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Digital technologies have transformed medical care and education by providing rapid access to knowledge and advanced methods, such as augmented reality and haptic feedback. These technologies are improving the efficiency of healthcare professionals and the quality of medical education. Particularly in Germany, where a shortage of skilled workers and an aging population are increasing pressure on the healthcare system, digital methods can help to optimize workflows and improve training. The integration of haptic feedback in this context makes it possible to make virtual objects tangible, increasing immersion and ultimately learning success. The application presented, SkillsLab+, uses augmented reality and haptic feedback via a data glove to provide a digitized version of the analog SkillsLab medical training programme. SkillsLab+ was evaluated using standardized questionnaires (Igroup Presence Questionnaire, presence, and haptic questionnaires). In order to determine the learning outcomes of the students, an AB test was carried out comparing the final grades. At the same time, a subjective questionnaire was used to assess whether students felt better prepared for the exam. In this context, this article aims to evaluate the learning success and compare the results with the previous proof of concept study of 2022. The results of the comparison show an improvement in the responses to the SkillsLab+ questionnaire in 2023. The result of the examination also improved compared to the group without AR experience. This shows the improvement in application and learning with the help of augmented reality and haptic feedback. They were more confident, had better results, and felt better prepared for the exams.

This article aims to address the research question of which educational strategies are employed by upper milieus to establish or maintain the 'structure of distances' in the field of higher education in late modernity. Inspired by Bourdieu's theory of social reproduction and conflict, the study examined 95 qualitative interviews conducted with master's students in Germany. In contrast to the extensive research on elite education, this study specifically focuses on the status reproduction of upper milieus in a country with a limited tradition of elite universities. The study incorporated three academic disciplines -- management/business administration, medicine, and musicology -- to account for the different capital compositions within the upper milieus. In this article, we discuss four exemplary strategies of distinction that appear to be particularly relevant for the upper milieus, comparing them with interviews conducted with students from middle and lower milieus. Finally, we relate the findings to current sociological diagnoses of social change in late modernity.

The purpose, aim and goals of higher education itself have been discussed and researched in the context of massified and marketised higher education in Germany, with a focus mainly on higher education national policies or the view of faculty staff. By shifting the perspective instead to the students, this article asks what higher education means to them nowadays. This study is based on 95 interviews with German graduate students from three disciplines (i.e. business administration/management, medicine and musicology) and it offers a typology of what students understand as the purpose of higher education. Six types were reconstructed from the empirical material, along three main lines of higher education's purpose (i.e. occupational, personal and societal). This paper also shows how the chosen discipline becomes more salient for the student's perception of higher education purpose than their social background. This questions previous research that found strong ties between instrumentalism and social background in higher education. This paper also demonstrates that social differences do matter in their egalitarian or elitist variation of understanding within non-instrumentalist types. Overall, this study illustrates how heterogenous contemporary higher education purpose has become, which mirrors a further general differentiation in higher education.

This systematic review reports the state-of-the-art and evidence supporting interprofessional problem-based learning (iPBL) as a developmental tool for interprofessional competences. A targeted search strategy deployed across seven electronic databases identified 32 studies which met inclusion criteria following independent double review. All study types were included. Aggregated results identified evidence (quantitative and/or qualitative) that iPBL promotes competences as categorised using the Interprofessional Education Collaborative (IPEC) framework, in Ethics/Values (n = 7); Roles/Responsibilities (n = 27); Interprofessional Communication (n = 19) and Teams/Teamwork (n = 21). Qualitative research dominated the literature. Limited, high-level quantitative data observed effects on students' attitudes and perceptions of interprofessional competences. Reporting of iPBL context and implementation mechanisms (e.g., trigger design) were largely absent in identified studies. Most iPBL (n = 26), was conducted in university rather than clinical settings.

To be proficient in communicating with patients, physicians need specified knowledge, skills and attitudes. Until now, medical educators have mostly focused on undergraduate students' communication knowledge and skills in training and assessment. Attitudes towards communication with patients have been researched less frequently, but it is plausible that they also influence physicians' behaviours in many ways. The present study investigates the communication-focused attitudes of senior medical students and their development through the clinical elective year using an innovative approach based on Q-methodology. We conducted a Q-methodology study using statements from the Kalamazoo Communication Skills Assessment Form. A total of 47 final-year medical students documented their attitudes towards communication by sorting these statements in regard to their importance into a normal distribution grid in medical interviews. Our innovative approach included three time points during the elective year at which these statements were sorted, with only a slight decrease of participants. We applied a Q-factor analysis and found three attitude profiles that were structurally stable over time. Attitude profile #1 focused on providing information and fostering shared decision making; profile #2 focused on the patients' concerns and emotions while meeting the patients' demands for sufficient information. Finally, the focus of attitude profile #3 was on using appropriate conversation techniques to structure communication and gather sufficient information. Overall, the respondents assigned increasing importance to building good relationships and making shared decisions with patients over time. Statements about structuring conversations and communication techniques were evaluated as less important by the end of the clinical elective year.

Clinical reasoning theories agree that knowledge and the diagnostic process are associated with diagnostic success. However, the exact contributions of these components of clinical reasoning to diagnostic success remain unclear. This is particularly the case when operationalizing the diagnostic process with diagnostic activities (i.e., teachable practices that generate knowledge). Therefore, we conducted a study investigating to what extent knowledge and diagnostic activities uniquely explain variance in diagnostic success with virtual patients among medical students. The sample consisted of N = 106 medical students in their third to fifth year of university studies in Germany (6-years curriculum). Participants completed professional knowledge tests before diagnosing virtual patients. Diagnostic success with the virtual patients was assessed with diagnostic accuracy as well as a comprehensive diagnostic score to answer the call for more extensive measurement of clinical reasoning outcomes. The three diagnostic activities hypothesis generation, evidence generation, and evidence evaluation were tracked. Professional knowledge predicted performance in terms of the comprehensive diagnostic score and displayed a small association with diagnostic accuracy. Diagnostic activities predicted comprehensive diagnostic score and diagnostic accuracy. Hierarchical regressions showed that the diagnostic activities made a unique contribution to diagnostic success, even when knowledge was taken into account. Our results support the argument that the diagnostic process is more than an embodiment of knowledge and explains variance in diagnostic success over and above knowledge. We discuss possible mechanisms explaining this finding.

