Formalizing a Residency Mentorship Program with a "Business of Medicine" Curriculum

BACKGROUND

Mentorship is critical for achieving success in academic medicine and is also considered one of the core professional competencies for residency training. Despite its importance, there has been a decline in the mentor-mentee relationship, largely due to time constraints and lack of clear guidelines for productive discussions. We provide a mentorship curriculum with an easily adoptable workbook which may serve as a guide for programs seeking more formalized mentorship opportunities.

METHODS

We created a mentorship curriculum that was divided into 4 quarterly sessions, each with topics to facilitate career guidance and development, and to provide insight into the practical aspects of business of medicine. The mentorship pilot curriculum was implemented during the 2017 to 2018 academic year. Specific questions were provided to stimulate reflection and appropriate discussion between resident mentee and faculty mentor. A post-curriculum survey was distributed to evaluate the effectiveness and satisfaction of the curriculum.

RESULTS

A total of 23 residents participated in this pilot project. A majority had not had any formal teaching related to the business aspects of medicine (82%). Upon completion of the curriculum, most residents felt several topics were sufficiently covered, and a majority were satisfied with the course and relationship developed with their mentor (87%).

CONCLUSIONS

Our pilot curriculum provides a model to address a knowledge gap in the practical aspects of medicine while simultaneously enhancing residency mentorship. The one-year course was generally well-received by residents and can serve as a model to other academic residency programs with similar challenges and goals.

Design Thinking in Medical Education: The Key Features and Practical Application

Design thinking is a process that applies both creativity and innovation to iteratively develop and implement a new product. The design thinking process also enhances design thinking skills that are essential for personal and professional life in a complex world. Health care is increasingly being faced with complex problems, and the education of current and future doctors in design thinking is an important curricular challenge for all medical educators. Medical educators will need to enhance their own design thinking skills to enable them to effectively respond to this challenge.

Bridging the Expertise of Advocates and Academics to Identify Reproductive Justice Learning Outcomes

Phenomenon: Reproductive justice (RJ) is defined by women of color advocates as the right to have children, not have children and parent children while maintaining reproductive autonomy. In the United States, physicians have been complicit in multiple historical reproductive injustices, involving coercive sterilization of thousands of people of color, low income, and disabilities. Currently, reproductive injustices continue to occur; however, physicians have no formal RJ medical education to address injustices. The objective of this study was to engage leading advocates within the movement using a Delphi method to identify critical components for such a curriculum. Approach: In 2016, we invited 65 RJ advocates and leaders to participate in an expert panel to design RJ medical education. A 3-round Delphi survey was distributed electronically to identify content for inclusion in an RJ curriculum. In the next 2 survey rounds, experts offered feedback and revisions and rated agreement with including content recommendations in the final curriculum. We calculated descriptive statistics to analyze quantitative data. A team with educational expertise wrote learning outcomes based on expert content recommendations. Findings: Of the 65 RJ advocates and leaders invited, 41 participated on the expert panel of the Delphi survey. In the first survey, the expert panel recommended 58 RJ content areas through open-ended response. Over the next 2 rounds, there was consensus among the panel to include 52 of 58 of these areas in the curriculum. Recommended content fell into 11 broad domains: access, disparities, and structural competency; advocacy; approaches to reproductive healthcare; contemporary law and policy; cultural safety; historical injustices; lesbian, gay, bisexual, transgender, queer/questioning, and intersex health; oppression, power, and bias training; patient care; reproductive health; and RJ definitions. The 97 learning outcomes created from this process represented both unique and existing educational elements. Insights: A collaborative methodology infused with RJ values can bridge experts in advocacy and academics. New learning outcomes identified through this process can enhance medical education; however, it is just as important to consider education in RJ approaches to care as it is knowledge about that care. We must explore the pedagogic process of RJ medical education while considering that expertise in this area may exist outside of the medical community and thus there is a need to partner with RJ advocates. Finally, we expect to use innovative teaching methods to transform medical education and achieve an RJ focus.

