[Verbundweiterbildung(plus) Baden-Württemberg: Development of educational meetings and implications for the implementation of family medicine training programmes in Germany]

BACKGROUND

The German Society of General Practice and Family Medicine (DEGAM) has defined educational seminars during post-graduate training as a core element to improve trainees' specific knowledge and competencies. Furthermore, these seminars facilitate networking among trainees and support the process of identity formation in family medicine. Since its implementation in 2009, the Verbundweiterbildung(plus) Baden-Württemberg (VWB(plus) Ba-Wü) has offered educational seminars. Aim of this article is to analyse the content of these educational seminars and to derive implications for other family medicine training programmes in Germany.

METHODS

From 2009 to 2015, the data from all educational seminars was descriptively analysed. Furthermore, two researchers categorised the seminar contents independently of each other and assigned them to the competence-based curriculum for family medicine training (Kompetenzbasiertes Curriculum Allgemeinmedizin, KCA).

RESULTS

Until 2015, 600 trainees participated in a starter seminar of the VWB(plus) Ba-Wü. In total, 1,116 teaching units and 160 different seminars covered all relevant topics of the KCA. A restructuring of organisational processes and seminars was necessary to handle the increase in the number of participants, including the development of specific software for electronic support. Of all these seminars, 56% were held by specialists or trainees in family medicine. The participating trainees rated the educational seminars in general and the possibility for networking as (very) good.

CONCLUSIONS

The contents of the educational seminars included in family medicine training programs will have to be specifically based on family medicine and cover all relevant aspects of the KCA - medical expertise, competencies and procedures. In order to ensure a common standard concerning didactic methods and qualifications of teachers, a didactic guideline is to be developed. The increasing demand of family medicine training programmes requires (further) development of the software eSchoolab, including integration of the KCA.

[The "National Aeronautics and Space Administration-Task Load Index" (NASA-TLX) - an instrument for measuring consultation workload within general practice: evaluation of psychometric properties]

OBJECTIVE

The aims of the study were the translation and a first reflection of the psychometric properties of the Aeronautics and Space Administration-Task Load Index (NASA-TLX), a multidimensional instrument to measure workload in general practice.

METHODS

During April and September 2015, the NASA-TLX was translated and evaluated. For this purpose, a questionnaire composed of the NASA-TLX items and others items related to demographic data, was developed. Postgraduate family medicine trainees and family physicians were then asked to assess patient consultations by applying the questionnaire. The psychometric properties of the NASA-TLX were identified using explorative and confirmatory factor analysis. Reliability was assessed using Cronbach's α.

RESULTS

Overall, 16 participants completed 769 surveys after a single patient consultation. The highest average was observed for the item 'mental demand' (mean 6.9 ± 5.4), followed by the item 'effort' (mean 6.6 ± 5.5). Factor analysis revealed a one-factor solution with an explained variance of 56.9 %. The German version of NASA-TLX demonstrated a high internal consistency (Cronbach's α = 0.84). Confirmatory factor analysis showed that there was an acceptable consistency between the expected unidimensional structure and the data.

CONCLUSIONS

The German version of NASA-TLX provides preliminary indications of psychometric properties and presents an important tool to evaluate family physicians' workload in direct patient contact.

Evaluation of attitudes towards telemedicine as a basis for successful implementation: A cross-sectional survey among postgraduate trainees in family medicine in Germany

BACKGROUND

By comparison with other countries of the European Union Germany is only middle-ranking in terms of telemedicine usage. There is a relevant gap between the legal framework and the actual state of implementation. Healthcare providers play an important role in this implementation process as they are increasingly confronted with the application of telemedical scenarios. Therefore, the aim of this survey was to determine attitudes towards telemedicine of postgraduate trainees in Family Medicine (FM) in Germany.

METHODS

A cross-sectional survey was conducted between July and October 2016 among postgraduate trainees in FM throughout Germany. The questionnaire covered four topics: attitudes towards telemedicine, barriers for the implementation of telemedicine, assessment of useful telemedical applications and telemedicine scenarios. A descriptive approach was used to analyze the data in order to derive determinants for the implementation of telemedicine.

