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Abstract Background Serious games are risk-free environments training various medical competencies, such as clinical reasoning, without endangering patients’ safety. Furthermore, serious games provide a context for training situations with unpredictable outcomes. Training these competencies is particularly important for healthcare professionals in emergency medicine. Methods Based on these considerations, we designed, implemented, and evaluated a serious game in form of an emergency department, containing the features of a virtual patient generator, a chatbot for medical history taking with self-formulated questions, artificially generated faces based on an artificial intelligence algorithm, and feedback for students. The development process was based on an already existing framework resulting in an iterative procedure between development and evaluation. The serious game was evaluated using the System Usability Scale and the User Experience Questionnaire. Results The System Usability Scale provided a substantial result for the usability. In terms of the user experience, four scales yielded positive results, whereas two scales yielded neutral results. Conclusion The evaluation of both usability and user experience yielded overall positive results, while simultaneously identifying potential areas for improvement. Further studies will address the implementation of additional game design elements, and testing student learning outcome.

Abstract Background Despite the challenging curriculum, medicine is a popular study program. We propose McClelland’s Motive Disposition Theory (MDT) as a possible theory for explaining medical students motivation. The theory describes how individuals differ in their behaviour due to their varying manifestations of certain motives. The three motives can thus influence the students behaviour and academic success. Using these motives, complimented with an altruism- and a freedom motive, this study was aimed at investigating young adults’ explicit motives to study medicine. In addition, we also wanted to find out whether there are gender differences in motives and other variables such as empathy, emotional intelligence and academic self-concept. Methods Over 20 universities across Germany were contacted and asked to share the online study with their first semester medical students in the winter term 2022/23, which resulted in a final N = 535. We used validated and reliable measurements, including a self-created and piloted questionnaire covering medicine-specific explicit motives. Results Comparing the mean scores between motives, we found that the altruism motive was the strongest motive (M = 5.19), followed by freedom (M = 4.88), affiliation (M = 4.72) and achievement (M = 4.59). The power motive achieved the lowest score (M = 3.92). Male students scored significantly higher for power (M = 4.24) than females did (M = 3.80, p

Abstract Background Artificial intelligence (AI) is becoming increasingly important in healthcare. It is therefore crucial that today’s medical students have certain basic AI skills that enable them to use AI applications successfully. These basic skills are often referred to as “AI literacy”. Previous research projects that aimed to investigate medical students’ AI literacy and attitudes towards AI have not used reliable and validated assessment instruments. Methods We used two validated self-assessment scales to measure AI literacy (31 Likert-type items) and attitudes towards AI (5 Likert-type items) at two German medical schools. The scales were distributed to the medical students through an online questionnaire. The final sample consisted of a total of 377 medical students. We conducted a confirmatory factor analysis and calculated the internal consistency of the scales to check whether the scales were sufficiently reliable to be used in our sample. In addition, we calculated t-tests to determine group differences and Pearson’s and Kendall’s correlation coefficients to examine associations between individual variables. Results The model fit and internal consistency of the scales were satisfactory. Within the concept of AI literacy, we found that medical students at both medical schools rated their technical understanding of AI significantly lower (M MS1 = 2.85 and M MS2 = 2.50) than their ability to critically appraise (M MS1 = 4.99 and M MS2 = 4.83) or practically use AI (M MS1 = 4.52 and M MS2 = 4.32), which reveals a discrepancy of skills. In addition, female medical students rated their overall AI literacy significantly lower than male medical students, t(217.96) = -3.65, p

Artificial Intelligence competencies will become increasingly important in the near future. Therefore, it is essential that the AI literacy of individuals can be assessed in a valid and reliable way. This study presents the development of the “Scale for the assessment of non-experts' AI literacy” (SNAIL). An existing AI literacy item set was distributed as an online questionnaire to a heterogeneous group of non-experts (i.e., individuals without a formal AI or computer science education). Based on the data collected, an exploratory factor analysis was conducted to investigate the underlying latent factor structure. The results indicated that a three-factor model had the best model fit. The individual factors reflected AI competencies in the areas of “Technical Understanding”, “Critical Appraisal”, and “Practical Application”. In addition, eight items from the original questionnaire were deleted based on high intercorrelations and low communalities to reduce the length of the questionnaire. The final SNAIL-questionnaire consists of 31 items that can be used to assess the AI literacy of individual non-experts or specific groups and is also designed to enable the evaluation of AI literacy courses’ teaching effectiveness.

