Aim: The need for a scientifically founded role script template for simulated participants (SPs) arises from the great importance that SPs have for teaching and assessments in the health professions. Stakeholders have thus far developed their own scripts, making usage across institutions and professions difficult. The aim of this research project is therefore to develop an evidence-based, interprofessional role script template for simulated participants. Method: To integrate the diverse traditions and needs of the professional groups, a multi-stage developmental and consensus process, based on the Delphi method, was conducted by a working group of 19 members over 10 rounds. This process incorporated, among other inputs, the findings of a systematic literature review, feedback from a 24-member interprofessional expert panel, and 11 reviews by experienced SPs. Results: The template has 13 categories, and its modular structure allows for flexible use in teaching and assessment, vocational training, academic studies, as well as further education and training. The template is designed to be consistently interprofessional and suitable for use in the fields of occupational therapy, midwifery, medicine, speech therapy, nursing science, pharmacy, physiotherapy, psychotherapy, emergency response services, veterinary medicine, and dentistry. Conclusion: The complex consensus process reflected the heterogeneity of SP practice in the health professions. Nevertheless, experiences were compiled in one template so that it is possible to interchange scripts between the professions and across institutions and to (further) develop them collectively. The next steps are to evaluate the template's usability and its ongoing development in the community of practice.

Background Persons with disabilities (PWD) continue to experience inequities in healthcare, partly because disability remains insufficiently addressed in undergraduate medical education. Experiential learning and meaningful involvement of PWD as educators have been proposed to improve disability competence, yet evidence on co-designed educational approaches and their longer-term impact remains limited. As part of the development of a longitudinal disability curriculum for undergraduate medical students at the University of Bern, Switzerland, we piloted two experiential workshops co-designed and delivered with an organization of persons with disabilities (OPD). Methods Seventeen medical students participated in two experiential workshops embedded within the planned longitudinal curriculum. The first workshop combined guided self-experience and reflection on environmental and attitudinal barriers, while the second used simulated clinical encounters with PWD educators providing structured feedback. The pilot was evaluated using pre- and post-workshop questionnaires, written qualitative feedback, and a focus group conducted one year later. Quantitative data were analyzed descriptively and qualitative data using thematic analysis. Results Students rated both workshops as highly relevant to their future clinical practice. Questionnaire responses indicated increased self-reported understanding of ableism, confidence in identifying barriers to care, and preparedness for clinical encounters with PWD. Qualitative analysis identified three main themes: (1) the authenticity and credibility of learning from educators with lived experience; (2) reduced apprehension and greater confidence during clinical interactions; and (3) increased awareness of environmental and attitudinal barriers, supporting a more person-centered approach to care. One year after participation, students described sustained changes in their communication, clinical practice, and awareness of accessibility issues. Conclusions This pilot suggests that experiential disability education co-designed and delivered with PWD is feasible, well accepted by medical students, and perceived as educationally valuable. Authentic interactions with educators with lived experience appeared to promote reflection, confidence and awareness that persisted beyond the immediate teaching sessions. Integrating PWD as equal educational partners represents a promising strategy for strengthening disability competence within undergraduate medical education.

Background: In addition to meeting legal requirements, education research studies in the health professions must also factor in aspects of ethical research. However, no specific guidance exists as of yet on how to implement these requirements and aspects in practice. Our aim was therefore to develop recommendations on how to apply aspects of ethical research when planning, conducting and publishing such studies. Method: The recommendations were developed by the members of the DACH Association for Medical Education’s Committee on Methodology in Educational Research in three steps: (1) identification of problematic areas in education research, (2) derivation of concrete measures and explanations, and (3) review of the recommendations by experts with different research perspectives. Results: Two separate sets of recommendations were developed. One set contains actions to ensure data protection, free consent, no harm to and the autonomy of participants (six areas with a total of 29 measures); the other addresses the quality assurance of studies and publications (four areas with a total of 14 measures). Discussion: The recommendations provide assistance when considering ethical aspects and applying them. However, they do not replace any existing rules or the individual reflections of the researchers. These recommendations should undergo continual development and be investigated in regard to their application and effect on decision-making processes in education research.

