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Background: The task of the Competence Centers for vocational training (KW) is to increase the attractiveness and quality of vocational (=post-graduate) training in general practice. For this purpose, they offer, among other things, a structured seminar program for post-graduate trainees in general practice (GP-trainees). During the Covid-19 pandemic the seminar program of the KWBW-Verbundweiterbildungplus® in Baden-Württemberg was converted to digital formats. The goal of the paper is to evaluate the acceptance by the GP-trainees and lecturers, to describe experiences with the conversion to e-learning and to derive recommendations with regard to the future orientation of seminar programs in post-graduate as well as continuing medical education. The implementation was based on a modified Kern-cycle and aimed at offering eight teaching units of 45 minutes each to a large number of GP-trainees. It tried to maintain the high quality of content and education as well as the interactive character of the previous seminars. For this purpose, the events were designed as synchronous webinars (six units) with asynchronous preparation and post-processing (two units) according to the flipped classroom method. The evaluation by the participating GP-trainees and lecturers was performed online using a multi-center developed and pre-piloted questionnaire. Results and discussion: N=101 GP-trainees participated in the evaluation of five individual seminar days in the second quarter of 2020 (response rate 97%). 58% (N=59) of the trainees were satisfied or very satisfied with the implementation. 82% (n=83) rated pre-tasks as helpful. 99% (n=100) would participate in an online seminar again. For 52% (n=53) of the trainees, the attitude towards e-learning had changed positively. The main advantages mentioned were no travel, save in time and costs as well as increased flexibility. The main disadvantages mentioned were less personal interaction and technical obstacles. The high acceptance of the new digital format showed the fundamental potential of e-learning in continuing medical education. The experiences can be a source of inspiration for other departments and KW. However, it also shows that important goals of KW, such as the personal interaction of the peer group, could not be achieved. In the future, it is important to develop a suitable mix of presence and digital formats with the aim to improve the attractiveness as well as sustainability of continuing medical education., Hintergrund: Um die Attraktivität und Qualität der Weiterbildung in der Allgemeinmedizin zu steigern, bieten die Kompetenzzentren Weiterbildung (KW) u.a. ein strukturiertes Seminarprogramm für Ärztinnen und Ärzte in Weiterbildung (ÄiW) an. Im Zuge der Covid-19-Pandemie wurde das Seminarprogramm der KWBW-Verbundweiterbildungplus® in Baden-Württemberg auf digitale Formate umgestellt. Ziel der Arbeit ist es, die Akzeptanz bei ÄiW und Dozierenden zu evaluieren, die Erfahrungen bei der Umstellung auf E-Learning zu beschreiben und daraus Empfehlungen abzuleiten im Hinblick auf die zukünftige Ausrichtung von Seminarprogrammen in der Facharztweiterbildung. Die Umsetzung orientierte sich an einem modifizierten Kern-Zyklus und hatte zum Ziel, einer großen Zahl von ÄiW weiterhin acht Unterrichtseinheiten (UE) à 45 min anbieten zu können und dabei die hohe inhaltliche und didaktische Qualität sowie den interaktiven Charakter der bisherigen Seminare beizubehalten. Dazu wurden die Veranstaltungen als synchrone Webinare (sechs UE) mit asynchroner Vor- und Nachbereitung (zwei UE) im Sinne der flipped classroom Methode konzipiert. Die Evaluation durch die teilnehmenden ÄiW und Dozierenden erfolgte online mittels eines multizentrisch entwickelten und vorab pilotierten Fragebogens. Ergebnisse und Diskussion: An der Evaluation der fünf Einzelseminartage im zweiten Quartal 2020 nahmen N=101 ÄiW teil (Rücklauf 97%). 58% (N=59) der ÄiW waren mit der Umsetzung zufrieden oder sehr zufrieden. 82% (N=83) empfanden die Vorbereitungsaufgaben als hilfreich. 99% (N=100) würden erneut an einem Online-Seminar teilnehmen. Bei 52% (N=53) der ÄiW hat sich die Einstellung gegenüber E-Learning positiv geändert. Vorteile ergäben sich v.a. durch den Wegfall der Anreise, Zeit- und Kostenersparnisse sowie eine erhöhte Flexibilität. Als nachteilig wurden insbesondere der geringere persönliche Austausch und technische Hürden genannt. Die hohe Akzeptanz des neuen digitalen Formats zeigt das grundsätzliche Potenzial von E-Learning in der ärztlichen Weiterbildung. Die Erfahrungen können Impulsgeber für andere Fachbereiche und KW sein. Allerdings zeigt sich auch, dass wichtige Ziele der KW, wie der persönliche kollegiale Austausch, damit nicht erreicht werden können. Für die Zukunft gilt es, eine geeignete Mischung aus Präsenz und digitalen Formaten zu entwickeln mit dem Ziel, die ärztliche Weiterbildung noch attraktiver und zukunftsfähiger zu gestalten., GMS Journal for Medical Education; 37(7):Doc97

A live attenuated vaccine (Zostavax (R)) against herpes zoster (HZ) and posther-petic neuralgia (PHN) was licensed for persons 50 years of age and older in 2006 and became available in Germany in September 2013. Based on the conclusion, that an effective and sustainable reduction of the HZ disease burden cannot be achieved with this vaccine, the STIKO decided against issuing a recommendation for routine HZ vaccination at this time. This decision is based on a systematic review of available data on the efficacy, duration of protection, and safety of the vaccine, and is supported by the results of health economic modelling. Both, the risk of developing HZ and the severity of the illness increase markedly with age. The efficacy of the vaccine, however, decreases with advancing age, from 70% for persons in their 50s to 41% for persons in their 70s to less than 20% for persons 80 years of age and older. The duration of vaccine related protection is limited to only a few years. The modelling results show only a slight, age-dependent reduction in the total number of HZ cases through vaccination with the live attenuated vaccine. The reduction ranged from 2.6% for persons vaccinated at the age of 50 to 0.6% for those vaccinated at the age of 80, based on assumed vaccine coverage of 35.5%. In addition to the vaccine's poor efficacy and duration of protection, HZ vaccination does not offer any added value in terms of herd immunity, since HZ is a disease of an endogenously reactivated pathogen with low transmission potential. Finally, the live attenuated vaccine is often contraindicated in persons who are at greatest risk of HZ and its complications. Thus, in the overall appraisal, the epidemiological benefit-risk assessment of the HZ vaccination did not lead to a recommendation for routine vaccination with the live attenuated vaccine. An individual benefit-risk assessment may, however, lead to a different decision in individual patients.

Rare species present a challenge under changing environmental conditions as the genetic consequences of rarity may limit species ability to adapt to environmental change. To evaluate the evolutionary potential of a rare species, we assessed variation in traits important to plant fitness using multigenerational common garden experiments. Torrey pine, Pinus torreyana Parry, is one of the rarest pines in the world, restricted to one mainland and one island population. Morphological differentiation between island and mainland populations suggests adaptation to local environments may have contributed to trait variation. The distribution of phenotypic variances within the common garden suggests distinct population‐specific growth trajectories underlay genetic differences, with the island population exhibiting substantially reduced genetic variance for growth relative to the mainland population. Furthermore, F1 hybrids, representing a cross between mainland and island trees, exhibit increased height accumulation and fecundity relative to mainland and island parents. This may indicate genetic rescue via intraspecific hybridization could provide the necessary genetic variation to persist in environments modified as a result of climate change. Long‐term common garden experiments, such as these, provide invaluable resources to assess the distribution of genetic variance that may inform conservation strategies to preserve evolutionary potential of rare species, including genetic rescue.