Teaching practical skills is of particular interest in the study of human medicine. With regard to medical statistics this means the use of statistical software, which may be effectively taught by a flipped classroom approach. As a pilot study, we designed and implemented an elective course on medical statistics that focused on hands-on data analysis in SAS Studio. Students independently prepared for class using materials such as pretaped asynchronous lectures, and worked on exercises during synchronous class sessions. On course evaluations completed by n 15 students out of 26, students rated their satisfaction with the course a mean of 1.3 (SD 0.6) on a scale where 1 best and 6 worst. Twelve (80%) indicated that they processed all materials provided, and 11 students (73%) rated the frequency of direct contact with the instructor as sufficient. Nearly all (14 out of 15) viewed the course as an adequate substitute for a full face-to-face course. Our results suggest that the proposed course design is well-accepted. The flipped classroom format offers high flexibility and can be implemented easily online. Our pilot data are encouraging regarding the aim of designing a prospective follow-up study which compares the flipped classroom approach to a teaching format based on attendance.

The way medical students learn anatomy is constantly evolving. Nowadays, technologies such as tablets support established learning methods like drawing. In this study, the effect of drawing on a tablet on medical students' anatomy learning was investigated compared to drawing or summarizing on paper. The quality of drawings or summaries was assessed as a measure of the quality of strategy implementation. Learning outcome was measured with an anatomy test, both immediately afterward and after 4-6 weeks to assess its sustainability. There were no significant group differences in learning outcome at both measurement points. For all groups, there was a significant medium strength correlation between the quality of the drawings or summaries and the learning outcome (p < 0.05). Further analysis revealed that the quality of strategy implementation moderated outcomes in the delayed test: When poorly implemented, drawing on a tablet (M = 48.81) was associated with lower learning outcome than drawing on paper (M = 58.95); The latter (M = 58.89) was related to higher learning outcome than writing summaries (M = 45.59). In case of high-quality strategy implementation, drawing on a tablet (M = 60.98) outperformed drawing on paper (M = 52.67), which in turn was outperformed by writing summaries (M = 62.62). To conclude, drawing on a tablet serves as a viable alternative to paper-based methods for learning anatomy if students can make adequate use of this strategy. Future research needs to identify how to support student drawing, for instance, by offering scaffolds with adaptive feedback to enhance learning.

Through co-occurrence analysis of 1139 documents (1964-2018) we identified discussions about the implementation of student teaching evaluation (SET). We found that: (1) Attention to SET originated in the US in the 1970s, spreading to German-speaking countries in the mid-1990s and continuing in China and Latin America in the early 2000s. (2) SET is commonly viewed as a control tool deserving methodological improvement, while bias is debated in the US. We also found local trajectories: (3) Whereas in the US and Latin America SET is primarily seen as a management tool, German-speaking and Chinese authors reflect more on improving teaching. Chinese scholars consider SET a valid instrument for state control associated with artificial intelligence. Also, (4) SET is commonly used in medical education in the US and the German-speaking region and in physical education in China. We conclude that SET is discussed cross-nationally but affected by regional path dependencies.

Technological approaches deploying three-dimensional visualization to integrate virtual anatomy are increasingly used to provide medical students with state-of-the-art teaching. It is unclear to date to which extent virtual anatomy may help replace the dissection course. Medical students of Johannes Kepler University attend both a dissection and a virtual anatomy course. This virtual anatomy course is based on Cinematic Rendering and radiological imaging and teaches anatomy and pathology. This study aims to substantiate student benefits achieved from this merged teaching approach. Following their dissection course, 120 second-year students took part in objective structured practical examinations (OSPE) conducted on human specimens prior to and following a course on Cinematic Rendering virtual anatomy. Likert-based and open-ended surveys were conducted to evaluate student perceptions of both courses and their utility. Virtual anatomy teaching was found to be unrelated to improvements in student's ability to identify anatomical structures in anatomical prosections, yielding only a 1.5% increase in the OSPE score. While the students rated the dissection course as being more important and impactful, the virtual anatomy course helped them display the learning content in a more comprehensible and clinically applicable way. It is likely that Cinematic Rendering-based virtual anatomy affects knowledge gain in domains other than the recognition of anatomical structures in anatomical prosections. These findings underline students' preference for the pedagogic strategy of the dissection course and for blending this classical approach with novel developments like Cinematic Rendering, thus preparing future doctors for their clinical work.

Sex and gender bias in anatomy learning materials are considered a "hidden obstacle" to gender equity in medical curricula. The purpose of this study was to investigate whether quantitative sex and gender biases do exist in popular anatomy e-learning platforms and compare the results with those found in contemporary textbooks and atlases. A systematic content-analysis was performed on N = 3767 images published from 2008 to 2021 in which sex/gender could be identified by considering technical aspects of illustration and various intersectional categories. E-learning platforms took into account an appropriate representation of the female body and presented even more females (n = 932/1412; 66%), more frequently from a ventral/anterior (X[superscript 2] = 26, P < 0.001) and whole-body perspective (X[superscript 2] = 27, P < 0.001). This was in contrast to German anatomy books, where the results pointed to a significant sex and gender bias. For example, all books assessed underrepresented females (n = 707/2355; 30%) and placed them in stereotypical sex-specific context (X[superscript 2] = 348, P < 0.001), showing them more often from a caudal/inferior (X[superscript 2] = 99, P < 0.001) and internal (X[superscript 2] = 132, P < 0.001) perspective. Altogether, the visual representation of sex and gender in anatomical curricula is still biased and the stereotypical perceptions of human anatomy seem to be a global issue. However, the increasing use of electronic learning platforms, which gradually replace traditional books is changing the way the male and female body is depicted, which might offer new opportunities for reducing stereotypes in anatomy education.