Introduction: Simulation-based teaching and assessment are integral to education in the health professions, with simulated patients (SP) being a widely accepted strategy. Ensuring high-quality SP role-portrayal is crucial for the authenticity and standardization of assessments, particularly in high-stakes exams like the Swiss Federal Licensing Examination (FLE). The study assesses the quality of SP role-portrayal over consecutive instances of the Swiss FLE. We hypothesized that the quality of role-portrayal improves over time. Methods: The study employed the FAIR OSCE instrument to assess SP role-portrayal in five consecutive FLE exams from 2016 to 2021. The instrument, developed between 2011 and 2014, includes four categories: introduction, delivery of information, portrayal, and others. Data analysis involved retrospective examination of FAIR OSCE ratings, calculating item scores, and overall mean scores for each exam year. Results: The study involved 37 SP educators observing 1803 SP-candidate interactions across five exam sites. Results demonstrated a continuous improvement in SP role-portrayal over the five-year period, with significant differences between 2016 and subsequent years. The overall mean scores of SP role-play ratings increased steadily, indicating a positive trend in SP performance. Discussion: The findings supported the hypothesis of continuous improvement of SP role-portrayal within the Swiss FLE. The quality of role portrayal not only improved consistently but also maintained a very high level, with no items on the FAIR OSCE instrument rated “do not agree” more than 5% of the time. This suggests that SPs role play aligned well with case scripts, reflecting the intended authenticity and standardization of assessments. Limitations were acknowledged, including potential bias in local SP educators rating their own SPs and the study’s sole focus on SP role-portrayal. While the findings contribute to understanding SP effectiveness in standardized, high-stakes clinical exams, the study did not scrutinize other potential sources of variance. Conclusion: In conclusion, the research demonstrated a continuous improvement and high quality of SP role-portrayal in the Swiss FLE over five years. Well-trained SPs, assessed using the FAIR OSCE instrument, play a crucial role in maintaining the standardized and high-quality nature of clinical skills exams in a high-stakes context. Further research could explore additional factors influencing overall exam quality and address potential biases in SP educator ratings.

Modern medical moulages are becoming increasingly important in simulation-based health professions education. Their lifelikeness is important so that simulation engagement is not disrupted while their standardization is crucial in high-stakes exams. This report describes in detail how three-dimensional transfers are developed and produced so that educators will be able to develop their own. In addition, evaluation findings and lessons learnt from deploying transfers in summative assessments are shared.Step-by-step instructions are given for the creation and application of transfers, including materials and photographic visualizations. We also examined feedback on 10 exam stations (out of a total of 81) with self-developed three-dimensional transfers and complement this with additional lessons learnt. By the time of submission, the authors successfully developed and deployed over 40 different three-dimensional transfers representing different clinical findings in high-stakes exams using the techniques explained in this article or variations thereof. Feedback from students and examiners after completing the OSCE is predominantly positive, with lifelikeness being the quality most often commented upon. Caveats derived from feedback and own experiences are included.The step-by-step approach reported can be adapted and replicated by healthcare educators to build their own three-dimensional transfers. This should widen the scope and the lifelikeness of their simulations. At the same time we propose that this level of lifelikeness should be expected by learners as not to disrupt simulation engagement. Our evaluation of their use in high-stakes assessments suggests they are both useful and accepted.

