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Teaching in surgery, one of the classical vast clinical and main disciplines beside internal medicine, also needs to be associated with great attention in regard to a valuable final result at the end of the study of human medicine. Surgery is not only the subject of a large number of lectures; it also represents one third (four months) of compulsory internship (practical year - in German, „Praktisches Jahr"") at the end of the study of medicine. Therefore, medical teaching of students should always be a part of serious and steady attempts to optimize the curriculum and contents as a component of guiding activities that focus on substantial improvement of the study of medicine. In detail, the classical and traditionally established type of teaching, i.e., the (oral) lecture, requires to be further developed and reasonably completed by numerous interactive and practice-oriented teaching, learning and examining modalities (obligatory or facultative seminars/courses, training in [very] small groups of students, bed-side teaching, individual practical exercises within the SkillsLab, groups of young researchers, research projects in teaching, scientific publications on topics and recommendable experiences of teaching that include students, „Teach-the-teacher" projects etc.). Although many novel concepts have been inaugurated and considerable advances have been achieved, there is a steady need for further improvement. In the presented representative, but medical school-specific overview, the current complex surgical teaching concept, which has been continuously optimized over the last couple of years at the Otto-von-Guericke University Medical School with a University Hospital of Magdeburg (Germany) is described as a scientific and systematizing document as well as a manuscript associated with ongoing preparation of an institutional "Teaching Manual" on surgical teaching and training for medical students. It should - last but not least - provide the basis for a public discussion, which might hopefully and possibly result in further structural reforms of (surgical) teaching in the near future. [ABSTRACT FROM AUTHOR]

Background: In all health-care systems, decisions need to be made regarding allocation of available resources. Evidence is needed for these decisions, especially in low-income countries. We aimed to estimate how health-care resources provided by the public sector were used in Malawi during 2015-19 and to estimate the effects of strengthening health-care services., Methods: For this modelling study, we used the Thanzi La Onse model, an individual-based simulation model. The scope of the model was health care provided by the public sector in Malawi during 2015-19. Health-care services were delivered during health-care system interaction (HSI) events, which we characterised as occurring at a particular facility level and requiring a particular number of appointments. We developed mechanistic models for the causes of death and disability that were estimated to account for approximately 81% of deaths and approximately 72% of disability-adjusted life-years (DALYs) in Malawi during 2015-19, according to the Global Burden of Disease (GBD) estimates; we computed DALYs incurred in the population as the sum of years of life lost and years lived with disability. The disease models could interact with one another and with the underlying properties of each person. Each person in the Thanzi La Onse model had specific properties (eg, sex, district of residence, wealth percentile, smoking status, and BMI, among others), for which we measured distribution and evolution over time using demographic and health survey data. We also estimated the effect of different types of health-care system improvement., Findings: We estimated that the public-sector health-care system in Malawi averted 41·2 million DALYs (95% UI 38·6-43·8) during 2015-19, approximately half of the 84·3 million DALYs (81·5-86·9) that the population would otherwise have incurred. DALYs averted were heavily skewed to children aged 0-4 years due to services averting DALYs that would be caused by acute lower respiratory tract infection, HIV or AIDS, malaria, or neonatal disorders. DALYs averted among adults were mostly attributed to HIV or AIDS and tuberculosis. Under a scenario whereby each appointment took the time expected and health-care workers did not work for longer than contracted, the health-care system in Malawi during 2015-19 would have averted only 19·1 million DALYs (95% UI 17·1-22·4), suggesting that approximately 21·3 million DALYS (20·0-23·6) of total effect were derived through overwork of health-care workers. If people becoming ill immediately accessed care, all referrals were successfully completed, diagnostic accuracy of health-care workers was as good as possible, and consumables (ie, medicines) were always available, 28·2% (95% UI 25·7-30·9) more DALYS (ie, 12·2 million DALYs [95% UI 10·9-13·8]) could be averted., Interpretation: The health-care system in Malawi provides substantial health gains with scarce resources. Strengthening