Introduction: During the SARS-CoV-2 pandemic, the training of medical students was severely disrupted. Government authorities imposed a second national lockdown, which lasted from December 2020 to May 2021, forcing medical schools to adapt their teaching strategies. Several surveys have assessed students' perspectives, but there is limited data available to objectively assess and compare different strategies between medical faculties. The aim of this study was to evaluate the lecturer-based perspective to assess the impact on the theoretical and practical education of medical students before and during the second lockdown. Methods: We developed a questionnaire focusing on theoretical and practical training during pandemic before and during the second lockdown. The questionnaire was sent by personal invitation in January 2021 to all responsible lecturers of gastroenterology and hepatology departments at university hospitals in Germany. Results: The complete response rate was obtained from 52.5% (21/40) teaching centres representative of all regions in Germany. While the majority of respondents (62%) reported a limited impact of the lockdown on theoretical training, 90.5% reported a significant impact on practical training during the SARS-CoV-2 pandemic response. Several centres adapted virtual or hybrid education early during the pandemic, bedside teaching was down to 38.1% (8/21), particularly for students in the early phase of education, suggesting a substantial long-term impact on students' skills. Conclusion: Our questionnaire-based data provide one of the first systematic evaluation of faculty-based assessments of the potential impact of the pandemic during lockdown on medical education. We observed considerable heterogeneity in strategies for maintaining teaching activities during the SARS-CoV-2 pandemic in Germany.

The Studentische Poliklinik is Germany's first student-run free clinic. Prior to fulfilling clinical obligations there, students must complete an extensive peer-assisted learning program (PAL). Due to capacity constraints, a web-based learning program involving virtual patients has been launched. The aim of this study was to evaluate and compare the effectiveness of Virtual Patient Learning (VPL) vs. PAL in the acquisition of basic medical knowledge and skills. Forty undergraduate medical students (m=9; f=31) in their third year were randomly assigned to either the PAL (n=20), or VPL (n=20). Short-term (after each seminar) and long-term learning retention (after completion of the electives) was measured using a validated theoretical test. Objective structured clinical examinations (OSCE) were used to assess practical knowledge. Additionally, the course itself was evaluated. Differences in theoretical knowledge between students in the PAL and VPL existed over the short term (VPL median = 100%; PAL median = 80; p = 0.006), but not over the long term (VPL = 94.17; PAL = 95.62 %; p = 0.617). An assessment of practical skills showed no differences in OSCE scores between the two different groups (VPL = 79.30 %; PAL = 80.26 %; p = 0.141). Students assessed their learning experience and the comprehensibility of seminars as either "very good" or "good". Basic medical knowledge and skills can be taught as effectively using VPL as PAL. Given the cost-effectiveness, high reproducibility and freedom of time and place, VPL should be performed more often when teaching family medicine in student-run free clinics. Ultimately, this may result in enhanced treatment quality and patient satisfaction.

In order to improve learning efficiency and memory retention in medical teaching, furthering active learning seems to be an effective alternative to classical teaching. One option to make active exploration of the subject matter possible is the use of virtual reality (VR) technology. The authors developed an immersive anatomy atlas which allows users to explore human anatomical structures interactively through virtual dissection. Thirty-two senior-class students from two German high schools with no prior formal medical training were separated into two groups and tasked with answering an anatomical questionnaire. One group used traditional anatomical textbooks and the other used the immersive virtual reality atlas. The time needed to answer the questions was measured. Several weeks later, the participants answered a similar questionnaire with different anatomical questions in order to test memory retention. The VR group took significantly less time to answer the questionnaire, and participants from the VR group had significantly better results over both tests. Based on the results of this study, VR learning seems to be more efficient and to have better long-term effects for the study of anatomy. The reason for that could lie in the VR environment's high immersion, and the possibility to freely and interactively explore a realistic representation of human anatomy. Immersive VR technology offers many possibilities for medical teaching and training, especially as a support for cadaver dissection courses.

Peer-assisted learning (PAL) is an educational method commonly applied in academic teaching. It is characterized by the interplay between peer teachers and learners who are at a similar academic level. Although it has been shown that peer teachers benefit from participating in PAL, little is known about their perception of motivation and rewards. Here we designed a questionnaire and measured the perception of intrinsic motivation and rewards of peer teachers from three different PAL programs. Overall, peer teachers were highly intrinsically motivated. The reward category Supporting Others was appreciated the most, followed by the reward categories Self-Improvement, Feedback, and Financial. The perception of rewards reflected the features of the three PAL programs. For example, the item "learning the teaching matter themselves" was most valued by peer teachers who were enrolled in a PAL program that deployed their peer teachers primarily to convey knowledge. In contrast, "actively shaping the teaching situation" was appreciated most by peer teachers of the PAL program that enables their peer teachers to conceive their teaching sessions independently. These findings go toward recommendations of the implementation and further development of PAL programs. If PAL programs clearly define their features and aims, they could specifically attract (and select) peer teachers and meet their needs as well as expectations, providing opportunities to gain knowledge and teaching experience. Ultimately, these PAL programs could better support the learners.

The aim of the 15 collaborative projects conducted during the new funding phase of the German research program Modeling and Measuring Competencies in Higher Education--Validation and Methodological Innovations (KoKoHs) is to make a significant contribution to advancing the field of modeling and valid measurement of competencies acquired in higher education. The KoKoHs research teams assess generic competencies and domain-specific competencies in teacher education, social and economic sciences, and medicine based on findings from and using competency models and assessment instruments developed during the first KoKoHs funding phase. Further, they enhance, validate, and test measurement approaches for use in higher education in Germany. Results and findings are transferred at various levels to national and international research, higher education practice, and education policy.

