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Item does not contain fulltext, BACKGROUND: Venous leg ulcers (VLU) have a prevalence of 1-2% in developed countries, and affected patients are severely and long-term impaired in daily activities, work, and social participation. Evidence-based outpatient treatment based on compression therapy is frequently not implemented. The "Ulcus Cruris Care" project was established to develop a disease management concept to improve outpatient treatment for patients with VLU in German primary care. For this purpose, a multifaceted intervention was conceived consisting of an online training for general practitioners and medical assistants, standardized treatment recommendations, e-learning and print-based information for patients, and a software support for case management. The main aims of the Ulcus Cruris Care intervention are to promote standardized treatment according to current scientific knowledge, to facilitate case management for VLU patients exerted by medical assistants, and to support patient education and participation in the treatment process. The UCC trial was designed to evaluate the effectiveness of the Ulcus Cruris Care intervention. METHODS: The UCC trial is a prospective cluster-randomized controlled multicenter trial. Fifty GP practices are intended to be recruited and randomized 1:1 to intervention or control arm. Patients with venous leg ulcers will be recruited by participating GP practices, to include a total of 63 patients in each arm. The primary outcome is time to ulcer healing. Secondary outcomes comprise number and sizes of ulcers, recurrence, pain intensity according to the visual analog scale, health-related quality of life according to EQ-5D-5L, depressiveness according to Patient Health Questionnaire (PHQ-9), patient satisfaction according to the Patient Assessment of Chronic Illness Care (PACIC-5A) query, and adherence to VLU treatment. The outcome analysis of the UCC trial is accompanied by a health economic analysis and a process evaluation. DISCUSSION: The UCC trial will eva

Background: In Germany, the (model) regulation for postgraduate medical education 2018, the professional codes of conduct of the regional medical councils and the health professions chamber laws of the federal states are the formal basis of postgraduate medical education, but say little about its structure, processes and results. The World Federation for Medical Education (WFME) has developed global standards for improving the quality of postgraduate medical education and published them in a revised edition in 2015. A German version which takes the specifics of medical training in Germany into account has not been published to date.Objective: The Committee for Postgraduate Medical Education (PGME) of the Society for Medical Education (GMA) has set itself the goal of firstly translating the WFME standards into German and secondly making recommendations for physicians with a license for post-graduate training (PLT) and training agents (TA) in clinics and practices which have been adapted to the German context.Methods: The WFME standards were translated into German by a working group of the GMA Committee for PGME, the terminology adapted to PGME in Germany and checked by an interdisciplinary panel of experts made up of 9 members of the committee. In a second step, the WFME basic standards and quality standards for PGME relevant to PLTs and TAs in Germany were iteratively determined by this panel of experts using the Nominal Group Technique (NGT) and compiled in the form of recommendations. Results: The translation of the WFME guidelines was approved by the expert group without any changes to the content, taking into account the terminological system of PGME in Germany. In a second step, 90 standards were identified which were considered helpful for PGME in Germany, especially for PLTs and TAs (such as development of a professional identity, a more patient-centered approach or support of self-directed learning). Care was taken to only give recommendations which can be i, Hintergrund: Die (Muster-)Weiterbildungsordnung 2018, die Berufsordnungen der Landesärztekammern und die Heilberufe-Kammergesetze der Bundesländer sind formale Grundlagen der ärztlichen Weiterbildung in Deutschland, sagen jedoch wenig zu deren Struktur, Prozessen und Ergebnissen aus. Die World Federation for Medical Education (WFME) hat globale Standards für die Qualitätsverbesserung der ärztlichen Weiterbildung entwickelt und in einer überarbeiteten Neuauflage im Jahr 2015 publiziert. Eine Fassung in deutscher Sprache unter Berücksichtigung der ärztlichen Weiterbildung in Deutschland ist bisher nicht publiziert.Zielsetzung: Der Ausschuss Weiterbildung der Gesellschaft für Medizinische Ausbildung (GMA) hat sich zum Ziel gesetzt, erstens die WFME Standards ins Deutsche zu übersetzen und zweitens Empfehlungen für Weiterbildungsbefugte (WBBef) und Weiterbildungsbeauftragte (WBBea) in Klinik und Praxis zu geben, die dem