Planetary health as a main topic for the qualification in digital teaching - a project report

Aim

To do justice to the need for planetary health in medical education, these are the aims of the online elective course "Planetary Health in Medical Education" (ME elective):1. Enable students to plan and realize their own course sessions on planetary health;2. Encourage communication among university medical faculties regarding planetary health in medical education;3. Reinforce competency in digital teaching and amplify the expert role as multiplicator among students pursuing a Master's degree in Medicinal Education (MME).

Method

The development of the ME elective followed Kern's six-step approach to curriculum development by means of cooperation between the German Medical Students' Association (Bundesvertretung der Medizinstudierenden in Deutschland, abbreviated as bvmd), and the MME study program. Based on general and specific needs analyses, core learning objectives regarding planetary health, medical education and digital education were identified in the National Catalogue of Learning Objectives in Undergraduate Medical Education (NKLM) and the MME study program and relevant teaching methods were selected.

Results

The ME elective, consisting of two contact hours per week per semester, was established at 13 medical schools as a four-phase course:1. Introduction to medical education using examples from planetary health;2. Lesson planning on a topic in planetary health under the supervision of MME students;3. Course sessions held by the undergraduate students; and4. Networking with the MME study program through participation in digital courses on planetary health and the pilot OSCE on planetary health.A total of 24 students attended the pilot in the 2022 summer semester.

Conclusion

The topic of planetary health combines interests that span many subjects and semester levels. As a collaborative, interdisciplinary and interprofessional subject, it lends itself to training students in a trans-institutional elective course to become multiplicators.

The Influence of Relaxing and Self-Selected Stimulating Music on Vertical Jump Performance in Male Volleyball Players

Most research concerning the effects of music on physical performance was conducted using endurance parameters. This study investigated the effects of relaxing (RLX) vs. self-selected stimulating music (SM) vs. no music (NM) on jump height (JH), jump power (PWR), and average rest period between jumps (RP) in 13 athletes (age: 25.5 ± 2.6 years). After a warm-up and listening to music (1 min) or NM, participants completed five squat jumps on a force plate. Psychological ratings of mood were assessed using a questionnaire before warm-up and after jumping. A one-way ANOVA was conducted to compare effects of music on JH, PWR, and RP. A Friedman test with Wilcoxon signed-rank test was used to detect changes in mood. There were no significant effects of music on JH (p = 0.162) and PWR (p = 0.162). A trend towards longer RP in RLX when compared to SM was detected (+2.72 s, +22%, p = 0.059, d = 0.35). Participants felt more "relaxed" (+3 ranks) and more "powerful" after listening to SM (+2 ranks). Following NM and RLX, athletes felt more "energetic" (each +3 ranks) but less energetic (-3 ranks) after SM. In conclusion, this study did not find any performance-enhancing effects of self-selected SM on jump performance. The influences of music on psychological ratings were inconclusive. For this reason, no evidence-based guidelines for the practical application of music in elite jumping athletes can be made, and more studies are warranted.

Digitalization within the MME study program - teaching and assessment of communicative and interprofessional skills in the Heidelberg module via video conference together with a virtual OSCE course

Background: Due to the corona pandemic, we conducted the Heidelberg module of the Master of Medical Education (MME) study program, which focuses on teaching and assessment of communicative and interpofessional skills, digitally for the first time. Method: We outsourced the teaching to a pre-module phase in the weeks upfront. During the module week, the lecturers picked up again and deepened the topics and the participants created, revised and simulated a virtual OSCE course. Results/Conclusion: Evaluation and reflection of the module showed that the digital implementation including an OSCE examination can be an appropriate alternative to a classroom-based training. However, important elements of the MME program that provide networking possibilities and personal exchange can only be replicated in the digital environment to a limited extent. In the future, sensibly applied digital components can be used to enrich the study program.

Do it together! Conception and long-term results of the trans-institutional Master of Medical Education (MME) program in Germany

Medical education has the responsibility to react to developments and changing demands in healthcare. This implies the need for experts in the area of medical education as well as nationally coordinated initiatives. An innovative model based on trans-institutional cooperation and nationwide consensus for establishing a master's degree course in Medical Education (MME) and long-term results are presented here to other countries and other programs, facing similar challenges. A MME program with the following goals was implemented at the Medical Faculty of Heidelberg University, Germany, in 2004: Qualification of leaders in medical faculties, professionalization and improvement of teaching quality, promotion of nationwide and international exchange, and stimulation of research in medical education. Since then, 15 cohorts with a total of 380 participants have started their studies, 179 participants have graduated and 90 publications resulted from the master's theses (as at November 2018). Evaluation and survey data revealed a very high degree of satisfaction among the participants and a lasting development to medical education experts. Our concept shows that the bundling of regional expertise into a clearly structured trans-institutional network can be a driving force for nationwide comprehensive changes, in order to address changing demands in healthcare systems and transfer it into medical education programs.