The acquisition of warranted domain-specific knowledge is essential for practical work in medicine. The medical field, however, suffers from 'information overload', and students and physicians rely on access to verified, up-to-date information. Based on prior research, we investigated (1) which media medical students use for learning, (2) how their media use changes over the course of studies, and (3) how their media use and changes therein influence their acquisition of medical knowledge. Moreover, we examined (4) the influence of factors such as media overload. In a pre-post design, we assessed the development of students' medical knowledge before (T1) and after (T2) attending physiology seminars, and examined the relationship between their knowledge development and media use. Our analyses showed a significant increase in students' domain-specific knowledge after the seminars. In contrast, their media use behavior did not change substantially, with online sources being used more frequently than textbooks and course materials. An increased use of additional textbooks and online sources from T1 to T2 was linked to a stronger increase in knowledge. The results indicate that students' media use behavior influences their knowledge gain over their course of study, which has important implications for developing curricula in medical education.

Integration of medical imaging into preclinical anatomy courses is already underway in many medical schools. However, interpretation of two-dimensional grayscale images is difficult and conventional volume rendering techniques provide only images of limited quality. In this regard, a more photorealistic visualization provided by Cinematic Rendering (CR) may be more suitable for anatomical education. A randomized, two-period crossover study was conducted from July to December 2018, at the University Hospital of Erlangen, Germany to compare CR and conventional computed tomography (CT) imaging for speed and comprehension of anatomy. Sixteen students were randomized into two assessment sequences. During each assessment period, participants had to answer 15 anatomy-related questions that were divided into three categories: parenchymal, musculoskeletal, and vascular anatomy. After a washout period of 14 days, assessments were crossed over to the respective second reconstruction technique. The mean interperiod differences for the time to answer differed significantly between the CR-CT sequence (-204.21 ± 156.0 seconds) and the CT-CR sequence (243.33 ± 113.83 seconds; P < 0.001). Overall time reduction by CR was 65.56%. Cinematic Rendering visualization of musculoskeletal and vascular anatomy was higher rated compared to CT visualization (P < 0.001 and P = 0.003), whereas CT visualization of parenchymal anatomy received a higher scoring than CR visualization (P < 0.001). No carryover effects were observed. A questionnaire revealed that students consider CR to be beneficial for medical education. These results suggest that CR has a potential to enhance knowledge acquisition and transfer from medical imaging data in medical education.

Simulation as a tool for medical education has gained considerable importance in the past years. Various studies have shown that the mastering of basic skills happens best if taught in a realistic and workplace-based context. It is necessary that simulation itself takes place in the realistic background of a genuine clinical or in an accordingly simulated learning environment. A panoramic projection system that allows the simulation of different scenarios has been created at the medical school of the Westphalian Wilhelms-University Muenster/Germany. The SimuScape© is a circular training room of six meters in diameter and has the capacity to generate pictures or moving images as well as the corresponding background noises for medical students, who are then able to interact with simulated patents inside a realistic environment. About 1,000 students have been instructed using the SimuScape© in the courses of emergency medicine, family medicine and anesthesia. The SimuScape©, with its 270 degree-panoramic projection, gives the students the impression "of being right in the center of action". It is a flexible learning environment that can be easily integrated into curricular teaching and which is in full operation for 10 days per semester. The SimuScape© allows the establishment of new medical areas outside the hospital and surgery for simulation and it is an extremely adaptable and cost-effective utilization of a lecture room. In this simulated environment it is possible to teach objectives like self-protection and patent care during disturbing environmental influences in practice.

Recently, medical students' scientific thinking skills have been identified as an important issue in medical education. Scientific thinking cannot be imparted in conventional lectures, but rather requires actively involving students. We modified a practical course in physiology. A study was designed to test whether the new course fosters scientific thinking without impairing the transfer of physiological knowledge. The study group consisted of 226 first-year medical students at the Medical Faculty Mannheim of Heidelberg University. Written consent to participate in the study was obtained from all participants. The group was then randomly divided into two groups (traditional vs. modified course). The subject of both courses was a laboratory experiment in skeletal muscle physiology. In the traditional course, the students addressed topics already presented in lectures. In the modified course, students dealt with the same topics as in the traditional course, but the experiment was expanded to include one issue not taught before. When working on this issue, the students were instructed in scientific thinking. All participants filled out a questionnaire with 15 multiple-choice questions addressing the physiological subject matter and four open-ended questions addressing the criteria of scientific methodology. Physiological knowledge in both groups did not differ [F(1)= 2.08, P=0.15]. Scores in scientific thinking in the modified course were higher (mean=4.20, SD=1.89) than in the traditional course (mean=2.04, SD=1.91) with F(1)=70.69, P<0.001, ?[subscript 2] 0.24 (large effect). Our study demonstrates that small adjustments to courses in medical education can promote scientific thinking without impairing knowledge transfer.

There are many benefits to peer and near-peer tutoring. The current literature suggests that near-peer teaching within the domain of gross anatomy may lead to the development of numerous competencies for burgeoning medical professionals. The aim of this study was a quantitative and qualitative approach to explore which professional and personal competencies anatomy tutors developed as a result of their teaching activities in a gross anatomy course at a medical school in Germany. For a period of 18 months, 24 peer tutors were followed and queried multiple times via questionnaire and semi-structured interviews. It was found that most of the skills tutors developed or strengthened over one semester matched most of the core competencies described in various official competency frameworks used for physician education. In particular, tutors thought that tutoring gross anatomy had improved their knowledge of professional behavior as well as their communication skills. They also felt that they had learned to take on more responsibility and to use available resources more effectively. Overall, tutoring gross anatomy was perceived as very challenging, but also very rewarding, mainly because it provided the opportunity to develop and strengthen important skills such as self-confidence, self-awareness, positive thinking, self-insight, and stress management. Ultimately, these are all factors that contribute to resilience, an important attribute for physicians.