Abstract Background The use of artificial intelligence applications in medicine is becoming increasingly common. At the same time, however, there are few initiatives to teach this important and timely topic to medical students. One reason for this is the predetermined medical curriculum, which leaves very little room for new topics that were not included before. We present a flipped classroom course designed to give undergraduate medical students an elaborated first impression of AI and to increase their “AI readiness”. Methods The course was tested and evaluated at Bonn Medical School in Germany with medical students in semester three or higher and consisted of a mixture of online self-study units and online classroom lessons. While the online content provided the theoretical underpinnings and demonstrated different perspectives on AI in medical imaging, the classroom sessions offered deeper insight into how “human” diagnostic decision-making differs from AI diagnoses. This was achieved through interactive exercises in which students first diagnosed medical image data themselves and then compared their results with the AI diagnoses. We adapted the “Medical Artificial Intelligence Scale for Medical Students” to evaluate differences in “AI readiness” before and after taking part in the course. These differences were measured by calculating the so called “comparative self-assessment gain” (CSA gain) which enables a valid and reliable representation of changes in behaviour, attitudes, or knowledge. Results We found a statistically significant increase in perceived AI readiness. While values of CSA gain were different across items and factors, the overall CSA gain regarding AI readiness was satisfactory. Conclusion Attending a course developed to increase knowledge about AI in medical imaging can increase self-perceived AI readiness in medical students.

BackgroundScoring and awarding credit are more complex for multiple-select items than for single-choice items. Forty-one different scoring methods were retrospectively applied to 2 multiple-select multiple-choice item types (Pick-N and Multiple-True-False [MTF]) from existing examination data. ObjectiveThis study aimed to calculate and compare the mean scores for both item types by applying different scoring methods, and to investigate the effect of item quality on mean raw scores and the likelihood of resulting scores at or above the pass level (≥0.6). MethodsItems and responses from examinees (ie, marking events) were retrieved from previous examinations. Different scoring methods were retrospectively applied to the existing examination data to calculate corresponding examination scores. In addition, item quality was assessed using a validated checklist. Statistical analysis was performed using the Kruskal-Wallis test, Wilcoxon rank-sum test, and multiple logistic regression analysis (P

The use of artificial intelligence (AI) is becoming increasingly important in various domains, making education about AI a necessity. The interdisciplinary nature of AI and the relevance of AI in various fields require that university instructors and course developers integrate AI topics into the classroom and create so-called domain-specific AI courses. In this paper, we introduce the “AI Course Design Planning Framework” as a course planning framework to structure the development of domain-specific AI courses at the university level. The tool evolves non-specific course planning frameworks to address the context of domain-specific AI education. Following a design-based research approach, we evaluated a first prototype of the tool with instructors in the field of AI education who are developing domain-specific courses in this area. The results of our evaluation indicate that the tool allows instructors to create domain-specific AI courses in an efficient and comprehensible way. In general, instructors rated the tool as useful and user-friendly and made recommendations to improve its usability. Future research will focus on testing the application of the tool for domain-specific AI course developments in different domain contexts and examine the influence of using the tool on AI course quality and learning outcomes.

Artificial intelligence literacy is a concept that has been the focus of exhaustive research recently. However, there are very few psychometrically sound and thoroughly evaluated instruments that attempt to assess AI literacy in a valid way. Therefore, this study presents an item set to assess the AI literacy of non-experts. In the context of a Delphi expert study, 53 subject matter experts participated in three iterative questionnaire rounds to generate potential AI literacy items and assess their content validity. In addition, the experts made suggestions on how the items’ wording accuracy could be improved and evaluated the wording suggestions of the other experts. Of 47 potential items, 38 were judged relevant for inclusion in a final AI literacy questionnaire. The result is one of the first freely available AI literacy item sets and represents an important first step in assessing AI literacy and its subconstructs. Finally, the development of the items through the execution of an iterative Delphi study and the strong focus on content validity contribute to the advancement of AI literacy theory.

