Evaluation of an OSCE’s implementation and a two-step approach for a theoretical and practical training program in Obstetrics and Gynecology

Objective structured clinical examination (OSCE) is a well-known assessment method to evaluate clinical skills and competence in healthcare. Following the recently reformed National Competence-Based Catalog of Learning Objectives in Medicine, the implementation of this assessment method in the training program for medical students is now obligatory in Germany. This major change requires a reorganization not only of the training programs but also of the students themselves and the way they learn. We performed a poll evaluating the students’ opinions regarding these major changes and the implementation of the OSCE with a new training program. To implement this assessment method and to evaluate the OSCE, Kern’s six-step approach comprising (1) problem identification and general needs assessment, (2) needs assessment of the targeted learners, (3) goals and objectives, (4) educational strategies, (5) implementation, and (6) evaluation and feedback was applied. To evaluate and gather feedback, a poll was used to analyze the student’s opinions regarding OSCE in gynecology and obstetrics and OSCE in general, in addition to the regular analysis of the students’ results. To reform the educational strategy, a two-step approach was developed: First, the students completed the regular training program and a written examination, and second, they participated in a 1-week clerkship, in small group teaching, and in the OSCE. The OSCE stations were developed primarily based on the National Competence-Based Catalog and the German Catalog of Learning Objectives in Medicine, as well as on the feedback of experts reflecting their expectations for physicians beginning their careers. The students performed well in the OSCE and gave positive feedback regarding this examination method. Furthermore, they welcomed the upcoming changes by considering OSCE a valuable assessment tool, and they showed appreciation for the two-step approach by supporting the combination of an OSCE and a written examination. Thus, this article presents the implementation of an OSCE and a strategy for the adaptation of the curriculum to fulfill the new OSCE requirements and—to our knowledge—reveals students’ primary opinions regarding the changes in their medical training program for the first time

Molecular marker of the early anterior-posterior axis formation in the rabbit

Im frühen embryonalen Stadium der Wirbeltiere entwickeln sich spezifische, morphologische Domänen als Zeichen der sich entwickelnden anterior-posterioren Achsenbildung und definieren somit die für die Gastrulation und weitere Entwicklung des Embryos notwendige Körperachse. Dabei scheinen Genexpressionen mit polarem Muster die Entwicklung der Achsenbildung oder auch die Bildung von multiplen Achsen, wie sie bei monochorial-monoamniotischen Zwillingen zu finden sind, zu beeinflussen. Im Huhn und in der Maus sind zahlreiche dieser molekularen Marker und deren Einfluss auf die Bildung des Primitivstreifens als evolutionär konserviertes Zeichen der abgeschlossenen Achsenbildung bekannt. Diese Modellorganismen lassen die Ähnlichkeit in der Morphologie oder die phylogenetische Nähe zum Menschen im Gegensatz zum Kaninchen, das als Modellorganismus mit einer flachen Keimscheibe die meisten Säuger repräsentiert, vermissen. Um einen Einblick in die molekulare Achsenbildung des Säugers zu bekommen und dessen Anpassungen an die unterschiedlichen Besonderheiten der Wirbeltiere zu analysieren, wurden bekannte Marker in der Achsenbildung auf ihre Expression im Kaninchen untersucht. Hierfür wurden die Sonden für die In-Situ-Hybridisierung entwickelt, sodass die Expressionen von DENND5B, ELK3, EOMES, ID3, LASS1, LITAF, LRP2, NODAL, PKDCC, PITX2, SALL1, SPOCK3 und TBX6 – auch histologisch – untersucht werden konnten. Die untersuchten Gene zeigen in verschiedenen Entwicklungsstadien der Achsenbildung ein achsenspezifisches Muster und lassen sich in eher ringförmige Muster und flächige Genexpressionen mit unterschiedlich starken Gradienten einteilen. Im Vergleich zum Huhn zeigt sich im Kaninchen eine invertierte zeitliche Abfolge des Auftretens der Genexpressionen und ein invertiertes Expressionsmuster passend zu der invertierten morphologischen Achsenbildung. Aus den Expressionsmuster leitet sich eine komplexe molekulare Regulation der Achsenbildung ab: eine ringförmige, periphere und eine kreisförmige, zentrale Domäne in der Keimscheibe, die zusammen mit Genexpressionen, die einen Gradienten herausbilden, eine Orientierung für die spätere Achse entwickeln. Dabei zeigt sich durch die Expressionsmuster von PKDCC und NODAL eine neue molekular definierte Struktur, die aufgrund einer ähnlichen PKDCC-exprimierende Domäne in der Maus evolutionär konserviert sein könnte. Gemeinsam mit der ersten morphologischen Domäne der Achsenbildung und des Bildungsortes des Primitivstreifens sorgen diese drei „Anker“ im gleichnamigen Modell für eine erfolgreiche Achsenbildung. During the early development of vertebrates, specific, morphological domains as signs of the developing anterior-posterior axis formation appear and define the body axes as the crucial step for Gastrulation and further development. Several expression patterns showing a polarity may be involved in the development of axis formation or of multiple axes as occurs in monochorial-monoamniotic twins. In the chick and mouse several of these molecular markers and their influence of the Primitive streak formation, as an evolutionarily conserved sign of completed axis formation, are known. In contrast to these model organisms, which lack either the similar morphology or the close phylogenetic relationship to the human embryo, the rabbit embryo represents most mammals by revealing a flat embryonic disc during its early development. To study the molecular axis formation of mammals and its adaptations in regard to the different morphologies in vertebrates, known markers of the axis formation were analysed in the rabbit. Therefore, probes of these genes were developed for In-Situ-hybridization, so that DENND5B, ELK3, EOMES, ID3, LASS1, LITAF, LRP2, NODAL, PKDCC, PITX2, SALL1, SPOCK3 and TBX6 are – also histologically – analysed. The analysed genes reveal polar patterns during the different stages of axis formation and can be classified as either ring-like or areal with a gradient caused by differing intensities. In comparison to the chick, the rabbit reveals an inverted chronology of the expression pattern and an inverted pattern suiting the inverted morphological axis formation. Based on the expression patterns a complex system of axis formation may be present: a ring-like domain in the periphery and a circular domain in the centre may – together with the areal genes’ expression patterns with gradient- develop an orientation for the future axis. During this process, the expression of pkdcc and nodal reveal a new molecularly defined domain which seems to be evolutionarily conserved by a similarly located pkdcc-expressing domain in the mouse. Together with the first morphological domain of the axis and the domain of the future appearance of the primitive streak, the anterior streak domain forms three anchors as part of the identically named model providing a stable axis formation and may be involved in the development of multiple axes. 2021-06-2

Intraoperative Utilization of Indocyanine Green (ICG) Dye for the Assessment of Ovarian Perfusion—Case Report and Review of the Literature

The assessment of ovarian perfusion after detorsion is crucial in the surgical management of patients with ovarian torsion. In current routine clinical practice, the surgical decision (preservation of the ovary versus oophorectomy) is based on the subjective impression of the surgeon. Intraoperative indocyanine green (ICG) angiography has been shown to sufficiently reflect tissue perfusion with a potential impact on the surgical procedure. Currently, there are only sparse data available on the utilization of ICG in the surgical treatment of ovarian torsion. Here, we describe the successful intraoperative use of ICG in a 17-year-old female patient with ovarian torsion who underwent ovary-preserving surgery. Further, a systematic literature review was performed. Based on the data available to date, the use of ICG in the surgical treatment of ovarian torsion is feasible and safe. The extent to which this might reduce the necessity for oophorectomy has to be evaluated in further investigations