Measuring teachers' skills to carry out the complex tasks required in teaching is an important means of evaluating the effectiveness of teacher education but remains a challenging activity to conduct in practice. It is necessary to optimise approaches for usability and effectiveness along a continuum from low-effort and low-authenticity measures such as paper-and-pencil tests to high-effort, high-authenticity measures such as extended classroom observations. The first part of the paper reviews a range of efforts toward measuring the competencies of teachers and other professionals in carrying out the tasks that make up their work. These include performance tests such as computer-based simulations or simulations using actors, as well as the use of tasks requiring participation in or responses to video vignettes. Video vignette approaches typically have been less interactive than performance tests and interactivity is seen as a desirable feature. A novel framework for developing performance-oriented testing is then outlined. The second part of the paper exemplifies this framework in relation to providing explanations in physics classrooms. The development of a novel test instrument following the framework is described, and findings on construct validity are presented to support the applicability of the presented approach.

While most German anatomy institutes provide only limited information about body donors and their lives, students have expressed a desire to learn more about these individuals, especially about their motivations to donate their bodies for the sake of medical education. In order to gratify this wish, as well as to further humanize body donors, an educational film was compiled, and a study designed to capture the film's effects on medical students. This is the first study using standardized, validated psychological tools to evaluate the impact of an educational film about body donors on students' empathy and psychological stress levels. The study followed a longitudinal, controlled, and cluster randomized design, including 77 (48 females/29 males) participants who watched the video either before, midway, or after the dissection course. Questionnaires were completed at four points in time applying the Jefferson Scale for Empathy (JSPE-S) and the Interpersonal Reactivity Index (IRI) to measure empathy. Psychological stress levels were recorded by the Brief Symptom Inventory (BSI). Overall, students recommended the film to be shown to all students (median 6.0; maximum on the six-point Likert scale). Viewing the film revealed no significant changes between study groups or over time in JSPE-S sum scores. All groups demonstrated a significant reduction of BSI values before the dissection course actually started and increased values during the course, but both developments appeared not to be associated with the intervention. Overall, the educational film did not correlate with any negative effects on students' empathy and psychological stress levels, and it was strongly approved of by students, as it provided more humanizing personal information about body donors without violating their anonymity.

The article deals with international experience in medical professional education and analyzes the modern trends in professional training of junior medical officers, specificity of their professional training in 1 and 2 accreditation levels institutions of higher medical education in the context of the European integration process. Subject Benchmark Statements of Ukrainian higher education were defined as a list of requirements for knowledge, abilities and skills in solving professional tasks. It is emphasized that targeted development of professional competecy is viewed as the most important practical objective of an educational institutions. It is specified that professional training of future nurses in Ukrainian medical colleges is characterized by certain advantages and disadvantages. Ukrainian and international experience in medical education was comparatively analyzed. The American, Canadian and European systems of professional training for medical specialists were considered. It is found that American colleges provide comprehensive and multilevel training for nursers. It is highlighted that integrated three-hour classes are the leading form of the education process organization in Canada. It combines theoretical and practical training. Considerable attention was paid to determining the current trends in the organization and functioning of nurse education in Europe, the USA and Canada. Based on the analysis of professional training junior medical officers in some European countries, the USA and Canada, it is concluded that it is esseintial to take into account positive aspects of European, American and Canadian experience in nure education while planning reforms in Ukraine.

Peer-assisted learning (PAL) is nowadays commonly implemented in medical education. Mostly PAL is utilized to specifically support teaching within one subject or a specific curricular situation. Here, we present a large-scale peer teaching program that aims to address the individual student's learning needs. In addition, it provides a platform for students to participate in academic teaching. A retrospective data analysis was performed to reveal the program's development and acceptance. The program was implemented in 2008/09 with three tutorials conducted by 24 student tutors to support students preparing for reexaminations. Since then, the program has continuously grown. In 2015/16, 140 tutors conducted 52 tutorials, consisting of 2,750 lessons for 1,938 tutees. New tutorial categories were continuously introduced. In 2015/16, these encompassed tutorials that were held concomitantly to the formal curriculum, tutorials that exceeded the contents of the formal curriculum, tutorials for preparation for the state examination, and electives. Evaluations among the tutees revealed that 93.5% of the respondents rated the courses overall as "good" or "excellent" (n 13,489) in 2015/16. All elements of the peer teaching program are managed by one academic group. This encompasses the organization of tutorials, the quality management, and the qualification of tutors, including content-related supervision and didactic training. We conclude that the implementation of a large-scale peer teaching program can complement the formal curriculum. This might be beneficial for both tutors who can actively train their didactic and content-related competencies, and tutees who can autonomously consolidate and expand their knowledge.

Many Anglo-American universities have undertaken a paradigm shift in how the dissection of human material is approached, such that students are encouraged to learn about the lives of body donors, and to respectfully "personalize" them as human beings, rather than treating the specimens as anonymous cadavers. For the purposes of this study, this provision of limited personal information regarding the life of a body donor will be referred to as "personalization" of body donors. At this time, it is unknown whether this paradigm shift in the personalization of body donors can be translated into the German-speaking world. A shift from donor anonymity to donor personalization could strengthen students' perception of the donor as a "first patient," and thereby reinforce their ability to empathize with their future patients. Therefore, this study aimed to collect data about the current status of donation practices at German-speaking anatomy departments (n = 44) and to describe the opinions of anatomy departments, students (n = 366), and donors (n = 227) about possible donor personalization in medical education. Anatomy departments in Germany, Austria, and Switzerland were invited to participate in an online questionnaire. One-tenth of registered donors at Ulm University were randomly selected and received a questionnaire (20 items, yes-no questions) by mail. Students at the University of Ulm were also surveyed at the end of the dissection course (31 items, six-point Likert-scale). The majority of students were interested in receiving additional information about their donors (78.1%). A majority of donors also supported the anonymous disclosure of information about their medical history (92.5%). However, this information is only available in about 28% of the departments surveyed and is communicated to the students only irregularly. Overall, 78% of anatomy departments were not in favor of undertaking donor personalization. The results appear to reflect traditional attitudes among anatomy departments. However, since students clearly preferred receiving additional donor information, and most donors expressed a willingness to provide this information, one could argue that a change in attitudes is necessary. To do so, official recommendations for a limited, anonymous personalization of donated cadaveric specimens might be necessary.

