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We study how patient-regarding altruism is formed by medical education. We elicit and structurally estimate altruistic preferences using experimental data from a large sample of medical students (N = 733) in Germany at different progress stages in their studies. The estimates reveal substantial heterogeneity in altruistic preferences of medical students. Patient-regarding altruism is highest for freshmen, significantly declines for students in the course of medical studies, and tends to increase again for last year students, who assist in clinical practice. Also, patient-regarding altruism is higher for females and positively associated to general altruism. Altruistic medical students have gained prior practical experience in healthcare, have lower income expectations, and are more likely to choose surgery and pediatrics as their preferred specialty., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

Low stakes assessment without grading the performance of students in educational systems has received increasing attention in recent years. It is used in formative assessments to guide the learning process as well as in large-scales assessments to monitor educational programs. Yet, such assessments suffer from high variation in students' test-taking effort. We aimed to identify institutional strategies related to serious test-taking behavior in low stakes assessment to provide medical schools with practical recommendations on how test-taking effort might be increased. First, we identified strategies that were already used by medical schools to increase the serious test-taking behavior on the low stakes Berlin Progress Test (BPT). Strategies which could be assigned to self-determination theory of Ryan and Deci were chosen for analysis. We conducted the study at nine medical schools in Germany and Austria with a total of 108,140 observations in an established low stakes assessment. A generalized linear-mixed effects model was used to assess the association between institutional strategies and the odds that students will take the BPT seriously. Overall, two institutional strategies were found to be positively related to more serious test-taking behavior: discussing low test performance with the mentor and consequences for not participating. Giving choice was negatively related to more serious test-taking behavior. At medical schools that presented the BPT as evaluation, this effect was larger in comparison to medical schools that presented the BPT as assessment.

Objective: Due to the increasing degree of internationalization and migration movements, German universities must increasingly pay attention to the cultural diversity of their students. Numerous studies have shown that there is still considerable room for improvement at German universities with regard to the integration of foreign students. Therefore, the University of Cologne aims at improving study conditions for students from third countries (especially non-EU) by introducing a compulsory study entry semester Studienstart International . In this study, we ask if effects on the dropout rates of international students before the introduction of Studienstart International can be observed after the introduction of the study entry semester. In addition, results of a survey of foreign students about familiarizing themselves with the German university educational system and on social contacts with fellow students are presented. Methods: After a one-year voluntary pilot phase in summer semester 2009 and winter semester 2009/10, Studienstart International was made compulsory for Non-EU students in preparation for the study of human medicine. 113 students of the human medicine degree program have taken part in this program since the beginning of winter semester 2016/17. The comparison of dropout rates before and after the introduction of Studienstart International as well as the results from a survey of foreign students are presented descriptively. Statistical significance of the difference in dropout rates between the two groups of students is tested using a Chi 2 -test. Results: The dropout rates of foreign students fell slightly from 19% to 14% following the introduction of the mandatory study entry semester, but this difference is not statistically significant (Chi 2 =0.785, df=1, p=0.376). According to the survey, almost three-quarters of foreign students have contact with German fellow students at the university, 55% of whom report daily contact. 68% of respondents have contact with German fellow students outside the university. 97% feel they are well prepared for the degree course and 91% say they know where to go with questions and problems during their studies. Conclusion: With the introduction of the compulsory study entry semester Studienstart International , the University of Cologne aims at improving integration of foreign students. Although dropout rates could not be significantly reduced, survey results suggest that Studienstart International can certainly support international students. Reliable statements on the success of the study cannot yet be made due to the small number of cases. A follow-up study will deal with this question.

Background: Progress testing is a longitudinal assessment that aims at tracking students' development of knowledge. This approach is used in many medical schools internationally. Although progress tests are longitudinal in nature, and their focus and use of developmental aspects is a key advantage, individual students' learning trajectories themselves play, to date, only a minor role in the use of the information obtained through progress testing. Methods: We investigate in how far between-person differences in initial levels of performance and within-person rate of growth can be regarded as distinct components of students' development and analyze the extent to which these two components are related to performances on national licensing examinations using a latent growth curve model. Results: Both, higher initial levels of performances and steepness of growth are positively related to long-term outcomes as measured by performance on national licensing examinations. We interpret these findings as evidence for progress tests' suitability to monitor students' growth of knowledge across the course of medical training. Conclusions: This study indicates that individual development as obtained by formative progress tests is related to performance in high-stakes assessments. Future studies may put more focus on the use of between-persons differences in growth of knowledge.

Unlabelled: CONSTRUCT: In this study, we examine the differences in test performance between the paper-based and the computer-based version of the Berlin formative Progress Test. In this context it is the first study that allows controlling for students' prior performance., Background: Computer-based tests make possible a more efficient examination procedure for test administration and review. Although university staff will benefit largely from computer-based tests, the question arises if computer-based tests influence students' test performance., Approach: A total of 266 German students from the 9th and 10th semester of medicine (comparable with the 4th-year North American medical school schedule) participated in the study (paper = 132, computer = 134). The allocation of the test format was conducted as a randomized matched-pair design in which students were first sorted according to their prior test results. The organizational procedure, the examination conditions, the room, and seating arrangements, as well as the order of questions and answers, were identical in both groups., Results: The sociodemographic variables and pretest scores of both groups were comparable. The test results from the paper and computer versions did not differ. The groups remained within the allotted time, but students using the computer version (particularly the high performers) needed significantly less time to complete the test. In addition, we found significant differences in guessing behavior. Low performers using the computer version guess significantly more than low-performing students in the paper-pencil version., Conclusions: Participants in computer-based tests are not at a disadvantage in terms of their test results. The computer-based test required less processing time. The reason for the longer processing time when using the paper-pencil version might be due to the time needed to write the answer down, controlling for transferring the answer correctly. It is still not known why students using the computer version (particularly low-performing students) guess at a higher rate. Further studies are necessary to understand this finding.

Background: Students' motivation to participate is one of the main challenges in formative assessment. The utility framework identifies potential points of intervention for improving the acceptance of formative assessment [Van Der Vleuten C. 1996. The assessment of professional competence: Developments, research and practical implications. Adv Health Sci Educ 1(1):41-67]. At the Medical Faculty of the University of Cologne, the paper-based version of the Berlin Progress Test has been transformed into computer-based version providing immediate feedback., Aim: To investigate whether the introduction of computer-based assessment (CBA) enhances the acceptance of formative assessment relative to paper-based assessment (PBA)., Methods: In a retrospective cohort study (PBA: N = 2597, CBA: N = 2712), students' overall acceptance of the two forms of assessment was surveyed, their comments were analyzed, and we analyzed their test behavior and categorized students into "serious" or "non-serious" test takers., Results: In the preclinical phase of medical education, no differences were found in overall acceptance of the two forms of assessment (p > 0.05). In the clinical phase, differences in favor of CBA were found in overall acceptance (p < 0.05), the proportion of positive comments (p < 0.001), and the proportion of serious participants (p < 0.001)., Conclusions: Introduction of immediate feedback via CBA can enhance the acceptance and therefore the utility of formative assessment.