Developing Physical Exam Skills in Residency: Comparing the Perspectives of Residents and Faculty About Values, Barriers, and Teaching Methods

BACKGROUND

The physical examination (PE) skills of residents are often not improved since medical school. Unfortunately, how residents learn PE is not well understood. There is a paucity of research on the factors involved and the differences between resident and faculty perspectives. The authors sought to determine resident and faculty perceptions about the value of PE, the major barriers to learning PE, and the most effective teaching methods.

METHODS

Based on a rigorous process of literature review and semi-structured interviews, the authors developed an online survey which was sent to 406 internal medicine residents and 93 faculty at 3 institutions. Residents and faculty answered questions about both their own opinions and about their perception of the other group's opinions.

RESULTS

About 283 residents (70%) and 61 faculty (66%) completed the survey. Both residents and faculty rated the importance of PE similarly. Residents rated being too busy, followed by a lack of feedback, as the most significant barriers to learning PE. Faculty rated a lack of feedback, followed by a lack of resident accountability, as the most significant barriers. Both groups rated the availability of abnormal findings as the least significant barrier. Both groups agreed that faculty demonstration at the bedside was the most effective teaching method.

CONCLUSION

This survey can serve as a needs assessment for educational interventions to improve the PE skills of residents by focusing on areas of agreement between residents and faculty, specifically faculty demonstration at the bedside combined with feedback about residents' skills.

Telehealth for the internal medicine resident: A 3-year longitudinal curriculum

AIMS

Across the United States of America, patients are increasingly receiving healthcare using innovative telehealth technologies. As healthcare continues to shift away from traditional office-based visits, providers face new challenges. Telehealth champions are needed to adapt technologies to meet the needs of patients, providers and communities, especially within the realm of primary care specialties. Given these challenges, this intervention aimed to incorporate telemedicine into internal medicine resident training across multiple training years to prepare them for practice in the current and changing healthcare system.

METHODS

Education and telehealth leaders at the Medical University of South Carolina identified key topics relevant to telehealth and the provision of general internal medicine services. With this as a framework, we developed a 3-year longitudinal telehealth curriculum for internal medicine resident physicians, consisting of an introduction to telemedicine equipment in the first year, didactic learning through in-person education and online modules in the second year and experiential learning through remote monitoring of chronic disease in the third year. Participants included approximately 100 internal medicine residents per year (2016-2019). Self-perceived knowledge, comfort and ability to provide telehealth services was assessed via a survey completed before and after participation in the curriculum.

RESULTS

Resident physicians' self-reported knowledge of telehealth history, access to care, contributions of telehealth applications and quality of care and communication each improved after completion of the online curriculum. There were also significant improvements in resident comfort and perceived ability to provide telehealth services after participation in the curriculum, as assessed via a survey. Overall, 41% of residents felt their ability to utilize telehealth as part of their current or future practice was greater than average after completion of the online modules compared to only 2% at baseline (p<0.01). Results also show residents accurately identify barriers to telehealth adoption at the healthcare system level, including the lack of clinical time to implement services (67% post- vs 47% pre-curriculum, p = 0.02), unfamiliarity with concepts (65% post- vs 21% pre-curriculum, p<-0.01) and concerns about consistent provider reimbursement (74% post- vs 39% pre-curriculum, p < 0.01).

CONCLUSION

Telemedicine and remote patient monitoring are an increasingly prevalent form of healthcare delivery. Internal medicine residents must be adept in caring for patients utilizing this technology. This curriculum was effective in improving resident comfort and self-efficacy in providing care through telehealth and provided residents with hands-on opportunities through supervised inclusion in remote patient-monitoring services. This curriculum model could be employed and evaluated within other internal medicine residency programmes to determine the feasibility at institutions with and without advanced telehealth centres.

A novel curriculum to train physician assistant students how to write effective discharge summaries

