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Introduction Interprofessional training wards (ITWs) are implemented to provide medical students with a holistic and authentic health care experience to improve their clinical competencies. Controlled outcome studies assessing students’ competencies after ITW-training are uncommon. In this case-control study, we assessed final-year medical students who received ITW-training regarding entrustable professional activities (EPAs) and communicative as well as social competencies. Methods In March 2021, 32 final-year students, 16 with (ITW group) and 16 without (control group) a previous four-week placement on an ITW participated in a training simulating the first day of residency. The simulated patients assessed students’ communication and interpersonal skills for history taking with the ComCare index after every consultation. Twelve prospective EPAs were assessed by three senior physicians after watching videos of the students’ case presentations. Results While baseline characteristics and ComCare index ratings were not significantly different between the two groups, the overall mean entrustment level for the 12 EPAs was significantly higher (p

Objectives To develop and validate a short instrument to assess undergraduate medical students’ communication and interpersonal skills in videographed history taking situations with simulated patients. Methods Sixty-seven undergraduate medical students participating in an assessment including videographed physician-patient encounters for history taking with five simulated patients were included in this study. The last video of each participant’s consultation hour was rated by two independent assessors with the eight-item ComCare index for assessment of communication and interpersonal skills newly designed for the external rater perspective (ComCareR). We compared the sum scores of the ComCareR with ratings of the same videos with the Kalamazoo Communication Skills Assessment Form from an observational perspective (KCSAFd-video) and the Global Rating scale (GR), which also measure communication and interpersonal skills. Results The ComCareR showed an excellent interrater reliability (ICC = .85). We found a small but significant correlation with the KCSAFd-video Interpersonal Competence (ρ = .34, 95% CI [.10,.54]) and a high positive correlation with the GR (ρ = .59, 95% CI [.40,.73]). Conclusions The ComCareR is a valid and brief index for holistic assessment of communication and interpersonal skills in physician-patient encounters. Practice implications The ComCareR can be used for quick rater-based assessment of physicians’ communication and interpersonal skills.

Background: Communication and interpersonals skills are important qualities of professionalism in medicine. In medical curricula, they are usually acquired in communication trainings and assessed in OSCEs. Studies show correlations as well as differences between communication ratings of examiners and simulated patients. In our study, simulated patients assessed medical students’ communication and interpersonal skills after a consultation hour from the internal and the external patient perspective. Methods: In December 2019, 52 final-year medical students participated in a consultation hour as part of a simulated first day of residency assessment. They were assessed twice with a questionnaire for communication and interpersonal skills (ComCare) by the simulated patients: directly after each consultation from the internal perspective of the patient’s view (internal perspective) and four month later from the 208 consultation videos from an external perspective of the patient’s view (external perspective). All eight ComCare items were assessed on a five-point Likert scale (1=full disagreement to 5=full agreement). Differences between the item means of internal and external perspective were examined by paired t-tests. Results: Overall, significantly higher ratings were found for all ComCare items from the external perspective except for the item “Interest”. Ratings for the items “Language” and “Listening” were significantly higher from the external perspective for all simulated patients. Significantly higher ratings for all items from the external perspective were observed for two simulated patients. Conclusion: Simulated patients’ ratings after a conversation seem to represent a more authentic view on students’ communication and interpersonal skills because of the emotionally experienced situation. The evaluation of those skills from a simulated patient perspective could be a valuable complement to communication ratings by examiners., Hintergrund: Kommunikative und zwischenmenschliche Fähigkeiten sind wichtige Eigenschaften der medizinischen Professionalität. In medizinischen Curricula werden sie üblicherweise in Kommunikationstrainings erworben und in OSCEs geprüft. Studien zeigen sowohl Korrelationen als auch Unterschiede zwischen den Kommunikationsbewertungen von Prüfer*innen und simulierten Patient*innen. In unserer Studie bewerteten simulierte Patient*innen die kommunikativen und interpersonellen Fähigkeiten von Medizinstudierenden nach einer Sprechstunde aus der internen und externen Patient*innenperspektive. Methoden: Im Dezember 2019 nahmen 52 Medizinstudierende im Praktischen Jahr an einer Sprechstunde teil, die zum Training eines simulierten ersten Arbeitstages in der ärztlichen Weiterbildung gehörte. Sie wurden zweimal mit einem Fragebogen für kommunikative und interpersonelle Fähigkeiten (ComCare) von den simulierten Patient*innen bewertet: direkt nach jeder Konsultation aus der internen Perspektive der Patient*innensicht (Innenperspektive) und vier Monate später anhand der 208 Konsultationsvideos aus der externen Perspektive der Patient*innensicht (Außenperspektive). Alle acht ComCare-Items wurden auf einer fünfstufigen Likert-Skala bewertet (1=volle Ablehnung bis 5=volle Zustimmung). Unterschiede zwischen den Item-Mittelwerten der Innen- und Außenperspektive wurden mittels gepaarter t-Tests untersucht. Ergebnisse: Insgesamt wurden für alle ComCare-Items, außer für das Item „Interesse“, signifikant höhere Bewertungen aus der Außenperspektive gefunden. Die Bewertungen für die Items „Sprache“ und „Zuhören“ waren aus der Außenperspektive für alle simulierten Patient*innen signifikant höher. Signifikant höhere Bewertungen für alle Items aus der Außenperspektive wurden bei zwei simulierten Patient*innen beobachtet. Schlussfolgerungen: Die Bewertungen von simulierten Patient*innen nach einem Konsultationsgespräch scheinen aufgrund der emotional erlebten Situation eine authentischere Sicht auf die kommunikativen und interpersonellen Fähigkeiten der Studierenden darzustellen. Die Bewertung dieser Fähigkeiten aus der Perspektive simulierter Patient*innen könnte eine wertvolle Ergänzung zu den Kommunikationsbewertungen durch Prüfer*innen darstellen., GMS Journal for Medical Education; 38(4):Doc82

