How professional and academic pre-qualifications relate to success in medical education: Results of a multicentre study in Germany

OBJECTIVE

Every year, many applicants want to study medicine. Appropriate selection procedures are needed to identify suitable candidates for the demanding curriculum. Although research on medical school admissions has shown good predictive validity for cognitive selection methods (undergraduate GPA, aptitude tests), the literature on applicants with professional and/or academic experience prior to entering medical school remains slim. In our study, we therefore aimed to examine the association between academic success in medical school and having previously completed vocational training in the medical field, voluntary service (≥11 months) or an academic degree.

METHODS

Data were collected in a multicentre, cross-sectional study at five medical schools in Germany (Baden-Wuerttemberg) from students during medical school (i.e. 3rd-, 6th-, and 10th-semester and final-year students). Academic success was assessed according to scores on the first and second state examinations, the total number of examinations repeated and the number of semesters beyond the standard period of study. For the analysis we calculated ordinal logistic regression models for each outcome variable of academic success.

RESULTS

A total of N = 2,370 participants (response rate: RR = 47%) participated in the study. Having completed vocational training was associated with a higher amount of repeated examinations (small effect), while having an academic degree was associated with worse scores on the second state examination (medium effect). No significant association emerged between voluntary service and academic success.

CONCLUSION

The results indicate that professional and academic pre-qualifications pose no advantage for academic success. Possible associations with the financing of study and living conditions of students with pre-qualifications were analysed and discussed in an exploratory manner. However, the operationalisation of academic success from objective and cognitive data should be critically discussed, as the benefits of prior experience may be captured by personal qualities rather than examination results.

Student experiences of professionalism and role models in an oral and maxillofacial surgery internship: A qualitative study

INTRODUCTION

Dental students have a clear concept of professionalism and the importance of role models. Our aim was to determine how dental students experience their first oral and maxillofacial surgery internship in terms of their concept of professionalism and their perception of role models.

METHODS

From June to August 2020, semi-structured telephone interviews were conducted with 22 dental students in their eighth and ninth semesters at the Medical Faculty of the University of Ulm. The interviews were transcribed and evaluated by qualitative content analysis according to Mayring.

RESULTS

The students' concept of dental professionalism was shaped by the elements of a good approach to patients, professional competence, and manual skills. This perception was not changed by the internship. Having a role model was seen as an important learning strategy, and role models were perceived in both positive and negative ways. Role models were perceived as positive if they corresponded to the student's concept of professionalism and as negative if they did not correspond to this concept, especially with regard to social interaction or the approach to patients. Students' reactions to discrepancies between their own moral values and the role models' behaviour were characterised by passivity and withdrawal. With regard to potential future careers, positive internship experiences supported student goals, whereas negative experiences raised doubts about them.

CONCLUSION

Supervising dentists may still underestimate the considerable impact of internships, and their awareness of this impact needs to be increased. Students' reactions to conflicts between reality and their own values do not appear to be constructive. One approach to solving this problem may be to include discussions of professional development in curricula.

Understanding of professionalism among medical students in the first year of the COVID-19 pandemic - a qualitative monocentric study

Objective

The existing literature indicates that medical students' understanding of professionalism is influenced by internal and external factors. Therefore, this study aimed to evaluate whether the early phase of the pandemic affected the understanding of professionalism among medical students at the University of Ulm.

Methods

In May and June 2020, semi-structured telephone interviews were conducted with 21 students (in the 8^th and 9^th semester) at the Medical Faculty of the University of Ulm. The interviews were transcribed and analyzed by a qualitative content analysis according to Mayring.

Results

The results showed shifts in students' perception of the importance of certain aspects of medical professionalism. Not only competency in the disciplines hygiene, virology, and microbiology came to the fore, but also personal qualities such as "radiating a sense of calm", empathy, and altruism; communicative competency; and the capacity for reflection. The students also perceived changes in the expectations placed on them. More emphasis was placed on their roles as scientific or medical advisors and as helpers in the health care system, a change that was sometimes emotionally stressful. With respect to the study objective, both limiting and supporting factors were named. For example, the clarification of the relevance of the medical professional was motivating.

Conclusion

The study showed that students' understanding of professionalism depends on context, as was suggested by earlier studies in experts. The perception of changed role expectations may thereby also play a role. One consequence of the findings may be to address such dynamics in suitable curricular events and discuss them with students to prevent them proceeding in an uncontrolled manner.

