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Background: As many as 50% of older smokers develop chronic obstructive pulmonary disease (COPD), and more than 80% of COPD-associated morbidity is caused by tobacco smoking. Despite the severe symptoms from which COPD patients suffer, they are often unable to quit smoking on their own. Methods: Experts from 9 medical societies, under the aegis of the German Society of Pulmonology and Respiratory Medicine (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin), have developed an S3 guideline on smoking cessation in COPD. They took previously published guidelines into account, as well as more than 2000 initially surveyed publications, and created the new guideline in two consensus conferences followed by a Delphi process. Results: The following strongly evidence-based statements can be made: A smoking cessation strategy based on a combination of medication and psychosocial support has been found to be effective in COPD patients. Smoking cessation improves pulmonary function, alleviates dyspnea and cough, reduces the frequency of COPD exacerbations, and lowers mortality. Smoking reduction alone does not improve pulmonary function or alleviate symptoms. Smoking cessation is the most effective and least expensive single means of lowering the risk of developing COPD and of arresting its progression. Smoking cessation should therefore be strongly promoted at all levels of health care delivery. Conclusions: There is no question that smoking cessation ranks among the most effective medical interventions, yet the German health care system still does not assign it an adequate priority. [ABSTRACT FROM AUTHOR]

BackgroundCurrently, there are no binding requirements for manufacturers prescribing which information must be included in the app descriptions of health apps. ObjectiveThe aim of this study was to investigate how medical students perceive a selection of quality principles, intended for usage decisions in the app context, and establish whether the information presented in a sample of app descriptions is perceived as sufficient for facilitating an informed usage decision. MethodsA total of 123 students (mean age 24.2 years, SD 3.4) participating in a 6-week teaching module covering cardiology and pulmonology at the University of Göttingen (original enrollment 152 students, response rate 80.9%) were included. Students were asked to read 3 store description texts of cardiological or pneumological apps and initially assess whether the descriptions sufficed for a usage decision. Subsequently, they were queried on their perception of the relevance of 9 predefined quality principles, formulated for usage decisions. An appraisal of whether the app description texts contained sufficient information to satisfy these quality principles followed. By means of 20 guiding questions, participants were then asked to identify relevant information (or a lack thereof) within the descriptions. A reassessment of whether the description texts sufficed for making a usage decision ensued. A total of 343 complete datasets were obtained. ResultsA majority of the quality principles were described as “very important” and “important” for making a usage decision. When accessed via the predefined principles, students felt unable to identify sufficient information within the app descriptions in 68.81% (2124/3087) of cases. Notably, information regarding undesired effects (91.8%, 315/343), ethical soundness (90.1%, 309/343), measures taken to avert risks (89.2%, 306/343), conflicts of interest (88.3%, 303/343), and the location of data storage (87.8%, 301/343) was lacking. Following participants’ engagement with the quality principles, statistically significant changes in their assessment of whether the app descriptions sufficed for a usage decision can be seen—McNemar-Bowker test (3)=45.803919, P

In describing the inverted classroom model (ICM), the following paper is meant to provide an introduction to the subject matter and to serve as a practical guide for those wishing to employ its methods in basic and advanced medical training and education. The ICM is a blended-learning method in which a self-directed learning phase (individual phase) precedes the classroom-instruction phase. During the online phase, factual knowledge is imparted that serves as a basis for the classroom phase. The classroom phase should subsequently be used to assimilate and implement the previously gained knowledge. In contrast, traditional course concepts impart factual knowledge in lectures, for example, or in other face-to-face teaching formats and are followed by the students’ self-instruction in order to assimilate this knowledge. The goal of the ICM is the shift from passive learning to accelerated learning in order to foster learning at cognitively demanding levels such as analysis, synthesis and evaluation. The concurrent increase in production and use of screencasts and educational videos, the Open Educational Resources “movement” and the widespread use of Massive Open Online Courses (MOOCS) have contributed to the increased dissemination of the inverted-classroom method. The intention of the present paper is to provide an introduction to the subject matter and simultaneously to offer a short overview of important projects and research results in the field of medical education and other health professions. Furthermore, an outline is given of the advantages and disadvantages of the model as well as its potential benefit to the future of medical education and training.

BackgroundPodcasts are popular with medical students, but the impact of podcast use on learning outcomes in undergraduate medical education has not been studied in detail. ObjectiveOur aim was to assess the impact of podcasts accompanied by quiz questions and lecture attendance on short- and medium-term knowledge retention. MethodsStudents enrolled for a cardio-respiratory teaching module were asked to prepare for 10 specific lectures by watching podcasts and submitting answers to related quiz questions before attending live lectures. Performance on the same questions was assessed in a surprise test and a retention test. ResultsWatching podcasts and submitting answers to quiz questions (versus no podcast/quiz use) was associated with significantly better test performance in all items in the surprise test and 7 items in the retention test. Lecture attendance (versus no attendance) was associated with higher test performance in 3 items and 1 item, respectively. In a linear regression analysis adjusted for age, gender, and overall performance levels, both podcast/quiz use and lecture attendance were significant predictors of student performance. However, the variance explained by podcast/quiz use was greater than the variance explained by lecture attendance in the surprise test (38.7% vs 2.2%) and retention test (19.1% vs 4.0%). ConclusionsWhen used in conjunction with quiz questions, podcasts have the potential to foster knowledge acquisition and retention over and above the effect of live lectures.

Background and objective: Evaluation is an integral part of education in German medical schools. According to the quality standards set by the German Society for Evaluation, evaluation tools must provide an accurate and fair appraisal of teaching quality. Thus, data collection tools must be highly reliable and valid. This review summarises the current literature on evaluation of medical education with regard to the possible dimensions of teaching quality, the psychometric properties of survey instruments and potential confounding factors.Methods: We searched Pubmed, PsycINFO and PSYNDEX for literature on evaluation in medical education and included studies published up until June 30, 2011 as well as articles identified in the “grey literature”. Results are presented as a narrative review.Results: We identified four dimensions of teaching quality: structure, process, teacher characteristics, and outcome. Student ratings are predominantly used to address the first three dimensions, and a number of reliable tools are available for this purpose. However, potential confounders of student ratings pose a threat to the validity of these instruments. Outcome is usually operationalised in terms of student performance on examinations, but methodological problems may limit the usability of these data for evaluation purposes. In addition, not all examinations at German medical schools meet current quality standards.Conclusion: The choice of tools for evaluating medical education should be guided by the dimension that is targeted by the evaluation. Likewise, evaluation results can only be interpreted within the context of the construct addressed by the data collection tool that was used as well as its specific confounding factors.

[english] Objective: The evaluation of medical research performance is a key prerequisite for the systematic advancement of medical faculties, research foci, academic departments, and individual scientists’ careers. However, it is often based on vaguely defined aims and questionable methods and can thereby lead to unwanted regulatory effects. The current paper aims at defining the position of German academic medicine toward the aims, methods, and consequences of its evaluation. Methods: During the Berlin Forum of the Association of the Scientific Societies in Germany (AWMF) held on 18 October 2013, international experts presented data on methods for evaluating medical research performance. Subsequent discussions among representatives of relevant scientific organizations and within three ad-hoc writing groups led to a first draft of this article. Further discussions within the AWMF Committee for Evaluation of Performance in Research and Teaching and the AWMF Executive Board resulted in the final consented version presented here.Results: The AWMF recommends modifications to the current system of evaluating medical research performance. Evaluations should follow clearly defined and communicated aims and consist of both summative and formative components. Informed peer reviews are valuable but feasible in longer time intervals only. They can be complemented by objective indicators. However, the Journal Impact Factor is not an appropriate measure for evaluating individual publications or their authors. The scientific “impact” rather requires multidimensional evaluation. Indicators of potential relevance in this context may include, e.g., normalized citation rates of scientific publications, other forms of reception by the scientific community and the public, and activities in scientific organizations, research synthesis and science communication. In addition, differentiated recommendations are made for evaluating the acquisition of third-party funds and the promotion of junior scientists.Conclusions: With the explicit recommendations presented in the current position paper, the AWMF suggests enhancements to the practice of evaluating medical research performance by faculties, ministries and research funding organizations.

