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Introduction: Reflective competence is fundamental for responsible medical practice and must be systematically incorporated in medical training. To promote this, a longitudinal portfolio-based mentoring program was made mandatory at the Medical Faculty of the University of T��bingen in 2013. This study examines medical students' attitudes toward professional reflection and toward the program in general to draw conclusions about conditions as well as the needs-based design of the program. Method: In winter semester 2017/18, a retrospective questionnaire survey with free text fields was conducted (total sample: N=1.405; students S 1-9; response 37%; S 1-4 ���Pre-clinic���: n=231; S 5-9 ���Clinic���: n=241). Opinion trends of semester groups were identified through seven semi-structured interviews with semester speaker and peer tutors. Results: Differences in understanding and attitudes resulted in three positions: 1=approval, 2=ambivalence, 3=rejection. All three groups included individuals from pre-clinical and clinical settings with varying levels of experience. Prior experience and hidden curriculum influenced the position. Opinion trends confirmed the feedback. Conclusion: Although reflection appears in the National Competence-based Learning Objectives Catalogue for Medicine (NKLM), reflective competence is not regarded as equivalent to other study content. Motivation, commitment on the part of the mentors, and a trusting mentor-mentee relationship are effective. The flexibility of the portfolio in terms of content and methodology, as well as the curricular integration of the program are also beneficial., Einleitung: Reflexionskompetenz ist eine Grundlage verantwortungsvollen ��rztlichen Handelns und muss in der ��rztlichen Ausbildung systematisch adressiert werden. Zur F��rderung dieser wurde 2013 an der Medizinischen Fakult��t der Universit��t T��bingen ein longitudinales Portfolio-gest��tztes Mentoring-Programm verpflichtend eingef��hrt. Diese Studie untersucht die Einstellungen der Medizinstudierenden auf die professionelle Reflexion und das Programm im Allgemeinen, um R��ckschl��sse auf Bedingungen und bed��rfnisgerechte Gestaltung des Programms zu ziehen. Methode: Im WS 2017/18 wurde retrospektiv eine Fragebogenbefragung mit Freitextfeldern durchgef��hrt (Gesamtstichprobe: N=1.405; Studierende FS 1-9; R��cklauf 37%; FS 1-4 ���Vorklinik���: n=231; FS 5-9 ���Klinik���: n=241). Meinungstrends der Semestergruppen wurden ��ber 7 semi-strukturierte Interviews mit Semestersprecher*innen und Peer-Tutor*innen ermittelt. Ergebnisse: Die Unterschiede in Verst��ndnis und Einstellungen ergaben 3 Positionen: 1=Zustimmung, 2=Ambivalenz, 3=Ablehnung. In allen 3 Gruppen waren Personen aus Vorklinik und Klinik mit unterschiedlichem Erfahrungsgrad. Vorerfahrung und hidden curriculum nahmen Einfluss auf die Position. Die Meinungstrends best��tigten das Feedback. Schlussfolgerung: Obgleich im nationalen kompetenzbasierten Lernzielkatalog Medizin (NKLM) verankert, wird die Reflexionskompetenz noch nicht gleichwertig zu anderen Studieninhalten gesehen. Erfolgswirksam sind Motivation, Engagement der Mentor*innen und ein vertrauensvolles Mentor-Mentee-Verh��ltnis. F��rderlich sind zudem eine inhaltliche und methodische Flexibilit��t des Portfolios sowie die curriculare Anbindung des Programms.

