Examiner effect on the objective structured clinical exam – a study at five medical schools

Background: The Objective Structured Clinical Examination (OSCE) is increasingly used at medical schools to assess practical competencies. To compare the outcomes of students at different medical schools, we introduced standardized OSCE stations with identical checklists. Methods: We investigated examiner bias at standardized OSCE stations for knee- and shoulder-joint examinations, which were implemented into the surgical OSCE at five different medical schools. The checklists for the assessment consisted of part A for knowledge and performance of the skill and part B for communication and interaction with the patient. At each medical faculty, one reference examiner also scored independently to the local examiner. The scores from both examiners were compared and analysed for inter-rater reliability and correlation with the level of clinical experience. Possible gender bias was also evaluated. Results: In part A of the checklist, local examiners graded students higher compared to the reference examiner; in part B of the checklist, there was no trend to the findings. The inter-rater reliability was weak, and the scoring correlated only weakly with the examiner’s level of experience. Female examiners rated generally higher, but male examiners scored significantly higher if the examinee was female. Conclusions: These findings of examiner effects, even in standardized situations, may influence outcome even when students perform equally well. Examiners need to be made aware of these biases prior to examining

Problems or prospects? Being a parent in the early phase of the COVID-19 pandemic in Germany

Background: In the early phase of the COVID-19 pandemic, many restrictions hit people in ways never seen before. Mental wellbeing was affected and burden was high, especially for high-risk groups such as parents. However, to our knowledge no research has yet examined whether being a parent was not only a risk for psychological burden but also a way to cope with the COVID-19 pandemic. Methods: An online survey was used to collect data from 1,121 participants from April to June 2020. In addition to demographic variables, risk factors (financial burden, problems complying with COVID-19 restrictions, and pre-treatment due to mental health problems) and protective factors (emotion regulation, humor, and crisis self-efficacy) were collected. The dataset was divided into three groups: parents whose children lived at home (n = 395), parents whose children did not (no longer) live at home (n = 165), and people who were not parents (n = 561). Results: A linear mixed effect model showed that parents had no higher burden than non-parents, and even less when children did not live at home. Expected risk factors were generally less important, and there were no differences between parents and non-parents. In contrast, parents had advantages in protective factors. Conclusion: In the early phase of the COVID-19 pandemic, it was shown that parents (with and without their children at home) were not necessarily at risk due to additional burden, but also had prospects of coping better with the situation than people without children

Elementos, tipologías constructivas y rehabilitaciones en la colonia Gassol de Bítem

Estudi d'un edifici colonial emblemàtic de les terres de l'Ebre. Identificació dels elements simbólics de l'edifici, tipologies constructives, patologies en l'edifici i repercussió de les intervencions que es van dur a terme en el transcurs dels anys en l'estat actual de l'edifici

Surface Modification by Complexes of Vitronectin and Growth Factors for Serum-Free Culture of Human Osteoblasts.

Cell attachment, expansion, and migration in three-dimensional biomaterials are crucial steps for effective delivery of osteogenic cells into bone defects. Complexes composed of vitronectin (VN), insulin-like growth factors (IGFs), and insulin growth factor-binding proteins (IGFBPs) have been reported to enhance cell attachment, proliferation, and migration in a variety of cell lines in vitro. The aim of this study was to examine whether prebound complexes of VN and IGFs _ IGFBPs could facilitate human osteoblast serum-free expansion in vitro and enhance cell attachment, proliferation, and migration in three-dimensional biomaterial constructs. Human osteoblasts derived from alveolar bone chips and the established human osteoblast cell line Saos-2 were used. These cells were seeded on tissue culture plates and porous scaffolds of type I collagen sponges and polyglycolic acid (PGA), which had been coated with VN _ IGFBP-5 _ IGF-I. Cell attachment, proliferation, and migration were evaluated by cell counting, confocal microscopy, and scanning electron microscopy. The number of attached human osteoblasts was significantly higher in VN-coated polystyrene culture dishes. Furthermore, significant increases in cell proliferation were observed when growth factors were bound to these surfaces in the presence of VN. In the two scaffold materials examined,greater cell attachment was found in type I collagen sponges compared with PGA scaffolds. However, coating the scaffolds with complexes composed of VN _ IGF-I or VN _ IGFBP-5 _ IGF-I enhanced cell attachment on PGA. Moreover, the presence of VN _ IGFBP-5 _ IGF-I resulted in significantly greater osteoblast migration into deep pore areas as compared with untreated scaffolds or scaffolds treated with fetal calf serum. These results demonstrated that complexes of VN _IGFBP-5 _ IGF-I can be used to expand osteoblasts in vitro under serum-free conditions and enhance the attachment and migration of human osteoblasts in three-dimensional culture. This in turn suggests a potential application in surface modification of biomaterials for tissue reconstruction