Kontext in Deutschland angepasst sind.Methoden: Die WFME Standards wurden von einer Arbeitsgruppe des GMA Ausschusses Weiterbildung ins Deutsche übersetzt, begrifflich an die ärztliche Weiterbildung in Deutschland adaptiert und von einer interdisziplinären Expertenrunde aus 9 Mitgliedern des Ausschusses geprüft. In einem zweiten Schritt wurden von dieser Expertenrunde mittels der nominalen Gruppentechnik (NGT) iterativ die für WBBef und WBBea in Deutschland relevanten WFME Grundstandards und Standards für eine Qualitätsentwicklung der ärztlichen Weiterbildung herausgearbeitet und in Form von Empfehlungen zusammengestellt. Ergebnisse: Die Übersetzung der WFME Richtlinien wurde unter Berücksichtigung der begrifflichen Systematik der Weiterbildung in Deutschland ohne inhaltliche Änderungen von der Expertengruppe konsentiert. In einem zweiten Schritt wurden 90 Standards identifiziert, die für die ärztliche Weiterbildung in Deutschland im Besonderen für WBBef und WBBea, als hilfreich eingeschätzt wurden (wie bspw. Entwicklung einer professionellen Identität

Contains fulltext : 243547.pdf (Publisher’s version ) (Open Access), BACKGROUND: During the first wave of the COVID-19 pandemic various ambulatory health care models (SARS-CoV-2 contact points: Subspecialised Primary Care Practices, Fever Clinics, and Special Places for Corona-Testing) were organised in a short period in Baden-Wuerttemberg, a region in Southern Germany. The aim of these SARS-CoV-2 contact points was to ensure medical treatment for patients with (suspected) and without SARS-CoV-2 infection. The present study aimed to assess the beliefs and practices of primary care physicians who either led a Subspecialised Primary Care Practice or a Primary Care Practice providing care as usual in Baden-Wuerttemberg during the first wave of the COVID-19 pandemic. METHODS: This cross-sectional study was based on a paper-based questionnaire in primary care physicians during the first wave of the pandemic. Participants were identified via the web page of the Association of Statutory Health Insurance Physicians Baden-Wuerttemberg. The questionnaire was distributed in June and July 2020. It measured knowledge, practices, self-efficacy and fears towards SARS-CoV-2, using newly developed questions. Data was descriptively analysed. RESULTS: One hundred fifty-five participants (92 leads of SARS-CoV-2 contact points/ 63 leads of primary care practices) completed the questionnaire. Out of 92 leads of SARS-CoV-2 contact points 74 stated to lead n Subspecialised Primary Care Practices. About half participants of both groups did not fear an own infection with the novel virus (between 50.8% and 62.2%), however about 75% feared financial loss. Knowledge was gained using various sources; main sources were the Association of Statutory Health Insurance Physicians (between 82.5% and 83.8%) and the German Society for Hygiene and Microbiology (RKI) (between 88.9% and 95.9%). Leads of Subspecialised Primary Care Practice felt more confident to perform anamnestic/diagnostic procedures (p < 0.001). The same was found for the confidence level regarding decisi

Contains fulltext : 238670.pdf (Publisher’s version ) (Open Access), BACKGROUND: Growing prevalence of chronic diseases is a rising challenge for healthcare systems. The Primary Care Practice-Based Care Management (PraCMan) programme is a comprehensive disease management intervention in primary care in Germany aiming to improve medical care and to reduce potentially avoidable hospitalisations for chronically ill patients. OBJECTIVES: This study aimed to assess the effect of PraCMan on hospitalisation rate and related costs. METHODS: A retrospective propensity-score matched cohort study was performed. Reimbursement data related to patients treated in general practices between 1st July 2013 and 31st December 2017 were supplied by a statutory health insurance company (AOK Baden-Wuerttemberg, Germany) to compare hospitalisation rate and direct healthcare costs between patients participating in the PraCMan intervention and propensity-score matched controls following usual care. Outcomes were determined for the one-year-periods before and 12 months after beginning of participation in the intervention. RESULTS: In total, 6148 patients participated in the PraCMan intervention during the observation period and were compared to a propensity-score matched control group of 6148 patients from a pool of 63,446 eligible patients. In the one-year period after the intervention, the per-patient hospitalisation rate was 8.3% lower in the intervention group compared to control (p = 0.0004). Per-patient hospitalisation costs were 9.4% lower in favour of the intervention group (p = 0.0002). CONCLUSION: This study showed that the PraCMan intervention may be associated with a lower rate of hospital admissions and hospitalisation costs than usual care. Further studies may assess long-term effects of PraCMan and its efficacy in preventing known complications of chronic diseases.

