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The CanMEDS roles were adapted in Denmark more than ten years ago. The complexity of the professional role is discussed from various aspects and put into perspective of the Danish culture and the Danish ethical rules for medical doctors. Redefinition of the role professional according to these aspects is recommended.

The surgical educational environment is potentially stressful and this can negatively affect students' learning. The aim of this study was to investigate whether veterinary students' level of anxiety is higher in a surgical course than in a non-surgical course and if pre-surgical training in a Surgical Skills Lab (SSL) has an anxiety reducing effect. Investigations were carried out as a comparative study and a parallel group study. Potential participants were fourth-year veterinary students who attended a surgical course (Basic Surgical Skills) and a non-surgical course (Clinical Examination Skills); both courses were offered in multiple classes (with a total of 171 students in 2009 and 156 students in 2010). All classes in 2009 participated in the SSL stage of the Basic Surgical Skills course before performing live-animal surgery, and one class (28 students) in 2010 did not. Two validated anxiety questionnaires (Spielberger's state-trait anxiety inventory and Cox and Kenardy's performance anxiety questionnaire) were used. Anxiety levels were measured before the non-surgical course (111 students from 2009) and before live-animal surgery during the surgical course (153 students from 2009 and 28 students from 2010). Our results show that anxiety levels in veterinary students are significantly higher in a surgical course than in a non-surgical course (p<.001), and that practicing in a SSL helps reduce anxiety before live-animal surgery (p<.005).

A surgical educational environment is potentially stressful and can negatively affect students' learning. The aim of the present study was to investigate the emotions experienced by veterinary students in relation to their first encounter with live-animal surgery and to identify possible sources of positive and negative emotions, respectively. During a Basic Surgical Skills course, 155 veterinary fourth-year students completed a survey. Of these, 26 students additionally participated in individual semi-structured interviews. The results of the study show that students often experienced a combination of emotions; 63% of students experienced negative emotions, while 58% experienced positive ones. In addition, 61% of students reported feeling excited or tense. Students' statements reveal that anxiety is perceived as counterproductive to learning, while excitement seems to enhance students' focus and engagement. Our study identified the most common sources of positive and negative emotions to be "being able to prepare well" and "lack of self-confidence," respectively. Our findings suggest that there are factors that we can influence in the surgical learning environment to minimize negative emotions and enhance positive emotions and engagement, thereby improving students' learning.

Introduction: The dropout level from the Danish medical schools is high, but we have only little insight into this problem. The purpose of this study was to qualify the ongoing discussions concerning dropout., Material and Methods: In this retrospective cohort study, relevant variables were extracted from the established database of Aarhus University for the 639 students initiating medicine studies between 1 January 1999 and 31 December 2000. A multivariate pre-admission and post-admission model was examined., Results: Of the 639 medical students, 20% dropped out. Most students dropped out during their first year. The type of admission exam was a strong predictor of dropout in the pre-admission model, whereas previous higher education protected against dropout. Obtaining leave was a very strong predictor of dropout in the post-admission model, whereas high grades protected against dropout., Conclusion: The dropout rate has been decreasing during the past decade. Young people considering studying medicine could be advised to choose natural science subjects in high school, and a number of research questions concerning preparedness for medical school are worth pursuing. Leave or very low grades during the first and second study years might serve as red flags to supervisors., Funding: Study research was funded by Aarhus University., Trial Registration: Not relevant, register-based research with no biological human material cannot be notified to the Danish Committee System. The Danish Data Protection Agency allows schools to conduct anonymized, non-sensitive, educational analyses without notification.

Background: Previous studies addressing teaching and learning in point-of-care ultrasound have primarily focussed on image interpretation and not on the technical quality of the images. We hypothesized that a limited intervention of 10 supervised examinations would improve the technical skills in Focus Assessed Transthoracic Echocardiography (FATE) and that physicians with no experience in FATE would quickly adopt technical skills allowing for image quality suitable for interpretation., Methods: Twenty-one physicians with no previous training in FATE or echocardiography (Novices) participated in the study and a reference group of three examiners with more than 10 years of experience in echocardiography (Experts) was included. Novices received an initial theoretical and practical introduction (2 hours), after which baseline examinations were performed on two healthy volunteers. Subsequently all physicians were scheduled to a separate intervention day comprising ten supervised FATE examinations. For effect measurement a second examination (evaluation) of the same two healthy volunteers from the baseline examination was performed., Results: At baseline 86% of images obtained by novices were suitable for interpretation, on evaluation this was 93% (p = 0.005). 100% of images obtained by experts were suitable for interpretation. Mean global image rating on baseline examinations was 70.2 (CI 68.0-72.4) and mean global image rating after intervention was 75.0 (CI 72.9-77.0), p = 0.0002. In comparison, mean global image rating in the expert group was 89.8 (CI 88.8-90.9)., Conclusions: Improvement of technical skills in FATE can be achieved with a limited intervention and upon completion of intervention 93% of images achieved are suitable for clinical interpretation.