Abstract Background Patients presenting with acute shortness of breath and chest pain should be managed according to guideline recommendations. Serious games can be used to train clinical reasoning. However, only few studies have used outcomes beyond student satisfaction, and most of the published evidence is based on short-term follow-up. This study investigated the effectiveness of a digital simulation of an emergency ward regarding appropriate clinical decision-making. Methods In this prospective trial that ran from summer 2017 to winter 2018/19 at Göttingen Medical University Centre, a total of 178 students enrolled in either the fourth or the fifth year of undergraduate medical education took six 90-min sessions of playing a serious game (‘training phase’) in which they managed virtual patients presenting with various conditions. Learning outcome was assessed by analysing log-files of in-game activity (including choice of diagnostic methods, differential diagnosis and treatment initiation) with regard to history taking and patient management in three virtual patient cases: Non-ST segment elevation myocardial infarction (NSTEMI), pulmonary embolism (PE) and hypertensive crisis. Fourth-year students were followed up for 1.5 years, and their final performance was compared to the performance of students who had never been exposed to the game but had otherwise taken the same five-year undergraduate course. Results During the training phase, overall performance scores increased from 57.6 ± 1.1% to 65.5 ± 1.2% (p

PurposePhysicians of all specialties must be familiar with important principles of infectious diseases, but curricular time for this content is limited and clinical teaching requires considerable resources in terms of available patients and teachers. Serious games are scalable interventions that can help standardize teaching. This study assessed whether knowledge and skills acquired in a serious game translate to better performance in a clinical examination.MethodsFifth-year undergraduate medical students (n = 100) at Goettingen Medical School were randomized to three groups receiving different levels of exposure to virtual patients presenting with signs and symptoms of either infective endocarditis or community-acquired pneumonia in a serious game simulating an accident and emergency department. Student performance was assessed based on game logfiles and an objective standardized clinical examination (OSCE).ResultsHigher exposure to virtual patients in the serious game did not result in superior OSCE scores. However, there was good agreement between student performance in the OSCE and in game logfiles (r = 0.477, p = 0.005). An Item Response Theory analysis suggested that items from the serious game covered a wider range of ability, thus better differentiating between students within a given cohort.ConclusionRepeated exposure to virtual patients with infectious diseases in a serious game did not directly impact on exam performance but game logfiles might be good and resource-sparing indicators of student ability. One advantage of using serious games in medical education is standardized content, a lower inhibition threshold to learn, and a need of less staff time compared to small-group clinical teaching.

Since artificial intelligence (AI) is finding its way into more and more areas of everyday life, improving the AI skills of non-experts is important and will become even more relevant in the future. While it is necessary that children learn about the possibilities of AI at an early age, adults in higher education and beyond should also have at least a basic understanding of AI (i.e., AI literacy) to be able to interact effectively with the technology. To evaluate the current state of the literature on AI literacy in higher and adult education, a scoping literature review was conducted with the objective of identifying thematic foci and recent research trends. Ten research databases were searched and out of 902 initial records, 30 studies were identified using predefined eligibility criteria, whereof the content was evaluated in the review. The results indicated that research in this area is still in its infancy and needs refinement in terms of how to define AI literacy in adult education as well as what content should be taught to non-experts. Lastly, several recommendations for research and practice are derived from the results.

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.

Background: Despite ultrasound being an inherent part of medical education, only a few German medical schools have established a comprehensive ultrasound curriculum. This study aimed to explore medical students' perspectives on ultrasound in medical education (USMed).Results: Between January 1st, 2019 und June 30th, 2019, an online survey was conducted among German medical students via the students' associations and their respective teaching facilities. The survey consisted of 17 items regarding USMed. Statements were rated on a 4-point Likert scale for agreement. In total, 1040 students from 31 German medical faculties participated. The majority (1021, 98.2%) reported a very high to high interest in curricular USMed. Students agreed (n = 945, 90.9%) that USMed would be helpful along their entire course of medical studies. Considering the best starting time for USMed, the opinions of German medical students diverged: students studying in a model curriculum preferred to start in the second year (40.7%) while 49% of the students studying in a traditional curriculum preferred to start in the third year (p ≤ 0.001). An insufficient allotment of time for USMed in the planned curriculum (675, 65%) and a lack of courses run by medical faculty (305, 29.4%) were listed as perceived significant barriers to the participation in USMed. Peer teaching was regarded as an effective method in realizing USMed by 731 (70.3%) students.Conclusion: German medical students are very interested and willing to participate in USMed. There appears to be a high demand for US courses offered by medical schools.