[english] Aims: In Germany, the final year of undergraduate medical education (‘practice year’) consists of three 16-week clinical attachments, two of which are internal medicine and surgery. Students can choose a specific specialty for their third 16-week attachment. Practice year students do not receive specific teaching to prepare them for the National Licensing Examination. It is unknown whether knowledge levels increase during this year. This study aimed at assessing knowledge at the beginning and the end of the final year of medical school. Methods: Three hundred pre-selected United States Medical Licensing Examination type items from ten medical disciplines were reviewed by ten recent medical graduates from the Netherlands and Germany. The resulting test included 150 items and was taken by 77 and 79 final year medical students from Göttingen and Hamburg at the beginning and the end of their practice year, respectively. Results: Cronbach’s α of the pre- and post-test was 0.75 and 0.68, respectively. Mean percent scores in the pre- and post-test were 63.9±6.9 and 69.4±5.7, respectively (p[german] Zielsetzung: In Deutschland besteht das letzte Jahr des Studiums der Humanmedizin ("Praktisches Jahr", PJ) aus drei Tertialen von je 16 Wochen, von denen eines in der Inneren Medizin und eines in der Chirurgie abzuleisten ist. Die Fachrichtung des dritten Tertials von 16 Wochen kann von den Studierenden frei gewählt werden. Während des Praktischen Jahres findet keine gezielte Vorbereitung auf den schriftlichen Teil des Staatsexamens statt. Es ist unklar, inwieweit die Studierenden während des Praktischen Jahres auch neue Wissensinhalte erlernen. Ziel dieser Studie war es, zu Beginn und am Ende des Praktischen Jahres Wissensinhalte zu überprüfen. Methodik: Zehn Absolventen des Medizinstudiums in Deutschland und den Niederlanden trafen eine Auswahl aus 300 vorselektierten Fragen der US-amerikanischen Abschlussprüfung (USMLE), die zehn verschiedenen Fachrichtungen zugeordnet waren. Die ausgewählten 150 Fragen wurden im Rahmen zweier Tests PJ-Studierenden aus Göttingen und Hamburg vorgelegt: einmal zu Beginn (n=77 Studierende) und einmal am Ende des Praktischen Jahres (n=79). Ergebnisse: Die interne Konsistenz der beiden Tests (Cronbach’s α) betrug 0,75 (Prätest) bzw. 0,68 (Posttest). Der Anteil richtig beantworteter Fragen betrug im Prätest 63,9±6,9 und im Posttest 69,4±5,7 (p

BackgroundAn accurate and up-to-date estimate of the potential reach of Internet-based smoking cessation interventions (ISCIs) would improve calculations of impact while an understanding of the characteristics of potential users would facilitate the design of interventions. ObjectiveThis study reports the prevalence and the sociodemographic, smoking, and Internet-use characteristics of smokers interested in using ISCIs in a nationally representative sample. MethodsData were collected using cross-sectional household surveys of representative samples of adults in England. Interest in trying an Internet site or “app” that was proven to help with stopping smoking was assessed in 1128 adult smokers in addition to sociodemographic characteristics, dependence, motivation to quit, previous attempts to quit smoking, Internet and handheld computer access, and recent types of information searched online. ResultsOf a representative sample of current smokers, 46.6% (95% CI 43.5%-49.6%) were interested in using an Internet-based smoking cessation intervention. In contrast, only 0.3% (95% CI 0%-0.7%) of smokers reported having used such an intervention to support their most recent quit attempt within the past year. After adjusting for all other background characteristics, interested smokers were younger (OR=0.98, 95% CI 0.97-0.99), reported stronger urges (OR=1.29, 95% CI 1.10-1.51), were more motivated to quit within 3 months (OR=2.16, 95% CI 1.54-3.02), and were more likely to have made a quit attempt in the past year (OR=1.76, 95% CI 1.30-2.37), access the Internet at least weekly (OR=2.17, 95% CI 1.40-3.36), have handheld computer access (OR=1.65, 95% CI 1.22-2.24), and have used the Internet to search for online smoking cessation information or support in past 3 months (OR=2.82, 95% CI 1.20-6.62). There was no association with social grade. ConclusionsAlmost half of all smokers in England are interested in using online smoking cessation interventions, yet fewer than 1% have used them to support a quit attempt in the past year. Interest is not associated with social grade but is associated with being younger, more highly motivated, more cigarette dependent, having attempted to quit recently, having regular Internet and handheld computer access, and having recently searched for online smoking cessation information and support.

[english] Aims: Different approaches to performance-oriented allocation of resources according to teaching quality are currently being discussed within German medical schools. The implementation of these programmes is impeded by a lack of valid criteria to measure teaching quality. An assessment of teaching quality should include structural and procedural aspects but focus on learning outcome itself. The aim of this study was to implement a novel, outcome-based evaluation tool within the clinical phase of a medical curriculum and address differences between the novel tool and traditional evaluation methods. Methods: Student self-assessments before and after completion of a teaching module were used to compute performance gains for specific learning objectives. Mean performance gains in each module were compared to student expectations before the module and data derived from a traditional evaluation tool using overall course ratings at the end of the module.Results: A ranking of the 21 modules according to computed performance gains yielded entirely different results than module rankings based on overall course ratings. There was no significant correlation between performance gain and overall ratings. However, the latter were significantly correlated to student expectations before entering the module as well as structural and procedural parameters (Pearson’s r 0.7-0.9).Conclusion: Performance gain computed from comparative self-assessments adds an important new dimension to course evaluation in medical education. In contrast to overall course ratings, the novel tool is less heavily confounded by construct-irrelevant factors. Thus, it appears to be more appropriate than overall course ratings in determining teaching quality and developing algorithms to guide performance-oriented resource allocation in medical education. [german] Zielsetzung: Aktuell werden an den deutschen medizinischen Fakultäten unterschiedliche Konzepte zur leistungsorientierten Mittelvergabe (LOM) in der Lehre diskutiert. Die Umsetzung scheitert mitunter am Mangel valider Messkriterien zur Beurteilung der Lehrqualität. Neben der Struktur und den Prozessen der Lehre sollte das Ergebnis der Lehre im Mittelpunkt der Qualitätsbewertung stehen. Ziele dieser Arbeit waren die Erprobung eines neuen, lernzielbezogenen Evaluationssystems im klinischen Abschnitt des Studiums der Humanmedizin und der Vergleich der Ergebnisse mit den Daten eines traditionellen Evaluationsverfahrens.Methodik: Aus studentischen Selbsteinschätzungen zu Beginn und Ende eines jeden Lehrmoduls wurde nach einer neu entwickelten Formel der lernzielbezogene, prozentuale Lernerfolg berechnet. Die Lernerfolgs-Mittelwerte pro Modul wurden mit traditionellen Evaluationsparametern, insbesondere mit Globalbewertungen, ins Verhältnis gesetzt.Ergebnisse: Der mittels vergleichender Selbsteinschätzungen berechnete Lernerfolg und die Globalbewertungen produzierten deutlich unterschiedliche Rangfolgen der 21 klinischen Module. Zwischen dem Lernerfolg und den Globalbewertungen fand sich keine statistisch signifikante Korrelation. Allerdings korrelierten die Globalbewertungen stark mit den studentischen Erwartungen vor Modulbeginn und mit strukturellen und prozeduralen Parametern der Lehre (Pearson’s r zwischen 0,7 und 0,9). Schlussfolgerung: Die Messung des Lernzuwachses mittels vergleichender studentischer Selbsteinschätzungen kann die traditionelle Evaluation um eine wichtige Dimension erweitern. Im Unterschied zu studentischen Globalbewertungen ist das neue Instrument lernzielbezogen und unabhängiger vom Einfluss Konstrukt-irrelevanter Parameter. Hinsichtlich der Entwicklung eines LOM-Algorithmus eignet sich das neue Instrument gut zur Beurteilung der Lehrqualität.

