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Background: One of the aims of the German student selection network (Studierendenauswahl-Verbund, stav) is to review existing procedures for selecting medical students and to relate their effectiveness to students’ career aspirations as well as to their further careers. Against the background of changes in the selection procedures and the introduction of the rural doctor quota (Landarztquote), the study conducted here aims at contributing to the current discussion on the future of GP (general practitioners) care, especially in rural areas.Methods: In 2019 and 2020, the stav conducted a German nationwide online survey among medical students towards the end of their “Practical Year” (Praktisches Jahr, final-year medical students in practical training). The associations between selection parameters and students’ interest in later working as a GP as well as students’ preference to later work in a place with a low population density were investigated. Furthermore, socio-demographic variables and variables related to medical studies were taken into account. Statistical comparisons were carried out using Chi- and Mann-Whitney U tests.Results: A total of 1,055 students in their Practical Year (65.4% female, 27 years) completed the survey. As their final professional position, 12.1% aspired to own a GP practice or work as employed GP after completing medical specialist training in general medicine (interested students: 9.9%) or general internal medicine (interested students: 9.5%). Compared to their fellow students, those interested in working as a GP had been more often admitted to medical school via the waiting time quota and had more often already completed vocational training in a medical-related field. 39.1% of those interested in working as a GP wanted to work in a place with a low population density. Coming from a place with a low population density as well as completing the medical internship (Famulatur) for GP care in such a place turned out to be positive influencing factors. Discussion: The observed associations between waiting time quota and interest in working as a GP as well as between origin from a place with a low population density and preferring to later work in such a place go hand in hand with changes in the access regulations for medical studies, which concern both the waiting time quota (abolition of the latter) and a regulation of the number of rural doctors (rural doctor quota). In order to evaluate the current changes in the access regulations for medical studies, longitudinal studies are desirable that cover the time from the application to study up to the medical specialist examination and further career.

Background/aim: In the 2012/13 winter semester, the Magdeburg Medical Faculty introduced a test of knowledge for the selection of applicants. The Hamburg Assessment Test for Medicine - Natural Sciences (HAM-Nat) comprises a multiple-choice test with questions on the aspects of biology, physics, chemistry and mathematics relevant to medicine, which was specifically developed for the selection of medicine applicants. The aim is to study how the HAM-Nat influences student selection, the reasons why students decide to take the test as part of their application procedure and what expectations they have of their course of study.Methods: The selection procedures applied at the university in 2011 (without HAM-Nat) and in 2012-2014 (with HAM-Nat) are compared. On the basis of the results of exploratory interviews, university entrants in winter semester 2013/2014 participated in a written survey on why they chose their subject and place of study and their expectations of their course of study. Results: No problems were encountered in introducing the extended selection procedure that included the HAM-Nat Test. The HAM-Nat had a great influence on the selection decision. About 65% of the students admitted would not have obtained a place if the decision had been based exclusively on their Abitur grade [grade obtained in the German school-leaving examination]. On average, male applicants obtained better HAM-Nat results than female ones. The questionnaire was answered by 147 out of 191 university entrants (77%). In the case of applicants from Saxony-Anhalt, the principle reasons for choosing the regional capital are its proximity, the social environment offered, good conditions for studying and the feel-good factor at the university. For the majority of applicants, however, particularly applicants from other federal states, the relatively good chances of admission in Magdeburg were the main reason. Conclusion: The Magdeburg Medical Faculty regards the HAM-Nat as a suitable tool for selecting applicants with outstanding knowledge of natural sciences and thus of increasing and harmonising levels of knowledge at the start of the course. Completion of the standard period of study and success in the 1st part of the German Medical Examination will be the subject of further observation of the students. The HAM-Nat, as a performance-related selection procedure, is not suitable for giving active preference to natives of Saxony-Anhalt in the application procedure but their number has increased since it was introduced. Applicants primarily use the selection procedure tactically to obtain the university place they want to study medicine. Specifics relating to curricula and university profile and research areas are not critical to their choice.

[english] Although some recent studies concluded that dexterity is not a reliable predictor of performance in preclinical laboratory courses in dentistry, they could not disprove earlier findings which confirmed the worth of manual dexterity tests in dental admission. We developed a wire bending test (HAM-Man) which was administered during dental freshmen’s first week in 2008, 2009, and 2010. The purpose of our study was to evaluate if the HAM-Man is a useful selection criterion additional to the high school grade point average (GPA) in dental admission. Regression analysis revealed that GPA only accounted for a maximum of 9% of students’ performance in preclinical laboratory courses, in six out of eight models the explained variance was below 2%. The HAM-Man incrementally explained up to 20.5% of preclinical practical performance over GPA. In line with findings from earlier studies the HAM-Man test of manual dexterity showed satisfactory incremental validity. While GPA has a focus on cognitive abilities, the HAM-Man reflects learning of unfamiliar psychomotor skills, spatial relationships, and dental techniques needed in preclinical laboratory courses. The wire bending test HAM-Man is a valuable additional selection instrument for applicants of dental schools.

The phenomenon of first impression is well researched in social psychology, but less so in the study of OSCEs and the multiple mini interview (MMI). To explore its bearing on the MMI method we included a rating of first impression in the MMI for student selection executed 2012 at the University Medical Center Hamburg-Eppendorf, Germany (196 applicants, 26 pairs of raters) and analyzed how it was related to MMI performance ratings made by (a) the same rater, and (b) a different rater. First impression was assessed immediately after an applicant entered the test room. Each MMI-task took 5 min and was rated subsequently. Internal consistency was [alpha] = 0.71 for first impression and [alpha] = 0.69 for MMI performance. First impression and MMI performance correlated by r = 0.49. Both measures weakly predicted performance in two OSCEs for communication skills, assessed 18 months later. MMI performance did not increment prediction above the contribution of first impression and vice versa. Prediction was independent of whether or not the rater who rated first impression also rated MMI performance. The correlation between first impression and MMI-performance is in line with the results of corresponding social psychological studies, showing that judgements based on minimal information moderately predict behavioral measures. It is also in accordance with the notion that raters often blend their specific assessment task outlined in MMI-instructions with the self-imposed question of whether a candidate would fit the role of a medical doctor.

