Objective: Teaching by trainee doctors is also established practice in general practice in English-speaking countries. This study examines the involvement of trainee doctors in the supervision of students in German general practices and the acceptance of trainee doctors as teachers from the perspective of physicians with a license for post-graduate training (PLT) and the trainee doctors themselves.Methodology: Semi-structured qualitative interviews were conducted with 9 PLTs and 9 trainees. The interview guide was developed based on the Theoretical Framework of Acceptance. Interviews were recorded, transcribed and evaluated using Kuckartz’s qualitative analysis.Results: Trainee doctors are involved in student supervision in GP teaching practices to varying degrees and often in unstructured ways. Supervision by trainees is considered advantageous as they are closer in terms of hierarchy, possess more up-to-date knowledge and are less far ahead in terms of knowledge and function as role models. However, professional uncertainty or revealing knowledge gaps to patients and students is experienced as difficult by some trainees. Competing for time with patient care is seen as a challenge. Better time planning and didactic preparation could avoid pressure in this area. Teaching is seen as part of the GP profession, especially by trainee doctors. However, a potential obligation to teach is seen as more of a hindrance to encouraging the next generation of doctors by both trainee doctors and PLTs. Conclusion: The inclusion of trainee doctors in student teaching is frequently practiced by those surveyed, which suggests a high level of acceptance but is not consistently implemented. Structured organization of teaching in real life, didactic qualifications and offering credits for teaching activities might further improve inclusion and acceptance.

Zusammenfassung Hintergrund In den vergangenen Jahren wurden in Deutschland 16 Kompetenzzentren für allgemeinmedizinische Weiterbildung (KW) mit dem Ziel gegründet, die Qualität und Effizienz der hausärztlichen Weiterbildung zu fördern. Ziel der Studie war es, geeignete Indikatoren für die externe Evaluation der KW zu identifizieren. Methoden Expert*innen aus den KW erarbeiteten ein Set aus möglichen Qualitätsindikatoren in 2 konsekutiven Workshops. Dieses Set wurde in einem 2‑stufigen Delphi-Prozess unter allen KW überarbeitet und priorisiert. Insgesamt nahmen im Zeitraum Februar bis Oktober 2020 70 Expert*innen aus 16 KW teil, davon 38 Expert*innen an beiden Befragungsrunden. Ergebnisse Die Expert*innen schlagen 61 mögliche Qualitätsindikatoren in 9 Themenbereichen vor: 1) Inanspruchnahme/Teilnahmequoten, 2) Qualität der praktischen Weiterbildung, 3) Qualität der KW-Angebote, 4) Organisation/Service, 5) objektive Kompetenzmessungen, 6) Erfolgs- und Abschlussquoten, 7) Versorgungsqualität und -quantität, 8) allgemeine Effekte und 9) Effizienz/Weiterbildungsdauer. Davon wurden 26 hoch, 18 mittelgradig und 17 gering priorisiert. Schlussfolgerungen Insbesondere quantitativ leicht zu erhebende Qualitätsindikatoren der Bereiche 1, 3, 4, 6 und 9 sind größtenteils etabliert und sollten für die Evaluation der KW fortgeführt werden. Darüber hinaus sollten geeignete Methoden zu inhaltlich-qualitativen Indikatoren, wie der Kompetenzentwicklung von Teilnehmer*innen in der Selbstwahrnehmung (3), der praktischen Weiterbildung (2), objektive Kompetenzmessung nach der Weiterbildung (5), zu allgemeinen Effekten (8) und zu Auswirkungen der KW auf die Versorgungsqualität (7), entwickelt werden. Methodisch wäre der Vergleich von Teilnehmer*innen und Nichtteilnehmer*innen durch eine externe, systematische Befragung erstrebenswert, sowohl während als auch nach der Weiterbildung. Verfahren zur objektiven Kompetenzbeurteilung von Absolvent*innen sollten in der allgemeinmedizinischen Weiterbildung etabliert werden.

