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Background: In accordance with the guidelines of the Association of Scientific Medical Societies in Germany (AWMF), the DEGAM ("Deutsche Gesellschaft für Allgemeinmedizin") S1 guideline "Chronic pain" required updating. Methods: A selective nonsystematic literature search was performed and comments from the DEGAM guideline commission were obtained. Results: The content of the previous version can largely be maintained. The content was expanded, particularly in the areas of assessment, nondrug therapy approaches and self-care and opioid management. The short version was supplemented by a document with explanations and implementation aids. Conclusions: Chronic noncancer pain is a very common reason for consultation with a general practitioner (GP). Recommendations for action and instruments specifically for the GP setting are urgently needed. An upgrade of the guideline to S2 or S3 level and practical aids for joint decision-making for individual long-term patient support should be developed in the future. [ABSTRACT FROM AUTHOR]

Background: The attractiveness of general practice (GP) is increasing, as is evident in its growing popularity among students and the sharp rise in specialist certifications. However, in view of the future challenges at the GP level of care, there is a shortage of young doctors. It would thus be desirable if postgraduate training could be completed quickly, particularly in this area. Objective: The aim of this article is to improve the state of knowledge of the actual length of postgraduate training in general practice and to identify the motives for choosing this specialty and possible factors influencing postgraduate training length. Project description: The cross-sectional study conducted of general practitioners (GPs) after completion of the medical specialist examination (survey period January 2020 to September 2023, population 530 persons, response rate 50%, n=265) examines the decision-making processes and the individual course of postgraduate training as pursued by newly certified general practitioners (Fachärzt*innen für Allgemeinmedizin - FÄ AM) in Hesse, Germany. Results: Excluding lateral entrants (Quereinsteiger*innen), the respondents' length of postgraduate training was 8.88 years on average (SD=3.97, median 7.75 years, Q1=6.0, Q3=10.0). The main reasons stated for choosing the specialty were personal role models and experiences made while studying. The descriptive analysis of the data collected indicates that an early choice of specialization could be associated with a shorter length of postgraduate training. Conclusion: Positive experiences during medical studies can contribute to a doctor's decision in favor of a specialty and may possibly be a factor in shortening the subsequent length of postgraduate training. From a healthcare perspective, medical education and postgraduate training should therefore be more closely linked so that those starting postgraduate training in general practice have a firm specialty preference in mind more frequently in future. [ABSTRACT FROM AUTHOR]

Objective: In Germany, the rotation into the general practitioner's practice (GPP) as part of postgraduate medical training in general practice traditionally takes place at the end of the training period. The aim of this study was to explore possible subsequent effects of beginning training in the GPP from the perspective of general practitioners (GPs) and GP trainees. Methods: Nationwide, GPs and GP trainees were recruited who started specialization in GP in the GPP. Semi-structured telephone interviews were conducted between June and October 2022 using a self-developed interview-guide. The results were transcribed verbatim and analyzed using content analysis. Results: N=15 interviews were conducted, averaging 54 minutes (32-75 minutes) each (9 federal states, 4 GPs, 11 GP trainees). From the participants' perspective, advantages included close supervision, flat hierarchies, more time for preparation and follow-up, self-directed learning as well as higher basic salary and regular working hours. Positive effects mentioned were reinforcement in career choice, early understanding of workflow in GPP, early development of a GP attitude and strengthening of professional self-confidence. Disadvantages included initial uncertainty at the beginning of the profession and limited opportunities for peer exchange. In conclusion, all participants would recommend beginning specialization with a rotation in the GPP. Discussion: Starting in GGP allows GP trainees to learn about GP in a self-directed, research-oriented manner and based on consultations which enables early professional identity formation. GP trainees should avoid lack of collegial support by participating in a postgraduate training program. In a second step, GP trainers perspectives need to be assessed. Conclusion: Beginning GP postgraduate training with a rotation in GP is advantageous and should be structurally promoted. [ABSTRACT FROM AUTHOR]

Objective: To aid the shortage of general practitioners (GPs) in Germany, since 2011 medical specialists from other fields may switch specialisation by undergoing a slim-lined training programme (lateral entry) into general practice (GP). Available published qualitative and quantitative data on lateral entrants (LEs) is scarce. Aim of the study was an explorative analysis of LEs in the competence centre for postgraduate medical education Baden-Wuerttemberg (KWBW). Methods: In 2016, a multicentric cohort study was initiated including all GP trainees entering the KWBW. Data from 2016 to 2022 was included (T0). A follow-up with graduates from the KWBW was performed once in 2023 (T1). Surveys at T0 and T1 were self-developed, piloted, and included questions on social demography, education, qualification, current training, working environment and professional plans. Dataset was analysed exploratively. Results: At T0, 884 GP trainees participated (response 95.2%). 23.8% of participants were LEs (N=210). Most LEs were specialists from anaesthesiology (34.8%), internal medicine (28.5%) and surgery (20.6%). LEs had been working in their previous specialty for a median of 3 years before starting GP-training. At T0, LEs were seven years older than their colleagues (p<0,001). The proportion of men among LEs was higher (34.3% vs 25.1%, p=0,009). LEs were more decisive to open their own GP practice (p=0,009). At T1, 48 LEs participated of which 92% were practising GPs (N=36). 64,5% considered themselves rural GPs and work in communities <20.000 people (N=36). LEs mainly choose GP because of its specific way of working, job dissatisfaction and personal motives such as opportunity to start a practice. Most LEs strongly agreed that they would switch to GP again. Discussion: LEs are a relevant party among GP trainees. Many LEs become self-employed and contribute essentially to providing primary care. Lateral entry attracts specialists, also from rural areas, seeking for professional satisfaction. This is why LEs should follow their new path within a regional competence centre providing GP specific courses, mentoring and a professional network. Conclusions: LEs graduating from KWBW have become an important pillar of primary care in Baden-Wuerttemberg. [ABSTRACT FROM AUTHOR]

