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Harendza S, Bußenius L, Gärtner J, Heuser M, Ahles J, Prediger S. "Fit for the finals" - project report on a telemedical training with simulated patients, peers, and assessors for the licensing exam. GMS JOURNAL FOR MEDICAL EDUCATION 2023; 40:Doc17. [PMID: 37361248 PMCID: PMC10285374 DOI: 10.3205/zma001599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/11/2023] [Accepted: 02/06/2023] [Indexed: 06/28/2023]
Abstract
Background Undergraduate medical students take the licensing exam (M3) as a two-day oral-practical examination. The main requirements are to demonstrate history taking skills and coherent case presentations. The aim of this project was to establish a training in which students can test their communication skills during history taking and their clinical reasoning skills in focused case presentations. Methods In the newly developed training, final-year students took four telemedical histories in the role of physicians from simulated patients (SP). They received further findings for two SPs and presented these in a handover, in which they also received a handover of two SPs which they had not seen themselves. Each student presented one of the two received SPs in a case discussion with a senior physician. Feedback was given to the participants on their communication and interpersonal skills by the SPs with the ComCare questionnaire and on the case presentation by the senior physician. Sixty-two students from the universities of Hamburg and Freiburg in their final year participated in September 2022 and evaluated the training. Results Participants felt that the training was very appropriate for exam preparation. The SPs' feedback on communication and the senior physician's feedback on clinical reasoning skills received the highest ratings in importance to the students. Participants highly valued the practice opportunity for structured history taking and case presentation and would like to have more such opportunities in the curriculum. Conclusion Essential elements of the medical licensing exam can be represented, including feedback, in this telemedical training and it can be offered independent of location.
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Affiliation(s)
- Sigrid Harendza
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Hamburg, Germany
| | - Lisa Bußenius
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Hamburg, Germany
| | - Julia Gärtner
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Hamburg, Germany
| | - Miriam Heuser
- Albert-Ludwigs-Universität Freiburg, Medizinische Fakultät, Studiendekanat, Freiburg, Germany
| | - Jonathan Ahles
- Albert-Ludwigs-Universität Freiburg, Medizinische Fakultät, Studiendekanat, Freiburg, Germany
| | - Sarah Prediger
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Hamburg, Germany
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Reifenrath J, Seiferth N, Wilhelm T, Holzmann-Littig C, Phillip V, Wijnen-Meijer M. Integrated clinical case discussions - a fully student-organized peer-teaching program on internal medicine. BMC MEDICAL EDUCATION 2022; 22:828. [PMID: 36457088 PMCID: PMC9713160 DOI: 10.1186/s12909-022-03889-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/10/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND In response to students´ poor ratings of emergency remote lectures in internal medicine, a team of undergraduate medical students initiated a series of voluntary peer-moderated clinical case discussions. This study aims to describe the student-led effort to develop peer-moderated clinical case discussions focused on training cognitive clinical skill for first and second-year clinical students. METHODS Following the Kern Cycle a didactic concept is conceived by matching cognitive learning theory to the competence levels of the German Medical Training Framework. A 50-item survey is developed based on previous evaluation tools and administered after each tutorial. Educational environment, cognitive congruence, and learning outcomes are assessed using pre-post-self-reports in a single-institution study. RESULTS Over the course of two semesters 19 tutors conducted 48 tutorials. There were 794 attendances in total (273 in the first semester and 521 in the second). The response rate was 32%. The didactic concept proved successful in attaining all learning objectives. Students rated the educational environment, cognitive congruence, and tutorials overall as "very good" and significantly better than the corresponding lecture. Students reported a 70%-increase in positive feelings about being tutored by peers after the session. CONCLUSION Peer-assisted learning can improve students´ subjective satisfaction levels and successfully foster clinical reasoning skills. This highlights successful student contributions to the development of curricula.
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Affiliation(s)
- Johannes Reifenrath
- School of Medicine, Technical University of Munich, TUM Medical Education Center, Ismaninger Str. 22, 81675, Muenchen, Munich, Germany.
