Die Vermittlung praktischer ärztlicher Fertigkeiten mittels Peer Teaching in medizinischen Curricula

Der Erwerb praktischer Fertigkeiten im Medizinstudium gewann in den letzten Jahren zunehmend an Bedeutung. Dennoch fühlen sich 64,7% der ärztlichen Berufsanfänger in Deutschland ungenügend auf ihren Berufseinstieg vorbereitet. Mit der Entwicklung des nationalen kompetenzbasierten Lernzielkatalogs Medizin (NKLM) wurde 2015 eine nationale Richtlinie zum Kompetenzerwerb während des Medizinstudiums geschaffen. Als eine ausgezeichnete Lehrmethode zur Vermittlung praktischer Fertigkeiten zeichnete sich Peer Teaching aus. In der vorliegenden Arbeit wird untersucht, inwieweit Peer Teaching den Berufseinstieg in den Arztberuf unterstützen kann. Im ersten Schritt wird hierzu das Tutorienprogramm des Lernzentrums der Charité – eines der umfangreichsten Peer Teaching- Programme Deutschlands – exemplarisch mit den nationalen Richtlinien auf Vollständigkeit abgeglichen um etwaige Lücken oder Redundanzen im Curriculum zu identifizieren. Im zweiten Schritt werden mit Hilfe einer explorativen Delphi-Studie sowohl zukünftige globale Trends im Gesundheitswesen herausgearbeitet, als auch die mittelfristige Zukunftsrelevanz der empfohlenen praktischen Lernziele bewertet, um zukünftige An- und Herausforderungen ärztlicher Berufsanfänger ableiten zu können. Im Rahmen einer Best Practice-Simulation eines Nachtdienstes in einer Notaufnahme im Peer Teaching-Setting wird imdritten Schritt deren Auswirkung auf das Selbstvertrauen und das feeling of preparedness der Teilnehmenden untersucht.The acquisition of practical skills in medical education has gained increasing importance during recent years. Nonetheless 64.7% of young medical professionals feel insufficiently prepared upon their entry into professional life. In 2015 the German National Competence-based Learning Objectives Catalogue for Undergraduate Mediacal Education (NKLM) was introduced to provide a national guideline for the akquisition of skills during medical education. A widely established method for conveying practical skills is peer teaching. This study set out to demonstrate how peer teaching may facilitate entry into professional life in medicine. As a first step the peer-tutorial programme of the Lernzentrum of the Charité Berlin – one of the most comprehensive peerteaching programmes in Germany – is matched against the NKLM to detect inadvertent gaps or redundancies in the curriculum. Secondly, an explorative delphi-study is used to identify future global trends in healthcare as well as to evaluate the medium-term relevance of recommended practical learning objectives in order to derive future demands and challenges that young medical professionals are faced with. Finally the impact of a simulated emergency department night-shift on self-confidence and feeling of preparedness of participants is investigated

Data from: The future of practical skills in undergraduate medical education – an explorative Delphi-Study

Background: 64% of young medical professionals in Germany do not feel adequately prepared for the practical requirements of the medical profession. The goal of “outcome-orientated training” is to structure medical curricula based on the skills needed when entering the workforce after completing undergraduate medical education, and thus to bridge the gap between the skills graduates have attained and those necessary for a career in the medical profession. Outcome frameworks (OFs) are used for this purpose. In preparation for developing the National Competence-Based Catalogue of Learning Objectives for Medicine (NKLM) – the German OF – the “Consensus Statement of Practical Skills in Undergraduate Medical Education” (which structures the teaching and acquisition of practical skills in Germany and which strongly influenced the “Clinical-Practical Skills” chapter of the NKLM) was published in 2011. It is not uncommon for at least a decade to elapse between the definition and implementation of an OF and the students’ graduation, which can further increase the gap between necessary and acquired skills. Thus, the purpose of this paper is to posit theses for future development in healthcare and to apply these theses to a current OF. Methodology: Partially structured interviews with experts were used to generate theses pertaining to general, future development in healthcare. These theses were assessed by physician experts based on the likelihood of implementation by the year 2025. The 288 learning goals of the consensus statement were assessed for their relevance for medical education in the interim. Results: 11 theses were generated for the development of medicine, and these theses were assessed and discussed by 738 experts. These theses include the increase in diseases associated with old age, the increasing significance of interprofessional cooperation, and the growing prevalence of telemedicine applications. Of the 288 learning goals of the consensus statement, 231 of the goals were assessed as relevant, and 57 were deemed irrelevant for the short-term future. Discussion: The theses on the future of healthcare, which were generated in this study and which were validated by numerous experts, provide indications of future developments of overall requirements for medical school graduates. For example, when applied to the content of the “Clinical-Practical Skills” NKLM chapter, they largely validate the future relevance of developing practical skills while also providing indications for their further development as applied to the consensus statement

The future of practical skills in undergraduate medical education – an explorative Delphi-Study