Copyright of Prävention und Gesundheitsförderung is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Due to the shortage of midwives in Germany, it is not always possible to provide comprehensive basic postnatal care for young families. Therefore, it is quite likely that general practitioners (GP), who serve as the first contact person in all health matters in our health care system, will be increasingly consulted regarding questions on postnatal care in the future. Consequently, the aim of this qualitative study was to explore central competencies for the care of families in the postnatal phase. Methods: Midwives were questioned about their postnatal activities with the help of a semistructured questionnaire. Thereafter, the interviews were evaluated using the Mayring method. Results: Interviews were conducted with 25 midwives with an average age of 45 years. Knowledge about the (patho)physiological processes of the mother and child during the postnatal phase, a supportive basic attitude, and time are important elements in the work with young postnatal families. Additionally, it is important to obtain competences in psychosocial issues. Conclusion: The acquisition of competences for the postnatal phase appears to be useful for GPs. Among other aspects, creation of a good networking structure with other health professions is important. [ABSTRACT FROM AUTHOR]

Background: In face of demographic challenges and increasing needs, primary care in Germany could be guaranteed and even expanded by integration of further health professions. Current practice and core principles of family medicine must be included. Objective: With the help of multifarious professional perspectives, the aim was to develop a model for an interprofessional primary care center in Germany (HÄPPI). Materials and methods: In nine workshops, a multiprofessional working group of the Baden-Wuerttemberg Association for General Practice/Family Medicine developed the HÄPPI model. In 2023, nine interviews (45–60 min) with stakeholders and various health professions (attorney, medical assistant, medical insurance representative, general practitioner, nurse, physician assistant, social worker, physician specialist) were conducted to explore principles of successful collaboration in an interprofessional primary care (IPPC) team. Results: An IPPC team could expand primary care, foster patient-centered care, and improve care for the chronically ill. Challenges are seen especially in documentation, organization of team collaboration, and framework conditions such as imbursement and legal restrictions. Helpful approaches include standardized documentation and continuous team-oriented communication. By inclusion of these interview results, the aims and scopes of HÄPPI were identified and formulated and the HÄPPI model was summarized in a short and long version. Conclusion: A future-oriented and feasible model for primary care in Germany could be described at the end of a semistructured iterative process, which could be implemented in a stepwise manner. Integration of further health professions offers various opportunities and requires sufficient team collaboration and IT support, as well as leadership and change-management skills. [ABSTRACT FROM AUTHOR]

The provision of care for sexually transmitted infections (STIs) in Germany is not transparent, STIs are still associated with negative prejudices and patients would like to have a physician to talk to. The most common bacterial and parasitic STIs are usually asymptomatic in women and can lead to serious long-term sequelae if left untreated. A sexual history should be taken at each initial consultation as a minimum. Patients should also be offered an appropriate STI test and vaccination as a preventative measure. After change of partner or if engaging in more than five risk contacts per year, testing for human immunodeficiency virus (HIV) and STIs should be carried out using serological parameters and selfswabs. Testing can be billed on a budget-neutral basis. In addition to antibiotic therapy, partner testing, monitoring the success of therapy and abstinence recommendations should be considered. Targeted referral strategies should be developed to complement care provided by general practitioners. [ABSTRACT FROM AUTHOR]

Background: Up to 90% of sexually transmitted infections (STI) are asymptomatic and often diagnosed late in women, leading to serious sequelae. In the German healthcare system, there is no specifically responsible provider for sexual health counselling. Patients are also referred to general practitioners (GPs), who often feel insecure regarding this topic. Objective: This article describes and discusses concrete GP practices in STI care for women. Methods: Data were collected using semi-standardised guide-assisted interviews including case studies between 10/2020 and 09/2021 and analysed using qualitative content analysis. Based on a theoretical sampling approach, 13 GPs without an infectious disease focus and 6 GPs in infectiology-/human immunodeficiency virus (HIV)-focused practices were included. Results: Many GPs think that care is provided mainly by gynaecology. They rarely take a sexual history and focus more on the diagnosis and treatment of urinary tract infections. Some physicians, however, offer urine polymerase chain reaction (PCR) or vaginal self-smears and treatment for all STI except HIV. Options for financial remuneration and services offered by the public health authorities are rarely used, and asymptomatic patients often have to pay out-of-pocket. Conclusion: Although many patients seek STI care from GPs, this is currently insufficiently covered in Germany. Sexual history and diagnostic possibilities should play a more prominent role in GP education and training in the future. A screening strategy, clear responsibilities, and referral pathways could significantly reduce the burden on patients and doctors. [ABSTRACT FROM AUTHOR]

Background: With the new licensing regulations, scientific research is to be integrated more strongly into medical studies. Objectives: Therefore, it should be examined in the field of family medicine how the integration of scientific research with patients into the existing curriculum can be implemented by the students and how the teaching physicians accept this extension of the teaching. Materials and methods: For this purpose, the medical students should examine patients with allopurinol treatment in family practices. In addition to a personal interview with the patients, data should also be taken from the patients' files. The entries in the examination forms were then checked against the patient files for correct data entry. In addition, the teaching physicians were interviewed about the teaching project using a questionnaire. Results: In all, 35 students in 29 teaching practices participated in the teaching project. In seven teaching practices (25%), patients with gout treatment were examined as planned. Dichotomous items and questions about personal data were consistently documented correctly by the students. Errors in documentation were observed in more complex items, such as questions about previous medication or previous illnesses. The teaching physicians reported time and staffing problems and difficulties in recruiting patients. Conclusions: For successful integration of scientific research into an existing course, all teachers involved should meet with the scientific staff as early as possible and plan the future realisation of the scientific research together. [ABSTRACT FROM AUTHOR]