We developed a 3.5-h training for general practitioners (GPs) in delivering brief stop-smoking advice according to different methods (ABC, 5As). In a pragmatic, cluster randomised controlled trial our training proved effective in increasing GP-delivered rates of such advice (from 13% to 33%). In this follow-up analysis we examined the effect of the training and compared ABC versus 5As on patient-reported quit attempts and point prevalence abstinence at weeks 4, 12 and 26 following GP consultation. Follow-up data were collected in 1937 smoking patients – independently of the receipt of GP advice – recruited before or after the training of 69 GPs. At week 26, ∼70% of the patients were lost to follow-up. All 1937 patients were included in an intention-to-treat analysis; missing outcome data were imputed. Quit attempts and abstinence rates did not differ significantly from pre- to post-training or between patients from the ABC versus the 5As group. However, ancillary analyses showed that patients who received GP advice compared to those who did not had two times higher odds of reporting a quit attempt at all follow-ups and abstinence at week 26. We reported that our training increases GP-delivered rates of stop-smoking advice, and the present analysis confirms that advice is associated with increased quit attempts and abstinence rates in patients. However, our training did not further improve these rates, which might be related to patients’ loss to follow-up or to contextual factors, e.g. access to free evidence-based cessation treatment, which can hamper the transfer of GPs’ advice into patients’ behaviour change.

This study assessed the effectiveness of a 3.5-h training session for general practitioners (GPs) in providing brief stop-smoking advice and compared two methods of giving advice – ABC versus 5As – on the rates of delivery of such advice and of recommendations of evidence-based smoking cessation treatment during routine consultations. A pragmatic, two-arm cluster randomised controlled trial was carried out including a pre-/post-design for the analyses of the primary outcome in 52 GP practices in Germany. Practices were randomised (1:1) to receive a 3.5-h training session (ABC or 5As). In total, 1937 tobacco-smoking patients, who consulted trained GPs in these practices in the 6 weeks prior to or following the training, were included. The primary outcome was patient-reported rates of GP-delivered stop-smoking advice prior to and following the training, irrespective of the training method. Secondary outcomes were patient-reported receipt of recommendation/prescription of behavioural therapy, pharmacotherapy or combination therapy for smoking cessation, and the effectiveness of ABC versus 5As regarding all outcomes. GP-delivered stop-smoking advice increased from 13.1% (n=136 out of 1039) to 33.1% (n=297 out of 898) following the training (adjusted odds ratio (aOR) 3.25, 95% CI 2.34–4.51). Recommendation/prescription rates of evidence-based treatments were low (

Abstract Background Nicotine replacement therapy (NRT) bought over the counter (OTC) appears to be largely ineffective for smoking cessation, which may be partially explained by poor adherence. We developed and evaluated the NRT2Quit smartphone app (for iOS) designed to improve quit attempts with OTC NRT by improving adherence to the medications. Methods This study was a pragmatic double-blind randomised controlled trial with remote recruitment through leaflets distributed to over 300 UK-based community pharmacies. The study recruited adult daily smokers (≥10 cigarettes per day) who bought NRT, wanted to quit smoking, downloaded NTR2Quit and completed the registration process within the app. Participants were automatically randomly assigned within the app to the intervention (full) version of NRT2Quit or to its control (minimal) versions. The primary outcome was biochemically verified 4-week abstinence assessed at 8-week follow-up using Russell Standard criteria and intention to treat. Bayes factors were calculated for the cessation outcome. Secondary outcomes were self-reported abstinence, NRT use, app use and satisfaction with the app. Results The study under-recruited. Only 41 participants (3.5% of the target sample) were randomly assigned to NRT2Quit (n = 16) or the control (n = 25) app versions between March 2015 and September 2016. The follow-up rate was 51.2%. The intervention participants had numerically higher biochemically verified quit rates (25.0% versus 8.0%, P = 0.19, odds ratio = 3.83, 0.61–24.02). The calculated Bayes factor, 1.92, showed that the data were insensitive to test for the hypothesis that the intervention app version aided cessation. The intervention participants had higher median logins (2.5 versus 0, P = 0.01) and were more likely to use NRT at follow-up (100.0% versus 28.6%, P = 0.03) and recommend NRT2Quit to others (100.0% versus 28.6%, P = 0.01). Conclusions Despite very low recruitment, there was preliminary but inconclusive evidence that NRT2Quit may improve short-term abstinence and adherence among smokers using NRT. Well-powered studies on NRT2Quit are needed, but different recruitment methods will be required to engage smokers through community pharmacies or other channels. Trial registration ISRCTN ISRCTN33423896 , prospectively registered on 22 March 2015.