Background: Physician assistants (PAs) are an integral part of inpatient care teams, but many PAs do not receive formal education on authoring discharge summaries. High-quality discharge summaries can mitigate patient risk during transitions of care by improving inter-provider communication. Objective: To understand the current state of discharge summary education at our institution, and describe a novel curriculum to teach PA students to write effective discharge summaries. Design: Students completed a pre-survey to assess both knowledge and comfort levels regarding discharge summaries. They wrote a discharge summary and received feedback from two evaluators, an inpatient provider (IPP) familiar with the described patient and a simulated primary care provider (PCP). Students completed a post-survey reassessing knowledge and comfort. Results: Prior to instituting this curriculum, the majority of students (92.9%) reported rarely or never receiving feedback on discharge summaries. Eighty-four of 88 (95.5%) eligible students participated. There was discordance between IPP and simulated PCP feedback on their assessment of the quality of discharge summaries; simulated PCPs gave significantly lower global quality ratings (7.9 versus 8.5 out of 10, p = 0.006). Key elements were missing from >10% of discharge summaries. Student response was favorable. Conclusion: Clinically relevant deficiencies were common in students' discharge summaries, highlighting the need for earlier, structured training. IPPs and simulated PCPs gave discordant feedback, emphasizing differing needs of different providers during transitions of care. This novel curriculum improved students' knowledge and confidence.

Standardized residency training: An equalizer for residents at different hospitals in Shanghai, China?

BACKGROUND

The residency training programme in Shanghai is the first in China to become standardized; however, there has been no evidence that the programme equalizes training quality. This cross-sectional study examined whether residents in all disciplines at different hospitals perceived equivalent improvement in professional competency after this programme.

METHODS

We recruited all 2283 residents who enrolled in the programme in 2013. Before graduation, the residents reported their perceived competency improvement as the primary outcome and their hospital of residency, awareness of the programme's requirements and policies, and demographic information as explanatory variables. We ran multivariate linear regressions and mixed-effect multilevel regression to examine whether the hospital type and the university affiliation were associated with perceived improvement.

RESULTS

A total of 2208 residents completed the survey. Although the adjusted multilevel regression analysis showed that the improvement scores at tertiary specialty hospitals and tertiary general hospitals were lower than those at secondary general hospitals, the difference was not statistically significant. No variance in improvement scores could be explained by the hospital type or university affiliation.

CONCLUSION

Receiving residency training at hospitals that were traditionally less resourced did not compromise educational quality based on the perception of the residents.

A model for surgical volunteerism: a qualitative study based in Cambodia

Medical volunteerism continues to attract many doctors from high-income nations to low- or middle-income countries (LMIC). In spite of the wealth of positive experiences of these volunteers documented in the literature, there is little evidence concerning the impact and effectiveness of their activity. We documented our model of five-year experience in the delivery of hand surgery in Cambodia, attempting a qualitative approach with attempts to understand the perceptions of local and volunteer surgeons. We conducted independent qualitative interviews with five visiting and 12 Cambodian surgeons who participated in our community-based and outcome-oriented hand surgery training programme between 2013 and 2015. Data were coded and analysed using a content analysis method and then individually grouped into categories; software was used to generate frequencies and quotations of codes. Our results highlighted factors contributing to the success of the medical volunteering programme, to its success, with suggestions for sustainability, motivation and commitment to such a programme. A clearly defined strategy by the volunteer group and a commitment to time and resources by both partners were found to be effective.

Standard Setting of Competency in Mastoidectomy for the Cross-Institutional Mastoidectomy Assessment Tool

OBJECTIVE

Competency-based surgical training involves progressive autonomy given to the trainee. This requires systematic and evidence-based assessment with well-defined standards of proficiency. The objective of this study is to develop standards for the cross-institutional mastoidectomy assessment tool to inform decisions regarding whether a resident demonstrates sufficient skill to perform a mastoidectomy with or without supervision.

METHODS

A panel of fellowship-trained content experts in mastoidectomy was surveyed in relation to the 16 items of the assessment tool to determine the skills needed for supervised and unsupervised surgery. We examined the consensus score to investigate the degree of agreement among respondents for each survey item as well as additional analyses to determine whether the reported skill level required for each survey item was significantly different for the supervised versus unsupervised level.

RESULTS

Ten panelists representing different US training programs responded. There was considerable consensus on cut-off scores for each item and trainee level between panelists, with moderate (0.62) to very high (0.95) consensus scores depending on assessment item. Further analyses demonstrated that the difference between supervised and unsupervised skill levels was significantly meaningful for all items. Finally, minimum-passing scores for each item was established.

CONCLUSION

We defined performance standards for the cross-institutional mastoidectomy assessment tool using the Angoff method. These cut-off scores that can be used to determine when trainees can progress from performance under supervision to performance without supervision. This can be used to guide training in a competency-based training curriculum.