Background: To promote the quality and efficiency of postgraduate specialization in general practice (GP), competence centers (KW)were established throughout Germany according to § 75a SGB V. In 2017 the KW Baden-Württemberg (KWBW) emerged from the former postgraduate training program Verbundweiterbildungplus Baden- Württemberg. The aim of this study was to analyze the participants of the KWBW in order to draw conclusions about the target group and to allow a benchmarking with other GP trainees. Methods: In 2016 an ongoing observational study was initiated at the KWBW. New participants complete a self-developed questionnaire with 54 (to maximum 62) items upon entry covering topics on sociodemographic background, studies/qualifications, postgraduate medical training, future plans and lateral recruitment (if applicable). A descriptive data-analysis of the years 2016--2022was performed. Results: N= 884/929 GP trainees participated (participation rate 95.2%). The mean age was 34 years (Q1; Q3; [min-max]:31; 38 [24-65]). 72.6% (n= 642) were female, 84.2% (n= 741) were married or in a committed partnership. 56.9% (n= 503) were parents. The average high school grade was 1.6 (Q1; Q3; [min-max]: 1.2; 2.0 [1.0--3.4]), 61.7% (n= 475) had completed amedical dissertation (Dr.med.). 24.5% (n= 217)were in their first or second year of training, 50.9%(n= 450) in their third to fifth year of training and 23.8% (n= 210) were graduates fromother medical specialties (lateral recruits). 55.7% (n= 492) were working full-time, 33.7% (n= 298) part-time and 10.5% (n= 93) were without employment. After the specialist exam, 97.8% (n= 847) planned to work in GP and 91.9% (n= 791) planned to stay in Baden-Württemberg. Thirty percent (n= 259) planned to work in a rural medical practice. 37.9% (n= 331) planned to become selfemployed, 9.1%(n= 79) excluded self-employmentwhile the majority (52.1%; n= 462) was undecided. Conclusions: The results presented allow further comparative studies. The KWBW attracts GP trainees that plan to work in primary care in Baden-Württemberg. Many of them have not yet decided whether to work self-employed or not. Therefore direct entry frommedical school into GP-specialization must be fostered. [ABSTRACT FROM AUTHOR]

Background: Family practice is an important setting for health promotion and prevention in Germany. However, there is a research gap regarding the involvement of nonmedical practice staff in health promotion. Therefore, our aim is to gain an indepth understanding of the role health care assistants (HCAs) can play regarding health promotion in family practice. Methods: We conducted 21 qualitative semi-structured interviews via telephone with 14 physicians and 7 HCAs, inquiring both professional groups about the role of HCAs concerning health promotion in their practice. The interviews were evaluated separately for both professions using thematic analysis. Results: In addition to organizational tasks such as making an appointment and communicating with physicians, HCAsmainly take on a key function as the first contact person in all practices: They recognize preventive needs, select eligible patients early at the reception and actively address them about preventive services. In some practices, HCAs carry out health-promoting measures such as training courses. However, with regard to further delegation of tasks, physicians in particular expressed concerns as they did not want to overburden HCAs. Conclusions: HCAs often take on organizational activities with regard to health promotion in family practice, but due to their function in the practice structure, they can also shape the practice as a health-promoting setting for patients. In addition, HCAs navigate patients with regard to preventive and health-promoting services. In accordance with their key role as initial contact, it should be worked out together with HCAs how health promotion can be addressed in a structured way at first contact. [ABSTRACT FROM AUTHOR]

Background: The forthcoming reform of medical education in Germany is poised to instigate significant transformations in the academic domain of general practice. Central to this reform is the adoption of the National Competence-Based Learning Objectives Catalogue for Medical Studies (NKLM 2.0), which serves as the foundational framework aligning medical training across German faculties with competence-based learning principles. Despite its promising potential, the extent to which currentmedical students encounter and develop competencies pertinent to family medicine (FM) remains largely unexplored. Objectives: The aim of this study is to describe the experience of competence in competences relevant to FM as well as the desire for competency-promoting learning opportunities at different points in time during medical undergraduate medical education at Saarland University (UdS). Materials and methods: The study is a simultaneous explorative mixed-methods study. 129 medical students from year one to five enrolled at UdS were anonymously surveyed on 29 FMsub-cometencies fromtheNKLM 2.0. Subsequently, semi-structured interviews were conducted with nine students. These were evaluated using qualitative content analysis. Results and discussion: The students experience of competence in FM relevant skills did not change significantly at different stages of their medical studies. For many of the learning objectives, the students felt incompetent at every stage of their studies. The desire for learning opportunities remained constant throughout their studies. The students perceived their learning progress most significantly during internships and elective courses. The FM learning activities at UdS were perceived as helpful for competence acquisition by the participants. The findings underline the importance of FM internships for acquiring practical skills and advocate for more competencepromoting learning opportunities in FM curricula. [ABSTRACT FROM AUTHOR]

Background: General practitioner (GP) care close to home is endangered by various factors. In Bavaria, the Beste Landpartie Allgemeinmedizin (BeLA) program aims to motivate students to work as (GPs) in rural areas. This study investigates the motives driving students to apply for the BeLA program and explores whether overarching factors influencing medical work in rural areas can be identified and used for recruitment. Methods: Eighteen guided exploration interviews were conducted. Fromthe individual motivations, positive expectations and a negative counter-image of medical work in the countryside were individually developed, and an ideal image (positive counterhorizon) of the assumed own medical professional activity in rural areas was drawn. Results: The aspects of country life mentioned by the students in the interviews can be divided into four categories: the quiet country life, the proximity to the patients, the family in the countryside, and the comparability with the city. The interviewees envision an ideal scenario ofmedical work in the countryside. The motivation is already so strong that the individual positive counter-horizon weakly weights negative aspects of the perfect image. The country is often idealized as a natural idyll. Conclusion: Upon entering the program, respondents strongly desire to become rural practitioners. To recruit undecided students considering rural practice, alternative strategies may be necessary for such programs. The strong personal connection shown by those motivated to work in rural areas provides potential avenues for adjusting medical study admission criteria, especially regarding the rural doctor quota. [ABSTRACT FROM AUTHOR]