Zusammenfassung Hintergrund Fur das Programm der Verbundweiterbildungplus Baden-Wurttemberg wurde ein Train-The-Trainer–Kurs (TTT-Kurs) fur weiterbildungsbefugte Arztinnen und Arzte fur das Fach Allgemeinmedizin entwickelt. Dieser vermittelt in 9,5 Unterrichtseinheiten a 45 Minuten inhaltliche, organisatorische und didaktische Qualifikationen fur die Weiterbildungstatigkeit. Der vorliegende Artikel beschreibt diesen Kurs und die Analyse der Begleitevaluation des seit funf Jahren bestehenden Angebotes und zieht Ruckschlusse fur die zukunftige Entwicklung der Kursinhalte fur im Aufbau befindliche TTT-Projekte. Methodik Fur die Evaluation des Kurses wurde ein Evaluationsbogen verwendet, der die Aspekte Informationsgehalt, Bezug zur Praxis, eigene Beteiligungsmoglichkeit und Arbeitsatmosphare der Seminare sowie didaktische Kompetenz der Dozenten abdeckt. Von Juli 2011 bis Marz 2016 nahmen 256 Teilnehmer an einer TTT-Veranstaltung teil und erhielten einen Evaluationsbogen. Die Daten wurden deskriptiv ausgewertet. Ergebnisse Insgesamt konnten 249 Evaluationsbogen ausgewertet werden (Rucklauf 97%). Die Teilnehmer waren mit der Gesamt-Veranstaltung, der Organisation und dem kollegialen Austausch sowie den einzelnen Unterrichtseinheiten durchgehend (sehr) zufrieden. Die Freitext-Ruckmeldungen waren ebenfalls uberwiegend positiv, insbesondere Informationen uber organisatorische und rechtliche Rahmenbedingungen sowie praktische Ubungen im Geben von Feedback als Instrument der Forderung von beruflicher Motivation und arztlicher Haltung wurden sehr geschatzt. Verbesserungswunsche seitens der Teilnehmer waren beispielsweise eine Wiederholung bzw. Vertiefung der Schulungsinhalte. Schlussfolgerungen Die teilnehmenden weiterbildungsbefugten Arztinnen und Arzte bewerteten den TTT-Kurs als sehr gut und erlebten diese Fortbildung als sehr bereichernd. Zukunftig sollten wiederkehrende Qualifikationsangebote und die Moglichkeit zum regelmasigen Austausch unter Weiterbildungsbefugten angeboten werden.

Zusammenfassung Ziel der Studie: Allgemeinmedizin (AM) beinhaltet die Grundversorgung aller Patienten. Dementsprechend führen Allgemeinärzte vielfältige diagnostische oder therapeutische Maßnahmen (= medizinische Prozeduren) durch. Für die Abschätzung des Leistungsspektrums von Hausärzten aus Sicht der Versorgungsforschung ist es unabdingbar, die wesentlichen medizinischen Prozeduren, die von Allgemeinärzten vorgehalten werden, zu kennen und wesentliche Einflussfaktoren darauf zu identifizieren. Methodik: Aus den Ergebnissen einer selektiven Literaturrecherche, den Anforderungen der Weiterbildungsordnung und den Erfahrungen der Autoren aus dem bisherigen Entwicklungsprozess des kompetenzbasierten Curriculums AM wurde ein Fragebogen mit 89 verschiedenen medizinischen Prozeduren erstellt. Dieser wurde an eine zufällige Stichprobe von 1 576 Allgemeinärzten in ganz Deutschland versendet. Ergebnisse: Die Rücklaufquote betrug 42%. 42 der 89 Prozeduren wurden von mindestens 50% der Teilnehmer in ihrer Praxis durchgeführt. Diese Prozeduren betreffen vor allem solche, die der Haut, den Augen, den Ohren, der Nase, dem Gastrointestinaltrakt, dem Harntrakt und dem Muskuloskeletalsystem zugeordnet werden können. Signifikante Unterschiede zeigten sich bei 25 der 42 häufigsten Prozeduren hinsichtlich ländlich und städtisch praktizierender Ärzte, bei 9 Prozeduren hinsichtlich der Dauer der hausärztlichen Tätigkeit und bei 19 Prozeduren hinsichtlich des Geschlechts der Teilnehmer. Schlussfolgerung: Mit der vorliegenden Erhebung konnte erstmals gezeigt werden, welche medizinischen Prozeduren von Allgemeinärzten mit welcher Häufigkeit in Deutschland durchgeführt werden. Mit der Lokalisation des Praxissitzes im ländlichen oder städtischen Bereich, dem Geschlecht und der Niederlassungsdauer konnten wesentliche Einflussfaktoren auf das Leistungsspektrum identifiziert werden.

Zusammenfassung Hintergrund Das Konzept der Deutschen Gesellschaft fur Allgemeinmedizin und Familienmedizin (DEGAM) fordert Begleitseminare uber die gesamte Weiterbildungszeit, um allgemeinmedizin-spezifisches Wissen und Kompetenzen sowie eine Vernetzung und Identitatsbildung von Arzten in Weiterbildung (AiW) zu fordern. Seit 2009 werden solche Seminare im Rahmen der Verbundweiterbildung plus Baden-Wurttemberg (VWB plus Ba-Wu) angeboten. Ziel dieses Artikels ist es, die Entwicklungen der Schulungstage der VWB plus Ba-Wu zu beschreiben und daraus Implikationen fur sich deutschlandweit entwickelnde Verbundweiterbildungsprogramme abzuleiten. Methoden Von 2009 bis 2015 wurden die Daten aller Schulungstage deskriptiv analysiert. Dabei wurden die abgehaltenen Unterrichtseinheiten sowie die Anzahl der Dozenten und deren fachliche Qualifikation ermittelt. Von zwei Wissenschaftlern wurden die Seminarinhalte unabhangig voneinander kategorisiert und dem Kompetenzbasierten Curriculum Allgemeinmedizin (KCA) zugeordnet. Ergebnisse Bisher nahmen 600 AiW an einer Auftaktveranstaltung der VWB plus Ba-Wu teil. Es wurden insgesamt 1.116 Unterrichtseinheiten mit 160 unterschiedlichen Seminarthemen abgehaltenen, die das gesamte KCA und daruber hinaus weitere Themen abdeckten. Um die organisatorischen Ablaufe bewaltigen zu konnen, wurde eine grundlegende Umstrukturierung der Schulungstage sowie die Entwicklung einer spezifischen, elektronisch unterstutzenden Software notwendig. 56% der Seminare wurden von Facharzten bzw. AiW fur Allgemeinmedizin abgehalten. Die Veranstaltungen sowie der kollegiale Austausch wurden durchgehend (sehr) gut von den AiW bewertet. Schlussfolgerung Um Begleitseminare in Verbundweiterbildungsprojekten zielgruppen- und bedarfsgerecht auszurichten, ist es entscheidend, die Inhalte thematisch an allen drei Teilen des KCA – medizinische Expertise, Kompetenzen und Prozeduren - und damit spezifisch-allgemeinmedizinisch auszurichten. Ein Dozentenleitfaden soll zukunftig helfen, dass deutschlandweit einheitliche Standards fur Didaktik und Qualifikationen der Dozenten bekannt sind. Die steigende Nachfrage von Verbundweiterbildungsprojekten bedeutet komplexe Organisationsablaufe, die ab einer Teilnehmerzahl von ca. 200 einer Softwareunterstutzung bedurfen. Diese soll zukunftig noch weiterentwickelt werden vor allem in Hinblick auf eine Integration des KCA.

