On the correlation between gratitude and resilience in medical students

Objective

Medical students' health and resilience have increasingly been the subject of current research in recent years. A variety of interventions are recommended to strengthen resilience or its known or suspected influencing factors, although the literature shows that the evidence on the effectiveness of the interventions is inconsistent. The present study investigated whether gratitude is a direct protective factor for resilience in medical students or whether resilience factors (optimism, self-efficacy, social support) and stress mediate the effects of gratitude on resilience.

Methods

90 medical students at Witten/Herdecke University took part in the study that determined their gratitude, resilience, optimism, self-efficacy, social support and stress levels using validated questionnaires (GQ-6, RS-25, LOT-R, SWE, F-SozU, PSS). Correlations were analyzed using Pearson correlation coefficients. In addition, a multivariate regression analysis and a path analysis were calculated to determine the direct and indirect effects of gratitude on resilience.

Results

Multivariate regression analysis showed that only optimism, social support and stress were significantly associated with resilience (B=0.48, 95% CI: 0.31, 0.66; B=0.23, 95% CI: 0.01, 0.44 and B=-0.02, 95% CI: -0.03, -0.001, respectively). The direct effect of gratitude on resilience was minimal and not significant in the path analysis. However, there was an indirect effect of gratitude on resilience (B=0.321; p<0.05). Mediation via the optimism variable was mainly responsible for this effect (indirect effect B=0.197; p<0.05).

Conclusion

This study shows that gratitude has only a minimal direct influence on resilience. However, results indicate that optimism as a mediating factor strengthens the resilience of medical students. Against this background, it may be useful to integrate interventions that promote an optimistic attitude into medical studies in order to strengthen the mental health of future doctors in the long term.

Comparison of empathy profiles of medical students at the start and in the advanced clinical phase of their training

Background

The National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM) cites empathy as a basic competence for medical doctors. Based on a multidimensional concept of clinical empathy, empathy profiles of medical students at the start of their training and in the 9th semester were identified and compared in order to draw conclusions for the conception of effective course offers.

Method

Using the Saarbrücker Personality Questionnaire on Empathy (SPF-IRI), self-rated empathy was recorded in a cross-sectional study of medical students (1st semester: N=192/9th semester: N=221). Two Stage Clustering was performed for data analysis.

Result

Three empathy profiles which could be meaningfully delineated by content were identified: 1. reflected, functional empathy, 2. unreflected, burdensome empathy and 3. distancing and avoidance. Students in the 9th semester mostly tended toward unreflected, burdensome empathy. Only one-third appeared capable of feeling empathy with patients while at the same time adequately regulating their own emotions and thus protecting themselves from emotional overload.

Conclusion

An adequately reflected and functional empathy among medical students can neither be assumed at the start of their training, nor do existing course offers appear to provide sufficient training for this. Empathy should thus be implemented as a competence which needs to be promoted over the entire course of study. Emotion regulation plays a key role.

Measuring an understudied factor in medical education - development and validation of the medical curiosity scale

Curiosity, which has been called the third pillar of academic achievement and positively predicts academic performance (von Stumm et al., 2011), is widely recognized as an important factor in acquiring knowledge and skills in medical training, and may be critical for students´ sound mental health. Medical educators have advocated that curiosity should play a more significant role in medical training and have criticized didactic barriers impeding student curiosity. However, in medical training, curiosity is understudied partly due to a lack of methods for measuring curiosity. Therefore, this study was designed to develop and validate a scale to measure medical curiosity. After reviewing the literature and interviewing a panel of experts (n = 7), 25 preliminary items assessing medical curiosity were developed and administered to n = 305 medical students (n = 163 female and n = 142 male) at Heidelberg University across all medical school years. Following exploratory factor analysis (EFA) with oblique (promax) rotation, we measured medical curiosity in a medical student sample. We have identified two distinct factors: intellectual medical curiosity (IMC) and social medical curiosity (SMC). IMC describes the desire to acquire medical knowledge for curiosity's sake, while SMC refers to curiosity about human nature and, in particular, patient health. Both factors showed good psychometric properties, with eigenvalues of 6.7 and 3.5, explaining 26.6% and 14.0% of the variance and internal consistencies of 0.796 and 0.866, respectively, and high convergent and discriminant validity. While first-year students showed significantly higher IMC scores than final-year medical students, SMC scores remained stable and tended to increase throughout medical school. This study has succeeded in developing the first scale to measure aspects of medical curiosity and, thus, lays the groundwork for future studies examining medical students' curiosity. A deeper understanding of medical students' curiosity can help to foster this curiosity effectively.

Prior participation as a standardized patient improves OSCE scores of third-year medical students: A pilot comparative study at Université Paris Cité Medical School

OBJECTIVE

Objective structured clinical examinations (OSCE) are one of the main modalities of skills' assessment of medical students. We aimed to evaluate the educational value of the participation of third-year medical students in OSCE as standardized patients.

METHODS

We conducted a pilot OSCE session where third-year students participated in sixth-year students' OSCE as standardized patients (cases). Their scores in their own subsequent OSCE exams were compared with third-year students who had not participated (controls). Students' perceptions (stress, preparedness, ease) regarding their OSCE were compared with self-administered questionnaires.

RESULTS

A total of 42 students were included (9 cases and 33 controls). Median [IQR] overall score (out of 20 points) obtained by the cases was 17 [16.3-18] versus 14.5 [12.7-16.3] for controls (p < 0.001). Students' perception of their evaluation (difficulty, stress, communication) was not significantly different between cases and controls. Most cases agreed that their participation was beneficial in reducing their stress (67%), increasing their preparedness (78%) and improving their communication skills (100%). All cases agreed that this participation should be offered more widely.

CONCLUSION

Students' participation in OSCE as standardized patients led to better performance on their own OSCE and were considered beneficial. This approach could be more broadly generalized to improve student performance.