interventions could potentially increase these gains, so should be a priority for investigation and investment. An individual-based simulation model of health-care service delivery is valuable for health-care system planning and strengthening., Funding: The Wellcome Trust, UK Research and Innovation, the UK Medical Research Council, and Community Jameel., Competing Interests: Declaration of interests TBH receives research funding from the UK Medical Research Council, UK Research and Innovation, and The Wellcome Trust, paid to their institution. NA receives research funding from the UK Medical Research Council and the Bill & Melinda Gates Foundation, paid to their institution. VC receives research funding from the UK Medical Research Council and UK Research and Innovation, paid to their institution, and consulting fees from Source Market Access. MC receives research funding from The Wellcome Trust, paid to their institution. JHC receives research funding from UK Research and Innovation and The Wellcome Trust, paid to their institution. JC receives research funding from UK Research and Innovation and The Wellcome Trust, paid to their institution. EJ receives research funding from UK Research and Innovation and The Wellcome Trust, paid to their institution. BLJ receives research funding from the UK Medical Research Council and the UK Department for International Development, paid to their institution. SM receives research funding from UK Research and Innovation and The Wellcome Trust, paid to their institution, and consulting fees from The Global Fund to Fight AIDS, Tuberculosis and Malaria. MM receives research funding from UK Research and Innovation and The Wellcome Trust, paid to their institution. TC receives research funding from UK Research and Innovation and The Wellcome Trust, paid to their institution; receives consulting fees from the UN Economic Commission for Africa; and is on a data safety monitoring board for a trial of adolescent mental health in Nepal. ANP receives research funding from The Wellcome Trust, paid to their institution; receives research funding from the Bill & Melinda Gates Foundation, The Wellcome Trust, the US National Institutes of Health, the UK National Institute for Health and Care Research, and the EU, paid to their institution; and receives consulting fees from WHO. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Distal radius fractures are the third most frequent fractures in Germany. The decision for conservative treatment and the weighing up of surgical treatment need an exact consideration of the indications based on instability criteria and the extent of possible articular involvement. Indications for an emergency operation must be excluded. In cases of stable fractures or multimorbid patients in a poor general condition conservative treatment is indicated. The principles for a successful treatment are the precise reduction and stable retention in a plaster splint. In the further course, fractures are closely monitored by biplanar radiography. This is necessary to rule out a secondary displacement until the swelling of the soft tissues has subsided and the plaster splint is changed to a circular cast approximately 11 days after the traumatic event. The total duration of immobilization is 4 weeks. Physiotherapy and ergotherapy including adjacent joints, starts after 2 weeks of treatment. This treatment is extended to the wrist after removal of the circular cast., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: The final year is the last part of the study of human medicine and can be regarded as an essential period, during which medical knowledge should be consequently converted into medical expertise. Since the amendment of the medical license policy ("Ärztliche Approbationsordnung" [ÄApprO]) from July 17, 2012, in particular, since April 01, 2013, German universities have been obliged to provide a training schedule such as a "logbook" for this final year, specifically for the mandatory time periods within surgery and internal medicine. In preparation for this innovation, the German Medical School Association ("Medizinischer Fakultätentag") presented basic logbooks as consensus documents in June 2012. The portfolio for each surgery discipline and the Magdeburg Medical School, had been developed on the basis of individual initiatives and used for years, and was revised, specified and further developed into a "logbook of the medical study's final year" - specific for daily practice and the Magdeburg Medical School, and to the guidelines of the Medical School Association ("Medizinischer Fakultätentag"). The aim of the present commentary is i) to present the Magdeburg Medical School logbook and its clinical planning for cases, diagnoses and (surgical) interventions, as a summary of institutional experience and ii) to describe the mandatory surgical part of the "Magdeburg's final year of the study of human medicine"., Method: Narrative short overview including individual teaching experiences and topic-related references from "PubMed" using terms for literature search such as "surgical