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Objective: A competency-based training of medical students that is adapted to the realities of care is required internationally and is being intended in Germany with the Master Plan for Medical Studies 2020. In order to test these competencies, the German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy (IMPP) has developed a concept for the redesign of the final part of the medical licensing examination in Germany. It focuses on general and interprofessional healthcare in the examination with outpatients. The aim of this work is to assess the feasibility of the new final examination on the basis of pilot examinations in family practices and to derive further steps for the national implementation.Methods: Fourteen medical students in their internship year completed a full examination with patients aged 42 to 84 years. Examiners evaluated the examination performance using standardised evaluation forms. Feasibility was qualitatively assessed in terms of compliance with content and time limits, examination results, patient reflections, and implementation in the practice. Results: Students were able to complete all tasks within the given time frame. Based on the evaluation forms, the examiners assessed the performance of the students. Patients appreciated the structured course of the examination in the familiar location of their family practice. For the nationwide implementation of the examination, 2,500 examination practices are required for about 10,000 examinees per year. Four students can then be examined on two days per year in each practice.Conclusions: Oral-practical examinations with outpatients in general medical practices can be carried out successfully throughout the nation. An implementation of the examinations throughout Germany requires that medical studies are restructured and that this new curriculum is implemented as intended by the Master Plan for Medical Studies 2020. Furthermore, training and remuneration of examiners together with a legal framework for the new examination must be established.

Aim: Due to the lockdown caused by the Corona pandemic, the internship (PJ=practical year) seminars of the elective subject “General Practice” at Ruhr-University Bochum had to be transferred on short notice into online teaching formats via a digital platform. At the end of these new online course, the four students evaluated the comprising 16 teaching units.Methods: The seminars, each comprising four teaching units, took place in online blended-learning units and online events. After completing the seminar program, the four participants filled out a written questionnaire regarding the implementation of digital teaching, quality of teaching content, acceptance as well as advantages and disadvantages of the teaching format.Results: The acceptance of digital teaching was very high among students. Advantages and disadvantages of this teaching format compared to the previous face-to-face events became apparent; a positive assessment of the possibilities of the online format clearly prevailed, as competence-oriented, interactive aspects were very well implemented.Conclusion: Due to the need of switching to digital teachings formats, new, innovative perspectives have arisen for PJ teaching in Bochum as well as for the more distant second location Ostwestfalen-Lippe. This is particularly true with regard to centralised seminar offers despite decentralised training centres. When implementing “new” licensing regulations this creates an opportunity for general practice to include teaching practices in training throughout the country.

Aim: The seminar program of the KWBW Verbundweiterbildungplus® is offered by the Competence Center for Postgraduate Medical Education in Baden-Württemberg (KWBW) for physicians specializing in general practice (GP trainees). Attendance is a voluntary one comprised of 48 curricular units of 45 minutes each per GP trainee. This seminar program is meant to be attended in parallel to the postgraduate medical education in clinic or practice. The intention behind this project was to develop objectives, topics and a feasible structure for a seminar curriculum while taking time and financial constraints into account.Method: The Kern cycle was applied in an open, modified nominal group consensus technique in the form of an iterative process. Participating were 17 experts from the departments of general practice at the universities in Freiburg, Heidelberg, Tuebingen and Ulm, plus a pediatrician.Results: The main objective was defined as empowering GP trainees to independently provide high-quality primary care, including in rural areas. A basic curriculum was defined based on relevant frameworks, such as the 2018 Model Regulation for Postgraduate Medical Training (Musterweiterbildungsordnung/MWBO) and the Competency-based Curriculum General Practice (KCA). Overall, the seminar curriculum has 62 basic modules with 2 curricular units each (e.g. Basic Principles of General Practice, Chest Pain, Billing) and another 58 two-unit modules on variable topics (e.g. digitalization, travel medicine) adding up to 240 (124+116) curricular units. A blueprint with a rotation schedule for all of the teaching sites in Baden-Württemberg allows regular attendance by n=400 GP trainees over a period of five years, with individual variability in terms of program length.Conclusion: The model entails a five-year, flexible program to accompany the postgraduate medical education in general practice which can also be implemented in multicenter programs and those with high enrollments. The model’s focus is on acquisition of core competencies for general practice. Despite the current shift to eLearning seminars due to SARS-CoV, the program’s implementation is being continued, constantly evaluated, and used to further develop the KWBW Verbundweiterbildung® program.