Competence-based catalog of learning objectives for the subject area of quality management in medical studies - position paper of the working group Quality Management in Education, Training and Continuing Education of the Society for Quality Management in Health Care (GQMG)

Background

Traditionally, direct medical competences are taught in medical studies, whereas leadership and quality management competences are hardly taught, although graduates are already confronted with management tasks at the beginning of their clinical work. With the upcoming amendment of the Medical Licensing Regulations, this topic area will probably be addressed and must be adequately taught by the faculties. The learning objectives in the area of quality management listed in the current working version of the German National Catalogue of Learning Objectives in Medicine (NKLM) 2.0 have so far been formulated in rather general terms and need to be concretized.

Aim

To develop a competence-based learning objectives catalog for the topic area of quality management in medical studies as a structured framework recommendation for the design of faculty teaching-learning programs and as a suggestion for further development of the NKLM.

Methods

The competence-based learning objectives catalog was developed by an eight-member working group "Quality Management in Education, Training and Continuing Education" of the Gesellschaft für Qualitätsmanagement in der Gesundheitsversorgung e.V. (GQMG) within the framework of a critical synthesis of central publications. The members of the project group have many years of project experience in quality management in health care as well as in university didactics.

Results

Six basic competence goals as well as 10 specific competence goals could be formulated and consented upon. These are each flanked by a list of essential basic concepts and examples. These focus on quality improvements, including patient safety and treatment success against the background of a physician leadership role in an interprofessional context.

Discussion

A competency-based set of learning objectives has been compiled that encompasses the necessary concepts and basic knowledge of quality management required for those entering the profession to understand and actively participate in quality management after completing medical school. To the authors' knowledge, no comparable learning objectives catalog is currently available for medical studies, even internationally.

"And how am I going to ask about this?" - introducing the course "sexual anamnesis" in peer teaching for medical students in Würzburg

AIM

A course on sexual anamnesis based on peer teaching was developed, piloted, and evaluated at the medical school of the University of Würzburg. The course is part of the expansion of the communication curriculum and in order to close existing gaps in medical education. An implementation of the course in the curriculum is meant to give all students the opportunity to acquire professional skills in this area.

METHOD

The course consists of knowledge transfer, interactive exercises, role plays with structured feedback, and an exchange with practitioners. A standardized online evaluation of the course took place in regard to teaching quality, subjective learning success, and acceptance. The voluntary course was conducted online in the summer semester of 2021 and in person in the winter semester of 2021/22. A total of 68 students participated. The training of the tutors was realized in cooperation with the "Deutsche Aidshilfe" (DAH).

RESULTS

The course was successfully conducted online and in person. A total of 60 students participated in the evaluation. More than 80% of the students rated the course as structured. They assessed an adequate mix of knowledge transfer and practical exercises. More than half of the students reported that they were more confident in performing sexual anamnesis after they participated in the course. There was an open exchange among the students. More than 90% of the students found the peer teaching by the tutors helpful.

CONCLUSION

The implementation of the course closes a relevant gap of the curriculum in Würzburg. Sexual anamnesis will be a regular part of the curriculum starting in the winter semester 2022/23. The concept can also be transferred to other universities.

Does a sense of gratitude protect against empathy loss in medical students? An exploratory study

INTRODUCTION

The promotion of physicians' empathy (PE) skills in medical school plays a central role in physician-patient communication. However, a significant decline in empathy among medical students during their training has been repeatedly reported. Gratitude could be a possible protective factor for PE. However, as some students do not seem to be affected by this empathy loss, this study explores the relationship between gratitude and PE.

METHODS

Using validated questionnaires (JSPE-S, IRI and GQ-6), 88 medical students at LMU München evaluated their self-assessed PE and gratitude. In addition, they went through four OSCE stations focusing on general medicine, in which their empathy and communication skills were assessed by simulated patients (SP) and by an assessor using the Berlin Global Rating. Correlations were analysed using Pearson's correlation coefficient and gender differences were analysed using Mann-Whitney U-tests.

RESULTS

In the self-assessment, there was a significant, moderate correlation between students' attitude towards empathy (JSPE-S) and their gratitude (GQ-6) and a weak correlation between the IRI subscale "Empathy" and the GQ-6. In terms of the performance-based assessment, there were also weak correlations between PE or communication skills and gratitude. There were no gender-specific differences in the gratitude of the students.

CONCLUSION

We were able to demonstrate a correlational relationship between gratitude and empathy in medical students. Whether gratitude acts causally as a protective or supportive factor for empathy remains open. A causal relationship of gratitude to empathy should therefore be examined in a prospective study design.

[Emergency Ultrasound Training for and with Medical Students]

Emergency Ultrasound Training for and with Medical Students Abstract. Practical basic skills in sonography are a mandatory part of Swiss medical schools since 2018. The universities of Basel and Bern teach students the content of the POCUS component "Basic Emergency Sonography" of the SGUM and have developed the e-learning tool "POCUS Emergency Sonography" for this purpose in cooperation. By using this innovative blend- ed learning concept, students acquire basic skills in sonography and can build upon this know-how in their further education.

Stress, anxiety, and depression among students at the Faculty of Medicine of Sousse (Tunisia)

OBJECTIVE

To evaluate the frequency of anxious and depressive symptoms and to determine their associated factors in a population of students enrolled at the Faculty of Medicine of Sousse (Tunisia).

METHODS

this is a descriptive cross-sectional study that took place at the Faculty of Medicine of Sousse over the period from 09/15/2017 to 03/15/2018. An anonymous questionnaire was administered to the students in the guided teaching rooms. The assessment of anxiety and depressive symptoms was based on the Anxiety and Depression Scale (HADS) and the quality of sleep was assessed by the PSQI questionnaire.