Background: Physicians’ communicative and social competences are highly relevant for doctor-patient relationships. Simulation-based learning is frequently used to provide students with learning experiences resembling realistic medical situations. This study aims to assess communication and interpersonal skills in medical students after simulated consultations with a newly designed short questionnaire. Methods: In 2019, 103 final year students participated in a simulated consultation hour seeing four simulated patients. Communicative and social competences were assessed by a questionnaire including items for communication (Com) and interpersonal (Care) skills. The questionnaire was used by the simulated patients (ComCareP) after each consultation and as self-assessment by the students (ComCareD) after the fourth consultation. An explorative factor analysis was performed and the results of ComCareP and ComCareD were compared with respect to students’ sex and advancement in their final year. Results: All ComCareP items loaded on one factor, which explained 50.7% of the variance. The participants self-assessed their communication and interpersonal skills significantly better than the simulated patients. No significant differences were found for students’ sexes or advancement in their final year except for the item “responding to patients’ needs satisfactorily” which was significantly lower in students at the end of their final year. Patients’ general “satisfaction with the consultation” was higher while physicians’ general “satisfaction with the consultation” was lower than their total ComCare mean score. The general satisfaction with the consultation showed a significant positive correlation with both ComCares’ total mean scores. Conclusion: The ComCare measures communication and interpersonal skills as one factor. It can be used directly after consultations and shows significant positive correlation with the general satisfaction with a consultation. Since simulated patients’ satisfaction with the consultation was higher than their ComCare score, other factors than communication and interpersonal skills could play a role for patient satisfaction with a conversation and need to be further investigated., Hintergrund: Die kommunikativen und sozialen Kompetenzen Mediziner*innen sind für die Beziehung von Ärzt*innen und Patient*innen von großer Relevanz. Simulationsbasiertes Lernen wird häufig eingesetzt, um den Studierenden Lernerfahrungen zu vermitteln, die realistischen medizinischen Situationen ähneln. Diese Studie zielt darauf ab, die kommunikativen und sozialen Kompetenzen von Medizinstudierenden im Anschluss an simulierte Konsultationen mit einem neu gestalteten kurzen Fragebogen zu beurteilen. Methoden: Im Jahr 2019 nahmen 103 Studierende während des Praktischen Jahres (PJ) an einer simulierten Sprechstunde mit vier simulierten Patient*innen teil. Die kommunikativen und sozialen Kompetenzen wurden anhand eines Fragebogens bewertet, welcher Items für Kommunikations- (Com) und zwischenmenschliche (Care) Fähigkeiten enthielt. Der Fragebogen wurde von den simulierten Patient*innen (ComCareP) nach jeder Konsultation und als Selbsteinschätzung der Studierenden (ComCareD) nach der vierten Konsultation verwendet. Es wurde eine explorative Faktorenanalyse durchgeführt und die Ergebnisse von ComCareP und ComCareD wurden im Hinblick auf das Geschlecht und den Fortschritt der Studierenden im PJ verglichen. Ergebnisse: Alle ComCareP-Items luden auf einen Faktor, was 50,7% der Varianz erklärte. Die Teilnehmer*innen bewerteten ihre Kommunikations- und zwischenmenschlichen Fähigkeiten signifikant besser als die simulierten Patient*innen. Es wurden keine signifikanten Unterschiede in Bezug auf das Geschlecht oder den Fortschritt der Studierenden im PJ gefunden, mit Ausnahme des Items "zufriedenstellend auf die Bedürfnisse der Patient*innen eingehen", das bei den Studierenden am Ende des PJs signifikant niedriger war. Die allgemeine „Zufriedenheit der Patient*innen mit dem Erstgespräch“ war höher, während die allgemeine „Zufriedenheit der Ärzt*innen mit dem Erstgespräch“ niedriger war als der Gesamtmittelwert von ComCare. Die allgemeine „Zufriedenheit mit dem Erstgespräch“ zeigte eine signifikant positive Korrelation mit den Gesamtmittelwerten beider ComCare Bögen. Schlussfolgerung: Der ComCare misst Kommunikation und zwischenmenschliche Fähigkeiten als einen Faktor. Er kann direkt nach einer Konsultation eingesetzt werden und zeigt eine signifikant positive Korrelation mit der allgemeinen Zufriedenheit mit einer Beratung. Da die Zufriedenheit der simulierten Patient*innen mit dem Erstgespräch höher war als deren ComCare-Gesamtwert, könnten neben der Kommunikation und den zwischenmenschlichen Fähigkeiten noch andere Faktoren eine Rolle für die Zufriedenheit der Patient*innen mit dem Erstgespräch spielen und müssen weiter untersucht werden., GMS Journal for Medical Education; 38(3):Doc68