The purpose of this study was to compare which learning outcomes relating to an Interprofessional Training Unit (ITU) experience were found to be most important by students and by alumni. A cohort of 428 students in the ITU was asked to write three short statements describing the most important learning outcomes from the ITU. Alumni from the same cohort were after graduation asked the same question. Furthermore, they were asked to fill out a 12-item questionnaire. The statements concerning learning outcome were analysed qualitatively and categorized. The number of statements in each category was counted and tested for statistical difference between students and alumni. Students stated "uniprofessionalism" as the most important learning outcome followed by "interprofessionalism", "professional identity" and "learning environment". Alumni on the other hand stated "professional identity" as most important learning outcome followed with "interprofessionalism", "learning environment" and "uniprofessionalism". The study indicated that over time the perceived outcome of learning experiences from an ITU change in priority.

Introduction: The purpose of this study was to assess the coherence between the undergraduate medical program at Aarhus University and the foundation year., Material and Methods: This cross-sectional questionnaire survey included 503 doctors graduated from Aarhus University from the winter of 2007/2008 to the summer of 2009., Results: The response rate was 73%. Approximately 73% of the respondents were in their foundation year or their first year of specialist training and 83% generally felt well-prepared. Respondents found that most of the learning outcomes of the undergraduate medical curriculum at Aarhus University are important for junior doctors. More than 90% of the respondents estimated that they were sufficiently prepared when it came to core outcomes such as history taking and physical examination. Five issues diverged considerably in importance stated and preparedness experienced: suggestion of diagnoses, initiation of treatment, pharmacotherapy, handling of own emotions and structuring of own learning. Also, 40% stated that their clerkships had only had little value in preparing them for their foundation year., Conclusion: Overall, graduates felt well-prepared and characterized the education coherent. However, the study raises major questions concerning clerkships and competence in treatments, pharmacotherapy and the more personal aspects of professionalism., Funding: not relevant., Trial Registration: not relevant.

Context: Very few studies have reported on the effect of admission tests on medical school dropout. The main aim of this study was to evaluate the predictive validity of non-grade-based admission testing versus grade-based admission relative to subsequent dropout., Methods: This prospective cohort study followed six cohorts of medical students admitted to the medical school at the University of Southern Denmark during 2002-2007 (n=1544). Half of the students were admitted based on their prior achievement of highest grades (Strategy 1) and the other half took a composite non-grade-based admission test (Strategy 2). Educational as well as social predictor variables (doctor-parent, origin, parenthood, parents living together, parent on benefit, university-educated parents) were also examined. The outcome of interest was students' dropout status at 2 years after admission. Multivariate logistic regression analysis was used to model dropout., Results: Strategy 2 (admission test) students had a lower relative risk for dropping out of medical school within 2 years of admission (odds ratio 0.56, 95% confidence interval 0.39-0.80). Only the admission strategy, the type of qualifying examination and the priority given to the programme on the national application forms contributed significantly to the dropout model. Social variables did not predict dropout and neither did Strategy 2 admission test scores., Conclusions: Selection by admission testing appeared to have an independent, protective effect on dropout in this setting., (© Blackwell Publishing Ltd 2011.)

In this paper we describe the first four phases of a curriculum reform covering the three clinical years of medical school at Aarhus University. The reform intends to ease students' transition from medical school to the foundation year, increase focus on communication, create more coherence between subjects, increase students' active participation, and align learning outcomes and assessments. More than 80 stakeholders participated in the first phases and five task forces gave their recommendations on how to achieve the intentions. The next phases are initiated on the basis of this solid work.

