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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., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2021 Demmer et al.)

Background: As doctors often fail to explain diagnoses and therapies to patients in an understandable and appropriate way, the improvement of doctor-patient communication is essential. The current medical training and examinations are focused on verbal rather than on written communication. Following the premise of "assessment drives learning", the final medical licensing examination in Germany has been further developed by the German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy (IMPP). As part of the discharge management the candidates have to prepare a report for the patient that is understandable and provides them with all important information about their stay in hospital. Aim: A standardized evaluation form for formative and summative feedback has been developed and tested with regard to applicability and the assurance of test quality criteria, especially the reliability to assess the written communication skills of the students. Methodology: In an expert consensus procedure, a draft for a standardized evaluation form was developed. This form was revised after an initial trial run on patient-directed reports written by students in their last year of medical studies. Afterwards twenty-one patient-directed reports were evaluated by fourteen different examiners. The reliability was tested by calculating the generalizability-coefficient and by analysing the inter-rater reliability. Results: The first test on the evaluation of the patient-directed reports indicated the practicability of the application and the usefulness of the evaluation form as an instrument for assessing the written communication skills of students. The analyses of the inter-rater reliability showed that the degree of agreement in the evaluations was partly different between two groups of examiners. The calculated G-coefficient indicates a high reliability. The content validity of the evaluation form was given through the comprehensive medical expertise in the development process. Conclusion: Assessing written patient-directed communication is a benefit of the newly developed last part of the medical licensing examination in Germany. Continuous formative assessment and feedback based on the evaluation form is intended to improve the written communication skills of future doctors. Furthermore, a better understanding of their diagnosis and treatment as well as a trusting relationship with their doctor may empower patients in the medical decision process and lead to fewer dismissal errors in the future. For consistent use of the evaluation form a standardized training of examiners should be implemented., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2021 Selgert et al.)

Background: Most medical students in Germany are admitted via selection procedures, which are adjusted to the demands of the universities. At Lübeck medical school, scores from interviews that measure non-academic skills and pre-university GPAs are summed to arrive at an admission decision. This article seeks to illuminate the effectiveness of this selection procedure in comparison to other non-selected student groups., Methods: Quota information and exam results from the first federal exam were linked for students admitted to Lübeck medical school between 2012 and 2015 (N = 655). Five different student groups (university-specific selection quota, pre-university GPA quota, waiting time quota, ex-ante quota and foreign students) were compared regarding exam attempts, written and oral grades, temporal continuity and examination success in the standard study period., Results: While the pre-university GPA quota outperformed all other quotas regarding written and oral grades, it did not differ from the selection quota regarding exam attempts, temporal continuity and examination success in the standard study period. Students in the waiting time and ex-ante quotas performed inferior by comparison. The results of foreign students were the most problematic., Conclusion: Students selected by the university show high temporal continuity and examination success. These results, and possible advantages in physician eligibility, argue for the utilisation of non-academic skills for admission.

Background and Aim: This study investigated the career preferences of medical graduates with regard to discipline, final position, preferred area of work, and work load after the completion of postgraduate according to gender in Germany., Methods: Standardized postal survey among all last year medical students in the medical faculties of Erlangen, Giessen, Hamburg, Heidelberg, Cologne, Leipzig and Magdeburg in 2009. 2017 persons were contacted and 1012 (48 %) participated. Descriptive statistics and regression analysis were performed. Qualitative interviews with graduates completed data collection., Results: Overall, graduates prefer the hospital over private practice as their workplace after postgraduate training. However, 50 % of male graduates but only 29 % of female graduates aspire a leading position in the hospital. Male graduates often prefer careers in surgical disciplines, specialized internal medicine whereas female graduates orient themselves towards gynecology, pediatrics and smaller clinical disciplines like dermatology. 80 % of male but only 40 % of female graduates prefer a full-time position after completion of postgraduate training, whereas 16 % of female graduates aim at a part-time position only., Conclusion: The results demonstrate the persistence of traditional role models among medical graduates. Men aim at leading positions in the hospital whereas women prefer lower hospital positions or outpatient practices. Women look for part-time jobs, at least temporarily for child rearing whereas men continue to prefer full-time jobs., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Empathy is a central element in daily patient care. The burnout syndrome seems to be a potential factor influencing physicians' empathic behavior negatively. In Germany up to 20 % of practicing physicians experience burnout. So far, there have been no studies measuring empathy and the degree of burnout among final-year medical students in Germany. The aim of the current study was to investigate final-year students' self-reported empathy, burnout and the association of job satisfaction and occupational self-efficacy with regard to potential gender differences., Methods: 127 medical students at the end of their final year (82 f, 45 m; 26.8 years of age) were surveyed using the Jefferson Scale of Physician Empathy (JSPE), the Maslach Burnout Inventory (MBI) and items addressing job satisfaction and occupational self-efficacy., Results: The mean JSPE score of all final-year students was 113.25 ± 10.21 (20=lowest possible empathy score, 140=highest possible empathy score). Based on the three dimensions of burnout, the students fell in the moderate burnout category in all subscales of the MBI. There was an association between a lower empathy score and a higher burnout score. Also, the MBI correlated negatively with final-year students' job satisfaction and occupational self-efficacy., Conclusion: Despite high self-rated empathy scores, the experience of burnout symptoms in medical students may begin as early as their final year of studies, where higher levels of burnout are associated with lower self-rated empathy scores. The number of final-year medical students affected by clinically significant burnout (up to 20 %) was just as high as among practicing physicians. Female students were found to be particularly affected. Given the rising numbers of female graduates, this shows that urgent action is required., (Copyright © 2012. Published by Elsevier GmbH.)