Train-the-Trainer-Seminare (TtT-Seminare) für Weiterbildungsbefugte (WBB) sind Bestandteile der nach § 75 SGB V eingerichteten Kompetenzzentren Weiterbildung Allgemeinmedizin (KW). Ziele der vorliegenden Studie waren die Analyse der bestehenden TtT-Angebote in Deutschland und die darauf aufbauende Überarbeitung der Checkliste TtT der Sektion Weiterbildung der DEGAM. In einer interprofessionellen Arbeitsgruppe wurde ein an der Checkliste TtT (Version 1, 2017) orientierter, strukturierter Interviewleitfaden konzipiert, konsentiert und mit zwei Testinterviews pilotiert. Über vier Monate (1.3.–30.6.2019) wurden alle KW mehrfach via E-Mail und telefonisch zur Teilnahme eingeladen. Die Auswertung der Ergebnisse der Befragung erfolgte deskriptiv und wurde durch Vertreter*innen der KW auf dem Jahreskongress der DEGAM inhaltlich bestätigt. 15 von 16 KW (94

Having teaching staff with didactic qualifications in university teaching leads to a measurable improvement in academic skills among students. Previous recommendations on the type and scope of medical didactic qualification measures primarily apply to teaching staff at university and in-patient settings. The situation of primary care medicine, which often employs external lecturers and whose teaching takes place to a considerable extent in decentralized training facilities (teaching practices) is not adequately addressed. Taking into account a survey on the status quo at higher education institutions for General Practice in Germany, recommendations for minimum standards are made, based on national and international recommendations on the content and scope of medical didactic qualification measures. These recommendations include preliminary work by the Personnel and Organizational Development in Teaching (POiL) Committee of the Society for Medical Education (GMA), the MedicalTeachingNetwork (MDN), the Society of University Teaching Staff in General Medicine (GHA) as well as the experiences of the committee members, who hail from the field of general medicine, internal medicine and pediatrics amongst others.

Objective: Training in the final year (FY) of undergraduate medical training currently does not adequately prepare students for the independent performance of medical professional activities after graduation. The concept of Entrustable Professional Activities (EPA) offers the opportunity for a competency-based FY training with the focus on medical professional activities.Methodology: In regular meetings, the FY sub-working group of the German Medical Faculty Association (MFT), which includes representatives with clinical and didactic expertise of the Associations of Internal Medicine, Surgery and General Medicine, developed a concept for the competecy-orientated, EPA-based, FY model logbook 2.0. The selection of the units of practice was made in a cross-disciplinary, consensus-orientated discussion process based on the question which medical professional activities a young professional has to master in the inpatient or outpatient working environment.Results: For the FY electives internal medicine, surgery and general medicine, a blueprint of a total of 18 comprehensive, partially interdisciplinary EPAs relating to inpatient and outpatient care contexts were developed. Each EPA was operationalised by a short description, supervision levels were attributed, and the process of transparent entrustment was determined.Conclusions: The concept for a new FY model logbook 2.0 focuses on the interdisciplinary core medical professional activities in an inpatient and outpatient care context, in order to facilitate transition from undergraduate training to professional practice, and to help avoid overload, thus increasing patient safety.

Objectives: The final year of undergraduate medical education (practical year) should foster the transition from undergraduate medical education to graduate medical education. Medical students in the practical year should be able to assume professional tasks, and supervisors should assign these tasks to them. In this pilot study, a curriculum based on the concept of entrustable professional activities (EPAs) was implemented and evaluated in the disciplines of internal medicine, surgery and general practice at four university hospitals. Methods: n=37 medical students and n=17 supervising physicians at four German university hospitals participated in the implementation study for one trimester. For evaluation purposes, we conducted focus group discussions and telephone interviews and analyzed them following qualitative content analysis. Results: We identified five different aspects as important for implementing the EPA curriculum in undergraduate medical education in the German context: 1. Implementation process of the EPA curriculum and required resources, 2. Entrustment process, 3. Feedback sessions with supervisors, 4. Students' and supervisors' role perception 5. Overall impact of EPAs on training conditions in the practical year. Conclusion: The study presents a practical implementation of the EPA curriculum in Germany's undergraduate medical education. Besides the need for time and resources, the concept shows good feasibility and fosters a competence-oriented undergraduate medical education in the practical year.

The Faculty of Medicine of the Ruhr University Bochum (RUB) introduced a model study course in medicine (MSM) in the winter semester 2003. For 9 consecutive years, 42 out of 280 first year students at the Ruhr University Bochum had the opportunity to begin their studies in the model study course in medicine. The places were allocated amongst the applicants internally through a raffle. The MSM was consistently problem-, practice- and patient-oriented and largely did away with lectures, broke with the distinction between a pre-clinical and clinical phase and tested basic knowledge in equivalent integrated exams focusing on clinical application. Following a comparative evaluation of the standard degree course (RSM) and the MSM, the faculty merged the two degree courses into the Integrated Reformed Medical Curriculum (IRMC), which has been on offer since 2013 and is characterized by a topic-oriented hybrid curriculum. This article examines experiences relating to the origins, conception and introduction of the MSM.

