Objectives: Demographic and structural changes in the healthcare sector have led to an increasing shortage of physicians in Germany in recent years, especially in rural areas. Medical schools are increasingly making curricular adjustments to enhance the appeal of urgently needed positions in the healthcare sector. Graduate tracking is essential for evaluating curricula and optimization efforts, and therefore for the targeted improvement of healthcare provision. Methods: Data on the professional activities of 333 medical graduates of the University of Witten/Herdecke (UW/H) were collected through online research based on the classification of the German physician statistics used by the German Medical Association (outpatient: employed or self-employed, inpatient: leading position or non-supervisory). Geographical analysis of the local retention effect was carried out using a geographic information system. Results: Tracking reveals a significantly higher proportion of graduates working in outpatient health care (49.7%), which is due to the 69% increase in the rate of self-employment compared to the national average. The geographical analysis reveals a strong concentration of alumni in close proximity of the alma mater (retention effect), i.e. a 207-fold increase of the alumni density within a distance of 6 km around the UW/H. The local retention effect ranges approximately 30 km, where the increase is still 12-fold. Conclusions: The methodological approach presented in this study provides a novel way for tracking alumni and quantifying their spatial distribution patterns. By demonstrating how such data can be systematically analyzed, the study offers a practical framework for the evaluation of medical faculties and can help estimating the potential impact of e.g. newly established medical faculties on local healthcare provision. Hence, this study can serve as a blueprint for similar alumni tracking approaches.
Background: When evaluating medical students, wouldn’t it be helpful to visualize and understand your students’ clinical reasoning (CR)? There are different types of CR for students to use in their multiple-choice questions (MCQs). While forward reasoning uses data to generate a hypothesis, backward reasoning looks at possible prompts (answers) to generate a hypothesis. This study implements a new approach to visualizing CR during digital MCQ assessment. Furthermore, it examines the effect of feedback given during the learning process, also known as formative feedback, on the thought process. Methods: Quantitative and qualitative data were collected at the end of two consecutive year 5 end-of-semester Family Medicine exams in 2023. Both exams consisted of 60 MCQs and an additional research component also comprising MCQs. During the research component students digitally recorded their reasoning process while answering MCQs. Qualitative data were coded via three rounds of coding, including two marking/coding parties. Results: This study was able to digitally visualize CR in a large cohort (n=210). On average, the exam questions were answered with 87% of CR. Forward reasoning was used significantly more often than backward reasoning (WS 22/23 p=0.006, SS 23 p<0.001). High performers were significantly more likely to use forward reasoning and backward reasoning than low performers (p<0.01). Formative Feedback had no significant influence on the choice of CR type (p=0.281). Follow-up questions might stimulate a change in CR behaviour; however further research is needed (p<0.001). Conclusion: This study illustrates an alternative method to visualize students’ cognitive processes on a large scale. This approach sheds light on the required cognitive processes. It may help educators to better understand what to focus on during curricular learning activities aimed at preparing for state exams. This method may be beneficial as a quality criterion for MCQ questions, as it does not only rely on expert opinion or question metrics but illustrates students’ cognitive processes when answering MCQ.
Objective: Breastfeeding and Nutrition Counselling (NC) plays an important role in paediatric and adolescent medicine for the prevention of nutrition-related diseases. The necessary fundamentals should already be taught during undergraduate medical education. The objectives of this paper were 1. to analyse the National Competence-Based Catalogue of Learning Objectives 2.0 (NKLM) with regard to nutrition-related competencies, 2. to identify possible discrepancies, and 3. to formulate recommendations. Methodology: With the help of a structured literature research, the competency goals which are necessary for primary preventive NC were identified and summarised in a theoretical catalogue of criteria. The NKLM 2.0 was subsequently checked for its content using the qualitative content analysis according to Mayring. Results: The final code system consisted of 82 codes. All 1,426 coded segments were distributed across the code categories as follows: “Preventive nutritional knowledge”: 532 (37.31%), “Communication competencies”: 442 (31%), “NC competencies”: 216 (15.15%), “Nutritional medicine”: 236 (16.55%). No teaching content was identified for 5 codes. Teaching formats and time frames were not specified. Conclusion: NKLM 2.0 covers most of the competencies required for adequate preventive medical NC. There are gaps in nutritional knowledge (nutrition of breastfeeding mothers, cooking and kitchen techniques, eating behaviour) and in nutrition counselling competencies (nudging, sensitive communication about body weight, systemic counselling). These topics can be taught in a targeted manner in communication courses or as part of culinary medicine programs. Mandatory advanced training in paediatrics and adolescent medicine, as well as clear guidelines regarding teaching formats and time requirements, appear to be sensible measures to ensure lasting learning success and effective prevention.