Measuring competency-relevant knowledge in the competency-oriented student progress test

Background: Since 2013 a competency-oriented student progress test (SKPT) has been administered at a number of German medical schools. The questions are generated on the basis of a two-dimensional blueprint, on which one axis contains the five competency domains - communicative competence (CO), practical clinical competence (CP), theoretical clinical competence (CT), scientific competence (SC), and professional decision-making competence (PR) - that form part of the competency model of the National Competency-based Catalogue of Learning Objectives for Undergraduate Medicine (NKLM). The feedback for students is structured in part according to these domains. The aim of our study is to examine if the results differentiated by competency domain show adequate measurement accuracy and if the results for the different domains also contain different information. Methods: The SKPTs for the years 2013 to 2017, taken by a total of 3,027 students, were examined. The measurement accuracy was determined using the coefficient glb (greatest bound to reliability) and the standard error of measurement; discriminant analysis of the principal components was carried out to demonstrate differentiation between the competency domains. Results: The reliability of the competency domains was above 0.8 for all SKPTs; exceptions to this were seen in two of the tests for CO and PR that had a reliability of 0.7-0.8. The results for all of the individual competency domains differed in their informational content compared to the overall of the other domains; the same applies for all pairwise comparisons, with the exceptions of CP and CT. Discussion: The SKPT feedback for students that is differentiated by competency domains basically fulfills the requirements for measurement reliability and distinctness. An improvement of the measurement quality for CO and PR and a better differentiation between CP and CT is desirable.

Do it together! Conception and long-term results of the trans-institutional Master of Medical Education (MME) program in Germany

Medical education has the responsibility to react to developments and changing demands in healthcare. This implies the need for experts in the area of medical education as well as nationally coordinated initiatives. An innovative model based on trans-institutional cooperation and nationwide consensus for establishing a master's degree course in Medical Education (MME) and long-term results are presented here to other countries and other programs, facing similar challenges. A MME program with the following goals was implemented at the Medical Faculty of Heidelberg University, Germany, in 2004: Qualification of leaders in medical faculties, professionalization and improvement of teaching quality, promotion of nationwide and international exchange, and stimulation of research in medical education. Since then, 15 cohorts with a total of 380 participants have started their studies, 179 participants have graduated and 90 publications resulted from the master's theses (as at November 2018). Evaluation and survey data revealed a very high degree of satisfaction among the participants and a lasting development to medical education experts. Our concept shows that the bundling of regional expertise into a clearly structured trans-institutional network can be a driving force for nationwide comprehensive changes, in order to address changing demands in healthcare systems and transfer it into medical education programs.

Development of a competency-based formative progress test with student-generated MCQs: Results from a multi-centre pilot study

INTRODUCTION

Progress tests provide students feedback on their level of proficiency over the course of their medical studies. Peer-assisted learning and competency-based education have become increasingly important in medical education. Although progress tests have been proven to be useful as a longitudinal feedback instrument, there are currently no progress tests that have been created in cooperation with students or that focus on competency in medical education. In this study, we investigated the extent to which students can be included in the development of a progress test and demonstrated that aspects of knowledge related to competency can be represented on a competency-based progress test.

METHODS

A two-dimensional blueprint for 144 multiple-choice questions (MCQs) covering groups of medical subjects and groups of competency areas was generated by three expert groups for developing the competency-based progress test. A total of 31 students from seven medical schools in Germany actively participated in this exercise. After completing an intensive and comprehensive training programme, the students generated and reviewed the test questions for the competency-based progress test using a separate platform of the ItemManagementSystem (IMS). This test was administered as a formative test to 469 students in a pilot study in November 2013 at eight medical schools in Germany. The scores were analysed for the overall test and differentiated according to the subject groups and competency areas.

RESULTS

A pool of more than 200 MCQs was compiled by the students for pilot use, of which 118 student-generated MCQs were used in the progress test. University instructors supplemented this pool with 26 MCQs, which primarily addressed the area of scientific skills. The post-review showed that student-generated MCQs were of high quality with regard to test statistic criteria and content. Overall, the progress test displayed a very high reliability. When the academic years were compared, the progress test mapped out over the course of study not only by the overall test but also in terms of the subject groups and competency areas.