Awareness of one's own strengths and weaknesses is a key qualification for the specialist physician. We examined how physicians undergoing specialist training in general medicine rate themselves in different areas. For this purpose, 139 participants receiving post-graduate training in general practice offered by the Medical Association of Westfalen-Lippe assessed themselves regarding their subjective confidence in 20 core competencies and 47 situations involving patient counseling in general practice. Their self-assessments were recorded on a five-point Likert scale. The study questions addressed acceptance and practicability of self-assessment, mean values, reliability, stratification and plausibility of the results in group comparison. On average participants rated their subjective confidence with 3.4 out of 5 points. The results are self-consistent (Cronbach's alpha > 0.8), although there are considerable differences among competencies and among participants. The latter can be explained partly by biographical data, which supports the plausibility of the data. Participants stated that regularly gathering data on subjective learning needs and the discussion of these needs with mentors and trainers contributes to improving their specialist training. Elements for self-assessment are suitable for integration into a postgraduate training portfolio. These should be supplemented by formative assessment procedures.

Tumorschmerz bei Pflegeheimbewohnern ist ein häufiges und bei steigender Lebenserwartung wachsendes Problem. Viele Besonderheiten sind zu beachten, allen voran die häufige Kombination demenzieller Entwicklungen, unzureichender Kommunikationsfähigkeiten und unzureichender Wahrnehmung der Problematik. Hier haben sich in letzter Zeit einfache Screeninginstrumente durchgesetzt, wie z.B. die Schmerzmessung mit eindimensionalen Skalen und die Beurteilung von Schmerz bei Demenz (BESD). Wenige Zusammenhänge zu Ätiologie und Pathophysiologie sind zu verstehen, um eine gezielte Schmerztherapie einzuleiten. Beachtet werden sollten Besonderheiten wie Durchbruchschmerzen, neuropathische Schmerzen, Schmerztherapie bei Demenz und die Finalphase. Dabei steht das Ziel, Menschen die letzte Lebensphase in der von ihnen gewünschten Umgebung zu ermöglichen und somit Klinikeinweisungen zu vermeiden, im Vordergrund. Besonderes Augenmerk ist auch auf Therapieziele, Methodenauswahl, Medikation und Dosierung bei zumeist schwer pflegebedürftigen Menschen zu legen.

Patients with life limiting diseases need special medical treatments at the end of life. In Germany, since 2007 there is specialized outpatient palliative care (SAPV) available for patients in need of special treatments additional to regular outpatient palliative care (AAPV). Distribution of specialized palliative care is not homogenous in german regions and there is no evidence about medical gain and total costs yet.Deceased patients from both groups are compared by propensity score matching with regard to their medical biographies of their last year of life. This retrospective study uses data of the health insurance company DAK. The data set contains information about items of medical care including their particular costs.Results show significant higher costs for patients in specialized care settings with exception of nursing costs. The most striking difference was found for drug expenditures which were twice as much for patients in specialized care than for patients treated with regular outpatient palliative care.The specialty of care is represented by the average costs of specialized outpatient palliative care in patients last year of life. A proportion of 75% of the costs for specialized outpatient palliative care follow from temporary inpatient care and drug expenditures. Further investigations should measure to what extend higher costs are resulting from additional benefits of care and how they could be interpreted in terms of cost efficiency.

Aim of the study: Family members caring for patients with dementia in a homecare setting often suffer from great physical and psychological stress. In order to find out the kind of therapy that also provides benefits for family carers, a questionnaire was developed and validated in the present study. The questionnaire lists different aspects of benefit (investments in care, stress, social participation and contacts) of Alzheimer therapy that should be rated from the point of view of the family carers.Methods: In the present study, the questionnaire was validated by asking family carers of patients with Alzheimer's (n=132) about their subjective views on the benefit of Alzheimer therapyResults: The strong and significant correlation indicates that the same construct was measured at both times of measurement and establishes the validity of the questionnaire. The most important aspects of benefit family carers mentioned concern benefits for the patient more than benefits for the family carers themselves, e.g. prolongation of a dignified life, prolonging the ability to communicate, relief about an improved state of the patient.Conclusion: The questionnaire is valid for evaluating Alzheimer therapy with regard to its benefit for family carers. In future, the choice of therapy should be based to a greater extent on its impact on the personal situation of family carers. The validated instrument would thus contribute to maintaining and prolonging family carers' capacities for providing good care at home.