RESULTS

In total, 388 postgraduate trainees from 13 of the 16 federal states in Germany answered the survey. Seventy-eight percent were female. Participants' mean age was 36 years. The majority of participants believed that only a fraction of the already existing technology in telemedicine is being used (70 %). The largest perceived barrier to telemedicine was data safety concerns. More than half of the participants (54 %) believed that telemedicine would change the doctor-patient relationship. 51 % of the participants were interested in training in telemedicine. In this respect, it is important to note that 27 % of the postgraduate trainees said their willingness to practice in rural areas might be facilitated through the availability of telemedical backup for family physicians.

CONCLUSIONS

Participating trainees in FM in Germany think that the potential for telemedicine is not yet fully exploited. Based on the results of this survey the next steps to be taken for the implementation of telemedicine applications can be addressed.

[With which level of competence do young medical professionals take up their career? - A survey among postgraduate trainees in Bavaria]

BACKGROUND

Undergraduate training aims to enable medical students to become fully qualified physicians. The aim of the study was to explore the competences that newly graduated doctors (beginners) bring along from medical school into their postgraduate training. In this way areas can be identified that need to be better addressed during either under- or postgraduate training.

METHODS

Competencies were assessed using a paper-based questionnaire that was sent out to 405 physicians in Bavaria being in the possession of a postgraduate training license in internal medicine, surgery and anaesthesiology. The questionnaire included items exploring the fields of competencies outlined in the CanMeds role descriptions. The results were analyzed using descriptive and exploratory methods.

RESULTS

190 of 405 questionnaires (47 %) were returned. 96 % of the participants were male, the average age was 54 years. The results indicated that most young medical professionals had the necessary theoretical knowledge to take up postgraduate training. However, putting theory into practice does not work well enough from the physician's point of view.

DISCUSSION

An approach to further support the transfer of enormous amounts of theoretical knowledge acquired during years of study into medical expertise is needed. In this respect, recently published competence-based curricula for under- and postgraduate training might prove useful.

Adaptation, psychometric properties and feasibility of the Professionalism Scale Germany

INTRODUCTION

Pre- and postgraduate education is meant to be competency-based. Over the last two decades various competency frameworks have been published. An important aspect of competency is professionalism, being discussed widely in the literature while a clear-cut definition is still lacking. The purpose of this study was to translate the Nijmegen Professionalism Scale into the German language, to adapt the scale to the German setting and to examine the psychometric properties, test-retest reliability and feasibility of the culturally adapted instrument designed to assess professionalism in general practice, in addition to the validity of the concept of professionalism and to testify the transfer across linguistic, cultural and societal differences.

METHOD

After translating the Nijmegen Professional Scale into German, we conducted its cultural adaptation, the German Professionalism Scale (Pro-D). Its psychometric properties were assessed using Cronbach's α, descriptive statistics, and test-retest reliability. The validation of the construct was analysed by confirmatory factor analysis. Feasibility was confirmed in interviews with GP trainees and their trainers.

RESULTS

A total of 133 trainees completed the Pro-D. The Pro-D showed high internal consistency (Cronbach's α 0.93) and good test-retest reliability (Spearman's rank correlation and Wilcoxon's matched-pairs test) for the different domains. Confirmatory factor analysis was unable to establish construct validity. Change in sensitivity of the instrument was good. Statements of interviews confirmed the feasibility of the new instrument.

CONCLUSIONS

We found good psychometric properties for the Pro-D. This might indicate transferability of the concept across linguistic, cultural and societal differences although the concept of professionalism was not replicated in a confirmatory factor analysis.

[Changing to a career in general practice - a qualitative study reveals motives of specialists]

BACKGROUND

In 2011, the national German Medical Association (Bundesärztekammer) published guidelines for a slim-lined training program in general practice (Quereinstieg) for qualified medical specialists in other fields (e. g., surgeons, internists or anesthesiologists). This step is part of a strategy to prevent further shortages of general practitioners in Germany. In the state of Baden-Wuerttemberg, qualified medical specialists are allowed to complete their general practice training in approximately two years instead of five. The aim of this study was to understand the reasons of specialists for changing to a career in general practice.

METHODS

The postgraduate training program Verbundweiterbildung^plusBaden-Württemberg had 597 trainees at the time of the study in December 2015. Previously qualified specialists in another medical discipline were identified and invited to participate in this study. Qualitative data was gathered using semi-structured interviews with content analysis of the interviews performed by three independent members of the research team.