[english] Introduction: Audio podcasts are an e-learning format that may help to motivate students to deal with the contents of medical education more intensely. We adopted a well-proven format from radio broadcasting, the radio documentary, to direct the listeners’ attention to information about practical courses in biochemistry over a period of 20 minutes at most. Information, original sounds, and a specific atmosphere allow listeners to perceive the contents intensely.Method: In order to organise the production of the podcast as cost-efficient and least time-consuming as possible, a student, a teacher, a clinician, and a technical assistant compile the core themes of their respective text blocks in an editorial conference first. After that, the speakers can elaborate on and record their blocks independently. Coordination is widely handled by the student. At two points of time, the podcasts were evaluated by the medical students by means of a questionnaire.Results: With little cost and time expenses, eight podcasts were produced. They have been used by the students extensively and have also been evaluated very positively by non-student listeners. For long-term usage, a regular reference to the podcast offer is required in the courses.Conclusion: Involving students, successful podcasts can be produced to support classroom teaching with little expenses and contribute to the external presentation of the medical faculty.[german] Einleitung: Audiopodcasts sind ein e-Learning Format, mit dem Studierende motiviert werden können, sich intensiver mit Lerninhalten des Medizinstudiums zu beschäftigen. Wir haben ein bewährtes Format aus dem Hörfunk, den „gebauten Beitrag“, übernommen, um die Aufmerksamkeit der Zuhörer über Zeiträume bis zu 20 Minuten auf Informationen zum Biochemiepraktikum zu richten. Informationen, O-Ton (Original-Ton) und spezifische Atmosphäre lassen den Hörer die Inhalte intensiv erleben.Methode: Um die Erstellung der Podcasts möglichst kostengünstig und wenig zeitintensiv zu gestalten, erarbeiten zunächst je ein Studierender, Dozent, Kliniker und technischer Angestellter in einer Redaktionskonferenz die Themenschwerpunkte der ihnen zugeordneten Textblöcke. Anschließend können die Sprecher die Blöcke unabhängig voneinander ausarbeiten und einsprechen. Die Koordination wird dabei weitgehend von dem Studierenden übernommen. Mit einem Fragebogen wurden die Podcasts zu zwei Zeitpunkten von Medizinstudierenden evaluiert.Ergebnisse: Mit geringem zeitlichen und finanziellen Aufwand wurden 8 Podcasts erstellt und unter veröffentlicht. Sie wurden in großem Umfang von den Studierenden genutzt und auch von vielen nicht studentischen Hörern sehr positiv bewertet. Für eine langfristige Nutzung ist ein regelmäßiger Hinweis auf das Podcast Angebot in Lehrveranstaltungen notwendig.Schlussfolgerung: Erfolgreiche Podcasts zur Unterstützung der Präsenzlehre können mit geringem Aufwand unter Einbezug von Studierenden erstellt werden und tragen zur Außendarstellung der Medizinischen Fakultät bei.

[english] Introduction: The present study examines the question whether the selection of dental students should be based solely on average school-leaving grades (GPA) or whether it could be improved by using a subject-specific aptitude test.Methods: The HAM-Nat Natural Sciences Test was piloted with freshmen during their first study week in 2006 and 2007. In 2009 and 2010 it was used in the dental student selection process. The sample size in the regression models varies between 32 and 55 students. Results: Used as a supplement to the German GPA, the HAM-Nat test explained up to 12% of the variance in preclinical examination performance. We confirmed the prognostic validity of GPA reported in earlier studies in some, but not all of the individual preclinical examination results. Conclusion: The HAM-Nat test is a reliable selection tool for dental students. Use of the HAM-Nat yielded a significant improvement in prediction of preclinical academic success in dentistry.[german] Einleitung: In der vorliegenden Untersuchung wird der Frage nachgegangen, ob die Auswahl der Studierenden in der Zahnmedizin alleine durch die Abiturdurchschnittsnote erfolgen sollte oder ob sie durch den Einsatz eines fachspezifischen Studierfähigkeitstest verbessert werden kann. Methoden: Der Naturwissenschaftstest HAM-Nat wurde in den Jahren 2006 und 2007 in der Erstsemesterwoche an den Studienanfängerinnen und -anfängern* erprobt sowie 2009 und 2010 im Auswahlverfahren eingesetzt. Die Stichprobengrößen der Regressionsmodelle variieren in allen Jahrgängen zwischen 32 und 55 Teilnehmern. Ergebnisse: Der HAM-Nat erklärte zusätzlich zur Abiturdurchschnittsnote bis zu 12 % der Leistungsvarianz in den vorklinischen Prüfungsleistungen. Die in anderen Studien gefundene prognostische Güte der Abiturdurchschnittsnote konnte für einige, aber nicht für alle Einzelprüfungen bestätigt werden. Schlussfolgerung: Der HAM-Nat erwies sich als zuverlässiges Auswahlinstrument in der Zahnmedizin. Durch den Einsatz des HAM-Nat wird die Vorhersage des vorklinischen, akademischen Studienerfolgs in der Zahnmedizin deutlich verbessert.