Goals: During the annual conference of the German College of General Practitioners and Family Physicians in September 2022, a workshop was offered about marketing of train-the-trainer seminars (TtT seminars) for general practice educators. The workshop focused on applying successful marketing strategies of successful entertainment companies--the so-called 4Pmodel ofmarketing--to TtT seminars of the competence centers for general practice training. Methods: In a World Café format, ideas and best-practice examples formarketing were collected, using the 4Pmodel of marketing. Staff from six competence centers led the workshop, which had seven participants. The authors systematized the results and the assignment to the 4P categories in a consensus-based method. Results: We collected examples for all four categories of the model: product, place, price, and promotion. Participants felt that central results of the exchange were the following: defining the core brand value of TtT seminars, communicating the brand promise, and implementing marketing strategies to increase attractiveness of the seminars. Conclusion: Applying concepts fromoutsidemedicine to themarketing of TtT seminars may provide competence centers with a promising change of perspective. [ABSTRACT FROM AUTHOR]

Background: With the new licensing regulations for doctors coming into force, medical faculties are faced with the task of recruiting and qualifying more GP colleagues to train students in their practices. Objective: The aim of the study was to determine the motivation of GPs to train students in their own medical practices. Method: A cross-sectional survey of Thuringian GPs was conducted from April to May 2020. 21 items on motivation, incentives and barriers were recorded and examined using univariate and multivariate analyses. Results: The response rate was 35.8% (538/1,513). The GPs surveyed considered themselves motivated to train students in their medical practices. The motives can be described as predominantly intrinsic: the mutual exchange of knowledge, desire to share knowledge and to promote future doctors. Incentives included the opportunity to keep up to date with the latest knowledge, further training and contacts with colleagues. Barriers to teaching in the own medical practice were concerns about not being able to treat the same number of patients, a possible disruption of practice operations and lack of space. An analysis of the subgroups of GPs who were not yet teaching physicians indicated similar motives and barriers regarding training students in their practices, with a slightly lower overall motivation. Conclusion: The results describe the facets of the motivation of Thuringian GPs to train students and can be helpful for the expansion of a sustainable network of training GP practices. It is essential to address motives, to counter difficulties with individual solutions and to create targeted incentives. [ABSTRACT FROM AUTHOR]

We understand clinical quality governance (CQG) as quality management in the clinical domain. In 2020, presumably due to the coronavirus pandemic, more patients requested to be vaccinated against influenza as compared to previous years so that it became apparent that there would be a shortage for high-risk patients. To meet the problem, we started a CQG process. This article is explicitly not a research article but an exemplary description of a CQG process intended as a stimulus and for discussion. We initiated the following process: (1) evaluation of the present state, (2) patients who already had requested a vaccination were prioritized and vaccinated first, and (3) contacting via telephone and vaccination of high-risk patients not on the list. We chose patients with chronic obstructive pulmonary disease (COPD) older than 60 years as an indicator for the group of highest priority. In the beginning only 3 (8%) of our 38 patients with COPD were vaccinated against influenza. After prioritization and vaccination of the high-risk collective in the list of those who had requested to be vaccinated, 25 (66%) of our 38 patients with COPD were vaccinated. After a phone call of high-risk patients not on the list, 28 (74%) patients were vaccinated. This represents an increase of vaccination coverage from 8% to 74% which is close to the rate recommended by the World Health Organization (WHO). In times of a pandemic, family physicians occasionally have to deal with a scarcity of resources and have to develop strategies for fair resource allocation. Not only in this context is CQG worth the effort. The generation of list queries could be improved by the providers of electronic patient records. [ABSTRACT FROM AUTHOR]

The DEGAM guideline "Protection against over- and underprovision - deciding together" was introduced in June 2019 and is regularly updated. The article provides a condensed and revised introduction to the guideline in order to raise awareness about the problem of over- and underprovision. Definitions of over- and underprovision are given, and the causes, dimensions, and possible solutions of both phenomena are explained. The guideline offers recommendations for avoiding over- and underprovision based on other DEGAM guidelines and the National Supply Guideline. The article deals with the influence of the industry on medical research and the resulting guideline recommendations. It emphasizes that a reasonable and responsible use of the technical means of medicine should be aimed at in order to avoid under-, over-, and malprovision. Primary care organized health systems are considered more effective in improving the quality of life for people with chronic health problems. Evidence-based medicine is presented as a method for making the best possible decisions in individual cases, taking into account patient preferences and existing clinical research. It emphasizes that the patient's will is an important factor in medical decisions. Reflection and improvement of one's own work are seen as part of the professionalism of physicians in order to correct over- and underprovision. The article emphasizes the importance of process quality in healthcare and makes it clear that guidelines cannot replace medical judgment and individual decisions. Clinical quality management can help structure decision-making processes better and reduce errors. Furthermore, the need for a climate-neutral society is emphasized in order to sustain people's health in the long term. The healthcare system accounts for about 5% of Germany's total CO2 emissions, with medical products and the transportation of patients and staff contributing to the emissions, especially. It is emphasized that over- and underprovision should be avoided in order to reduce unnecessary emissions and conserve resources. The book "Climate Crisis and Health: On the Risks of a Human-Made Dynamics for Body and Soul" by Scherer M, Berghold J, and Hierdeis H addresses the impact of the climate crisis on health. It argues that a primary care system is necessary to improve healthcare, as outlined in a position paper by DEGAM. It also emphasizes that medical guidelines should take into account the time doctors need to adequately treat patients. [Extracted from the article]

Background: Fatigue is one of the most common reasons for seeking medical counseling in the family medicine (FM), often entailing diagnostic uncertainty. Patients use terms describing emotional, cognitive, physical, and behavioral aspects. A number of biological, mental, and social causes may underlie the symptom of fatigue, often in combination. This guideline describes the procedures to be applied for primary undetermined symptomatology. Methods: The experts involved conducted a systematic search using the terms for fatigue in the context of FM in PubMed, Cochrane Library and via manual search. Concerning related guidelines, the National Institute for Health and Care Excellence (NICE) guideline was used for myalgic encephalitis/chronic fatigue syndrome (ME/CFS). In a structured consensus process, broad approval of the core recommendations/background text of the revised guideline was attained. Most important messages: 1) Alongside gathering information concerning the symptom characteristics, the anamnesis aims to collect information about preexisting health conditions, sleeping behavior, use of drugs and psychosocial factors. 2) Depression and anxiety as two common causes will be identified based on screening questions. The occurrence of post-exertional malaise (PEM) will be inquired. 3) The following basic diagnostics are recommended: physical examination, laboratory tests (blood glucose, full blood count, blood sedimentation/CRP, transaminases/γ- GT, TSH). 4) Further examinations should be conducted only in case of specific indications. 5) A biopsychosocial approach is to be adopted. 6) Behavioral therapy and symptom-oriented activating measures can improve fatigue in underlying diseases and undetermined fatigue. 7) In case of PEM, further ME/CFS criteria should be collected and patients have to be supervised accordingly. [ABSTRACT FROM AUTHOR]