Background: To assess the student perspective on acceptability, realism, and perceived effect of communication training with peer role play (RP) and standardised patients (SP)., Methods: 69 prefinal year students from a large German medical faculty were randomly assigned to one of two groups receiving communication training with RP (N = 34) or SP (N = 35) in the course of their paediatric rotation. In both groups, training addressed major medical and communication problems encountered in the exploration and counselling of parents of sick children. Acceptability and realism of the training as well as perceived effects and applicability for future parent-physician encounters were assessed using six-point Likert scales., Results: Both forms of training were highly accepted (RP 5.32 +/- .41, SP 5.51 +/- .44, n.s.; 6 = very good, 1 = very poor) and perceived to be highly realistic (RP 5.60 +/- .38, SP 5.53 +/- .36, n.s.; 6 = highly realistic, 1 = unrealistic). Regarding perceived effects, participation was seen to be significantly more worthwhile in the SP group (RP 5.17 +/- .37, SP 5.50 +/- .43; p < .003; 6 = totally agree, 1 = don't agree at all). Both training methods were perceived as useful for training communication skills (RP 5.01 +/- .68, SP 5.34 +/- .47; 6 = totally agree; 1 = don't agree at all) and were considered to be moderately applicable for future parent-physician encounters (RP 4.29 +/- 1.08, SP 5.00 +/- .89; 6 = well prepared, 1 = unprepared), with usefulness and applicability both being rated higher in the SP group (p < .032 and p < .009)., Conclusions: RP and SP represent comparably valuable tools for the training of specific communication skills from the student perspective. Both provide highly realistic training scenarios and warrant inclusion in medical curricula. Given the expense of SP, deciding which method to employ should be carefully weighed up. From the perspective of the students in our study, SP were seen as a more useful and more applicable tool than RP. We discuss the potential of RP to foster a greater empathic appreciation of the patient perspective.

Background: The final year of medical education is considered crucial in making students 'fit for purpose'. Studies have shown that many students leave medical school without having experienced sufficient preparation for their upcoming professional life., Aim: The aim of this study was to examine the effectiveness of a supplementary internal medicine final year curriculum on clinical reasoning skills., Method: Final year internal medicine students from two universities participated in the study which was based on a static-group design. The experimental group (n = 49) took part in a final year student curriculum with interactive case-based seminars and skills training sessions. The comparison group (n = 25) did not receive any additional training beyond working on the ward. Clinical reasoning skills were assessed using a key-feature pre-post test., Results: Prior to their clinical rotation, the two groups did not differ in the key-feature examination (p < 0.924). The experimental group performed significantly better than the comparison group (p < 0.028) in the post-intervention key-feature examination., Conclusions: Supplementary interactive case-based seminars and skills training sessions are effective and significantly improve the clinical reasoning skills of final year students in internal medicine. Further study is warranted and should look to examine the effectiveness of a final year student curriculum on other performance measures.