Abstract Background The German clinical guideline on tobacco addiction recommends that general practitioners (GPs) provide brief stop-smoking advice to their patients according to the “5A” or the much briefer “ABC” method, but its implementation is insufficient. A lack of training is one barrier for GPs to provide such advice. Moreover, the respective effectiveness of a 5A or ABC training regarding subsequent delivery of stop-smoking advice has not been investigated. We developed a training for GPs according to both methods, and conducted a pilot study with process evaluation to optimize the trainings according to the needs of GPs. This study aims at evaluating the effectiveness of both trainings. Methods A pragmatic 2-arm cluster randomised controlled trial with a pre-post data collection will be conducted in 48 GP practices in North Rhine-Westphalia (Germany). GPs will be randomised to receive a 3.5-h-training in delivering either 5A or ABC, including peer coaching and intensive role plays with professional actors. The patient-reported primary outcome (receipt of GP advice to quit: yes/no) and secondary outcomes (recommendation rates of smoking cessation treatments, group comparison (5A versus ABC): receipt of GP advice to quit) will be collected in smoking patients routinely consulting their GP within 4 weeks prior, and 4 weeks following the training. Additional secondary outcomes will be collected at 4, 12 and 26 weeks following the consultation: use of cessation treatments during the last quit attempt (if so) since the GP consultation, and point-prevalence abstinence rates. The primary data analysis will be conducted using a mixed-effects logistic regression model with random effects for the cluster variable. Discussion If the training increases the rates of delivery of stop-smoking advice, it would offer a low-threshold strategy for the guideline implementation in German primary care. Should one method prove superior, a more specific guideline recommendation can be proposed. Trial registration German Clinical Trials Register (DRKS00012786); registered on 22th August 2017, prior to the first patient in.

Abstract Background Concerns have been raised that observing other people using e-cigarettes may undermine motivation to quit by renormalising smoking. This study aimed to explore associations between regular exposure to other people’s e-cigarette use and motivation to stop smoking and quit attempts in smokers. Methods Data were from 12,787 smokers in England who participated in the Smoking Toolkit Study between November 2014 and May 2018. At baseline, respondents were asked whether anyone other than themselves regularly used an e-cigarette in their presence, whether they had made a quit attempt in the past year and how motivated they were to stop. Data at 6-month follow-up were available for 1580 respondents, who reported on whether they had attempted to quit in the past 6 months. Results Smokers who reported regular exposure to e-cigarette use by others were more likely than those who did not to have tried to stop smoking in the past year (32.3% vs. 26.8%; unadjusted RR 1.21, 95% CI 1.11–1.31) and have high motivation to quit (16.6% vs. 14.2%; unadjusted RR 1.17, 95% CI 1.05–1.30) but were not significantly more or less likely to make a quit attempt over the subsequent 6 months (34.4% vs. 31.3%; unadjusted RR 1.10, 95% CI 0.88–1.38). In models that adjusted for participants’ own current e-cigarette use and unadjusted and adjusted models excluding current e-cigarette users from the sample, there were no significant associations between exposure to e-cigarette use by others and past quit attempts (RR 0.97–1.00), high current motivation to quit (RR 0.97–1.00) or prospective quit attempts (RR 0.94–1.12). In contrast, exposure to use of cigarettes was associated with low motivation to quit even after adjustment (RR 0.89) but not with quit attempts. Participants’ own use of e-cigarette was strongly associated with high motivation to quit (RR 1.95) and past quit attempts (RR 2.14) and appeared to account for the bivariate associations with reported exposure to e-cigarettes. Conclusion Smokers who report regular exposure to other people using e-cigarettes are more likely to report past quit attempts and high current motivation to quit, but there does not appear to be an independent association with motivation or quit attempts after adjustment for their own current use of e-cigarettes. In contrast, reported exposure to other people using cigarettes was independently and negatively associated with high motivation.