[english] Aims: Tests with natural-scientific content are predictive of the success in the first semesters of medical studies. Some universities in the German speaking countries use the ‘Test for medical studies’ (TMS) for student selection. One of its test modules, namely “medical and scientific comprehension”, measures the ability for deductive reasoning. In contrast, the Hamburg Assessment Test for Medicine, Natural Sciences (HAM-Nat) evaluates knowledge in natural sciences. In this study the predictive power of the HAM-Nat test will be compared to that of the NatDenk test, which is similar to the TMS module “medical and scientific comprehension” in content and structure. Methods: 162 medical school beginners volunteered to complete either the HAM-Nat (N=77) or the NatDenk test (N=85) in 2007. Until spring 2011, 84.2% of these successfully completed the first part of the medical state examination in Hamburg. Via different logistic regression models we tested the predictive power of high school grade point average (GPA or “Abiturnote”) and the test results (HAM-Nat and NatDenk) with regard to the study success criterion “first part of the medical state examination passed successfully up to the end of the 7 semester” (Success7Sem). The Odds Ratios (OR) for study success are reported.Results: For both test groups a significant correlation existed between test results and study success (HAM-Nat: OR=2.07; NatDenk: OR=2.58). If both admission criteria are estimated in one model, the main effects (GPA: OR=2.45; test: OR=2.32) and their interaction effect (OR=1.80) are significant in the HAM-Nat test group, whereas in the NatDenk test group only the test result (OR=2.21) significantly contributes to the variance explained. Conclusions: On their own both HAM-Nat and NatDenk have predictive power for study success, but only the HAM-Nat explains additional variance if combined with GPA. The selection according to HAM-Nat and GPA has under the current circumstances of medical school selection (many good applicants and only a limited number of available spaces) the highest predictive power of all models. [german] Ziele: Tests mit naturwissenschaftlichen Inhalten sind prädiktiv für den Studienerfolg in den ersten Semestern des Medizinstudiums. Einige deutschsprachige Universitäten verwenden für die Studienbewerberauswahl den Test für Medizinische Studiengänge (TMS), dessen Test-Modul „Medizinisch-naturwissenschaftliches Grundverständnis“ die Fähigkeit zu schlussfolgerndem Denkens erfasst. Im Hamburger Auswahlverfahren für Medizinische Studiengänge - Naturwissenschaftsteil (HAM-Nat) werden dagegen naturwissenschaftliche Kenntnisse überprüft. In dieser Studie vergleichen wir die prädiktive Stärke des HAM-Nat mit einem Test (NatDenk), der dem TMS-Modul „Medizinisch-naturwissenschaftliches Grundverständnis“ inhaltlich und strukturell ähnelt.Methoden: Im Jahr 2007 nahmen 162 Studienanfänger der Humanmedizin freiwillig am HAM-Nat (N=77) oder am NatDenk (N=85) teil. Bis zum Frühjahr 2011 hatten 84,2% der Testteilnehmer das Physikum in Hamburg bestanden. Mittels verschiedener logistischer Regressionsmodelle überprüften wir die Vorhersagekraft der Abiturnote und der Testergebnisse (HAM-Nat und NatDenk) auf das Studienerfolgskriterium „Physikum nach 7 Studiensemestern bestanden“. Berichtet werden die Odds Ratios (OR) für Studienerfolg.Ergebnisse: Für beide Testgruppen bestand ein signifikanter Zusammenhang zwischen Testergebnis und Studienerfolg (HAM-Nat: OR=2,07; NatDenk: OR=2,58). Werden beide Zulassungskriterien in einem Modell geschätzt, sind in der HAM-Nat Gruppe beide Haupteffekte (Abitur: OR=2,45; Test: OR=2,32) und deren Interaktionseffekt (OR=1,80) signifikant, während in der NatDenk Gruppe nur das Testergebnis (OR=2,21) allein einen signifikanten Beitrag zur Aufklärung der Varianz liefert.Schlussfolgerungen: Für sich genommen haben sowohl HAM-Nat als auch NatDenk prädiktive Information für den Studienerfolg, allerdings klärt die Abiturnote nur bei Verwendung des HAM-Nat zusätzliche Varianz auf. Die Auswahl nach HAM-Nat und Abiturnote hat unter den aktuellen Bedingungen des Medizinerauswahlverfahrens mit vielen guten Bewerbern aber nur wenigen Studienplätzen die höchste Vorhersagekraft aller Modelle.

[english] Introduction: The Internet represents a central communication medium for patients and physicians. Some national information is available regarding the design of physicians‘ homepages and patient requirements regarding homepages of physicians in private practice. To date, no data are available for homepages of medical faculties and their users‘ needs.Methods: In 2008 the homepages of the 36 German medical faculties were analyzed according to a catalogue of 128 criteria assigned to five domains which had been developed from the literature. Structure, content and extent were compared. Results: The homepages covered the criteria to a very different extent. The best homepage reached 80%, the worst only 26% of the achievable points. The mean was slightly above 50% . Faculties addressed mainly applicants and students as their target groups, less frequently lecturers and alumni.Conclusion: This study shows differences in quality and quantity of the „teaching section“ on websites of medical faculties. The results allow faculties to use the criteria to adjust their websites with regard to addressing the relevant target groups of students, applicants, lecturers and alumni comprehensively.[german] Einleitung: Für Ärzte und Patienten stellt das Internet ein zentrales Informationsmedium im Gesundheitswesen dar. Es liegen national einige Informationen zur Gestaltung einer Arzthomepage und zu Patientenwünschen an den Internetauftritt eines niedergelassenen Arztes vor. Für Internetauftritte medizinischer Fakultäten und die Bedürfnisse ihrer Zielgruppen gibt es bislang keine Daten.Methoden: In 2008 wurden die Internetauftritte der 36 Medizinischen Fakultäten anhand von über 100 aus der Literatur entwickelten Kriterien erfasst, die fünf Bereichen zugeordnet wurden. Aufbau, Inhalt und Umfang wurden miteinander verglichen. Ergebnisse: Die Internetauftritte deckten die Kriterien in sehr unterschiedlichem Umfang ab. Der beste Auftritt erreichte 80%, der schlechteste lediglich 26% der erreichbaren Punkte, im Mittel wurde gut die Hälfte der Kriterien erfüllt. Die Fakultäten bedienten vor allem Studienbewerber und Studierende als Zielgruppen, weniger die Lehrenden und Alumni. Schlussfolgerung: Die vorliegende Studie zeigt Qualitäts – und Quantitätsunterschiede der Lehrbereiche der Internetauftritte medizinischer Fakultäten. Die Ergebnisse bieten den Fakultäten anhand der Kriterien die Möglichkeit, ihre Internetauftritte zu überarbeiten, um den relevanten Zielgruppen der Studierenden, Studieninteressierten, Lehrenden und Absolventen eine umfassende Informationsplattform zu bieten.