Objectives Worldwide, not only the number of female medical students, but also of female surgeons increases. Simultaneously, younger generations take a closer look to their work-life balance. With this in mind, it seems necessary to evaluate the expectations of female surgeons in particular with respect to pregnancy during their surgical career. Methods Therefore, a nationwide survey was conducted in Germany from July to December 2016 under the auspices of the German Society of Surgery as well as the Professional Board of German Surgeons. The questionnaire involved 2,294 female surgeons and 1,843 complete records were evaluated. Results Of the analyzed answers, 62% of the women (n=781) were operating during pregnancy. The joy of surgery (91.6%), followed by team spirit (57.1%), were the main motivations to perform operations while pregnant. Operative activity decreased from 30.8% in the first 3 months of pregnancy to 21.5% during the last three months. Regarding the possible complaints, e.g., leg edema, back pain, premature labor and vaginal bleeding, there were no significant differences between the women with or without activity in the operating room. Sick leave due to pregnancy (1–10 days) was stated by 40.4% of respondents. Conclusion Despite strong legal regulations for pregnant surgeons, the survey showed that most female surgeons are eager to operate despite their pregnancy. The results also demonstrate no significant differences regarding complications during pregnancy- or pregnant-dependent absence from work. Hospitals and surgical departments are asked to establish proper working conditions for pregnant surgeons and pregnancy should not be an obstacle for a career in surgery.

Background: Competence-based assessment formats in medical education usually focus on individual facets of competence (FOCs). The concept of 'Entrustable Professional Activities' (EPAs) encompasses supervisors' decisions on which level of supervision a trainee requires to perform a professional activity including several FOCs. How the different FOCs as perceived by clinician raters contribute to entrustment decisions is yet unclear.Objective: How do FOC perceptions relate to entrustment-decisions?Methods: Sixty-seven advanced medical students participated in an assessment simulating the first day of a resident physician. Participants were rated by supervisors for seven FOCs and twelve EPAs.Results: There was a positive correlation between FOC and EPA scores. Each EPA displayed a different correlation pattern with FOC ratings.Discussion: For most EPAs high levels of entrustment were associated with high ratings for selected FOCs. The results are in alignment with the assumption that each EPA encompasses a different set of FOCs.Conclusions: In our simulated workplace-based assessment, entrustment decisions for EPAs reflect the FOCs observed in a trainee. Thus, assessment of FOCs alongside with EPA ratings could add to the understanding of factors contributing to entrustment decisions.