Objective: Caring for refugee patients places special demands on health professionals. To date, medical students in Germany have rarely been systematically prepared for these challenges. This article reports on the development, conceptualisation, implementation, evaluation, and relevance of a multidisciplinary elective for medical students in the clinical study phase.Methodology: The course content was developed based on a needs-assessment among medical students and in cooperation with medical colleagues working in the field of refugee care. The course consisted of a seminar with medical, legal, administrative and socio-cultural learning content as well as a field placement in the medical outpatient clinic of the local reception centre for asylum seekers, which was accompanied by a systematic reflection process. The evaluation concept contained qualitative and quantitative elements. Results: 123 students completed the elective over six semesters (summer 2016 through to winter 2018). It was continuously evaluated and further developed. The students reported learning progress mainly in the following areas: Legal foundations of the asylum procedure and health care entitlements for asylum seekers; multi-perspectivity through multidisciplinarity as well as professional, ethical, interpersonal, and political insights gained through the practical experience.Summary: To prepare students for the complex challenges to be faced in medical care for refugees, a structured, multidisciplinary teaching programme, which combines theory, practice and reflection helps to foster insights into the many facets of this field of activity. The questions students brought to the seminar, the course contents and evaluation results are intended to inspire the design and implementation of similar courses at other universities., Zielsetzung: Die medizinische Versorgung Geflüchteter stellt besondere Anforderungen an Gesundheitsfachkräfte. Medizinstudierende in Deutschland werden bisher kaum systematisch auf diese vorbereitet. Im Beitrag wird über die Entwicklung, Konzeption, Umsetzung, Evaluation und Bedeutung eines multidisziplinären Wahlfachs für Medizinstudierende im klinischen Studienabschnitt berichtet.Methodik: Die Entwicklung der Kursinhalte erfolgte auf Grundlage von Bedarfsanalysen bei Medizinstudierenden und in Kooperation mit in der Flüchtlingsversorgung tätigen ärztlichen Kollegen. Die Lehrveranstaltung bestand aus einem Seminar mit medizinischen, juristischen, administrativen und sozio-kulturellen Lerninhalten sowie einer systematisch reflektierten Hospitation in der medizinischen Ambulanz des lokalen Ankunftszentrums für Asylsuchende. Das Evaluationskonzept enthielt qualitative und quantitative Elemente. Ergebnisse: Ab dem Sommersemester 2016 bis einschließlich Wintersemester 2018 absolvierten 132 Studierende das Wahlfach. Es wurde fortlaufend evaluiert und weiterentwickelt. Mehrheitlich werden vor allem Lernfortschritte in folgenden Bereichen berichtet: Rechtliche Grundlagen des Asylverfahrens und der Versorgung; Mehrperspektivität durch Multidisziplinarität sowie Erkenntnisse durch die Praxiserfahrung im fachprofessionellen, berufsethischen, zwischenmenschlichen und politischen Bereich.Zusammenfassung: Mittels eines strukturierten, multidisziplinären Lehrangebotes, welches Theorie-, Praxis- und Reflexionselemente verknüpft, kann Studierenden ein Einblick in die vielen Facetten der medizinischen Versorgung Geflüchteter ermöglicht werden, um sie auf die komplexen Herausforderungen dieses Handlungsfeldes vorzubereiten. Die Studierendenfragen, Kursinhalte und Auswertungsergebnisse können Anregung für die Implementierung ähnlicher Lehrveranstaltungen geben.

Aim: The seminar program of the KWBW Verbundweiterbildungplus® is offered by the Competence Center for Postgraduate Medical Education in Baden-Württemberg (KWBW) for physicians specializing in general practice (GP trainees). Attendance is a voluntary one comprised of 48 curricular units of 45 minutes each per GP trainee. This seminar program is meant to be attended in parallel to the postgraduate medical education in clinic or practice. The intention behind this project was to develop objectives, topics and a feasible structure for a seminar curriculum while taking time and financial constraints into account.Method: The Kern cycle was applied in an open, modified nominal group consensus technique in the form of an iterative process. Participating were 17 experts from the departments of general practice at the universities in Freiburg, Heidelberg, Tuebingen and Ulm, plus a pediatrician.Results: The main objective was defined as empowering GP trainees to independently provide high-quality primary care, including in rural areas. A basic curriculum was defined based on relevant frameworks, such as the 2018 Model Regulation for Postgraduate Medical Training (Musterweiterbildungsordnung/MWBO) and the Competency-based Curriculum General Practice (KCA). Overall, the seminar curriculum has 