[english] Objective: The University Hospital in Hamburg (UKE) started to develop a test of knowledge in natural sciences for admission to medical school in 2005 (Hamburger Auswahlverfahren für Medizinische Studiengänge, Naturwissenschaftsteil, HAM-Nat). This study is a step towards establishing the HAM-Nat. We are investigating Methods: 316 first-year students participated in the study in 2007. They completed different versions of the HAM-Nat test which consisted of items that had already been used (HN2006) and new items (HN2007). Four weeks later half of the participants were tested on the HN2007 version of the HAM-Nat again, while the other half completed the test of scientific reasoning. Within this four week interval students were offered a five day chemistry course.Results: Parallel forms reliability for four different test versions ranged from r=.53 to r=.67. The retest reliabilities of the HN2007 halves were r=.54 and r=.61. Correlations of the two HAM-Nat versions with the test of scientific reasoning were r=.34 und r=.21. The crash course in chemistry had no effect on HAM-Nat scores.Conclusions: The results suggest that further versions of the test of natural sciences will not easily conform to the standards of internal consistency, parallel-forms reliability and retest reliability. Much care has to be taken in order to assemble items which could be used interchangeably for the construction of new test versions. The test of scientific reasoning and the HAM-Nat are tapping different constructs. Participation in a chemistry course did not improve students’ achievement, probably because the content of the course was not coordinated with the test and many students lacked of motivation to do well in the second test.[german] Ziele: Die Universität Hamburg hat im Jahr 2005 begonnen, einen Naturwissenschaftstest zur Auswahl von Studienbewerbern zu entwickeln (Hamburger Auswahlverfahren für Medizinische Studiengänge, Naturwissenschaftsteil, HAM-Nat). Diese Studie ist ein weiterer Schritt, den HAM-Nat zu etablieren. Wir untersuchen Methoden: 316 Studienanfänger nahmen an der Studie in der Orientierungseinheit im Jahr 2007 teil. Sie bearbeiteten verschiedene Versionen des HAM-Nat, die jeweils aus alten Fragen (HN2006) und neuen Fragen (HN2007) bestanden. Nach vier Wochen bekam die eine Hälfte der Studienanfänger erneut den HAM-Nat, allerdings nur die 2007er Version; die andere Hälfte bekam das Modul „Naturwissenschaftliches Denken“. Innerhalb dieser 4 Wochen konnten die Studienanfänger an einem fünftägigen Chemiekurs teilnehmen.Ergebnisse: Die Paralleltest-Reliabilitäten für die vier Testversionen lagen zwischen r=.53 und r=.67. Die Retest-Reliabilitäten der beiden 2007er Testhälften lagen bei r=.54 und r=.61. Die HAM-Nat Versionen HN2006 und HN2007 korrelierten mit dem Modul „Naturwissenschaftliches Denken“ zu r=.34 und r=.21. Studierende, die zwischen Test und Testwiederholung einen Chemiekurs absolviert hatten, verbesserten dadurch nicht ihre Testleistungen.Schlussfolgerungen: Die Ergebnisse lassen erwarten, dass weitere Testversionen zu naturwissenschaftlichem Wissen ebenfalls keine hohe interne Konsistenz, Paralleltest-Reliabilität oder Retest-Reliabilität ergeben. Daher ist für den Aufbau einer Sammlung von Items, die austauschbar für die Erzeugung von Parallelversionen benutzt werden können, große Sorgfalt erforderlich. Das Testmodul „Naturwissenschaftliches Denken“ misst im Wesentlichen etwas anderes als der HAM-Nat. Die Tatsache, dass die Teilnahme an einem Chemiekurs keinen Effekt auf die Leistungen im Chemie-Teil des HAM-Nat hatte, ist vermutlich auf fehlende Abstimmung der Inhalte des Kurses mit dem Test zurückzuführen und auf die geringe Motivation der Studienteilnehmer, besonders zum zweiten Testzeitpunkt.