RESULTS

In total, 36 out of 597 trainees were identified as previously qualified specialists in another medical discipline. All 36 were invited to take part and 15 agreed to participate in this study. Overall, 15 interviews were performed, with a mean time of 24.19minutes. Participants with a median age of 40 years (33-59 years) - mainly anesthesiologists (n=7), surgeons (n=3) and internists (n=3) - presented with an average of 6.5 years of professional experience in their specialty. First, the participants' motivation to switch career arose from the wish to intensify the quality of patient contacts with a holistic approach including family and social background and from the infinite variety of general practice. Another reason given for a career change was self-employment opportunities. Finally, feelings of frustration over poor working conditions in hospitals resulted in a job search elsewhere in medicine, taking account of the challenges of ageing and family life. A major finding was that without the slim-lined program, the majority of participants would not have changed their career.

DISCUSSION

The slim-lined training program in general practice attracts experienced medical doctors. Specialists decide to change career because of the particular ways of working in general practice and with the intention to improve their daily work as a physician, either to improve individual working conditions and/or to improve their individual curative work profile. In addition, specialists are attracted by the concept of self-employment in general practice. Therefore, appreciation of the specific ways of working in general practice as well as management skills are most important during the reduced 2-year training. Further studies should investigate if facilitating a career switch to general practice is a good way to improve the shortage of general practitioners.

[Professionalism in general practice in Germany - a qualitative approximation]

BACKGROUND

Pre- and postgraduate education is meant to be competency-based. Over the last two decades various competency frameworks have been published. One competency is professionalism, a definition of which has not yet been developed but is being discussed in the literature. The aim of this qualitative study is an approximation to professionalism among German general practitioners and general practitioner trainees.

METHODS

A qualitative study was conducted by interviewing seven pairs of GPs and their trainees. All interviews were recorded and transcribed. The analysis was performed according to Mayring supported by the software Atlas.ti.

RESULTS

Four categories of professionalism emerged: responsibility towards patients, responsibility towards other professionals, responsibility towards the society and responsibility towards oneself. Professionalism was perceived as important for general practice in Germany. In addition, barriers of professional behaviour have been identified.

CONCLUSION

The perception of professionalism among German GPs and GP trainees is in accordance with the frameworks of professionalism found in the literature. These results underline the need for conceptualising professionalism among general practice trainees in Germany.

[Determinants of participation in seminars as part of a post-graduate training programme: a qualitative study with general practice residents]

BACKGROUND

Germany is facing a shortage of primary care physicians (general practitioners, GPs). To improve post-graduate training in general practice, competency centres were established across Germany. The core of their work is a seminar programme. It was observed that some GP trainees constantly participate, while others are seldomly seen. The aim of this study was to explore what helps and what hinders constant participation.

METHODS

GP trainees of the Verbundweiterbildung^plus Baden-Württemberg (2008 - 2017), predecessor of the KWBW Verbundweiterbildung^plus© program (2017 - present), were included in the study. First, participation in the years 2014 and 2015 was analysed. We recruited the very active as well as the no-show participants for semi-structured telephone interviews. Content analysis was performed by three independent scientists.

RESULTS

Participation of n=353 trainees was analysed. N=30 trainees participated in the study (including n=13 no show). The average interview length was 25minutes (13-36minutes). Trainees felt motivated by practice-oriented, varying and learner-oriented subjects. They highlighted the professional and personal interaction and its networking effects. Participants favoured lecturing during working days, topics structuring daily training and supporting every day practice. The seminar moderators' treasure trove of experience and their teaching competencies were regarded as essential. The fact that employers do not regularly grant time away from work to attend the training programme was cited as a major inhibiting factor. Other reasons given for non-attendance included long travel distances, repeat topics or an imbalance between gain of knowledge and social interactions, and finally, a high individual level of work strain, given the dual burden on those trying to combine work and family life and taking on the main responsibility for children.

CONCLUSIONS

The main enablers (motivators) of participation were practice- and learner-oriented topics and beneficial social interactions. During the seminars, participants experience group membership and the enthusiastic (learning) atmosphere boosts trainees to proceed with their training and follow their career paths in general practice. Continuous participation requires protected time. Competence centres for postgraduate medical education should take these findings into consideration for quality management and programme planning, and, if possible, should initiate and evaluate appropriate countermeasures.