Improving the atmospheric component of hydrological models is beneficial for applications such as water resources assessment and hydropower operations. Within this goal, precise characterization of rain microphysics is key for climate and weather modeling, and thus for hydrometeorological applications. Such characterization can be achieved by analyzing the evolution in time of the particle size distribution (PSD) of hydrometeors, which can be measured at ground using disdrometers for validation. The estimation, however, depends on the choice of the PSD form (the shape) and on the parameters to define the exact shape. In the case of modeling rain microphysics, two approaches compete: the use of the number concentration of drops decoupled from the shape of the distribution (the [ N T, E( D), E( D2)] and the { N T, E( D), E[log( D)]} models), and the ( N0, Λ, μ) model that embeds in N0 both the shape of the distribution and the number concentration of drops. Here we use a comprehensive dataset of disdrometer measurements to show that the N T-based approaches allow a more precise characterization of the drop size distribution (DSD) and also a physically based modeling of the microphysical processes of rain since N T is analytically independent of the shape of the DSD {parameterized by E( D), and E( D2) or E[log( D)]}. The implication is that numerical models would benefit from decoupling the number of drops from the shape of distribution in their modules of precipitation microphysics in order to improve outputs that eventually feed hydrological models. [ABSTRACT FROM AUTHOR]

Amir H Sam,1 Chee Yeen Fung,1 Janina Barth,2 Tobias Raupach3 1Medical Education Research Unit, Imperial College School of Medicine, Imperial College London, London, UK; 2Division of Medical Education Research and Curriculum Development, University Medical Centre Göttingen, Göttingen, Germany; 3Institute for Medical Education, University Hospital Bonn, Bonn, GermanyCorrespondence: Tobias RaupachInstitute for Medical Education, University Hospital Bonn, Bonn, D-53127, GermanyTel +49 228 287-52160Email Tobias.Raupach@ukbonn.deIntroduction: Evaluation of individual teachers in undergraduate medical education helps clinical teaching fellows identify their own strengths and weaknesses. In addition, evaluation data can be used to guide career decisions. In order for evaluation results to adequately reflect true teaching performance, a range of parameters should be considered when designing data collection tools.Methods: Clinical teaching fellows at five London teaching hospitals were evaluated by third-year students they had supervised during a ten-week clinical attachment. The questionnaire addressed (a) general teaching skills and (b) student learning outcome measured via comparative self-assessments. Teachers were ranked using different algorithms with various weights assigned to these two factors.Results: A total of 133 students evaluated 14 teaching fellows. Overall, ratings on teaching skills were largely favourable, while the perceived increase in student performance was modest. Considerable variability across teachers was observed for both factors. Teacher rankings were strongly influenced by the weighting algorithm used. Depending on the algorithm, one teacher was assigned any rank between #2 and #10.Conclusion: Both parts of the questionnaire address different outcomes and thus highlight specific strengths and weaknesses of individual teachers. Programme directors need to carefully consider the weight assigned to individual components of teacher evaluations in order to ensure a fair appraisal of teacher performance.Keywords: clinical teaching, evaluation, learning outcome, undergraduate medical education

Introduction: Various scoring approaches for Multiple True‐False (MTF) items exist. This study aimed at comparing scoring results obtained with different scoring approaches and to assess the effect of item cues on each scoring approaches' result. Materials and Methods: Different scoring approaches (MTF, Count‐2, Count‐3, "Vorkauf‐Method," PS50, Dichotomized MTF, "Blasberg‐Method," Multiple response (MR), Correction for Guessing, "Ripkey‐Method," Morgan‐Method, Balanced Scoring Method) were retrospectively applied to all MTF items used within electronic examinations of undergraduate dental students at the University Medical Center Göttingen in the winter term 2016/2017 (1297 marking events). Item quality was evaluated regarding formal parameters such as presence of cues and correctness of content. Differences between scoring results of all scoring approaches and the differences between each methods' scoring results of items with and without cues were calculated by Wilcoxon rank sum tests (P < .05). Results: Average scoring results per item highly differed between the scoring approaches and ranged from 0.46 (MR) to 0.92 (Dichotomized MTF). Presence of cues leads to significantly higher scoring in case of all scoring approaches (P < .001; +0.14 on average). However, effect of cues differed amongst scoring approaches and ranged from +0.04 (Dichotomized MTF) to +0.20 (MR). Conclusion: Scoring of MTF items is complex. The data presented in this manuscript may help educators make informed choices about scoring algorithms. [ABSTRACT FROM AUTHOR]

Background: Serious games are risk-free environments training various medical competencies, such as clinical reasoning, without endangering patients' safety. Furthermore, serious games provide a context for training situations with unpredictable outcomes. Training these competencies is particularly important for healthcare professionals in emergency medicine., Methods: Based on these considerations, we designed, implemented, and evaluated a serious game in form of an emergency department, containing the features of a virtual patient generator, a chatbot for medical history taking with self-formulated questions, artificially generated faces based on an artificial intelligence algorithm, and feedback for students. The development process was based on an already existing framework resulting in an iterative procedure between development and evaluation. The serious game was evaluated using the System Usability Scale and the User Experience Questionnaire., Results: The System Usability Scale provided a substantial result for the usability. In terms of the user experience, four scales yielded positive results, whereas two scales yielded neutral results., Conclusion: The evaluation of both usability and user experience yielded overall positive results, while simultaneously identifying potential areas for improvement. Further studies will address the implementation of additional game design elements, and testing student learning outcome., (© 2024. The Author(s).)

Background: Time-since-death (TSD) diagnostics are crucial in forensic medical casework. The compound method by Henssge and Madea, which combines temperature and non-temperature-based techniques, is widely used to estimate TSD. This study aims to validate the predictive ability of this method in a cohort of 76 deceased individuals with known times of death (TOD)., Methods: A convenience sample of 76 deceased individuals was examined at the Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf. The study included individuals who died at the hospital and those with sudden death in public. Exclusion criteria included age under 18, known infection or sepsis, polytrauma, bleeding, and hyperthermia. The TSD interval was calculated using the Deathtime software., Results: The overall agreement between the actual TOD and the 95% prediction interval for the TSD was 36.8% (95% CI: 26.1 to 48.7). Warm-stored corpses showed a higher agreement (61.9% [95% CI: 38.4 to 81.9]) compared to cold-stored corpses (27.3% [95% CI: 16.1 to 41.0]). Factors such as body mass index (BMI) and body surface area (BSA) were found to influence the odds of agreement. Assuming a plausible range of ambient temperatures between death and admission improved the agreement in cold-stored cases., Conclusion: The study found low to moderate agreement between the actual TOD and the 95% prediction interval using the Henssge method. Incorporating BMI and BSA could improve the predictive accuracy of TSD estimations. Further research with larger sample sizes and external validation is recommended to refine the model., (© 2024. The Author(s).)

Background: The Masterplan Medicine 2020 adopted in 2017 entails many changes to the medical studies curriculum. The new structure affects the content of the coursework and its main focus. A major goal of this masterplan is to prepare young physicians by teaching the skills that are essential for the future profession. The National Competence-Based Learning Objectives Catalog for Medicine (NKLM) provides the basis for the teaching content., Methods: The Working Group Teaching of the German Society of Ophthalmology (Arbeitsgemeinschaft Lehre der DOG) actively supports this transformation. In cross-site collaboration, teaching materials for various teaching formats have been compiled by relying on the NKLM (e.g., recordings of operations, slides for small group instruction, image galleries, case studies). An online library named the DOG-EyeTeacher was then created., Results: The aim of the DOG-EyeTeacher is to relieve the training clinics and to establish basic standards in teaching materials, thereby enabling the necessary focus on medical education. The provision of these teaching materials should deepen the interest in ophthalmology among future doctors., Conclusion: The DOG-EyeTeacher is our response to the challenges associated with the planned restructuring of the medical curriculum. Since October 2023, any DOG member involved in teaching can create an account free of charge to use our materials., (© 2024. The Author(s).)