The specialty of care is represented by the average costs of specialized outpatient palliative care in patients last year of life. A proportion of 75% of the costs for specialized outpatient palliative care follow from temporary inpatient care and drug expenditures. Further investigations should measure to what extend higher costs are resulting from additional benefits of care and how they could be interpreted in terms of cost efficiency.

Background: Germany is developing towards an aging society where more people reach higher ages and live longer. Therapeutic regimen for analgesics and multimedication becomes increasingly important. Aim of this paper is to evaluate the use of analgesics and the resulting costs in the last three years of life.Methods: Datawere provided by a statutory health insurance in Germany (DAK), costs and resource use of a total of n = 2312 patients who died of natural causes in 2012 were examined. Analgesics were divided into three groups based on the WHO Analgesics Scheme.Results: The average number of prescribed analgesics increased from 1.4 three years before death to 5.2 in the last year of life, which equals a plus of 358 %. Metamizol (WHO level I) was the most frequently prescribed analgesic in the last year of life. The share of strong opioids (WHO level III) increased by 50 % from three years prior to death to the last year of life.Conclusion: There is a huge increase of the prescription of analgesics prior to death to be observed in Germany. If a patients' end of life is foreseeable, an effective therapy free of adverse events should be provided since most patients are old and will be treated with multiple drugs. Overall costs of drugs show only the third highest share (12.6 %) of all costs of medical services in the last year of life (after in-patient treatment and nursing).

Hintergrund: Vor dem Hintergrund einer alternden deutschen Gesellschaft geraten die Frage der Multimedikation im Bereich der Schmerzmitteltherapie im Alter und die daraus resultierenden Kosten vermehrt in den Fokus der Aufmerksamkeit. Ziel der vorliegenden Arbeit ist die Evaluation der Inanspruchnahme von Analgetika und der daraus resultierenden Kosten in den letzten drei Lebensjahren auf der Basis von Krankenkassendaten. Methoden: In einer retrospektiven Sekundärdatenanalyse von 2312 gesetzlich Versicherten (DAK), die im Jahr 2012 auf natürlichem Weg oder krankheitsbedingt verstorben sind, wurden die direkten medizinischen Kosten der letzten drei Lebensjahre ermittelt. Berücksichtigung fand dabei im Speziellen die Schmerzmitteltherapie am Lebensende, insbesondere die verschriebenen Wirkstoffe nach WHO-Stufenschema. Ergebnisse: Die durchschnittliche Anzahl verschriebener Schmerzmittel stieg vom drittletzten zum letzten Lebensjahr von 1,4 auf 5,2 an, was einer Erhöhung von 358 % entspricht. Von allen verschriebenen Wirkstoffen wurde Metamizol (WHO-Stufe I) mit Abstand am häufigsten verschrieben. Der Anteil an starken Opioiden (WHO-Stufe III) erhöht sich vom drittletzten zum letzten Lebensjahr um 50 %. Fazit: Es lässt sich ein sehr starker Anstieg an Schmerzmittelverordnungen in den letzten drei Lebensjahren vor dem Tod feststellen. Bei absehbarem Lebensende sollte eine wirksame und möglichst nebenwirkungsfreie Schmerztherapie gewährleistet werden, da es sich i. d. R. um schwache, ältere Patienten mit Multimedikation handelt. Die Daten zeigen auch, dass Kosten für Arzneimittel mit 12,6 % lediglich den drittgrößten Kostenblock im letzten Lebensjahr ausmachen (nach stationären Behandlungskosten und Pflegekosten).

Identifikation von Faktoren für eine spätere hausärztliche Tätigkeit von Fachärzten für Allgemeinmedizin vor dem Hintergrund drohender Versorgungsprobleme, insbesondere im ländlichen Raum. Retrospektive Analyse der Datenbank der Ärztekammer Westfalen-Lippe zum Verbleib der Absolventen zwölf Monate nach Facharztanerkennung. Von 3.998 Fachärzten für Allgemeinmedizin aus den Jahren 1992–2012 waren zwölf Monate nach Facharztanerkennung 73