This project report describes the development of theGlobal questions and in-depth items were formulated for each of the sub-competencies of the six core competencies of the KLM model. Depending on the number of sub-competencies, there are 3-4 subscales for each core competency, comprising 69 items in total. Data from 90 participants of medical didactic courses were analysed. Item analyses supported the hypothesized scales.The internal consistencies (Cronbach's alpha: CR-α) of the 22 subscales ranged from CR-α=.70 to CR-α=.93, and the item difficulty indices of the subscales ranged from 18% to 89%. For 2 subscales, some items had a difficulty index of more than 80%, and for 3 subscales, the difficulty index of some items was less than 25%.The FKM_L was developed to assess individual and group profiles of teachers' competence in medicine. The results of this first psychometric analysis are promising: With the help of the FKM_L, teachers can learn about and reflect on aspects of their teaching competencies in the context of medical didactic courses. Based on their FKM_L profiles, they can decide whether they want to selectively optimize their competence characteristics. For providers, the FKM_L is suitable as a screening tool to identify, among other things, gaps in the training offered. Further analyses are necessary to check limitations identified in some scales and to improve individual items. In addition, research on the construct and criterion-related validity of the instrument is required.In diesem Projektbericht wird die Entwicklung und teststatistische Überprüfung desFür die Teilkompetenzen der sechs Kernkompetenzen des KLM-Modells wurden jeweils Globalfragen und vertiefende Items formuliert. Je Kernkompetenz gibt es in Abhängigkeit von der Zahl der Teilkompetenzen 3-4 Subskalen, die 69 Items umfassen. Alle Skalen wurden itemanalytisch überprüft. Analysiert wurden Daten von 90 Teilnehmerinnen und Teilnehmern medizindidaktischer Kurse.Die inneren Konsistenzen (Cronbachs Alpha: CR-α) der 22 Subskalen liegen zwischen CR-α=.70 und CR-α=.93, die Schwierigkeitsindices der Items der Subskalen zwischen 18% und 89%. Bei 2 Subskalen wiesen einige Items einen Schwierigkeitsindex von über 80% auf, bei 3 Subskalen betrug der Schwierigkeitsindex einiger Items weniger als 25%.Der FKM_L wurde zur Erfassung von individuellen und gruppenbezogenen Kompetenzprofilen von Lehrenden in der Medizin entwickelt. Die Ergebnisse dieser ersten teststatistischen Analyse sind vielversprechend: Mit Hilfe des FKM_L können Lehrende im Rahmen medizindidaktischer Kurse Aspekte ihrer Lehrkompetenzen kennenlernen und reflektieren. Anhand ihrer FKM_L-Profile können sie entscheiden, ob sie ihre Kompetenzausprägungen punktuell optimieren möchten. Für Anbieter eignet sich der FKM_L als Screening-Instrument, um u.a. Lücken im Ausbildungsangebot festzustellen. Weitere Analysen sind notwendig, um festgestellte Einschränkungen bei einigen Skalen zu überprüfen und einzelne Items anzupassen. Darüber hinaus ist eine Überprüfung der Konstrukt- und der kriterienbezogenen Validität des Instruments erforderlich.

Internationally, scientific and research-related competencies need to be sufficiently targeted as core outcomes in many undergraduate medical curricula. Since 2015, standards have been recommended for Germany in the National Competency-based Learning Objective Catalogue in Medicine (NKLM). The aim of this study is to develop a multi-center mapping approach for curricular benchmarking against national standards and against other medical faculties.A total of 277 faculty members from four German medical faculties have mapped the local curriculum against the scientific and research-related NKLM objectives, using consented procedures, metrics, and tools. The amount of mapping citations of each objective is used as indicator for its weighting in the local curriculum. Achieved competency levels after five-year education are compared.All four programs fulfill the NKLM standards, with each emphasizing different sub-competencies explicitly in writing (Scholar: 17-41% of all courses; Medical Scientific Skills: 14-37% of all courses). Faculties show major or full agreement in objective weighting: Scholar 44%, scientific skills 79%. The given NKLM competency level is met or even outperformed in 78-100% of the courses.The multi-center mapping approach provides an informative dataset allowing curricular diagnosis by external benchmarking and guidance for optimization of local curricula.