Tuebingen's "Sectio Chirurgica" (TSC) is an innovative, interactive, multimedia, and transdisciplinary teaching method designed to complement dissection courses. The Tuebingen's "Sectio Chirurgica" (TSC) allows clinical anatomy to be taught via interactive live stream surgeries moderated by an anatomist. This method aims to provide an application-oriented approach to teaching anatomy that offers students a deeper learning experience. A cohort study was devised to determine whether students who participated in the TSC were better able to solve clinical application questions than students who did not participate. A total of 365 students participated in the dissection course during the winter term of the 2012/2013 academic year. The final examination contained 40 standard multiple-choice (S-MC) and 20 clinically-applied multiple-choice (CA-MC) items. The CA-MC items referred to clinical cases but could be answered solely using anatomical knowledge. Students who regularly participated in the TSC answered the CA-MC questions significantly better than the control group (75% and 65%, respectively; P < 0.05, Mann-Whitney U test). The groups exhibited no differences on the S-MC questions (85% and 82.5%, respectively; P > 0.05). The CA-MC questions had a slightly higher level of difficulty than the S-MC questions (0.725 and 0.801, respectively; P = 0.083). The discriminatory power of the items was comparable (S-MC median Pearson correlations: 0.321; CA-MC: 0.283). The TSC successfully teaches the clinical application of anatomical knowledge. Students who attended the TSC in addition to the dissection course were able to answer CA-MC questions significantly better than students who did not attend the TSC. Thus, attending the TSC in addition to the dissection course supported students' clinical learning goals.

Integration of anatomy and clinical teaching is a theoretical ideal, yet there is a worldwide paucity of such amalgamation. These teaching models provide support for medical trainees, an important element in Germany where orthopedic intern numbers have declined and anecdotal evidence suggests disinterest in orthopedics. The aim of the study was to develop an integrated anatomy-surgical course for undergraduate medical training, assess the model developed, and explore how medical students perceive orthopedics as a career. The course was to deliver medical anatomy and clinical orthopedic training, focusing on interdisciplinary teaching and learning, vertical integration of clinical knowledge and skills, and professional interaction. Survey evaluation of the course and students' perceptions of orthopedic careers was performed, including Likert-type responses rating variables of interest. A phased-concept program of five courses, each optional and under one-week in duration, was developed parallel to the undergraduate medical program. Delivered by anatomists and surgeons, courses included biomechanics, advanced dissection, surgical approaches, casts and implants, and sports medicine. Course data indicate positive support for course format, stimulation of interest, and high clinical relevance. Students are generally interested in surgery, and identify hierarchy, lawsuits, bureaucracy and physical stress as barriers to orthopedic careers. This novel phased-concept successfully delivers combined anatomy and surgery training in a vertically-integrated format while addressing students' clinical and professional skills. The format facilitates an appreciation of potential career options in orthopedics, while fostering professional skills during medical training. Barriers to careers in orthopedics can now be addressed in future courses.

Preparing medical graduates who are competent to work in a global environment requires broad integration of international and intercultural perspectives throughout the medical curriculum. Employing Leask and Bridge's "conceptual framework of internationalisation of the curriculum," this article first highlights the emphasis placed on international mobility, global health, and cultural competency as ways to address internationalization of the curriculum within the discipline of medicine. Second, it highlights the influence of national and regional contexts on internationalizing the curriculum by comparing approaches from Germany and Australia. A review of the literature reveals that in spite of some contextual differences, medicine seems to struggle with a disciplinary understanding of an internationalized curriculum that is comprehensive and coherent. This article argues that what is needed instead is a transformative approach to learning and to curriculum development in medicine. Finally, implications for future research and practice are considered.

When making personally relevant decisions (e.g. on health-related issues), laypersons have to deal increasingly with science-based knowledge claims that are frequently not only inconsistent if not contradictory but also beyond their own everyday understanding. Nevertheless, they need to reason about these issues. The present interview study investigates the concrete reasoning about and resolution of a scientific conflict between knowledge claims put forward by medical experts in 21 laypersons and 20 intermediately knowledgeable persons. Results showed that explanation patterns were influenced by assumptions about not only the tentative nature of knowledge but also about the person of the expert and the institutional practice of science. When trying to resolve the conflict, both groups reported significantly more strategies of evaluating and validating the source rather than assessing the claim's veracity based on their own understanding. Hence, when facing scientific conflicts, source validation and deference to another's expertise is rather the rule than the exception. Modern societies are based on an elaborate division of cognitive labor, underlining the need to evaluate the social context in which knowledge claims are derived. The discussion derives implications for learning and instruction.