In healthcare, clinicians are expected to communicate in a compassionate way with patients.1 Although medical training for students at the University of Bern offers communication training, for example, breaking bad news or motivational interviewing, compassion or compassionate behaviour is not yet specifically addressed. An interdisciplinary team (medical education, psychology, communication and palliative care) designed and piloted an elective blended course with 1 day of classroom training to improve sixth-year medical students' compassion in patient–physician communication. The learning goals of the pilot included (a) understanding the role of compassion in the patient-physician relationship; (b) characterise the components of compassion; (c) reflecting one's own emotions and developing self-compassion techniques; (d) demonstrate understanding a patient's situation; and (e) developing a compassionate care plan together with the patient. In order to learn about the existing concepts and the importance of compassion, students (n = 8) received preparatory e-learning material in advance. Its contents were discussed and reflected upon during the classroom training. Preparatory reading included directions regarding self-compassion techniques and two case descriptions to initiate reflection about one's own emotions. These materials were contemplated during the training with an expert input about self-compassion and group discussions about integrating these techniques into daily clinical practice. Using simulation, students then explored their feelings and emotions from a patient perspective through self-exposure to various life conditions, such as physical restrictions (wearing bariatric suits or age simulator) or having stigmatising skin diseases (using a moulage of psoriasis or acne). The goal was to foster a deeper understanding of the patient's situation through own experiences. Based on these experiences (‘how did I feel myself, and what might be the related feeling of my patient?’), students created a communication guide for a conversation with simulated patients (SP). In a second step, students used this guide in SP interactions trying to shift from medical reasoning and counselling to assessing and addressing emotions and individual suffering. The final step in this interaction then was to create a compassionate care plan yielding to integrate medical treatment and emotional comfort. The evaluation of the course included (a) students' verbal feedback immediately after the training, (b) students' written evaluation in respect of content and learning goals as well as methodological and didactic aspects and (c) students' self-assessment of skills in compassionate communication using the Sinclair Compassion Questionnaire (SCQ) prior and after the training (www.compassionmeasure.com). Our interactive compassion training seems to address students' needs and expectations in terms of a high quality and compassionate patient-physician interaction. Students very much appreciated the exchange and the reflections within the group about compassion, communication and their own experiences during simulation. Before the training, the majority rated themselves according to the SCQ in most items as ‘somewhat competent’ or ‘neutral’. After the training, students' ratings were more differentiated, ranging from ‘somewhat lacking competence’ to ‘very competent’. All participants strongly recommended offering this ‘compassion training’ to all medical students as a mandatory class; one student even regarded this training as being one of the most important aspects of medical school. Andrea Lörwald, Seraina Petra Lerch, Daniel Bauer, Steffen Eychmüller and Sibylle Jeanine Felber made substantial contributions to conception and design of the course. Daniel Bauer, Steffen Eychmüller, Sibylle Jeanine Felber, Seraina Petra Lerch, Florence Liaudet and Andrea Lörwald conducted the training and acquired the data for evaluation. Florence Liaudet, Sibylle Jeanine Felber, Steffen Eychmüller, Seraina Petra Lerch and Andrea Lörwald analysed and interpreted the data. Sibylle Jeanine Felber and Andrea Lörwald drafted the manuscript. Daniel Bauer, Steffen Eychmüller and Seraina Petra Lerch revised it critically for important intellectual content. All authors approved the version to be published and agree to be accountable for all aspects of this study.