RESULTS

A total of 202 medical students participated in the study. The average PSQI score was 5.62±2.87 and 47% of students had poor sleep quality (PSQI ≥ 6). Symptoms of anxiety and depression were observed in 73 (36.1%) and 45 (22.3%) students respectively. The mean HADS-A score was 9.21±4.17 and that of the HADS-D score was 7.37±4.06. In univariate analysis, the factors found to predict a high level of perceived stress were the study cycle (p=0.022) and poor quality of sleep (p 11) were the use of sleeping pills (p=0.004), the quality of sleep (p<0.001), and a high level of perceived stress (p<0.001). The high level of perceived stress was found to predict depression (p=0.006).In the multivariate analysis of variables in the present study, poor sleep quality was a factor independently related to high perceived stress in medical students (ORa=9.062 [4.247-19.334]) while being a medical student of the 1st cycle proved to be a protective factor (ORa=0.101 [0.025-0.406]). Use of sleeping pills (ORa=4.481 [1.135-17.682]), poor sleep quality (ORa=2.131 [1.081-4.203]) and high level of perceived stress (ORa=5.790 [2.444-13.716]) were factors independently related to anxiety symptoms. Female sex was a protective factor for depressive symptoms (ORa=0.440 [0.205-0.945]) while a high level of perceived stress was a factor independently related to depressive symptoms (ORa=3.429 [1.469-8.005]). HAD-A and HAD-D scores were correlated (r=0.631 ; p<0.001).

CONCLUSION

sleep disturbances, perceived stress, anxious and depressive symptoms are common among Tunisian medical students. Prevention strategies targeting the improvement of sleep quality and student stress management should be developed at the faculty and ministerial level.

Are we confident that final-year medical students know at least basics about diabetes?: A preliminary report from the multicenter, survey-based Diabetes Know-Me study

BACKGROUND

We present the results of the pilot study of a multinational "Diabetes Know-Me" project investigating knowledge regarding diabetes of medical students. This is the first collaborative project of the ISPAD JENIOUS group.

METHODS

Students of the final year of medical studies from six countries answered a 25-question survey regarding basic knowledge concerning diabetes (1091 surveys handed out, response rate 86%).

RESULTS

Among the responders (58% female) 90% confirmed attending diabetology classes; 11% planned to specialize in diabetology. There were significant differences between countries in the median score of correct answers ranging from 10/25 to 22/25. Attending diabetes classes (20 vs. 13/25, p < 0.0001) was the strongest factor associated with improved knowledge about diabetes (other factors analyzed were: gender, familiar/personal experience of diabetes, interest to specialize in diabetology).

CONCLUSIONS

Basic knowledge about diabetes remains a challenge. Participating in classes concerning diabetes contributed the most to the diabetes-related knowledge among students of the final year of medical faculties.

General medicine, first-line medicine in Morocco: How is it perceived by medical students and how to enhance their interest in this career?

In Morocco, family medicine does not exist, and it is general medicine that plays the role of family medicine and is also first line medicine and primary care. The current medical school curriculum is not fully in harmony with the real health needs of the population. We questioned 6th and 7th year students about the pertinence of two rotations in general medicine, that is, in a health centre and a private practice, via an anonymous questionnaire disseminated online in June 2020. A total of 266 responses were collected. Out of these, 41.5% of responses were enrolled in 6th year, versus 58.5% in 7th year. Then, 59.1% of students were females. In addition, 84.8% of them declared their intention to pursue a career in a medical specialty, whereas only 15.2% of them were interested in a career as a general practitioner. Notably, 67.4%, 26.5% and 6.1%, respectively, thought that general medicine was very undervalued, a little undervalued and not undervalued. It should be noted that 3.8%, 44.1% and 52.1%, respectively, were interested, somewhat interested and not at all interested in family medicine as a specialty if it was implemented. To that end, various actions need to be undertaken, including the introduction of quality teaching in the 6th and 7th years of medical studies, focused on the development of the knowledge and skills required, the strengthening of pre-existing practical training periods in public health and the introduction of a rotation in private practices of general medicine.

Communicative and social competence in the medical curriculum of the Medical University of Innsbruck: learning objectives, content, and teaching methods

Aim: The Austrian Competence Level Catalogue for Medical Skills clearly states the importance of teaching communicative and social competence in the different subject areas of undergraduate medical and dental education. This paper aims to present an overview of the academic courses at the Medical University of Innsbruck that explicitly address the promotion of communication and social skills in medical students. Method: This paper focuses on educators' descriptions of how communicating with patients is taught. The Medical University's longitudinal curriculum on medical interviewing is presented in detail. The courses on ethical principles in the dissection course, palliative medicine, and gender medicine are also outlined as examples. In addition, lecturers (n=536) participated in an online survey to determine the teaching and testing content regarding patient communication and to measure the value attached to the associated teaching and learning methods. Results: The examples given by educators to illustrate learning objectives, educational content, and the teaching methods used to impart communicative and social competence provide an overview of the courses which focus on this topic or intentionally address it during the course. The results of the online survey offer a broad overview of the awareness of the topic at the university. Different testing formats are used to assess the skills being taught. Conclusion: Familiarity with the various teaching methods used in the different courses is important for developing communicative and social competence in medical education. Active networking is necessary to anchor communicative and social competency as a major thread throughout an entire medical curriculum.

Medical Studies during the COVID-19 Pandemic: The Impact of Digital Learning on Medical Students' Burnout and Mental Health

Objectives: The aim of this ecological study was to investigate what the impact of digital learning due to the COVID-19 pandemic was on the burnout and overall mental health (MH) of medical students. Background: During the unprecedented era of the COVID-19 pandemic, the majority of countries worldwide adopted very strong measures. Universities closed their doors, and education continued through digital learning lectures. Methods: An anonymous questionnaire was administered to all 189 eligible candidates before and during the COVID-19 pandemic. Mental health was assessed via the MH domain of the 36-item Short Form Health Survey (SF-36) and burnout with the Maslach Burnout Inventory—Student Survey (MBI-SS). Results: The overall response rate was 81.5%. The overall burnout prevalence did not differ significantly between the two periods (pre-COVID-19 18.1% vs. COVID-19 18.2%). However, the burnout prevalence dropped significantly in year 4 (pre-COVID-19 40.7% vs. COVID-19 16.7%, p = 0.011), whereas it increased significantly in year 6 (pre-COVID-19 27.6% vs. COVID-19 50%, p = 0.01). When looking at each MBI-SS dimension separately, we found that emotional exhaustion decreased significantly in year 4 but increased in year 6, and cynicism increased in all years. The overall MH deteriorated significantly between the two periods (pre-COVID-19 58.8 ± 21.6 vs. COVID-19 48.3 ± 23, p < 0.001). Conclusions: Digital learning in medical studies carries significant risks. Not only does the MH deteriorate, but cynicism levels also increase. Emotional exhaustion was found to increase particularly in final year students, who struggle with the lack of clinical experience just before they start working as qualified junior doctors.