Background: In the last 5 years, 16 Competence Centers for Postgraduate Medical Education (KW) were founded in Germany with the aim to promote the quality and efficiency of specialty training in Family Medicine. The aim of the study was to identify suitable indicators for the external evaluation of the KW. Methods: Experts from the KW developed a set of possible quality indicators in two consecutive workshops. This set was revised and prioritized in a two-stage Delphi process among all KW. In total, 70 experts from 16 KW participated in the period February to October 2020, 38 of them in both survey rounds. Results: The participants proposed and prioritized 61 possible quality indicators in 9 subject areas: (1) participation rates, (2) quality of practical training, (3) quality of KW offers, (4) service, (5) objectified assessment of competences, (6) success and completion rates, (7) quality and quantity of patient care, (8) general effects, and (9) efficiency/duration of training. Conclusions: Quantitatively easy to collect quality indicators of the areas (1), (3), (4), (6), and (9) are mostly established and should be continued evaluating the KW. In addition, appropriate methods should be introduced for content-related quality indicators such as the competence development of participants in self-perception (3), practical training (2), objective competence measurement after training (5), general effects (8), and the effects of KW on the quality of care (7). Methodologically, the comparison of participants and nonparticipants by means of an external, systematic survey would be desirable both during and after the training. Procedures for objective competence assessment of graduates should be established in general medical training. [ABSTRACT FROM AUTHOR]

Background: Practice guidelines are an important instrument for quality improvement – also in primary care. For years, members of the German College of General Practice and Family Medicine (DEGAM) have developed methodologically ambitious guidelines for family physicians or have been involved in the development of interdisciplinary guidelines mostly on a voluntary basis. Since 2020, the Innovation Committee of the German Federal Joint Committee (G-BA) has announced funding programs for the (further) development of guidelines. Objectives: This publication intends to present DEGAM guideline projects currently funded by the Innovation Committee of the G‑BA. Materials and methods: The concepts of the funded guidelines are briefly described by the authors. Results: In the second round of the G‑BA's call for proposals for the funding of practice guidelines (in 2021), five author teams of DEGAM guidelines applied and received funding. The funded DEGAM guideline projects include (a) the development of a new guideline, (b) the update of two existing guidelines, and (c) the update and upgrading of an existing DEGAM guideline from S1 to S3 level, as well as the update of an S3 guideline as a living guideline. Conclusions: Guideline development is resource-intensive and requires voluntary commitment. The G‑BA funding opens up opportunities for DEGAM to (further) develop guidelines that would otherwise not have been developed at all or not as upgrades. In order to advance guideline programs, additional funding is needed, since the resources of voluntary guideline authors are limited. The G‑BA funding also supports the recruitment of young researchers for guideline development in the medium term. The extent to which this G‑BA support is sustainable will be proven in the future. [ABSTRACT FROM AUTHOR]

Copyright of Zeitschrift für Gerontologie und Geriatrie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Complications arising in connection with medical treatment are a burden on patients, relatives, practice staff and physicians. Therefore, dealing with treatment errors is of crucial importance. With this training article, we would like to inform you about the main features of civil medical liability law and give tips on how to deal professionally with treatment errors. Methods Based on a structured literature review as well as the experience of the three authors (DO: lawyer with a focus on medical law, HOW and JS: specialists in family medicine with experience as expert reviewers), topics for training in the border area between medicine and law were developed. Afterwards, these topics were weighted within the framework of a Germany- wide online survey of family physicians in the „Damocles study - To what extent do fears of legal consequences influence family physicians' actions?“ 413 family physicians (49 % female, mean age: 50 years) participated in the survey. A maximum of three areas could be selected from five topics. The topic „Dealing professionally with treatment errors“ was selected most frequently as a legal topic by 245 (59 %). Main messages * Civil liability is usually at the forefront of medical malpractice cases, because the main issues are damages and compensation for pain and suffering. * The license to practice medicine is never jeopardized by a treatment error in civil proceedings and usually not in criminal proceedings. * It is important to be prepared for a prompt and detailed discussion with the patient. * Written information to patients or lawyers should only be given after prior legal consultation with the liability insurer in order not to jeopardize the insurance cover. Conclusions There is a high demand among family physicians for continuing education courses with a legal focus. Therefore, in the future, legal content should be taught more frequently in the context of medical training and continuing education. [ABSTRACT FROM AUTHOR]

Background Since 2019, the competence center for specialist training in family medicine Bavaria (KWAB) offers an individual mentoring program to accompany specialist training in family medicine. The mentors are confidants for matters of specialist training, private practice, career development and compatibility of work and family life. The training takes place after registration via an online portal. Methods The evaluation was conducted 24 months after the start of KWAB mentoring (06/30/2021-08/01/2021). All active participants were interviewed via online survey. In each case, separate questionnaires were developed, which inquire on the one hand about the content-related aspects of the mentoring, such as topics discussed, and on the other hand about the individual mentoring relationship, such as the interpersonal relationship. The mentees received 39 questions (34 closed, 5 open) and the mentors received 26 questions (21 closed, 5 open), which were subsequently analyzed using descriptive statistics. Results N = 30 mentors and N = 72 mentees were invited to participate in the evaluation (25 (83 %) mentors and 32 (44 %) mentees participated). More than half of the participants met each other at least twice. The main methods of communication were telephone, face-to-face meetings, and email contacts. The individual time commitment in each case was judged to be appropriate. According to the mentors, the mentees showed interest in the content of the program and demonstrated availability and commitment. All respondents indicated a high level of satisfaction with one-on-one mentoring and would recommend it to others. Conclusions Mentors and mentees in family medicine residency reported a great benefit from the one-on-one mentoring offered and a will to continue their mentoring relationships even after the project period. [ABSTRACT FROM AUTHOR]