OUTLOOK

Further development in cooperation with students will be continued. Focus will be on compiling additional questions and test formats that can represent competency at a higher skill level, such as key feature questions, situational judgement test questions and OSCE. In addition, the feedback formats will be successively expanded. The intention is also to offer the formative competency-based progress test online.

Is German Medical Education Research on the rise? An analysis of publications from the years 2004 to 2013

OBJECTIVES

The point of departure for the present work is the observation that, in comparison with Anglo-American countries or the Netherlands, Germany was responsible for only a marginal number of international publications in the field of medical education research before 2004. Recent years, however, have seen an increase in the importance of medical education research in Germany. The objective of this article is to evaluate the extent to which this trend can be substantiated by increased German publishing activity since the year 2004 in international, English-language journals in the subject area of "medical education research".

METHODS

In the framework of a literature and content analysis, German-author articles from the years 2004 to 2013 in six international, English-language medical education research journals were evaluated. In order to obtain an overview of German research activity in this area, all project and original works with German first and last authors were identified and subjected to a more in-depth content analysis.

RESULTS

In total, 10,055 articles were examined. The evaluation shows that between the years 2004 and 2013 179 articles (of which 145 are project or original works) by German authors were published in the journals examined. Fluctuations over the course of time were evidenced. The project and original works are primarily cross-sectional studies (27.8%) and randomised control studies (25.6%) on the subject of "teaching and learning methods" (43.6%).

CONCLUSIONS

In comparison with the years 2004-2008, a significant rise can be seen in the number of publications by German education researchers in international journals since the year 2009.

Paediatric trauma: injury pattern and mortality in the UK

OBJECTIVE

Trauma accounts for a large proportion of childhood deaths. No data exist about injury patterns within paediatric trauma in the UK. Identification of specific high-risk injury patterns may lead to improved care and outcome.

METHODS

Data from 24 218 paediatric trauma cases recorded by the Trauma Audit and Research Network (TARN) from 1990 to 2005 were analysed. Main injury, injury patterns and outcome were analysed. Mortality at 93 days' post-injury was the major outcome measure.

RESULTS

Limb injuries occurred in 65.0% of patients. In infants 81.4% of head injuries were isolated, compared with 46.5% in 11-15-year-old children. Thoracic injuries were associated with other injuries in 68.4%. The overall mortality rate was 3.7% (n = 893). Mortality decreased from 4.2% to 3.1%; this was most evident in non-isolated head injuries. It was low in isolated injuries: 1.5% (n = 293). In children aged 1-15 years the highest mortalities occurred in multiple injuries including head/thoracic (47.7%) and head/abdominal injuries (49.9%). Having a Glasgow Coma Scale of <15 on presentation to hospital was associated with a mortality of 16%.

CONCLUSIONS

Differences in injury patterns and mortality exist between different age groups and high-risk injury patterns can be identified. With increasing age, a decline in the proportion of children with head injury and an increase in the proportion with limb injury were observed. This information is useful for directing ongoing care of severely injured children. Future analyses of the TARN database may help to evaluate the management of high-risk children and to identify the most effective care.

Neu entwickeltes Kiefergelenkkopfimplantat zur temporären Kondylus-Rekonstruktion in der ablativen Tumorchirurgie

BACKGROUND

Based on own retrospective studies a condylar head add-on system for immediate, temporary reconstruction in patients undergoing ablative surgery requiring the removal of the manibular condyle has been developed in cooperation with the Department of Oral and Maxillofacial Surgery of the University of Tennessee, USA, and the Association for the Study of Internal Fixation (AO/ASIF).

PURPOSE

The design of the new condylar head add-on system and its use in an anatomical dissection study on a human cadaver are introduced and discussed. DESIGN AND FIRST EXPERIENCES: The condylar replacement is made of commercial pure titanium and is conceived as an add-on system. It consists of a reconstruction plate (2.4 Uni-LOCK-System) und an adaptable condylar head that can be fitted on either side. The offset of the condylar head in a medial direction allows anatomically correct positioning of the implant. The slanted oval head shall provide a large contact area while maintaining function of the mandibular joint. The height-adjustable positioning of the condylar head add-on with four different fixations plates facilitates an intraoperative vertical correction of the condylar head without necessary bending of a new reconstruction plate. A condylar head add-on used on both sides and combined with the frequently used 2.4 Uni-LOCK-plate benefits from reduced storekeeping and turns out to be advantageous from an economic point of view.

PERSPECTIVE

An international, prospective multi-center study evaluating the intraoperative applicability of the new condylar head add-on system and its functional as well as aesthetic results during the first two postoperative years has started in September 2006.