[Five-year experience with Train-the-Trainer courses for general practice trainers - a qualitative and quantitative analysis]

BACKGROUND

A Train-The-Trainer course (TTT course) for general practice trainers was developed as part of the program Verbundweiterbildung^plus Baden-Württemberg. The course included aspects of training such as organizational and legal knowledge as well as didactic skills for trainers in 9.5 teaching units (45minutes each). The present article analyzes the evaluation of the course and considers possible future developments for TTT courses in Germany.

METHODS

An evaluation tool was used covering aspects such as information, relevance for daily work, opportunities for participant engagement in the seminars and working environment as well as didactic competencies among teachers. Within five years, 256 trainers participated in a TTT course and received an evaluation sheet. Data were analyzed descriptively.

RESULTS

249 evaluation sheets were included (response rate 97 %). Overall, the participants were (very) satisfied with the course in general, its organization, the exchange with colleagues and the teaching units. The participants used the free text mode to give positive feedback; in particular, teaching units in organizational and legal regulations as well as practical feedback training to strengthen professionalism were evaluated positively. Suggestions for improvements included follow-up courses or a deepening of understanding of course contents.

CONCLUSION

The participants gave a very positive overall rating and claimed to have benefited from the course contents. Future projects should address further qualifications of general practice trainers and facilitate the exchange with colleagues on an ongoing basis.

[Structuring and supporting specialist training in general practice: Evaluation of a Hesse-wide mentoring program for doctors]

INTRODUCTION

Due to the growing shortage of general practitioners (GPs), solutions are being sought to improve the structure and attraction of specialist training in general practice. In 2012, the Competence Center for Specialist Training in General Practice was set up in the federal state of Hesse, Germany, in order to provide a seminar- and mentoring program to complement standard specialist training. The present paper examines whether the mentoring program, which was based on needs assessment, supports doctors in training (DiT) to become specialists in general practice.

METHODS

A mixed-methods design was used for the evaluation of the mentoring program. The pilot cohort monitored in this study was surveyed using a guideline-based interview. The cohort consisted of the first cohort of participants in the Specialist Training Academy (n=21), which was divided into two mentoring groups. Responses were evaluated with the help of the MAXQDA 11 program and qualitative content analysis to structure content. Furthermore, all 16 group meetings were assessed by means of evaluation sheets (n=132) and analyzed descriptively using the statistics program SPSS (IBM statistics, Version 20).

RESULTS

Of the 21 DiTs of the total sample that took part in the interviews, two-thirds of the surveyed mentees were female (71.4 %). The mentoring and seminar programs encouraged the mentees in their decision for and their identification with specialist training in general practice and helped them overcome any doubts about their choice. The decisive factors in the mentoring process were interacting with like-minded people, discussing organizational questions and having a fixed contact person in case of questions and doubts. The evaluation sheets made it clear that the mentees regarded the mentoring as supportive (99.3 % positive). Compared to the other mentoring group, participants in the one group felt they were better supported by mentoring, found the interaction with other DiTs more helpful, the interaction between mentors and the group exactly right, and the topics they discussed more relevant.

CONCLUSION

The provided mentoring program fulfilled the expectations of the DiTs in general practice. Combined with the Specialist Training Academy's seminar program, the two programs complement each other and are an important step towards making specialist training in general practice more attractive.

[Consultation skills training as an element of general practice training in Germany - a qualitative survey]

INTRODUCTION

The consultation is at the heart of general practice. It is the central setting through which primary care is delivered. The competency requirements are laid down internationally by competency-based curricula for undergraduate and postgraduate education. So far, there is no competency-based vocational training to develop consultation skills in general practice in Germany. The study describes experiences with consultation skills training as an element of general practice training as reported by trainees and trainers in Germany.

METHODS

A qualitative and exploring approach was chosen because there is little experience with the German situation. We conducted structured focus group interviews with trainees and trainers, respectively. We recruited all participants by e-mail via the mail distributor "Junge Allgemeinmedizin Deutschland" (JADE, a trainee and junior GP organization) and the academic teachers of the Friedrich-Alexander University Erlangen-Nürnberg. Altogether, four focus group interviews with three to five participants were conducted, varying in length from 25 to 65minutes. All interviews were recorded digitally and transcribed verbatim. Then a qualitative content analysis was performed.

