Martina Kadmon

Kompetenzorientierung in der medizinischen Ausbildung

Competency-based medical education is a prerequisite to prepare students for the medical profession. A mandatory professional qualification framework is a milestone towards this aim. The National Competency-based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM) of the German Medical Faculty Association (MFT) and the German Medical Association will constitute a basis for a core curriculum of undergraduate medical training. The Surgical Working Group on Medical Education (CAL) of the German Association of Surgeons (DGCH) aims at formulating a competency-based catalogue of learning objectives for surgical undergraduate training to bridge the gap between the NKLM and the learning objectives of individual medical faculties. This is intended to enhance the prominence and visibility of the surgical discipline in the context of medical education. On the basis of different faculty catalogues of learning objectives, the catalogue of learning objectives of the German Association of Orthopedics and Orthopedic Surgery and the Swiss Catalogue of Learning Objectives representatives of all German Surgical Associations cooperated towards a structured selection process of learning objectives and the definition of levels and areas of competencies. After completion the catalogue of learning objectives will be available online on the webpage of the DGCH.ZusammenfassungKompetenzorientierung in der medizinischen Ausbildung gilt als Voraussetzung, um Studierende auf die Erfordernisse des Arztberufes vorzubereiten. Die Formulierung eines verbindlichen Fachqualifikationsrahmens ist ein Meilenstein in diese Richtung. Mit dem Nationalen Kompetenzbasierten Lernzielkatalog Medizin (NKLM) schaffen der Medizinische Fakultätentag (MFT) und die Gesellschaft für Medizinische Ausbildung (GMA) die Basis für ein Kernkurrikulum bis zur Approbation zur Ärztin bzw. zum Arzt. Die Chirurgische Arbeitsgemeinschaft Lehre der Deutschen Gesellschaft für Chirurgie (DGCH – CAL) möchte mit dem Nationalen Lernzielkatalog Chirurgie eine Brücke zwischen NKLM und Lernzielkatalogen an den medizinischen Fakultäten schlagen. Er soll die Basis für ein chirurgisches Kernkurrikulum darstellen und die Sichtbarkeit unseres Faches in der studentischen Ausbildung stärken. Auf der Grundlage verschiedener Lernzielkataloge an medizinischen Fakultäten, des Lernzielkatalogs für Orthopädie-Unfallchirurgie und des Schweizer Lernzielkatalogs erfolgte mit Vertretern aller chirurgischen Fachgesellschaften ein strukturierter Selektionsprozess für Lernziel-Items sowie die Definierung von Kompetenzebenen und Kompetenzbereichen. Nach Komplettierung wird der Lernzielkatalog in elektronischer Form auf der Webseite der DGCH zugänglich gemacht werden.AbstractCompetency-based medical education is a prerequisite to prepare students for the medical profession. A mandatory professional qualification framework is a milestone towards this aim. The National Competency-based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM) of the German Medical Faculty Association (MFT) and the German Medical Association will constitute a basis for a core curriculum of undergraduate medical training. The Surgical Working Group on Medical Education (CAL) of the German Association of Surgeons (DGCH) aims at formulating a competency-based catalogue of learning objectives for surgical undergraduate training to bridge the gap between the NKLM and the learning objectives of individual medical faculties. This is intended to enhance the prominence and visibility of the surgical discipline in the context of medical education. On the basis of different faculty catalogues of learning objectives, the catalogue of learning objectives of the German Association of Orthopedics and Orthopedic Surgery and the Swiss Catalogue of Learning Objectives representatives of all German Surgical Associations cooperated towards a structured selection process of learning objectives and the definition of levels and areas of competencies. After completion the catalogue of learning objectives will be available online on the webpage of the DGCH.