Summary Introduction Pre- and postgraduate education is meant to be competency-based. Over the last two decades various competency frameworks have been published. An important aspect of competency is professionalism, being discussed widely in the literature while a clear-cut definition is still lacking. The purpose of this study was to translate the Nijmegen Professionalism Scale into the German language, to adapt the scale to the German setting and to examine the psychometric properties, test-retest reliability and feasibility of the culturally adapted instrument designed to assess professionalism in general practice, in addition to the validity of the concept of professionalism and to testify the transfer across linguistic, cultural and societal differences. Method After translating the Nijmegen Professional Scale into German, we conducted its cultural adaptation, the German Professionalism Scale (Pro-D). Its psychometric properties were assessed using Cronbach's α, descriptive statistics, and test-retest reliability. The validation of the construct was analysed by confirmatory factor analysis. Feasibility was confirmed in interviews with GP trainees and their trainers. Results A total of 133 trainees completed the Pro-D. The Pro-D showed high internal consistency (Cronbach's α 0.93) and good test-retest reliability (Spearman's rank correlation and Wilcoxon's matched-pairs test) for the different domains. Confirmatory factor analysis was unable to establish construct validity. Change in sensitivity of the instrument was good. Statements of interviews confirmed the feasibility of the new instrument. Conclusions We found good psychometric properties for the Pro-D. This might indicate transferability of the concept across linguistic, cultural and societal differences although the concept of professionalism was not replicated in a confirmatory factor analysis.

Rare species present a challenge under changing environmental conditions as the genetic consequences of rarity may limit species ability to adapt to environmental change. To evaluate the evolutionary potential of a rare species, we assessed variation in traits important to plant fitness using multigenerational common garden experiments. Torrey pine, Pinus torreyana Parry, is one of the rarest pines in the world, restricted to one mainland and one island population. Morphological differentiation between island and mainland populations suggests adaptation to local environments may have contributed to trait variation. The distribution of phenotypic variances within the common garden suggests distinct population‐specific growth trajectories underlay genetic differences, with the island population exhibiting substantially reduced genetic variance for growth relative to the mainland population. Furthermore, F1 hybrids, representing a cross between mainland and island trees, exhibit increased height accumulation and fecundity relative to mainland and island parents. This may indicate genetic rescue via intraspecific hybridization could provide the necessary genetic variation to persist in environments modified as a result of climate change. Long‐term common garden experiments, such as these, provide invaluable resources to assess the distribution of genetic variance that may inform conservation strategies to preserve evolutionary potential of rare species, including genetic rescue.

A Train-The-Trainer course (TTT course) for general practice trainers was developed as part of the program VerbundweiterbildungAn evaluation tool was used covering aspects such as information, relevance for daily work, opportunities for participant engagement in the seminars and working environment as well as didactic competencies among teachers. Within five years, 256 trainers participated in a TTT course and received an evaluation sheet. Data were analyzed descriptively.249 evaluation sheets were included (response rate 97 %). Overall, the participants were (very) satisfied with the course in general, its organization, the exchange with colleagues and the teaching units. The participants used the free text mode to give positive feedback; in particular, teaching units in organizational and legal regulations as well as practical feedback training to strengthen professionalism were evaluated positively. Suggestions for improvements included follow-up courses or a deepening of understanding of course contents.The participants gave a very positive overall rating and claimed to have benefited from the course contents. Future projects should address further qualifications of general practice trainers and facilitate the exchange with colleagues on an ongoing basis.

Provenance studies are an increasingly important analog for understanding how trees adapted to particular climatic conditions might respond to climate change. Dendrochronological analysis can illuminate differences among trees from different seed sources in terms of absolute annual growth and sensitivity to external growth factors. We analyzed annual radial growth of 567 36-year-old pitch pine (Pinus rigida Mill.) trees from 27 seed sources to evaluate their performance in a New Jersey Pine Barrens provenance experiment. Unexpectedly, missing rings were prevalent in most trees, and some years—1992, 1999, and 2006—had a particularly high frequency of missing rings across the plantation. Trees from local seed sources (, PLoS ONE, 11 (5), ISSN:1932-6203

INTRODUCTION The 'Verbundweiterbildung(plus) Baden-Wurttemberg' (Verbundweiterbildung(plus)) - a structured general practice (GP) postgraduate training program - developed a 'rural day' as an intervention to ensure rural health exposure for GP trainees. This project report presents the outcome of the intervention: intention to work in a rural area. METHODS At the time of the study, 500 GP trainees were enrolled in Verbundweiterbildung(plus). Invitations to complete an internet-based questionnaire were distributed by email to the 274 GP trainees who had previously been asked to participate in one of eight rural days. The questionnaire contained 4 generic and 10 specific items for participants in the rural days and 4 items specific to non-participants. Mixed-methods analyses were performed using the Statistical Package for the Social Sciences. RESULTS Of the 274 GP trainees invited to complete the questionnaire, 38 of 80 rural day participants and 72 of 194 non-participants completed the questionnaire (overall response rate 40%). Participants and non-participants did not differ significantly regarding age, sex and origin. Nearly half of the participants claimed the rural day changed their overall attitudes towards rural areas positively. However, there was no significant difference in the intention to work in a rural area for participants before and after the rural day experience. CONCLUSIONS The rural day increased positive attitudes towards rural areas in general but had no influence on intention to work in rural practice. More awareness and responsibility regarding workforce shortages in rural primary health care among political stakeholders, trainers and trainees is needed. Duration of the intervention should be extended and possibly complemented by offering rotations in rural practices to increase the effect. Enabling factors and barriers regarding working in rural areas are already known by political stakeholders, trainers and trainees and need to be more adequately addressed during GP postgraduate training.

Conserving forest genetic resources and, indeed, preventing species extinctions will be complicated by the expected changes in climate projected for the next century and beyond. This paper uses case examples from rare spruces (Picea sp.) from North America to discuss the interplay of conservation, genetics, and climate change. New models show how climate change will affect these spruces, making it necessary to relocate them if they are to survive, a tool known as assisted migration or, preferably, assisted colonization. The paper concludes with some speculation on the broader implications of climate change, and the relevance of conservation to preserving the necessary ecological services provided by forests.