Teamwork, communication and exchange despite Covid-19 - experiences from a digital elective in human medicine studies as part of the HiGHmed project

Introduction: In order to promote training and further education on topics related to the digitization of medicine, the HiGHmeducation consortium is developing online learning modules. These modules could also be offered across locations. For students of human medicine, an elective for the acquisition of data literacy has been implemented. Originally designed as a blended learning offer, the elective was then carried out completely online due to the Covid-19 pandemic. Despite the lack of classroom teaching, the aim was to achieve intensive cooperation between the students. Project description: In the elective, the students worked on a total of 14 learning tasks, so-called e-tivities, which stimulate collaborative work and thus promote the examination of the learning content. These asynchronous learning activities were supplemented by video conferences, in which the students also took on the role of presenters. The teachers accompanied this learning process as e-moderators. Results: In April/May 2020, the elective course was carried out with 12 students entirely online. Despite a workload that was experienced as high, the elective was rated very well by the students. Discussion: The didactic concept of the elective enabled an active engagement with the learning material and the social interaction between the learners. With the digital learning offers, the learners were able to gain new experiences which are also of professional relevance. Conclusion: The didactic concept of the elective can be transferred to other courses. Future studies must show which long-term learning effects can be generated by digital teaching based on teamwork, communication and exchange.

Resilience and coping strategies of undergraduate medical students at the University of the Free State

Background

Medical studies place students at risk for burnout. Resilience enables students to cope with adversity. Students’ coping skills will ensure the well-being of future healthcare professisonals.

Objectives

This study investigated resilience and coping among undergraduate medical students.

Setting

Undergraduate students at the University of the Free State medical school.

Methods

A cross-sectional study was performed. Quantitative data regarding resilience (Connor-Davidson Resilience Scale), coping strategies (Brief COPE questionnaire) and relevant information were collected by means of an anonymous self-administered questionnaire.

Results

Five hundred students (pre-clinical n = 270; clinical n = 230; approximately 62% female) participated. Most students self-reported high resilience (84.6% pre-clinical; 91.8% clinical). Mean resilience scores were 72.5 (pre-clinical) and 75.4 (clinical). Clinical students had higher resilience scores, while black, pre-clinical, first-generation and female students scored lower.

Academic stress was most prominent (> 85%) and associated with lower resilience scores. Most students used adaptive coping strategies (e.g. instrumental or emotional support) associated with significantly increased resilience scores. Students who used dysfunctional strategies (e.g. substance abuse) had significantly lower resilience scores.

Conclusion

Associations between resilience scores and year of study, gender, ethnicity, levels and type of stress varied. Academic pressure was a major source of stress. Adaptive coping strategies were associated with higher resilience scores.

The "practice track" - How can teaching content related to outpatient healthcare be integrated into medical studies? Learning objectives, conception and implementation of a specialized voluntary program

The "practice track" (PAT) at Goethe University Frankfurt provides students with the opportunity to focus on outpatient care during their medical studies. The aim of this article is to describe the objectives, conception and implementation of the program. At the Institute of General Practice, a new teaching concept has been developed in cooperation with the Dean's Office of the Faculty of Medicine at Goethe University and further partners. Medical students generally receive their training in highly specialized hospitals. However, the new concept will allow them to gain a practical insight into the outpatient care provided by physicians in private practice during their medical studies. Every year, 15 interested students will be able to participate in the longitudinal program, which includes internships, seminars and mentoring sessions. In the three current PAT cohorts, all 45 places have been taken up, and the first cohort has now completed the program. In addition to practical skills in the disciplines of family medicine, internal medicine, surgery, gynecology and pediatrics, it has been possible to show students the full scope of ambulatory health care. However, legal limitations to the implementation of the program in registered medical practices have meant that some parts of it could only be carried out voluntarily. Against the background of the current and future situation in health care, it makes sense that registered physicians in private practice should teach medical students about outpatient care during their medical studies. In order to establish such programs and permit their complete integration into the medical curriculum, it is essential that the necessary changes are made to medical licensing regulations.

Studies on acceptance, evaluation and impact of the Cologne program "Research and Medical Studies"

Introduction: The curricular implementation of events (or programs) for science-related training in human medicine has been on the agenda of the medical faculties since the publication of the Federal-State Working Group [1]. The Medical Faculty of the University of Cologne developed and established a systematic, longitudinal science curriculum together with the start of the model curriculum in human medicine in 2003. Here, we investigate the questions of whether the described (para-) curricular elements are accepted by students and lecturers and how they are evaluated, especially by students. In addition, we investigate whether selected parameters can be used to demonstrate changes in the students' scientific activities. Project description: The program "Research and Medical Studies" (RaMS) consists of several components: these elements of the mandatory curricular (Scientific Projects, SP) and optional components (Research in Medical Studies (RiMS), Research Track (RT), Research Fair Cologne (RFC)) are described here. Results were recorded at various levels: Likert Scale evaluation of the event's elements were collected as satisfaction parameters from the studentsProcess data on participation in the voluntary events were collected and evaluated as absolute and relational figures (WS 12/13-SS 17). Data on the outcome of the RaMS program were collected: Type of scientific projects in the academic years 2011/12-2014/15), number and type of available projects offered at the RFC (in the years 2011-18) and number of student research funding applications in a comparison of the periods 2010-13 vs. 2014-17). Results: The students' acceptance of mandatory and paracurricular courses of the RaMS program is pleasingly high, which is not surprising, at least in the case of the voluntary courses. The participation of students in RiMS, RT and RFC is satisfactory for voluntary courses. In the case of the RT, with certified participation of approximately 47% of all registrations (corresponding to 10% of the total cohort), this is comparable to similar programs. It can be shown that the number of experimental science projects has more than doubled over time in parallel with the development of RaMS. The average number of provided projects according to the RFC is 42 (which corresponds to a placement rate of approx. 1:4). The number of successful student applications for a research support grant during the period the measures were implemented has doubled. Discussion and conclusion: The RaMS program shows a route for the implementation of the SP required by the next licensing regulations in medical education, which was initially supported and expanded solitarily, later by further elements (RiMS), also in the sense of a science-based career development (RT, RFC). The student acceptance and the measured success, in the form of successful participation in the Research Track, increased choice of experimental projects, significant increase of submitted as well as approved research grants and the high project placement rate of the Research Fair, encourage the further development of the program, which is indicated in the conclusion.