[english] Aims: Since 2005 German medical faculties are allowed to select 60% of their freshmen. Nevertheless, many faculties stick to a selection based merely on the grade point average assigned by the secondary school (Abiturnote) which is the best known predictor of success in German medical schools. Methods: In order to improve selection with respect to medical school dropout numbers we developed the HAM-Nat (Hamburg Admission test for Medicine - part Natural sciences), a test consisting of 52 multiple-choice questions from the topics of chemistry, physics, biology and mathematics, and assessed its difficulty with pupils of 6 different schools. Then the HAM-Nat was administered to 333 first-year students just before the start of their courses in October 2006. After the first academic year the power of the HAM-Nat to predict individual study success was compared to that of the grade point average. Study success was measured by the number of passed exams. Outcomes: The HAM-Nat was found to correlate better with study success than the grade point average. A projection based on data from older student cohorts shows that student selection with the HAM-Nat can reduce the number of students dropping out compared with a selection based on the grade point average alone. Other parameters like chosen natural science subjects at school or an industrial training in medicine or other areas do not predict academic success. Conclusions: The HAM-Nat is a valuable tool to predict student success at medical school. Based on this study Hamburg’s medical faculty has decided to introduce the HAM-Nat to select its entrants in 2008. [german] Zielsetzung: Seit das Hochschulrahmengesetz 2005 den Hochschulen ermöglicht, 60% der Medizinstudienanfänger selbst auszuwählen, sind die Medizinischen Fakultäten auf der Suche nach dem optimalen Auswahlverfahren. Viele tun sich schwer, ein Auswahlkriterium zu definieren. Noch schwieriger ist es, einen Test für die Auswahl eines zukünftigen „guten Arztes“ zu entwickeln und zu validieren. Daher beschränkt sich das Auswahlverfahren in Hamburg auf das pragmatische Ziel die Studienabbrecherzahl zu reduzieren, damit möglichst viele Studienanfänger durch gute Lehre zu „guten Ärzten“ ausgebildet werden. Methodik: Zu diesem Zweck wurde der HAM-Nat (Hamburger Auswahlverfahren für Medizinische Studiengänge - Naturwissenschaftsteil) mit 52 Multiple-choice Fragen auf Schulniveau über naturwissenschaftliche Kenntnisse und ihre Anwendung entwickelt, zunächst an 6 Schulen in 3 Bundesländern erprobt und dann mit 333 Studienanfängern im Oktober 2006 durchgeführt. Das Testergebnis und die Abiturnote wurden mit dem Studienerfolg in den ersten beiden Semestern korreliert. Als Studienerfolgsparameter wurde die Anzahl der bestandenen Leistungsnachweise verwendet. Ergebnisse: Das HAM-Nat-Ergebnis korreliert nach dem 2. Semester höher mit dem Studienerfolg als die Abiturnote, von der es relativ unabhängig ist. Insbesonders zeigt die Simulation eines Auswahlverfahrens unter Berücksichtigung von HAM-Nat-Ergebnis und Abiturnote eine deutliche Reduktion der Zahl der Studienabbrecher im Vergleich zur jetzigen Auswahl nur nach Abiturnote. Weitere abgefragte mögliche Studienauswahlparameter wie belegte naturwissenschaftliche Kurse oder eine abgeschlossene Berufsausbildung korrelieren nicht mit besserem Studienerfolg. Schlussfolgerung: Der HAM-Nat ist ein wertvolles zusätzliches Auswahlverfahren für Studienbewerber in der Medizin. Aufgrund dieser Ergebnisse hat die Medizinische Fakultät Hamburg beschlossen, den HAM-Nat für die Studienbewerberauswahl zum Wintersemester 2008/2009 einzuführen.

Sixty years of research have not added up to a concordant evaluation of the influence of spatial and manual abilities on dental skill acquisition. We used Ackerman's theory of ability determinants of skill acquisition to explain the influence of spatial visualization and manual dexterity on the task performance of dental students in two consecutive preclinical technique courses. We measured spatial and manual abilities of applicants to Hamburg Dental School by means of a multiple choice test on Technical Aptitude and a wire-bending test, respectively. Preclinical dental technique tasks were categorized as consistent-simple and inconsistent-complex based on their contents. For analysis, we used robust regression to circumvent typical limitations in dental studies like small sample size and non-normal residual distributions. We found that manual, but not spatial ability exhibited a moderate influence on the performance in consistent-simple tasks during dental skill acquisition in preclinical dentistry. Both abilities revealed a moderate relation with the performance in inconsistent-complex tasks. These findings support the hypotheses which we had postulated on the basis of Ackerman's work. Therefore, spatial as well as manual ability are required for the acquisition of dental skills in preclinical technique courses. These results support the view that both abilities should be addressed in dental admission procedures in addition to cognitive measures.

Medical professionals who represent the communities they serve are in a better position to understand patients' social circumstances and communicate in a more patient-centered way. International studies show limited diversity and underrepresentation of certain social groups in the population of physicians and medical students. We designed an observational study to investigate the cultural and socio-economic diversity of physicians and medical applicants in comparison to the general population in Germany. We invited 15,195 physicians in Hamburg and 11,287 medical applicants in Germany to participate in an online survey between June and August 2022. The lower three quintiles of objective socio-economic background (SEB) were vastly underrepresented in all subsamples of the study and in particular amongst applicants and students admitted in Hamburg: 57.9% of physicians and 73.8% of medical students in Hamburg originate from the top quintile of SEB. The Turkish and Polish communities were particularly underrepresented in the group of physicians from Hamburg and medical applicants and students in Germany (p = 0.02; p < 0.001). In line with existing evidence, the vast majority of physicians and medical students come from the most affluent households when entering medical school. Widening participation strategies are needed to facilitate fairer access to the study of medicine in Germany. [ABSTRACT FROM AUTHOR]

Background: The validity of selection tests is underestimated if it is determined by simply calculating the predictoroutcome correlation found in the admitted group. This correlation is usually attenuated by two factors: (1) the combination of selection variables which can compensate for each other and (2) range restriction in predictor and outcome due to the absence of outcome measures for rejected applicants. Methods: Here we demonstrate the logic of these artifacts in a situation typical for student selection tests and compare four different methods for their correction: two formulas for the correction of direct and indirect range restriction, expectation maximization algorithm (EM) and multiple imputation by chained equations (MICE). First we show with simulated data how a realistic estimation of predictive validity could be achieved; second we apply the same methods to empirical data from one medical school. Results: The results of the four methods are very similar except for the direct range restriction formula which underestimated validity. Conclusion: For practical purposes Thorndike’s case C formula is a relatively straightforward solution to the range restriction problem, provided distributional assumptions are met. With EM and MICE more precision is obtained when distributional requirements are not met, but access to a sophisticated statistical package such as R is needed. The use of true score correlation has its own problems and does not seem to provide a better correction than other methods. [ABSTRACT FROM AUTHOR]

