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The development of the internal medicine courses at Hannover Medical School from 2001 to 2018.

ABSTRACT: Aim: The subject-based model curriculum at the Hannover Medical School (MHH) is characterized by two major features: early and continuous contact with patients and the interconnection of theoretical and clinical content. The progressive adaptations to the internal medicine curriculum which is taught longitudinally over five years are presented. Methods: Looking back on 17 years of experience with our model curriculum and the events leading to its inception, we summarize the challenges and subsequent modifications to the longitudinal internal medicine curriculum. Some of these challenges are likely to occur in other subjects and can therefore be generalized. Results: Integrating preclinical and clinical content was more resource intensive than thought and unexpectedly led to capacity problems since the German courts ruled that the presence of more teachers brought with it an obligation to enroll more students. In response to this, teaching responsibilities were extended to both outpatient facilities and academic teaching hospitals. Major changes included a more even distribution of clinical content in the first year, a rigorous standardization of teaching content in clinical skills, increased adaptation of content to reflect prior knowledge in the third and fourth years, and a focus on clinical reasoning in the fifth year. Restructuring the academic year into three ten-week blocks (two in the winter term and one in the summer term) allowed the retention of small groups. Conclusion: These measures rely heavily on considering teaching responsibilities within rotation plans, curriculum development and continuous faculty engagement. Since teachers are not sufficiently familiar with the distinctions between teaching formats, they mostly consider how far students have advanced in their studies when choosing course content. This implies that the current nomenclature requires improvement.

SUBMITTER: Bintaro P

PROVIDER: S-EPMC6883248 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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The development of the internal medicine courses at Hannover Medical School from 2001 to 2018.

Bintaro Philip P Schneidewind Sabine S Fischer Volkhard V

GMS journal for medical education 20191015 5

<b>Aim:</b> The subject-based model curriculum at the Hannover Medical School (MHH) is characterized by two major features: early and continuous contact with patients and the interconnection of theoretical and clinical content. The progressive adaptations to the internal medicine curriculum which is taught longitudinally over five years are presented. <b>Methods:</b> Looking back on 17 years of experience with our model curriculum and the events leading to its inception, we summarize the challen ...[more]

PMID: 31815166

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Project description:In the model medical curriculum HannibaL at Hannover Medical School (MHH, Hannover, Germany), communication skills in taking case histories and disclosing diagnoses (breaking bad news) are assessed through an objective structured clinical examination (OSCE). This is part of the examinations which at the MHH represent the equivalent to the First Part of the Medical Examinations. The second year doctor-patient communication course preparing for these examinations was evaluated during the 2009/10 academic year.Using questionnaires specific to the learning objectives, learning needs were assessed, pre-post comparisons of self-assessed competencies were performed and key teaching methods were evaluated (5-point Likert scales, "5"=fully agree). At T0 (start of the course) 267 students participated (response rate: 93.7%), of which 180 filled out the T1 questionnaire during the last session of the course (67.4%). Within-subject analyses of variance and paired t-tests were conducted.The highest learning needs were found for the "to show how"-items regarding history taking and disclosing diagnoses (M=4.4). The T1-T0 comparisons showed the greatest improvements for history taking ("to know how": mean difference = +1.7, "to show how": +1.8, p<.0001 as with all tests) and the "to know how"-item regarding the disclosure of diagnoses (+1.6), followed by the "to show how"-items on disclosing a diagnosis (+1.4), shared decision making (+1.2), self-assessing one's own strengths/weaknesses (+1.0) and confidently approaching new patients (+0.7). Students with T0 values of 1 or 2 on the respective scales improved on average by 2.2 points across all items, students with the value of 3 by 1.1, and from 4 or 5 by 0.1. Methodically, the use of simulated patients was rated the most helpful (M=4.8, 87% with the scale value 5). This doctor-patient communication course is associated with substantial improvements regarding all key learning objectives. Regarding methods, the deployed simulated patients (2-4 per 10-student-course group in 3 of the 7 course sessions, respectively) were rated the most helpful. The present evaluation calls for both further development of the doctor-patient communication curriculum at the MHH and joint activities across medical schools, which are discussed at the end of the paper.