Digital skills for medical students - qualitative evaluation of the curriculum 4.0 "Medicine in the digital age"

Introduction: The digital transformation has far-reaching implications for the qualification profile of medical students, which have not been addressed in medical studies so far. Teaching concept: The competence-oriented blended learning curriculum "Medicine in the digital age" has been implemented at Mainz University Medical Centre since 2017. It represents a curricular reform project of the "Curriculum 4.0" program (Stifterverband). In six modules, the qualification requirements for digital skills are addressed. Evaluation Methodology: The qualitative evaluation of the course concept took place in the form of semi-structured interviews. All 58 participants from five courses were interviewed. Results: Using the "Qualitative Content Analysis" according to Philipp Mayring, the statements were divided into deductive main categories (process, content, methodology, learning success, learning experience and conclusion). The results reflect the student's view of the curriculum and the current qualification needs that still need to be specialised. Discussion: The didactic teaching of digital skills is a relevant and highly topical component of the further development of medical studies. In this development, the focus is not only on technological skills, but also on the.

Mental health and wellbeing among Moroccan medical students: a descriptive study

Medical students are tomorrow's healthcare professionals (HCPs), and their role in the design and delivery of healthcare in the future is crucial. Following an invitation to participate in a global call on mental health and wellbeing among medical students, it was decided to include Moroccan medical students based in the Faculty of Medicine and Pharmacy of Rabat between March 2019 and May 2019. Six hundred and thirty-seven medical students from the Faculty of Medicine and Pharmacy of Rabat responded to the BMA (British Medical Association) online survey, with females representing 66% of students. Medical studies were considered the main source of stress by 90% of respondents. The CAGE test screened 5% of students to be at risk of alcohol related health problems. Thirteen per cent of respondents reported substance misuse, 20% consumed alcohol, and 13% reported Illicit drug use. Almost half of Moroccan medical students had minor psychiatric disorder according to GHQ-12. Very high rates of burnout were found among undergraduate medical students, at 93%, and 68% reported, respectively, exhaustion and disengagement. This study showed very high levels of burnout among Moroccan undergraduate medical students. These results draw attention to the poor mental wellbeing of medical students. It is important that careful steps are put in place to support medical students who need this help.

The model medical degree programme "human medicine" in Oldenburg - the European Medical School Oldenburg-Groningen

In the summer of 2012 the School of Medicine and Health Sciences at the Carl von Ossietzky University of Oldenburg became the first new medical faculty to be founded in Germany in more than 20 years. The faculty was established within the framework of the European Medical School Oldenburg Groningen, a cooperation project between the University of Oldenburg and the University of Groningen. In addition to the University of Groningen and its faculty of medical sciences (Universitair Medisch Centrum Groningen - UMCG), four hospitals in Oldenburg are involved in the programme as cooperation partners, as well as a network of general practitioner practices that provide training and academic teaching hospitals across northwest Germany. The programme itself is a model medical degree programme with a modular structure, a highly integrative approach and an early and consistent focus on practical skills and patient-centredness. In addition to the early introduction to outpatient care in the first years of study, longitudinal pathways and a strong focus on research with early integration of scientific activities into medical studies are the defining characteristics of this programme. The two faculties in Oldenburg and Groningen coordinated their respective curriculums during the founding phase and recognise each other's study modules as equivalent to their own. This has created the preconditions for students from Oldenburg to obtain Dutch qualifications (Bachelor of Human Life Sciences and/or Master of Science in Medicine) in addition to the German "Staatsexamen" (the state examination in medicine) under certain circumstances. Irrespective of whether they intend to obtain these qualifications, all students from Oldenburg must spend at least a year studying at the partner university in Groningen. In exchange, up to 40 students from Groningen have the option to complete part of their studies in Oldenburg.

The importance of self-awareness: musings of a medical student

OBJECTIVE

Self-awareness is essential for combating burnout, promoting self-care, and wellbeing in health professionals. This article examines modern day roadblocks to developing this skill in medical practice and highlights some simple solutions for consideration.

CONCLUSION

The capacity for self-awareness is essential to the modern-day physician seeking a long and fulfilling career. Mindfulness meditation and reflective writing are two simple, proven methods that can be easily implemented into medical training.

Simulated patients in medical education - a survey on the current status in Germany, Austria and Switzerland

Objective: In German-speaking countries (Germany, Austria, Switzerland), simulated patients (SPs) have been a fixture for years and are used in teaching and examinations. As part of ongoing methodological standardization efforts and to support current and future faculty and curriculum developments, this exploratory study systematically investigates how and under what framework and conditions SPs are currently used in German-speaking countries. Methodology: The online questionnaire developed in cooperation with the Committee for Simulated Patients of the Society for Medical Education comprises 58 questions covering the organization and administration, size and design of the SP pool, general conditions and minimum standards for the assignments of the SPs. All medical faculties from Germany, Austria and German-speaking Switzerland were invited to participate in the survey and a descriptive data analysis was performed. Results: 38 responses from 45 faculties were included in the evaluation of the survey (response rate: 84.4%). Most SP programs are affiliated with the Office of the Dean of Studies and skills labs or training centers and funded by faculty resources. Both the working hours in the SP programs and the qualifications of the employees vary extensively. The same applies to the number and average age of the employed SPs. On average each faculty uses 1,290 SP hours per year (min=45, max=6,500). The majority of SPs are used in a teaching environment, together with lecturers. At all sites, SPs provide feedback to students. This is always based on a uniform standard. All SPs receive training, which predominantly focuses on playing their role and giving feedback. Discussion: There are a variety of SP programs in German-speaking countries. While there are a few clear similarities (for example, feedback from SPs), many organizational and methodological aspects are handled differently. Although this allows innovation and flexibility, it also weakens the didactic SP method in its standardization and thus in the comparability of quality. A certain degree of standardization and high methodical quality is of great importance, especially in scientific and faculty internal discussions and with a view to the use of SPs in high-stakes examinations which must be improved in the future.

