Exploring the introduction of entrustment rating scales in an existing objective structured clinical examination

Background: The concept of EPAs is increasingly applied to assess trainees’ workplace performance by means of entrustment ratings. OSCEs assess performance in a simulated setting, and it is unclear whether entrustment ratings can be integrated into these exams. This study explores the introduction of an entrustment rating scale into an existing OSCE. Methods: A 6-point entrustment scale was added to the standard ratings in an OSCE administered prior to students’ final clerkship year in an undergraduate medical programme. Standard OSCE ratings assess clinical and communication skills. Assessors (n = 54) rated students’ performance (n = 227) on a diverse set of clinical tasks and evaluated the addition of entrustment scales to OSCEs. Descriptive and inferential statistics were calculated for analyses. Results: Student performance varied across the stations, as reflected in both the standard OSCE ratings and the added entrustment ratings. Students received generally high standard OSCE ratings, whereas entrustment ratings were more widely distributed. All students passed the OSCE, and only a small proportion of students did not reach the expected pass threshold of 60% on the standard ratings in the single stations. The proportion of students who did not reach the expected entrustment level in the respective stations was noticeably higher. Both the clinical and communication skill ratings were related to the entrustment rating in most OSCE stations. A majority of the assessors positively evaluated the addition of entrustment ratings into the OSCE. Discussion: The findings provide an empirical basis to broaden our understanding of the potential use of entrustment ratings in existing OSCEs. They provide directions for future, more specific studies. The ratings might be used for formative feedback on students’ readiness for workplace practice

Effects of COVID-19 Pandemic on Progress Test Performance in German-Speaking Countries

Background. The COVID-19 pandemic has been the source of many challenges for medical students worldwide. The authors examined short-term effects on the knowledge gain of medical students in German-speaking countries. Methods. The development of the knowledge gain of medical students during the pandemic was measured by comparing the outcomes of shared questions within Berlin Progress Test (PT) pairs. The PT is a formative test of 200 multiple choice questions at the graduate level, which provides feedback to students on knowledge and knowledge gain during their course of study. It is provided to about 11,000 students in Germany and Austria around the beginning of each semester. We analyzed three successive test pairs: PT36-PT41 (both conducted before the pandemic), PT37-PT42 (PT37 took place before the pandemic; PT42 was conducted from April 2020 onwards), and PT38-PT43 (PT38 was administered before the pandemic; PT43 started in November 2020). The authors used mixed-effect regression models and compared the absolute variations in the percentage of correct answers per subject. Results. The most recent test of each PT pair showed a higher mean score compared to the previous test in the same pair (PT36-PT41 : 2.53 (95% CI: 1.31-3.75), PT37-PT42 : 3.72 (2.57-4.88), and PT38-PT43 : 5.66 (4.63-6.69)). Analogously, an increase in the share of correct answers was observed for most medical disciplines, with Epidemiology showing the most remarkable upsurge. Conclusions. Overall, PT performance improved during the pandemic, which we take as an indication that the sudden shift to online learning did not have a negative effect on the knowledge gain of students. We consider that these results may be helpful in advancing innovative approaches to medical education

Communication skills training in undergraduate medical education at Charité - Universitätsmedizin Berlin.