Purpose: To enhance the recognition of educational effort and thereby support faculty vitality, the authors aimed to identify essential categories of educational effort from the perspective of clinical faculty and determine whether the emerging categories were in concordance with an organizational perspective., Method: The authors performed nominal group processes in four groups in 2008, with the participation of 24 clinical faculty members, 6 in each group, representing 18 (medical, surgical, paraclinical, and psychiatric) specialties at 14 hospitals in Denmark. Subsequently, the authors performed a comparative analysis of the emerging essential categories and the organizational work by the national panel on medical education, appointed by the Association of American Medical Colleges (AAMC)., Results: The four groups of clinical faculty members agreed on categories of educational effort. This quantitative consistency in prioritization was supported by qualitative consistency, as the authors observed similar uses of words and phrases among all four groups. The top priority in essential categories of educational effort was "Visibility of planned educational activities on the work schedule," which received 39% of all votes. The comparative analysis showed that the essential categories of educational effort suggested by clinical faculty were in concordance with the steps developed by the AAMC., Conclusions: The high degree of consistency among clinical faculty from different locations and specialties and the high concordance with the organizational work of the AAMC suggest that it is possible to develop standardized measurements of educational effort. Clinical faculty emphasized that a good starting point for educational measurements is the work schedule.

Background: Newly qualified doctors are expected to be able to conduct a cardiac auscultation unassisted, but studies show conflicting results regarding cardiac auscultation skills., Methods: A two-part test instrument was designed containing innovative recordings of heart sounds from patients with common cardiac murmurs as well as healthy controls. A total number of 109 participants were tested, representing four levels of clinical experience. The content validity of the test instrument was studied by a postal questionnaire to 114 clinical teachers at the University Hospital of Aarhus, Denmark., Results: A significant correlation was found between level of experience and the ability to diagnose the conditions from which the murmurs originated (r = 0.45, P < 0.0001). No correlation was found between level of experience and the ability to identify persons with cardiac murmurs from healthy controls. All groups showed a tendency to interpret healthy heart sounds as cardiac murmurs., Conclusions: Diagnostic ability was found to correlate positively with clinical experience, whereas the ability to distinguish cardiac murmurs from normal heart sounds seems independent of clinical experience.

Peer-led training has been identified as a useful tool for delivering undergraduate healthcare training. In this paper we describe the implementation of the European Resuscitation Council BLS/AED Course as a peer-led training program for medical students.

Background and Aims: The purpose of this study was to understand more completely the (tacit) curriculum design models of medical faculty. We report on two research questions: (1) Can medical faculty give an account of their curriculum design assumptions? and (2) What are their assumptions concerning curriculum design?, Method: We conducted an explorative, qualitative case study. We interviewed educational decision makers at the three Danish medical schools and associate professors from different courses concerning curriculum design. We carried out four individual, in-depth interviews and four focus groups with 20 participants in all., Results and Conclusions: Only one decision maker had an explicit curriculum design model. However, all participants had assumptions concerning curriculum design. We displayed their assumptions as five essentially different and increasingly complex models: the method-driven, pragmatically driven content-driven, outcome-driven and vision-driven curriculum design models. In the five models, the role of learning outcomes differs. The differences range from a belief that learning outcomes are essential, to a belief that learning outcomes are unimportant, to a belief that learning outcomes are incompatible with higher education. Finally, we found that teachers do not necessarily play a clear, central role in curriculum design.

Introduction: Physicians are expected to manage their role as teamleader during resuscitation. During inter-hospital transfer the physician has the highest medical credentials on a small team. The aim of this study was to describe physician behaviour as teamleaders in a simulated cardiac arrest during inter-hospital transfer. Our goal was to pinpoint deficits in knowledge and skill integration and make recommendations for improvements in education., Method: An ambulance was the framework for the simulation; the scenario a patient with acute coronary syndrome suffering ventricular fibrillation during transportation. Physicians (graduation age < or =5 years) working in internal medicine departments in Denmark were studied. The ambulance crew was instructed to be passive to clarify the behaviour of the physicians., Results: 72 physicians were studied. Chest compressions were initiated in 71 cases, ventilation and defibrillation in 72. The median times for arrival of the driver in the patient cabin, initiation of ventilation and chest compressions, and first defibrillation were all less than 1min. Medication was administered in 63/72 simulations (88%), after a median time of 210 s. Adrenaline was the preferred initial drug administered (58/63, 92%). Tasks delegated were ventilations, chest compressions, defibrillation, and administration of medication (97%, 92%, 42%, and 10% of cases, respectively)., Discussion and Conclusion: Junior physicians performed well with respect to the treatment given and the delegation of tasks. However, variations in the time of initiation it took for each treatment indicated lack of leadership skills. It is imperative that the education of physicians includes training in leadership.