From the inverted classroom to the online lecture hall: Effects on students' satisfaction and exam results

On-site teaching at Ulm University was restricted in the summer semester (SS) 2020 due to the Corona pandemic. The biochemistry seminar "From gene to protein" in the 2nd preclinical semester, which had been successfully conducted as an Inverted Classroom (IC), had to be changed to an online concept. The aim of this study was to analyze the concept conversion in terms of students' satisfaction and knowledge acquisition. In the seminar, human medical students of the 2nd semester acquired biochemical and competency-oriented learning content. In SS2019, the course was taught using the IC concept. For the conversion to the online format in the SS2020, alternative teaching materials were developed and used. Students' satisfaction was assessed by an evaluation questionnaire and knowledge acquisition was tested by a written biochemistry exam. For both teaching concepts a high level of satisfaction was detected. Individual evaluation criteria were evaluated similarly by the students for both concepts. The online concept led up to significantly higher biochemistry exam scores. Due to the high levels of students' satisfaction in both concepts and the results of the biochemistry exam, it can be concluded that online teaching offers a suitable substitute. Based on these results, it is worth to undertake further research on digitization of studies.

Do medical students recognise the deteriorating patient by analysing their vital signs? A monocentric observational study based on the National Early Warning Score 2

OBJECTIVE

Assessment of the expertise of medical students in evaluating vital signs and their implications for the current risk of a patient, an appropriate monitoring frequency, and a proper clinical response.

METHODS

251 second-year and 267 fifth-year medical students in a curriculum consisting of 6 years of medical school at Ulm University, Germany, were interviewed in a paper-based questionnaire. The students were asked to rate their proficiency in interpreting vital signs and to give pathological thresholds of vital signs. Based on the National Early Warning Score 2 (NEWS2), nine vital signs of fictional patients were created and students were asked to comment on their clinical risk, to set an appropriate monitoring frequency as well as a clinical response.

RESULTS

Interviewing medical students regarding each vital sign individually, the students indicated a pathological threshold in accordance with the NEWS2 for respiratory rate, temperature, and heart rate. By contrast, inappropriate pathological limits were given regarding oxygen saturation and systolic blood pressure. Translating the vital signs into nine fictional patients, fifth-year medical students overall chose an appropriate response in 78% (67%-78%, median±IQR). In detail, fifth-year students successfully identified patients at very high or low risk and allocated them accordingly. However, cases on the edge were often stratified inappropriately. For example, a fictional case with vital signs indicating a surging sepsis was frequently underappreciated (48.5%) and allocated to an insufficient clinical response by fifth-year students.

CONCLUSIONS

Recognising the healthy as well as the deteriorating patient is a key ability for future physicians. NEWS2-based education might be a valuable tool to assess and give feedback on student's knowledge in this vital professional activity.

Innovative Lehrmethoden: Einsatz eines ophthalmochirurgischen Wetlabs im Studentenunterricht

Hintergrund Ein erhöhter Bedarf an ärztlichem Nachwuchs in Deutschland führt dazu, dass der Wettbewerb um die besten Köpfe schon während des Studiums beginnt. Daher ist es Aufgabe der Universitätskliniken, ihren Studierenden bestmögliche Lehrveranstaltungen anzubieten, um Interesse am jeweiligen Fachgebiet zu wecken. Wir überprüften deshalb den Einfluss eines ophthalmochirurgischen Wetlabs auf die Lehre im Rahmen des klinischen Studienabschnitts.

Material/Methoden Im Rahmen der Intensivwoche Augenheilkunde an unserer Universitätsklinik wurde den Studierenden die freiwillige Teilnahme an dem ophthalmochirurgischen Wetlab angeboten. Zu Beginn und am Ende der Intensivwoche sowie am Ende des Wetlabs beantworteten die Studierenden Fragebögen mit Fragen zum Interesse an dem Fachgebiet Augenheilkunde sowie der konkreten Bewertung des Wetlabs.