Prophylaktische Chirurgie der familiären adenomatösen Polyposis coli

ZusammenfassungDie familiäre adenomatöse Polyposis coli (FAP) kann heute nicht mehr als einheitliche Krankheitsentität mit standardisiertem Therapiekonzept gesehen werden. Grundsätzlich ist jedoch die prophylaktische Kolektomie nach der phänotypischen Manifestation kolorektaler Polypen, aber vor der Entwicklung eines kolorektalen Karzinoms zu fordern. Die Festlegung des optimalen Operationszeitpunktes ist eine klinische Entscheidung, die unabhängig von der molekularen Diagnose getroffen wird. Bei Vorliegen einer klassischen FAP steht die Indikation zur restaurativen Proktokolektomie und ileoanalen Pouchanlage außer Frage. Dagegen ist für die attenuierten FAP-Varianten zusätzliche Evidenz aus klinischen Studien erforderlich, um die chirurgische Taktik und den Vorteil der prophylaktischen Chirurgie im Vergleich zum regelmäßigen endoskopischen Screening im Sinne einer Reduktion der Karzinomrate und der Mortalität zu belegen.AbstractFamilial adenomatous polyposis coli (FAP) may not be considered a single disease entity with standardized guidelines for operative treatment. However, prophylactic colectomy after the manifestation of polyps but prior to the development of colorectal cancer is essential. The optimal timing of prophylactic surgery remains a clinical decision taken independently of mutation analysis. In case of the classic FAP phenotype, restorative proctocolectomy and ileal pouch-anal anastomosis is the procedure of choice. The development of reliable guidelines for attenuated FAP variants requires further evidence from clinical studies on surgical strategy and the advantages of prophylactic surgery over regular endoscopic screening with removal of polyps.Familial adenomatous polyposis coli (FAP) may not be considered a single disease entity with standardized guidelines for operative treatment. However, prophylactic colectomy after the manifestation of polyps but prior to the development of colorectal cancer is essential. The optimal timing of prophylactic surgery remains a clinical decision taken independently of mutation analysis. In case of the classic FAP phenotype, restorative proctocolectomy and ileal pouch-anal anastomosis is the procedure of choice. The development of reliable guidelines for attenuated FAP variants requires further evidence from clinical studies on surgical strategy and the advantages of prophylactic surgery over regular endoscopic screening with removal of polyps.

Intestinal cytomegalovirus infection in patients hospitalized for exacerbation of inflammatory bowel disease: a 10-year tertiary referral center experience.

Objectives This 10-year retrospective cohort study aims to determine the prevalence and risk factors of cytomegalovirus (CMV) infection in inpatients with exacerbated inflammatory bowel disease (IBD). Methods All patients admitted to the Department of Gastroenterology of the University Hospital Heidelberg for IBD exacerbation between January 2004 and June 2013 were enrolled. To identify the risk factors of CMV infection, infected individuals were compared with those with excluded infection. Results Among 297 patients with exacerbated IBD, 21 had confirmed CMV infection and 79 had excluded CMV infection, whereas the remaining patients had not been sufficiently tested for CMV. Taking into account only sufficiently tested individuals, the prevalence of CMV infection was 22.7% in ulcerative colitis and 16.0% in Crohn’s disease. The occurrence of CMV infection was associated with the following variables at admission: age of 30 years or more [odds ratio (OR) 14.29; P=0.004], disease duration less than 60 months (OR 7.69; P=0.011), a blood leukocyte count less than 11/nl (OR 4.49; P=0.041), and immunosuppressive therapy (OR 6.73; P=0.0129). CMV-positive patients remained in the hospital longer than noninfected patients (P=0.0009). In the CMV-positive cohort, a 66-year-old woman died of CMV pneumonia and sepsis, whereas there was no death in the CMV-negative cohort. Conclusion Immunuosuppressive therapy and age older than 30 years were identified as the main risk factors for the development of CMV infection in exacerbated IBD. Because of the risk of death, diagnostics of CMV infection should especially be initiated in older patients on immunosuppressive therapy.

[Competency-based medical education: National Catalogue of Learning Objectives in surgery].