Background: The working environment of pre-hospital emergency medicine represents the framework conditions of high-risk organisations. Non-technical skills are an important foundation for successful performance. In Germany, a new job profile - advanced paramedic - was introduced in 2014, which for the first time also included non-technical skills in the curriculum. Another special feature is that for the first time it is regulated how paramedics proceed with selected extended procedures, such as the application of selected medication. The advanced paramedic has a mandatory annual training requirement of 30 hours. Since there are no requirements in terms of content, we investigated whether training of non-technical or technical skills improve the care of a simulated patient. The results should indicate which priorities should be set in training. Methods: Teams were randomised while training and debriefing took place depending on the study arm with a focus on technical procedures and non-technical skills. Six months later, we evaluated the performance of the teams in a simulation scenario using “time-key-item-product” score and the use of incident management methods. Results: Comparing performance with crisis resource management (CRM)/ non-technical skills and technical training, we found no significant difference in time-key-item-product score (TKIP). There was also no difference in the application of incident management methods. Checklists were only used in small numbers. Over half of the teams failed to complete 75% of the required procedures in the scenario. Conclusion: It is noticeable that only a few groups carried out all required procedures. The incomplete treatment suggests that the use of checklists can help emergency teams. Dealing with non-technical skills should be trained intensively, as their use does not yet appear to be routine.
Objective: When moving to a new country for their university studies, international students are confronted with numerous difficulties in their social and academic life. Various projects have been developed to support international students in facing these difficulties, such as peer-assisted learning tutorials. In this study, our goal was to evaluate preclinical international medical students’ objective improvement of knowledge after attending a three-day peer-led revision course for the subjects ‘medical psychology and medical sociology’. Methods: The sample consisted of n=30 international students. The objective improvement of knowledge was quantified by the amount of correctly answered questions in the post-test compared to the pre-test. Students were randomly separated into groups based on which test version (A or B) was written in the pre-test. For the comparison between pre- and post-times and between groups, a two-way ANOVA was calculated. Results: International students significantly improved their knowledge, as reflected in higher post-test scores compared to pre-test scores (F1,22=13.470, p=0.001). Conclusion: International students showed an improvement in their knowledge, suggesting a potential benefit from participating in a peer-led revision course. Peer-led tutorial programs for international students should be implemented further in medical faculties as means of supporting these students academically and socially.
Introduction: The “National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education” (NKLM) constitutes the content framework for medical studies in the Federal Republic of Germany. It defines the competencies that are deemed to be essential for all graduates to acquire by the conclusion of their studies, irrespective of the specialisation they subsequently pursue in residency. Another objective is to achieve what is termed “constructive alignment”, i.e. coordination between state examinations and faculty learning, teaching and assessment. This manuscript describes the development of the NKLM since 2009, with the overarching objective being the continual enhancement of the catalogue’s usability for the faculties. Project description: The creation and revision of the catalogue were conceptualised and coordinated in various constellations by the Association for Medical Education (GMA), the German Association of Medical Faculties (MFT), and the LOOOP research team at Charité and Brandenburg Medical School. The most recent findings from educational research have been continuously incorporated into the structure of the catalogue and the processing algorithms. In light of the aforementioned algorithms, the catalogue has been revised by a team of over 1,000 subject matter experts. The release of Version 2.1 is scheduled for the summer of 2026. Summary and outlook: The catalogue has undergone a series of refinements, improvements to its internal structure, and a substantial reduction in content scope across three interim versions: NKLM 1.0, NKLM 1.0 (neo), and NKLM 2.0. The NKLM serves as the foundation for the core curricula of the faculties. It is designed to be a living document that is continually adapted to new findings and topics. Development of the subsequent version, designated as 3.0, is already in preparation.