Background The digitalization of vaccination management is intended to increase vaccination rates. Part of the digitization strategy is the use of an electronic vaccination card (EVC), which has been available to people with statutory health insurance in Germany since 01.01.2022. The study aimed to find out how the planned concept of the EVC can be improved following assessments from various doctors and medical assistants that use the system. Methods In a qualitative study design, guided interviews were conducted with practicing physicians from the fields of general (n = 4) and pediatrics and adolescent medicine (n = 3) as well as with medical assistants (n = 4). The evaluation was carried out qualitatively by content analysis according to Mayring. Results The respondents have a fundamentally positive view of the introduction of the EVC. They hope for a better overview, constant availability, and simplified exchange of data. Above all, the transfer of vaccination data from the analogue to the digital vaccination card, including the functionality of the telematics infrastructure interface, pose challenges. The respondents would like to see further functions added, such as a reminder function, the possibility of transmitting the vaccination data to a surveillance system and information on available vaccines. The respondents assume a predominantly positive reaction from their patients but consider good education to be necessary in order to achieve widespread use of the EVC. Conclusions The practice teams assume that the introduction of the EVC will initially lead to additional work. In the long term, they hope for positive changes (workload reduction, time savings or error minimization). So far, the EVC does not seem to have arrived in practice; to what extent this will happen remains to be seen. [ABSTRACT FROM AUTHOR]

Background In 2017, the agreement on an intermediate level of outpatient palliative care (BQKPMV) emerged. It is unclear what role BQKPMV plays in healthcare practice and what experiences family physicians have with the implementation. Methods In September 2021, all 5012 family physicians in Lower Saxony were invited to participate in an online or paper-based questionnaire survey on the implementation of BQKPMV. Data were analysed using descriptive statistics and frequency analyses. Results With 665 responses, a participation rate of 13 % was achieved. Data from 642 family physicians were included in the analysis. 13 % of the respondents (n = 84) are aware of BQKPMV. 71% of the participants with knowledge of BQKPMV (n = 58) have decided not to participate in the agreement. Thirty-eight of these family physicians justify this by saying that they consider the existing forms of outpatient palliative care to be sufficient. More than half of the participants see difficulties in the practical implementation. Conclusions The results of the survey of family physicians in Lower Saxony indicate that BQKPMV is rarely used in the clinical practice of the participants. Respondents see limitations in the feasibility of BQKPMV. Due to the rather low response rate and the regional connection, reliable nationwide conclusions about the reality of care can only be drawn to a limited extent. It is conceivable that, in addition to providing all family physicians with low-threshold information about BQKPMV, the framework conditions of BQKPMV need to be adjusted, e.g. in the areas of qualification requirements, remuneration and the distribution of tasks. Recommendations for optimising BQKPMV are developed in the overall project and enable a comprehensive evaluation of the implementation of this form of care. [ABSTRACT FROM AUTHOR]

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Background This paper explores the role of providing structure for students within a new blended-learning family medicine curriculum at Saarland University. This study intends to clarify the role of different structural elements for different learning approaches (deep vs. structured vs. surface learning). Methods This study is based on a mixed-methods approach. Fifth year medical students' (n = 84) learning approaches, measured by a shortened version of the ASSIST questionnaire, were correlated with students' academic performance in state exams and the family medicine exam. Based on learning approaches and age, participants were purposefully sampled into two semi-structured group interviews with seven participants each. Results Although surface approach learning weakly correlated with lower performance in the first state exam (rho = 0.231), surface approach learning did not correlate with lower performance in the family medicine assessment. Based on qualitative results, the structural design of the curriculum seemed to have a high impact on students' satisfaction and motivation to learn. The reduction of extraneous cognitive load was identified as effective in motivating students to study. Deep-learning students highlighted the positive effects of curriculum activities that foster germane cognitive load through schema- based learning. Conclusions Especially for surface approach learners it may be important to provide structured guidance and provide a clear alignment of course content in a blended-learning curriculum, even in higher education. Deep and structured approach learners also benefit from a clear course structure that keeps extraneous cognitive load low and fosters schema acquisition. [ABSTRACT FROM AUTHOR]

Background Due to the COVID-19 pandemic, the Objective Structured Clinical Examination (OSCE) examinations were cancelled in the short term. This project described how to offer medical students an alternative assessment at Miller's competence level of "shows how". Methods Students produced videos in which they can be seen performing various physical examinations related to family medicine consultations. Trained assessors rated the videos uploaded to the learning platform and gave verbal feedback if requested. Results The grading (65 "very good" and 38 "good") was very mild. Twelve per cent of the students requested verbal feedback. Their evaluation of the procedure was mixed. The evaluators consistently assessed their task and the process as positive. Technically, the video-based assessment could be implemented without any problems. Conclusions The short-term implementation of a video-based assessment in the context of medical education proved to be feasible. It could serve not only as an emergency solution under a pandemic, but also as an additional opportunity for formative feedback in the future. [ABSTRACT FROM AUTHOR]

