Implementing a logbook on entrustable professional activities in the final year of undergraduate medical education in Germany – a multicentric pilot study

Objectives: The final year of undergraduate medical education (practical year) should foster the transition from undergraduate medical education to graduate medical education. Medical students in the practical year should be able to assume professional tasks, and supervisors should assign these tasks to them. In this pilot study, a curriculum based on the concept of entrustable professional activities (EPAs) was implemented and evaluated in the disciplines of internal medicine, surgery and general practice at four university hospitals.Methods: n =37 medical students and n =17 supervising physicians at four German university hospitals participated in the implementation study for one trimester. For evaluation purposes, we conducted focus group discussions and telephone interviews and analyzed them following qualitative content analysis.Results: We identified five different aspects as important for implementing the EPA curriculum in undergraduate medical education in the German context: Implementation process of the EPA curriculum and required resources, Entrustment process, Feedback sessions with supervisors, Students' and supervisors' role perception Overall impact of EPAs on training conditions in the practical year. Conclusion: The study presents a practical implementation of the EPA curriculum in Germany's undergraduate medical education. Besides the need for time and resources, the concept shows good feasibility and fosters a competence-oriented undergraduate medical education in the practical year.Hintergrund: Das letzte Jahr der medizinischen Ausbildung (Praktisches Jahr) soll den Übergang zwischen dem Medizinstudium und der ärztlichen Weiterbildung fördern. Medizinstudierende im Praktischen Jahr sollten befähigt werden, professionelle Aufgaben zu übernehmen. Diese sollten ihnen von Supervisor/innen auch übertragen werden. In dieser Pilotstudie wird ein Curriculum-basiertes Konzept zu anvertraubaren professionellen Tätigkeiten (APT) eingeführt und an vier Universitätskliniken für die Fachbereiche Innere Medizin, Chirurgie und Allgemeinmedizin evaluiert.Methode: N =37 Medizinstudierende und N =17 supervidierende Ärzt/Ärztinnen an vier deutschen Universitätskliniken nahmen an der Implementierungsstudie für ein Tertial teil. Zur Evaluationszwecken führten wir Fokusgruppen und Telefoninterviews durch und analysierten dessen Transkripte nach einem qualitativ inhaltsanalytischen Ansatz.Ergebnisse: Wir konnten fünf Aspekte identifizieren, die sich als wichtig für die Implementierung eines APT-Curriculums im Medizinstudium im deutschsprachigen Kontext herausgestellt haben: Der Implementationsprozess des APT-Curriculums und die dafür benötigten Ressourcen, Prozess des Anvertrauens, Feedbackgespräche mit Supervisor/innen, Rollenwahrnehmung der Medizinstudierenden und der Supervisor/innen, Gesamteinfluss der APTs auf die Trainingsbedingungen im Praktischen Jahr. Schlussfolgerung: Die Studie zeigt eine praktische Implementierung des APT-Curriculums im deutschsprachigen Medizinstudium. Neben dem Bedarf an Zeit und Ressourcen, zeigt das Konzept gute Durchführbarkeit und fördert eine kompetenzorientierte medizinische Ausbildung im Praktischen Jahr

Validity evidence for the Hamburg multiple mini-interview

Abstract Background Multiple mini-interviews (MMI) become increasingly popular for the selection of medical students. In this work, we examine the validity evidence for the Hamburg MMI. Methods We conducted three follow-up studies for the 2014 cohort of applicants to medical school over the course of two years. We calculated Spearman’s rank correlation (ρ) between MMI results and (1) emotional intelligence measured by the Trait Emotional Intelligence Questionnaire (TEIQue-SF) and the Situational Test of Emotion Management (STEM), (2) supervisors’ and practice team members’ evaluations of psychosocial competencies and suitability for the medical profession after a one-week 1:1 teaching in a general practice (GP) and (3) objective structured clinical examination (OSCE) scores. Results There were no significant correlations between MMI results and the TEIQue-SF (ρ = .07, p > .05) or the STEM (ρ = .05, p > .05). MMI results could significantly predict GP evaluations of psychosocial competencies (ρ = .32, p < .05) and suitability for the medical profession (ρ = .42, p < .01) as well as OSCE scores (ρ = .23, p < .05). The MMI remained a significant predictor of these outcomes in a robust regression model including gender and age as control variables. Conclusions Our findings suggest that MMIs can measure competencies that are relevant in a practical context. However, these competencies do not seem to be related to emotional intelligence as measured by self-report or situational judgement test

Viral Vector-Based Delivery of CRISPR/Cas9 and Donor DNA for Homology-Directed Repair in an In Vitro Model for Canine Hemophilia B

Gene therapy represents an attractive alternative to treat hemophilia B. Here we established three hepatocyte-derived cell lines based on Huh7, PLC/PRF/5, and Hep3B cells stably carrying a mutated canine FIX (cFIXmut) transgene containing a single point mutation in the catalytic domain. Based on these in vitro models resembling a commonly used canine large animal model, the tetracycline-controlled transcriptional activator (Tet-on)-inducible CRISPR/Cas9 system and an optimized donor were used to correct mutated cFIX gene through homology-directed repair (HDR). For efficient delivery of designer nuclease and donor DNA, we produced a high-capacity adenovirus vector type 5 (HCAdV5) containing the Tet-on-inducible cFIX-specific CRISPR/Cas9 system and a single-stranded adeno-associated virus type 2 vector (ssAAV2) containing the modified donor. Moreover, we designed a single HCAdV5 delivering all components for HDR. Our amplification-refractory mutation system based on qPCR analysis (ARMS-qPCR) revealed that the single vector application in Huh7-cFIXmut cells resulted in up to 5.52% HDR efficiencies, which was superior to the two-vector strategy. Furthermore the single vector also resulted in increased phenotypic correction efficiencies assayed by ELISA. We conclude that HDR in combination with viral vector delivery holds great promise for the correction of mutated FIX in disease models. Keywords: hemophilia B, gene therapy, homology directed repair, CRISPR/Cas9, HCAdV5, ssAAV2, single vecto

CRISPR/Cas9 delivery with one single adenoviral vector devoid of all viral genes

Abstract The Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/Cas9 system revolutionized the field of gene editing but viral delivery of the CRISPR/Cas9 system has not been fully explored. Here we adapted clinically relevant high-capacity adenoviral vectors (HCAdV) devoid of all viral genes for the delivery of the CRISPR/Cas9 machinery using a single viral vector. We present a platform enabling fast transfer of the Cas9 gene and gRNA expression units into the HCAdV genome including the option to choose between constitutive or inducible Cas9 expression and gRNA multiplexing. Efficacy and versatility of this pipeline was exemplified by producing different CRISPR/Cas9-HCAdV targeting the human papillomavirus (HPV) 18 oncogene E6, the dystrophin gene causing Duchenne muscular dystrophy (DMD) and the HIV co-receptor C-C chemokine receptor type 5 (CCR5). All CRISPR/Cas9-HCAdV proved to be efficient to deliver the respective CRISPR/Cas9 expression units and to introduce the desired DNA double strand breaks at their intended target sites in immortalized and primary cells