Unlabelled: OBJECTIVES The reliability of individual non-cognitive admission criteria in medical education is controversial. Nonetheless, non-cognitive admission criteria appear to be widely used in selection to medicine to supplement the grades of qualifying examinations. However, very few studies have examined the overall test generalisability of composites of non-cognitive admission variables in medical education. We examined the generalisability of a composite process for selection to medicine, consisting of four variables: qualifications (application form information); written motivation (in essay format); general knowledge (multiple-choice test), and a semi-structured admission interview. The aim of this study was to estimate the generalisability of a composite selection., Methods: Data from 307 applicants who participated in the admission to medicine in 2007 were available for analysis. Each admission parameter was double-scored using two random, blinded and independent raters. Variance components for applicant, rater and residual effects were estimated for a mixed model with the restricted maximum likelihood (REML) method. The reliability of obtained applicant ranks (G coefficients) was calculated for individual admission criteria and for composite admission procedures., Results: A pre-selection procedure combining qualification and motivation scores showed insufficient generalisability (G = 0.45). The written motivation in particular, displayed low generalisability (G = 0.10). Good generalisability was found for the admission interview (G = 0.86), and for the final composite selection procedure (G = 0.82)., Conclusions: This study revealed good generalisability of a composite selection, but indicated that the application, composition and weighting of individual admission variables should not be random. Knowledge of variance components and generalisability of individual admission variables permits evidence-based decisions on optimal selection strategies.

In 2007 the Faculty of Health Sciences, Aarhus University, took a first step towards outcome-based education. During an educational development process, all courses developed clear, consistent descriptions of learning outcomes and extensive, template-based course descriptions. This enabled the Faculty to implement a new national grading system and to prepare for Aarhus University's application for an ECTS label. Furthermore, the process created the basis for alignment of outcomes, assessment and teaching. In this paper, we share results, problems encountered and lessons learned.

The University of Aarhus and Further Training Region North (Danish: Videreuddannelsesregion Nord) arranged a 24-hour experimental course in research training for junior physicians. Previously, the course has been imparted as three course days with daytime training, but this time it had the form of one 24-hour session. The idea behind the new concept is to combine a high professional content with considerable change in the form of the course. The response from course participants was very positive, and the course organisers are most satisfied with the achieved results.

Introduction: The medical profession and hospital practice have changed over the last decades without a concomitant change in Danish clerkships. Therefore, the aim of this study was to analyze learning and supervision in clerkships and to discuss how traditional clerkship learning matches a modern effective hospital environment., Material and Methods: A qualitative field study based on 38 days of observations ( asymptotically equal to 135 hours) with 6 students in 8th Semester in 2 internal medical and 3 surgical wards at 2 teaching hospitals in Aarhus County during 2003. The 6 students were interviewed prior to and following clerkship. Data were coded using Ethnograph and analyzed qualitatively., Results: The students typically participated in 6 learning activities: morning reports, ward rounds, out-patient clinics, on call, clerking, and operating theatres. A common feature for the first 3 activities was the students' observational role in contrast to their more active role in the latter 3 activities. Supervision was primarily indirect as the doctors worked and thereby served as tacit role models. When direct, the supervision was didactic and characterized by information transfer., Conclusion: A clerkship offers important learning opportunities for students. They are exposed to many patients and faced with various clinical problems. However, the benefit of students learning in authentic environments is not fully utilized, and the didactic supervision used by doctors hardly matches the learning conditions in a busy hospital. Consequently, we need to reassess the students' roles and doctors' supervisory methods.

Introduction: The purpose of this study was to do a quantitative description of how medical students spend their time during their clerkship in the eighth semester of study. We examined to what degree students have the possibility to learn both from the doctors and other staff and through active participation in daily work routines., Subjects and Methods: Time registration was carried out through observation of six medical students spread over 32 observation days, corresponding to 6,674 minutes. The observations cover surgical and medical clerkships in two hospitals in Aarhus, Denmark., Results: The study revealed that the students (1) were present in the clinic about four hours a day; (2) spent about two-thirds of their time with doctors; (3) received guidance to a limited degree when they spent time with doctors; (4) carried out specific and visible actions in relation to patients to a limited degree; (5) practically did not co-operate with the nursing staff., Conclusion: Recent learning theories recommend that students should work actively on a subject or a task and that they should receive guidance to ensure their reflection on the tasks performed. We observed that students have plenty of opportunity to learn through watching experienced practitioners. However, the limited amount of guidance and the students' role as observers indicate that the learning potential of being with doctors and patients is not being exploited sufficiently.