Zusammenfassung Hintergrund Grunde fur den zunehmenden (Haus-)Arztemangel in Deutschland und die daraus abzuleitenden Masnahmen werden gegenwartig inner- wie auserhalb der arztlichen Profession diskutiert und erforscht. Eine Umfrage sollte die Perspektive der betroffenen Arzte in Weiterbildung einholen. Methoden Nach Ubersetzung des englischsprachigen Fragebogen des „Vasco da Gama Movement“ wurde eine internet-basierte Umfrage 2009 durchgefuhrt und deskriptiv-exploratorisch analysiert. Ergebnisse Von den 436 Teilnehmern (Durchschnittsalter 36 Jahre, 64% Frauen, 49 Monate Weiterbildung) wurden fachspezifische („Breite des Fachs“, „individueller Zugang zu Patienten“, etc.) und geschlechtsspezifische Berufswahlfaktoren (Frauen: „Vereinbarkeit von Beruf und Familie“; Manner: „Autonomie und Unabhangigkeit“) genannt. Trotz hoher Arbeitszeit war die Zufriedenheit mit dem Beruf insgesamt hoch, jedoch nicht mit dem Gehalt. Den Teilnehmern wichtige Rahmenbedingungen bzw. Inhalte der Weiterbildung waren: „Strukturierte Weiterbildungsrotation“, „Weiterbildungsrotationen in Krankenhausern“, „betriebswirtschaftliche Kenntnisse“ und „Interprofessionelle Zusammenarbeit“ (alle >88%). Schlussfolgerungen Die Umfrage liefert wichtige strukturell-organisatorische und inhaltlich-fachliche Ansatzpunkte zur Verbesserung der Weiterbildung, die auch die geschlechtsspezifischen Lebensumstande von Arzten in WB einschliesen sollte. Neben Berucksichtigung bei der Planung und Weiterentwicklung begonnener Weiterbildungsmodelle und -programme erscheint idealerweise ein flachendeckender und nachhaltiger Ansatz notwendig, der interdisziplinare und intersektorale Kooperationen fordert.

ine Verbundweiterbildung bedeutet ur Arzte in Weiterbildung, dass sie ihre esamte Weiterbildung in einer Region urchlaufen konnen. Dies hat vielfalige Vorteile, u.a. sich nicht mehrfach ewerben zu mussen, nicht umziehen Weiterbildung zum Facharzt fur Allgemeinmedizin vergleichbar mit anderen Fachgebieten durchlaufen werden. Zahlreiche Anleihen fur strukturierte und inhaltlich auf Allgemeinmedizin fokussierte Weiterbildungen gibt es im europaischen Ausland seit vielen Jahren [1,2]. Auch in der ehemaligen DDR waren Rotationen durch verschiedene (DEGAM) eine Schrift zur Verbundweiterbildung herausgegeben, die 2009 aktualisiert wurde [4]. Zusatzlich zu den dort bereits erwahnten Strukturmerkmalen wurden im Baden-Wurttemberger Programm Verbundweiterbildungplus weitere Elemente etabliert, die im Folgenden dargestellt werden. Zunachst soll jedoch u mussen, den eigentlichen Berufsunsch nicht verheimlichen zu mussen nd die Weiterbildungszeit langfristig lanen zu konnen. Dadurch kann die

The German Society of General Practice and Family Medicine (DEGAM) has defined educational seminars during post-graduate training as a core element to improve trainees' specific knowledge and competencies. Furthermore, these seminars facilitate networking among trainees and support the process of identity formation in family medicine. Since its implementation in 2009, the Verbundweiterbildung(plus) Baden-Württemberg (VWB(plus) Ba-Wü) has offered educational seminars. Aim of this article is to analyse the content of these educational seminars and to derive implications for other family medicine training programmes in Germany.From 2009 to 2015, the data from all educational seminars was descriptively analysed. Furthermore, two researchers categorised the seminar contents independently of each other and assigned them to the competence-based curriculum for family medicine training (Kompetenzbasiertes Curriculum Allgemeinmedizin, KCA).Until 2015, 600 trainees participated in a starter seminar of the VWB(plus) Ba-Wü. In total, 1,116 teaching units and 160 different seminars covered all relevant topics of the KCA. A restructuring of organisational processes and seminars was necessary to handle the increase in the number of participants, including the development of specific software for electronic support. Of all these seminars, 56% were held by specialists or trainees in family medicine. The participating trainees rated the educational seminars in general and the possibility for networking as (very) good.The contents of the educational seminars included in family medicine training programs will have to be specifically based on family medicine and cover all relevant aspects of the KCA - medical expertise, competencies and procedures. In order to ensure a common standard concerning didactic methods and qualifications of teachers, a didactic guideline is to be developed. The increasing demand of family medicine training programmes requires (further) development of the software eSchoolab, including integration of the KCA.

BACKGROUND AND PURPOSE Switching brand-name drugs to generics is reasonable and desired for economic reasons. Few data exist about problems, if any, during the switching in general practice. In this survey, the view of general practitioners (GPs) should be ascertained. METHODS GPs in five counties in the German federal states Thuringen and Baden-Wurttemberg, who took part in a study on generic drug prescribing, were asked to complete a questionnaire about experiences and attitudes toward generic drug prescription. RESULTS A total of 195 (84%) of 233 GPs answered the questionnaire. Two thirds (127/195) stated, that brands and generics are pharmacologically equivalent. Many of these GPs estimated to prescribe generic drugs in > 50% of instances; fewer doctors did so, if they had doubts as to the equivalence of generics (65% vs. 46%; p 10% of patients strictly reject generic drugs. CONCLUSION An optimized cooperation between GPs and hospital physicians could facilitate the consumption of generic potential in pharmacotherapy. Reasons for the obvious contrast between the proven pharmacological equivalence of brand-name and generic drugs and the problems encountered after switching reported by GPs should be further studied.

Chihuahua spruce (Picea chihuahuana Martinez) is a montane subtropical conifer endemic to the Sierra Madre Occidental in northwestern Mexico. Range-wide variation was investigated using maternally inherited mitochondrial (mtDNA) and paternally inherited chloroplast (cpDNA) DNA markers. Among the 16 mtDNA regions analysed, only two mitotypes were detected, while the study of six cpDNA microsatellite markers revealed eight different chlorotypes. The average cpDNA diversity (H = 0.415) was low but much higher than that for mtDNA (H = 0). The distribution of mitotypes revealed two clear nonoverlapping areas (G(ST) = N(ST) = 1), one including northern populations and the second one including the southern and central stands, suggesting that these two regions may represent different ancestral populations. The cpDNA markers showed lower population differentiation (G(ST) = 0.362; R(ST) = 0.230), implying that the two ancestral populations continued to exchange pollen after their initial geographic separation. A lack of a phylogeographic structure was revealed by different spatial analyses of cpDNA (G(ST) > R(ST); and samova), and reduced cpDNA gene flow was noted among populations (Nm = 0.873). Some stands deviated significantly from the mutation-drift equilibrium, suggesting recent bottlenecks. Altogether, these various trends are consistent with the hypothesis of a population collapse during the Holocene warming and suggest that most of the modern P. chihuahuana populations are now effectively isolated with their genetic diversity essentially modelled by genetic drift. The conservation efforts should focus on most southern populations and on the northern and central stands exhibiting high levels of genetic diversity. Additional mtDNA sequence analysis confirmed that P. martinezii (Patterson) is not conspecific with P. chihuahuana, and thus deserves separate conservation efforts.

Numerous populations from six spruce taxa, including four relict endemics, Picea chihuahuana (Chihuahua spruce), P. martinezii (Martinez spruce), P. mexicana (Mexican spruce), and P. breweriana (Brewer spruce), and two widespread species, P. engelmannii (Engelmann spruce) and P. pungens (blue spruce), were compared at homologous isozyme loci to test various hypotheses about their affinities and origins. Each of the species was clearly separated, and Neighbor-Joining and Unweighted Pair Group analyses of Nei's genetic distance grouped all populations within a taxon into their own clusters. Spruces from Flys Peak, Chiricahua Mountains, Arizona, joined a P. engelmannii cluster and were not a bridge to P. mexicana as previously believed. Spruces from Cerro Mohinora, Chihuahua, were clearly P. mexicana, not phantom hybrids of P. chihuahuana and P. pungens. Nuclear random amplified polymorphic DNA and chloroplast simple sequence repeat and cleaved amplified polymorphic genetic markers were compared in ...