Introduction: Interprofessional collaboration is considered a key determinant of patient care quality and safety, yet it remains only partially embedded in the curricula of healthcare professions. The IPAPA project, developed at the University Hospital Bonn, addresses this gap through the design of a simulation-based interprofessional training programme for final-year medical students in their elective anaesthesiology rotation and trainee anaesthesia assistants, based on the evidence-informed TeamSTEPPS® programme. Objective: This project report aims to describe the curricular development, implementation, and instructional design of the IPAPA teaching concept and to contextualise initial experiences from the accompanying evaluation. Methods: The teaching intervention was developed in accordance with Kern’s six-step approach to curriculum development. Interprofessional learning objectives were derived from the National Competence-Based Learning Objectives Catalogue for Medicine and the German training and examination regulations for anaesthesia assistants and operating theatre technicians (ATA-OTA-APrV), and translated into an adapted TeamSTEPPS® 3.0-based teaching and learning concept with simulation-based components. Implementation was complemented by an accompanying evaluation. Results: The IPAPA concept, comprising eight teaching units, was integrated as a mandatory course into both the final-year elective rotation in anaesthesiology and the training programme for trainee anaesthesia assistants. Initial qualitative feedback from participants suggests high acceptance of the format, particularly with regard to the practical simulations and the structured interprofessional communication. Joint participation of both professional groups was described as realistic and conducive to mutual role understanding. Conclusion: This project report illustrates how an interprofessional, simulation-based team training programme can be developed and implemented within an anaesthesiology training context. IPAPA thus contributes to the structured integration of interprofessional teaching formats and may serve as a model for comparable educational settings.
Objective: A key recommendation for further improvement of undergraduate medical education is vertical integration, in particular the close connection of basic medical science and clinical learning content. The project described here aimed to develop and implement an interdisciplinary spiral curriculum for biochemistry, which has its own subject systematics, is integrated into the organ- and topic-related modules of the Brandenburg reformed medical study programme and exploits learning theory-based benefits of vertical integration. This project report provides a specific implementation example for practitioners. Methodology: Curriculum development took place in an interdisciplinary process. Learning success was analysed comparatively using the Progress Test Medicine, and student perception was evaluated using a questionnaire. Results: The spiral curriculum for biochemistry is fully integrated into a Z-curriculum, both across the entire length of the study programme as well as at the level of modules, modules’ learning objectives, weekly topics and interdisciplinary classes. Exemplary mapping with the NKLM and the national catalogue of exam-relevant topics, comparable learning success with other universities and student evaluations confirm the intended subject systematics, the high degree of vertical integration and its positive evaluation, e.g. in terms of relevance of learning content and deep learning. According to level 9 of Harden's integration ladder, the biochemical subject identity has been retained, but subject autonomy has been largely abandoned. Conclusion: The spiral curriculum for biochemistry implements key recommendations for further improvement of undergraduate medical education, demonstrates the successful application of the principles of vertical integration and confirms the opportunities associated with its use.
Anatomy teaching in medical schools has experienced a reduction in teaching hours in recent decades, which has led to the implementation of innovative methodologies, such as gamification and serious games, to improve student learning and motivation. In this study we evaluated the impact of these tools on the final grades of students enrolled in human anatomy I: Locomotor system for four consecutive academic years (2020-2024). Two groups were compared: one with traditional methodology and another that integrated gamification activities, and in which the content, teaching staff and assessment criteria remained unchanged. Students who participated in gamified teaching obtained significantly (p<0.005) better grades than the control group in the four teaching courses studied. However, no significant differences were observed between sexes or between the different academic years. Gamification in higher education, in addition to motivating and energising classes, is an effective and versatile tool for optimising academic performance in the health sciences.