«Period Shaming», «Period Poverty» oder «Tampon Tax» beschreiben Aspekte der Ungleichbehandlung von Frauen im Kontext ihrer Mens. Period Shaming beschreibt dabei ein Schamgefuhl im Kontext der Menstruation. Es kann bereits mit der Menarche beginnen, durch eine verbreitete Vorstellung einer Unreinheit des menstruierenden Korpers verstarkt und durch Drittpersonen aktiv getriggert werden. Period Poverty beschreibt die auf eingeschrankten monetaren Verhaltnissen basierende Nichtnutzung von Periodenprodukten, die nicht nur gesundheitliche Implikationen hat, sondern auch in westlichen Landern z.B. zu Schulabsenzen fuhrt und damit die Bildung nachteilig beeinflusst. Die Tampon Tax schliesslich ist eine missbilligende Beschreibung des Umstandes, dass in vielen Landern Periodenprodukte als zu hoch besteuert gesehen werden. Die bundesdeutsche Gesetzgebung erkennt erst 2019 an, dass Periodenprodukte als Gegenstande des Grundbedarfs anzusehen und mit einem ermassigten Mehrwertsteuersatz zu belegen sind. Dabei steht den Initiatorinnen nicht die finanzielle Entlastung im Vordergrund als vielmehr die Abschaffung einer strukturellen Benachteiligung der Menstruierenden und Anerkennung, dass die Periode weder als freiwillig noch als Luxus erlebt wird. Die schottische Regierung geht weiter und erlasst 2020 ein Gesetz, demzufolge Periodenprodukte allgemein kostenlos erhaltlich sind und das u.a. Hochschulen verpflichtet, Studentinnen Periodenprodukte kostenlos zur Verfugung zu stellen. Mit diesem Beispiel vor Augen und angesichts des Bekenntnisses der Universitat Bern zur Gleichstellung von Frauen und Mannern, entschieden wir uns, innerhalb unseres eigenen Handlungs- und Einflussbereiches eine Veranderung anzustossen. Seit November 2020 werden im Skills Lab der Medizinischen Fakultat Bern «BiSS» sowie den Lernzentren auf den Damentoiletten aller Stockwerke Periodenprodukte kostenlos zur Verfugung gestellt. Die entstandenen Kosten fur Binden und Tampons sowie schone Schachteln zur Aufbewahrung (einmalige Anschaffung) an den 6 Stationen lagen bei ca. CHF 100.-. Um die Effekte auf die Studentinnen zu evaluieren, wurden gut sichtbar Feedbackzettel ausgelegt. Das Feedback der Studentinnen war durchweg positiv. Die ca. 40 Ruckmeldungen sind von allgemein zustimmender Natur («gueti sach», «mega cool»), es wird aber auch der Wunsch geaussert, umweltvertragliche Cups anzubieten. Das Feedback zeigt auch, dass die Periodenprodukte derzeit v.a. als Backup genutzt werden: «super Idee, v.a. wenn man seine Sachen vergessen hat». Wir verstehen diese Ruckmeldungen als Motivation, nun eine Finanzierung uber universitare Mittel anzustossen, aber auch, den Nutzerinnen des BiSS zu erklaren, dass das Angebot nicht nur als Backup gedacht ist, sondern, wie auch Toilettenpapier, fest als Ressource eingeplant werden darf. Wir hoffen, damit einen kleinen Schritt Richtung Gendergerechtigkeit gemacht zu haben und andere Einrichtungen zu ermutigen ahnlich vorzugehen.

Background Moulages can greatly extend the possibilities of simulation in teaching and assessment. Since moulages that fit an educator’s exact needs are often unavailable commercially, this paper explains how 2-dimensional transfer tattoos can be independently developed, produced, and evaluated. Methods From representative photographs of the specific skin condition an analogue copy of the pathological finding is drawn. Once validated by the medical expert, it can be digitized by scanning and processed using graphics software. The final digital image file is printed onto transfer paper. Once applied and fixed onto the intended wearer, usually a simulated patient, its authenticity can be confirmed, and further transfer tattoos can be produced. Results Using this moulage technique we produced 10 different 2-dimensional transfer tattoos to date, including hematoma, Janeway lesions and splinter nails. These moulages are used in clinical skills training, formative and high-stakes summative assessment in undergraduate medical and nursing programs. Conclusions By sharing our development process for 2-dimensional transfer tattoos, health profession educators can produce their own that best fit their local educational needs. Due to their high authenticity and standardization, 2-dimensional transfer tattoos are ideal for use in high-stakes assessment.