Ergebnisse Das Interesse der Studierenden an der Augenheilkunde konnte durch die Intensivwoche und zusätzlich durch das Wetlab gesteigert werden. Das Wetlab bereicherte die Intensivwoche und wurde von den Teilnehmenden mit der Schulnote 1,12 bewertet. Die Gesamtbewertung der Intensivwoche war unter Teilnehmenden des Wetlabs signifikant besser als in der Gruppe ohne Wetlab-Teilnahme. Das Wetlab bereitete den Studierenden große Freude, ermöglichte das Anwenden des theoretisch erworbenen Wissens, erlaubte wertvolle Einblicke in das Fach Augenheilkunde und war problemlos umsetzbar.

Schlussfolgerung Die Integration eines Wetlabs in die Lehre im klinischen Studienabschnitt wird von den Studierenden sehr positiv bewertet und ermöglicht diesen einen wertvollen Einblick in das Fachgebiet Augenheilkunde sowie in das Berufsfeld des Augenarztes.

How do German medical students perceive role models during clinical placements ("Famulatur")? An empirical study

BACKGROUND

Studies have demonstrated the importance of role models in medical education. Medical students in Germany participate in clinical placements ("Famulatur") that last 4 months in total and represent the first real-world setting where students encounter possible role models in their clinical education. These placements are an extracurricular activity, however, and regarded as the "black box" of medical education. This study aimed to evaluate whether and how students experience role models during clinical placements, the qualities associated with potential role models and whether role model-related learning gains are relevant.

METHODS

We recruited 96 students (mean age: 23.83 years; 75% female) in their 5th to 9th semesters at the Faculty of Medicine at the University of Ulm, Germany, who were participating in a clinical placement between July and October 2015. Participants completed a questionnaire at the beginning of a 5-day working week to record sociodemographic and other information and another one at the end of the week to assess various aspects of their experiences. On each of the 5 days, they completed a structured questionnaire to record their perceived role models and self-assessed learning gains.

RESULTS

Role models and role modelling play an important role in clinical placements. The positive function of medical staff as role models predominated (88.4%) across all specialties. Junior doctors were the most frequently perceived role models (28.5%), followed by consultants (25.1%) and nursing staff (22.4%). The most commonly perceived positive quality was the interaction with students (16.5%), followed by team behaviour (13.6%), interaction with patients (13.6%) and professional expertise (13.4%). Students also had various kinds of learning gains such as knowledge or skills.

CONCLUSIONS

Although these clinical placements are extracurricular activities in Germany and their content is not regulated, they are home to a relevant amount of role modelling. Students experience the various medical professions in different roles and in a range of tasks and interactions. Defining basic learning objectives could help to increase the relevance of these placements for the medical curriculum in Germany and transfer the associated learning gains from the hidden to the open curriculum.

[Augmented Reality in Ophthalmology: Technical Innovation Complements Education for Medical Students]

BACKGROUND

At the Medical Faculty of the University of Ulm, the learning objectives of ophthalmology are taught to students in a one-week block course in the fourth year of study. According to the National Competency-based Learning Objective Catalogue Medicine (NKLM), one of these learning objectives is the clinical examination of the eye, including the eye fundus examination. In order to best train this expertise as defined in the NKLM, a novel, augmented reality-based training simulator (Eyesi Indirect, VRmagic Holding AG, Mannheim, Germany) was integrated into the teaching at the University Eye Hospital Ulm. During the block week, two key questions were examined: Does the one week block lesson increase interest in ophthalmology? How do students assess the use of an innovative e-learning technology compared to three other classical teaching methods for learning ophthalmoscopy?

MATERIAL/METHODS

As part of the student teaching (block weeks July and October 2016), 292 students were questioned by questionnaire anonymously and on a voluntary basis regarding their assessment of the block week and the training simulator at the beginning and end of the one week event. The ophthalmoscopies were classically practiced on the ophthalmoscope trainer, head model and on fellow students and then performed on the new training simulator.

RESULTS

Overall, there was little interest among the students in ophthalmology. However, the block week helped to increase interest (p < 0.001). The assessments of attractiveness before and after the block week of ophthalmology as a later professional goal and as an optional subject in the practical year were also significantly increased (p < 0.001 or p = 0.031). With regard to the use of e-learning technologies, it was shown that the handling of the simulator for learning ophthalmoscopy was rated more attractive by the students than the classical technology-based teaching methods (all p < 0.01). The joy of learning could only be further increased by practicing on a fellow student (p = 0.051).

