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.