Objectives: The invasion of Ukraine has severely disrupted medical education. This study evaluated a blended digital intervention to support medical students and examined factors influencing students’ experiences under the conditions. Methods: Two blended online modules (Medical Communication and Clinical Reasoning) were co-developed by the University of Würzburg and two Ukrainian medical universities. The modules combined asynchronous learning materials with synchronous online sessions, including simulated patients alongside case-based discussions. Displaced Ukrainian physicians contributed as instructors. A cross-sectional mixed-methods evaluation was conducted at the end of teaching using an online questionnaire with 15 Likert-scale items and open-ended questions. Quantitative data were analysed using descriptive statistics, exploratory factor analysis, and regression analyses with interaction terms. Qualitative responses underwent thematic content analysis. Results: In total, 376 valid questionnaires were completed (response rate: 28.8% of 1,306 module participations). Factor analysis identified three perceived outcome dimensions: teaching quality, learning gain, and module experience. These accounted for 54% of the total variance and captured students’ perceived effectiveness of the modules. Ratings were high for organisation, clarity, and interactivity, while perceived learning gain was positive but lower for compensating missing practical training. War- and infrastructure-related interruptions were negatively associated with ratings, with a significant interaction of study location indicating stronger effects in Ternopil than in Vinnytsya. Qualitative comments corroborated these findings and highlighted practical relevance, cultural adaptation, and participants’ exposure to different professional practices. Conclusion: The blended online modules were positively evaluated, and represent a scalable and resilient approach to sustaining medical training in conflicts and other resource-limited contexts.
Film-based pedagogy, especially cinemeducation as a teaching methodology, has become more visible as an arts and humanities teaching format. However, many existing cinemeducation courses at medical schools use films that, while valuable in their time, may no longer reflect current societal or medical discourses. This study aimed to identify contemporary films that resonate with present-day issues in medicine, assess students’ motivation to engage with cinemeducation, and explore interest in transdisciplinary learning. For the first time, three medical students participated in BaseCamp at the Locarno Film Festival, a young talents program that fosters transdisciplinary exchange. They screened festival films with medical themes and organised a 75-minute workshop with students from film, natural sciences, arts, and medicine. The workshop focused on how students from these fields can collaborate to create transdisciplinary learning environments. The students identified seven films with medical topics in the Locarno Film Festival program. Evaluations showed that the students were highly motivated to further engage with cinemeducation and promote transdisciplinary education. The exchange generated innovative approaches, including the use of video essays for cinemeducation and producing films together with art and film students. Medical students like to exchange ideas with other cinemeducation projects worldwide, which is supported by a mean Likert score of 1.3 (n=3). A transdisciplinary medical film festival and a cinemeducation symposium could be a first step.