CONCLUSION

The results of the present study show a positive impact of the block week on the attractiveness assessment of the specialty by the participating students. Innovative e-learning methods can increase the enjoyment of learning. However, the training simulator cannot provide a complete replacement of the training on a real person.

Anonymous body or first patient? A status report and needs assessment regarding the personalization of donors in dissection courses in German, Austrian, and Swiss Medical Schools

Many Anglo-American universities have undertaken a paradigm shift in how the dissection of human material is approached, such that students are encouraged to learn about the lives of body donors, and to respectfully "personalize" them as human beings, rather than treating the specimens as anonymous cadavers. For the purposes of this study, this provision of limited personal information regarding the life of a body donor will be referred to as "personalization" of body donors. At this time, it is unknown whether this paradigm shift in the personalization of body donors can be translated into the German-speaking world. A shift from donor anonymity to donor personalization could strengthen students' perception of the donor as a "first patient," and thereby reinforce their ability to empathize with their future patients. Therefore, this study aimed to collect data about the current status of donation practices at German-speaking anatomy departments (n = 44) and to describe the opinions of anatomy departments, students (n = 366), and donors (n = 227) about possible donor personalization in medical education. Anatomy departments in Germany, Austria, and Switzerland were invited to participate in an online questionnaire. One-tenth of registered donors at Ulm University were randomly selected and received a questionnaire (20 items, yes-no questions) by mail. Students at the University of Ulm were also surveyed at the end of the dissection course (31 items, six-point Likert-scale). The majority of students were interested in receiving additional information about their donors (78.1%). A majority of donors also supported the anonymous disclosure of information about their medical history (92.5%). However, this information is only available in about 28% of the departments surveyed and is communicated to the students only irregularly. Overall, 78% of anatomy departments were not in favor of undertaking donor personalization. The results appear to reflect traditional attitudes among anatomy departments. However, since students clearly preferred receiving additional donor information, and most donors expressed a willingness to provide this information, one could argue that a change in attitudes is necessary. To do so, official recommendations for a limited, anonymous personalization of donated cadaveric specimens might be necessary. Anat Sci Educ 11: 282-293. © 2017 American Association of Anatomists.

Online or face-to-face instruction? A qualitative study on the electrocardiogram course at the University of Ulm to examine why students choose a particular format

BACKGROUND

Since the introduction of the e-learning electrocardiogram (ECG) course 'ECG Online' into the curriculum at the University of Ulm, a small but relatively constant number of students have decided not to participate in the online course but to attend the face-to-face course, although the content of both courses is identical. The present study examined why students prefer one format or the other.

METHODS

In a qualitative research approach, ten medical students were questioned in a guided interview. At the time of the survey the interviewees were enrolled in the 7th to 10th semesters. Among the respondents, 2 had participated only in the face-to-face ECG course, 4 only in the online version and 4 in both the face-to-face and the online course.

RESULTS

Interestingly, the very factors associated with e-learning - and always praised as advantages of it - are viewed critically by the students. Thus, although the 24-h access to learning content was consistently evaluated positively, the unlimited availability (lack of expiry date) was not seen as conducive to learning. The lack of fixed time constraints and the attendant lack of pressure were important reasons why some of the students had discontinued the online course prematurely. A similar distinction was seen in the flexibility of location for e-learning, because the very obligation to be physically present on a particular day at a fixed time led to a higher degree of commitment to courses and a willingness to actually attend the course until the end. In addition, if the content has a high degree of perceived professional relevance face-to-face courses are preferred because they offer the possibility of direct interaction.

CONCLUSIONS

Even though the small sample size limits the generalisability of the results, our findings indicate that when developing online courses students' needs could be better met if measures were included to strengthen extrinsic and intrinsic motivation and formats were favoured that enable students to have a minimum level of personal interaction with the lecturer.