Project description:BackgroundThe medical school admission process is complicated, perhaps reflecting unresolved debates concerning the most important skills necessary to become an ideal physician. The Goldman Medical School at Ben-Gurion University in Israel is known for placing great emphasis on the personal attributes of candidates in addition to their academic excellence. To this end, 1-h consecutive interviews are embedded in the admission process. This study aims to determine whether there is an association between candidates' personal interview ratings and the ratings assigned to these students at the conclusion of their 6th year internal medicine sub-internship.MethodsOur study sample included 136 students who were admitted to the medical school in 2015, and who completed their 6th year internal medicine sub-internship in 2019-2020. Our data were derived from the admissions information for each candidate and from structured interviews concerning medical competence and personal traits, which were completed by medical personnel who were in contact with these students during their clinical rounds.ResultsHigher interview ratings of candidates during the admission process were associated with a higher probability that students would be evaluated as top-rated internists 6 years later (Odds Ratio (OR) = 9.4, p-value = 0.049), independent of gender (OR for male vs female = 0.2, p-value = 0.025) and age (OR = 1.3 per each year, p-value = 0.115). Although significant, the numeric difference in interview rating was relatively small (median 9.5 and 9.4 for top-rated and not top-rated internists, respectively).ConclusionsOur study shows that high personal interview ratings assigned to candidates as part of the medical school admission process are predictive of high performance ratings of students after they complete their 6th year internal medicine sub-internships. These findings demonstrate the value and importance of using semi-structured personal interviews in the medical school admission process.

Project description:Importance:Increasing diversity in the physician workforce is a fulcrum for reducing health disparities. Efforts to increase the diversity in the internal medicine (IM) workforce may improve health equity among an increasingly diverse population with increasing prevalence of chronic disease. Objectives:To assess diversity trends in the academic IM workforce and evaluate how well these trends reflected medical student diversity and the changing demographic composition of the general population. Design, Setting, and Participants:This secondary analysis of a cross-sectional study analyzed data from January 1, 1980, to December 31, 2018, from the Association of American Medical Colleges Faculty Roster and Applicant Matriculant File, which capture full-time US medical school faculty and matriculants, respectively, and population data through 2017 from the US Census Bureau. Main Outcomes and Measures:The study calculated the proportions of women and individuals from racial/ethnic groups that are traditionally underrepresented in medicine (URM) among IM faculty and faculty in all other clinical departments. These data were compared with the proportions of female and URM matriculants in US medical schools and the proportions of women and individuals from underrepresented racial/ethnic groups in the population. The analysis was stratified by sex, race/ethnicity, and intersections of sex and race/ethnicity. Results:From 1980 to 2018, the absolute number of full-time IM faculty increased from 10?964 to 42?547. Although IM was the department classification with the most women faculty, in 2018 it continued to have a lower proportion of women (n?=?17?165 [40.3%]) compared with all other clinical departments (n?=?48?936 [43.2%]). Among IM faculty, the percentage of URM faculty members more than doubled during the study period (from 4.1% to 9.7%) but still made up only a small portion of faculty members. The percentage of female matriculants among medical school matriculants increased steadily (from 28.7% in 1980 to 51.6% in 2018) and was nearly identical to their population representation in 2017 (50.7% compared with 50.8%). Although the percentage of URM matriculants had nearly doubled since 1980 (from 11.3% to 18.1%), it still lagged far behind the proportion of individuals in the US population who are members of underrepresented racial/ethnic groups (18.1% vs 31.5% in 2017). Conclusions and Relevance:This cross-sectional study found that progress has been made in diversifying academic IM faculty; however, it does not yet reflect the diversity of medical students or the US population. Continued efforts to increase the diversity of the academic IM workforce are needed.

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The development of the internal medicine courses at Hannover Medical School from 2001 to 2018.

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The development of the internal medicine courses at Hannover Medical School from 2001 to 2018.

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