Watson fundoplication in children: a comparative study with Nissen fundoplication

BACKGROUND

Nissen fundoplication is the gold standard antireflux procedure in children. In 1996, one pediatric surgeon adopted the anterior fundoplication described by Watson in 1991. This procedure is reported to achieve good reflux control while permitting burping, active vomiting, and reducing gas bloat. An audit project was undertaken to compare the clinical outcome of children undergoing Nissen and Watson fundoplication.

METHODS

The case notes of 144 children undergoing open fundoplication between February 1995 and February 2002 were reviewed retrospectively.

RESULTS

Results of 72 boys and 59 girls comprising 76 Nissen and 55 Watson fundoplications were assessed. In each group, one death occurred within 1 month of operation. Chest infections occurred in 6.6% (Nissen) and 1.8% (Watson), and wound infections in 2.6% and 1.8%, respectively. Dysphagia was recorded in 7.9% of Nissen and 1.8% of Watson fundoplications. Follow-up data were analyzed in 70 children with Nissen and 48 children with Watson fundoplication. When overall clinical outcome was assessed for those patients with a minimum follow-up of 1 year, 85.1% Nissen and 88.2% Watson were judged good/excellent; 14.9% Nissen and 11.8% Watson were judged poor/bad.

CONCLUSION

Watson fundoplication can safely be performed in children with comparable clinical outcome to Nissen fundoplication.

Colonic transit time--what is normal?

BACKGROUND

Constipation is a common problem in childhood, and various radiologic methods have been advocated for investigation. Colonic transit time (CTT) has been used in adults to investigate colonic motility, but few studies evaluate this method in children. Data on CTT in the normal paediatric population are scarce.

METHODS

The colonic transit time was measured in 22 healthy children (median age, 10 years; range, 4 to 15 years) by Abrahamsson's method. Children took bolus ingestions of radiopaque markers on 6 consecutive days, and on day 7 a single abdominal x-ray was performed. This was evaluated for total and segmental colonic transit time.

RESULTS

The mean total CTT was 40 hours, and the upper limit of normal (95th percentile) was 84 hours. The upper limit of normal for segmental transit time was as follows: 14 hours for the ascending, 33 hours for the transverse, 21 hours for the descending, and 41 hours for the rectosigmoid colon.

CONCLUSIONS

CTT provides an objective measure to assess childhood constipation. To date, 6 studies using 5 different methods have been published reporting values for healthy children. Comparing these, Abrahamson's method has low radiation exposure and is well tolerated. This study contributes additional normal values in children.

Chronic disease self-management: improving health outcomes

Chronic disease has become pandemic in the United States, and estimates are that it will affect 148 million people by the year 2030. Patients with chronic illnesses cost the health care system over three times more than individuals without chronic conditions. The US Department of Veterans' Affairs (VA) Sunshine HealthCare Network, composed of VA health care facilities in Florida and Puerto Rico, recognized that the needs of its increasing number of veterans with chronic diseases were unmet by traditional medical interventions. The Network implemented a chronic disease self-management pilot program to evaluate its value for the veteran population. Results of the pilot indicate that this program will make a positive, lasting change in the health status and quality of life for veterans with chronic disease.

The U3 promoter and the nef gene of simian immunodeficiency virus (SIV) smmPBj1.9 do not confer acute pathogenicity upon SIVagm

Two chimeric proviruses comprising the U3 promoter and the nef gene of simian immunodeficiency virus (SIV) smmPBj1.9 in addition to other genomic regions of SIVagm3mc from African green monkeys (Cercopithecus aethiops) were constructed. The derived chimeric viruses (SIVagm3mc/SIVsmmPBj1.9) were both able to replicate in nonstimulated peripheral blood leukocytes from pig-tailed macaques (Macaca nemestrina), a biological property often correlated with acute pathogenicity. However, only one of the chimeric viruses was acutely pathogenic, inducing a rapid depletion of the peripheral CD4+ T cells in two infected pig-tailed macaques within 10 days after infection in a manner similar to infection with SIVsmmPBj1.9 itself. The other chimeric virus actively replicated during the first 8 weeks after experimental infection of two pig-tailed macaques but induced neither acute disease nor CD4+ T-cell depletion for 113 weeks after infection. Thus, the U3 promoter and the nef gene of SIVsmmPBj1.9 alone appear to be insufficient to confer acute pathogenicity to SIVagm3mc.

