Performance of international medical students in psychosocial medicine

Background: Particularly at the beginning of their studies, international medical students face a number of language-related, social and intercultural challenges. Thus, they perform poorer than their local counterparts in written and oral examinations as well as in Objective Structured Clinical Examinations (OSCEs) in the fields of internal medicine and surgery. It is still unknown how international students perform in an OSCE in the field of psychosocial medicine compared to their local fellow students. Methods: All students (N = 1033) taking the OSCE in the field of psychosocial medicine and an accompanying written examination in their eighth or ninth semester between 2012 and 2015 were included in the analysis. The OSCE consisted of four different stations, in which students had to perform and manage a patient encounter with simulated patients suffering from 1) post-traumatic stress disorder, 2) schizophrenia, 3) borderline personality disorder and 4) either suicidal tendency or dementia. Students were evaluated by trained lecturers using global checklists assessing specific professional domains, namely building a relationship with the patient, conversational skills, anamnesis, as well as psychopathological findings and decision-making. Results: International medical students scored significantly poorer than their local peers (p < .001; η2 = .042). Within the specific professional domains assessed, they showed poorer scores, with differences in conversational skills showing the highest effect (p < .001; η2 = .053). No differences emerged within the multiple-choice examination (p = .127). Conclusion: International students showed poorer results in clinical-practical exams in the field of psychosocial medicine, with conversational skills yielding the poorest scores. However, regarding factual and practical knowledge examined via a multiple-choice test, no differences emerged between international and local students. These findings have decisive implications for relationship building in the doctor-patient relationship

Early detection of psychosis in children and adolescents - have developmental particularities been sufficiently considered?

The early detection and treatment of persons at risk for psychosis is currently regarded as a promising strategy in fighting the devastating consequences of psychotic disorders. The two current favored at-risk approaches, i.e., the «ultra high risk» and the «basic symptom» criteria, were developed mainly using adult samples. Initial evidence suggests, however, that they cannot simply be applied to children and adolescents. For «ultra-high risk» criteria, there is indication of some attenuated psychotic symptoms being potentially nonspecific in adolescents, and of brief limited intermittent symptoms being difficult to clinically classify in children when observable behavioral correlates are missing. For basic symptoms, too, only a preliminary indication of their usefulness in children and adolescents exists. Since developmental peculiarities in the assessment of basic symptoms should be considered, a child and youth version of the Schizophrenia Proneness Instrument (SPI-CY) was developed. In conclusion, research on the clinical-prognostic validity of the at-risk criteria and their potential adaption to the special needs of children and adolescents is needed. If a «Prodromal Risk Syndrome for Psychosis» or «Attenuated Psychotic Symptoms Syndrome» are included in the upcoming DSM-5, it should be highlighted that its suitability for children and adolescents is only insufficiently known.Die Früherkennung und Frühbehandlung von Personen mit erhöhtem Psychoserisiko gilt derzeit als vielversprechende Strategie, die weitreichenden negativen Konsequenzen psychotischer Störungen zu reduzieren. Die beiden derzeitigen Risikokriteriensätze, die «ultra-high risk» und die Basissymptom-Kriterien, wurden vorwiegend an Erwachsenenstichproben entwickelt. Erste Studien sprechen dafür, dass diese Kriterien nur eingeschränkt auf Kinder und Jugendliche übertragbar sein könnten. Für die «ultra-high risk»-Kriterien gibt es Hinweise, dass einige attenuierte psychotische Symptome im Jugendalter möglicherweise nicht ausreichend spezifisch und, wenn beobachtbare Verhaltenskorrelate fehlen, kurze intermittierende psychotische Symptome im Kindesalter schwer klassifizierbar sind. Auch für die Basissymptom-Kriterien liegen nur sehr vorläufige Hinweise auf ihre Eignung bei Kindern und Adoleszenten vor. Da entwicklungsbezogene Besonderheiten auch bei der Erhebung von Basissymptomen berücksichtigt werden sollten, wurde eine Kinder- und Jugendversion des Schizophrenia Proneness Instrument (SPI-CY) entwickelt, die in der vorgelegten Arbeit vorgestellt wird. Somit sind gezielte Studien zur Validierung und ggf. Adaptation der Risikokriterien für Kinder und Jugendliche dringend erforderlich, insbesondere wenn ein «Prodromal Risk Syndrome for Psychosis» oder «Attenuated Psychotic Symptoms Syndrome» in das DSM-5 aufgenommen wird. In diesem Fall müsste betont werden, dass die klinisch-prognostische Validität dieses Risikosyndroms für Kinder und Jugendliche noch unzureichend geklärt ist

Developing medical educators : a mixed method evaluation of a teaching education program

Background: It is well accepted that medical faculty teaching staff require an understanding of educational theory and pedagogical methods for effective medical teaching. The purpose of this study was to evaluate the effectiveness of a 5-day teaching education program. Methods: An open prospective interventional study using quantitative and qualitative instruments was performed, covering all four levels of the Kirkpatrick model: Evaluation of 1) "Reaction" on a professional and emotional level using standardized questionnaires; 2) "Learning" applying a multiple choice test; 3) "Behavior" by self-, peer-, and expert assessment of teaching sessions with semistructured interviews; and 4) "Results" from student evaluations. Results: Our data indicate the success of the educational intervention at all observed levels. 1) Reaction: The participants showed a high acceptance of the instructional content. 2) Learning: There was a significant increase in knowledge (P<0.001) as deduced from a pre-post multiple-choice questionnaire, which was retained at 6 months (P<0.001). 3) Behavior: Peer-, self-, and expert-assessment indicated a transfer of learning into teaching performance. Semistructured interviews reflected a higher level of professionalism in medical teaching by the participants. 4) Results: Teaching performance ratings improved in students' evaluations. Conclusions: Our results demonstrate the success of a 5-day education program in embedding knowledge and skills to improve performance of medical educators. This multimethodological approach, using both qualitative and quantitative measures, may serve as a model to evaluate effectiveness of comparable interventions in other settings

Challenges in the early detection of psychosis in children and adolescents

The early detection and treatment of persons at-risk for psychosis is currently regarded a promising strategy in fighting the devastating consequences of psychotic disorders. The two current at-risk approaches, i.e., the "ultra high risk" and the "basic symptom" criteria, were mainly developed on adult samples. Initial evidence suggests, however, that they cannot simply be applied to children and adolescents. For ultra high risk criteria, there is indication of some attenuated psychotic symptoms being potentially non-specific in adolescents and of brief limited intermittent symptoms being difficult to clinically classify in children when observable behavioral correlates are missing. For basic symptoms, too, only preliminary indication of their usefulness in children and adolescents exists. Since developmental peculiarities in the assessment of basic symptoms should be considered, a child and youth version of the Schizophrenia Proneness Instrument (SPI-CY) was developed. In conclusion, research on the clinical-prognostic validity of the at-risk criteria and their potential adoption to the special needs of children and adolescents is needed. If a Prodromal Risk Syndrome for Psychosis or Attenuated Psychotic Symptoms Syndrome will be included into DSM-V, it has to be highlighted that its suitability for children and adolescents is only insufficiently known

Time resolved reflectivity and transmission measurements during laser induced blow-off of thin metal films

Time resolved reflectivity and transmission measurements with nanosecond time resolution are used to follow the evolution of ablation and material transport during Ar+ and ArF excimer laser induced blow-off of W and Cr films deposited onto glass substrates. The analysis of the optical transients combined with heat flow calculations provides evidence that solid phase material removal is the dominant mechanism for the ablation of W films, while Cr is ablated in the form of vapor and small molten droplets. © 1993.Peer Reviewe