Background: Despite the challenging curriculum, medicine is a popular study program. We propose McClelland's Motive Disposition Theory (MDT) as a possible theory for explaining medical students motivation. The theory describes how individuals differ in their behaviour due to their varying manifestations of certain motives. The three motives can thus influence the students behaviour and academic success. Using these motives, complimented with an altruism- and a freedom motive, this study was aimed at investigating young adults' explicit motives to study medicine. In addition, we also wanted to find out whether there are gender differences in motives and other variables such as empathy, emotional intelligence and academic self-concept., Methods: Over 20 universities across Germany were contacted and asked to share the online study with their first semester medical students in the winter term 2022/23, which resulted in a final N = 535. We used validated and reliable measurements, including a self-created and piloted questionnaire covering medicine-specific explicit motives., Results: Comparing the mean scores between motives, we found that the altruism motive was the strongest motive (M = 5.19), followed by freedom (M = 4.88), affiliation (M = 4.72) and achievement (M = 4.59). The power motive achieved the lowest score (M = 3.92). Male students scored significantly higher for power (M = 4.24) than females did (M = 3.80, p < .001), while female students found affiliation more important (M = 4.81) than male students did (M = 4.59, p = .016). Female participants scored significantly higher for emotional intelligence (p = .010) and several personality aspects, including empathy (p < .001), but showed a significantly lower academic self-concept (p = .033), compared to their male colleagues. Nonetheless, the effect sizes were mostly small to medium., Conclusions: Our findings suggest that first-year medical students are primarily motivated by humanitarian factors to study medicine, compared to motives related to money or power. This is mostly in line with earlier studies using qualitative approaches, showing that MDT can be applied to explain explicit motives in medical students., Trial Registration: The longitudinal project, which this study was part of, was registered via OSF ( https://archive.org/details/osf-registrations-mfhek-v1 ) on the 28th of September 2022 under the title "Transformation of emotion and motivation factors in medical students during the study progress: A multicenter longitudinal study"., (© 2024. The Author(s).)

Purpose: Many curricula promote frontal teaching approaches, potentially decreasing interaction and motivation - also within infection prevention & control and infectious diseases (IPC/ID). We aimed to investigate the implementation of three innovative teaching methods (ITM) within IPC/ID education: game-based learning (GBL), peer-teaching (PT) and misinformation detection (MID)., Methods: Multi-phase study involving third-year medical students was conducted. Phase-1 included a cross-sectional survey, assessing previous ITM-experience and interest to participate in phase-2, where the students were divided into teams. Each team prepared a video covering an IPC/ID-topic with deliberately placed misinformation, which had to be identified and corrected by the opposing team, followed by qualitative evaluation (phase-3). Finally, the MID-concept was incorporated into regular curricula in a non-competitive environment (phase-4) and evaluated within a cohort not involved in phases 1-3., Results: 276 students responded to phase-1. 58% expressed interest in participating in phase-2. Roughly 59% [47-71%] CI-95% of respondents without previous PT-experience stated interest in PT, while the interest in GBL and MID was even higher. 19 students participated in phase-2. All topic MID-scores ranged between 6 and 8/10 points, except for emporiatrics (3/10). Post-hoc analysis revealed a positive student-perception of ITM, particularly GBL. Phase-4 received 103 responses with general positive evaluation. Major agreements existed on the usefulness of critical information evaluation for medical practice (82% [75-91%] CI-95%) and of MID during studies (69% [59-79%] CI-95%)., Conclusion: our results hint at a relatively high interest in ITM and show MID applicability in regular IPC/ID curricula, which could be of advantage for the learning environment., (© 2024. The Author(s).)

Problem: Creating medical exam questions is time consuming, but well-written questions can be used for test-enhanced learning, which has been shown to have a positive effect on student learning. The automated generation of high-quality questions using large language models (LLMs), such as ChatGPT, would therefore be desirable. However, there are no current studies that compare students' performance on LLM-generated questions to questions developed by humans., Approach: The authors compared student performance on questions generated by ChatGPT (LLM questions) with questions created by medical educators (human questions). Two sets of 25 multiple-choice questions (MCQs) were created, each with 5 answer options, 1 of which was correct. The first set of questions was written by an experienced medical educator, and the second set was created by ChatGPT 3.5 after the authors identified learning objectives and extracted some specifications from the human questions. Students answered all questions in random order in a formative paper-and-pencil test that was offered leading up to the final summative neurophysiology exam (summer 2023). For each question, students also indicated whether they thought it had been written by a human or ChatGPT., Outcomes: The final data set consisted of 161 participants and 46 MCQs (25 human and 21 LLM questions). There was no statistically significant difference in item difficulty between the 2 question sets, but discriminatory power was statistically significantly higher in human than LLM questions (mean = .36, standard deviation [SD] = .09 vs mean = .24, SD = .14; P = .001). On average, students identified 57% of question sources (human or LLM) correctly., Next Steps: Future research should replicate the study procedure in other contexts (e.g., other medical subjects, semesters, countries, and languages). In addition, the question of whether LLMs are suitable for generating different question types, such as key feature questions, should be investigated., (Copyright © 2023 the Association of American Medical Colleges.)

The evaluation of teaching can be an essential driver for curriculum development. Instruments for teaching evaluation are not only used for the purpose of quality assurance but also in the context of medical education research. Therefore, they must meet the common requirements for reliability and validity. This position paper from the GMA Teaching Evaluation Committee discusses strategic and methodological aspects of evaluation in the context of undergraduate medical education and related courses; and formulates recommendations for the further development of evaluation. First, a four-step approach to the design and implementation of evaluations is presented, then methodological and practical aspects are discussed in more detail. The focus here is on target and confounding variables, survey instruments as well as aspects of implementation and data protection. Finally, possible consequences from evaluation data for the four dimensions of teaching quality (structural and procedural aspects, teachers and outcomes) are discussed., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2024 Haverkamp et al.)

Background: Artificial intelligence (AI) is becoming increasingly important in healthcare. It is therefore crucial that today's medical students have certain basic AI skills that enable them to use AI applications successfully. These basic skills are often referred to as "AI literacy". Previous research projects that aimed to investigate medical students' AI literacy and attitudes towards AI have not used reliable and validated assessment instruments., Methods: We used two validated self-assessment scales to measure AI literacy (31 Likert-type items) and attitudes towards AI (5 Likert-type items) at two German medical schools. The scales were distributed to the medical students through an online questionnaire. The final sample consisted of a total of 377 medical students. We conducted a confirmatory factor analysis and calculated the internal consistency of the scales to check whether the scales were sufficiently reliable to be used in our sample. In addition, we calculated t-tests to determine group differences and Pearson's and Kendall's correlation coefficients to examine associations between individual variables., Results: The model fit and internal consistency of the scales were satisfactory. Within the concept of AI literacy, we found that medical students at both medical schools rated their technical understanding of AI significantly lower (M MS1 = 2.85 and M MS2 = 2.50) than their ability to critically appraise (M MS1 = 4.99 and M MS2 = 4.83) or practically use AI (M MS1 = 4.52 and M MS2 = 4.32), which reveals a discrepancy of skills. In addition, female medical students rated their overall AI literacy significantly lower than male medical students, t(217.96) = -3.65, p <.001. Students in both samples seemed to be more accepting of AI than fearful of the technology, t(745.42) = 11.72, p <.001. Furthermore, we discovered a strong positive correlation between AI literacy and positive attitudes towards AI and a weak negative correlation between AI literacy and negative attitudes. Finally, we found that prior AI education and interest in AI is positively correlated with medical students' AI literacy., Conclusions: Courses to increase the AI literacy of medical students should focus more on technical aspects. There also appears to be a correlation between AI literacy and attitudes towards AI, which should be considered when planning AI courses., (© 2024. The Author(s).)

Serious games, as a learning resource, enhance their game character by embedding game design elements that are typically used in entertainment games. Serious games in its entirety have already proven their teaching effectiveness in different educational contexts including medical education. The embedded game design elements play an essential role for a game's effectiveness and thus they should be selected based on evidence-based theories. For game design elements embedded in serious games used for the education of medical and healthcare professions, an overview of theories for the selection lacks. Additionally, it is still unclear whether and how single game design elements affect the learning effectiveness. Therefore, the main aim of this systematic review is threefold. Firstly, light will be shed on the single game design elements used in serious games in this area. Second, the game design elements' underlying theories will be worked out, and third, the game design elements' effectiveness on student learning outcome will be assessed. Two literature searches were conducted in November 2021 and May 2022 in six literature databases with keywords covering the fields of educational game design, serious game, and medical education. Out of 1006 initial records, 91 were included after applying predefined exclusion criteria. Data analysis revealed that the three most common game design elements were points, storyline, and feedback. Only four underlying theories were mentioned, and no study evaluated specific game design elements. Since game design elements should be based on theories to ensure meaningful evaluations, the conceptual GATE framework is introduced, which facilitates the selection of evidence-based game design elements for serious games., (© 2024. The Author(s).)