Cheating is a common phenomenon in high stakes admission, licensing and university exams and threatens their validity. To detect if some exam questions had been affected by cheating, we simulated how data would look like if some test takers possessed item preknowledge: Responses to a small number of items were set to correct for 1–10% of test takers. Item difficulty, item discrimination, item fit, and local dependence were computed using an IRT 2PL model. Then changes in these item properties from the non-compromised to the compromised dataset were scrutinized for their sensitivity to item preknowledge. A decline in the discrimination parameter compared with previous test versions and an increase in local item dependence turned out to be the most sensitive indicators of item preknowledge. A multiplicative combination of shifts in item discrimination, item difficulty, and local item dependence detected item preknowledge with a sensitivity of 1.0 and a specificity of .95 if 11 of 80 items were preknown to 10% of the test takers. Cheating groups smaller than 5% of the test takers were not detected reliably. In the discussion, we outline an effective search for items affected by cheating, which would enable faculty staff without IRT knowledge to detect compromised items and exclude them from scoring. [ABSTRACT FROM AUTHOR]

Background Multiple mini-interviews (MMIs) are a valuable tool in medical school selection due to their broad acceptance and promising psychometric properties. With respect to the high expenses associated with this procedure, the discussion about its feasibility should be extended to costeffectiveness issues. Methods Following a pilot test of MMIs for medical school admission at Hamburg University in 2009 (HAM-Int), we took several actions to improve reliability and to reduce costs of the subsequent procedure in 2010. For both years, we assessed overall and inter-rater reliabilities based on multilevel analyses. Moreover, we provide a detailed specification of costs, as well as an extrapolation of the interrelation of costs, reliability, and the setup of the procedure. Results The overall reliability of the initial 2009 HAM-Int procedure with twelve stations and an average of 2.33 raters per station was ICC=0.75. Following the improvement actions, in 2010 the ICC remained stable at 0.76, despite the reduction of the process to nine stations and 2.17 raters per station. Moreover, costs were cut down from $915 to $495 per candidate. With the 2010 modalities, we could have reached an ICC of 0.80 with 16 single rater stations ($570 per candidate). Conclusions With respect to reliability and cost-efficiency, it is generally worthwhile to invest in scoring, rater training and scenario development. Moreover, it is more beneficial to increase the number of stations instead of raters within stations. However, if we want to achieve more than 80 % reliability, a minor improvement is paid with skyrocketing costs. [ABSTRACT FROM AUTHOR]

Background: Based on sequence similarity, the superfamily of G protein-coupled receptors (GPRs) can be subdivided into several subfamilies, the members of which often share similar ligands. The sequence data provided by the human genome project allows us to identify new GPRs by in silico homology screening, and to predict their ligands. Results: By searching the human genomic database with known nucleotide receptors we discovered the gene for GPR99, a new orphan GPR. The mRNA of GPR99 was found in kidney and placenta. Phylogenetic analysis groups GPR99 into the P2Y subfamily of GPRs. Based on the phylogenetic tree we propose a new classification of P2Y nucleotide receptors into two subgroups predicting a nucleotide ligand for GPR99. By assaying known nucleotide ligands on heterologously expressed GPR99, we could not identify specifically activating substances, indicating that either they are not agonists of GPR99 or that GPR99 was not expressed at the cell surface. Analysis of the chromosomal localization of all genes of the P2Y subfamily revealed that all members of subgroup "a" are encoded by less than 370 kb on chromosome 3q24, and that the genes of subgroup "b" are clustered on one hand to chromosome 11q13.5 and on the other on chromosome 3q24-25.1 close to the subgroup "a" position. Therefore, the P2Y subfamily is a striking example for local gene amplification. Conclusions: We identified a new orphan receptor, GPR99, with homology to the family of G protein-coupled nucleotide receptors. Phylogenetic analysis separates this family into different subgroups predicting a nucleotide ligand for GPR99. [ABSTRACT FROM AUTHOR]

A photoaffinity ligand for the head-activator (HA) receptor from hydra was synthesized using solid- phase peptide synthesis and coupling of two HA peptides over their ε-amino groups of Lys7 with succinimidyl esters. The new ligand, Bpa-HA-HA bipeptide, contains one normal HA peptide and another where p-benzoylphenylalanine (Bpa) was added at the amino terminus to allow ultraviolet activation and Tyr11 instead of Phe11 for radioiodination. The 125I-Bpa-HA-HA bipeptide bound with nanomolar affinity to the HA receptor from the multiheaded mutant of Chlorohydra viridissima measured in a filter assay. After photoaffinity labeling of the hydra membrane fraction, a 200-kDa band was detected using reducing or non-reducing SDS/PAGE and autoradiography. Unlabeled HA derivatives, but no other neuropeptides, inhibited the labeling. Competition experiments with HA-HA homobipeptide in the nanomolar range indicate that predominantly the low-affinity and not the high-affinity HA receptor was photolabeled. Further evidence that the labeled molecule is the HA receptor comes from specific photoaffinity labeling with a second ultraviolet-activatable ligand containing p-nitrophenylalanine. The HA receptor could be functionally solubilized with Triton X-100 or Chaps. In the solubilizate the 200-kDa HA receptor was photolabeled specifically by both ligands. Liquid-phase isoelectric focussing of the solubilizate indicated a pI of about 5.4 of the photolabeled molecule. After chemical deglycosylation with trifluoro- methanesulfonic acid, the apparent molecular mass of the labeled molecule was decreased to 180 kDa, indicating that the receptor is glycosylated. [ABSTRACT FROM AUTHOR]