[Project Report: Evaluation of the Practical Year (PY) at the Charité Medical School, University Medicine Berlin]

BACKGROUND

In Germany, the final year of medical school consists of a series of clinical externships termed "Practical Year" (PY). Logbooks have been introduced to document the clinical experience and the value of the teaching program (First Ordinance amending the Licensing Regulations for Physicians, July 14, 2012). However, little is known about how PY education is experienced by students, what problems they face, what support they seek to manage their problems, and how the logbooks contribute to training.

OBJECTIVE

We assessed the PY education at the Charité Medical School (University Medicine Berlin) in terms of the requirement profile, quality of training, logbooks, satisfaction, and general conditions.

MATERIAL AND METHODS

We developed a questionnaire to assess PY education by relying on medical students' experiences. This tool was developed in parallel with the introduction of the logbooks. We contacted 6,068 students between May 2014 to September 2017 via e-mail. The students were asked to participate in the evaluation on a voluntary basis and answer 39 questions. The questionnaire was completed using an anonymous online form, taking into account legal data protection regulations.

RESULTS

We evaluated 1,957 questionnaires (31.1 %). The students were mostly satisfied (67.6 %) with their supervision. Patient encounters were, for the most part (85.5 %), perceived as informative, and the quality of continuing education as high (91.3 %), and most students (76.1 %) were directly involved in patient care. The students (87.8 %) felt that they had made progress during the PY teaching period, although the logbooks were rarely (14 %) used and apparently not reviewed by the teaching staff. The students judged some rotations harshly when they were dissatisfied with both teaching and supervision.

CONCLUSIONS

In general, the PY experience at the Charité was rated positively. Some rotations receiving poor evaluations desperately need to be reviewed. The role of the logbook seems to be imperfectly defined. The survey results suggest that further evaluation of our program is needed with ongoing participation of students and their representatives.

Successful completion of clinical electives - Identification of significant factors of influence on self-organized learning during clinical electives with student focus groups

Background: The Medical Licensure Act prescribes a total of four months of clinical electives in which the medical students are to work in a self-organized manner in outpatient and inpatient care. Since no specific learning objectives or learning content are given and students come into contact with different structures of outpatient and inpatient care, the learning success in a clinical elective is often rather random. In order to make self-organized learning (SOL) in clinical electives as effective as possible, we identified factors in the area of inpatient care that have an influence on SOL and thus the learning success during a clinical elective. Methods: To investigate this question a qualitative and explorative approach was chosen. In 2015, a total of 21 students from semester 1 to 11 participated in six semi-structured focus group discussions at Hamburg Medical Faculty. In these, the students were asked about their experiences and expectations with regard to SOL in clinical electives. The interviews were transcribed literally and analyzed using Grounded Theory in parallel to further data collection. Results: Three main categories were identified, which had an impact on SOL in clinical electives, each with two sub-categories: People (elective students and physicians), learning itself (learning content and learning process) and the framework (local conditions and organizational structure). For example, elective students exhibiting openness and self-initiative as well as a good working atmosphere and few hierarchical structures were conducive to SOL, while shyness and lack of integration into the ward's medical team inhibited SOL. A mentor formally assigned to the student can promote SOL through guidance, supervision and the transfer of responsibility. Continuous feedback from mentors or peers promotes SOL. Framework conditions, such as a smooth administrative organization, also affect SOL, but elective students have limited influence over these. Conclusion: The creation of suitable framework conditions and considering the needs of the people involved in clinical electives and the requirements of learning itself are necessary steps in order to enable successful SOL during clinical electives. Suitable framework conditions could be compiled and widely disseminated on an empirical basis. Training for teachers and elective students on various aspects of clinical electives, from professional behavior to practical skills, could be a suitable preparatory measure to promote SOL in clinical electives and contribute to a better learning success of the elective students.

From HAM-Nat to the "Physikum" - Analysis of the study success parameters before and after the introduction of a science test in the approval procedure

Background/Objectives: For the winter semester 2012/13, the Medical School of Otto-von-Guericke University Magdeburg introduced the HAM-Nat test (Hamburg Assessment Test for Medical Degrees - Natural Sciences Section) for the selection of its study applicants with the aim of improving the academic success of their students in the pre-clinical part which has a heavy emphasis on natural sciences. The study examines the extent to which the new University Selection Procedure (AdH) influences two criteria for measuring students' success, compliance with the standard period of study up until the first part of the medical state exam (M1) and its result. Methodology: A comparison of above-mentioned parameters for measuring student success for the matriculation years 2008-2011 (no HAM-Nat test, Pre-Matriculation) and those of the matriculation years 2012-2014 (Nat-Matriculation), whose students have passed the HAM-Nat test in the selection process of the university. In addition, it was taken into account the number of course certificates gained within the standard time period. In the Nat-Matriculation, the HAM-Nat results were merged with the associated M1 exam results. Results: The proportion of AdH students who were admitted to the Physikum (first part of the medical state exam (M1)) within the standard period of study only increased slightly in the period studied. Within the AdH group, 70% of the Pre-Matriculation group gained entry to the second phase of studies without delay, rising to 78% in the AdH-group of the Nat-Matriculation. For all admission groups taken together, the overall grades for the first section of the medical state exam 2010-2016 show a positive trend, regardless of the selection procedure. The proportion of correctly answered questions in the nationwide M1 increased accordingly in the period studied. The better those matriculating had performed in the HAM-Nat test, the better their results were in the written and oral parts of the first part of the medical state exam. Conclusion: Although a significant proportion of students in the AdH group had obtained their place of study only on the basis of their test result and the score in the HAM-Nat test only weakly correlated with the school leaving grade (Abitur), the quantifiable study success parameters to date - in an albeit short observation period before and after introduction of the test - improved slightly. The number of Nat-Matriculations is too low to be able to assess the effect of the HAM-Nat test bearing in mind natural fluctuations. Nevertheless, the HAM-Nat test as an instrument of selection also made it possible for candidates with originally insufficient Abitur grades to gain admission without negative effects on the study success of the AdH cohort.