Die Wertigkeit des gemeinsamen Faches Orthopädie-Unfallchirurgie im 2. Staatsexamen – Vergleich der schriftlichen 2. Staatsexamina mit dem Nationalen Kompetenzbasierten Lernzielkatalog Chirurgie

Zusammenfassung Hintergrund Der Nationale Kompetenzbasierte Lernzielkatalog Chirurgie (NKLC) definiert für jedes seiner 230 Lernziele eine Kompetenzebene von „Kompetenzebene 1: Faktenwissen“ bis zu „Kompetenzebene 3: selbstständiges Handeln“. Trotz des erwiesenen Einflusses von summativen Prüfungen auf das Lernverhalten von Studierenden bilden diese Lernziele nicht die Grundlage für das 2. Staatsexamen. Die vorliegende Studie untersucht, inwiefern die Prüfungsfragen des 2. Staatsexamens bereits die orthopädisch-unfallchirurgischen Lernziele des NKLC adressieren und welche thematische Schwerpunktsetzung hierbei erfolgt. Material und Methoden Es erfolgte eine retrospektive Analyse basierend auf den Examensfragen von Herbst (H) 2009 bis Herbst 2014 (n = 11). Zunächst wurden im NKLC durch 5 Ober- und Fachärzte die Lernziele aus den Bereichen Orthopädie und Unfallchirurgie identifiziert. Nachfolgend wurden aus den 11 untersuchten Staatsexamina die Fragen definiert, die sich auf die orthopädisch-unfallchirurgischen Lernziele bezogen. Analysiert wurden die Gesamtzahl der Fragen, die Anzahl der Fragen pro Examen sowie pro Lernziel und Kompetenzebene. Ergebnisse Insgesamt konnten 113 Lernziele des NKLC (entspricht 49,1% aller Lernziele des NKLC) dem Fach Orthopädie und Unfallchirurgie zugeordnet werden. Im Studienzeitraum adressierten 543 Fragen diese 113 Lernziele (entspricht 15,6% aller 3480 Fragen). Pro Examen konnten durchschnittlich 49,36 ± 14,1 (Min. 30; Max. 80) Fragen mit Bezug zu Orthopädie und Unfallchirurgie identifiziert werden. Insgesamt wurden 13,45 ± 6,39 (Min. 6; Max. 24) Fragen zu Lernzielen (LZ) der Kompetenzebene 3a und b, 21,45 ± 9,94 (Min. 9; Max. 39) Fragen zu LZ der Kompetenzebene 2 und 14,45 ± 6,36 (Min. 6; Max. 25) Fragen zu LZ der Kompetenzebene 1 gestellt. Die Mehrheit der Fragen adressierten „Erkrankungen des rheumatischen Formenkreises“ (n = 16 im Herbst 2009). Schlussfolgerung Die Anzahl der Fragen mit unfallchirurgisch-orthopädischem Schwerpunkt im 2. Staatsexamen erscheint in Relation zur Gesamtzahl aller gestellten Fragen ausreichend hoch. Allerdings liegt eine thematische Imbalance vor, und gerade klinisch wichtige Lernziele mit hoher Kompetenzebene werden nicht ausreichend häufig geprüft. Eine bessere Abstimmung der Staatsprüfung mit den Lernzielkatalogen ist erforderlich.</jats:p