Auscultation torsos are widely used to teach position-dependent heart sounds and murmurs. To provide a more realistic teaching experience, both whole body auscultation mannequins and torsos have been used in clinical examination skills training at the Medical Faculty of the University of Muenster since the winter term of 2008-2009. This training has since been extended by simulated patients, which are normal, healthy subjects who have undergone attachment of the electronic components of the auscultation mannequins to their chests to mimic pathophysiological conditions ("hybrid models"). The acceptance of this new learning method was examined in the present pilot study. In total, 143 students in their second preclinical year who were participating in auscultation training were randomized into an intervention group (hybrid models) and a control group (auscultation mannequins). One hundred forty-two (99.3%) of these students completed a self-assessment Likert-scale questionnaire regarding different teaching approaches (where 1 = "very poor" to 100 = "very good"). The questionnaire focused on the "value of learning" of different teaching approaches. Direct comparison showed that students evaluated the hybrid models to be significantly more effective than the auscultation mannequins (median: 83 vs. 64, P < 0.001). The cardiac auscultation training was generally assessed positively (median: 88). Additionally, verbal feedback was obtained from simulated patients and tutors (trained students who had successfully passed the course a few semesters earlier). Personal feedback showed high satisfaction from student tutors and simulated patients. Hybrid simulators for teaching cardiac auscultation elucidated positive responses from students, tutors, and simulated patients.

The training of motor skills is a crucial aspect of medical education today. Serious games and haptic virtual simulations have been used in the training of surgical procedures. Otherwise, however, a combination of serious games and motor skills training is rarely used in medical education. This article presents Skills-O-Mat, an interactive serious game for training rhythmic and period motor skills. In its first application the game supports dental students being trained in alginate mixing in a blended learning course. Designed as reusable component, the game follows an effective learning design and uses constant immediate feedback to support students' learning. The effectiveness of the use of the game in learning was compared to learning in a traditional workshop using a randomized controlled trial (N = 30 test group, N = 25 control group). Participants of the evaluation were dental students aged 20 to 23 years in the 2nd year of study (40% male, 60% female; 46.7% with no experience, 50% had little experience in mixing alginate). An analysis of the results of the evaluation gives indications of the positive learning effect of the game. The game was rated a valuable instrument for teaching and developing practical skills.

The practice of dissection teaches students not only the foundations of anatomical knowledge but also encourages the development of professional competencies. Yet, the dissection of cadavers in the gross anatomy course can be a stress factor for medical students. There are a minor proportion of students who demonstrate strong emotional reactions in anticipation of being confronted with a cadaver. Therefore, in 2008, the authors implemented a voluntary course entitled, "Anatomical demonstrations of organ systems" (AD-OS) in advance of the dissection course to ease this psychological burden. The question of whether attendees of AD-OS showed less mental distress at the start of the dissection course compared with those that had not or only infrequently visited AD-OS was addressed. AD-OS attendees assessed their expected mental distress using a five-point Likert scale before starting the dissection course and a second time at the end of their first day, after they had been confronted with a cadaver. AD-OS was evaluated as excellent and the majority of students participated actively during teaching sessions. Overall, female students showed higher levels of mental distress. AD-OS attendees assessed themselves as being less burdened by mental distress than members of the control group. Longitudinal analysis revealed that students who visited AD-OS showed a marked decrease of their mental distress level, comparing prospective and retrospective ratings. This was significantly (P less than 0.001; Z = -6.061) different from nonattendees or those who visited AD-OS only infrequently. AD-OS satisfied its intended teaching goals and proved that a step-by-step introduction of dissection through anatomical demonstrations helped to reduce the mental distress of students. Future studies are planned to measure mental distress with objective instruments. (Contains 5 figures and 4 tables.)

To compare different scoring algorithms for Pick-N multiple correct answer multiple-choice (MC) exams regarding test reliability, student performance, total item discrimination and item difficulty. Data from six 3rd year medical students' end of term exams in internal medicine from 2005 to 2008 at Munich University were analysed (1,255 students, 180 Pick-N items in total). Scoring Algorithms: Each question scored a maximum of one point. We compared: (a) Dichotomous scoring (DS): One point if all true and no wrong answers were chosen. (b) Partial credit algorithm 1 (PS50): One point for 100% true answers; 0.5 points for 50% or more true answers; zero points for less than 50% true answers. No point deduction for wrong choices. (c) Partial credit algorithm 2 (PS1/m): A fraction of one point depending on the total number of true answers was given for each correct answer identified. No point deduction for wrong choices. Application of partial crediting resulted in psychometric results superior to dichotomous scoring (DS). Algorithms examined resulted in similar psychometric data with PS50 only slightly exceeding PS1/m in higher coefficients of reliability. The Pick-N MC format and its scoring using the PS50 and PS1/m algorithms are suited for undergraduate medical examinations. Partial knowledge should be awarded in Pick-N MC exams.

The gross anatomy dissection course is a cost-intensive piece of undergraduate medical education that students and professionals alike describe as very important within the overall medical curriculum. We sought to understand more explicitly students' valuation of gross anatomy as an "important" course and so developed a quantitative longitudinal questionnaire. Medical students (n = 124) enrolled in the winter term 2006/2007 gross anatomy course at the Ulm University Faculty of Medicine were surveyed anonymously prior to, in the middle of, and at the end of the dissection course. Subgroups of students expressing rising or falling opinions of course value were identified and correlated with student opinions about the course's ability to convey professional competencies. Five-point Likert scales were used for each survey item, which included such standardized instruments as the NeoFFI, BSI, and FBM. The study confirmed that medical students believe dissection to be valuable. Students indicated that participation in the course facilitated acquisition of anatomy knowledge as well as skills related to teamwork, coping with stress, and, to a lesser extent, time management. Students also noted that they developed less empathy than expected beforehand. Significant subgroup differences were observed relative to the competencies of teamwork, stress coping strategies, and empathy, as well as in students' stress levels associated with having to take a dissection course. Our study builds on previous work that has shown dissection courses help students develop professional competencies. The increase in professionalism might be a reason for the generally high value students place on the gross anatomy dissection course. (Contains 3 tables and 2 figures.)