Background: General practitioners and general internists occupy a key position in German and Austrian healthcare systems. They provide primary care and act as gatekeepers between medical disciplines and sectors of care. Their explicit medical knowledge levels, however, can be quite disparate. Objective: This study analyses whether general practitioners' performances on a standardised knowledge test changes with four relevant socio-demographic variables. Design: The survey was based on the Progress Test Medicine (PTM), a standardised 200 item knowledge test on graduate level. After formal blueprinting and item analysis, 60 items of PTM were selected ("PTM-GP") for our study. Participants: PTM-GP was presented ad hoc to general practitioners and internists from Germany and Austria at a number of professional meetings in 2011. 161 volunteers completed the survey. Main measures: For evaluation, correlation analysis (Spearman), Kruskal Wallis-tests for non-parametric data and an analysis of covariance (ANCOVA) were calculated. Results: Overall, four indicators turned out to be slightly significant for the performance on the PTM-GP, namely: time passed since graduation, the grade received in the licensing examination, the type of institution for postgraduate training, and the medical specialisation. Conclusions: Recent graduates performed better in the PTM-GP; a doctor's licensing examination grade as well as training at a university hospital correlated positively with PTM-GP performance. A general doctor's knowledge level is moderately influenced by exam grades, time since graduation, the institutional affiliation of postgraduate training and medical specialisation. Individual changes in knowledge over time have to be deliberately considered in lifelong learning. In consequence, the on-going teaching of medical knowledge should be integrated mandatory and verifiable into general doctors' everyday practices, e.g. through repetitive knowledge tests with individual feedback and recommendations for further continuing medical education (CME).

In order to protect patients and students during the Covid 19 pandemic, the third section of the medical examination (M3) in Halle (Saale) was conducted in a modified form in accordance with the "Verordnung zur Abweichung von der Approbationsordnung fur Arzte bei einer epidemischen Lage von nationaler Tragweite" [1]. The one-day examination took place at the Dorothea Erxleben Learning Center (DELH) of the Martin Luther University Halle-Wittenberg on standardized simulation subjects. In contrast to previous years, all examiners were examined individually in internal medicine, surgery and their elective subject of the practical year. In the evaluations carried out, the standardized cases were assessed as consistent and fair by examiners and exam takers. Approximately 90% of the examiners could imagine to test a state examination with simulated patients again. After successful pilot testing, a study will be conducted in the coming exam to determine whether the substitution of real patients with simulated patients in the M3 exam can contribute to better standardization and objectivity while maintaining the same high level of acceptance in the exam. Whether the high acceptance will remain constant can only be checked in the course of the study.

Medical education has a long tradition of using various patient representations in teaching and assessment. With this literature review we aim, first, to provide an overview of the most important patient representations used to teach and assess clinical skills, considering in particular “summative exams” that have a pass or fail outcome; second, to provide arguments for choosing certain patient representations; and third, to show the advantages and limitations of different patient representations, especially simulated patients (SPs) and real patients (RPs). Typical patient representations include case narratives, anatomical models, simulators and mannequins, as well as SPs and RPs. The literature indicates that there are multiple ways of using various patient representations in teaching and that the intended didactical purpose informs the choice of representation. Early in the educational programme, even low-fidelity patient representations can be a good fit for assessment purposes if chosen to match the educational level. The use of RPs in summative, high-stakes assessments (exams with particularly important consequences for the examinee) is limited for methodological and ethical reasons. The methodological implementation of summative exams also entails specific challenges, such as ensuring measurement reliability and fairness towards the examinees. Carefully prepared, SPs can perform their roles with a sufficient degree of authenticity, making summative exams more manageable, and imposing no strain or risk on RPs. The ongoing debate concerning the use of SPs and RPs in summative assessment highlights perceived limitations of SPs in relation to RPs that are often not supported by research. Evidence shows that SPs, in combination with additional simulation modalities as needed, represent the first choice for summative clinical assessment. We also consider the strengths and limitations of this review and reflect on the applicability of our findings. We conclude that in order to select the right patient representations in clinical teaching and/or assessment, a number of perspectives must be considered: (i) the learning goals, aligned with the stage of study, (ii) the corresponding requirements of the clinical task itself (e.g., performing a phlebotomy or a communication task), (iii) the level of authenticity required and (iv) the resources needed, taking patient safety and feasibility into consideration.