Longitudinal curriculum development: gradual optimization of a biochemistry seminar

Objective: The Master Plan for Medical Studies 2020 places additional emphasis on curricular development processes. In addition, institutes may recognize a need to optimize their courses, for example because of poor evaluations. Frequently, however, the resources required for comprehensive optimizations are not available. In the present study, we aimed to use the example of a biochemistry seminar that takes place in the preclinical part of the medical degree at Ulm University Medical School to show how a course can be successfully optimized in small steps and evaluation results can be used for quality assurance. Methods: Similar to a continuous improvement process (CIP), over the course of five years a biochemistry seminar was gradually optimized in three steps. This process used structural, methodological, and content components, such as vertical integration, the inverted classroom method, and competence orientation. For quality assurance, we analyzed the official, standardized evaluation sheets from a total of n=1248 students. We evaluated the optimization process on the basis of responses to evaluation statements that were arranged into categories such as "organization, structure, implementation" and "quality of teaching," free text information, and the results of a pilot study conducted in parallel. We then determined the usefulness of the students' evaluation results for evaluating the optimization process. Results: Each developmental step resulted in a significantly more positive overall evaluation of the seminar by the students. This result was independent of whether the development was on a structural or methodological/content-related level. In addition, the evaluations of the categories that were optimized were significantly better. For example, the vertical integration and introduction of the inverted classroom method were accompanied by a better evaluation of the "quality of teaching" and a change in the structure led to a higher score in the category "organization, structure, implementation." A comparison with the free text evaluation sheets and the results of the pilot study supports the results. Conclusion: Although optimization of a curriculum or course is a major task, it can also be successfully completed in small steps. With this approach, new learning goals, for example as required in the Master Plan for Medical Studies 2020, can be continuously integrated and student satisfaction with a course can be increased. Student evaluation results can represent a kind of quality assurance in this process and can provide important impulses for optimization.

Implementation of an ACPE-Accredited PharmD Curriculum at a Saudi College of Pharmacy

Objective. To establish an academic curricular collaboration between the newly established college of pharmacy at King Saud Bin Abdulaziz Saudi University for Health Sciences (KSAU-HS) and a US college of pharmacy accredited by the Accreditation Council for Pharmacy Education, and assess measures of success. Methods. Criteria for selecting a college for collaboration were established. A systematic approach was followed in negotiating legal, logistical, and financial issues with the selected collaborating institution. Course materials were transferred and implemented and minimal changes were made to the alignment and sequencing of lectures. The faculty at KSAU-HS developed and implemented research and seminar courses. Pharmacy practice experiences were designed and rubrics were developed. Results. All courses were implemented successfully. The PharmD students scored significantly higher in all academic levels in a benchmarked progress test than did students in other programs. Students' evaluation of 43 first-, second-, and third-year courses in 2017-2018 using a survey that assessed numerous aspects of each course showed significantly higher overall satisfaction than the institutional averages. Also, female students indicated significantly higher satisfaction with the PharmD program than did male students. Conclusion. The transfer and implementation of an accredited PharmD curriculum to the KSAU-HS College of Pharmacy went smoothly and the program was launched on time. Learning and teaching success was facilitated by the KSAU-HS faculty. Program outcomes were verified by students' high scores on a benchmarked examination and by their satisfaction with the courses.

Talking About Ethical Issues in Surgery-Results of a Novel Online Pilot Curriculum

OBJECTIVES

Surgical ethics has been suggested as a distinct field of study apart from clinical ethics due to a unique practice type and treatment dynamic. At our institution, most if not all teaching of clinical ethics is undertaken by nonsurgical faculty. We introduced a novel online Surgical Ethics Program (SEO) in a pilot form (SEO-P) for initial presentation to learners in our environment. The overall goal of our educational intervention was to enhance knowledge, understanding and appreciation for surgical ethics in medical students and to evaluate our curriculum.