Objective: The aim of this study was to develop a self-assessment instrument for measuring medical professionalism among medical students and to conduct an initial evaluation of its psychometric properties. Methods: The MediProf questionnaire was developed in an iterative process based on the Professionalism Scale Germany (Pro-D). It comprises a total of 64 items, of which 61 are rated on a four-point Likert scale (1=strongly disagree; 4=strongly agree) and cover four dimensions of medical professionalism: towards 1) oneself, 2) patients, 3) other healthcare professions, and 4) society. Three items assess the relevance and the extent to which the topic is addressed at the respondents’ own institution. Comprehensibility and feasibility were evaluated in two pretests. In 2024, the questionnaire was administered online to 224 medical students. Statistical analyses were conducted using SPSS and Stata. In addition to calculating scale scores per dimension, item discrimination, and item difficulty, we assessed internal consistency using Cronbach’s alpha (α) and conducted a confirmatory factor analysis. Multiple linear regression analyses were used to examine the influence of sociodemographic factors on self-assessed professionalism. Results: Analysis of the complete questionnaire data from 155 students demonstrated good internal consistency for the MediProf questionnaire across all 61 items (α=0.90), with good to acceptable values for the individual dimensions: 1) α=0.84; 2) α=0.75; 3) α=0.77; and 4) α=0.62. Most items showed good discrimination. The factor analysis indicated an overall relationship between the items and the four dimensions, with high interdependencies and weak factor loadings. Students rated their professionalism overall as high (mean=3.3; SD=0.2). Regression analyses revealed no significant influence of sociodemographic variables on self-assessed professionalism. The majority of participants considered the topic very important (94.5%) and called for stronger curricular integration (79.5%). Conclusions: The newly developed MediProf questionnaire provides, for the first time, a German-language self-assessment instrument with good psychometric properties for measuring medical professionalism among medical students. The participants’ expressed desire for stronger curricular integration highlights the importance of early and continuous promotion of professionalism throughout medical education.
Aim: The CanMEDS framework of the Royal college of physicians and surgeons of Canada and its role profile were originally contrived for the training of specialist physicians. But they also deliver an ideal teaching content to engage undergraduate medical students with the examination of their own professional development as well as with the institutional and social expectations of physicians. Integrating the physician’s roles of CanMEDS into teaching can thus be recognized as an element of professional identity formation. As an example, the article presents a lecture series of the TUM Medical Education Center that implements the CanMEDS framework in its current version from 2015 into its teaching. Method: The article showcases the lecture series “Introduction to clinical medicine” that underwent a reconceptualization and gradual redesign starting with the 2022 winter semester. The general structure as well as content-specific outlines of the lecture series are presented in line with the respective roles of the CanMEDS framework. Special attention is payed to the applied teaching methods of the lecture series (impulse-based teaching, panel discussions, photo competition). Results: After currently two iterations assessments deliver a so far very positive résumé. Comprised of direct gradings as well as text comments by the students the evaluation offers first insights into the reception of the contents and methods (interactivity, reflective practice and duration). Conclusion: The positive feedback regarding the redesign so far is an encouragement for further adjustments in the chosen direction. A next step is to establish the used methods on a broader basis in lectures that involve elements of professional identity formation.
Objective: The aim of this study was to qualitatively describe the relationships between the experience of meaningfulness, crises of meaning and the motivation of medical students. Methods: Semi-structured interviews using an interview guide with 20 students in the clinical study phase were analyzed using type-building qualitative content analysis according to Kuckartz. Results: Sources of professional meaning were identified as belonging and teamwork, performance and striving for development, autonomy, coherence and social relevance. Transition phases, pressure to perform, negative practical experiences and professional or system-related challenges were cited as inhibiting factors for a good experience of meaningfulness. The students reported that experiences of meaningfulness and crises of meaning had an impact on their motivation. Four specific student-types were elaborated, regarding the degree of motivation for their studies and later career entry, in professional meaningfulness and crises: Students with a calling had the strongest motivation and the highest experience of meaningfulness with hardly any crises of meaning. Students who are seekers had a high experience of meaningfulness, but their motivation was low due to crises of meaning, in contrast to students who are doubters, who also had a low experience of meaningfulness. Students who are work-to-live persons, despite low levels of experience of meaningfulness or crises of meaning, showed motivation for their studies and later careers. Conclusion: Students’ experiences of meaningfulness and crises of meaning were shown to be related to their motivation to study and later career entry. The proposed typology revealed individual accentuations of the students on how they can cope with experiences of meaningfulness and motivation. Further research is required to confirm the relationships found and to develop targeted interventions based on them.