Gross dissection for demonstrating anatomy of the human pelvis has traditionally involved one of two approaches, each with advantages and disadvantages. Classic hemisection in the median plane through the pelvic ring transects the visceral organs but maintains two symmetric pelvic halves. An alternative paramedial transection compromises one side of the bony pelvis but leaves the internal organs intact. The authors propose a modified technique that combines advantages of both classical dissections. This novel approach involves dividing the pubic symphysis and sacrum in the median plane after shifting all internal organs to one side. The hemipelvis without internal organs is immediately available for further dissection of the lower limb. The hemipelvis with intact internal organs is ideal for showing the complex spatial relationships of the pelvic organs and vessels relative to the intact pelvic floor. (Contains 7 figures.)

Introduction: Since reliable information is scarce to describe continuing medical education (CME) and revalidation in Europe, we carried out a survey in 5 selected countries (France, Germany, Italy, Spain, and the United Kingdom). Methods: A tested questionnaire was sent to 2 experts per country (except in Germany), during August-September 2004. Results: In the analyzed countries medical societies, medical associations, and employers are the main CME providers. Pharmaceutical industry sponsorship accounts on the average for more than 50% of the CME financing in those countries. In all 5 countries, CME accreditation systems exist; the national health authorities and medical associations are mainly responsible for them. In France, Italy, and Germany CME is mandatory; in Spain and the United Kingdom it is voluntary. CME credits/points are mainly used for professional career purposes. Revalidation systems have not been introduced in any of these countries, although in the United Kingdom it is being introduced as part of a relicensing process. Discussion: Recommendations for the implementation of a European system of CME/CPD harmonization are made by the authors. (Contains 3 tables.)

Introduction: This survey aimed to investigate German ambulatory physicians' opinions about mandatory continuing medical education (CME) and CME resources shortly before the introduction of mandatory CME in 2004. Methods: A structured national telephone survey of general practitioners and specialists was conducted. Main outcome measures were opinions about mandatory CME, preferred CME media, and financial aspects of CME. Data analysis applied Pearson's correlation coefficient for explorative analysis of correlations, analysis of variance for group comparison, and 2-test for investigation of distribution of 2 or more categorical variables. Results: Of the 511 participants, 73% felt that CME supported them in keeping up to date with new medical knowledge, yet only half believed in its ability to minimize medical errors or increase quality of patient care. Traditional ways of learning were preferred. Significant differences in CME behavior were found between primary-care physicians and specialists, the latter using more communicative media. Also, a small group of very skeptical physicians who do not agree with the need for CME in general was identified. Average expenditure for CME was estimated between 500 and 1000 Euros per year. A majority of physicians called for other parties, eg, health insurances or government, to share the financial responsibility for CME. Discussion: Mandatory CME was accepted as a necessity already before the new legislation took effect, with prevailing skepticism at the same time. Future research is needed on how to motivate physicians and especially certain subgroups of physicians to use CME methods shown to be effective in changing clinical behavior. (Contains 4 tables.)

Communication skills training is an accepted part of undergraduate medical programs nowadays. In addition to learning experiences its importance should be emphasised by performance-based assessment. As detailed checklists have been shown to be not well suited for the assessment of communication skills for different reasons, this study aimed to validate a global rating scale. A Canadian instrument was translated to German and adapted to assess students' communication skills during an end-of-semester-OSCE. Subjects were second and third year medical students at the reformed track of the Charite-Universitaetsmedizin Berlin. Different groups of raters were trained to assess students' communication skills using the global rating scale. Validity testing included concurrent validity and construct validity: Judgements of different groups of raters were compared to expert ratings as a defined gold standard. Furthermore, the amount of agreement between scores obtained with this global rating scale and a different instrument for assessing communication skills was determined. Results show that communication skills can be validly assessed by trained non-expert raters as well as standardised patients using this instrument.

Introduction: There is a strong need for high-quality continuing medical education (CME) in Germany. To maintain a medical license, physicians are required to participate in regular training. Although evidence suggests that compared to lectures interactive methods can impart sustainable knowledge and a high degree of satisfaction, few interactive CME courses are offered. Methods: We designed an interactive, team-based CME concept and launched it in a series of seminars on internal medicine. The group work was designed using team-based learning. Pre- and postcourse knowledge tests with an electronic voting system and paper questionnaires (Likert scale 1-6) were used to evaluate knowledge, motivation, and expectations of the participants (n = 159). Results: Participants rated the interactivity and team-based discussion (mean: 4.57, SD: 1.41) of the CME seminars as highly important reasons to participate and stated that the CME course was very instructional (mean: 5.16, SD: 0.84) and the case discussions enhanced their learning (mean: 5.46, SD: 0.75). The majority of participants stated that their expectations were met. The participants enhanced their outcome from a mean of 47.2% right answers prior to the course to 70.3% in the postcourse test ( p less than 0.001). Discussion: An interactive, case-based design of a CME course following the team-based learning concept leads to a significant gain in the participants' knowledge with an identified preknowledge level. Participants' expectations seemed fulfilled by a CME course design, which combines small group discussions in the lecture hall with didactic lectures and intensive discussion. (Contains 3 tables and 1 figure.)

Suicide and assisted suicide are not criminal acts in Germany. However, attempting suicide may create a legal duty for physicians to try to save a patient's life. This study presents data on medical students' legal knowledge and ethical views regarding physician assisted suicide (PAS). The majority of 85 respondents held PAS to be illegal. More than a third of the students viewed PAS in certain situations to be ethically acceptable whereas a smaller proportion thought that it should be legal. Compared with German physicians the medical students taking part in this study were less opposed to PAS. The majority perceived the undergraduate training concerning ethical aspect of assisted death as deficient.

Presents invited reports that express the personal views of physiologists on the historical influences of physiology education in their countries. Includes reports from Argentina, Australia, Germany, Hungary, India, the Netherlands, Switzerland, and the United Arab Emirates. (DDR)