SETTING

SEO-P was undertaken over a 4-week period in 2018 with 9 fourth-year medical students enrolled in a surgery elective at our institution. These learners all had career plans in general surgery or a surgical subspecialty. There was 3 weeks of content: (1) background in clinical ethics as it applies to surgical practice, (2) surgical consents and autonomy, and (3) the impaired physician. All pilot learners were evaluated with: (1) postprogram final exam assessment (compared to preprogram knowledge base test), (2) self-reflection essay of ethical practice in surgery, (3) evaluation of 2 case studies, and (4) an assessment of participation in online discussion forums. Postprogram survey of the learners was also undertaken in an anonymous fashion.

RESULTS

Four of 9 or 44.4% of students scored greater than or equal to 80% on the postprogram knowledge assessment test. A preprogram knowledge-based examination of all learners yielded a mean and standard deviation of 57.1 ± 6.0%. Postprogram knowledge-based test with mean and standard deviation was 78.8 ± 15%. This was a statistically significant increase in scores (p = 0.004; t test). All 9 passed the course with a mean final summative course grade of 95.2 ± 3.2%. From the postprogram evaluation survey, all 7 students who responded felt that the SEO-P would help them become an "ethical" practitioner. Surprisingly, only half of the learners (57.1%) thought "technology used to support the SEO Course (i.e., the chosen curriculum management system) was effective in conducting the course."

CONCLUSIONS

We set forth to use "web-based" technology to enhance exposure of medical students in our institution to surgical ethics. Hence, we designed our pilot curriculum to be a completely online offering. We feel that the utilization of the surgical voice, that is a surgical ethics curriculum developed by surgeons to explore surgically related clinical ethical issues, is an essential theme and goal of our program. Future challenges will be to present this voice in an effective manner with either an improved curriculum delivery system or by potentially utilizing a blended approach.

Jordanian Nursing Student and Instructor Perceptions of the Clinical Learning Environment

Background Training within clinical areas is a vital part of nursing education. In order to effectively modify and facilitate such training, it is important to understand the perceptions of nursing educators and students about what constitutes effective practices.

OBJECTIVE

This study explores perceptions of Jordanian nursing students and clinical instructors related to clinical training and the learning environment.

DESIGN

Interpretative phenomenological qualitative approach was used in this study.

METHOD

semi-structured focus group interviews in two Jordanian Universities Results: The study identified four themes focused on the experiences of these participants. Themes were attributes of clinical training placement, attributes of clinical instructors, attributes of clinical nursing curriculum and student's attributes. The first theme had two subthemes "Structure and nature of clinical placement" and "Nurses' collaboration".

CONCLUSION

The study recommendations are: nursing schools should plan students' clinical experience taking into consideration the challenges associated with these attributes.

Integrating Refugee Healthcare Professionals In The UK National Health Service: Experience From A Multi-Agency Collaboration

PURPOSE

Refugee healthcare professionals (RHPs) may encounter several barriers to employment upon moving to the UK, such as conversion of professional qualifications and a lack of familiarity with the recruitment process. The Building Bridges Programme (BBP) is a London-based multi-agency collaboration which helps refugee healthcare professionals seek employment in the UK National Health Service (NHS).

METHODS

We have kept an electronic database of all RHPs who have participated in the BBP from October 2009 to March 2018. Data collected include gender, language spoken, country of initial medical qualification, immigration status, religion, ethnicity and professional work experience. In this paper, we focus on employment outcomes and determine the proportion (%) of RHPs joining the BBP who enter employment in the NHS.

RESULTS

Between October 2009 and March 2018, the BBP supported 372 refugee doctors, 42 refugee pharmacists, 69 refugee dentists, 25 refugee biomedical scientists, 4 refugee physiotherapists and 83 refugee nurses. The following are the results for the RHPs who settled into a registered NHS position appropriate to their (home country) professional qualifications: 98/372 (26%) doctors, 4/42 (10%), pharmacists, 17/69 (25%) dentists, 1/25 (9%) biomedical scientists, 1/4 (25%) physiotherapists and 2/83 (2%) nurses. The following are the results for the RHPs who settled in associated healthcare profession positions: 109/372 (29%) doctors, 16/42 (38%) pharmacists, 12/69 (17%) dentists, 10/25 (40%) biomedical scientists, 3/4 (75%) physiotherapists and 34/83 (41%) nurses.