RESULTS

The statements of the ten trainees and five trainers mapped a system of four main categories: (a) association with the term consultation, (b) parts of a consultation, (c) competencies required for professional practice, (d) consultation skills training as an element of vocational training. Overall, all participants regarded the consultation as the most important element in general practice. Important content of consultations is to build a relationship with the patient, gather information, conduct physical examinations and achieve informed consent on further proceedings. All participants agreed that physicians need different sets of competencies: medical expertise, communication skills, examination skills and professionalism. Finally, there was a broad consensus that a competency-based general practice training to support the development of consultation skills is lacking in Germany. The majority acknowledged the need for change.

CONCLUSION

So far, the consultation skills development within the general practice training in Germany is regarded as deficient. Both trainees and trainers have stressed the importance of change in vocational training. With the new competency-based curriculum for general practice in Germany and the associated development of supporting tools important prerequisites have been provided.

[How do young general practitioners experience the transition to general practice? A qualitative study]

BACKGROUND

Although the role of general practice has been strengthened in recent years, undergraduate teaching at medical schools and the clinical phase of specialist training remain dominated by specialized care of seriously ill people in hospitals. It is to be assumed that young doctors' views on medical care are strongly shaped by this clinical focus.

OBJECTIVE

To investigate how young general practitioners (GPs) perceive transition from medical school and hospital work to general practice.

METHODS

In a qualitative study, a total of 13 physicians in specialist training for general practice as well as general practitioners who had completed their specialist examination up to two years ago participated in problem-oriented interviews. The interviews were analyzed using content analysis.

RESULTS

The significant differences between hospital-based and primary care practice initially came as quite a shock to the study participants. Key differences and challenges compared to working in a hospital included: 1) the totally different type of patients or complaints they faced; 2) learning that in many situations one can and should bide one's time ("wait-and-see" approach); 3) ruling out avoidable dangerous developments in patients reliably and coping with the corresponding residual risk; 4) the discovery that sometimes it makes sense not to make a diagnosis; 5) that the doctor-patient relationship should be more cooperative in general practice; and 6) that GPs are often under pressure to act although there is no clear need for taking action or no clear treatment option from a medical and scientific point of view.

CONCLUSIONS

Our findings confirm that young doctors' initial views on medical care are strongly shaped by the clinical focus of medical schools and hospital work. Working in general practice is perceived as being very different from working in a hospital.

[Where did all the men in child and adolescent psychiatry and psychotherapy go? The influence of gender on the choice of specialization]

Where did all the men in child and adolescent psychiatry and psychotherapy go? The influence of gender on the choice of specialization Abstract. Objective: To examine the factors influencing graduates to choose child and adolescent psychiatry (CAP) or orthopaedic surgery (OR) as a career specialty. Method: We distributed a web-based survey to residents in child and adolescent psychiatry and orthopedic surgery in Germany. The survey included questions related to the factors contributing to their career choice, particularly sociodemographic, workplace, and education-related matters. Results: 101 participants completed the questionnaires (CAP: 49 women, 10 men; OR 21 women and 21 men). CAP residents were significantly older and more often married with children. Exposure to the subject during medical school was significantly more common among OR residents. CAP residents rated the factors "time for breaks," "regular work hours," "structured workday," "reconciliation of work and family life," "overall work load," and "sufficient time for each individual patient" as significantly more important than did OR residents. OR residents in turn considered "spectacular cases," "fast decision-making," "high technical requirements," and "positive experiences during medical school" as significantly more important. A family-friendly workplace was especially more important to woman in CAP. Conclusions: There is a need to rebrand the perception of psychiatry and to expose medical students early on to the subject if we are to attract more (male) psychiatrists in the future.

[The importance of the learning environment and reduction of burnout in clinical training: an analysis of the Competence Centre for Residency Training in Family Medicine Bavaria (CCRTB)]

BACKGROUND

The Competence Centre for Residency Training in Family Medicine Bavaria (CCRTB) was established to improve the quality of postgraduate medical training by offering additional seminars and mentoring programmes as well as regular 'train-the-trainer' courses for educating physicians. In addition, residents have the opportunity to participate in a regional training network.

OBJECTIVE

The aim was to assess the burden of burnout and the importance of the learning environment in the clinical training phase.

METHODS

We conducted a cross-sectional study. Burnout was assessed using the Maslach Burnout Inventory (MBI), which comprises the scales "Emotional Exhaustion", "Depersonalisation" and "Personal Accomplishment". The quality of the learning environment was recorded using the German version of the Dutch Residency Educational Climate Test (D-RECT German). In addition, multivariable linear regressions were performed to estimate the impact of learning environment, year of training and participation in a regional network on the level of burnout.