Estimating demographic parameters is fundamental for conservation programs. Inferences are generally derived from the variation of unlinked nuclear genomic regions, which are often unavailable for non-model species. These limitations can be circumvented using universal polymorphic markers that can be easily transferred across taxa, such as cytoplasmic single sequence repeats (SSRs). These markers are sensitive to population expansions, but no formal test has been conducted to explore if they can be used to infer and distinguish between competing bottleneck scenarios. Herein, we simulated the evolution of ten linked haploid SSRs in populations submitted to different bottleneck regimes (θ 1 = 1, 10, 50 and 90 % of θ 0) at different times (τ = 0.5, 1 and 10). The variation of these markers, as compiled with six summary statistics, allowed to detect severe population collapses independently of τ, and as long as populations kept roughly constant effective sizes after the size reduction. Mild declines became difficult to infer as τ increased, and small bottlenecks were virtually undetectable with these markers. More complex frameworks, such as bottlenecks followed by expansions, were also difficult to infer. Comparisons with chloroplast SSR variation in the Mexican relict Picea mexicana and the eastern North American Picea rubens suggested that these species went through bottlenecks of different intensities. While P. mexicana suffered a severe population decline that could be dated back to the last interglacial, P. rubens went through a more recent (i.e. late Pleistocene) and milder bottleneck. These results indicate that linked SSRs can be used as proxies to infer basic parameters related to strong population declines in species that lack adequate genomic resources.

4 PREMISE OF THE STUDY: Variation in a species is a blend of adaptive, random, and migratory responses. Pitch pine ( Pinus rigida ), a highly variable eastern conifer, has occupied multiple glacial refugia, whose harsh conditions favored adaptations enhancing subsequent dispersal and recolonization of newly deglaciated sites. We assessed phenotypic diversity in long-term growth trials to elucidate both the adaptations and likely refugia. METHODS: Pitch pine progeny from 31 areas were grown in common gardens in six locations, from eastern Massachusetts to Korea. KEY RESULTS: Survival increased with source latitude, but seedlings from southern latitudes were tallest in the fi rst (postplanting) year, but that advantage dissipated in later years. Progeny from northern latitudes were precocious, highly fecund, had smaller seeds, and more seeds per cone. Seed mass de- creased with latitude in both parents and progeny. Serotinous cones were notably common in the New Jersey Pine Plains and Acadia National Park. Vari- ous disease agents and frost burn exhibited latitudinal trends that were nonlinear, with a break in the regression slope at about 40 ° N latitude. Cluster analysis identifi ed both northern and southern groups, largely split between unglaciated and deglaciated terrain, but with Acadia and the Pine Plains as unique outliers. Within the southern group, provenances were organized into contiguous subgroups, but geographic structure was less evident in the northern group. CONCLUSIONS: The present range of pitch pine was colonized by migrants from at least three diff erent refugia, including at least one on the exposed con- tinental shelf during the Last Glacial Maximum.

Mexican spruce (Picea mexicana Martinez), an endangered species of the highest sky islands in Mexico's Sierra Madre Oriental and Sierra Madre Occidental, is threatened by fire, grazing, and global warming. Its conservation depends on whether it also is threatened by inbreeding and loss of genic diversity. We used 18 isozyme markers in 12 enzyme systems to assay genic diversity, characterize the mating system, and test for recent bottlenecks in three known populations. Unbiased, expected heterozygosity (H e ) averaged 0.125. Despite a separation of 676 km between populations in the Sierra Madre Oriental and the Sierra Madre Occidental, Wright's F ST , the proportion of total genic diversity among populations, was only 6.9%. Nei's genetic distance was 0.001 between the populations in the Sierra Madre Oriental and more than an order of magnitude greater, 0.019, between the Sierra Madre Oriental and Sierra Madre Occidental. However, both values point to relatively recent divergence. Mating systems were predominantly outcrossing, but with significant selfing. Multilocus estimates of selfing varied from 19% to 41%, and the means of single-locus estimates were higher, suggesting that additional inbreeding occurred by mating among relatives. Despite significant inbreeding, observed heterozygosity was as high as or higher than H e ; Wright's fixation index, F IS , was −0.107. Under the observed level of selfing, positive values of F IS were expected. Therefore, selection against inbreds and homozygotes must be intense. Cornuet-Luikart tests indicate recent bottlenecks in at least two of the three populations. The results suggest that Mexican spruce is a genetically viable species, and threats are primarily environmental.

Pinus pinceana) has a restricted and fragmented range, trees are widely scattered within populations, and reproduction is limited. Nevertheless, genetic diversity was high; based on 27 isozyme loci in 18 enzyme systems, unbiased expected heterozygosity averaged 0.174. Differentiation also was high (FST 5 0.152), reflecting isolation between southern, central, and northern fragments of the range. Among populations in the northern fragment, FST was only 0.056, and the number of migrants per generation (Nm) was 4.21, which should preclude fixation. Nm between central and southern populations or between them and populations in the northern fragment was lower, 0.99‐1.66, indicating a degree of genetic isolation. Multilocus outcrossing rates ( tm) ranged from 0.836 in the south to 0.897 in the north. Therefore, selfing is low but statistically significant. The equilibrium inbreeding coefficient

Martínez spruce (Picea martínezii T.F. Patterson) is a conifer currently passing through a bottleneck, reduced to a few relict populations totaling less than 800 trees. We used isozyme markers to analyze the mating system and survey the level of genic diversity in two populations. The mating system was characterized by a high frequency of selfing. The multilocus outcrossing rates (tm) and 95% confidence intervals were only 0.399 (0.197 < tm< 0.601) for the smallest population and 0.589 (0.475 < tm< 0.703) or 0.685 (0.465 < tm< 0.905), depending on year, for the largest. These are among the lowest rates of outcrossing observed in conifers. The fixation indices for the two populations were -0.058 and 0.121, less than expected for such high levels of selfing. Expected heterozygosity, unbiased He, based on 22 loci in 13 enzyme systems, was 0.121 and 0.101 in the two populations. The proportion of the total genic diversity between populations, FST, was 2.4%. Nm, the number of migrants per generation, was about 1.00 or 10.17, depending on the method of estimation. The time since the two populations were isolated was estimated from Nei's genetic distance as only 150 to 15 000 years, which is consistent with a hypothesis of population collapse during late Pleistocene or Holocene warming. We discuss the implications for conservation.