| | - Nick Seiferth
- School of Medicine, Technical University of Munich, TUM Medical Education Center, Ismaninger Str. 22, 81675, Muenchen, Munich, Germany
| | - Theresa Wilhelm
- School of Medicine, Technical University of Munich, TUM Medical Education Center, Ismaninger Str. 22, 81675, Muenchen, Munich, Germany
| | - Christopher Holzmann-Littig
- School of Medicine, Technical University of Munich, TUM Medical Education Center, Ismaninger Str. 22, 81675, Muenchen, Munich, Germany
- Department of Nephrology, Hospital Klinikum Rechts Der Isar of the Technical University of Munich, Munich, Germany
| | - Veit Phillip
- Department of Internal Medicine II, Hospital Klinikum Rechts Der Isar of the Technical University of Munich, Munich, Germany
| | - Marjo Wijnen-Meijer
- School of Medicine, Technical University of Munich, TUM Medical Education Center, Ismaninger Str. 22, 81675, Muenchen, Munich, Germany
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Sartania N, Sneddon S, Boyle JG, McQuarrie E, de Koning HP. Increasing Collaborative Discussion in Case-Based Learning Improves Student Engagement and Knowledge Acquisition. MEDICAL SCIENCE EDUCATOR 2022; 32:1055-1064. [PMID: 36276760 PMCID: PMC9584010 DOI: 10.1007/s40670-022-01614-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In the transition from academic to clinical learning, the development of clinical reasoning skills and teamwork is essential, but not easily achieved by didactic teaching only. Case-based learning (CBL) was designed to stimulate discussions of genuine clinical cases and diagnoses but in our initial format (CBL'10) remained predominantly tutor-driven rather than student-directed. However, interactive teaching methods stimulate deep learning and consolidate taught material, and we therefore introduced a more collaborative CBL (cCBL), featuring a structured format with discussions in small breakout groups. This aimed to increase student participation and improve learning outcomes. METHOD A survey with open and closed questions was distributed among 149 students and 36 tutors that had participated in sessions of both CBL formats. A statistical analysis compared exam scores of topics taught via CBL'10 and cCBL. RESULTS Students and tutors both evaluated the switch to cCBL positively, reporting that it increased student participation and enhanced consolidation and integration of the wider subject area. They also reported that the cCBL sessions increased constructive discussion and stimulated deep learning. Moreover, tutors found the more structured cCBL sessions easier to facilitate. Analysis of exam results showed that summative assessment scores of subjects switched to cCBL significantly increased compared to previous years, whereas scores of subjects that remained taught as CBL'10 did not change. CONCLUSIONS Compared to our initial, tutor-led CBL format, cCBL resulted in improved educational outcomes, leading to increased participation, confidence, discussion and higher exam scores.
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Affiliation(s)
- Nana Sartania
- Undergraduate Medical School, School of Medicine, University of Glasgow, Glasgow, UK
| | - Sharon Sneddon
- Undergraduate Medical School, School of Medicine, University of Glasgow, Glasgow, UK
| | - James G. Boyle
- Undergraduate Medical School, School of Medicine, University of Glasgow, Glasgow, UK
| | - Emily McQuarrie
- Undergraduate Medical School, School of Medicine, University of Glasgow, Glasgow, UK
| | - Harry P. de Koning
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Lai JH, Cheng KH, Wu YJ, Lin CC. Assessing clinical reasoning ability in fourth-year medical students via an integrative group history-taking with an individual reasoning activity. BMC MEDICAL EDUCATION 2022; 22:573. [PMID: 35883069 PMCID: PMC9316809 DOI: 10.1186/s12909-022-03649-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The most important factor in evaluating a physician's competence is strong clinical reasoning ability, leading to correct principal diagnoses. The process of clinical reasoning includes history taking, physical examinations, validating medical records, and determining a final diagnosis. In this study, we designed a teaching activity to evaluate the clinical reasoning competence of fourth-year medical students. METHODS We created five patient scenarios for our standardized patients, including hemoptysis, abdominal pain, fever, anemia, and chest pain. A group history-taking with individual reasoning principles was implemented to teach and evaluate students' abilities to take histories, document key information, and arrive at the most likely diagnosis. Residents were trained to act as teachers, and a post-study questionnaire was employed to evaluate the students' satisfaction with the training activity. RESULTS A total of 76 students, five teachers, and five standardized patients participated in this clinical reasoning training activity. The average history-taking score was 64%, the average key information number was 7, the average diagnosis number was 1.1, and the average correct diagnosis rate was 38%. Standardized patients presenting with abdominal pain (8.3%) and anemia (18.2%) had the lowest diagnosis rates. The scenario of anemia presented the most difficult challenge for students in history taking (3.5/5) and clinical reasoning (3.5/5). The abdominal pain scenario yielded even worse results (history taking: 2.9/5 and clinical reasoning 2.7/5). We found a correlation in the clinical reasoning process between the correct and incorrect most likely diagnosis groups (group history-taking score, p = 0.045; key information number, p = 0.009 and diagnosis number, p = 0.004). The post-study questionnaire results indicated significant satisfaction with the teaching program (4.7/5) and the quality of teacher feedback (4.9/5). CONCLUSIONS We concluded that the clinical reasoning skills of fourth-year medical students benefited from this training course, and the lower correction of the most likely diagnosis rate found with abdominal pain, anemia, and fever might be due to a system-based teaching modules in fourth-year medical students; cross-system remedial reasoning auxiliary training is recommended for fourth-year medical students in the future.