Tobacco smoking is the greatest preventable health risk. The effects are serious, both individually and societal. Nevertheless, the current prevalence of tobacco smokers in Germany is still high at around 35 %. A recent strong increase in actively smoking adolescents (14- to 17-year-olds, current prevalence approx. 16 %) and young adults (18- to 24-year-olds, current prevalence approx. 41 %) is also a cause for concern. About a third of all inpatients continue smoking while being treated. The hospitalization of active smokers in acute and rehabilitation hospitals serves as a "teachable moment" for initiation of cessation offers. An intervention that begins in hospital and continues for at least a month after discharge results in about 40 % additional smokefree patients. It is scientifically well-researched, effective and cost-efficient. After initiation in hospital these measures can be continued via ambulatory cessation programs, rehabilitation facilities, an Internet or telephone service. In Germany, there are structured and quality-assured cessation offers, both for the inpatient and for the outpatient area. The biggest obstacle to broad establishment of such offers is the lack of reimbursement. Two feasible ways to change this would be the remuneration of the existing OPS 9-501 "Multimodal inpatient treatment for smoking cessation" and the establishment of quality contracts according to § 110a SGB V. An expansion of tobacco cessation measures in healthcare facilities would reduce smoking prevalence, associated burden of disease and consecutive costs., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Purpose:  Medical education has been transformed during the COVID-19 pandemic, creating challenges regarding adequate training in ultrasound (US). Due to the discontinuation of traditional classroom teaching, the need to expand digital learning opportunities is undeniable. The aim of our study is to develop a tele-guided US course for undergraduate medical students and test the feasibility and efficacy of this digital US teaching method., Materials and Methods:  A tele-guided US course was established for medical students. Students underwent seven US organ modules. Each module took place in a flipped classroom concept via the Amboss platform, providing supplementary e-learning material that was optional and included information on each of the US modules. An objective structured assessment of US skills (OSAUS) was implemented as the final exam. US images of the course and exam were rated by the Brightness Mode Quality Ultrasound Imaging Examination Technique (B-QUIET). Achieved points in image rating were compared to the OSAUS exam., Results:  A total of 15 medical students were enrolled. Students achieved an average score of 154.5 (SD ± 11.72) out of 175 points (88.29 %) in OSAUS, which corresponded to the image rating using B-QUIET. Interrater analysis of US images showed a favorable agreement with an ICC (2.1) of 0.895 (95 % confidence interval 0.858 < ICC < 0.924)., Conclusion:  US training via teleguidance should be considered in medical education. Our pilot study demonstrates the feasibility of a concept that can be used in the future to improve US training of medical students even during a pandemic., Competing Interests: Erik Schmok is an employee of Amboss., (Thieme. All rights reserved.)

Background: Scoring and awarding credit are more complex for multiple-select items than for single-choice items. Forty-one different scoring methods were retrospectively applied to 2 multiple-select multiple-choice item types (Pick-N and Multiple-True-False [MTF]) from existing examination data., Objective: This study aimed to calculate and compare the mean scores for both item types by applying different scoring methods, and to investigate the effect of item quality on mean raw scores and the likelihood of resulting scores at or above the pass level (≥0.6)., Methods: Items and responses from examinees (ie, marking events) were retrieved from previous examinations. Different scoring methods were retrospectively applied to the existing examination data to calculate corresponding examination scores. In addition, item quality was assessed using a validated checklist. Statistical analysis was performed using the Kruskal-Wallis test, Wilcoxon rank-sum test, and multiple logistic regression analysis (P<.05)., Results: We analyzed 1931 marking events of 48 Pick-N items and 828 marking events of 18 MTF items. For both item types, scoring results widely differed between scoring methods (minimum: 0.02, maximum: 0.98; P<.001). Both the use of an inappropriate item type (34 items) and the presence of cues (30 items) impacted the scoring results. Inappropriately used Pick-N items resulted in lower mean raw scores (0.88 vs 0.93; P<.001), while inappropriately used MTF items resulted in higher mean raw scores (0.88 vs 0.85; P=.001). Mean raw scores were higher for MTF items with cues than for those without cues (0.91 vs 0.8; P<.001), while mean raw scores for Pick-N items with and without cues did not differ (0.89 vs 0.90; P=.09). Item quality also impacted the likelihood of resulting scores at or above the pass level (odds ratio ≤6.977)., Conclusions: Educators should pay attention when using multiple-select multiple-choice items and select the most appropriate item type. Different item types, different scoring methods, and presence of cues are likely to impact examinees' scores and overall examination results., (©Philipp Kanzow, Dennis Schmidt, Manfred Herrmann, Torsten Wassmann, Annette Wiegand, Tobias Raupach. Originally published in JMIR Medical Education (https://mededu.jmir.org), 27.03.2023.)

Serious games (computer-based learning games) are increasingly used in medical education at various levels, as user access is independent of location and time and promotes non-linear learning. In legal medicine, interactive digital media are still scarce. The freely accessible online serious game "Adventure Legal Medicine" was developed as part of the "Hamburg Open Online University". The goal was to teach the basics of forensic casework in a point-and-click adventure setting consisting of five cases. During development, 40 medical students were asked to evaluate the game anonymously. The System Usability Scale (SUS) resulted in a mean score of 86.7 (SD 8.3), which corresponds to above-average usability. Further specific evaluations revealed a good to very good rating of the game with no differences in terms of gender (p = 0.214), first-year versus advanced students (p = 0.393) and students who never/rarely or sometimes/often played computer games (p = 0.780). Since there are only a few digital media so far that allow curricular integration into undergraduate teaching in legal medicine, this serious game represents a possibility to integrate digital media into both face-to-face teaching and distance learning and to use it as a supplement to the medical school's own teaching offer, encouraging users to actively engage with the subject., (© 2023. The Author(s).)

Background: The use of artificial intelligence applications in medicine is becoming increasingly common. At the same time, however, there are few initiatives to teach this important and timely topic to medical students. One reason for this is the predetermined medical curriculum, which leaves very little room for new topics that were not included before. We present a flipped classroom course designed to give undergraduate medical students an elaborated first impression of AI and to increase their "AI readiness"., Methods: The course was tested and evaluated at Bonn Medical School in Germany with medical students in semester three or higher and consisted of a mixture of online self-study units and online classroom lessons. While the online content provided the theoretical underpinnings and demonstrated different perspectives on AI in medical imaging, the classroom sessions offered deeper insight into how "human" diagnostic decision-making differs from AI diagnoses. This was achieved through interactive exercises in which students first diagnosed medical image data themselves and then compared their results with the AI diagnoses. We adapted the "Medical Artificial Intelligence Scale for Medical Students" to evaluate differences in "AI readiness" before and after taking part in the course. These differences were measured by calculating the so called "comparative self-assessment gain" (CSA gain) which enables a valid and reliable representation of changes in behaviour, attitudes, or knowledge., Results: We found a statistically significant increase in perceived AI readiness. While values of CSA gain were different across items and factors, the overall CSA gain regarding AI readiness was satisfactory., Conclusion: Attending a course developed to increase knowledge about AI in medical imaging can increase self-perceived AI readiness in medical students., (© 2022. The Author(s).)

Objective: Clinical reasoning is an essential skill, the foundations of which should be acquired during medical school. Within the format of test-based learning, such examinations can also be used to support the long-term retention of procedural knowledge necessary for clinical reasoning. The aim was to investigate whether repeated exposure to clinical cases in obstetrics and gynecology (OBGYN) with built-in questions leads to higher learning outcome than pure reading cases and what influence the delay between the intervention and the final test has on the retention of the respective content., Methods: In this non-randomised crossover study, 5th-year medical students (duration of the study is 6 years) taking a 1-week clinical attachment in OBGYN participated in computer-based case seminars in winter term 2020/2021, in which different case histories on gynecological-obstetric diseases were presented. Case content was identical for all groups, but the presentation format (cases with key feature questions vs read-only cases) of individual case vignettes changed weekly. The also intervention was repeated after 2 weeks for each group. Knowledge was assessed in an entry and an exit exam consisting of 40 short-answer questions., Results: A total of 94 out of 118 eligible students participated in the study (response rate: 79.7%). Learning outcome was significantly higher for items presented in the key feature format compared to items presented as read-only cases (74.2 ± 8.6% vs. 71.0 ± 9.2%; p = 0.017). Furthermore, the analysis showed that the temporal distance of the intervention package from the final examination had no influence on retention., Conclusion: This is the first study to demonstrate an effect of test-enhanced learning on clinical reasoning in the subject of OGBYN. In this cross-over study, repeated testing was more effective than repeated case-based learning alone. Curricular implementation of longitudinal key feature testing can thus improve learning outcomes for OBGYN., (© 2022. The Author(s).)