logbook", "practical year" and "medical teaching". The background and aims of the document's modifications are explained for each surgical discipline., Results: The "Logbook" is subdivided into 6 chapters: introduction, basics, statement of requirement, selected surgical diseases and interventions as well as information on final year-associated events and courses and instructions for creating the obligatory case report., Conclusion: The presented "Magdeburg Medical School Final Year Logbook of the Surgical Disciplines" has been created according to the requirements of the German Medical School Association ("Medizinischer Fakultätentag") and has been simultaneously adapted to the conditions and established medical teaching at the presenting Medical School. In particular, the medical students are given a document related to daily clinical practice, which allows them, within an overall teaching concept, to acquire indispensable expertise., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Student education focuses increasingly on case-related teaching. Often the consent of the patient to participate in student education is supposed to be provided. In most instances this is taken for granted - which it is not. Here, we investigated the motivation of the patients to participate in student education and influence factors using an anonymised survey., Material and Methods: The survey was performed from 2017/01/01 until 2017/04/30 and recruited inpatients of a university department of trauma surgery. The questionnaire contained 10 multiple choice questions targeting socio-demographic factors and the motivation of the patients to participate in different aspects of medical education. This was captured using a 5-point Likert scale. The electronic analysis of the questionnaire was performed with the program KLAUS (Blubbsoft GmbH, Berlin, Germany) after digitalizing the data., Results: In total 162 questionnaires were analysed. The patients were generally highly motivated to participate in bedside teaching and a student examination as well as consenting to the collection of pictures, videos and X-ray images or subsequent contact. Patient satisfaction was a principle factor. There was a positive correlation between the satisfaction with the motivation to participate in bedside teaching and a student examination as well as giving consent to the collection of pictures, videos and X-ray images or subsequent contact. There was significantly decreased motivation for participation in a lecture. In comparison, male patients had greater motivation to participate in a lecture. Moreover 40- to 49-year-old patients were significantly less motivated to participate in a lecture than 20- to 29-year-old and 50- to 59-year-old patients. Patient satisfaction had no influence on motivation to participate in a lecture., Conclusion: The motivation of the patients to participate in bedside teaching and a student examination as well as giving consent to the collection of pictures, videos and X-ray images or subsequent contact correlated with patient satisfaction. Socio-demographic factors are less important. Patient motivation to participate in a lecture is lower regardless of patient satisfaction., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Introduction: Simultaneous fracture of the acromion and coracoid process represents a double disruption of the superior shoulder suspensory complex (SSSC). To date, the two largest reported series have comprised five and eight cases. The aim of this study was to investigate the functional outcome in patients who sustained this rare injury and to provide a review of the relevant literature., Material and Methods: In this retrospective study, patients who were surgically treated between 2009 and 2014 were identified from medical records and the patients were asked to attend a follow-up examination. Functional results, measured as the Constant score and Disabilities of the Arm, Shoulder and Hand (DASH) score, were the main outcomes of the study., Results: A total of six patients underwent surgery for this type of double disruption of the SSSC. All but one patient suffered a high-impact trauma with other associated injuries. The coracoid fracture was classified as type I according to Ogawa in all cases, and the acromion fracture was type III according to Kuhn in 5 out of 6 cases. At least one of the fracture sites was stabilized. Of the patients one showed a concurrent lateral clavicle fracture, representing a third disruption of the SSSC, and another had a fracture of the medial third of the clavicle, representing a strut fracture. In these cases, two fracture sites were operated on. At an average follow-up period of 47 months all but one fracture had healed. In one patient, asymptomatic non-union of the acromion was found. The average DASH score was 22 points and the average Constant score was 74 points., Conclusion: This rare injury pattern is usually caused by high-impact trauma, and concomitant injuries frequently occur. Nevertheless, surgical stabilization of at least one of the fracture sites showed satisfactory functional results.