62 basic modules with 2 curricular units each (e.g. Basic Principles of General Practice, Chest Pain, Billing) and another 58 two-unit modules on variable topics (e.g. digitalization, travel medicine) adding up to 240 (124+116) curricular units. A blueprint with a rotation schedule for all of the teaching sites in Baden-Württemberg allows regular attendance by n=400 GP trainees over a period of five years, with individual variability in terms of program length.Conclusion: The model entails a five-year, flexible program to accompany the postgraduate medical education in general practice which can also be implemented in multicenter programs and those with high enrollments. The model's focus, Zielsetzung: Das Seminarprogramm der KWBW Verbundweiterbildungplus® (Kompetenzzentrum Weiterbildung Baden-Württemberg) für Ärzt*innen in Weiterbildung Allgemeinmedizin (ÄiW AM) beinhaltet jährlich weiterbildungsbegleitend und auf freiwilliger Basis 48 Unterrichtseinheiten (UE) à 45 Min pro AiW AM. Intention des Projekts war, unter Berücksichtigung der zeitlichen und finanziellen Limitationen Ziele, Themen und eine umsetzbare Struktur eines Seminarcurriculums zu entwickeln. Methodik: Der Kern-Zyklus wurde in einem offenen, modifizierten nominalen Gruppenkonsensusverfahren in einem iterativen Prozess angewendet. Insgesamt waren 17 Expert*innen aus den allgemeinmedizinischen universitären Einrichtungen Freiburg, Heidelberg, Tübingen und Ulm sowie ein Pädiater beteiligt. Ergebnisse: Als Hauptziel wurde definiert, ÄiW AM zu befähigen, allgemeinmedizinisch selbständig und in hoher Qualität, auch in ländlichen Gebieten, tätig zu sein. Auf Basis relevanter Rahmenstrukturen wie der Musterweiterbildungsordnung 2018 und dem Kompetenzbasierten Curriculum Allgemeinmedizin wurde ein Basiscurriculum definiert. Insgesamt umfasst das Seminarcurriculum 62 Basismodule à 2 UE (z.B. Grundprinzipien der AM, Brustschmerz, Abrechnung) sowie weitere 58 offene Module à 2 UE (z.B. Digitalisierung, Reisemedizin) mit 240 (124+116) UE. Ein Blueprint mit Rotationsplan für alle Standorte in Baden-Württemberg ermöglicht n=400 ÄiW AM eine regelmäßige Teilnahme über 5 Jahre, die bzgl. der Dauer variiert werden kann. Schlussfolgerung: Das Modell beschreibt ein 5-jähriges, flexibles, weiterbildungsbegleitendes Seminarprogramm für ÄiW AM, welches auch in multizentrischen und teilnehmerstarken Programmen umsetzbar ist und auf den Erwerb von Kernkompetenzen für die spätere allgemeinmedizinische Tätigkeit ausgerichtet ist. In der aktuellen Umstellung auf e-Learning-Seminare aufgrund von SARS-CoV wird die Implementierung fortgesetzt, kontinuierlich evaluiert und für die Weiterentwicklung der KWBW Verbundwei

Contains fulltext : 218873.pdf (publisher's version ) (Open Access), BACKGROUND: Providing end of life care (EoLC) is an important aspect of primary care, which reduces the risk of hospital admission for most patients. However, general practitioners (GPs) seem to have low confidence in their ability to provide EoLC. Little is known about an adequate volume and kind of training in EoLC among GP trainees. METHODS: We performed a before-after comparison in all post-graduate GP trainees who were registered in the vocational training program (KWBW VerbundweiterbildungPLUS). They were offered participation within a two-day seminar focussing on palliative care in 2017. Those who attended the seminar (intervention group I) completed a paper-based questionnaire directly before the intervention (T1) and 6 months after (T2). None-attendees (group C) were also asked to fill out the questionnaire once. The questionnaire covered previous experiences in palliative care, self-assessment of competencies in EoLC in the organisation of patient care as well as in control of symptoms, attitudes towards death and caring for dying patients and questions about GPs' role in EoLC. RESULTS: In total, 294 GP trainees (I: n = 219; C: n = 75) participated in the study. Of those, more than 90% had previously gained experience in EoLC mainly during vocational training in the hospital rotation. Around a third had previously gained competencies in EoLC in medical school. Between groups I (T1) and C no significant differences were observed in socio-demographic characteristics, pre-existing experience or overall expertise. At T2, 75% of participants of group I declared they have extended their competencies in EoLC after the intervention and 70% classified the intervention as helpful or very helpful. Overall, they rated their competencies significantly higher than at T1 (p < 0.01). In detail, competencies in organisation of EoLC and competencies in handling of symptoms significantly improved (p < 0.01). Due to the intervention, 66% could reflect their attitudes towards