RESULTS

129 clinical residents enrolled in the CCRTB were invited to participate in the study, 78 (61%) of whom submitted a response. 76 (59%) of these residents were included in the analyses. The present study discloses an increased burden of burnout among residents in the clinical training phase, with approx. 40% reaching a critical burnout score. A higher quality of the learning environment was associated with significantly milder burnout symptoms on the majority of the D-RECT scales.

CONCLUSION

Family medicine residents in the clinical training phase show a high burden of burnout. Therefore, increasing the quality of the learning environment appears to be an effective key element in achieving a reduction of burnout in clinical training. This might contribute to an increase in professional satisfaction, which finally may also prevent migration from the medical profession.

[Mentoring in family medicine: Consultation needs of family medicine trainees]

BACKGROUND AND OBJECTIVE

More than 600 trainees in family medicine (FM trainees) have participated in the Verbundweiterbildung(plus) (VWB(plus)) since this rotation network programme has been implemented in 2009. Mentoring as need-based support and counselling is an essential element of this programme. The aim of this study was to identify FM trainees' most frequent reasons for counselling in order to explore the qualifications and requirements to be a mentor.

METHODS

141 e-mails written between December 2009 and July 2014 were analysed according to Mayring. This procedure generated thematic categories of common reasons for seeking counselling.

RESULTS

32 % of all VWB(plus) participants asked mentors of the programme for advice. The most frequent questions (38 %) related to job vacancies, the application process and employment contracts. The second most common inquiries (30 %) referred to participation in the VWB(plus) as well as contents of education meetings within the VWB(plus). Other questions pertained to general aspects of postgraduate training in family medicine (16 %), individual conflict consulting (10 %) and funding applications (6 %).

CONCLUSION

The results of the needs assessment survey reveal that a mentoring programme needs competent advisors with experience in family medicine. While FAQ lists are helpful in answering general questions, specific requests such as, for example, a personal crisis require individual counselling provided by a mentor.

[Rheumatology from A to Z - a Web-Based Information Tool]

Rheumatology from A to Z - a Web-Based Information Tool Abstract. Online health information is consulted frequently. However, appropriately examining this data for its quality, trustworthiness, and clinical relevance presents a challenge even for medical professionals. This project offers contents in the area of the musculoskeletal system that has been compiled and verified by experts. Overall, 222 terms are defined, explained and equipped with clinically relevant details in order to provide interested professionals with quick and encompassing access to high-quality, subject-specific information. In addition, these terms are supplemented with a total of 2150 links to websites of verified quality with further information. All content is provided in English and German and can be retrieved either by website or by app.

[The Logic Model - a rationale for an encompassing evaluation framework of the German Competence Centers for Postgraduate Medical Education in general practice]

BACKGROUND

The Competence Centers for Postgraduate Medical Education (KW) established throughout Germany represent complex programs to increase the efficiency and quality of postgraduate medical education in general practice. So-called Logic Models serve as the framework for evaluations and quality management processes of complex programs in many areas. The aim of this article is to develop such a model, using the example of the Competence Center in Baden-Württemberg (KWBW) in order to structure its complex program logic and use it as a framework for future evaluations and quality management processes.

METHODS

The adaptation of the Logic Model to the KWBW took place in an informal, nominal group process with employees and participants of the program.

RESULTS

We identified 76 core elements of the KWBW. These core elements were classified in one of the five pillars of the Logic Model (input, activity, output, outcome and impact) and categorized according to fields of action and target groups.

DISCUSSION

The Logic Model, which was developed using the KWBW as an example, identifies and structures important core elements of a complex postgraduate medical training program for the first time. It seems to be well suited for visualizing the internal logic of this complex program and the interaction of the various elements within the KWBW. It can thus be used as the basis for a comprehensive and systematic evaluation concept and for quality assurance.

CONCLUSION

The model is also a prerequisite for comparative research questions of other university programs for postgraduate medical education and thus offers an opportunity for cooperative development efforts. This article therefore contributes to promoting quality in continuing medical training.