CONCLUSION

The BBP provides a useful model that is transferable to other countries. Future studies assessing the utility of such programmes should ensure that the long-term employment outcomes of RHPs are more closely tracked. A key limitation of this paper is the absence of a control group of participants who did not join the BPP, which would help to conclusively demonstrate whether participants who joined our programme had a statistically significant improvement in employment outcomes.

Dignitary Medicine: A Novel Area of Medical Training

Dignitary medicine (DM) involves the provision of healthcare to government leaders and other high-profile individuals collectively referred to as "dignitaries." Due to the unique circumstances around their lifestyle, dignitaries often receive suboptimal healthcare. We define the requisite skills needed to practice DM based on the available literature and provide a framework for training providers in these skills. A review of the English language medical literature focussing on adult subjects was performed, searching for terms such as "dignitary medicine," "VIP medicine," and "protective medicine." Literature was gathered from CINAHL, Google Scholar, PubMed, EBSCOHost, and San Bernardino County Library databases and then analyzed by experienced DM providers. A total of 23 relevant articles were eligible for review. No meta-analyses on the subject exist. We found that existing studies highlight skills in wellness, executive health, and protective medicine, which form the backbone of DM. The burgeoning field of DM encompasses several disciplines and skills. We strongly recommend a structured curriculum for the field of DM, focused on dignitary wellness, executive health, and protective medicine.

The Aachen model study course in medicine - development and implementation. Fifteen years of a reformed medical curriculum at RWTH Aachen University

Objective: The Aachen model study course in medicine was developed in response to a negative appraisal of the Faculty of Medicine of the RWTH Aachen University by the Science Council in 2000. The aim is to create graduates who are capable of further training and can work in evidence-based and patient-centered health care while incorporating scientific findings. Methodology: In 2003 the medical degree was fully switched over to the model study course format. This means an annual cohort size of about 280 students. These go through a modularized and integrated curriculum, which is designed as a learning spiral. This requires a special interdisciplinary collaboration of teachers and curriculum planners. In addition to the modules, longitudinal elements such as workplace-based examinations, communication or practical skills are embedded in the curriculum. Results: The state exam results of the Aachen graduates have already improved significantly even for the first cohort and the university has been able to maintain an almost uninterrupted high level from 2008 to 2018. The students satisfaction with the model course is not only evident in the student course assessment and qualitative group discussions but also in various national rankings. Conclusion: The complete redesign of the course starting from the first semester onwards posed major challenges for all those involved in the faculty. The implementation of a completely reformed curriculum, such as the model study course, can only succeed through constructive cooperation of the various stakeholders at a faculty. The reorientation was able to address the major flaws of the 2002 report by the Science Council, student dissatisfaction and the poor performance in the nationwide state exams.

The development of the internal medicine courses at Hannover Medical School from 2001 to 2018

Aim: The subject-based model curriculum at the Hannover Medical School (MHH) is characterized by two major features: early and continuous contact with patients and the interconnection of theoretical and clinical content. The progressive adaptations to the internal medicine curriculum which is taught longitudinally over five years are presented. Methods: Looking back on 17 years of experience with our model curriculum and the events leading to its inception, we summarize the challenges and subsequent modifications to the longitudinal internal medicine curriculum. Some of these challenges are likely to occur in other subjects and can therefore be generalized. Results: Integrating preclinical and clinical content was more resource intensive than thought and unexpectedly led to capacity problems since the German courts ruled that the presence of more teachers brought with it an obligation to enroll more students. In response to this, teaching responsibilities were extended to both outpatient facilities and academic teaching hospitals. Major changes included a more even distribution of clinical content in the first year, a rigorous standardization of teaching content in clinical skills, increased adaptation of content to reflect prior knowledge in the third and fourth years, and a focus on clinical reasoning in the fifth year. Restructuring the academic year into three ten-week blocks (two in the winter term and one in the summer term) allowed the retention of small groups. Conclusion: These measures rely heavily on considering teaching responsibilities within rotation plans, curriculum development and continuous faculty engagement. Since teachers are not sufficiently familiar with the distinctions between teaching formats, they mostly consider how far students have advanced in their studies when choosing course content. This implies that the current nomenclature requires improvement.