Background: Objective Structured Clinical Examinations (OSCEs) have become an established examination format at German medical faculties. Medical experts routinely use a summative assessment to evaluate practical and communicative skills, while the use of the OSCE format by student examiners, as a formative examination, remains rather limited.Objective: The formative OSCE program of the Department of General Practice and Implementation Research at the Heidelberg Medical Faculty, which is conducted and evaluated by peer tutors, is examined with regard to its quality criteria and compared with summative OSCEs from other departments. Methods: Difficulties and discriminatory power of individual testing stations were determined for the summative, as well as the formative OSCE, and compared with each other. To assess the reliability of the measurements, an analysis of the data was carried out using the Generalizability theory. In addition, a comparison is made between the assessments of student examiners and second assessments by medical experts.Results: The stations of the formative OSCE show similar difficulties as those of the summative comparison OSCEs (Pform=0.882; Psum=0.845 - 0.902). With respect to measurement reliability, there are no differences between the OSCE in General Medicine and the other subjects. The assessments of student examiners and medical experts correlate highly (r=0.888).Conclusion: The formative OSCE in General Medicine is comparable to the summative comparison formats in terms of its quality criteria. The use of student examiners can be a reliable alternative to medical experts in formative OSCEs., Hintergrund: Objective Structured Clinical Examinations (OSCEs) sind mittlerweile ein etabliertes Prüfungsformat an deutschen medizinischen Fakultäten. Üblicherweise werden darin praktische und kommunikative Fertigkeiten von medizinischen Experten summativ bewertet. Der Einsatz des OSCEs als formatives Prüfungsformat mit studentischen Prüfern findet bislang eher wenig Anwendung.Zielsetzung: Der an der Medizinischen Fakultät Heidelberg im Fach Allgemeinmedizin durchgeführte formative OSCE, der von Peer-Tutoren durchgeführt und bewertet wird, soll hinsichtlich seiner Gütekriterien untersucht und mit denen summativer OSCEs aus anderen Fachbereichen verglichen werden. Methodik: Schwierigkeiten und Trennschärfen der einzelnen Stationen werden für die summativen sowie den formativen OSCE bestimmt und einander gegenübergestellt. Zur Beurteilung der Messzuverlässigkeit wird eine Analyse der Daten mittels der Generalisierbarkeitstheorie durchgeführt. Zusätzlich findet ein Vergleich zwischen den Bewertungen der studentischen Prüfer und Zweitbewertungen medizinischer Experten statt.Ergebnisse: Die Stationen des formativen OSCEs weisen ähnliche Schwierigkeiten wie die der summativen Vergleichs-OSCEs auf (Pform=0.882; Psum=0.845 - 0.902). Bezüglich der Messzuverlässigkeit zeigen sich keine Unterschiede zwischen dem OSCE Allgemeinmedizin und denen der anderen Fächer. Die Bewertungen der studentischen Prüfer und der medizinischen Experten korrelieren hoch (r=0.888).Schlussfolgerung: Der formative OSCE Allgemeinmedizin ist hinsichtlich seiner Qualitätskriterien vergleichbar mit denen der summativen Vergleichsformate. Der Einsatz studentischer Prüfer kann bei formativen OSCEs eine verlässliche Alternative zu medizinischen Experten darstellen.

Contains fulltext : 215654.pdf (publisher's version ) (Open Access), BACKGROUND: User understanding of information technology systems (IT-Systems) is a prerequisite for their use. This study aimed to explore how primary care physician trainees learn, understand and use IT-Systems. METHODS: A paper-based survey study among 301 primary care physician trainees in Baden-Wuerttemberg, Germany, was performed. The questionnaire included measures of understanding and use of nine specific system features, five possible learning strategies, a validated scale for affinity for technology interaction, and five individual and three practice characteristics. RESULTS: The sample comprised 94 respondents (31.6% response rate). Between 3.2 and 59.6% said to know specific systems features well; between 13.8 and 42.6% expressed a wish to know more about specific system features. The predominant strategy for learning system features was explanation by others: 51.7 to 66.7% had applied this strategy to learn the features. Between 18.6 and 41.4% had learned the features by trial and error. A better understanding of system features was associated with the use of a trial and error strategy for learning system features (beta = 0.260, p = 0.012). The use of a greater variety of learning strategies was associated with higher affinity for technology interaction (beta = 0.215, p = 0.037). CONCLUSION: The study suggests that many physicians need a better understanding of IT-Systems. The role of manuals, online resources and courses in learning IT-Systems seems limited. The new generation of primary care physicians seem to learn features of IT-Systems through explanation by others and trying in their ambulatory practices. The relevance of IT-Systems in healthcare is high, but physicians need more support in learning to use system features.