Competency-based medical education is a prerequisite to prepare students for the medical profession. A mandatory professional qualification framework is a milestone towards this aim. The National Competency-based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM) of the German Medical Faculty Association (MFT) and the German Medical Association will constitute a basis for a core curriculum of undergraduate medical training. The Surgical Working Group on Medical Education (CAL) of the German Association of Surgeons (DGCH) aims at formulating a competency-based catalogue of learning objectives for surgical undergraduate training to bridge the gap between the NKLM and the learning objectives of individual medical faculties. This is intended to enhance the prominence and visibility of the surgical discipline in the context of medical education. On the basis of different faculty catalogues of learning objectives, the catalogue of learning objectives of the German Association of Orthopedics and Orthopedic Surgery and the Swiss Catalogue of Learning Objectives representatives of all German Surgical Associations cooperated towards a structured selection process of learning objectives and the definition of levels and areas of competencies. After completion the catalogue of learning objectives will be available online on the webpage of the DGCH.ZusammenfassungKompetenzorientierung in der medizinischen Ausbildung gilt als Voraussetzung, um Studierende auf die Erfordernisse des Arztberufes vorzubereiten. Die Formulierung eines verbindlichen Fachqualifikationsrahmens ist ein Meilenstein in diese Richtung. Mit dem Nationalen Kompetenzbasierten Lernzielkatalog Medizin (NKLM) schaffen der Medizinische Fakultätentag (MFT) und die Gesellschaft für Medizinische Ausbildung (GMA) die Basis für ein Kernkurrikulum bis zur Approbation zur Ärztin bzw. zum Arzt. Die Chirurgische Arbeitsgemeinschaft Lehre der Deutschen Gesellschaft für Chirurgie (DGCH – CAL) möchte mit dem Nationalen Lernzielkatalog Chirurgie eine Brücke zwischen NKLM und Lernzielkatalogen an den medizinischen Fakultäten schlagen. Er soll die Basis für ein chirurgisches Kernkurrikulum darstellen und die Sichtbarkeit unseres Faches in der studentischen Ausbildung stärken. Auf der Grundlage verschiedener Lernzielkataloge an medizinischen Fakultäten, des Lernzielkatalogs für Orthopädie-Unfallchirurgie und des Schweizer Lernzielkatalogs erfolgte mit Vertretern aller chirurgischen Fachgesellschaften ein strukturierter Selektionsprozess für Lernziel-Items sowie die Definierung von Kompetenzebenen und Kompetenzbereichen. Nach Komplettierung wird der Lernzielkatalog in elektronischer Form auf der Webseite der DGCH zugänglich gemacht werden.AbstractCompetency-based medical education is a prerequisite to prepare students for the medical profession. A mandatory professional qualification framework is a milestone towards this aim. The National Competency-based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM) of the German Medical Faculty Association (MFT) and the German Medical Association will constitute a basis for a core curriculum of undergraduate medical training. The Surgical Working Group on Medical Education (CAL) of the German Association of Surgeons (DGCH) aims at formulating a competency-based catalogue of learning objectives for surgical undergraduate training to bridge the gap between the NKLM and the learning objectives of individual medical faculties. This is intended to enhance the prominence and visibility of the surgical discipline in the context of medical education. On the basis of different faculty catalogues of learning objectives, the catalogue of learning objectives of the German Association of Orthopedics and Orthopedic Surgery and the Swiss Catalogue of Learning Objectives representatives of all German Surgical Associations cooperated towards a structured selection process of learning objectives and the definition of levels and areas of competencies. After completion the catalogue of learning objectives will be available online on the webpage of the DGCH.

Quality of life ten and more years after restorative proctocolectomy for patients with familial adenomatous polyposis coli.

PURPOSE: Few studies on long-term quality of life after restorative proctocolectomy and ileal pouch-anal anastomosis have been published. Most of them survey a mixed patient population of familial adenomatous polyposis and ulcerative colitis. The present study analyzes long-term results more than 10 years after ileal pouch-anal anastomosis for patients with familial adenomatous polyposis, exclusively. METHODS: One hundred thirty-five patients who underwent ileal pouch-anal anastomosis more than 10 years ago were identified from the prospective familial adenomatous polyposis registry at Heidelberg University hospital. They received the German version of the health-specific Short Form 36 Health Survey and the disease-specific Gastrointestinal Quality of Life Index by mail. To assess the impact of disease-specific factors, 10 questions asking for ability to work, current medication, pouchitis, and extracolonic manifestations of familial adenomatous polyposis were added to the Gastrointestinal Quality of Life Index questionnaire. RESULTS: Among 84 patients who answered the questionnaires the median follow-up was 13.4 years (range, 10.3–23.8 y).The results of the Short Form 36 Health Survey were comparable to a German normative population in all dimensions, whereas the overall score for the Gastrointestinal Quality of Life Index was significantly reduced compared with healthy individuals (111.8 vs 120.8, P = .0014). Carcinoma at the time of ileal pouch-anal anastomosis, desmoid tumors, or duodenal adenomas had no significant influence on quality of life. More than 7 bowel movements during the daytime were found to reduce quality of life significantly (103.5 vs 115, P = .0127). More than 2 defecations per night diminished the score further (101 vs 125, P < .0001). Patients younger than 40 years at the time of ileal pouch-anal anastomosis had significantly better results than older patients (120 vs 109.5, P = .0076). CONCLUSION: Ileal pouch-anal anastomosis is a safe surgical procedure with a high quality of life comparable to that of a normative population after long-term follow-up of patients with familial adenomatous polyposis.