The model medical degree programme "human medicine" in Oldenburg - the European Medical School Oldenburg-Groningen

In the summer of 2012 the School of Medicine and Health Sciences at the Carl von Ossietzky University of Oldenburg became the first new medical faculty to be founded in Germany in more than 20 years. The faculty was established within the framework of the European Medical School Oldenburg Groningen, a cooperation project between the University of Oldenburg and the University of Groningen. In addition to the University of Groningen and its faculty of medical sciences (Universitair Medisch Centrum Groningen - UMCG), four hospitals in Oldenburg are involved in the programme as cooperation partners, as well as a network of general practitioner practices that provide training and academic teaching hospitals across northwest Germany. The programme itself is a model medical degree programme with a modular structure, a highly integrative approach and an early and consistent focus on practical skills and patient-centredness. In addition to the early introduction to outpatient care in the first years of study, longitudinal pathways and a strong focus on research with early integration of scientific activities into medical studies are the defining characteristics of this programme. The two faculties in Oldenburg and Groningen coordinated their respective curriculums during the founding phase and recognise each other's study modules as equivalent to their own. This has created the preconditions for students from Oldenburg to obtain Dutch qualifications (Bachelor of Human Life Sciences and/or Master of Science in Medicine) in addition to the German "Staatsexamen" (the state examination in medicine) under certain circumstances. Irrespective of whether they intend to obtain these qualifications, all students from Oldenburg must spend at least a year studying at the partner university in Groningen. In exchange, up to 40 students from Groningen have the option to complete part of their studies in Oldenburg.

HannibaL - the model curriculum at Hannover Medical School: targets, implementation and experiences

Aim: The model curriculum known as HannibaL is an integrated, professionally-based adaptive curriculum that began at the Hannover Medical School (MHH) during the 2005/06 academic year. HannibaL turns medical students into competent physicians through its patient-based interdisciplinary instruction. This paper provides an overview of the curriculum's creation, educational content and philosophy and reflects on the experience that has been gathered. Also described are organizational and quality assurance measures which were also employed to implement the model curriculum. Method: The central ideas and processes are reported in a primarily narrative manner in an attempt to present the information coherently. The aspects discussed are setting up the model curriculum, central features of teaching and exams with their underlying educational premises; organization and evaluation are also covered in the context of the research literature on curriculum and faculty development. Developing the teaching and learning culture of the model curriculum is also explored. Results: The basic objectives were realized, including the design of learning spirals and intensifying the inclusion of patients and practical elements at the beginning of study. However, plans to allow students more freedom to pursue their own learning and research interests have not yet been satisfactorily implemented. Key areas to support teaching have been expanded (teacher training for instructors, student advising, course evaluations). Conclusion: The model curriculum and its aims are widely recognized and supported not only by medical students and instructors, but also external committees and experts. As a consequence, HannibaL will be developed further in upcoming years to implement the objectives which have not yet been met and to master new challenges faced by medical education.

The modular curriculum of medicine at the Charité Berlin - a project report based on an across-semester student evaluation

Aim: The introduction of a reform clause into the German licensing laws for medical doctors has enabled German faculties to pilot alternative designs for medical degree programmes. The aim of this project report is to outline the curricular features of the modular curriculum of medicine (MCM) at the Charité and to assess the results of its implementation based on a student evaluation across semesters. Project outline: The MCM was planned and implemented in a competency- and outcome-based manner from 2010-2016 in a faculty-wide process. The curriculum is characterised by a modular structure, longitudinal teaching formats and the integration of basic and clinical science. In the winter semester 2017, evaluations by students in semesters 1-10 were carried out. The results were analysed descriptively, and the coverage of overarching learning outcomes was compared to the results of a survey carried out amongst students on the traditional regular curriculum of medicine track in 2016. Results: A total of 1,047 students participated in the across-semester evaluation (return rate 35%). A high percentage of the respondents positively rated the achieved curricular integration and longitudinal teaching formats. The majority of the respondents agreed with the relevance of the overarching learning outcomes. Students' evaluations of the coverage of learning outcomes showed a differentiated picture for the MCM. Compared to the regular curriculum track, the coverage in the MCM programme showed substantial improvements in all aspects. Students found themselves to be better prepared for the M2 state examination and the practical year. The students' overall satisfaction with their decisions to study in the MCM was high. Conclusions: The results of the student evaluation show that a significant improvement in medical education has been achieved at the Charité with the new integrated, outcome-oriented design and the implementation of the MCM. At the same time, ongoing weaknesses have been revealed that serve as a basis for the continued development of the curriculum. This report aims to contribute to the discussion of the future of undergraduate medical education in Germany.