Introduction: We compared and contrasted the learned and intended practical clinical skills of the three Danish medical schools., Material and Methods: An anonymous questionnaire listing 210 practical clinical skills was posted to 226 newly qualified Danish physicians. They were asked if they could meet the minimum level for each of the skills, which had earlier been identified by a Delphi study., Results: The response rate was 80%. None of the responders met the minimum of all the 210 skills. Only 8% (14) met the minimum level for at least 90% (189) of the skills. On average, the responders met the minimum for 74% (155) of the skills. More than 90% of the responders could take medical histories and carry out examinations. The responders did not meet 28 medical emergency procedures., Discussion: We found that the clinical skills learned constituted 75% of those intended. Those responsible for pre- and postgraduate medical training should be aware of the discrepancy between expected and learned skills. We discuss the role of experts in the process of defining the core curriculum.

Objective: To compare and contrast the learned and an intended curricula of practical clinical skills across the three Danish medical schools., Context: The three Danish medical schools had comparable discipline-based curricula with 3 years of mainly basic science and 3(1/2) years of mainly clinical education. Danish physicians work as pre-registration house officers (PRHOs) for 1(1/2) years after graduation., Methods: An anonymous questionnaire listing 210 practical clinical skills was mailed to 226 newly graduated Danish physicians. They were asked if they could meet the minimum level for each of the skills listed as identified by a previous Delphi study., Results: The response rate was 80%. None of the responders met the minimum of all the 210 skills. Only 8% (14) met the minimum level for at least 90% (189) of the skills. On average the responders met the minimum of 74% (155) of the skills. More than 90% of the responders mastered basic history and examination skills. The responders did not meet 28 medical emergency procedures., Conclusions: We found that the learned curriculum of clinical skills constituted 75% of the intended curriculum. Those responsible for pre- and postgraduate medical education should be aware of the discrepancy between expected and learned curriculum. We discuss the role of experts in the process of defining the core curriculum.

Introduction: In the new medical curriculum at the University of Aarhus, a third term, 20-week course focussing on early patient contact was launched., Material and Methods: Nine prototypical and clinically important disease entities each formed the basis of one-week courses covering an introductory clinical lecture, presentation of "paper" cases, and formalised training of pertinent clinical skills. This was integrated with plenaries and group work in physiology pertaining to the disease and the patient cases. In addition, seminars were held in patient-doctor relationships, and environmental and social medicine. Introductory lectures were given on topics, such as medical ethics, taxonomy of diseases, the organisation of hospital-based health care. At the end of the term, the students resided for eight weeks at county hospitals, which do not traditionally participate in pregraduate teaching. Each student followed one particular patient, which formed the basis of a written essay., Results: Early clinical lectures (87 +/- 8%, mean +/- SD) and use of clinical cases (73 +/- 8%) were well received by third term students, and 87% found that the "paper" cases facilitated their understanding of physiology. The evaluation of the hospital training was very positive (rated excellent or good by > 95%)., Discussion: We conclude that early introduction to clinical practice is feasible and well received by the students.

Introduction: The aim of the present study was to use the Delphi technique to identify standards of quality for the curriculum of basic clinical skills in the pre-registration internship., Method: The Delphi method was used with a selected panel of 52 experts to set a level of competence for 213 practical clinical skills in a series of three questionnaires., Results: For the pre-registration internship, the panel reached a 75% level of consensus for 80% of the basic clinical skills. A total of 47 basic clinical skills were identified (97% level of consensus) as core skills that should be mastered by the time of registration., Discussion: The study suggests that further investigations should be performed to identify a core curriculum of basic clinical skills common to all pre-registration internists. In addition, a curriculum of electives should be based on the special characteristics of each training department.

Introduction: The necessity of defining standards in medical education is increasingly recognised. The aim of the present study was to adapt the Delphi method in establishing a consensus about competence levels of basic clinical skills in the undergraduate medical curriculum., Method: We used a Delphi design with two postal rounds. An expert panel of 52 physicians was selected on the criteria of knowledge and practical engagement in medical education. Questionnaires were set up with lists of 213 practical skills based on literature studies. Six levels of competence were identified. The task of the panel was to select the competence level for each skill., Results: The panel reached a 75% level of consensus in 212 of the 213 skills. A core curriculum of basic clinical skills in the medical education of Danish undergraduates is proposed., Discussion: The Delphi method was found applicable to qualify the process of identifying goals in a medical curriculum design.