Head activator (HA) is a neuropeptide conserved from hydra to humans. It acts in the development of neuronal cells and is, in hydra, an important factor in head regeneration. Here we report the solubilization and purification of one head activator receptor (Kd ≈ 1 nM) from a multiheaded mutant of Chlorohydra viridissima using HA affinity chromatography. Functional solubilization of the HA receptor from hydra membranes was best performed with Triton X-100 or Chaps. The addition of salt or urea and the protein concentration were important parameters in determining the yield of solubilized receptor. For affinity chromatography HA was coupled to Sepharose. The length of the spacer was optimized with respect to binding of the solubilized HA receptor. After rigorous washing a 200-kDa protein was eluted from HA Sepharose but not from control Sepharoses coupled to bradykinin or without peptide. Ligand binding was preserved in the eluate from the HA Sepharose, and a 200-kDa protein could be photoaffinity labeled. The 200-kDa protein was shown to be glycosylated mainly of the N-linked type. By Edman degradation of the purified protein sequence information was obtained for the N-terminus and after protease digestion for several internal peptides. [ABSTRACT FROM AUTHOR]

The single-transmembrane receptor SorLA/LR11 contains binding domains typical for lipoprotein receptors and a VPS10 domain, which binds the neuropeptide head-activator. This undecapeptide enhances proliferation of neuronal precursor cells in a SorLA-dependent manner. Using specific inhibitors we found previously that head activator activates shedding of SorLA by the metalloprotease TACE close to the transmembrane domain releasing the large extracellular part of the receptor. Here we show that the remaining COOH-terminal membrane fragment of SorLA is processed by γ-secretase. Inhibition of γ-secretase by specific inhibitors or overexpression of dominant negative presenilin mutants and knock out of the presenilin genes led to accumulation of the SorLA membrane fragment and also of full-length SorLA in the membrane. In an in vitro assay we observed the γ-secretase-dependent release of the two soluble cleavage products, the SorLA cytoplasmic domain and the SorLA β-peptide. These processing steps are reminiscent of a novel signaling pathway that has been described for the notch receptor. Here, the notch cytoplasmic domain is released into the cytoplasm by the γ-secretase and migrates to the nucleus where it acts as a transcriptional regulator. In parallel we found that a fusion protein of the released cytoplasmic tail of SorLA with EGFP located to the nucleus only if the nuclear localization signal of SorLA was intact. In a reporter gene assay the cytoplasmic domain of SorLA acted as a transcriptional activator indicating that SorLA might directly regulate transcription after activation by β-secretase. [ABSTRACT FROM AUTHOR]

Abstract Background Knowledge in natural sciences generally predicts study performance in the first two years of the medical curriculum. In order to reduce delay and dropout in the preclinical years, Hamburg Medical School decided to develop a natural science test (HAM-Nat) for student selection. In the present study, two different approaches to scale construction are presented: a unidimensional scale and a scale composed of three subject specific dimensions. Their psychometric properties and relations to academic success are compared. Methods 334 first year medical students of the 2006 cohort responded to 52 multiple choice items from biology, physics, and chemistry. For the construction of scales we generated two random subsamples, one for development and one for validation. In the development sample, unidimensional item sets were extracted from the item pool by means of weighted least squares (WLS) factor analysis, and subsequently fitted to the Rasch model. In the validation sample, the scales were subjected to confirmatory factor analysis and, again, Rasch modelling. The outcome measure was academic success after two years. Results Although the correlational structure within the item set is weak, a unidimensional scale could be fitted to the Rasch model. However, psychometric properties of this scale deteriorated in the validation sample. A model with three highly correlated subject specific factors performed better. All summary scales predicted academic success with an odds ratio of about 2.0. Prediction was independent of high school grades and there was a slight tendency for prediction to be better in females than in males. Conclusions A model separating biology, physics, and chemistry into different Rasch scales seems to be more suitable for item bank development than a unidimensional model, even when these scales are highly correlated and enter into a global score. When such a combination scale is used to select the upper quartile of applicants, the proportion of successful completion of the curriculum after two years is expected to rise substantially.

Abstract Background Based on sequence similarity, the superfamily of G protein-coupled receptors (GPRs) can be subdivided into several subfamilies, the members of which often share similar ligands. The sequence data provided by the human genome project allows us to identify new GPRs by in silico homology screening, and to predict their ligands. Results By searching the human genomic database with known nucleotide receptors we discovered the gene for GPR99, a new orphan GPR. The mRNA of GPR99 was found in kidney and placenta. Phylogenetic analysis groups GPR99 into the P2Y subfamily of GPRs. Based on the phylogenetic tree we propose a new classification of P2Y nucleotide receptors into two subgroups predicting a nucleotide ligand for GPR99. By assaying known nucleotide ligands on heterologously expressed GPR99, we could not identify specifically activating substances, indicating that either they are not agonists of GPR99 or that GPR99 was not expressed at the cell surface. Analysis of the chromosomal localization of all genes of the P2Y subfamily revealed that all members of subgroup "a" are encoded by less than 370 kb on chromosome 3q24, and that the genes of subgroup "b" are clustered on one hand to chromosome 11q13.5 and on the other on chromosome 3q24-25.1 close to the subgroup "a" position. Therefore, the P2Y subfamily is a striking example for local gene amplification. Conclusions We identified a new orphan receptor, GPR99, with homology to the family of G protein-coupled nucleotide receptors. Phylogenetic analysis separates this family into different subgroups predicting a nucleotide ligand for GPR99.