Induction of antibodies against SIV antigens after intramuscular nucleic acid inoculation using complex expression constructs

By studying the infection of rhesus macaques with simian immunodeficiency virus (SIVmac) the potential of nucleic acid immunisation against AIDS can be evaluated. As a first step towards the development of suitable expression constructs, the levels and the durations of expression elicited by the house-keeping gene promoters of the murine phospho-glycerate kinase (PGK) gene and rat proto-ras 1Ha, a lentiviral LTR and the CMV-intron A promoter were tested in BALB/c mice intramuscularly inoculated with marker gene constructs encoding luciferase. The expression levels achieved by the CMV-intron A and the lentiviral promoter were comparably high, and also the PGK promoter induced a high level of expression for at least 64 days. Following the inoculation of plasmids comprising single or multiple genes of SIV, the induction of specific antibodies directed against SIV antigens was demonstrated. We previously showed in vitro that int- and nef-defective mutants of SIVmac were able to initiate a limited and self-abortive infection of permissive cells in the absence of chromosomal integration of the viral DNA. Intramuscular inoculations in monkeys using int-defective proviral DNA of SIV will show whether an increased immune response may be induced by expression of viruses undergoing a self-limited replication in vivo.

Modulation of accessory cell function of immortalized bone marrow-derived macrophages by granulocyte/macrophage colony-stimulating factor

To generate cloned macrophage populations with sensitivity towards granulocyte/macrophage colony-stimulating factor (GM-CSF), bone marrow-derived macrophages (BMM phi) were immortalized by transformation with SV40. A panel of transformed clones was established. The majority of clones represented independently derived transformants, as evidenced by restriction fragment length polymorphism using genomic DNA digested with EcoRI and TaqI and the 5.2 kb SV40 DNA for hybridization analysis. The cells belong to the macrophage lineage according to several criteria, e.g. the presence of nonspecific esterase, their phagocytic capacity and their morphology. Many clones were potent antigen-presenting cells (APC), without exogenous stimulation. Two clones, which did not act efficiently as APC when used untreated, were positively responsive to GM-CSF. GM-CSF stimulation of both clones resulted in potent APC capacity. I-A alpha, I-A beta and gamma chain-specific transcripts were observed upon stimulation with GM-CSF, corresponding to detectable levels of class II surface display as revealed by cytofluorometric analysis. Thus the macrophage clones established will allow dissection of the differential effects of GM-CSF on the parameters of antigen presentation.

Blastocystis hominis--a potential intestinal pathogen

The parasite Blastocystis hominis has been found in 10% to 18% of stool specimens submitted to microbiology laboratories. Controversy exists as to whether this organism can cause illness in humans. We have reviewed the records of 65 symptomatic patients with B hominis in their stool. We conclude that B hominis is a potential pathogen that may or may not require drug therapy depending on the overall clinical circumstances, the severity of symptoms, and the presence of other pathogenic organisms.

[The Ha(La) antibody as a serologic marker of systemic lupus erythematosus]

Ha(La)-antibodies are detected by counterimmunoelectrophoresis (CIE) in sera of systemic lupus erythematosus (SLE) patients, but not in sera of patients with progressive systemic scleroderma (PSS) (n = 38), rheumatoid arthritis (n = 91), ankylosing spondylitis (n = 97), and other rheumatic diseases (n = 452). This antibody specificity was found in 27 out of 103 SLE patients (26%). However, 50% of SLE patients with Sjögren's syndrome (n = 12) showed the Ha(La)-antibody, suggesting a strong association in this clinical subgroup. Thus the Ha(La)-antibody can serve as a serological marker and helpful diagnostic tool for SLE. Additionally, the Ha(La)-antibody reacts with specific puffs in polytene chromosome preparations of Drosophila melanogaster. Therefore, this heterologous antigen system is suitable for the identification of Ha(La) sera.

Fermentative degradation of nonionic surfactants and polyethylene glycol by enrichment cultures and by pure cultures of homoacetogenic and propionate-forming bacteria

Linear alkyl ethoxylates (polyethylene glycol alkyl ethers) were fermented completely to methane and CO2 in enrichment cultures inoculated with anoxic sewage sludge. Long-chain fatty acids were released as intermediates. No degradation was found with polypropylene glycol and polypropylene glycol-containing surfactants. Two types of primary ethoxylate-degrading bacteria were isolated and characterized. Both degraded polyethylene glycols with molecular weights of 1,000 completely. Strain KoB35 fermented polyethylene glycol, ethoxyethanol, and lactate to acetate and propionate and was assigned to the described species Pelobacter propionicus. Strain KoB58 converted polyethylene glycol and many other substrates to acetate only and was assigned to the genus Acetobacterium. The pathways of anaerobic degradation of nonionic surfactants are discussed with respect to their limitations and the various groups of bacteria involved.