Concept and benefits of the Inverted Classroom method for a competency-based biochemistry course in the pre-clinical stage of a human medicine course of studies

Background: Medical students often have a problem recognising the relevance of basic science subjects for their later professional work in the pre-clinical stage of their studies. This can lead to a lower motivation to learn biochemical content and dissatisfaction in the courses amongst the students. Alternative teaching methods such as the Inverted Classroom (IC) method can address this deficiency. The goal of this study was: to analyse the motivation and satisfaction of the students in a biochemistry seminar through the use of the e-learning-based IC method, to investigate the acceptance against the IC teaching method in biochemistry, and to compare the learning success achieved using the IC approach with that of a traditional course. We also investigated how a biochemistry course in the pre-clinical stage of a human medicine course of studies can be successfully organised according to the IC method. Furthermore, we examined the benefits of the IC method over conventional teaching formats. Method: The IC method was implemented in accordance with the guidelines of the GMA committee "New Media" [30] in a biochemistry seminar for two student IC intervention groups with 42 students. A part of the factual knowledge from the on-site phase in the form of teaching videos together with self-learning control tasks were provided online before the seminar for both IC intervention groups. Exporting content to the self-learning phase creates new free time in the on-site phase, during which the content can be critically considered and processed and additional competency-based learning objectives can be taught. Identical biochemistry teaching content was taught in parallel control groups (14 student groups with n=299 students), but no material was handed out beforehand for a self-learning phase. These students only received the materials after the on-site phase. Motivation and satisfaction as well as the acceptance for the teaching methods were recorded by questionnaires, the acquisition of knowledge by MC exams. Results: On a Likert scale from 1 (strongly disagree) to 6 (strongly agree), the students in the IC intervention groups could be seen to be much more motivated (5.53) than students in the control group (4.01). Students in the IC intervention groups also recognised the relevance of the learning content much more clearly (5.44) than students in the control group (4.01). Furthermore, the IC group also observed that additional competencies were trained in addition to the biochemistry content. In addition, the IC intervention group award the event a school grade of 1.53, the traditional control group a grade of 2.96. The teaching videos were rated very positively by both groups with an average school grade of 1.3 in each case. A qualitative analysis showed that the motivation and a positive attitude of the lecturers played a decisive role in the successful implementation of the IC method. Discussion and conclusion: Pre-clinical students display a high acceptance of the e-learning-based IC method. Teaching communication competencies in a biochemistry seminar was also rated very positively by the students. The quality of the teaching video and the motivation of the lecturers were shown to be a critical parameter for the successful performance of the IC method. What's more, the IC method can contribute to implementing a competence orientation in medical studies.

Cluster-randomized Studies in Educational Research: Principles and Methodological Aspects

An increasing number of studies are being performed in educational research to evaluate new teaching methods and approaches. These studies could be performed more efficiently and deliver more convincing results if they more strictly applied and complied with recognized standards of scientific studies. Such an approach could substantially increase the quality in particular of prospective, two-arm (intervention) studies that aim to compare two different teaching methods. A key standard in such studies is randomization, which can minimize systematic bias in study findings; such bias may result if the two study arms are not structurally equivalent. If possible, educational research studies should also achieve this standard, although this is not yet generally the case. Some difficulties and concerns exist, particularly regarding organizational and methodological aspects. An important point to consider in educational research studies is that usually individuals cannot be randomized, because of the teaching situation, and instead whole groups have to be randomized (so-called "cluster randomization"). Compared with studies with individual randomization, studies with cluster randomization normally require (significantly) larger sample sizes and more complex methods for calculating sample size. Furthermore, cluster-randomized studies require more complex methods for statistical analysis. The consequence of the above is that a competent expert with respective special knowledge needs to be involved in all phases of cluster-randomized studies. Studies to evaluate new teaching methods need to make greater use of randomization in order to achieve scientifically convincing results. Therefore, in this article we describe the general principles of cluster randomization and how to implement these principles, and we also outline practical aspects of using cluster randomization in prospective, two-arm comparative educational research studies.

The impact of motivation and teachers' autonomy support on children's executive functions

The present study investigates the interplay of executive functions, motivation, and teacher's autonomy support in school context. In a cross-sectional study design 208 students from different school types completed a standardized motivation questionnaire and processed two executive function tasks. All teachers who teach these students were asked about their autonomy supporting behavior by a standardized test. Multilevel analyses assessed the effects of the student's motivation and their teachers' autonomy support on student's executive functions. Our results show considerable relationships between these variables: high executive function capacities came along with teacher's autonomy support and student's intrinsic motivation styles, whereas low executive function capacities were related to external regulation styles. The results indicate the importance of autonomy support in school instruction and disclose the need to popularize the self-regulation approach.