Introduction Medical professionalism is an increasingly important issue in medical education. The dissection course represents a profound experience for undergraduate medical students, which may be suitable to address competencies such as self-reflection and professional behavior. Material and methods Based on a needs assessment, a seminar on medical professionalism was developed to parallel the dissection course. The conceptual framework for the teaching intervention is experiential learning. Specific learning goals and an interview guideline were formulated. After a pilot run, peer-teaching was introduced. Results Over three terms (winter 2012/13, 2013/14, 2014/15), an average of 129 students voluntarily participated in the seminar, corresponding to 40% of the student cohort. The evaluation (n = 38) shows a majority of students agreeing that the seminar offers support with this extraordinary situation in general and also that the seminar helps them to become first impressions on how to cope with death and dying in their later professional life as a doctor, and, that it also provides them the means to reflect upon their own coping mechanisms. Conclusion Although not yet implemented as an obligatory course, the seminar is appreciated and positively evaluated. Medical professionalism is an implicit aspect of the dissection course. To emphasize its importance, a teaching intervention to explicitly discuss this topic is advisable.

Dieser Praxisleitfaden unterstützt Studierende und Nachwuchswissenschaftler/innen bei der Verbesserung ihrer individuellen Vortragsqualität. Wissenschaftliche Ergebnisse effektiv, überzeugend und authentisch zu präsentieren, ist eine grundlegende Kompetenz für jeden Studierenden. Die Zuhörer wollen interessiert, informiert und überzeugt werden. Um diese Erwartungen zu erfüllen, benötigen die Präsentierenden das effektive Zusammenspiel von Wort, Bild und Körpersprache. Dieser Praxisleitfaden zeigt, was einen wirkungsvollen Vortrag ausmacht, wie persönliche Stärken und Optimierungspotenzial erkannt werden können und wie sich ein individueller Vortragsstil entwickeln lässt. Die Autoren beschreiben praktische Situationen und geben Hilfestellungen, die sofort umsetzbar und anwendbar sind. So lassen sich auch schwierige Situationen problemlos meistern. Mit vielen Tipps, Anregungen und Checklisten!

Background The Collaborator, Health Advocate and Leader/Manager roles are highly relevant for safe patient management and optimization of healthcare system in rehabilitation and prevention. They are defined in competency-based frameworks and incorporate competencies empowering physicians to master typical daily tasks in interdisciplinary, interprofessional and institutional collaboration. However, appropriate implementation of roles remains difficult in undergraduate medical education (UME) and needs to be closely monitored. The aim of this cross-institutional mapping study was to examine for the roles of Collaborator, Health Advocate and Leader/Manager: (1) To what extent do German UME programs explicitly meet the given standards after 5 years of study? (2) Which information may be obtained from multi-site mapping data for evidence-based reflection on curricula and framework? Methods In a joint project of eight German UME programs, 80 to 100% of courses were mapped from teachers’ perspective against given national standards: (sub-)competency coverage, competency level attainment and assessment. All faculties used a common tool and consented procedures for data collection and processing. The roles’ representation was characterized by the curricular weighting of each role content expressed by the percentage of courses referring to it (citations). Data were visualized in a benchmarking approach related to a general mean of the intrinsic roles as reference line. Results (Sub-)competencies of the Health Advocate are consistently well-integrated in curricula with a wide range of generally high curricular weightings. The Collaborator reveals average curricular representation, but also signs of ongoing curricular development in relevant parts and clear weaknesses regarding assessment and achieved outcomes. The Leader/Manager displays consistently lowest curricular weightings with several substantial deficiencies in curricular representation, constructive alignment and/or outcome level. Our data allow identifying challenges to be considered by local curriculum developers or framework reviewers (e.g. non-achievement of competency levels, potential underrepresentation, lacking constructive alignment). Conclusion Our non-normative, process-related benchmarking approach provides a differentiated crosscut snapshot to compare programs in the field of others, thus revealing shortcomings in role implementation, especially for Leader/Manager and Collaborator. The synopsis of multi-site data may serve as an external reference for program self-assessment and goal-oriented curriculum development. It may also provide practical data for framework review.