Abstract Background The Choosing Wisely campaign highlights the importance of clinical reasoning abilities for competent and reflective physicians. The principles of this campaign should be addressed in undergraduate medical education. Recent research suggests that answering questions on important steps in patient management promotes knowledge retention. It is less clear whether increasing the authenticity of educational material by the inclusion of videos further enhances learning outcome. Methods In a prospective randomised controlled cross-over study, we assessed whether repeated video-based testing is more effective than repeated text-based testing in training students to choose appropriate diagnostic tests, arrive at correct diagnoses and identify advisable therapies. Following an entry exam, fourth-year undergraduate medical students attended 10 weekly computer-based seminars during which they studied patient case histories. Each case contained five key feature questions (items) on the diagnosis and treatment of the presented patient. Students were randomly allocated to read text cases (control condition) or watch videos (intervention), and assignment to either text or video was switched between groups every week. Using a within-subjects design, student performance on video-based and text-based items was assessed 13 weeks (exit exam) and 9 months (retention test) after the first day of term. The primary outcome was the within-subject difference in performance on video-based and text-based items in the exit exam. Results Of 125 eligible students, 93 provided data for all three exams (response rate 74.4%). Percent scores were significantly higher for video-based than for text-based items in the exit exam (76.2 ± 19.4% vs. 72.4 ± 19.1%, p = 0.026) but not the retention test (69.2 ± 20.2% vs. 66.4 ± 20.3%, p = 0.108). An additional Bayesian analysis of this retention test suggested that video-based training is marginally more effective than text-based training in the long term (Bayes factor 2.36). Regardless of presentation format, student responses revealed a high prevalence of erroneous beliefs that, if applied to the clinical context, could place patients at risk. Conclusion Repeated video-based key feature testing produces superior short-term learning outcome compared to text-based testing. Given the high prevalence of misconceptions, efforts to improve clinical reasoning training in medical education are warranted. The Choosing Wisely campaign lends itself to being part of this process.

Abstract Background The seven categories of the Stanford Faculty Development Program (SFDP) represent a framework for planning and assessing medical teaching. Nevertheless, so far there is no specific evaluation tool for large-group lectures that is based on these categories. This paper reports the development and psychometric validation of a short German evaluation tool for large-group lectures in medical education (SETMED-L: ‘Student Evaluation of Teaching in MEDical Lectures’) based on the SFDP-categories. Methods Data were collected at two German medical schools. In Study 1, a full information factor analysis of the new 14-item questionnaire was performed. In Study 2, following cognitive debriefings and adjustments, a confirmatory factor analysis was performed. The model was tested for invariance across medical schools and student gender. Convergent validity was assessed by comparison with results of the FEVOR questionnaire. Results Study 1 (n = 922) yielded a three-factor solution with one major (10 items) and two minor factors (2 items each). In Study 2 (n = 2740), this factor structure was confirmed. Scale reliability ranged between α = 0.71 and α = 0.88. Measurement invariance was given across student gender but not across medical schools. Convergent validity in the subsample tested (n = 246) yielded acceptable results. Conclusion The SETMED-L showed satisfactory to very good psychometric characteristics. The main advantages are its short yet comprehensive form, the integration of SFDP-categories and its focus on medical education.

Abstract Background The prevalence of tobacco smoking in Germany is high (~27%). Monitoring of national patterns of smoking behaviour and data on the “real-world” effectiveness of cessation methods are needed to inform policies and develop campaigns aimed at reducing tobacco-related harm. In England, the Smoking Toolkit Study (STS) has been tracking such indicators since 2006, resulting in the adaptation of tobacco control policies. However, findings cannot be directly transferred into the German health policy context. The German Study on Tobacco Use (DEBRA: “Deutsche Befragung zum Rauchverhalten”) aims to provide such nationally representative data. Methods/Design In June 2016, the study started collecting data from computer-assisted, face-to-face household interviews in people aged 14 years and older. Over a period of 3 years, a total of ~36,000 respondents will complete the survey with a new sample of ~2000 respondents every 2 months (=18 waves). This sample will report data on demographics and the use of tobacco and electronic (e-)cigarettes. Per wave, about 500–600 people are expected to be current or recent ex-smokers (

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.