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Affiliation(s)
- Jian-Han Lai
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Medical Education, MacKay Memorial Hospital, No. 92, Sec. 2, Chung-Shan North Road, Taipei, Taiwan
- MacKay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Kuan-Hao Cheng
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Medical Education, MacKay Memorial Hospital, No. 92, Sec. 2, Chung-Shan North Road, Taipei, Taiwan
| | - Yih-Jer Wu
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Medical Education, MacKay Memorial Hospital, No. 92, Sec. 2, Chung-Shan North Road, Taipei, Taiwan
| | - Ching-Chung Lin
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
- Department of Medical Education, MacKay Memorial Hospital, No. 92, Sec. 2, Chung-Shan North Road, Taipei, Taiwan.
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Zottmann JM, Horrer A, Chouchane A, Huber J, Heuser S, Iwaki L, Kowalski C, Gartmeier M, Berberat PO, Fischer MR, Weidenbusch M. Isn't here just there without a "t" - to what extent can digital Clinical Case Discussions compensate for the absence of face-to-face teaching? GMS JOURNAL FOR MEDICAL EDUCATION 2020; 37:Doc99. [PMID: 33364378 PMCID: PMC7740012 DOI: 10.3205/zma001392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 06/01/2023]
Abstract
Objective: COVID-19 challenges curriculum managers worldwide to create digital substitutes for classroom teaching. Case-based teaching formats under expert supervision can be used as a substitute for practical bedside teaching, where the focus is on teaching clinical reasoning skills. Methods: For medical students of LMU and TU Munich, the interactive, case-based, and supervised teaching format of Clinical Case Discussion (CCD) was digitised and implemented as dCCD in their respective curricula. Case discussions were realised as videoconferences, led by a student moderator, and took place under the supervision of a board-certified clinician. To prevent passive participation, additional cognitive activations were implemented. Acceptance, usability, and subjective learning outcomes were assessed in dCCDs by means of a special evaluation concept. Results: With regard to acceptance, students were of the opinion that they had learned effectively by participating in dCCDs (M=4.31; SD=1.37). The majority of students also stated that they would recommend the course to others (M=4.23; SD=1.62). The technical implementation of the teaching format was judged positively overall, but findings for usability were heterogeneous. Students rated their clinical reasoning skills at the end of the dCCDs (M=4.43; SD=0.66) as being significantly higher than at the beginning (M=4.33; SD=0.69), with low effect size, t(181)=-2.352, p=.020, d=0.15. Conclusion: Our evaluation data shows that the dCCD format is well-accepted by students as a substitute for face-to-face teaching. In the next step, we plan to examine the extent to which participation in dCCDs leads to an increase in objectively measured clinical reasoning skills, analogous to a face-to-face CCD with on-site attendance.
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Affiliation(s)
- Jan M. Zottmann
- LMU Munich, University Hospital, Institute for Medical Education, Munich, Germany
| | - Anna Horrer
- LMU Munich, University Hospital, Institute for Medical Education, Munich, Germany
| | - Amir Chouchane
- Technical University of Munich, School of Medicine, TUM Medical Education Center, Munich, Germany
| | - Johanna Huber
- LMU Munich, University Hospital, Institute for Medical Education, Munich, Germany
| | - Sonja Heuser
- LMU Munich, University Hospital, Institute for Medical Education, Munich, Germany
| | - Lica Iwaki
- LMU Munich, University Hospital, Institute for Medical Education, Munich, Germany
| | - Christian Kowalski
- LMU Munich, University Hospital, Department of Anesthesiology, Munich, Germany
| | - Martin Gartmeier
- Technical University of Munich, School of Medicine, TUM Medical Education Center, Munich, Germany
| | - Pascal O. Berberat
- Technical University of Munich, School of Medicine, TUM Medical Education Center, Munich, Germany
| | - Martin R. Fischer
- LMU Munich, University Hospital, Institute for Medical Education, Munich, Germany
| | - Marc Weidenbusch
- LMU Munich, University Hospital, Institute for Medical Education, Munich, Germany
- LMU Munich, University Hospital, Department of Internal Medicine IV, Munich, Germany
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Wijnen-Meijer M. Preparing students for lifelong learning by means of metacognition. GMS JOURNAL FOR MEDICAL EDUCATION 2020; 37:Doc54. [PMID: 32984513 PMCID: PMC7499462 DOI: 10.3205/zma001347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Marjo Wijnen-Meijer
- Technical University of Munich, TUM School of Medicine, TUM Medical Education Center (TUM MEC), Munich, Germany
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