The scientific term paper at the Charité: a project report on concept, implementation, and students' evaluation and learning

Aim: Better training in scientific skills, such as the ability to conduct research independently, has been one of the main drivers of reform in medical education. The aim of this article is to report on the scientific term paper module in the modular curriculum of medicine (MCM) at the Charité. This module is an established example of undergraduate medical students conducting their own scientific investigations. Project outline: A faculty-wide, outcome-oriented process resulted in a four-week module for writing a scientific term paper in the 6^th semester of the MCM as part of a longitudinal science curriculum. Acquired competencies were assessed through a written term paper and an oral presentation. Two student cohorts (winter terms 2013 and 2014) were surveyed on how they rated the module concept, organizational aspects and the quality of support. We further analysed the chosen topics of the papers as well as student assessment results. Results: The student evaluation (return rates of 193 and 197, 71% and 77%) showed high overall satisfaction with the module. This result was evident in the high rating of the module concept and organizational aspects, a positive attitude towards scientific research, and strong motivation to pursue further scientific research. There was a wide spectrum of term paper topics with a focus on literature reviews. Most of the student work was assessed as good or very good. Conclusion: The scientific term paper module has proven itself as a curricular concept for students to perform own scientific research in the MCM, with strong acceptance and good performance by students. This project report can serve as basis and guidance for development and further improvements to promote scientific competencies in undergraduate medical education in other faculties.

Gerontology competencies: Construction, consensus and contribution

The Academy for Gerontology in Higher Education (AGHE) in 2014 approved the first integrative "Gerontology Competencies for Undergraduate and Graduate Education"©. This article describes the background, thought development, guiding framework and consensus process for its construction. A modified Delphi method utilizing seven review rounds within three developmental cycles, with gerontology educators from 30 institutions, achieved input and consensus. The comprehensive framework has ten major domains, employs three categories each including multiple selective competencies. Six Category I competencies are essential orientations to gerontology. Four Category II competencies are "interactional" processes of knowing and doing across the field. Category III provides eight selective competencies for sectors where gerontologists may work. From educators' feedback, gerontology characteristics emerged: multi-system approaches; interdisciplinary; communication of older adults' "voices" and strengths; research utilization. The discussion includes the contribution of competency-based gerontology to students and aging workforce development as well as next steps, outcome measurement, levelling and accreditation.

Perceptions of occupational therapy threshold concepts by students in role-emerging placements in schools: A qualitative investigation

INTRODUCTION

Traversing threshold concepts has been identified as crucial in becoming an occupational therapist. To support this learning, previous research has emphasised the value of students engaging in practice-based learning, accompanying reflection, and a curriculum which makes threshold concepts explicit to students. Role-emerging placements form part of students' practice-based learning in many universities and could offer a valuable opportunity for students to learn threshold concepts. Understanding the value of threshold concepts to enhance role-emerging placement learning from both the students' and educators' perspectives warrants further research. The aim of this study was to examine how occupational therapy students on role-emerging placements in school settings experienced applying threshold concepts and how it impacted on their learning.

METHODS

An epistemological position of social constructionism and a qualitative research design was used. This included semi-structured focus group interviews and reflective logs that enabled exploration of 13 student's and one supervisor's perspectives of learning during the placement. Template analysis was used to analyse the data.

RESULTS

Students spoke of their learning of the threshold concepts of client-centredness, occupation, and understanding and applying occupational therapy theory in practice. These are expressed within the three emergent themes; 'curriculum supports in placement', 'uncertainty when applying their own knowledge', and 'placement context and expectations'.

CONCLUSION

Results suggest that learning happens within the liminal spaces which occurred from an intersection with the threshold concepts, the curriculum, knowledge generation and use, and the context and expectations of the role-emerging placement. Engaging with uncertainty may be considered a vital part of this process and something which should be valued.