Non-technical skills (NTS) in medical care are essential to ensure patient safety. Focussing on applicants' NTS during medical school admission could be a promising approach to ensure that future physicians master NTS at a high level. Next to pre-university educational attainment, many selection tests have been developed worldwide to facilitate and standardise the selection process of medical students. The predictive validity of these tests regarding NTS performance in clinical settings has not been investigated (yet). Therefore, we explored the predictive validities and prognosis of the Hamburg MMI (HAM-Int), HAM-Nat, PEA, and waiting as well as other quota (as example) designated by the Federal Armed Forces) for NTS performance in clinical emergency medicine training of medical students. During 2017 and 2020, N = 729 second, third, and fourth year students were enrolled within the study. The mean age of participants was 26.68 years (SD 3.96) and 49% were female students. NTS of these students were assessed during simulation scenarios of emergency training with a validated rating tool. Students admitted via waiting quota and designated by the Armed Forces performed significantly better than students admitted by excellent PEA ( p = 0.026). Non-EU students performed significantly inferior ( p = 0.003). Our findings provide further insight to explain how and if admission to medical school could predict NTS performance of further physicians.

Introduction: The Internet represents a central communication medium for patients and physicians. Some national information is available regarding the design of physicians' homepages and patient requirements regarding homepages of physicians in private practice. To date, no data are available for homepages of medical faculties and their users' needs., Methods: In 2008 the homepages of the 36 German medical faculties were analyzed according to a catalogue of 128 criteria assigned to five domains which had been developed from the literature. Structure, content and extent were compared., Results: The homepages covered the criteria to a very different extent. The best homepage reached 80%, the worst only 26% of the achievable points. The mean was slightly above 50% . Faculties addressed mainly applicants and students as their target groups, less frequently lecturers and alumni., Conclusion: This study shows differences in quality and quantity of the "teaching section" on websites of medical faculties. The results allow faculties to use the criteria to adjust their websites with regard to addressing the relevant target groups of students, applicants, lecturers and alumni comprehensively.

Aims: Tests with natural-scientific content are predictive of the success in the first semesters of medical studies. Some universities in the German speaking countries use the 'Test for medical studies' (TMS) for student selection. One of its test modules, namely "medical and scientific comprehension", measures the ability for deductive reasoning. In contrast, the Hamburg Assessment Test for Medicine, Natural Sciences (HAM-Nat) evaluates knowledge in natural sciences. In this study the predictive power of the HAM-Nat test will be compared to that of the NatDenk test, which is similar to the TMS module "medical and scientific comprehension" in content and structure., Methods: 162 medical school beginners volunteered to complete either the HAM-Nat (N=77) or the NatDenk test (N=85) in 2007. Until spring 2011, 84.2% of these successfully completed the first part of the medical state examination in Hamburg. Via different logistic regression models we tested the predictive power of high school grade point average (GPA or "Abiturnote") and the test results (HAM-Nat and NatDenk) with regard to the study success criterion "first part of the medical state examination passed successfully up to the end of the 7(th) semester" (Success7Sem). The Odds Ratios (OR) for study success are reported., Results: For both test groups a significant correlation existed between test results and study success (HAM-Nat: OR=2.07; NatDenk: OR=2.58). If both admission criteria are estimated in one model, the main effects (GPA: OR=2.45; test: OR=2.32) and their interaction effect (OR=1.80) are significant in the HAM-Nat test group, whereas in the NatDenk test group only the test result (OR=2.21) significantly contributes to the variance explained., Conclusions: On their own both HAM-Nat and NatDenk have predictive power for study success, but only the HAM-Nat explains additional variance if combined with GPA. The selection according to HAM-Nat and GPA has under the current circumstances of medical school selection (many good applicants and only a limited number of available spaces) the highest predictive power of all models.

The recycling of the amyloid precursor protein (APP) from the cell surface via the endocytic pathways plays a key role in the generation of amyloid beta peptide (Abeta) in Alzheimer disease. We report here that inherited variants in the SORL1 neuronal sorting receptor are associated with late-onset Alzheimer disease. These variants, which occur in at least two different clusters of intronic sequences within the SORL1 gene (also known as LR11 or SORLA) may regulate tissue-specific expression of SORL1. We also show that SORL1 directs trafficking of APP into recycling pathways and that when SORL1 is underexpressed, APP is sorted into Abeta-generating compartments. These data suggest that inherited or acquired changes in SORL1 expression or function are mechanistically involved in causing Alzheimer disease.

The single transmembrane receptor sorLA/LR11 contains binding domains typical for the low-density lipoprotein receptors and a VPS10 domain which, in the related receptor sortilin, binds the neuropeptide neurotensin. SorLA is synthesized as a proreceptor which is processed to the mature form by a furin-like propeptidase. Endogenous sorLA and its hydra homologue HAB bind the neuropeptide head activator (HA). Transiently expressed partial sorLA constructs were investigated for ligand binding. We found that HA binds with nanomolar affinity to the VPS10 domain. The sorLA propeptide also bound to the VPS10 domain, whereas the receptor-associated protein RAP interacted both with the class A repeats and the VPS10 domain. The sorLA propeptide inhibited binding of HA to full-length sorLA and to the VPS10 domain. It also interfered with binding of HA to hydra HAB, which is taken as evidence for a highly conserved tertiary structure of the VPS10 domains of this receptor in hydra and mammals. The propeptide inhibited HA-stimulated mitosis and proliferation in the human neuroendocrine cell line BON and the neuronal precursor cell line NT2. We conclude that sorLA is necessary for HA signaling and function.