Introduction Lack of smoking cessation education in undergraduate medical training hinders healthcare professionals in providing adequate tobacco cessation counselling. We developed a comprehensive 4-h smoking cessation counselling course for medical students that is easy to incorporate in a medical school curriculum, and assessed its short-term outcome for knowledge, skills, and attitudes. Material and Methods Eighty-eight medical students (53f, 35 m) were educated by a doctoral student in five identical 4-h courses. A 45-min theoretical introduction was followed by patient-physician role-playing by student pairs. Knowledge, skills, and attitude were assessed before and 4 weeks after the course by questionnaires, and by blinded analysis of pre- and post-course videos of a five-minute standardized patient situation. Results Knowledge: Before the course 10.6 (mean, SD: 2.7) questions out of 29 were answered correctly, and increased to 19.2 (3.6) after the course (p

Introduction Varenicline is an effective smoking cessation medication. Some concern has been raised that its use may precipitate adverse cardiovascular events although no patho-physiological mechanism potentially underlying such an effect has been reported. The aim of this study was to test the hypothesis that varenicline impacts on sympatho-vagal balance during smoking withdrawal. Material and Methods In this randomised, placebo-controlled trial, muscle sympathetic nerve activity (MSNA), baroreflex sensitivity (BRS), heart rate, and blood pressure were assessed in 17 smokers four weeks before a quit attempt (baseline) and again on the third day of that quit attempt (acute smoking withdrawal). Results Regarding the primary endpoint of our study, we did not find a significant effect of varenicline compared to placebo on changes in MSNA burst incidence between baseline and acute smoking withdrawal (−3.0 ± 3.3 vs.−3.9 ± 5.0 bursts/100 heart beats; p = 0.308). However, heart rate and systolic blood pressure significantly decreased in the placebo group only, while no significant changes in these parameters were observed in the varenicline group. Exposure to smoking cues during acute withdrawal lead to a significant increase of heart rate in the placebo group, while heart rate decreased in the varenicline group, and the difference in these changes was significant between groups (+2.7 ± 1.0 vs.−1.8 ± 0.5 1/min; p = 0.002). In all 17 participants combined, a significant increase in heart rate during smoking cue exposure was detected in subjects who relapsed in the course of six weeks after the quit date compared to those who stayed abstinent (+2.5 ± 1.2 vs.−1.1 ± 0.7; p = 0.018). Six-week abstinence rates were higher in the varenicline group compared to placebo (88 vs. 22 % p = 0.015). Conclusions We did not find evidence of adverse effects of varenicline on sympatho-vagal balance. Varenicline probably blunts the heart rate response to smoking cues, which may be linked to improved cessation outcome.

Background Little is known about the knowledge and attitudes towards tobacco use among medical students in Canada. Our objectives were to estimate the prevalence of tobacco use among medical students, assess their perceived level of education about tobacco addiction management and their preparedness to address tobacco use with their future patients. Methods A cross-sectional online survey was administered to University of Alberta undergraduate medical school trainees. The 32-question survey addressed student demographics, tobacco use, knowledge and attitudes around tobacco and waterpipe smoking, tobacco education received in medical school, as well as knowledge and competency regarding tobacco cessation interventions. Results Of 681 polled students, 301 completed the survey. Current (defined as “use within the last 30 days”) cigarette, cigar/cigarillo and waterpipe smoking prevalence was 3.3%, 6% and 6%, respectively. One third of the respondents had ever smoked a cigarette, but 41% had tried cigars/cigarillos and 40% had smoked a waterpipe at some time in the past. Students reported moderate levels of education on a variety of tobacco-related subjects but were well-informed on the role of tobacco in disease causation. The majority of students in their final two years of training felt competent to provide tobacco cessation interventions, but only 10% definitively agreed that they had received enough training in this area. Conclusions Waterpipe exposure/current use was surprisingly high among this sample of medical students, a population well educated about the role of tobacco in disease causation. The majority of respondents appeared to be adequately prepared to manage tobacco addiction but education could be improved, particularly training in behavioral modification techniques used in tobacco use cessation.