Objective: The objective of this article is a description of the longitudinal communication curriculum in the Model Medicine Curriculum (MSM) at Charité - Universitätsmedizin Berlin. The authors describe the planning and integration of the curriculum into the study program, outline how communicative competence is taught and evaluated in the MSM, and identify which challenges need to be mastered in the process. Project description: Starting with the introduction of the MSM in 2010, students have been spending 102 class hours, spread out over seven semesters, practicing social and communicative competences in the interactive small group format "Communication, Interaction & Teamwork (KIT)". The course contents are closely linked to the topics covered each semester and increase in complexity over the course of their studies. The contents are selected by the KIT planning group whose members continually check the curriculum's timeliness and determine any changes. Students as well as instructors have opportunities for evaluating KIT throughout, and their evaluations are taken into consideration as KIT continues to be updated. Instructors from different disciplines teach KIT courses. They participate in mandatory didactic trainings that prepare them to teach KIT. During their 4th and 9th semesters, respectively, students take summative exams that test their communicative competence. Results: According to the semester evaluations by students and instructors, students participating in KIT improved their conversation management skills (students: M=2.2, SD=1.1, instructors: M=1.9, SD=0.7, on a scale of 1-5). In addition, students and graduates rate KIT to be (very) relevant, consider the degree to which it is taught in the MSM to be (very) high, and consider KIT to be a meaningful part of the curriculum. Students taking the summative exams in their 4th and 9th semesters achieve a mean score of 75.9%, respectively 76.9%, in the purely communicative stations and 82.6%, respectively 83.3%, in the global evaluation of communicative competence in clinical-practical stations. Discussion: Survey and exam results alike indicate that the communication training is well accepted by students and instructors and that the training led to an improvement in general and specific communicative skills. Due to a lack of control groups or a pre-post design, it has thus far not been possible to unequivocally demonstrate a causal relationship between communicative competence trainings and good test results. Quality control measures, such as trainings for instructors and regular course evaluations, have been designed to address any challenges in the implementation of the communication curriculum at the faculty level. Conclusion: Building on the experience with the Charité's Reformed Medical Curriculum, a longitudinal, competence-based communication curriculum was integrated into the MSM's overall curriculum. This measure remedied a gap in the medical training that many graduates of regular study programs had previously bemoaned (Jansen 2010 [1])

Clinical and pathophysiologic spectrum of acquired distal renal tubular acidosis

Clinical and pathophysiologic spectrum of acquired distal renal tubular acidosis. Urinary acidification was studied in nine patients with hyper-chloremic metabolic acidosis. The aim of this study was to investigate the mechanism(s) of impaired distal acidification by the systematic administration of sodium sulfate and neutral phosphate. No impairment of proximal acidification was apparent because all patients had a fractional bicarbonate excretion below 5% at plasma bicarbonate concentrations above 22 mEq/liter. All patients except two were unable to lower urine pH below 5.5 despite systemic metabolic acidosis. The two patients who lowered urine pH normally were hyperkalemic and had selective aldosterone deficiency. Six patients failed to lower the urine pH below 5.5 with sodium sulfate (6.04 ± 0.16) and were unable to achieve a normal urine minus blood (U-B) Pco2 gradient with neutral phosphate (2.8 ± 3.5mm Hg). Control subjects, the two patients with selective aldosterone deficiency, and the remaining patient lowered the urine pH below 5.5 and increased the U-B Pco2 gradient above 25mm Hg in response to sodium sulfate and neutral phosphate infusion, respectively. The abnormal response to these agents exhibited by six patients strongly suggests that the mechanism of impaired distal acidification was that of secretory failure of the proton pump. The normal response of the remaining three patients indicates that the proton pump was able to secrete hydrogen ions normally under maximal stimulation. This pattern is totally predictable in patients with isolated selective aldosterone deficiency who are also capable of lowering the urine pH normally in the presence of systemic metabolic acidosis. The distinctive acidification pattern of the remaining patient who was also hyperkalemic can be explained on the basis of a voltage-dependent type of distal renal tubular acidosis. This type may be disclosed by the findings of impairment of both hydrogen ion and potassium secretion.Aspects clinique et physiopathologique de l'acidose tubulaire distale acquise. L'acidification urinaire a été étudiée chez neuf malades ayant une acidose métabolique hyperchlorémique. Le but de ce travail était d'étudier le mécanisme de l'altération de l'acidification distale par l'administration de sulfate de sodium et de phosphate neutre. Il n'est pas apparu d'altération de l'acidication proximale puisque tous les malades avaient une excrétion fractionnelle de bicarbonate inférieure à 5% à des concentrations de bicarbonate plasmatique supérieures à 22 mEq/litre. Tous les malades sauf deux étaient incapables d'abaisser leur pH urinaire au dessous de 5,5 malgré l'acidose métabolique. Les deux malades qui abaissaient le pH de l'urine à des valeurs normales étaient hyperkaliémiques et avaient un déficit sélectif d'aldostérone. Six malades n'ont pu abaisser leur pH urinaire en dessous de 5,5 avec le sulfate de sodium (6,04 ± 0,16) et ont été incapables de réaliser un gradient de Pco2 normal urine-sang sous phosphate neutre (2,8 ± 3,5mm Hg). Les sujets contrôles, les deux malades ayant un déficit d'aldostérone et le dernier malade ont abaissé le pH de l'urine au dessous de 5,5 et augmenté le gradient de Pco2 à plus de 25mm Hg en réponse aux administrations de sulfate de sodium et de phosphate neutre, respectivement. La résponse anormale des six malades suggère fortement que le mécanisme de l'altération de l'acidification distale est un défaut de fonctionnement de la pompe à protons. La réponse normale des trois derniers malades indique que la pompe était capable de sécréter des ions hydrogène dans des conditions de stimulation maximales. Cette modalité est prévisible chez les malades qui ont un déficit sélectif et isolé d'aldostérone et qui sont aussi capables d'abaisser le pH de leur urine en présence d'une acidose métabolique systémique. La modalité d'acidification particulière du dernier malade qui était en même temps hyperkaliémique peut être expliquée par un mécanisme dépendant de la différence de potentiel. Cette situation peut être reconnue par la constatation d'un désordre portant à la fois sur la sécrétion de ions hydrogène et celle de potassium