[Point-of-care information in GP practices: Results of a survey among German GP specialists and GP trainees]

BACKGROUND

Specific questions often arise in the context of consultations regarding, for example, diagnostics and therapeutic management. This case-specific search for information is referred to as point-of-care information. In recent years, it has been influenced by an increase in digitalization and by the development of medical expert systems providing information for medical professionals. Data on the search behavior of German general practitioners (GPs) using digital media for obtaining point-of-care information have so far not been available. The aims of this study were to describe occasion-related point-of-care information as a function of the continuing education status and to identify requirements for online research platforms.

METHODS

In a cross-sectional survey, 829 GP specialists (FÄ) and 475 physicians in training (ÄiW) were invited to answer a self-developed, partially standardized questionnaire.

RESULTS

In total, 356 questionnaires were returned (response rate: 27%). Of these, 241 (68%) were answered by FÄ and 110 (31%) by ÄiW; five participants did not provide information on their specialist status. 66% of the FÄ and 89% of the ÄiW look up information every day. 46% of the FÄ and 73% of the ÄiW use their smartphone for this purpose. Both groups most often search for medical content (94%) and for information on medications (84%). Medical expert systems are more often used by ÄiW than by FÄ; 59% of the FÄ and 82% of the ÄiW are willing to pay a fee for these services. A quick overview and relevance of information were perceived as important criteria for good information sources.

DISCUSSION

German GPs frequently search for occasion-related information. There are generation-related differences regarding, among other things, the use of and the receptiveness to fee-based expert systems. The clarity of presentation and the relevance of the information provided are important requirements of effective information platforms.

CONCLUSION

The quick search for evidence-based information relevant to clinical practice presents a challenge, particularly in broad-range specialties such as general medicine. Web-based sources are becoming increasingly popular in this regard - a trend likely to intensify in future generations of physicians. This offers great potential for medical expert systems and app-based access to best-practice guidelines. These formats should be further developed in collaboration with scientific professional societies.

[Active participation in research and teaching during post-graduate GP training: perspectives of future general practitioners]

BACKGROUND

Academic institutions of general practice at German medical faculties have grown during the past years. This leads to an increase in the need of qualified young researchers and teachers in general practice (GP). Little is known about the interest in research and teaching skills and their training among general practice trainees and young GPs.

RESEARCH QUESTION

This cross-sectional survey among GP trainees and young GPs examined 1. if there is an interest in the training in research and teaching skills during post-graduate GP training, 2. which fostering and hindering factors have an effect on this interest and 3. which roles are attributed to academic institutions of general practice.

METHODS

A web-based cross-sectional study was performed among members of "Verbundweiterbildung^plus", a network of GP trainees, as well as "Junge Allgemeinmedizin Deutschland", the German network of young GPs. Descriptive analysis was conducted.

RESULTS

148 GP trainees and young GPs participated in the study, 76% (n=109) of them were GP trainees. There was interest in a position in research and teaching during post-graduate GP training among 55% (n=78). Factors associated with the interest in a position in research and teaching during post-graduate GP training were (MV 5-point Likert scale ± SD): compatibility of clinical work and research/teaching and of family and career (4.4±0.8; 4.7±0.6 respectively). The roles of academic institutions of general practice were attributed to training of medical students (4.6±0.6), post-graduate GP training (4.5±0.7) and research (4.5±0.7). GP trainees assessed the importance of training in research and teaching skills during post-graduate GP training and of the compatibility of family and career differently from young GPs (3.7±1.0 vs. 4.1±0.8 p=0.027; 4.8±0.5 vs. 4.3±0.9, p=0.016). Those interested in a position in research and teaching during post-graduate GP training showed a stronger interest in specific training in research skills (3.7±1.1 vs. 2.8±1.1, p<0.001), a future clinical position in a research practice (3.8±1.2 vs. 2.5±1.2, p<0.001) and as a lecturer at an academic institution of general practice (4.3±0.9 vs. 3.9±1.1, p=0.04).

DISCUSSION

There is an interest in professional involvement in research and teaching during post-graduate GP training among GP trainees and young GPs. For those interested, structured concepts (e.g. "clinician scientist") need to be developed in order to facilitate the combination of clinical work and a position in research and teaching during post-graduate GP training. In doing so, the existing potential could be better exploited and more future GPs could be involved in research and teaching.