Background: The amended German license to practice medicine (AAppO) focuses on practically oriented, patient-centred medical education. After the cancellation of the former medical doctor traineeship "Arzt im Praktikum" (AiP) qualification period in October 2004, the final year of medical education, the so-called "practical year" (PJ), has become a key teaching module in realising the demands of the AAppO. So far no studies have been carried out in the German-speaking area to qualitatively assess the specific needs and central problems that PJ students are facing. The aim of this investigation was to representatively evaluate the expectancies and experiences of final-year medical students in a workplace learning environment., Methods: 65 students (30 male, 35 female, age 25.4 +/- 2 years) of two German university hospitals participated in focus groups both prior and subsequent (n = 60; drop-out rate 7.7%) to a 4-month period of internal medicine traineeship during their final year. Focus group protocols were transcribed and subjected to content analysis., Results: 1137 individual statements on relevant topics were identified from the transcriptions. Students widely reported lack of time on the part of supervising doctors and exorbitant assignment to routine jobs. This results in insufficient training of independent patient management, followed by feelings of uncertainty and the fear of making medical errors., Conclusions: Specific educational strategies and motivation of medical teachers are important factors to the workplace learning environment. A structured curriculum including cognitive, procedural and communicative learning objectives and the introduction of defined time slots for bedside teaching is considered a good first step in this process.

Introduction: Recently, efforts have been undertaken to enhance the face validity of technical skills training by introducing role-plays and standardised patients. Since little is known about the effects of role-playing with respect to the realism of a training situation and students' objective performance, we performed a randomized controlled trial., Methods: 36 medical students participated in videotaped small group skills-lab sessions on the topics of Doppler sonography and gastric tube insertion. One half of the students participated in role-plays and the other half practised without role-playing. Realism of the training situation was analysed by means of post-intervention self-selected student survey evaluations. Technical performance and patient-physician communication were assessed by independent ratings of the videotaped sessions., Results: The physician's role was regarded to be significantly more realistic when performing role-plays. Assessment of videotaped sessions showed that practising technical skills by performing role-plays resulted in significantly better patient-physician communication whereas students' technical performance did not differ between groups., Conclusion: Introducing role-plays enhances the realism of technical skills training and leads to better patient-physician communication. Students do not seem to be overstrained by practising clinical technical skills using role-plays. We conclude that role-playing is a valuable method in practising technical skills.

Introduction: Integrating medical students into their future working environment is of utmost importance in order to ensure a smooth transition from university life to clinical practice. In the German-speaking area, there has so far been no quantitative analysis of the extent or the quality of supervision received by medical students during their ward clerkship during their clinical studies in the specialist field of internal medicine., Methods: In the summer of 2005, 161 medical students in their 6th and 7th semester undertook ward clerkships on internal wards at the University Clinic of Heidelberg and its academic hospitals. Using a questionnaire, a survey was conducted among these students about the intensity and quality of supervision received during their work on ward., Results: Medical students working on the wards of academic hospitals were significantly more frequently co-supervised by senior physicians (p < 0.001), while a higher level of co-supervision by final year students was reported for the University Clinic (p < 0.001). Students supervised by final year students reported greater subjective learning outcomes (p < 0.001). However, this had no effect on the extent to which students felt integrated on the ward., Discussion: Final year students play a central role in incorporating medical students into the ward routines of teaching hospitals. While they cannot replace instruction or supervision by a qualified physician, the promising potential of "peer-teaching" programmes should be utilized and junior physicians should be systematically prepared for and supervised in this important function.

Background: The implementation of the cross-sectional subject of palliative care (Q13) at medical faculties in Germany is heterogeneous. In faculties without a chair for palliative medicine, other solutions are needed., Objectives: This study describes the development and implementation process of the new educational concept in Q13 at the Hannover Medical School and its evaluation by medical students and lecturers., Materials and Methods: The new educational concept was developed in 2017/18 following the six-step approach of curriculum development by Kern, and was implemented and tested in the academic year 2018/19. Evaluation was assessed in two steps, both in qualitative and quantitative terms (mixed methods): an anonymous written evaluation by students with the option of free text answers and feedback discussions with lecturers., Results: Students and lecturers welcomed the new educational concept in equal measures. Students thought that education in Q13 stimulates reflection on the individual attitude towards the issues of death and dying and prepares them for encounters with terminally ill and dying people. The case-based learning units in particular led to a consolidation of theoretical knowledge (i.e. pain management) with adequate patient orientation. Teachers positively highlighted the organization and the educational material. Content structuring was considered to be particularly helpful., Conclusions: With the new teaching concept, medical students feel well prepared for the treatment of terminally ill and dying patients. The combination of different learning formats with an interdisciplinary and cross-sectoral focus promotes education with a practical orientation.