Objectives: Video-based worked examples enable medical students to successfully prepare for breaking-bad-news (BBN) encounters with simulated patients (SPs). This is especially true when examples include hints that signal important content. This paper investigates whether the beneficial effect of hints only applies to video-based worked examples or also text-based examples. Methods: One-hundred-and-forty-seven fourth-year medical students attending a BBN training participated in either of two equally scaffolded, randomised field trials. Prior to encountering SPs, the students worked through an e-learning module introducing the SPIKES protocol for delivering bad news; it contained the same worked example presented to either of four groups as text or video, with or without additional hints denoting the SPIKES steps being implemented. Results: Only a main effect of 'hints' was revealed, implying that students in the hints groups delivered the news to an SP significantly more appropriately than those in the without-hints groups. Conclusions: Independent of their presentation format, worked examples with hints best foster students' BBN skills learning. Practice implications: In addition to video, text-based worked examples can effectively prepare students for BBN simulations if hints are included. This offers an affordable alternative to video examples, as text examples can be generated with less effort. (C) 2020 Elsevier B.V. All rights reserved.

In the wake of the Covid-19 pandemic, people over 65 or suffering from certain conditions were deemed at high risk and asked to isolate themselves. This led to the simulated patient (SP) program at the University of Bern being depleted of middle-aged and elderly SP. Meanwhile, an OSCE had to be delivered using adapted cases that minimized physical contact between candidates and SP. Short of suitable cases at such short notice, the case of an elderly patient with postural instability had to be added to the exam blueprint. With elderly SP off the roster, it was decided to use makeup effects to achieve visual authenticity. A combination of wigs (grey hair, hairdo), 3D Probondo transfers (forehead wrinkles), old age stipple (crow's feet), and colouring (age spots) were used to achieve the old-age effects, while SPs wore scarves to cover their neckline. The lower face was covered with protective face masks in accordance with the exam's Covid-19 hygiene protocol. Case-related feedback from candidates and examiners was analysed for any direct or indirect remark attributable to the ageing effects. As no comment touched upon the subject of the appearance of age, this was interpreted as success, as any distracting effect from the SPs' appearance in this regard would surely have prompted remarks or even complaints. The SPs' feedback revealed how applying the ageing effects helped them adopt the octogenarian's role. This report explains how SP in their fifties were made fit for an octogenarian's case in an OSCE using makeup effects. The effort required for the ageing simulation was considerable, but it is hoped that in future, with more planning time, the amount of effort required can be reduced. The feedback obtained from the candidates suggest the appearance of SPs was not experienced as a distraction, which was the primary objective of this exercise. Adapting our approach to their own contexts allows educators to include cases with elderly patients in their OSCE that cannot be re-written for younger SP, so long as Covid-19 prevents elderly SP from participating.

Objective: ECG interpretation is prone to errors that can lead to relevant misdiagnoses and incorrect treatment. Prompts are one way in lectures to encourage learning from one's own mistakes and to reduce error rates. Prompts are measures such as questions, hints, and suggestions of content-related or metacognitive nature, which can lead to self-explanation in the learner and thus to a deeper understanding of an issue. The aim of the study was therefore to investigate whether the use of prompts can reduce the error rate in ECG interpretation among students. Method: In a 2x2 experimental test and control group design, N=100 final year medical students carried out ECG interpretation tasks in the form of online case vignettes in CASUS (R). In these tasks, justification prompts (B) and error analysis prompts (F) were systematically varied in four groups and the learning success was measured using a knowledge test. In addition, prior knowledge in ECG interpretation, motivation, interest in the topic, subjective confidence in ECG interpretation, and cognitive load was collected. Results: Neither error analysis prompts nor justification prompts had a significant effect on the correct ECG interpretation by students, F(1,96)=1.03, p=.31. Justification prompts seemed to have a positive effect on the confidence of answering the questions, F(1,96)=10.15, p=.002, partial eta(2) =.10; and a negative effect on student motivation, F(1,96)=8.13 , p=.005, partial eta(2) =.08; but both with comparable diagnostic accuracy. Conclusion: The present study could not confirm the positive effects of prompts on the error rate in ECG interpretation reported in the literature but showed significant effects on subjective confidence and motivation which should be investigated in further studies.

