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Background: Bedside courses are of outstanding importance when training medical students. The fact that less and less teaching is taking place nowadays at the patient's bedside makes it all the more important that the available time be put to effective use. The aim of this study was to check whether structured improvement measures in the course (scripts, lecturer briefing, e-learning cases) would improve the abilities of the students on the basis of a subjective self-assessment as well as an external assessment by the lecturers with respect to clinical abilities. Methods: Bedside teaching takes place in the fourth study year in the Medical Clinics of the TU Munich. Both students and lecturers had the chance to hand in an anonymous, quantitative self- and external assessment of the clinical abilities of the students (German grading system) after every course date. This assessment took place online in the three categories "Medical history & examination", "Diagnosis" and "Therapy". An overall period of four semesters, each with 6 course dates, was investigated. After two of the total of four semesters in the study, the course was changed by introducing scripts, lecturer briefing as well as interactive e-learning cases. The self- and external assessment was compared both within the semester (date 1-3: A; date 4-6: B), during the course as well as before and after introducing the improvement measures ("before" (T0): SS 2012, SS 2013, "after" (T1): WS 2013/2014, SS 2014).Results: There was a significant improvement in one's own abilities on the basis of the self-assessment within each semester when comparing the first (A) and the last (B) course dates. Moreover, there was a significant improvement in the performances in all three categories when T0 was compared with T1, from both the point of view of the students ("Medical history & examination": T0 =2.5±0.9, T1=2.2±0.7, pp

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

We analyse interactions between teachers and students during video-recorded bedside teaching sessions in internal medicine, orthopaedics and neurology. Multiple raters used a high-inference categorical scheme on 36 sessions. Our research questions concern the types of student mistakes, clinical teachers' reactions to them and if they use different strategies to address different types of mistakes. We used a Poisson model and generalized mixed models to analyse these research questions. Most frequently, students made reproduction mistakes. Relatively high rates of rejection and a similar prevalence of low and high levels of elaboration and correction time for students were observed. Reproduction mistakes were associated with the highest level of rejection and the lowest level of elaboration. High levels of elaboration were observed when students were applying skills in new situations. Students were most often allowed time to correct when mistakes in the areas of analysis or application of skills and knowledge had occurred. There is a decrease in the rate of making mistakes for neurology and orthopaedics compared to internal medicine. Reproduction mistakes influence significantly the outcome feedback compared to application mistakes. Analytic and reproduction mistakes influence elaboration significantly compared to application mistakes. We found a significant effect whether the lecturer allows time for correction of reproduction mistakes compared to application mistakes. These results contribute to the understanding of interactive, patient-centred clinical teaching as well as student mistakes and how teachers are reacting to them. Our descriptive findings provide an empirical basis for clinical teachers to react to student mistakes in didactically fruitful ways.

Purpose: To advance the learning of professional practices in teacher education and medical education, this conceptual paper aims to introduce the idea of representational scaffolding for digital simulations in higher education. Design/methodology/approach: This study outlines the ideas of core practices in two important fields of higher education, namely, teacher and medical education. To facilitate future professionals' learning of relevant practices, using digital simulations for the approximation of practice offers multiple options for selecting and adjusting representations of practice situations. Adjusting the demands of the learning task in simulations by selecting and modifying representations of practice to match relevant learner characteristics can be characterized as representational scaffolding. Building on research on problem-solving and scientific reasoning, this article identifies leverage points for employing representational scaffolding. Findings: The four suggested sets of representational scaffolds that target relevant features of practice situations in simulations are: informational complexity, typicality, required agency and situation dynamics. Representational scaffolds might be implemented in a strategy for approximating practice that involves the media design, sequencing and adaptation of representational scaffolding. Originality/value: The outlined conceptualization of representational scaffolding can systematize the design and adaptation of digital simulations in higher education and might contribute to the advancement of future professionals' learning to further engage in professional practices. This conceptual paper offers a necessary foundation and terminology for approaching related future research.

Purpose: The purpose of this paper is to conceptualize error reporting as a strategy for informal workplace learning and investigate nurses' error reporting cost/benefit evaluations and associated behaviors. Design/methodology/approach: A longitudinal survey study was carried out in a hospital setting with two measurements (time 1 [t1]: implementation of a critical incident reporting (CIR) system; t2: three months after t1). Correlational and hierarchical cluster analyses were used to interpret the data. Findings: Positive cost-benefit correlations and negative cross-correlations were found, with no substantial changes over time. "Reporters" and "learners" were differentiated regarding error-reporting behaviors. Cost-benefit perceptions predicted membership in the "reporters" group; perception of effort costs negatively predicted an error-reporting preference. Research limitations/implications: This study was limited, in that only a questionnaire was used to collect data. Practical implications: Stressing the benefits of CIR systems should contribute to reducing employees' perception of reporting costs; thus, ease of use is a critical factor in CIR system use. Originality/value: The study empirically probes a well-established theoretical model, and various ideas for further research are suggested.