Background: Validation of examinations is usually based on classical test theory. In this study, we analysed a key feature examination according to item response theory and compared the results with those of a classical test theory approach., Methods: Over the course of five years, 805 fourth-year undergraduate students took a key feature examination on general medicine consisting of 30 items. Analyses were run according to a classical test theory approach as well as using item response theory. Classical test theory analyses are reported as item difficulty, discriminatory power, and Cronbach's alpha while item response theory analyses are presented as item characteristics curves, item information curves and a test information function., Results: According to classical test theory findings, the examination was labelled as easy. Analyses according to item response theory more specifically indicated that the examination was most suited to identify struggling students. Furthermore, the analysis allowed for adapting the examination to specific ability ranges by removing items, as well as comparing multiple samples with varying ability ranges., Conclusions: Item response theory analyses revealed results not yielded by classical test theory. Thus, both approaches should be routinely combined to increase the information yield of examination data.

Competing Interests: Conflict of interest: None declared.

Prior work experience in a relevant medical profession is an important admission criterion currently used at many German medical schools in addition to cognitive criteria. In other countries, work experience is often considered in later admission stages (e.g., interviews with pre-selected subgroups of applicants). However, evidence for its predictive validity for study success in addition to cognitive admission criteria is currently lacking. We therefore assessed whether completed vocational training in a relevant medical profession can predict study performance in the first two years of study in addition to cognitive admission criteria. Admission and study performance data of all currently enrolled medical students at two German medical schools (Göttingen and Heidelberg) beginning with the 2013/14 cohort were retrospectively analyzed. Cognitive admission criteria in our sample were GPA grades and a cognitive test ("Test für Medizinische Studiengänge", TMS). We defined the study outcome parameter as the mean percentile rank over all performance data points over the first two years of study for each location, respectively. A multi-level model with varying intercepts by location, GPA, TMS, vocational training, and sex as predictors accounted for 14.5% of the variance in study outcome. A positive predictive association with study outcome was found for vocational training (ß = 0.33, p = .008) beyond GPA (ß = 0.38, p < .001) and TMS (ß = 0.26, p < .001). Our results support the use of prior vocational training as a selection criterion for medical studies potentially adding predictive validity to cognitive criteria., (© 2022. The Author(s).)

Background: Chronic kidney disease (CKD) is a global burden affecting both children and adults. Novel imaging modalities hold great promise to visualize and quantify structural, functional, and molecular organ damage. The aim of the study was to visualize and quantify murine renal vasculature using label-free raster scanning optoacoustic mesoscopy (RSOM) in explanted organs from mice with renal injury., Material and Methods: For the experiments, freshly bisected kidneys of alpha 8 integrin knock-out (KO) and wildtype mice (WT) were used. A total of n=7 female (n=4 KO, n=3 WT) and n=6 male animals (n=2 KO, n=4 WT) aged 6 weeks were examined with RSOM optoacoustic imaging systems (RSOM Explorer P50 at SWL 532nm and/or ms-P50 imaging system at 532 nm, 555 nm, 579 nm, and 606 nm). Images were reconstructed using a dedicated software, analyzed for size and vascular area and compared to standard histologic sections., Results: RSOM enabled mapping of murine kidney size and vascular area, revealing differences between kidney sizes of male (m) and female (f) mice (merged frequencies (MF) f vs. m: 52.42±6.24 mm 2 vs. 69.18±15.96 mm 2 , p=0.0156) and absolute vascular area (MF f vs. m: 35.67±4.22 mm 2 vs. 49.07±13.48 mm 2 , p=0.0036). Without respect to sex, the absolute kidney area was found to be smaller in knock-out (KO) than in wildtype (WT) mice (WT vs. KO: MF: p=0.0255) and showed a similar trend for the relative vessel area (WT vs. KO: MF p=0.0031). Also the absolute vessel areas of KO compared to WT were found significantly different (MF p=0.0089). A significant decrease in absolute vessel area was found in KO compared to WT male mice (MF WT vs. KO: 54.37±9.35 mm 2 vs. 34.93±13.82 mm 2 , p=0.0232). In addition, multispectral RSOM allowed visualization of oxygenated and deoxygenated parenchymal regions by spectral unmixing., Conclusion: This study demonstrates the capability of RSOM for label-free visualization of differences in vascular morphology in ex vivo murine renal tissue at high resolution. Due to its scalability optoacoustic imaging provides an emerging modality with potential for further preclinical and clinical imaging applications., (© 2022. The Author(s).)

Background: The coronavirus pandemic has led to increased use of digital teaching formats in medical education. A number of studies have assessed student satisfaction with these resources. However, there is a lack of studies investigating changes in student performance following the switch from contact to virtual teaching. Specifically, there are no studies linking student use of digital resources to learning outcome and examining predictors of failure., Methods: Student performance before (winter term 2019/20: contact teaching) and during (summer term 2020: no contact teaching) the pandemic was compared prospectively in a cohort of 162 medical students enrolled in the clinical phase of a five-year undergraduate curriculum. Use of and performance in various digital resources (case-based teaching in a modified flipped classroom approach; formative key feature examinations of clinical reasoning; daily multiple choice quizzes) was recorded in summer 2020. Student scores in summative examinations were compared to examination scores in the previous term. Associations between student characteristics, resource use and summative examination results were used to identify predictors of performance., Results: Not all students made complete use of the digital learning resources provided. Timely completion of tasks was associated with superior performance compared to delayed completion. Female students scored significantly fewer points in formative key feature examinations and digital quizzes. Overall, higher rankings within the student cohort (according to summative exams) in winter term 2019/20 as well as male gender predicted summative exam performance in summer 2020. Scores achieved in the first formative key feature examination predicted summative end-of-module exam scores., Conclusions: The association between timely completion of tasks as well as early performance in a module and summative exams might help to identify students at risk and offering help early on. The unexpected gender difference requires further study to determine whether the shift to a digital-only curriculum disadvantages female students., Competing Interests: The authors have declared that no competing interests exist.

Purpose: Physicians of all specialties must be familiar with important principles of infectious diseases, but curricular time for this content is limited and clinical teaching requires considerable resources in terms of available patients and teachers. Serious games are scalable interventions that can help standardize teaching. This study assessed whether knowledge and skills acquired in a serious game translate to better performance in a clinical examination., Methods: Fifth-year undergraduate medical students ( n = 100) at Goettingen Medical School were randomized to three groups receiving different levels of exposure to virtual patients presenting with signs and symptoms of either infective endocarditis or community-acquired pneumonia in a serious game simulating an accident and emergency department. Student performance was assessed based on game logfiles and an objective standardized clinical examination (OSCE)., Results: Higher exposure to virtual patients in the serious game did not result in superior OSCE scores. However, there was good agreement between student performance in the OSCE and in game logfiles ( r = 0.477, p = 0.005). An Item Response Theory analysis suggested that items from the serious game covered a wider range of ability, thus better differentiating between students within a given cohort., Conclusion: Repeated exposure to virtual patients with infectious diseases in a serious game did not directly impact on exam performance but game logfiles might be good and resource-sparing indicators of student ability. One advantage of using serious games in medical education is standardized content, a lower inhibition threshold to learn, and a need of less staff time compared to small-group clinical teaching., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Aster, Scheithauer, Middeke, Zegota, Clauberg, Artelt, Schuelper and Raupach.)