Background: Coding diagnoses is part of a physician's daily routine. Good coding quality has several functions; it is, for example, the basis for the remuneration of contract doctors. In the field of general medicine, this process can, however, pose a particular challenge, as diagnoses are naturally more often excluded than made. In addition, the process of diagnosing informs treatment., Methods: 23 semi-structured interviews were conducted with general practitioners from Schleswig-Holstein. The interviews were recorded with a dictaphone, pseudonymized, transcribed and then analyzed by content analysis according to Mayring., Results: 87 % (N = 20) of the participants were male, the mean age was 57 years, and the mean duration of work experience was 23 years. The ICD-10 (International Classification of Diseases) coding system was often criticized for not representing general medical practice and placing an increased administrative and time burden on physicians. At the same time, diagnostic pressure from external economic interests was perceived. Specifications of practice management systems or their additional programming options were used, among other things, to search for a code. Particular challenges arose in this context, e.g., complex clinical pictures and lack of time. Prescriptions without indication, among other things, have been made at the request of patients, due to a lack of time and concerns about doctor switching. In these cases, a diagnosis in the ICD-10 code that justified the therapy was sometimes used., Conclusions: The path leading from clinical findings to therapy and finally to the appropriate diagnostic code is a complex one, and it involves various influencing factors, including non-medical factors. These influencing factors must be taken into account in future secondary data analyses. The ICD-10 is not the ideal choice for mapping these processes in general medicine., (Copyright © 2024. Published by Elsevier GmbH.)

Background The shortage of family physicians (FP) in rural areas is a challenge. It is therefore of interest how primary care can be made sustainable and how medical students can be motivated to work in rural areas. The program „Beste Landpartie Allgemeinmedizin“ (BeLA) was developed to promote medical students for rural regions and to strengthen primary care. Methods Interviews have been conducted at regular intervals on an ongoing basis since 2020 to investigate motivational retention effects during the program. The current 33 interviews were analysed following the Grounded theory methodology combined with a systems theory reading of functional analysis. Results The program was rated extremely positively by all participants and the effects are evident in a variety of ways. Both students whose choice to pursue family practice is already determined and students who merely have tendencies toward family practice are addressed. Especially the emerging ideas of working as a FP and the motives for owning a FP practice or work as an employed FP are revealing in this context. Thus, motivationalgenetic, motivational-stabilizing, synergetic and prospective effects can be identified. This is shown by the fact that both new motives for choosing family practice are generated and existing motives are addressed and strengthened, as well as diverse long-term potentials regarding the choice of family medicine and one's own future work are created. Conclusions The effects of a program such as BeLA which offers an early support in medical education show that a sustainable supply of high-quality trained FP can succeed in rural regions. Especially the ideas of working as a FP as well as the aspiration to own a FP practice or work as an employed FP shows potentials how to counteract the shortage of FP effectively. [ABSTRACT FROM AUTHOR]

Background A variety of measures are being taken to counteract the shortage of family physicians in Germany. One of these is the socalled lateral entry into family medicine, which has been possible in Lower Saxony since 2018. With regard to socio - demographic and professional data as well as with regard to job satisfaction and work-life balance the study aimed to show: Whether the possibility of lateral entry motivates physicians to switch to family medicine and to what extent physicians in lateral entry (QE) differ from physicians who have not yet acquired a specialist certificate (AT). Methods Physicians in vocational training (ÄiW) for family medicine were invited to participate in an online-based survey with the help of the Association of Statutory Health Insurance Physicians of Lower Saxony (KVN). The questionnaire contained 40 items on sociodemographic and occupational history variables as well as on various aspects of vocational training. The data were analyzed using descriptive statistical methods. Results Of 180 ÄiW contacted, 64 completed the questionnaire (35 %). For 65 % of the QE, a change to family medicine without lateral entry would not have been an option. 75 % of the QE are specialists in anesthesia or surgery. Work-life balance was considered better in the outpatient sector than in the inpatient sector by all participants. For QE, aspects such as the teaching of business knowledge and a perspective of further employment in the training practice are of higher relevance than for other ÄiW. Conclusions The results suggest that the opportunity for lateral entry can be a pathfinder for a change to family medicine. The attractiveness seems to be particularly high in specialties with classically inpatient career paths. QE expectations of switching to family medicine are met, including work-life balance and career satisfaction. [ABSTRACT FROM AUTHOR]

Background Family practices are the primary contact for inquiries relating to COVID-19. This study reveals the reasons why German family practices are called during the pandemic and which burden is associated with patients' inquiries related to COVID-19 among practice assistants (PAs). Methods On April 28, 2021 a cross-sectional flash mob study was conducted in family practices across Germany. The study material and invitation were disseminated via social media and postal or electronic mails. During half a day, participating practices counted every incoming call. For calls addressing COVID-19, the reason, duration, and perceived stress level were documented. Descriptive statistics and regression analyses were performed using SPSS. Results 5,646 calls, 1,826 of which were related to COVID-19 (32.3 %), were documented by 73 practices (practice average: 25.0 ± 17.7) within a single Wednesday morning. Most calls addressed vaccination (n = 1,050, 59.0 %). During 22.0 % (n = 388) of COVID-19-related calls, PAs felt stressed, which was mainly influenced by the call duration (calls of 5 minutes and longer were perceived significantly more stressful [OR 8.94, 95 % CI 6.47--12.37]). Feeling well-prepared to meet patients' inquiries relating to COVID-19 was a protective factor for the average stress perceived per PA. Overall, less than 10 % of calls on COVID-19 were transferred to a physician. Conclusions Family practice teams experience a high volume of partly stressful phone calls about COVID-19 but are often able to handle the pandemic challenges. PAs play a central role in advising the practice population on issues related to COVID-19. This deserves greater recognition. [ABSTRACT FROM AUTHOR]

Background At Saarland University a competency-based blended learning curriculum was implemented in family medicine for year five medical students. Considering the shortage of future family physicians, this study investigates whether the curriculum increases the attraction of and assesses motivational drivers in family medicine as a postgraduate career choice. Methods During summer semester 2021, two online questionnaires were used to compare students' likelihood to engage in post-graduate training in family medicine, before and after curriculum participation. K-means Cluster analysis was performed to identify different motivational clusters of students, based on results from the Academic Motivation Scale. Motivational drivers were identified by descriptive quantitative analyses. JASP (Version 0.14.1) and Jamovi (Version 1.6) were used for data analyses. Results 109 out of 111 enrolled students participated in the first questionnaire; 103 continued to participate in the second questionnaire. The likelihood to engage in family medicine specialty training increased significantly after participation in the curriculum (p = 0.016). Four constant motivational clusters were identified. Students perceived the focus on relevant primary care learning outcomes, the alignment of curriculum and exam content, the alignment of learning outcomes with state exam content, symptom-based learning, communication at eye level and the increased self-confidence in dealing with common disease patterns as particularly motivating. Conclusions A compulsory family medicine curriculum in medical school may influence a students' choice to specialize in this field. The identified motivational drivers seem to be useful for future curriculum redesign projects in family medicine. [ABSTRACT FROM AUTHOR]