Medical education has a long tradition of using various patient representations in teaching and assessment. With this literature review we aim, first, to provide an overview of the most important patient representations used to teach and assess clinical skills, considering in particular "summative exams" that have a pass or fail outcome; second, to provide arguments for choosing certain patient representations; and third, to show the advantages and limitations of different patient representations, especially simulated patients (SPs) and real patients (RPs).Typical patient representations include case narratives, anatomical models, simulators and mannequins, as well as SPs and RPs. The literature indicates that there are multiple ways of using various patient representations in teaching and that the intended didactical purpose informs the choice of representation. Early in the educational programme, even low-fidelity patient representations can be a good fit for assessment purposes if chosen to match the educational level. The use of RPs in summative, high-stakes assessments (exams with particularly important consequences for the examinee) is limited for methodological and ethical reasons. The methodological implementation of summative exams also entails specific challenges, such as ensuring measurement reliability and fairness towards the examinees. Carefully prepared, SPs can perform their roles with a sufficient degree of authenticity, making summative exams more manageable, and imposing no strain or risk on RPs. The ongoing debate concerning the use of SPs and RPs in summative assessment highlights perceived limitations of SPs in relation to RPs that are often not supported by research. Evidence shows that SPs, in combination with additional simulation modalities as needed, represent the first choice for summative clinical assessment. We also consider the strengths and limitations of this review and reflect on the applicability of our findings.We conclude that in order to select the right patient representations in clinical teaching and/or assessment, a number of perspectives must be considered: (i) the learning goals, aligned with the stage of study, (ii) the corresponding requirements of the clinical task itself (e.g., performing a phlebotomy or a communication task), (iii) the level of authenticity required and (iv) the resources needed, taking patient safety and feasibility into consideration.

No matter how good a patient simulator’s acting skills, no one can present a rash on demand. Yet illnesses and conditions involving the skin are manifold, and integumentary findings often prompt further monitoring and investigation, apart from impacting upon the patient’s well-being simply for aesthetic reasons. In fact, beyond obvious points of contact e.g. during wound management, nursing staff are also predestined to discover skin conditions, due to the length of time spent with patients but also because of the closer proximity during acts of personal care. Hence developing practical skills around the detection and care of skin conditions is a relevant objective in medical and nursing education programs alike and contributes to patient safety.In this workshop, we want to introduce modern moulage techniques from makeup to three-dimensional transfer tattoos allowing for the presentation of skin conditions in simulation-based education, with visual and haptic fidelity, acting as visual cues in teaching or assessment in medical or nursing education. After a discussion of somewhat obvious scenarios in clinical skills teaching and assessment, the workshop will engage in a deliberation of more uncommon applications and offer participants a chance to experience moulage themselves.

Objective: The individualized two-stage selection procedure for medical studies at Witten/Herdecke University (UW/H) has been in use for more than 30 years and comprises explicit and implicit selection criteria. This analysis aims at identifying the implicit criteria and answering the question whether an internal consistency of these implicit criteria may be verified for the different phases of the selection procedure (when evaluating the statements of purpose, during the selection weekend and during the concluding discussions of assessors). Methodology: Three qualitative studies on all phases of the selection procedure at UW/H have been conducted for determining the implicit assessment criteria of assessors: statements of purpose in extreme group comparison (12 admissions versus 18 rejections); semi-structured expert interviews (N=25) on the selection weekend; focus group analysis of the concluding discussions on two selection weekends (N=16). Results: The content analysis of the statements of purpose yielded 14 main categories with significant deviations between extreme groups in the categories school career, reasons for application and reflections as well as regarding the higher education entrance qualification grade. Based on the expert interviews, three main categories could be identified: intellectual ability, motivation and social competence, and the ability to reflect as a cross-content category. The focus group analysis yielded four main categories: performance, personality, personal growth potential and ability to reflect. Most frequently, the ability to reflect was mentioned as an assessment criterion. Conclusion: The main assessment categories are: motivation for the medical profession and starting studies at UW/H; performance and scholastic aptitude; personality, personal growth potential and social competence, as well as the ability to reflect as the most important basic competence and general category. Assessors consider the ability to reflect as a predictor of lifelong professional development as a physician.