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

Introduction: An oral exam (30-60 minutes) is administered at the end of every post-graduate medical specialty program or is required to attain additional specialized qualifications. In both undergraduate and post-graduate medical education oral exams are not considered to be very objective or reliable. To improve the quality of exams in medical specialties, the Regional Medical Association for South Baden (Bezirksärztekammer Südbaden) decided in 2013 to offer a training program for head examiners and others responsible for administering exams in medical specialties.Project Description: Following a survey of examiners and examinees conducted from January through June, 2013, on the difficulty level of examination questions, satisfaction with the test, and the need for training in administering exams, the first workshop of its kind was designed. Since 2013, six workshops with a total of 93 participants have been held and evaluated.Results: The evaluations (response rate: 86%) showed a high level of acceptance for the concept behind the training. A large number of participants felt the need to define minimum standards for exams, to standardize the required level of difficulty and the assessment criteria in each subject, and to give examiners the appropriate tools needed to improve the validity and reliability of the exams.Conclusion: Offering a training program for those responsible for administering medical specialty exams appears to be both meaningful and necessary in order to meet the existing need for increased validity and reliability. In light of the initial experiences with this workshop and the differing percentages of failed exam attempts nationwide, the implementation of examiner training is to be recommended in other regions in Germany. In other European countries examiners conducting medical specialty exams undergo appropriate training before administering their first exam.

[english] Objectives: Amended in 2013, the current version of the German Medical Licensure Regulation contains structural specifications that are also required of non-university institutions involved in Practical Year clinical training. The criteria are worded in relatively general terms. Furthermore, not all of the structural specifications can be readily applied to every subject area. In order to ensure commensurability in Practical Year instruction in Germany, not least in light of recently introduced Practical Year mobility, it is necessary to define consistent quality criteria for Practical Year training. The authors therefore propose a catalogue of criteria for the quality management process in Practical Year instruction facilities.Methods: In January 2014, the board of directors of the German Society for Medical Education decided to establish a committee comprised of representatives from various German medical faculties. In a process similar to the Delphi methodology, the group developed criteria for structure, process and outcome quality in Practical Year training in Germany.Results: The criteria developed for structure, process and outcome quality apply to Practical Year training in academic teaching hospitals and university medical centres. Furthermore, modalities for review are proposed. Conclusions: The present catalogue of criteria is intended to contribute to the formation of a basis for the most consistent quality standards possible for Practical Year instruction in Germany.