[Can medical students' motivation for a course of basic physiology education integrating into lectures some active learning methods be improved?]

La motivation des étudiants est une condition essentielle à l’apprentissage et la perception qu’a l’étudiant de la valeur qu’il accorde à une activité est l’une des trois composantes majeures de cette motivation. Comment amener les étudiants à percevoir l’utilité et l’intérêt de leurs cours universitaires tout en suscitant leur motivation ? L’objectif de l’étude est de déterminer la perception de la valeur attribuée par les étudiants au cours fondamental de physiologie et d’évaluer l’impact de l’intégration de quelques méthodes d’apprentissage actif aux exposés magistraux sur la motivation des étudiants du premier cycle des études médicales dans une jeune faculté. Cette étude prospective, a concerné les étudiants de deuxième année de médecine (PCEM2). Nous avons procédé initialement à une appréciation de la perception de la motivation des étudiants pour les cours universitaires via un premier questionnaire, après nous avons intégré deux activités pédagogiques: l’étude de cas et la réalisation de carte conceptuelle aux exposés magistraux du module de physiologie et à la fin nous avons évalué via un deuxième questionnaire l’impact de ces deux activités sur la motivation des étudiants. 131 et 109 étudiants ont rempli et rendu respectivement le 1^er et le 2^ème questionnaire parmi les 249 étudiants inscrits en PCEM2. La motivation de nos étudiants à l’égard de leurs cours universitaires était globalement très favorable, même si la motivation pour le cours de physiologie (70,8%) était légèrement moins importante que pour l’ensemble des cours (80%). Nos étudiants avaient apprécié les deux activités proposées et seulement 13% (pour l’étude de cas) et 16,8% (pour la carte) ne se montraient pas satisfaits. 40,9% des étudiants avaient réalisé une carte conceptuelle et la qualité de ces productions, jugée sur l’identification des concepts et des liens inter concepts, était globalement satisfaisante pour une première expérience. Influencée par de multiples facteurs internes et externes, la motivation des étudiants reste une grande problématique en milieu universitaire. Dans ce contexte, une planification rigoureuse d’activités pédagogiques diversifiées et actives est l’une des principales portes offertes à l’enseignant pouvant susciter cette motivation.

"History, Theory and Ethics of Medicine": The Last Ten Years. A Survey of Course Content, Methods and Structural Preconditions at Twenty-nine German Medical Faculties

Objective: "History, Theory, Ethics of Medicine" (German: "Geschichte, Theorie, Ethik der Medizin", abbreviation: GTE) forms part of the obligatory curriculum for medical students in Germany since the winter semester 2003/2004. This paper presents the results of a national survey on the contents, methods and framework of GTE teaching. Methods: Semi-structured questionnaire dispatched in July 2014 to 38 institutions responsible for GTE teaching. Descriptive analysis of quantitative data and content analysis of free-text answers. Results: It was possible to collect data from 29 institutes responsible for GTE teaching (response: 76%). There is at least one professorial chair for GTE in 19 faculties; two professorial chairs or professorships remained vacant at the time of the survey. The number of students taught per academic year ranges from <100 to >350. Teaching in GTE comprises an average of 2.18 hours per week per semester (min: 1, max: 6). Teaching in GTE is proportionally distributed according to an arithmetic average as follows: history: 35.4%, theory 14.7% and ethics 49.9%. Written learning objectives were formulated for GTE in 24 faculties. The preferred themes of teaching in history, theory or ethics which according to respondents should be taught comprise a broad spectrum and vary. Teaching in ethics (79 from a max. of 81 possible points) is, when compared to history (61/81) and theory (53/81), attributed the most significance for the training of medical doctors. Conclusion: 10 years after the introduction of GTE the number of students and the personnel resources available at the institutions vary considerably. In light of the differences regarding the content elicited in this study the pros and cons of heterogeneity in GTE should be discussed.

Peer-led Stress Prevention Seminars in the First Year of Medical School--A Project Report

INTRODUCTION

From the beginning of the first year of medical studies, increased psychological stress and elevated burnout prevalence rates can be registered compared to sample populations. Characterized by learning "on an equal footing", the principle of peer-assisted learning (PAL) is widely used in medical education. This report aims to showcase the development and evaluation of peer-led stress prevention seminars for first year medical students after one year of implementation.

PROJECT DESCRIPTION

With each of the three sessions lasting 90 min., the stress prevention seminars took place in small groups (6-10 students) in the period from November 2013 to January 2014 and from November 2014 to December 2014 at the Medical Faculty of Heidelberg. Led by trained peers, the seminar content ranged from psycho-educational elements, i.e. time management strategy development and test anxiety assistance, to relaxation techniques. All seminar sessions were evaluated via questionnaire. All questions were answered on a Likert scale ranging from 1 to 7 (1=strongly agree; 7=strongly disagree).

RESULTS

75 students consented to participate in seminars (65% female; aged 20.5±3.3 years). The series of seminars was averagely given the school grade of 1.2±0.4 (1=very good to 6=unsatisfactory) in WS 2013/14 and 1.5±0.5 in the following year and the peer tutors' competence was evaluated as very high (1.4 to 1.5 approval rate on the Likert scale).

DISCUSSION

The seminar sessions' importance to the students is underlined by their very positive evaluations. This offer seems to have benefited students especially during the demanding transitional phase at the start of their studies. Both the implementation of the preventive measure at an early stage as well as the use of PAL seem to have proven effective.

CONCLUSION

PAL seems to be effective in the field of stress prevention. However, specific efficacy studies are still lacking.

Desire and reality--teaching and assessing communicative competencies in undergraduate medical education in German-speaking Europe--a survey

Objectives: Increasingly, communicative competencies are becoming a permanent feature of training and assessment in German-speaking medical schools (n=43; Germany, Austria, Switzerland – ”D-A-CH”). In support of further curricular development of communicative competencies, the survey by the “Communicative and Social Competencies” (KusK) committee of the German Society for Medical Education (GMA) systematically appraises the scope of and form in which teaching and assessment take place.