Objectives: Effective instructional approaches are needed to enable undergraduates to optimally prepare for the limited training time they receive with simulated patients (SPs). This study examines the learning effects of different presentation formats of a worked example on student SP communication. Methods: Sixty-seven fourth-year medical students attending a mandatory communication course participated in this randomized field trial. Prior to the course, they worked through an e-learning module that introduced the SPIKES protocol for delivering bad news to patients. In this module, a single worked example was presented to one group of students in a text version, to a second group in a video version, and to a third group in a video version enriched with text hints denoting the SPIKES steps. Results: The video-with-hints group broke bad news to SPs significantly more appropriately than either of the other groups. Although no further condition-related effects were revealed, students who learned from the text version most frequently (although non-significantly) ignored unpleasant emotions (standardised emotional cues and concerns) expressed by the SPs. Conclusions: The learning effect was strongest when the video-based worked example was accompanied by hints. Practice implications: Video-related learning approaches that embed attention-guiding hints can effectively prepare undergraduates for SP encounters. (c) 2018 Elsevier B.V. All rights reserved.

A great deal has been written about environmental politics, neoliberalism, political mobilization, and resource extraction in South America. In Unearthing Conflict, Fabiana Li synthesizes these themes while providing a detailed history of mining in Peru’s central highlands. Li centers her discussion on the conflicts associated with mining and how transformations in mining technologies and practices shape collective knowledge about nature. In doing so, she suggests that conflicts are related to a hegemonic economic structure that emphasizes resource extraction as a means of progress and development. Li does a commendable job of integrating relevant literature and making connections to previous scholarship while writing in a manner that is accessible to a broad audience.Fieldwork for Unearthing Conflict took place in Peru’s central highlands. It was multi-sited with most of the research having been conducted in La Oroya and Cajamarca. While a couple of maps are provided in the text, a more detailed map would help readers to identify the multiple sites of fieldwork and their relationship to one another. Li is forthcoming about the fact that she has a personal connection to Peru and to La Oroya. She was born in Peru, and her maternal grandfather, the son of Chinese immigrants, was born in La Oroya and lived there for most of his youth. This connection lends credibility to Li’s writing and serves to affirm her position as a scholar with a deeply personal interest in La Oroya and its residents and history.Unearthing Conflict is organized into three parts that come together in a fluid manner and without any discontinuity. Li begins by tracing changes in Peru’s mining industry from the early 1900s to state control in the 1970s and 1980s and then to privatization in the 1990s. She brings together content from multiple mining sites while analyzing the conflicts associated with mining and pollution, and how pollution “came to matter” (37). She strikes an eloquent balance between historical depth and ethnographic detail while analyzing how neoliberal policies promoted mining expansion as well as the development of a network of NGOs and advocacy groups that made pollution relevant. Li promotes a view of nature as an active entity that shapes the decisions that people make. She does so in part by asking the question, “What does it mean to say that a mountain must give its consent to be mined?” (108). In asking this question, and what follows, Li emphasizes the interactions between humans and nature and how alternative forms of activism and protest underscore nature (water) as fundamental to human life. Without being heavy handed, she calls into question a nature/culture dichotomy and instead emphasizes how water, livelihood, landscape, and identity are interwoven. Li’s discussion of accountability is particularly keen. She emphasizes how private corporations establish relations with the state as well as a sense of shared responsibility with citizens, state organizations, and NGOs through the production of an Environmental Impact Assessment (EIA). Li argues that the inclusion of citizens and NGOs in environmental monitoring and assessment creates a sense of shared responsibility while defining spaces for opposition.Writing style and ethnographic depth are the strengths of Li’s work. If there is any area of weakness, it is that she establishes a theoretical framework based on three core concepts: practices of accountability, audit cultures, and equivalence, but the themes do not receive equal treatment throughout the text. Unearthing Conflict is engaging and detailed. It is especially relevant given the current prominence of mining in Peru, and it is a welcome addition to anthropological literature on environmental politics and resource extraction. The text is suitable for students, and it provides ample information on environmental politics and activism as well as on Andean worldview and culture. Scholars and students interested in Andean South America will find Unearthing Conflict to be an insightful and enjoyable read.