[Impact of an elective course in evidence-based clinical decision-making on competencies and attitudes of medical students: A pilot study]

BACKGROUND

Evidence-based medicine (EbM) as a teaching subject is increasingly taken into account in the Master Plan 2020. To date, neither theoretical requirements nor practical applications of EbM have been consistently implemented in the clinical curriculum. To fill this gap, a digital and tutor-based EbM course has been developed. The aim is to identify the student characteristics (statistical competence, Need for Cognition (NFC), work and experience patterns (AVEM), diagnostic uncertainty) of the first cohort in order to ensure successful course implementation and to prepare future doctors for their role as mediators of health literacy using EbM methods.

METHODS

The long-term study started in the summer term 2019 with 10 medical students during their clinical training. The measurements were conducted before (t0) and after course attendance (t1). Socio-demographic variables were taken at t0, the Quick Risk Test, PRU questionnaire, the NFC scale and the AVEM were collected at t0 and t1.

RESULTS

Half of the students started their doctoral thesis before attending the course. The first test results of the Quick Risk Test (t0) were between 50 % and 90 % and at t1 between 60 % and 100 %. The students showed high scores on the NFC scale (X¯=4.6, SD=0.52, Δ X¯ t0 - t1=0.1) and medium scores on the Perfectionism scale (X¯=3.8, SD=0.51, Δ X¯ t0 - t1=0.1), Resignation Tendency (X¯=3.8, SD=1.17, Δ X¯ t0 - t1=0.1) and on the scale Aggressive Problem Solving (X¯=3.9, SD=1.06, Δ X¯ t0 - t1=0.2). They achieved high levels of Anxiety Due to Diagnostic Uncertainty (X¯=4.8, SD=0.69, Δ X¯ t0 - t1=0.4) and on the scale Concern about Poor Outcomes (X¯=3.9, SD=1.54, Δ X¯ t0 - t1=0.6). The scale Restraint in Disclosing Uncertainty to Patients was more pronounced than the scale Restraint in Disclosing Errors to Physicians (X¯=3.5, SD=0.93, Δ X¯ t0 - t1=-0.3 compared to X¯=2.3, SD=1.20, Δ X¯ t0 - t1=0.1).

DISCUSSION

Statistical competence improved with course attendance, with only one student being able to correctly answer all items at t1. NFC and AVEM were strongly expressed and were not very sensitive to change in the sample. The greatest changes were observed on the scales of concern about poor results and fear of diagnostic uncertainty, both of which decreased with course participation.

CONCLUSION

In the long term, the development of a new measuring instrument to assess EbM competencies instead of the Quick Risk Test is conceivable. The longitudinal design will also enable us to make causal interpretations and to track changes in students' competence feelings, behaviour and attitudes.

Asynchronous, digital teaching in times of COVID-19: a teaching example from general practice

Background: The SARS-CoV-2 pandemic had a strong impact on academic teaching and could change it sustainably. Ad hoc digitization of teaching had to be carried out. General practice teaching situation: Education in general practice at the Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) offers, in addition to the main lecture, various elective courses, clinical traineeships, internship as well as the elective part in the final practical year. The main lecture and one clinical elective course were offered digitally in the summer term 2020. Digital methods: In the main lecture, an adapted inverted-classroom concept was used. Podcasts and audio annotated videos were provided. Teaching materials were reflected via a weekly, 1hr video consultation and in a forum. An asynchronous learning module was developed for the elective course "Smart Decision-making in Clinical Practice". Each module consisted of course preparation, podcasts and follow-ups as well as a supervised forum. Results: The main lecture (response rate n=115/170; 67.6%) was rated "very good" on average. The same applies to the commented videos. The forum, reflective video consultation and teaching materials were rated "good" on average. The predominantly desired forms of presence were "Focus on virtual with in-depth presence phases" (n=54) and "Focus on presence phases, virtual support only" (n=37). Discussion and implications: The digital restructuring enables students to work on the course contents independently. This requires self-regulation strategies, which in future shall be taught through portfolio work. The teaching focus shifts from a passive teaching format to an interactive one. First evaluation results showed a very good acceptance by the students.

Aged care reforms: policy implications for rural and remote Australia

In 1996, the Federal Government announced a draft of reforms in the aged care sector, including the controversial proposal to introduce upfront bonds for new nursing home residents with assets of more than $23,000. Following effective lobbying from welfare and church groups and pensioner organisations, the Prime Minister announced the axing of the bonds policy for nursing home residents in November 1997 and its replacement with an accommodation charge of $380 per annum for 5 years. The social justice and ideological underpinnings of these Aged Care Reforms remain contentious, and have fundamental and long-term policy implications for the provision of aged care services in rural and remote areas.