Relaunch der Zeitschrift TATuP im 25. Jahr ihres Bestehens. Erste Erfahrungen mit OJS 3.0 - Anforderungen an Artikeldesign und Nutzungsfunktionalitäten

Der Vortrag behandelt den Relaunch der Zeitschrift TATuP - Technikfolgenabschätzung in Theorie und Praxis, die ab 2017 als begutachtete Open Access Zeitschrift im oekom Verlag erscheint. Im Zuge dieses Relaunch wird das Open Journal System (OJS) für die redaktionellen Abläufe und für die Veröffentlichung der Artikel eingesetzt. Die bisherigen Erfahrungen mit der Version 3.0 sowie Anforderungen an das Artikeldesign werden erläutert

N2O-Freisetzung zweier Ackerflächen mit unterschiedlichen Ertragserwartungen nach Einarbeitung von 15N-markiertem Senf

Auf zwei Teilertragsflächen eines Ackers im Tertiären Hügelland Bayerns wurden Ver¬suchs¬plots eingerichtet, auf denen 15N-angereicherter Senf ausgebracht wurde, als Kontrolle dienten jeweils zwei Plots ohne Senfapplikation. Die N2O-Emissionen aus den Hoch¬ertrags¬plots waren höher als aus den Plots im Niedrigertragsbereich. Dies wurde auf die höheren Wassergehalte des Hochertragsbodens zurückgeführt. Durch die Senfapplikation erhöhte sich die annuelle N2O-Emission um 2,1 (Niedrig-ertrag) bzw. 1,7 kg N2O-N ha-1 (Hoch¬ertrag) auf 4,0 bzw. 4,7 kg N2O-N ha-1 a-1. Bezogen auf den zusätzlich über den Senf eingebrachten N (55 kg N ha-1) berechnen sich daraus Emissionsfaktoren von 3,7 bzw. 3,1%. Im Gegensatz dazu konnte anhand der 15N-Anreicherung der N2O-Emission nach¬gewiesen werden, dass lediglich jeweils 0,16 kg N ha-1 (entsprechend 0,3%) direkt aus dem Senfmaterial stammte. Somit wurde durch die Zugabe von Senf bodeninterner N durch Priming freigesetzt und in N2O umgewandelt

The Bugle

Weekly newspaper from May, Oklahoma that includes local, state, and national news along with advertising