Methods: The iterative online questionnaire, developed in cooperation with KusK, comprises 70 questions regarding instruction (n=14), assessment (n=48), local conditions (n=5), with three fields for further remarks. Per location, two to three individuals who were familiar with the respective institute’s curriculum were invited to take part in the survey.

Results: Thirty-nine medical schools (40 degree programmes) took part in the survey. Communicative competencies are taught in all of the programmes. Ten degree programmes have a longitudinal curriculum for communicative competencies; 25 programmes offer this in part. Sixteen of the 40 programmes use the Basler Consensus Statement for orientation. In over 80% of the degree programmes, communicative competencies are taught in the second and third year of studies. Almost all of the programmes work with simulated patients (n=38) and feedback (n=37). Exams are exclusively summative (n=11), exclusively formative (n=3), or both summative and formative (n=16) and usually take place in the fifth or sixth year of studies (n=22 and n=20). Apart from written examinations (n=15) and presentations (n=9), practical examinations are primarily administered (OSCE, n=31); WPA (n=8), usually with self-developed scales (OSCE, n=19). With regards to the examiners’ training and the manner of results-reporting to the students, there is a high variance.

Conclusions: Instruction in communicative competencies has been implemented at all 39 of the participating medical schools. For the most part, communicative competencies instruction in the D-A-C-H region takes place in small groups and is tested using the OSCE. The challenges for further curricular development lie in the expansion of feedback, the critical evaluation of appropriate assessment strategies, and in the quality assurance of exams.

Quality management of clinical-practical instruction for Practical Year medical students in Germany - proposal for a catalogue of criteria from the German Society of Medical Education

Objectives: Amended in 2013, the current version of the German Medical Licensure Regulation contains structural specifications that are also required of non-university institutions involved in Practical Year clinical training. The criteria are worded in relatively general terms. Furthermore, not all of the structural specifications can be readily applied to every subject area. In order to ensure commensurability in Practical Year instruction in Germany, not least in light of recently introduced Practical Year mobility, it is necessary to define consistent quality criteria for Practical Year training. The authors therefore propose a catalogue of criteria for the quality management process in Practical Year instruction facilities.

Methods: In January 2014, the board of directors of the German Society for Medical Education decided to establish a committee comprised of representatives from various German medical faculties. In a process similar to the Delphi methodology, the group developed criteria for structure, process and outcome quality in Practical Year training in Germany.

Results: The criteria developed for structure, process and outcome quality apply to Practical Year training in academic teaching hospitals and university medical centres. Furthermore, modalities for review are proposed.

Conclusions: The present catalogue of criteria is intended to contribute to the formation of a basis for the most consistent quality standards possible for Practical Year instruction in Germany.

Parents studying medicine - the dichotomy of studying with a family

Introduction: In this article the personal study and life situation of parents who are also medical students at the Medical School of the Goethe University Frankfurt am Main is discussed. There is a special focus on the topics “studying with children” and “family-friendly university”, which have been present in discussions about university development and in the daily life of academics, especially during the last decade. The workgroup “Individual Student Services” at the medical faculty at the Goethe University tries to meet the necessities of the individual study courses and to support the study success with a new counselling and student service concept.

Methods: The experience of parents studying medicine was recorded in semi-structured interviews (Date: April 2010), which were held as part of the sponsored pilot project on part-time medical studies (“Pilot Project Part-time Medical Studies”). Additionally, study results from the Medical School of the Goethe University Frankfurt am Main were integrated as well as a literature analysis.

Results: It was found that the teaching demands and support services, which have been suggested and needed for years now, have been partially implemented and are without sufficient support at the faculty level to date. Thus the current situation of medical students with children is still difficult and seems a big challenge for everyone involved.

Solution: As part of the “Individual Student Services” a new pilot project on part-time medical studies was established in November 2009. Only the use of new, unconventional and innovative ideas allows universities to adequately support the changing and heterogeneous student population and support them to successfully completing their medical studies.

How to add more "family" to the work-life-balance? - family friendliness in medical under- and postgraduate studies and the workplace

Today universities have to compete for the best brains more than ever before. The issues of reconciliation of work/study and family and the work-life balance have become increasingly important recently in higher education policy development as higher education institutions in the competition for the best minds are already forced to tackle these issues, some of which are still novel to them, as they are faced with demographic change. High dropout rates among students with children, increasing shortages of physicians and high sector emigration and high levels of childlessness among graduates serve as indicators for urgent action towards more family-oriented university and faculty strategies. But how can medical schools, hospitals and (teaching) hospitals achieve a family-oriented profile? Which key players, which areas of higher education management are relevant to management and decision-making structures? What exemplary measures for designing family-friendly medical studies and work places offer success? The underrepresentation of women in the next generation of scientists also poses an additional challenge to the development of an innovative higher education policy if it is to be sustainable. Thus strategies promoting the next generation and family orientation are key factors for a future-oriented higher education policy. These factors should therefore be seen as leadership strategies which will introduce measures that will make (re)design the university's profile. To this end, a holistic approach which will lead to fundamental reforms of higher education structures which are outlined below and illustrated with examples are a prerequisite for successful implementation.

[Ethical Attitudes of Brazilian Medical Students and Graduates with Active Methodologies.]

The objective of this study was to conduct a diagnosis of the comprehensive inclusion of ethics in Brazilian medical training with a problem-based learning methodology and to describe students' and graduates' perceptions of ethical attitudes. The methodological design was a descriptive and documental case study with a qualitative and quantitative approach. The sample consisted of 20 students per course year, totaling 120 students and 40 alumni from two graduating classes at the ESCS School of Medicine. The project was approved by the Institutional Review Board of the State Health Secretariat, Federal District, Brazil. ESCS students and graduates showed that they approach ethical conflicts and respect for patients. However, an analysis of ethical sensitivity revealed weak perceptions and inappropriate attitudes by medical students, especially in the early years of medical school, requiring more systematic discussions on ethical and bioethical aspects integrated with practical activities, in order to increase and strengthen ethical reflection by students.