quantity rather than quality of teaching. Conclusion: A nationwide agreement on a generalizable definition of high-quality teaching is desirable. At the same time, reliable and valid tools measuring teaching quality need to be identified and/or created. This could be accomplished through a wider collaboration of medical schools and could represent an advancement for the allocation of resources for high-quality teaching. [ABSTRACT FROM AUTHOR]

Post-mortem chemical excitability of the iris is one of the non-temperature-based methods in forensic diagnosis of the time since death. Although several authors reported on their findings, using different measurement methods, currently used time limits are based on a single dissertation which has recently been doubted to be applicable for forensic purpose. We investigated changes in pupil-iris ratio after application of acetylcholine (n = 79) or tropicamide (n = 58) and in controls at upper and lower time limits that are suggested in the current literature, using a digital photography-based measurement method with excellent reliability. We observed "positive," "negative," and "paradox" reactions in both intervention and control conditions at all investigated post-mortem time points, suggesting spontaneous changes in pupil size to be causative for the finding. According to our observations, post-mortem chemical excitability of the iris should not be used in forensic death time estimation, as results may cause false conclusions regarding the correct time point of death and might therefore be strongly misleading. [ABSTRACT FROM AUTHOR]

Introduction: Serious Games are increasingly being used in undergraduate medical education. They are usually intended to enhance learning with a focus on knowledge acquisition and skills development. According to the current literature, few studies have assessed their effectiveness regarding clinical reasoning (CR). The aim of this prospective study was to compare a Serious Game, the virtual Accident & Emergency department ‘EMERGE’ to small-group problem-based learning (PBL) regarding student learning outcome on clinical reasoning in the short term. Methods: A total of 112 final-year medical students self-selected to participate in ten 90-minute sessions of either small-group PBL or playing EMERGE. CR was assessed in a formative examination consisting of six key feature cases and a final 45-minute EMERGE session. Results: Overall, the EMERGE group (n = 78) scored significantly higher than the PBL group (n = 34) in the key feature examination (62.5 (IQR: 17.7)% vs. 54.2 (IQR: 21.9)%; p = 0.015). There was no significant difference in performance levels between groups regarding those cases which had been discussed in both instructional formats during the training phase. In the final EMERGE session, the EMERGE group achieved significantly better results than the PBL group in all four cases regarding the total score as well as in three of four cases regarding the final diagnosis and the correct therapeutic interventions. Conclusion: EMERGE can be used effectively for CR training in undergraduate medical education. The difference in key feature exam scores was driven by additional exposure to more cases in EMERGE compared to PBL despite identical learning time in both instructional formats. EMERGE is a potential alternative to intensive small-group teaching. Further work is needed to establish how Serious Games enhance CR most effectively. [ABSTRACT FROM AUTHOR]

Summary: Background: Student evaluations of teaching can provide useful feedback for teachers and programme coordinators alike. We have designed a novel evaluation tool assessing teacher performance and student learning outcome. This tool was implemented at two German medical schools. In this article, we report student and teacher perceptions of the novel tool, and the implementation process. Methods: Focus group discussions as well as one‐to‐one interviews involving 22 teachers and 31 undergraduate medical students were conducted. Following adjustments to the feedback reports (e.g. the colour coding of results) at one medical school, 42 teachers were asked about their perceptions of the revised report and the personal benefit of the evaluation tool. Results: Teachers appreciated the individual feedback provided by the evaluation tool and stated that they wanted to improve their teaching, based on the results; however, they missed most of the preparative communication. Students were unsure about the additional benefit of the instrument compared with traditional evaluation tools. A majority was unwilling to complete evaluation forms in their spare time, and some felt that the new questionnaire was too long and that the evaluations occurred too often. They were particularly interested in feedback on how their comments have helped to further improve teaching. Student evaluations of teaching can provide useful feedback Conclusion: Despite evidence of the utility of the tool for individual teachers, implementation of changes to the process of evaluation appears to have been suboptimal, mainly owing to a perceived lack of communication. In order to motivate students to provide evaluation data, feedback loops including aims and consequences should be established. [ABSTRACT FROM AUTHOR]

Background:Evaluation is an integral part of curriculum development in medical education. Given the peculiarities of bedside teaching, specific evaluation tools for this instructional format are needed. Development of these tools should be informed by appropriate frameworks. The purpose of this study was to develop a specific evaluation tool for bedside teaching based on the Stanford Faculty Development Program’s clinical teaching framework. Methods:Based on a literature review yielding 47 evaluation items, an 18-item questionnaire was compiled and subsequently completed by undergraduate medical students at two German universities. Reliability and validity were assessed in an exploratory full information item factor analysis (study one) and a confirmatory factor analysis as well as a measurement invariance analysis (study two). Results:The exploratory analysis involving 824 students revealed a three-factor structure. Reliability estimates of the subscales were satisfactory (α = 0.71–0.84). The model yielded satisfactory fit indices in the confirmatory factor analysis involving 1043 students. Discussion:The new questionnaire is short and yet based on a widely-used framework for clinical teaching. The analyses presented here indicate good reliability and validity of the instrument. Future research needs to investigate whether feedback generated from this tool helps to improve teaching quality and student learning outcome. [ABSTRACT FROM PUBLISHER]