Background: Professional identity formation (PIF) in medical education is a complex and transformative process that aims to enable students to meet the expectations of medical integrity and societal responsibility. It involves the acquisition of necessary competencies and the development of a professional identity. Teaching this aspect remains challenging-even in competency-based curricula. Methods such as portfolios, reflective writing, and coaching are used to promote long-term identity development and awareness of the physician's role. Project description: In 2012, a longitudinal track titled "Professional Identity Formation" (PIF) was established at the University of Oldenburg, modelled on a program at its partner institution in Groningen. Early student evaluations indicated that the relevance of this track was often questioned-particularly in the early years of study. As a result, a substantial reform was implemented in the winter semester 2021/22. Current evaluation results show increased acceptance: 74% of surveyed students (n=203) now consider PIF to be well integrated into the overall curriculum. Nonetheless, the success of the program still strongly depends on the engagement and quality of the assigned tutors. Conclusion: Competency-based support for professional identity formation is a challenging endeavour that depends not only on the structural and didactic design of the curriculum but also on students' willingness to engage with reflective methods and topics. The implementation of the program by tutors-despite extensive training-remains a critical but hard-to-control factor. However, the effectiveness of the PIF track depends heavily on these instructors.
Objectives: Critically reflecting on history of medicine during Nazism and the Holocaust (MNH) which included egregious ethical violations such as genocide complicity is a powerful platform for scaffolding Professional Identity Formation (PIF) with contemporary relevance for health professions education (HPE), clinical and research practices, and public policy. The study explored the longitudinal impact of MNH curriculum with an Auschwitz Memorial study trip on personal and PIF including moral development as a key PIF component. Methods: The authors used immersion-crystallization qualitative thematic analysis to analyze medical and psychology students’ reflective writings at 6 weeks (N=10) and 1.5 to 2 years (N=24) post 2019 MNH curriculum with study trip. Results: Four distinct themes were identified, ie. curriculum and study trip impact on me as a 1) person, 2) student & future health professional, 3) member of a health profession (and health system), and 4) global citizen & part of humanity (philosophical/existential aspects). Each theme included five subthemes, ie. moral sensitivity, moral judgment, moral motivation, moral character, and moral outcome. Themes/subthemes were mapped to a conceptual framework for a moral development model within personal and PIF. Conclusions: This curriculum catalyzed critically reflective learning/meaning-making supporting history-informed personal and PIF, and moral development within HPE. Students described compelling and relevant impact of the MNH curriculum on their perspectives and behavior within their studies, the health care system, and society. MNH curriculum is proposed as a fundamental HPE component cultivating attitudes, values, and behaviors for empathic, morally courageous leadership within inevitable healthcare and societal challenges.
Background: The promotion of Professional Identity Formation (PIF) is gaining increasing international attention. At the newly established Medical Faculty of Augsburg, the longitudinal PIF curriculum Maturitas was developed based on the Canadian model at McGill University and implemented within the core curriculum beginning in the winter semester 2019/2020. Aim: This manuscript describes the development process during the first four semesters. The process can be divided into three phases, with a particular focus on the second phase. A central conceptual shift was to understand professional identity development as a continuous process from layperson to physician, highlighting the intermediate identity of “being a medical student” as a distinct developmental stage. Approach: Within Maturitas, both curricular teaching formats and a mentoring program were introduced and successfully established. The developmental process was accompanied by literature review, formative evaluation, and continuous feedback from students and faculty. Reflective analysis resulted in the identification of key enabling factors and challenges for the implementation and sustainability of PIF curricula. Results: Initial feedback indicates positive effects such as strengthened reflective capacity. However, challenges remain, including variable participation rates and the lack of systematic assessment of defined learning outcomes. Open questions include how the long-term effectiveness and sustainability of the curriculum can be demonstrated, how PIF-related content can be integrated across subjects, and how faculty-wide competence curricula can be implemented in a resource-efficient manner. Conclusion: The Augsburg experience illustrates that longitudinal PIF curricula can be successfully integrated into a core medical curriculum. At the same time, ongoing critical evaluation, iterative adaptation, and long-term assessment are required to meaningfully anchor professional identity formation alongside knowledge acquisition and clinical skills training.