Medical students are supposed to achieve a certain level of entrustment in different professional activities including relevant core and medical competences at the end of their undergraduate studies. To measure relevant facets of competence (FOC) and to evaluate entrusted professional activities (EPA), an assessment, which simulated a first day of residency in a hospital, was carried out twice. In total, 119 students participated once and 11 students participated twice. Linear regression models showed an influence of FOC rating in “Verbal communication with colleagues and supervisors” and “Structure, work planning and priorities” on EPA ratings. Students who participated twice showed significant improvements in these two FOCs and in two EPAs related to these FOCs. The FOC “Responsibility” and the personality characteristics “Extraversion” and “Conscientiousness” positively influenced more difficult entrustment decisions, while “Agreeableness” had a negative influence on their entrustment level. Our assessment format including the FOC and EPA instruments shows good validity and provides important aspects of competence and professionalism, which should be included in teaching and feedback during the final year of undergraduate medical education.

Background Assessing competence of advanced undergraduate medical students based on performance in the clinical context is the ultimate, yet challenging goal for medical educators to provide constructive alignment between undergraduate medical training and professional work of physicians. Therefore, we designed and validated a performance-based 360-degree assessment for competences of advanced undergraduate medical students. Methods This study was conducted in three steps: 1) Ten facets of competence considered to be most important for beginning residents were determined by a ranking study with 102 internists and 100 surgeons. 2) Based on these facets of competence we developed a 360-degree assessment simulating a first day of residency. Advanced undergraduate medical students (year 5 and 6) participated in the physician’s role. Additionally knowledge was assessed by a multiple-choice test. The assessment was performed twice (t1 and t2) and included three phases: a consultation hour, a patient management phase, and a patient handover. Sixty-seven (t1) and eighty-nine (t2) undergraduate medical students participated. 3) The participants completed the Group Assessment of Performance (GAP)-test for flight school applicants to assess medical students‘ facets of competence in a non-medical context for validation purposes. We aimed to provide a validity argument for our newly designed assessment based on Messick’s six aspects of validation: (1) content validity, (2) substantive/cognitive validity, (3) structural validity, (4) generalizability, (5) external validity, and (6) consequential validity. Results Our assessment proved to be well operationalised to enable undergraduate medical students to show their competences in performance on the higher levels of Bloom’s taxonomy. Its generalisability was underscored by its authenticity in respect of workplace reality and its underlying facets of competence relevant for beginning residents. The moderate concordance with facets of competence of the validated GAP-test provides arguments of convergent validity for our assessment. Since five aspects of Messick’s validation approach could be defended, our competence-based 360-degree assessment format shows good arguments for its validity. Conclusion According to these validation arguments, our assessment instrument seems to be a good option to assess competence in advanced undergraduate medical students in a summative or formative way. Developments towards assessment of postgraduate medical trainees should be explored.

Background The clinical reasoning process, which requires biomedical knowledge, knowledge about problem-solving strategies, and knowledge about reasons for diagnostic procedures, is a key element of physicians’ daily practice but difficult to assess. The aim of this study was to empirically develop a Clinical Reasoning Indicators-History Taking-Scale (CRI-HT-S) and to assess the clinical reasoning ability of advanced medical students during a simulation involving history taking. Methods The Clinical Reasoning Indictors-History Taking-Scale (CRI-HT-S) including a 5-point Likert scale for assessment was designed from clinical reasoning indicators identified in a qualitative study in 2017. To assess indicators of clinical reasoning ability, 65 advanced medical students (semester 10, n = 25 versus final year, n = 40) from three medical schools participated in a 360-degree competence assessment in the role of beginning residents during a simulated first workday in hospital. This assessment included a consultation hour with five simulated patients which was videotaped. Videos of 325 patient consultations were assessed using the CRI-HT-S. A factor analysis was conducted and the students’ results were compared according to their advancement in undergraduate medical training. Results The clinical reasoning indicators of the CRI-HT-S loaded on three factors relevant for clinical reasoning: 1) focusing questions, 2) creating context, and 3) securing information. Students reached significantly different scores (p p Conclusions The newly developed CRI-HT-S worked well for quantitative assessment of clinical reasoning indicators during history taking. Its three-factored structure helped to explore different aspects of clinical reasoning. Whether the CRI-HT-S has the potential to be used as a scale in objective structured clinical examinations (OCSEs) or in workplace-based assessments of clinical reasoning has to be investigated in further studies with larger student cohorts.