Summary Pinus sabiniana Dougl. (grey pine) forms savanna forests in the foothills surrounding California's Great Central Valley. However, its fossil record, which dates from the late Miocene through the Pliocene and Pleistocene, is found exclusively in southern California, south of the species’ present range. A total of twenty-nine isozyme loci, representing eighteen enzyme systems, was assayed to analyse the genetic structure in eight populations of grey pine and attempt to track its migration history from southern to northern California. Expected heterozygosity in the two southernmost samples was 0.128 and 0.150, and heterozygosity tended to decrease with increasing latitude, suggesting the loss of diversity as grey pine dispersed northward. However, genetic distances between populations were very small, even on opposite sides of the treeless Great Central Valley; and estimated time since divergence was 900 to 9000 years at a maximum. Wright's FST, the proportion of total genetic diversity among populations, was only 0.057, which is similar to values found in many conifers with continuous distributions. Nm, the number of migrants among populations per generation, was 4.1 to 6.7, depending on estimator, and indicates that gene flow is extensive, or was so in the recent past. In every population, observed heterozygosity was less than expected heterozygosity, and the fixation index, FIS, for the progeny was 0.128, which indicates a fairly high rate of inbreeding. The genetic similarity of disjunct populations, in combination with paleogeographic and paleoclimatic evidence, suggests that grey pine formed a continuous population throughout the Great Central Valley, perhaps between 12,000 and 8000 yrs BP. Its range became fragmented during the Xerothermic, when it ascended into the foothills. Gaps in its range correlate with late Pleistocene–early Holocene lakes in adjacent basins and with the Sacramento–San Joaquin Delta.

Fragmentation and reduction in population size are expected to reduce genetic diversity. However, examples from natural populations of forest trees are scarce. The range of Chihuahua spruce retreated northward and fragmented coincident with the warming climate that marked the early Holocene. The isolated populations vary from 15 to 2441 trees, which provided an opportunity to test whether census number is a good predictor of genetic diversity. Mean expected heterozygosity, He, based on 24 loci in 16 enzyme systems, was 0.093 for 10 sampled populations, which is within the range reported for conifers. However, estimates varied more than twofold among populations and He was closely related to the logarithm of the number of mature trees in the population (rHe,N = 0.93). Diversity among populations, FST, was 24.8% of the total diversity, which is higher than that observed in almost all conifer species studied. Nei's genetic distance, D, was not related to geographic distance between populations, and D was 0.033, which is higher than estimates for most wide-ranging species. Most populations had excess homozygosity and the fixation index, FIS, was higher than that reported for all but one species of conifer. Nm, the number of migrants per generation, was 0.43 to 0.76, depending on estimation procedure, and is the smallest observed in conifers. The data suggest that populations of Chihuahua spruce have differentiated by drift and that they are effectively isolated. The results illustrate how a combination of paleontological observation and molecular markers can be used to illuminate recent evolutionary events. Multilocus estimates of outcrossing for two small populations were zero (complete selfing) and 0.153, respectively, which are in striking contrast to the near complete outcrossing observed in most conifers. The high fixation index and a high proportion of empty seeds (45%) suggest that inbreeding may be a serious problem for conservation of Chihuahua spruce.

The German Standing Committee on Vaccination (Standige Impfkommission, STIKO) recommends vaccinating risk groups against hepatitis B and gives advice for postexposure prophylaxis. STIKO has recently revised this recommendation, focusing on: (i) classification of risk groups, (ii) duration of protection after primary immunization, and (iii) anti-HBs threshold that defines successful hepatitis B vaccination. Orientating literature reviews were performed for the first objective. Examples of population subgroups at increased risk were identified and classified into three indication groups. Systematic reviews on the duration of vaccine-induced protection identified one randomized controlled trial (RCT) and nine cohort studies. When applying the grading of recommendation, assessment, development, and evaluation (GRADE) methodology, evidence from RCTs was considered of very low quality regarding the question of whether hepatitis B can be prevented for 15 years after successful primary vaccination (anti-HBs ≥ 10 IU/l) with a vaccine efficacy of 96 % against chronic hepatitis, 89 % against HBsAg positivity, and 73 % against isolated anti-HBc positivity. However, seven cohort studies showed that no cases of clinical hepatitis B or HBsAg positivity occurred during a maximum follow-up period of 10 years in settings comparable to the situation in Germany when anti-HBs ≥ 10 IU/l was used to indicate vaccination success. Less than 1 % of vaccinated study participants had isolated anti-HBc positivity. GRADE assessment of two cohort studies revealed that evidence of very low quality exists that the use of anti-HBs ≥ 100 IU/l to measure vaccination success leads to a lower frequency of anti-HBc positivity during follow-up than the use of anti-HBs ≥ 10 IU/l. The recommendation was revised according to this evidence.

The German Standing Committee on Vaccination (STIKO) recommends seasonal influenza vaccination for children and adolescents with chronic medical conditions that put them at risk for severe influenza illness. In addition to trivalent inactivated influenza vaccines (TIV), a trivalent live-attenuated influenza vaccine (LAIV) was licensed for children and adolescents aged 2–17 years in the European Union in 2011. Employing the methodology of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group, we examined the evidence for efficacy and safety of LAIV relative to TIV to guide STIKO’s decision on whether LAIV should be preferentially recommended for at-risk children. In our meta-analysis of data from two randomized trials directly comparing LAIV and TIV in children aged ≤ 6 years, the protective efficacy of LAIV against laboratory-confirmed influenza was 53 % [95 % confidence interval (CI): 45–61 %] higher than that of TIV. A similar study in individuals aged 6–17 years showed a 32 % (95 % CI: 3–52 %) higher efficacy of LAIV. The quality of the evidence for a superior protective efficacy of LAIV against all relevant clinical outcomes was rated ‘moderate’ for children aged 2–6 years and ‘low’ for the age group 7–17 years. Regarding safety outcomes, the available data suggest no significant differences between LAIV and TIV. Based on these results, STIKO recommends that LAIV should be used preferentially for influenza vaccination of at-risk children aged 2–6 years. In children and adolescents aged 7–17 years, either LAIV or TIV may be used without specific preference. Possible contraindications and the vaccinee’s and his/her guardians’ preferences should be taken into account.

Background Improving postgraduate medical training is one important step to attract more medical students into general practice. Keeping pace with international developments moving to competence-based curricula for general practice training, the aim of this project was to develop and implement such a curriculum in Germany. Methods A five-step, peer-based method was used for the curriculum development process including panel testing and a “test version” of the curriculum for the pilot implementation phase. The CanMEDS framework served as a basis for a new German competence-based curriculum in general practice training. Four curricula from European countries and Canada were reviewed and, following required cultural adaptions, key strengths from these were integrated. For the CanMEDS “medical expertise” element of the curriculum, the WONCA ICPC-2 classification of patient’s “reason for encounters” was also integrated. Results Altogether, 37 participants were involved in the development process representing 12 different federal states in Germany, and including an expert advisor from Denmark. An official “test version” of the curriculum consisting of three parts: medical expertise, additional competencies and medical procedures was established. A system of self-assessment for trainees was integrated into the curriculum using a traffic light scale. Since March 2012, the curriculum has been made freely available online as a “test version”. In 2014, an evaluation is planned using feedback from users of the test model as a further stage of the implementation process. Conclusions The first German competence-based curriculum for general practice training has been developed using a pragmatic peer controlled approach and implementation is being trialed with a “test version” of the curriculum. This model project and its peer-based methodology may support competence-based curriculum development for other medical specialties both inside and outside Germany.