Developing medical educators – a mixed method evaluation of a teaching education program

Background It is well accepted that medical faculty teaching staff require an understanding of educational theory and pedagogical methods for effective medical teaching. The purpose of this study was to evaluate the effectiveness of a 5-day teaching education program. Methods An open prospective interventional study using quantitative and qualitative instruments was performed, covering all four levels of the Kirkpatrick model: Evaluation of 1) ‘Reaction’ on a professional and emotional level using standardized questionnaires; 2) ‘Learning’ applying a multiple choice test; 3) ‘Behavior’ by self-, peer-, and expert assessment of teaching sessions with semistructured interviews; and 4) ‘Results’ from student evaluations. Results Our data indicate the success of the educational intervention at all observed levels. 1) Reaction: The participants showed a high acceptance of the instructional content. 2) Learning: There was a significant increase in knowledge (P<0.001) as deduced from a pre-post multiple-choice questionnaire, which was retained at 6 months (P<0.001). 3) Behavior: Peer-, self-, and expert-assessment indicated a transfer of learning into teaching performance. Semistructured interviews reflected a higher level of professionalism in medical teaching by the participants. 4) Results: Teaching performance ratings improved in students’ evaluations. Conclusions Our results demonstrate the success of a 5-day education program in embedding knowledge and skills to improve performance of medical educators. This multimethodological approach, using both qualitative and quantitative measures, may serve as a model to evaluate effectiveness of comparable interventions in other settings.

Integrative vs. Traditional Learning from the Student Perspective.

Background: The interdisciplinary surgery block of the reformed undergraduate curriculum HeiCuMed includes daily cycles of interactive case-based seminars, problem-based tutorials, case presentation by students, skills and communication training, and bedside teaching. The teaching doctors receive didactic training. In contrast, the previous traditional course was based on lectures with only two weekly hours of bedside teaching. Didactic training was not available. Objective: The present work aims at analysing the importance of active participation of students and the didactic components of the reformed and traditional curricula, which contribute to successful learning as evaluated by the students. Method: Differentiated student evaluations of the undergraduate surgical courses between 1999 and 2008 were examined by correlation and regression analyses. Results: The evaluation scores for organisation, dedication of the teaching staff, their ability to make lessons interesting and complex topics easily understandable, and the subjective gain of knowledge were significantly better in HeiCuMed than in the traditional curriculum. However, the dependence of knowledge gain on the didactic quality was the same in both curricula. The quality of discussions and the ability of the teaching doctors to promote active student participation were important to the subjective gain of knowledge in both seminars and practical courses of the reformed curriculum as well as for the overall evaluation of the practical courses but not the gain of knowledge in the traditional curriculum. Conclusion: The findings confirm psychological-educational perceptions, that competent implementation of integrative didactical methods is more important to successful teaching and the subjective gain of knowledge than knowledge transfer by traditional classroom teaching.

Professionalisierung der Lehre im chirurgischen Alltag

ZusammenfassungHintergrundFür die kompetenzorientierte Lehre in der Chirurgie ist eine umfassende medizindidaktische Professionalisierung der Aus- und Weiterbilder unverzichtbar. Die Chirurgische Arbeitsgemeinschaft Lehre hat sich daher zur Aufgabe gemacht, ein entsprechendes Ausbildungskonzept zu entwickeln.MethodeIm ersten Schritt wurde hierzu von der Core Group eine Bestandsaufnahme der relevantesten Lehrhemmnisse vorgenommen. Unter Berücksichtigung dieser Rahmenbedingungen wurde ein trimodulares Kurskonzept entwickelt, das sowohl die unterschiedlichen Vorkenntnisse und Funktionen der Dozenten adressiert wie auch Konzepte einer modernen kompetenzbasierten Hochschuldidaktik.ErgebnisDer A-Kurs richtet sich an medizindidaktische Novizen mit Fokus auf Anamneseerhebung, klinische Untersuchung und die Vermittlung einfacher praktischer Fertigkeiten. Der B-Kurs wurde für erfahrenere Kliniker konzipiert und soll zu kompetenzbasierter Lehre in komplexen Lehrszenarien wie eine Operation oder eine Visite qualifizieren, während sich der C-Kurs schließlich an einen Personenkreis richtet, der mit der Organisation und Administration klinischer Lehre betraut ist.AbstractBackgroundFor competency-oriented teaching in surgery a comprehensive medical educational training and professionalization of clinical teachers is essential. The Surgical Working Group for Teaching has therefore set itself the task of developing an appropriate training concept.MethodIn the first step the core group took stock of the most relevant educational barriers in the clinical environment. Taking into account these findings a trimodular course was devised that addressed both previous knowledge and different clinical functions of the faculty as well as modern concepts of competency-based academic teaching.ResultsThe A course is designed for medical teaching of novices with a focus on collation of the medical history, clinical examination and teaching of practical skills. The B course is devised for experienced clinicians and should qualify them for competency-based teaching in complex educational scenarios, such as the operating room or ward rounds, while the C course is directed to a group of persons entrusted with the organization and administration of clinical teaching.BACKGROUND For competency-oriented teaching in surgery a comprehensive medical educational training and professionalization of clinical teachers is essential. The Surgical Working Group for Teaching has therefore set itself the task of developing an appropriate training concept. METHOD In the first step the core group took stock of the most relevant educational barriers in the clinical environment. Taking into account these findings a trimodular course was devised that addressed both previous knowledge and different clinical functions of the faculty as well as modern concepts of competency-based academic teaching. RESULTS The A course is designed for medical teaching of novices with a focus on collation of the medical history, clinical examination and teaching of practical skills. The B course is devised for experienced clinicians and should qualify them for competency-based teaching in complex educational scenarios, such as the operating room or ward rounds, while the C course is directed to a group of persons entrusted with the organization and administration of clinical teaching.