Background Physicians need a set of specific competences to perform well in interprofessional teams in their first year of residency. These competences should be achieved with graduation from medical school. Assessments during undergraduate medical studies are mostly rated by supervisors only. The aim of our study was to compare the rating of core facets of competence of medical students late in their undergraduate training as well as the rating confidence between three different groups of assessors (supervisors, residents, and nurses) in an assessment simulating the first day of residency. Methods Sixty-seven advanced medical students from three different medical schools (Hamburg, Oldenburg and Munich) participated in a 360-degree assessment simulating the first working day of a resident. Each participant was rated by three assessors – a supervisor, a resident and a nurse – in seven facets of competence relevant for the first year of residency: (1) responsibility, (2) teamwork and collegiality, (3) knowing and maintaining own personal bounds and possibilities, (4) structure, work planning and priorities, (5) coping with mistakes, (6) scientifically and empirically grounded method of working, and (7) verbal communication with colleagues and supervisors. Means of all assessed competences and confidences of judgement of the three rating groups were compared. Additionally, correlations between assessed competences and confidence of judgement within each group of raters were computed. Results All rating groups showed consistent assessment decisions (Cronbach’s α: supervisors = .90, residents = .80, nurses = .78). Nurses assessed the participants significantly higher in all competences compared to supervisors and residents (all p ≤ .05) with moderate and high effect sizes (d = .667–1.068). While supervisors’ and residents’ ratings were highest for “teamwork and collegiality”, participants received the highest rating by nurses for “responsibility”. Competences assessed by nurses were strongly positively correlated with their confidence of judgment while supervisors’ assessments correlated only moderately with their confidence of judgment in two competences. Conclusions Different professional perspectives provide differentiated competence ratings for medical students in the role of a beginning resident. Rating confidence should be enhanced by empirically derived behavior checklists with anchors, which need to be included in rater training to decrease raters’ subjectivity. Electronic supplementary material The online version of this article (10.1186/s12909-019-1473-6) contains supplementary material, which is available to authorized users.

Background Residents face demanding situations on the job and have been found to perceive high levels of strain. Medical students also reported a high degree of strain and even depressive tendencies when entering their clinical rotations. The aim of this study was to explore the perceived strain of medical students from different undergraduate curricula and at different stages of academic advancement during different phases of an assessment simulating a resident’s first day in hospital. Methods Sixty-seven undergraduate medical students participated in the following three phases of the assessment in the role of a resident: a consultation hour with five simulated patients, a management phase with interprofessional contact, and a patient handover with a colleague. They completed the Strain Perception Questionnaire (STRAIPER) after each phase. Students from different undergraduate curricula (VI: vertically integrated, n = 35 versus non-VI: not vertically integrated, n = 26) and different academic advancement (semester 10, n = 26 versus final year, n = 41) were compared. Results All students showed the highest strain level after the management phase compared to the consultation hour and the handover. Medical students from a non-VI curriculum felt significantly more strain in the dimension of agitation (p

Background Frameworks like the CanMEDS model depicting professional roles and specific professional activities provide guidelines for postgraduate education. When medical graduates start their residency, they should possess certain competencies related to communication, management and professionalism while other competencies will be refined during postgraduate training. Our study aimed to evaluate the relevance of different competencies for a first year resident required for entrustment decision from the perspective of physicians from medical faculties with different undergraduate medical curricula. Methods Nine hundred fifty-two surgeons and internists from three medical schools with different undergraduate medical curricula were invited to rank 25 competencies according to their relevance for first year residents. The rankings were compared between universities, specialties, physicians’ positions, and gender. Results Two hundred two physicians participated, 76 from Hamburg University, 44 from Oldenburg University, and 82 from Technical University Munich. No significant differences were found regarding the top 10 competencies relevant for first year residents between the universities. ‘Responsibility’ was the competency with the highest rank overall. Internists ranked ‘Structure, work planning and priorities’ higher while surgeons ranked ‘Verbal communication with colleagues and supervisors’ higher. Consultants evaluated ‘Active listening to patients’ more important than department directors and residents. Female physicians ranked ‘Verbal communication with colleagues and supervisors’ and ‘Structure, work planning and priorities’ significantly higher while male physicians ranked ‘Scientifically and empirically grounded method of working’ significantly higher. Conclusions Physicians from universities with different undergraduate curricula principally agreed on the competencies relevant for first year residents. Some differences between physicians from different positions, specialties, and gender were found. These differences should be taken into account when planning competence-based postgraduate education training programs.

Eine familienfreundliche und gendergerechte Chirurgie – wie soll das gehen? Das Projekt FamSurg bietet Antworten, damit Vereinbarkeit von Familie und Beruf in diesem Fachgebiet kein Widerspruch bleiben muss.