 Premise of the study: Fire in the New Jersey Pine Plains has selectively maintained a dwarf growth form of pitch pine ( Pinus rigida ), which is distinct from the surrounding tall forest of the Pine Barrens and has several other inherited adaptations that enable it to survive in an environment dominated by fi  Methods: Pitch pine progeny from two Pine Plains sites, the West and East Pine Plains, were grown in common garden environments with progeny from two Pine Barrens stands, Batsto and Great Egg Harbor River. The tests were replicated in filocations: in New Jersey, Connecticut, two sites in Massachusetts, and Korea. One of the tests was monitored for up to 36 yr.  Key results: Progeny of Pine Plains origin were, in general, shorter, more crooked, precocious, bore more cones, had a higher frequency of serotinous cones, and had a higher frequency of stem cones than did Pine Barrens progeny, wherever they were grown.  Conclusions: The Pine Plains is an ecotype that has evolved in response to disturbance. The several characters that distinguish it from the surrounding tall forest of the Pine Barrens are inherited. The dwarf stature and crooked form not only enable the ecotype to persist in an environment of frequent fi res but also increase its fl ammability.

PREMISE OF THE STUDY Climate change may threaten endemic species with extinction, particularly relicts of the Arcto-Tertiary Forest, by elimination of their contemporary habitat. Projections of future habitat are necessary to plan for conservation of these species. METHODS We used spline climatic models and modified Random Forests statistical procedures to predict suitable habitats for Brewer spruce (Picea breweriana), which is endemic to the Klamath Region of California and Oregon. We used three general circulation models and two sets of carbon emission scenarios (optimistic and pessimistic) for future climates. KEY RESULTS Our procedures predicted present occurrence of Brewer spruce perfectly. For the decades 2030, 2060, and 2090, its projected range within the Klamath Region progressively declined, to the point of disappearance in the decade 2090. The climate niche was projected to move north to British Columbia, the Yukon Territory, and southeastern Alaska. CONCLUSION The results emphasize the necessity of assisted colonization and trans-boundary movement to prevent extinction of Brewer spruce. The projections provide a framework for formulating conservation plans, but planners must also consider regulations regarding international plant transfers.

We compared genetic diversity estimated from allozymes and from random amplified polymorphic DNA (RAPDs) in a sample of 210 Great Basin bristlecone pines (Pinus longaeva Bailey) from three groves in the White Mountains, California, USA. The White Mountains are the most westerly extension of bristlecone pine and home to the oldest known living trees. We assayed two forks of each tree to determine whether they originated from multiple seed caches of the Clark’s nutcracker. Despite the limited and fragmented distribution of bristlecone pine, its level of genetic diversity was comparable to that of other pines, but lower than that reported for eastern populations of Great Basin bristlecone pine. Twenty-six of 36 allozymes were polymorphic (p95 5 38.9%; p 5 63.0%), with observed heterozygosity (Ho) of 0.122 and expected heterozygosity (He) of 0.134. The proportion of the total variation among populations (GST) was only 0.011. The high proportion of trees with multiple stems was not due to germination in seed caches; only six of 210 forked trees had multiple allozyme genotypes. Of the 42 RAPD loci scored, 27 were monomorphic. Genetic diversity for RAPDs was nearly the same as that for allozymes (p95 5 34.1%, He 5 0.130). However, the estimates of diversity and differentiation were much higher (He 5 0.321, GST 5 0.039) after excluding monomorphic loci. Few studies have compared estimates of genetic diversity and genetic structure from the same sample using both allozymes and random amplified polymorphic DNA (RAPD), and more comparisons are needed to draw definitive conclusions regarding the relative merits of these two markers, particularly in highly heterozygous forest trees. Great Basin bristlecone pine (Pinus longaeva Bailey) would be an especially interesting species for such a comparison because estimates of genetic diversity in the species are the highest ever reported in the well-studied genus Pinus (Hiebert and Hamrick, 1983; Ledig, 1998). Furthermore, genetic diversity of bristlecone pine in the White Mountains, at the western extreme of the species’ range (Fig. 1), is an unknown quantity, and these groves contain the oldest known living trees, some in excess of 4500 yr old (Schulman, 1958). In addition to the intrinsic interest of ancient bristlecone pine, it has been suggested that the high frequency of multistemmed trees in the White Mountains, USA, is a result of seed caches by Clark’s nutcracker ( Nucifraga columbiana), and seed caching would be critical to the genetic structure of the species. Because allozymes and RAPDs each have advantages and disadvantages as markers for genetic variation, the comparison of the two applied to the same set of samples would indicate whether genetic parameters estimated by one were comparable 1

Brewer spruce (Picea breweriana), a relict of the widespread Arcto-Tertiary forests, is now restricted to a highly fragmented range in the Klamath Region of California and Oregon. Expected heterozygosity for 26 isozyme loci, averaged over 10 populations, was 0.121. More notable than the relatively high level of diversity when compared to other woody endemics was the strong decrease in expected heterozygosity with latitude. Differentiation ( FST) was 0.152, higher than values for many north temperate conifers with larger distributions. The number of migrants per generation (Nm) was 1.34 or 2.70, depending on the method of estimation. Inbreeding appeared low; FIS was only 0.003, in agreement with multilocus population outcrossing rates (tm), which were generally well above 0.90. No difference in tm was found between isolated vs. clustered trees. However, the number of seeds per cone was greatest in the densest populations; tm is a measure of effective outcrossing after mortality in the embryonic stage, whereas a reduced number of seeds per cone indicates self pollination. Selfing increased after logging; outcrossing rate before logging was 0.961 and after logging, 0.756. Despite Brewer spruce’s narrow, fragmented distribution, the outlook for its conservation was good, with the exception of possible negative effects of logging. Brewer spruce (Picea breweriana Wats.) is a relict of the Arcto-Tertiary forest, most species of which are now extinct in western North America. According to the fossil record, Brewer spruce had a wide distribution in the Pliocene and Miocene, at least as far east as Idaho and Nevada, north to central Oregon, and south to central California (Wolfe, 1964). The fossil species, Sonoma spruce (Picea sonomensis Axelrod), which is synonymous with Brewer spruce, occurred in the Creede Flora in the San Juan Mountains of southwestern

Premise of the study: Modeling the contemporary and future climate niche for rare plants is a major hurdle in conservation, yet such projections are necessary to prevent extinctions that may result from climate change. Methods: We used recently developed spline climatic models and modifi ed Random Forests statistical procedures to predict suitable habitats of three rare, endangered spruces of Mexico and a spruce of the southwestern USA. We used three general circulation models and two sets of carbon emission scenarios (optimistic and pessimistic) for future climates. Key results: Our procedures predicted present occurrence perfectly. For the decades 2030, 2060, and 2090, the ranges of all taxa progressively decreased, to the point of transient disappearance for one species in the decade 2060 but reappearance in 2090. Contrary to intuition, habitat did not develop to the north for any of the Mexican taxa; rather, climate niches for two taxa re-materialized several hundred kilometers southward in the Trans-Mexican Volcanic Belt. The climate niche for a third Mexican taxon shrank drastically, and its two mitotypes responded differently, one of the first demonstrations of the importance of intraspecific genetic variation in climate niches. The climate niche of the U.S. species shrank northward and upward in elevation. Conclusion: The results are important for conservation of these species and are of general signifi cance for conservation by assisted colonization. We conclude that our procedures for producing models and projecting the climate niches of Mexican spruces provide a way for handling other rare plants, which constitute the great bulk of the world ’s endangered and most vulnerable flora.