The professional behavior of future doctors is increasingly important in medical education. One of the first subjects in the curriculum to address this issue is gross anatomy. The Tuebingen Medical Faculty implemented a learning portfolio and a seminar on medical professionalism during the dissection course. The aims of this research project are to get an overview of how students form a professional identity in the dissection course and to compare the content of both their oral and written reflections on the course. A qualitative analysis was conducted of the oral and written reflections on the dissection laboratory experience. This study was conducted during winter term 2013/2014 with a cohort of 163 participants in the regular dissection course. Written reflection texts (from n = 96 students) and audio recordings from four oral reflection seminar discussions (with n = 11 students) were transcribed and deductively categorized with Mayring's qualitative content analysis method. Both qualitative analyses show that students reflected on many topics relevant to professional development, including empathy, respect, altruism, compassion, teamwork, and self-regulation. Quantitative analysis reveals that students who attended the oral reflection wrote significantly more in their written reflection than students who did not. There is, however, no difference in the reflection categories. Reflection content from students corresponds with categories derived from existing competency frameworks. Both the seminar (oral reflections) and the learning portfolio (written reflections) present excellent opportunities to foster professional development during anatomy education; the key is using them in conjunction with the dissection course.

Objectives: Transition to competency-based medical education is a highly challenging endeavor. Students, teachers and institutions need curricular transparency for understanding the build-up of competencies in terms of coverage, sequence and consistence of learning objectives and assessment. The project aim was to develop and implement a web-based interactive platform for curriculum mapping, diagnostics, and development. The tool should be transferable to other faculties and allow description and visualization of medical curricula in comparison to given national competency-based standards. Methods: In a design-based multi-center approach, four German medical faculties cooperated and developed a standardized, common mapping tool (MERlin database). Implemented are techniques for big data handling and visual analytics. Results: The platform profile is adapted closely to user needs. Intuitive data entry and comfortable quality maintenance support teacher engagement. Individual navigation for curricular diagnostics is guided by practice-oriented questions. Sophisticated, easy-understandable visualizations show curricular strengths and weaknesses. Transparency in contributing departments facilitates goal-oriented dialogs. Currently, 14 of 38 German faculties use the platform. Conclusions: In view of huge amounts of data and complex curricular structures, the MERlin database facilitates effective curriculum mapping, goal-oriented curriculum development, comparison to national competency-based standards, effective data sharing and benchmarking across faculties with different curriculum management systems.

Background: Simulation training in medical education is a valuable tool for skill acquisition. Standard audio/video-feedback systems for training surveillance and subsequent video feedback are expensive and often not available. Methods: We investigated solutions for a low-budget audio/video-feedback system based on consumer hardware and open source software. Results: Our results indicate that inexpensive, movable network cameras are suitable for high-quality video transmission including bidirectional audio transmission and an integrated streaming platform. In combination with a laptop, a WLAN connection, and the open source software iSpyServer, one or more cameras represent the easiest, yet fully functional audio/video-feedback system. For streaming purposes, the open source software VLC media player yields a comprehensive functionality. Using the powerful VideoLAN Media Manager, it is possible to generate a split-screen video comprising different video and audio streams. Optionally, this system can be augmented by analog audio hardware. In this paper, we present how these different modules can be set up and combined to provide an audio/video-feedback system for a simulation ambulance. Conclusions: We conclude that open source software and consumer hardware offer the opportunity to build a low-budget, feature-rich and high-quality audio/video-feedback system that can be used in realistic medical simulations.