Background The rural doctor quota ("Landarztquote") for medical studies was introduced in Rhineland-Palatinate in winter 2020/2021. The quota intends to ensure and improve FP care in rural regions in the future. Since autumn 2020, 39 students have started their medical studies at the University Medical Center of the Johannes Gutenberg University Mainz via the rural doctor quota. The aim of this study was to examine in more detail what the students' ideas and expectations are with regard to their studies and future work as rural doctors. Methods In 2021 we conducted 20 guideline-based individual interviews by video or telephone with students who obtained a study place via the rural doctor quota. We did a qualitative content analysis according to Mayring. Results In general, students expect a strong link between theoretical and practical content from the very beginning of their studies. It is important for students to gain an early insight into the daily practice of family doctors. In addition, they also asked for specific preparatory courses or support services regarding setting up a practice, as well as business management aspects of running a practice. At the beginning of their work as specialists, however, most students would prefer to work in a joint practice, as they consider the challenges of setting up their own practice to be very high. Conclusions In addition to the teaching of practice-oriented medical expertise and the expansion of practice days, it will also be important in the future to offer courses on practice management to take away students' fear of setting up a practice. The teaching content of the accompanying program should be increasingly oriented to the students' previous professional experience. [ABSTRACT FROM AUTHOR]

Background and teaching situation: The SARS-CoV-2 pandemic had a substantial didactic impact on medical teaching. In Erlangen, the lecture "General Practice" was offered asynchronously and digitally in an inverted-classroom concept. Contents were available via a learning platform. The lecture was presented using annotated videos, consolidation materials and control questions. A forum encouraged for discussions and feedback and collected in-depth aspects for a case-based video consultation. The aim of this work is to evaluate and critically examine the digital teaching concept during the SARS-CoV-2 pandemic. Methodology: Two semester cohorts evaluated the lecture. Overall impression of the lecture, didactic elements, suitability and the desired future lecture format were surveyed quantitatively. Free text answers were evaluated by means of qualitative content synthesis. Results: In terms of overall impression, the students (N=199) rated the lecture on average as "very good" (M=1.41, SD=.57). Digital methods were perceived as suitable for supporting self-study, and digital usage was rated as unproblematically (M=1.18, SD=.50). Desired future teaching formats were blended learning concepts (79.4%). Organisation, structure and content presentation were highly appreciated. The time for completing the course was perceived critically. The students urged for more practical and consolidating lecture work. Discussion and implications: The results illustrate high acceptance of digital teaching and underline the demand for future blended learning concepts. It is particularly important to better consider the students' time investment and practical relevance of digital self-learning mechanisms. [ABSTRACT FROM AUTHOR]

Background Around one in 20 patients in family practice brings at least one genetically influenced health condition into consultation. To ensure comprehensive health care, knowledge of genetic aspects of diseases should be imparted in post-graduate training programs in family medicine. The topic of genetics is already anchored in some international curricula in the field of family medicine. The aim of the study was to determine which topics and competencies regarding genetics are relevant during post-graduate training from the point of view of family physicians in Germany. Methods A cross-sectional postal survey was carried out in the period between 11/2018 and 02/2019 by using a questionnaire that was sent to 2,012 family physicians in Germany. Beside sociodemographic aspects, the confidence to carry out genetic tasks as well as interpreting pedigrees were questioned with a Likert scale from 1 (strongly agree) to 6 (strongly disagree). In addition, relevance of various post-graduate training content on genetic topics was requested using a Likert scale from 1 (very relevant) to 6 (not relevant at all). The analysis of the data was carried out using SPSS 27.0 (IBM). Results A total of 292 (15 %) family physicians took part in the survey. 52 % of the participants were female and the average age was 53. In the mean of 3.2 (SD 1.5) family physicians felt confident in interpreting pedigrees. 25 of the participants (9 %) created a pedigree in the last twelve months. Cancer (M 1.6; SD 0.7) and multifactorial diseases with a genetic component (M 1.7; SD 0.9) were graded most relevant to post-graduate training. Conclusions There is a heterogeneous awareness of genetically (co-)determined diseases in family practice. Based on existing uncertainties in dealing with associated consultation issues as well as genetic topics identified as relevant for post-graduate medical education, knowledge and skills competencies on specific genetic topics should be taken up. [ABSTRACT FROM AUTHOR]

Patient and Public Involvement (PPI) has gained importance in Germany and is also increasingly implemented in research in family medicine. Internationally, diverse frameworks give recommendations on how to successfully design and implement PPI in specific contexts. However, it is crucial to share experiences on PPI in specific settings such as family medicine in order to learn from each other. Thus, this article provides an overview of PPI concepts in the practice-based research networks (PBRNs) of the Initiative of German Practice-Based Research Networks -- DESAM-ForNet. In the PBRNs patients and the public are involved in the research process by repeated group meetings in "public forums" (BayFoNet), "round tables" (FoPraNet-BW) or "patient advisory boards" (HAFO.NRW, RESPoNsE, SaxoForN) with a special focus on the planning and dissemination phase of projects. The most successful recruitment strategies so far have encompassed individual patient contacts of family physicians, postings/posters, local self-help organizations and standardized patient programs. Evaluation of PPI is currently being designed in most PBRNS. Overall, the PBRN-specific PPI concepts represent diverse possibilities to create long-term collaborative partnerships with patients and the public. These exemplary concepts are meant to encourage the further development and implementation of adapted PPIconcepts in family medicine research. [ABSTRACT FROM AUTHOR]