The Three-Level Curriculum Sports Psychiatry and an Evaluation of the First Course "Basic Health Care in Sports Psychiatry"

Due to scientific progress and diversification in medicine and psychiatry, there is a need for specialization in sports psychiatry. Therefore, the SSSPP has been developing a curriculum on sports psychiatry. Different backgrounds and approaches within the above-mentioned areas are presented here since they have influenced the development of the three-level curriculum. The structure of the three-level curriculum, which contains theory, practical experience, and supervision, encompassing 80 hours of additional training, will also be explained. Within this curriculum, basic knowledge in sports medicine, sports psychology, sports science, and applied sports theory will also be taught. Other subjects include sports and exercise on mental disorders, mental disorders in competitive sports, sports as a coping strategy, and other contents. Moreover, different contents and key topics of the curriculum's three levels will be presented.

Development of a curriculum for infection control nurses for the qualification of infection control link nurses – results of focus group interviews with ward managers and infection control nurses in acute care hospitals in Germany

Background: In the guidelines issued by the Robert Koch Institute, the training and establishing of infection control link nurses (HYG-PFLEGs) as multipliers is stipulated in order to propagate the acceptance and implementation of recommended hygiene measures. To date, there is no standardized format for the further education of these nurses in Germany. Aim: To develop a modular curriculum for HYG-PFLEGs to be trained by infection control nurses. Method: Ward managers (n = 15) and infection control nurses (n = 14) from different hospitals in North Rhine-Westphalia were interviewed about the specific requirements for curricula for infection control link nurses. Four focus group interviews were carried out between October 2012 and January 2013. The tape recordings were transcribed and analysed according to Mayring’s content analysis. Results: HYG-PFLEGs were regarded as an indispensable entity for controlling the flow of information between the wards and hygiene teams in hospitals. A core curriculum adjustable for differing institutions should contain a high share of hygiene-related contents, pedagogical-didactical, and psychological competencies as well as practical forms of education. Conclusions: Within the context of the implementation of complex interventions these results provide a basis for the development and implementation of a modular curriculum for infection control link nurses.

[Development of a pharmacological curriculum for general practice: Identifying and prescribing orally administered pharmacological substances with relevance for general practice]

BACKGROUND

General practitioners (GPs) are among the specialists who prescribe the highest number of medication. Therefore the improvement of pharmacological competencies is an important part of the GP specialist training. The self-concept of general practice stating that GPs are the first contact persons for all health problems makes it challenging to define and acquire competencies for specialist training. While the "Competence-based Curriculum" developed by the German College of General Practitioners and Family Physicians defines diagnoses, reasons for counselling and competencies which are essential for general practice, a similar orientation guide is lacking for the pharmacological field. The aim of this study is to define and characterize pharmacological substances which every GP should know so well that he or she is able to conduct counselling and monitoring.

METHODS

We analysed private and public health insurance prescriptions of all general practices participating in the CONTENT project in the period from 2009 to 2014. The analysis was limited to substances with oral application which were prescribed at least once by at least 25 % (n = 11) of the practices. While the 100 most frequent prescriptions were included due to their frequency, less frequently prescribed substances were assessed concerning their relevance for general practice in a rating procedure. The substances included were classified by diagnoses and reasons for counselling.

RESULTS

We analysed 1,912,896 prescriptions from 44 practices and 112,535 patients on the basis of the Anatomical Therapeutic Chemical (ATC) classification system. After applying the inclusion criteria, 453 substances were left, 302 of which were considered relevant for general practice and could be assigned to 45 diagnoses / reasons for counselling.

CONCLUSIONS

The result of this study could be considered a working draft for a pharmacological curriculum for general practice, which may complement the "Competence-based Curriculum" in the medium term.

[Promising Future in General Internal Medicine for the Next Generation of Physicians]

Promising Future in General Internal Medicine for the Next Generation of Physicians Abstract. We are facing a lack of specialists in general internal medicine in general practitioners' practices as well as in hospitals, while at the same time the population ages and usually displays several chronic diseases (multimorbidity). Thanks to more university places, an improved job description for general internal medicine and new further education offers (curricula), interest in general internal medicine increased again, as surveys of students indicate. The young generation of family doctors and generalists in hospitals wishes flexible working conditions in order to reconcile work, family and spare time in the best possible way. Working atmosphere and colleagues have a high priority. These wishes must now be incorporated into attractive further training with flexible curricula and mentoring offers so that young talents can successfully be promoted.