Introduction: Observational and trial evidence conflict on the efficacy of two contrasting behavioral approaches to quitting smoking-gradual and abrupt. Observational data suggest an abrupt approach to quitting is superior to a gradual approach, whilst trials show no difference. One potential explanation is self-selection in observational data, whereby people can choose their quit approach, and those who find it harder to quit may be more likely to choose a gradual quit approach. This study aims to investigate potential explanations for these conflicting findings., Aims and Methods: This study aims to investigate potential explanations for these conflicting findings. We used observational data from a nationally representative sample of adults in England from November 2006 to February 2020 who reported smoking and had made at least one quit attempt in the past year (n = 21 542). We used logistic regression models to assess the association between abrupt versus gradual quit attempts and quit success, adjusting for sociodemographic, smoking, and quit attempt characteristics., Findings: Abrupt, versus gradual, attempts were associated with improved quit success in an unadjusted model (odds ratio = 2.02, 95% CI = 1.86 to 2.19). This association remained after adjusting for a broad range of relevant confounders (odds ratio = 1.75, 95% CI = 1.59 to 1.93)., Conclusions: Among a representative sample of adults who had smoked and made a quit attempt in the past year, there was evidence of an association between abrupt attempts and quit success before and after adjusting for relevant confounders. This suggests that the differences in quit success seen between abrupt and gradual quit attempt types are not completely driven by self-selection in observational data., Implications: We investigated explanations for conflicting findings on the efficacy of gradual versus abrupt approaches to quitting smoking between trial and observational data. Despite adjusting observational data for sociodemographic, smoking, and quit attempt characteristics, an association between abrupt quitting and quit success remained. Therefore, differences in quit success were not completely driven by the self-selection of a gradual approach by people who found it especially difficult to quit or differences in the use of quitting aids. However, characteristics adjusted for were limited by the data available, and future research should continue to investigate the difference in findings across study types to inform cessation support., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.)

Background: Despite ultrasound being an inherent part of medical education, only a few German medical schools have established a comprehensive ultrasound curriculum. This study aimed to explore medical students' perspectives on ultrasound in medical education (USMed). Results: Between January 1 st , 2019 und June 30 th , 2019, an online survey was conducted among German medical students via the students' associations and their respective teaching facilities. The survey consisted of 17 items regarding USMed. Statements were rated on a 4-point Likert scale for agreement. In total, 1040 students from 31 German medical faculties participated. The majority (1021, 98.2%) reported a very high to high interest in curricular USMed. Students agreed ( n = 945, 90.9%) that USMed would be helpful along their entire course of medical studies. Considering the best starting time for USMed, the opinions of German medical students diverged: students studying in a model curriculum preferred to start in the second year (40.7%) while 49% of the students studying in a traditional curriculum preferred to start in the third year ( p ≤ 0.001). An insufficient allotment of time for USMed in the planned curriculum (675, 65%) and a lack of courses run by medical faculty (305, 29.4%) were listed as perceived significant barriers to the participation in USMed. Peer teaching was regarded as an effective method in realizing USMed by 731 (70.3%) students. Conclusion: German medical students are very interested and willing to participate in USMed. There appears to be a high demand for US courses offered by medical schools., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Recker, Barth, Lo, Haverkamp, Nürnberg, Kravchenko, Raupach and Schäfer.)

This study assessed the effectiveness of a 3.5-h training session for general practitioners (GPs) in providing brief stop-smoking advice and compared two methods of giving advice - ABC versus 5As - on the rates of delivery of such advice and of recommendations of evidence-based smoking cessation treatment during routine consultations. A pragmatic, two-arm cluster randomised controlled trial was carried out including a pre-/post-design for the analyses of the primary outcome in 52 GP practices in Germany. Practices were randomised (1:1) to receive a 3.5-h training session (ABC or 5As). In total, 1937 tobacco-smoking patients, who consulted trained GPs in these practices in the 6 weeks prior to or following the training, were included. The primary outcome was patient-reported rates of GP-delivered stop-smoking advice prior to and following the training, irrespective of the training method. Secondary outcomes were patient-reported receipt of recommendation/prescription of behavioural therapy, pharmacotherapy or combination therapy for smoking cessation, and the effectiveness of ABC versus 5As regarding all outcomes. GP-delivered stop-smoking advice increased from 13.1% (n=136 out of 1039) to 33.1% (n=297 out of 898) following the training (adjusted odds ratio (aOR) 3.25, 95% CI 2.34-4.51). Recommendation/prescription rates of evidence-based treatments were low (<2%) pre-training, but had all increased after training ( e.g. behavioural support: aOR 7.15, 95% CI 4.02-12.74). Delivery of stop-smoking advice increased non-significantly (p=0.08) stronger in the ABC versus 5As group (aOR 1.71, 95% CI 0.94-3.12). A single training session in stop-smoking advice was associated with a three-fold increase in rates of advice giving and a seven-fold increase in offer of support. The ABC method may lead to higher rates of GP-delivered advice during routine consultations., Competing Interests: Conflict of interest: S. Kastaun has nothing to disclose. Conflict of interest: V. Leve has nothing to disclose. Conflict of interest: J. Hildebrandt has nothing to disclose. Conflict of interest: C. Funke has nothing to disclose. Conflict of interest: S. Klosterhalfen has nothing to disclose. Conflict of interest: D. Lubisch has nothing to disclose. Conflict of interest: O. Reddemann has nothing to disclose. Conflict of interest: H. McRobbie reports honoraria for speaking at smoking cessation meetings and attending advisory board meetings from Pfizer and Johnson & Johnson outside the submitted work. Conflict of interest: T. Raupach reports personal fees from Pfizer, Novartis, GlaxoSmithKline, AstraZeneca and Roche as a speaker in activities related to continuing medical education, and grants from Pfizer and Johnson & Johnson, outside the submitted work. Conflict of interest: R. West reports grants and personal fees from Pfizer, Johnson & Johnson and GlaxoSmithKline, and personal fees from acting as an advisor to the UK's National Centre for Smoking Cessation and Training, outside the submitted work. Conflict of interest: S. Wilm has nothing to disclose. Conflict of interest: W. Viechtbauer has nothing to disclose. Conflict of interest: D. Kotz has nothing to disclose., (Copyright ©ERS 2021.)

We developed a 3.5-h training for general practitioners (GPs) in delivering brief stop-smoking advice according to different methods (ABC, 5As). In a pragmatic, cluster randomised controlled trial our training proved effective in increasing GP-delivered rates of such advice (from 13% to 33%). In this follow-up analysis we examined the effect of the training and compared ABC versus 5As on patient-reported quit attempts and point prevalence abstinence at weeks 4, 12 and 26 following GP consultation. Follow-up data were collected in 1937 smoking patients - independently of the receipt of GP advice - recruited before or after the training of 69 GPs. At week 26, ∼70% of the patients were lost to follow-up. All 1937 patients were included in an intention-to-treat analysis; missing outcome data were imputed. Quit attempts and abstinence rates did not differ significantly from pre- to post-training or between patients from the ABC versus the 5As group. However, ancillary analyses showed that patients who received GP advice compared to those who did not had two times higher odds of reporting a quit attempt at all follow-ups and abstinence at week 26. We reported that our training increases GP-delivered rates of stop-smoking advice, and the present analysis confirms that advice is associated with increased quit attempts and abstinence rates in patients. However, our training did not further improve these rates, which might be related to patients' loss to follow-up or to contextual factors, e.g. access to free evidence-based cessation treatment, which can hamper the transfer of GPs' advice into patients' behaviour change., Competing Interests: Conflict of interest: S. Kastaun has nothing to disclose. Conflict of interest: W. Viechtbauer has nothing to disclose. Conflict of interest: V. Leve has nothing to disclose. Conflict of interest: J. Hildebrandt has nothing to disclose. Conflict of interest: C. Funke has nothing to disclose. Conflict of interest: S. Klosterhalfen has nothing to disclose. Conflict of interest: D. Lubisch has nothing to disclose. Conflict of interest: O. Reddemann has nothing to disclose. Conflict of interest: T. Raupach reports personal fees from Pfizer, Novartis, GlaxoSmithKline, AstraZeneca and Roche as a speaker in activities related to continuing medical education, and grants from Pfizer and Johnson & Johnson, outside the submitted work. Conflict of interest: S. Wilm has nothing to disclose. Conflict of interest: D. Kotz has nothing to disclose., (Copyright ©The authors 2021.)