Zusammenfassung Hintergrund Zur Sicherstellung der hausarztlichen Versorgung ist es notwendig, Arzte nah an ihrem spateren Berufsfeld in hausarztlichen Praxen weiterzubilden. Die Grundlage hierfur bildet auf Seiten der weiterbildungsbefugten Arzte der Besitz einer Weiterbildungsbefugnis. Wahrend in anderen Landern spezifische Qualifizierungsmasnahmen fur weiterbildungsbefugte Arzte durchgefuhrt werden, ist dies in Deutschland nicht ublich. Die vorliegende Umfrage wurde durchgefuhrt, um Perspektiven und Erfahrungen weiterbildungsbefugter Arzte im Fach Allgemeinmedizin u.a. im Hinblick auf die Einfuhrung zusatzlicher Qualifizierungsmasnahmen zu explorieren. Methoden Mit Hilfe eines selbsterstellten 3-seitigen Fragebogens wurden alle Arzte mit Weiterbildungsbefugnis fur das Fach Allgemeinmedizin in Baden-Wurttemberg postalisch befragt. Ergebnisse Von 1780 angeschriebenen Arzten beteiligten sich 656 Arzte an der Umfrage (Rucklaufquote 37%), davon 18% Frauen. Knapp ein Viertel bildete zum Zeitpunkt der Umfrage weiter, wahrend 36% angaben, gerade auf der Suche nach einem Arzt in Weiterbildung zu sein. Als Grunde fur die Nichtbesetzung einer Weiterbildungsstelle wurde von 323 Arzten und damit am haufigsten „keine Bewerber“ angegeben. Als Motivation weiterzubilden wurden am haufigsten „kollegialer Austausch“ (83%) und „Begeisterung fur Lehre“ (69%) genannt. Nur 2% der Arzte gaben an, schon einmal schlechte Erfahrungen mit einem Arzt in Weiterbildung gemacht zu haben. Informationsbedarf wird insbesondere bei der Erstellung bzw. Umsetzung eines Curriculums sowie bei rechtlichen und steuerlichen Rahmenbedingungen rund um die Weiterbildung gesehen. Schlussfolgerungen Mit der vorliegenden Umfrage wurden erstmals Meinungen und Erfahrungen weiterbildungsbefugter Arzte im Fach Allgemeinmedizin erhoben. Die Ergebnisse liefern einen wichtigen Beitrag zur Verbesserung der Weiterbildungsbedingungen fur das Fach Allgemeinmedizin u.a. im Hinblick auf die Entwicklung von Qualifizierungsmasnahmen fur weiterbildungsbefugte Arzte.

Zusammenfassung Hintergrund Aufgrund des zunehmenden Arztemangels, der Zuwachs der Krankheitslast in einer alter werdenden Gesellschaft und der Verteilung der Arzteschaft ist die flachendeckende Versorgung der Bevolkerung durch Hausarzte in Deutschland gefahrdet. Nach Losungsansatzen, mehr junge Arzte fur eine Tatigkeit als Hausarzt zu gewinnen, wird gesucht. Ziel dieser Studie war es, aus Sicht von Arzten in Weiterbildung, individuelle Grunde fur die Berufswahl Allgemeinmedizin, Meinungen zur derzeitigen Weiterbildungssituation und zu Verbesserungen in der allgemeinmedizinischen Weiterbildung in Deutschland zu explorieren. Methodik Es wurden 13 halbstrukturierte Interviews mit Arzten in Weiterbildung durchgefuhrt. Diese Interviews wurden mit einem Audiogerat aufgenommen und anschliesend transkribiert. Die Auswertung erfolgte nach der qualitativen Inhaltsanalyse nach Mayring mit Hilfe des Softwareprogramms Atlas.ti. Ergebnisse Beweggrunde fur das Gebiet der Allgemeinmedizin sind neben der ganzheitlichen Betrachtung des Patienten, die Moglichkeit Behandlungserfolge direkt mit zu erleben, das breite medizinische Arbeitsspektrum, die Selbststandigkeit sowie die positive „work-life-balance“. Barrieren innerhalb der Weiterbildung wurden in der fehlenden Struktur der einzelnen Weiterbildungsabschnitte und der Vergutung der ambulanten Weiterbildungsphase gesehen. Als Barrieren auserhalb der Weiterbildung wurden die als abschreckend wahrgenommenen Rahmenbedingungen der hausarztlichen Tatigkeit dargestellt. Als allgemeiner Verbesserungsvorschlag wurde eine starkere Prasenz des Fachs wahrend des Studiums genannt. Eine Weiterqualifizierung der Weiterbildungsbefugten wurde als wunschenswert dargestellt. Konkret wurde eine bessere Bezahlung, mehr Struktur fur die Weiterbildungsabschnitte und eine gezielte inhaltliche Vorbereitung auf die spatere Tatigkeit gefordert. Schlussfolgerungen Die Ergebnisse der vorliegenden Studie lassen erkennen, dass zur Nachwuchsgewinnung in der Allgemeinmedizin Einzelmasnahmen nicht ausreichen, sondern ein Masnahmenbundel notwendig ist, welches auf Aspekte innerhalb der Weiterbildung sowie der Rahmenbedingungen abzielt.

In order to ensure the delivery of primary care part of the vocational medical training must take place in the general practice setting. In Germany, this requires the authorization to provide general practitioner (GP) training. While in many countries specific qualification programmes for GP trainers are obligatory, this does not yet apply in Germany. The aim of this survey was to explore perspectives and experiences of GP trainers focusing on their needs in view of a possible qualification course.A three-page questionnaire was developed and sent to all 1,780 GP trainers in the federal state of Baden-Wuerttemberg, Germany.Of the 1,780 GP trainers 656 responded (response rate: 37%), 18% of them being female trainers. About a quarter of the respondents had a vocational trainee, while 36% were looking for one at the time of the survey. The reason most frequently given for not having a vocational trainee was "no applicants" (n=323). Motivational reasons for involvement as a GP trainer were most commonly "interpersonal co-operation" (83%) and "enthusiasm for education" (69%). Only 2% of the respondents reported a bad experience with vocational trainees. Special needs were expressed regarding both legal and fiscal issues with vocational trainees in general practice and the development of a curriculum.For the first time the perspectives and experiences of GP trainers have been explored in the present study. The results may provide a basis for the development of a qualification programme for GP trainers in Germany.

The increasing shortage of (primary care) physicians in Germany is currently being discussed within and outside the profession. A national survey among general practice trainees aimed to explore their perspectives of vocational training (VT).After translation, cultural adaptation and web implementation of the questionnaire of the "Vasco da Gama Movement," the survey was conducted during 2009. Descriptive analyses were performed.Among 436 participants (mean age 36 years, 64% female, 49 months of VT) discipline-specific ("medically diverse discipline", "one-to-one care", and "holistic approach"), but also gender-related (females: "compatibility with family life", males: "autonomy and independence", and "opportunities to start their own practice") aspects were important to their choice of career. Despite the heavy workload job satisfaction, but not salary satisfaction, was generally high. Participants rated the following general conditions and content of VT as important: "structured rotations", "rotations in hospitals", "management skills", "working in a local care setting and in a multidisciplinary team" (all88%).These results provide clues to improving VT in General Practice with respect to organisation and content including the consideration of gender-related living conditions. Furthermore, improvement and further development of VT programmes should ideally be part of an area-wide, interdisciplinary and intersectoral approach.