Medizinische Prüfung zwischen Wunsch und Wirklichkeit – Analyse der Übereinstimmung zwischen dem 2. Abschnitt der ärztlichen Prüfung und dem Nationalen Kompetenzbasierten Lernzielkatalog Chirurgie

Background The working party of the German Society for Surgery (DGCH) on undergraduate surgical education has developed a national expertise-based catalogue of learning goals in surgery (NKLC). This study analyses the extent to which the questions of the German second medical licensing examination compiled by the IMPP are congruent with the NKLC and which thematic focus is emphasised. Materials and Methods Firstly, a guideline and evaluation sheet were developed in order to achieve documentation of the individual examination questions of the second licensing examination with respect to the learning goals of the NKLC. In a retrospective analysis from autumn 2009 to autumn 2014, eleven licensing examinations in human medicine were screened independently by three different reviewers. In accordance with the guideline, the surgical questions were identified and subsequently matched to the learning goals of the NKLC. The analysis included the number of surgical learning goals as well as the number of surgical questions for each examination, learning goal, and different levels of expertise (LE). Results Thirteen reviewers from six surgical disciplines participated in the analysis. On average, reviewers agreed on the differentiation between surgical and non-surgical questions in 79.1% of all 3480 questions from 11 licensing examinations. For each examination (n = 320 questions), 98.8 +/- 22.6 questions (min.: 69, max.: 150) were rated as surgical. For each surgical learning goal addressed, 2.2 +/- 0.3 questions (min.: 1, max.: 16) were asked. For each examination, 23.5 +/- 6.3 questions (min.: 11; max.: 31) referred to learning goals of LE 3, 52.5 +/- 16.7 questions (min.: 34; max.: 94) addressed learning goals of LE 2 and 22.8 +/- 7.7 questions (min.: 9; max.: 34) were related to learning goals of LE 1. 64 learning goals (27.8% of all learning goals of the NKLC) were not reflected in the examinations. With a total of 70 questions, the most frequently examined surgical topic was "disorders of the rheumatic spectrum". Conclusion The number of surgical examination questions in the German second medical licensing examination seems to be sufficient. However, the questions seem to be unevenly distributed between different surgical areas of undergraduate education. In order to achieve a more homogenous representation of relevant surgical topics, improved alignment is needed between the state examination with existing catalogues of learning goals by the IMPP

Additional file 3: of Examiner effect on the objective structured clinical exam – a study at five medical schools

Part B: Checklist for communication and interaction. Blank English version of checklist part B with a global rating scale including 5 items, each being scored on a 5-step-scale for OSCE stations testing joint examination. (DOC 36 kb

Transforming knowledge systems for life on Earth : Visions of future systems and how to get there

Formalised knowledge systems, including universities and research institutes, are important for contemporary societies. They are, however, also arguably failing humanity when their impact is measured against the level of progress being made in stimulating the societal changes needed to address challenges like climate change. In this research we used a novel futures-oriented and participatory approach that asked what future envisioned knowledge systems might need to look like and how we might get there. Findings suggest that envisioned future systems will need to be much more collaborative, open, diverse, egalitarian, and able to work with values and systemic issues. They will also need to go beyond producing knowledge about our world to generating wisdom about how to act within it. To get to envisioned systems we will need to rapidly scale methodological innovations, connect innovators, and creatively accelerate learning about working with intractable challenges. We will also need to create new funding schemes, a global knowledge commons, and challenge deeply held assumptions. To genuinely be a creative force in supporting longevity of human and non-human life on our planet, the shift in knowledge systems will probably need to be at the scale of the enlightenment and speed of the scientific and technological revolution accompanying the second World War. This will require bold and strategic action from governments, scientists, civic society and sustained transformational intent.Peer reviewe