Background: 64% of young medical professionals in Germany do not feel adequately prepared for the practical requirements of the medical profession. The goal of “outcome-orientated training” is to structure medical curricula based on the skills needed when entering the workforce after completing undergraduate medical education, and thus to bridge the gap between the skills graduates have attained and those necessary for a career in the medical profession. Outcome frameworks (OFs) are used for this purpose. In preparation for developing the National Competence-Based Catalogue of Learning Objectives for Medicine (NKLM) – the German OF – the “Consensus Statement of Practical Skills in Undergraduate Medical Education” (which structures the teaching and acquisition of practical skills in Germany and which strongly influenced the “Clinical-Practical Skills” chapter of the NKLM) was published in 2011.It is not uncommon for at least a decade to elapse between the definition and implementation of an OF and the students’ graduation, which can further increase the gap between necessary and acquired skills. Thus, the purpose of this paper is to posit theses for future development in healthcare and to apply these theses to a current OF. Methodology: Partially structured interviews with experts were used to generate theses pertaining to general, future development in healthcare. These theses were assessed by physician experts based on the likelihood of implementation by the year 2025. The 288 learning goals of the consensus statement were assessed for their relevance for medical education in the interim. Results: 11 theses were generated for the development of medicine, and these theses were assessed and discussed by 738 experts. These theses include the increase in diseases associated with old age, the increasing significance of interprofessional cooperation, and the growing prevalence of telemedicine applications. Of the 288 learning goals of the consensus statement, 231 of the goals were assessed as relevant, and 57 were deemed irrelevant for the short-term future. Discussion: The theses on the future of healthcare, which were generated in this study and which were validated by numerous experts, provide indications of future developments of overall requirements for medical school graduates. For example, when applied to the content of the “Clinical-Practical Skills” NKLM chapter, they largely validate the future relevance of developing practical skills while also providing indications for their further development as applied to the consensus statement

Der praktische Nutzen des Konsensusstatements "praktische Fertigkeiten im Medizinstudium" – eine Validierungsstudie [The practial use of the consensus statement on practical skills in medical school – a validation study]

[english] Objective: The importance of the acquisition of practical medical skills during medical school is increasing. With the consensus statement “Practical Skills,” developed by the GMA as part of the National Competency-Based Learning Objective Catalogue for Medicine (NKLM), a reference frame was created for the procurement of such skills. This frame consists of 290 learning objectives divided by “organ system,” type (core or elective learning objective), current stage of medical education and level of instruction. By comparing a large and well evaluated range of student tutorials with the consensus statement, one can analyze the practical benefit of the statement, as well as evaluate the tutorial program for completeness. Methods: In the first stage, four evaluators in two groups independently classified all consensus statement’s learning objectives by each of the 48 tutorials currently offered. The inter-rater reliability among the evaluators of each group was calculated both collectively, and according to each organ system. In the second stage, disagreements in the classification were resolved through discussion and consensus decision-making. The coverage of the learning objectives by the tutorials, in the required level of instruction, was then analyzed separately by learning objective type and organ system. Reasons for any initial dissent were recorded and grouped thematically. Results: The correlation between the classifications of the two evaluators was moderately significant. The strength of this correlation, and thus the precision of individual learning goals wording, varied according to organ system. After a consensus was reached, the results show that the offered tutorials covered 66% of all learning objectives, as well as 74% of the core objectives. The degree of coverage differed according to organ system and stage of medical education. Conclusion: The consensus statement is suitable to systematically analyze and develop teaching units. The comparison with established curricula also offers possibilities for further development of the consensus statement, and therefore also of the NKLM. <br>[german] Zielsetzung: Die Bedeutung des Erwerbs praktischer Fertigkeiten im Medizinstudium nimmt zu. Mit dem Konsensusstatement „praktische Fertigkeiten“ hat die GMA im Rahmen der Entwicklung des Nationalen Kompetenzbasierten Lernzielkatalogs Medizin (NKLM) eine Referenz für deren Vermittlung entwickelt, die 290 Lernziele nach Organsystem, Typ (Kern- oder Wahlziel), Reifezeitpunkt der Studierenden und Lernzieltiefe gliedert. Durch den Abgleich eines umfangreichen und gut evaluierten studentischen Tutorienangebots mit dem Konsensusstatement soll einerseits der praktische Nutzen des Konsensusstatements analysiert und andererseits das Tutorienangebot selbst auf Vollständigkeit hin untersucht werden.Methodik: Vier Bewerter/-innen haben in einem ersten Schritt in zwei Gruppen alle Lernziele des Konsensusstatements durch eines der 48 angebotenen Tutorien unabhängig voneinander klassifiziert. Zwischen den Bewertern/-innen einer Gruppe wurde die Interrater-Reliabilität insgesamt und in Abhängigkeit vom Organsystem berechnet. In einem zweiten Schritt wurde Dissens in der Klassifikation durch Diskussion und Konsensfindung gelöst. Anschließend wurde die Abdeckung der Lernziele in der geforderten Tiefe durch das Tutorienangebot getrennt nach Lernzieltyp und Organsystem analysiert. Gründe für den initialen Dissens wurden protokolliert und thematisch gruppiert. Ergebnisse: Die Klassifikationen der beiden Bewerter/-innen korrelieren signifikant in moderater Stärke, die Stärke der Korrelation variiert in Abhängigkeit vom Organsystem und damit auch der Formulierung der einzelnen Lernziele. Nach Konsentierung ergab sich folgendes Bild: 66% aller Lernziele und 74% der Kernziele wurden durch das Tutorienangebot abdeckt. Der Grad der Abdeckung unterschied sich abhängig von Organsystem und Reifezeitpunkten. Schlussfolgerung: Das Konsensusstatement ist geeignet, ein Unterrichtsangebot systematisch zu analysieren und weiterzuentwickeln. Der Abgleich mit etablierten Curricula eröffnet darüber hinaus Möglichkeiten für die Weiterentwicklung des Konsensusstatements und damit des NKLMs

Delphi_Rohdaten - english

Delphi_Rohdaten - englis