Professionalization of surgical education in the daily clinical routine. Training concept of the Surgical Working Group for Teaching of the German Society of Surgery

ZusammenfassungHintergrundFür die kompetenzorientierte Lehre in der Chirurgie ist eine umfassende medizindidaktische Professionalisierung der Aus- und Weiterbilder unverzichtbar. Die Chirurgische Arbeitsgemeinschaft Lehre hat sich daher zur Aufgabe gemacht, ein entsprechendes Ausbildungskonzept zu entwickeln.MethodeIm ersten Schritt wurde hierzu von der Core Group eine Bestandsaufnahme der relevantesten Lehrhemmnisse vorgenommen. Unter Berücksichtigung dieser Rahmenbedingungen wurde ein trimodulares Kurskonzept entwickelt, das sowohl die unterschiedlichen Vorkenntnisse und Funktionen der Dozenten adressiert wie auch Konzepte einer modernen kompetenzbasierten Hochschuldidaktik.ErgebnisDer A-Kurs richtet sich an medizindidaktische Novizen mit Fokus auf Anamneseerhebung, klinische Untersuchung und die Vermittlung einfacher praktischer Fertigkeiten. Der B-Kurs wurde für erfahrenere Kliniker konzipiert und soll zu kompetenzbasierter Lehre in komplexen Lehrszenarien wie eine Operation oder eine Visite qualifizieren, während sich der C-Kurs schließlich an einen Personenkreis richtet, der mit der Organisation und Administration klinischer Lehre betraut ist.AbstractBackgroundFor competency-oriented teaching in surgery a comprehensive medical educational training and professionalization of clinical teachers is essential. The Surgical Working Group for Teaching has therefore set itself the task of developing an appropriate training concept.MethodIn the first step the core group took stock of the most relevant educational barriers in the clinical environment. Taking into account these findings a trimodular course was devised that addressed both previous knowledge and different clinical functions of the faculty as well as modern concepts of competency-based academic teaching.ResultsThe A course is designed for medical teaching of novices with a focus on collation of the medical history, clinical examination and teaching of practical skills. The B course is devised for experienced clinicians and should qualify them for competency-based teaching in complex educational scenarios, such as the operating room or ward rounds, while the C course is directed to a group of persons entrusted with the organization and administration of clinical teaching.BACKGROUND For competency-oriented teaching in surgery a comprehensive medical educational training and professionalization of clinical teachers is essential. The Surgical Working Group for Teaching has therefore set itself the task of developing an appropriate training concept. METHOD In the first step the core group took stock of the most relevant educational barriers in the clinical environment. Taking into account these findings a trimodular course was devised that addressed both previous knowledge and different clinical functions of the faculty as well as modern concepts of competency-based academic teaching. RESULTS The A course is designed for medical teaching of novices with a focus on collation of the medical history, clinical examination and teaching of practical skills. The B course is devised for experienced clinicians and should qualify them for competency-based teaching in complex educational scenarios, such as the operating room or ward rounds, while the C course is directed to a group of persons entrusted with the organization and administration of clinical teaching.

Medical and Surgical Conditions for the Treatment of Malabsorption

In this edition of VISZERALMEDIZIN, we address an important medical subject in the best tradition of interdisciplinary expertise in gastrointestinal medicine and surgery, i.e. digestive insufficiency, maldigestion and malabsorption, as well as their causes, pathophysiology, and therapeutic approaches.