Background: Low response rates threaten the reliability and validity of student evaluations of teaching. Previous research has shown that asking students to predict how satisfied their fellow students were with a course produces reliable results at lower response rates. The aim of this study was to investigate whether this prediction-based method can also be used to evaluate student learning outcome., Methods: Before and after a cardiorespiratory module, 128 fourth-year medical students provided self-assessments and predictions of performance on 27 specific learning objectives and took formative tests on the respective contents. Pre-post performance gain was compared across all three modalities., Results: Formative exam results indicated a performance gain of 63.0%. Self-assessed and prediction-based performance gains were identical (67.8%) but both slightly overestimated actual performance gain. Irrespective of the method used, a response rate of 20% was sufficient to produce reliable results. Compared to male students, females greatly overestimated their peers' performance which led to inflated performance gain values., Conclusions: Student self-assessments and predictions are equally valid sources of learning outcome measures, and low response rates are sufficient to produce stable results. When using a prediction-based approach, a tendency to overestimate learning outcome in female students needs to be taken into account.

Background: Patients presenting with acute shortness of breath and chest pain should be managed according to guideline recommendations. Serious games can be used to train clinical reasoning. However, only few studies have used outcomes beyond student satisfaction, and most of the published evidence is based on short-term follow-up. This study investigated the effectiveness of a digital simulation of an emergency ward regarding appropriate clinical decision-making., Methods: In this prospective trial that ran from summer 2017 to winter 2018/19 at Göttingen Medical University Centre, a total of 178 students enrolled in either the fourth or the fifth year of undergraduate medical education took six 90-min sessions of playing a serious game ('training phase') in which they managed virtual patients presenting with various conditions. Learning outcome was assessed by analysing log-files of in-game activity (including choice of diagnostic methods, differential diagnosis and treatment initiation) with regard to history taking and patient management in three virtual patient cases: Non-ST segment elevation myocardial infarction (NSTEMI), pulmonary embolism (PE) and hypertensive crisis. Fourth-year students were followed up for 1.5 years, and their final performance was compared to the performance of students who had never been exposed to the game but had otherwise taken the same five-year undergraduate course., Results: During the training phase, overall performance scores increased from 57.6 ± 1.1% to 65.5 ± 1.2% (p < 0.001; effect size 0.656). Performance remained stable over 1.5 years, and the final assessment revealed a strong impact of ever-exposure to the game on management scores (72.6 ± 1.2% vs. 63.5 ± 2.1%, p < 0.001; effect size 0.811). Pre-exposed students were more than twice as likely to correctly diagnose NSTEMI and PE and showed significantly greater adherence to guideline recommendations (e.g., troponin measurement and D-dimer testing in suspected PE)., Conclusions: The considerable difference observed between previously exposed and unexposed students suggests a long-term effect of using the game although retention of specific virtual patient cases rather than general principles might partially account for this effect. Thus, the game may foster the implementation of guideline recommendations.

Introduction: In summer term 2020, the clinical phase of the undergraduate medical curriculum at University Medical Center Göttingen was restructured since distance teaching had to be used predominantly due to contact restrictions during the COVID-19 pandemic. This paper investigates the impact of restructuring the clinical curriculum on medical students' satisfaction and learning outcomes. Methods: In each cohort, the 13-week curriculum was divided into two parts: During the first 9 weeks, factual knowledge was imparted using distance teaching by means of a modified inverted classroom approach. This was followed by a 4-week period of adapted classroom teaching involving both real and virtual patients in order to train students' practical skills. The evaluation of the 21 clinical modules comprised students' satisfaction with distance teaching as well as students' learning outcome. The latter was assessed by means of comparative self-assessment (CSA) gain and the results of the module exams, respectively. Data of summer term 2020 (= distance teaching, DT) were compared with respective data of winter term 2019/20 (= classroom teaching, CT) and analysed for differences and correlations. Results: Response rates of evaluations were 51.3% in CT and 19.3% in DT. There was no significant difference between mean scores in module exams in CT and DT, respectively. However, CSA gain was significantly lower in DT (p=0.047) compared with CT. Further analyses revealed that CSA gain depended on the time point of data collection: CSA gain was lower the more time had passed since the end of a specific module. Moreover, we found positive correlations between CSA gain and students' satisfaction with various aspects of distance teaching, particularly with "communication between teachers and students" (rho=0.674; p=0.002). Discussion and conclusions: Although some limitations and confounding factors have to be taken into account (such as evaluation response rates, assessment time points, and proportion of familiar items in module exams), the following recommendations can be derived from our findings: A valid assessment of students' learning outcome by means of exam results requires that as few exam items as possible are familiar to the students. CSA gain seems to be valid if assessment time points are standardised and not contaminated by students' learning activities for other modules. Good communication between teachers and students may contribute to increase students' satisfaction with distance teaching., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2021 Seifert et al.)

Introduction: Almost half of smoking quit attempts are "spontaneous" (initiated as soon as the decision to quit has been made) and are associated with increased success rates. This study aimed to assess to what extent other factors may account for this association., Methods: Data were used from respondents to a survey representative of the adult population in England from 2006 to 2016. We included 2018 respondents who were current smokers at baseline and had attempted to quit between baseline and 6-month follow-up. Logistic regression models assessed the association between quit success and spontaneous quit attempts while adjusting for smoking, sociodemographic, and quit attempt characteristics., Results: Spontaneous quit attempts were associated with greater odds of quit success (OR = 1.31, 95% CI = 1.07 to 1.60) but the association was not significant in the fully adjusted model (ORadj = 1.19, 95% CI = 0.95 to 1.49). In this adjusted model, those who attempted to quit without cutting down first (ORadj = 3.08, 95% CI = 2.46 to 3.88) and were male (ORadj = 1.44, 95% CI = 1.16 to 1.80) had greater odds of success; although a greater number of attempts in the past 6 months, stronger urges to smoke (strong vs. none), higher daily cigarette consumption, and lower social grade (E vs. AB) were associated with lower odds of success (ORadj range = 0.32-0.98, p < .030). Quit attempts made without cutting down first were correlated with spontaneous quit attempts (r = .150, p < .001) and appeared to account for the diminished association between spontaneous quitting and success (ORadj = 1.18, 95% CI = 0.96 to 1.46)., Conclusions: The increased success rate of spontaneous quit attempts appears to be because spontaneous quit attempts are more likely to be made without cutting down first., Implications: The apparent benefit of spontaneous over planned quit attempts may be attributable to the former being more likely to involve quitting without cutting down first (ie, abrupt cessation) than cutting down first (ie, gradual cessation) and so this may be a more useful target for advice to improve the chances of successful quitting., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.)

The objective of the present study was to investigate the association between angiotensin-converting enzyme (ACE) inhibitor use and cancer incidence (overall, and breast, prostate, and colorectal cancers specifically) in a large representative sample of US adults. Cross-sectional data on cancer diagnosis, timing of cancer diagnosis, ACE inhibitor use, and other characteristics were extracted from 49 512 adults aged ≥ 20 years participating in the National Health and Nutrition Examination Survey (1999-2016). Multivariable-logistic and propensity score matching (PSM) regressions examined the relationship between pre-diagnosis use of ACE inhibitors and diagnosis of all cancers, and breast, prostate, and colorectal cancers specifically. Overall, we observed an increased likelihood of cancer diagnosis [odds ratio (OR) 1.269, 95% confidence interval (CI) 1.088-1.480] among those who used ACE inhibitors compared to non-ACE inhibitor use, and for prostate cancer diagnosis (OR 1.438, 95% CI 1.090-1.897), after adjusting for age, sex, body mass index, race/ethnicity, educational attainment, physical activity, alcohol drinking status, smoking status, and high blood pressure. PSM regression retrieved more conservative estimates such that the increased likelihood of cancer diagnosis was only observed when comparing ACE inhibitor users with non-drug users (OR 1.022, 95% CI 1.016-1.027). Compared with non-ACE inhibitor use, ACE inhibitor use was associated with an increased risk of prostate cancer. In conclusion, in this large representative sample of US adults, it was found that ACE inhibitor use may have a marginal influence on some cancers.