Introduction Early defibrillation is an important factor of survival in cardiac arrest. However, novice resuscitators often struggle with cardiac arrest patients. We investigated factors leading to delayed defibrillation performed by final-year medical students within a simulated bystander cardiac arrest situation. Methods Final-year medical students received a refresher lecture and basic life support training before being confronted with a simulated cardiac arrest situation in a simulation ambulance. The scenario was analyzed for factors leading to delayed defibrillation. We compared the time intervals the participants needed for various measures with a benchmark set by experienced resuscitators. After training, the participants were interviewed regarding challenges and thoughts during the scenario. Results The median time needed for defibrillation was 158 s (n = 49, interquartile range: 107-270 s), more than six-fold of the benchmark time. The major part of total defibrillation time (49%; median, n = 49) was between onset of ventricular fibrillation and beginning to prepare the defibrillator, more specifically the time between end of preparation of the defibrillator and actual delivery of the shock, with a mean proportion of 26% (n = 49, SD = 17%) of the overall time needed for defibrillation (maximum 67%). Self-reported reasons for this delay included uncertainty about the next step to take, as reported by 73% of the participants. A total of 35% were unsure about which algorithm to follow. Diagnosing the patient was subjectively difficult for 35% of the participants. Overall, 53% of the participants felt generally confused. Conclusions Our study shows that novice resuscitators rarely achieve guideline-recommended defibrillation times. The most relative delays were observed when participants had to choose what to do next or which algorithm to follow, and thus i.e. performed extensive airway management before a life-saving defibrillation. Our data provides a first insight in the process of defibrillation delay and can be used to generate new hypotheses on how to provide a timely defibrillation.

Peer-assisted learning (PAL) has a long tradition and is nowadays implemented in the curricula of most medical faculties. Besides traditional areas of application like problem-based learning, anatomy, or CPR, more and more departments and institutes have established PAL as part of their everyday teaching. This narrative review provides some background information and basic definitions of PAL. It offers an overview on features and determinants as well as underlying learning theories and developments in PAL. In addition, motives for implementation are highlighted followed by a comparison of advantages and disadvantages. After outlining aspects of quality management including the training of tutors and the evaluation and acceptance of PAL formats, this review concludes with an outlook on how PAL can proceed into the future and where further research is necessary.

Objective: After passing of the National Competency-based Learning Objectives Catalogue in Medicine (Nationaler Kompetenzbasierter Lernzielkatalog Medizin, [NKLM, retrieved on 22.03.2016]), the German medical faculties must take inventory and develop their curricula. NKLM contents are expected to be present, but not linked well or sensibly enough in locally grown curricula. Learning and examination formats must be reviewed for appropriateness and coverage of the competences. The necessary curricular transparency is best achieved by systematic curriculum mapping, combined with effective change management. Mapping a complex existing curriculum and convincing a faculty that this will have benefits is not easy. Headed by Tübingen, the faculties of Freiburg, Heidelberg, Mannheim and Tübingen take inventory by mapping their curricula in comparison to the NKLM, using the dedicated web-based MERLIN-database. This two-part article analyses and summarises how NKLM curriculum mapping could be successful in spite of resistance at the faculties. The target is conveying the widest possible overview of beneficial framework conditions, strategies and results. Part I of the article shows the beneficial resources and structures required for implementation of curriculum mapping at the faculties. Part II describes key factors relevant for motivating faculties and teachers during the mapping process. Method: The network project was systematically planned in advance according to steps of project and change management, regularly reflected on and adjusted together in workshops and semi-annual project meetings. From the beginning of the project, a grounded-theory approach was used to systematically collect detailed information on structures, measures and developments at the faculties using various sources and methods, to continually analyse them and to draw a final conclusion (sources: surveys among the project participants with questionnaires, semi-structured group interviews and discussions, guideline-supported individual interviews, informal surveys, evaluation of target agreements and protocols, openly discernible local, regional or over-regional structure-relevant events). Results: The following resources and structures support implementation of curriculum mapping at a faculty: Setting up a coordination agency (≥50% of a full position; support by student assistants), systematic project management, and development of organisation and communication structures with integration of the dean of study and teaching and pilot departments, as well as development of a user-friendly web-based mapping instrument. Acceptance of the mapping was increased particularly by visualisation of the results and early insight into indicative results relevant for the department. Conclusion: Successful NKLM curriculum mapping requires trained staff for coordination, resilient communication structures and a user-oriented mapping database. In alignment with literature, recommendations can be derived to support other faculties that want to map their curriculum.