How much GK is in the NKLM? A comparison between the catalogues of exam-relevant topics (GK) and the German National Competence-based Learning Objectives Catalogue for Undergraduate Medical Education (NKLM)

Evaluation of the National Competence Based Catalogue of Learning Objectives (NKLM 2.0) for undergraduate medical education at the Medical School Hannover

Background

The National Competence-Based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM) serves as the foundation for curricular development in undergraduate medical education in Germany. A new version of the NKLM was launched in 2021, and medical faculties are now evaluating the learning objectives (LOs). This paper describes the evaluation process used at Hannover Medical School.

Methods

The evaluation process was structured in three steps. LOs were rated as "keep", "modify" or "delete". First, the 1133 LOs were compared with the mapping of the Hannover curriculum from 2017. Then, a small team from the Curricular Development Department conducted a pre-evaluation of the 1133 LOs. Finally, a group of clinical experts and students discussed and agreed on the ratings.

Results

For 868 LOs, one or more counterparts were found in the mapping, but 265 new LOs were not found and thus, classified as new. In the first rating, 779 LOs were kept, 300 were modified (172 due to wording), 45 were deleted, and there was no rating for 9 LOs. The expert group changed 47 of the pre-evaluation decisions. The final rating was to keep 738 LOs, modify 356, and delete 39 LOs.

Conclusion

This method effectively evaluated the LOs from NKLM 2.0 while balancing expert knowledge and an overview of the curriculum.

Patterns of Domain-Specific Learning Among Medical Undergraduate Students in Relation to Confidence in Their Physiology Knowledge: Insights From a Pre-post Study

RESEARCH FOCUS

The promotion of domain-specific knowledge is a central goal of higher education and, in the field of medicine, it is particularly essential to promote global health. Domain-specific knowledge on its own is not exhaustive; confidence regarding the factual truth of this knowledge content is also required. An increase in both knowledge and confidence is considered a necessary prerequisite for making professional decisions in the clinical context. Especially the knowledge of human physiology is fundamental and simultaneously critical to medical decision-making. However, numerous studies have shown difficulties in understanding and misconceptions in this area of knowledge. Therefore, we investigate (i) how preclinical medical students acquire knowledge in physiology over the course of their studies and simultaneously gain confidence in the correctness of this knowledge as well as (ii) the interrelations between these variables, and (iii) how they affect the development of domain-specific knowledge.

METHOD

In a pre-post study, 169 medical students' development of physiology knowledge and their confidence related to this knowledge were assessed via paper-pencil questionnaires before and after attending physiology seminars for one semester. Data from a longitudinal sample of n = 97 students were analyzed using mean comparisons, regression analyses, and latent class analyses (LCAs). In addition, four types of item responses were formed based on confidence and correctness in the knowledge test.

RESULTS

We found a significant and large increase in the students' physiology knowledge, with task-related confidence being the strongest predictor (apart from learning motivation). Moreover, a significantly higher level of confidence at t2 was confirmed, with the level of prior confidence being a strong predictor (apart from knowledge at t2). Furthermore, based on the students' development of knowledge and confidence levels between measurement points, three empirically distinct groups were distinguished: knowledge gainers, confidence gainers, and overall gainers. The students whose confidence in incorrect knowledge increased constituted one particularly striking group. Therefore, the training of both knowledge and the ability to critically reflect on one's knowledge and skills as well as an assessment of their development in education is required, especially in professions such as medicine, where knowledge-based decisions made with confidence are of vital importance.

(Re-) Defining evolutionary medicine

The applicability of evolutionary biology principles to diseases has been largely questioned by the medical field. While Evolutionary Medicine (EM) developed in part to lessen this gap, EM is an independent field from both evolution and medicine, whose continued narrowing of topics as a consequence of its reductionist approach, in addition to its focus to introduce itself at a late stage in medical education, has led to its continued resistance toward implementation. In turn, this has had a profound and lasting impact on the awareness of evolution in medicine among physicians. For both the evolutionary and medical communities to reach a common perspective and obtain a greater frame-work of medical thought, a comprehensive view of the evolution of the healthy human being needs to be introduced as a starting point during the premedical curriculum. Here, we present our views on the ongoing challenges that have caused the continued division between the evolutionary fields and medicine, and provide solutions to help bridge the gap for an interdisciplinary field of evolution in medicine.

Changes of collective orientation through a medical student's anaesthesia simulation course - simulation-based training study with non-technical skills debriefing versus medical debriefing

BACKGROUND

Non-technical skills (NTS) are known to have a positive impact on quality of medical care. The team performance enhancing behaviour, as an example for NTS, is termed "Collective Orientation" (CO). In this study, we investigated the effect of a simulator-based anaesthesia training upon student's CO in relation to medical and TeamGAINS (guided team self-correction, advocacy-inquiry and systemic-constructivist techniques) debriefing. We hypothesized (a) the scale collective orientation, as demonstrated in other team setting, is applicable to fourth year German medical students, (b) collective orientation increases by a four-hour anaesthesia simulation course, (c) the change in collective orientation can be influenced by type of debriefing.

METHOD

All classes of an anaesthesia module (4th year medical students) were randomized into two groups. Students took part in a four-hour simulation course with team scenarios, supported by a simulated nurse. In group one the trainer focused on a debriefing on medical problems and in group two, a debriefing according to the specifications of the TeamGAINS concept was conducted. The primary outcome was the mean difference between the collective orientation measured (via questionnaires) immediately before (T1) and after (T2) training.

RESULTS

Cronbach's alpha for all scales and measurement points was higher than 0.72. The scale "affiliation" decreases in the group medical debriefing MD = 0.1 (p = 0.008; r = 0.31) and was unchanged in the group TeamGAINS. "Dominance" increases in both groups. The values were MD = 0.19 (p = 0.003; r = 0.25) for medical debriefing and MD = 0.22 (p = 0.01; r = 0.40) for TeamGAINS debriefing.

CONCLUSION

The collective orientation questionnaire can be applied to fourth year medical students. Simulation courses influence the attitude towards teamwork. The influence is negatively to the subscale "affiliation" by a "medical debriefing" and independently regardless of the nature of the debriefing for the subscale "dominance". We recommend a debriefing for medical students using the TeamGAINS approach to clarify the connection between the individual performance and non-technical skills. Anaesthesia simulation courses have the potential being a part of a longitudinal education curriculum for teaching non-technical skills.