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

[english] Aims: In most German medical faculties, credits in general practice can be earned via exams using multiple-choice questions (MCQ). Measures such as peer-reviews may help assure the quality of these exams. In order to use time and personnel intensive peer reviews effectively and efficiently, the procedures used are key. Therefore, we wanted to find out whether there are differences between group and individual reviews regarding defined parameters.Methods: We conducted a controlled cross-over study with three GP reviewers from four different German universities. Each reviewed 80 MCQs, 40 individually and 40 within a group, including external assessments by a panel of experts. Furthermore all reviewers were asked to evaluate the review process and the time spent carrying out these reviews.Outcomes: We found no significant differences between the reliability and the validity of individual reviews versus group reviews. On average slightly more time was spent on group reviews compared with the individual reviews. The subjective assessments of the study participants regarding their satisfaction with the process and the efficiency and effectiveness of the reviews suggest a preference for group reviews.Conclusions: Based on this study, there are no definite recommendations for or against either approach. When choosing between the two, the specific work structures and organisation at the local faculty should be taken into account.[german] Zielsetzung: Im Fach Allgemeinmedizin werden die obligat zu benotenden Leistungsnachweise an vielen Hochschulstandorten über Klausuren mit Multiple-Choice-Fragen (MCF) erbracht. Zur Qualitätssicherung bietet sich u.a. ein Peer-Review-Verfahren der eingesetzten MCF an. Für die optimale Effektivität und Effizienz solcher zeit- und personalintensiven Peer-Reviews ist nicht zuletzt die Verfahrensweise von Bedeutung. Ziel der Studie war es zu untersuchen, ob sich Einzel- von Gruppen-Reviews hinsichtlich definierter Parameter unterscheiden. Methodik: In einer kontrollierten Studie mit cross-over Design, durchgeführt mit je drei allgemeinmedizinischen Reviewern vier verschiedener deutscher Hochschulstandorte, wurden die Beurteilungen der Reviewer von 80 MCF (für jeden Teilnehmer jeweils 40 im Einzel-, 40 im Gruppen-Review) mit externen Beurteilungen durch ein Expertengremium und untereinander verglichen. Daneben wurden über Fragebögen subjektive Einschätzungen der Studienteilnehmer zum Review und der Zeitaufwand erfasst.Ergebnisse: Statistisch signifikante Unterschiede in der Validität und Reliabilität fanden sich zwischen Einzel- und Gruppen-Review nicht. Der Zeitaufwand für die Gruppen-Reviews lag im Mittel etwas höher als für die Einzel-Reviews. Die subjektiven Einschätzungen der Studienteilnehmer zur Zufriedenheit mit dem Review-Prozess, der Effektivität und Wichtigkeit der Reviews lassen auf eine Präferenz für den Gruppen-Review schließen.Schlussfolgerungen: Eindeutige Empfehlungen für oder gegen die Durchführung eines der beiden Review-Verfahren lassen sich aufgrund der Studienergebnisse nicht abgeben. Die spezifische Arbeitsstruktur und –organisation sowie die Präferenzen der Mitarbeiter an den einzelnen Hochschulstandorten sollten bei der Wahl des Verfahrens berücksichtigt werden.

[english] The survey on family-friendly study organisation in medical schools conducted by the University Hospital in Ulm has identified a need for improvement in various respects in Freiburg. Due to the specific structure of medical school and the high amount of mandatory lectures, students with children face serious problems in balancing family life and their studies at the same time. On the other hand, the freer, modular structure of the clinical curriculum in Freiburg has been mainly rated as positive by the interviewees. In order to improve the situation of students with children, the interviewees favour a more flexible curriculum in general as well as an increase in information and advice services offered by the faculty.In the first place, the results of the study encourage us to maintain the modular structure in the final two clinical years in Freiburg in view of current curriculum developments. Additionally, we aim to offer targeted support to students with children. Furthermore, a wider range of e-learning supported lectures is to help students manage their studies with childcare and family obligations.[german] Die Ulmer Studie zur Familienfreundlichkeit identifiziert für die Medizinische Fakultät in Freiburg Verbesserungsbedarf in verschiedenen Punkten. Die Vereinbarkeit von Familie und Studium gestaltet sich aufgrund der spezifischen Struktur des Medizinstudiums sowie der Vielzahl an Pflichtveranstaltungen als schwierig. Als überwiegend positiv bewerten die Befragten hingegen die bestehende Blockstruktur im zweiten Studienabschnitt. Um die Situation Studierender mit Kindern zu verbessern, ist aus Sicht der Befragten eine Flexibilisierung der Studienstruktur sowie ein Ausbau der Informations- und Beratungsangebote wünschenswert.Die Umfrageergebnisse bestärken die Medizinische Fakultät Freiburg darin, im Zuge der gegenwärtigen Curriculumsentwicklung die Blockstruktur in den letzten beiden Studienjahren zu erhalten. Spezifische Informationsangebote sollen die Studierenden mit Beratungsbedarf gezielt unterstützen (z.B. im Hinblick auf Kinderbetreuungseinrichtungen oder die Studienplanung). Um eine Flexibilisierung des Studienangebots zu erreichen, setzt die Fakultät zudem auf den verstärkten Einsatz von E-Learning-Angeboten.