Background: The final year of medical training in Germany is one of the least structured and standardized years of medical school. Medical students often complain about a lack of guidance, supervision and feedback. They are mostly asked to perform delegable nonmedical tasks even though student experiences in this period critically determine future decisions for certain medical specialties. Consequently, right from the beginning many young professionals feel overburdened especially by the time pressure of everyday clinical practice. The planned amendment of the medical licensing regulations will make competence-based training even more important. This article therefore aims to examine the extent to which a mentoring-based curriculum with workplace-based examinations during the final year of medical studies can make a valuable contribution to this.
Methods: After a needs assessment (structured literature search, results evaluation and focus groups with both students and medical specialists), a mentoring-based curriculum for final year medical students was developed following the Kern cycle. In 2 work sessions 10 discipline-specific competencies for the fields of anesthesiology, critical care, emergency and pain medicine were established and prioritized, which had to be mastered by every student independently at the end of the training period. Assessment of these competencies was performed on a regular basis by trained mentors in the form of workplace-based assessments (mini-clinical evaluation exercise, mini-CEX, direct observation of procedural skills, DOPS). Multiperspective evaluation was and is the foundation of continuous program development. By September 2019 a total of 40 students had completed the modified curriculum and were subsequently interviewed online about various aspects of the tertial.
Results: The response rate to the survey was 80% (n = 32). The gender ratio was balanced (male = 50%, female = 50%). Prioritization and assessment of 10 competencies by trained mentors enabled a focused, demand-driven and high-quality training of final year medical students. Surveyed students found the section mentoring and feedback to be very positive and it supported their learning success (grade 1.5). Despite firmly established feedback structures, in retrospect almost half (51.6%) wanted more structured feedback. Workplace-based assessments were mostly previously unknown (64.6%) but were experienced as helpful and meaningful (76.7%). Students felt confident and prepared for the final state examination (81.3%) and their career start (71.0%) after being part of the program. These findings were accompanied by a high level of satisfaction (grade 1.7) as well as a high recommendation rate for this institution (as a training program for final year medical students and as a career start for residents, both with 93.7%). Thus, the good evaluation results of the department before the start of the project could again be slightly improved.
Conclusion: A demand-driven, mentoring-based curriculum with integrated workplace-based assessments not only led to high overall student satisfaction but also promoted the quality of teaching in an effective and resource-saving way. Mentoring promotes learning success mainly through feedback and individual learning support and also supports the communicative and social skills of students and mentors alike.
Zusammenfassung: HINTERGRUND: Das praktische Jahr (PJ) ist an vielen Universitäten der am wenigsten strukturierte und standardisierte Studienabschnitt. Studierende beklagen mangelnde Anleitung, Supervision und Feedback. Häufig übernehmen sie delegationsfähige, nichtmedizinische Aufgaben, obwohl das PJ ein Hauptentscheidungsfaktor für die spätere Facharztwahl ist.
Methoden: Nach einer Bedarfsanalyse erfolgte die Entwicklung eines Mentoring-basierten Curriculums für Studierende im PJ mithilfe des Kern-Zyklus. Hierzu wurden 10 fachspezifische klinisch-praktische Basiskompetenzen etabliert, die jeder Studierende bis zum Tertialende beherrschen sollte. Eine Überprüfung erfolgte formativ anhand von arbeitsplatzbasierten Prüfungen. Das Tertial wurde durch alle Studierenden abschließend online evaluiert.
Ergebnisse: Die Priorisierung und Prüfung von klinisch-praktischen Kompetenzen durch Mentoren/Mentorinnen ermöglichten eine bedarfsorientierte und qualitative hochwertige Ausbildung. Das Mentoring und Feedback wurden durchweg positiv beurteilt und unterstützten den Lernerfolg (Note 1,5). Das Prüfungsformat wurde mehrheitlich als unbekannt (64,6 %), aber hilfreich und sinnvoll erlebt (76,7 %). Studierende fühlten sich durch das Curriculum gut auf die Staatsexamensprüfung (81,3 %) und den Berufsbeginn vorbereitet (71,0 %). Dies ging mit einer hohen Zufriedenheit (Note 1,7) einher.
Schlussfolgerungen: Ein bedarfsgerechtes, Mentoring-basiertes Curriculum mit integrierten arbeitsplatzbasierten Prüfungen geht nicht nur mit einer hohen Ausbildungszufriedenheit einher, sondern fördert effektiv und ressourcenschonend die Ausbildungsqualität.
Keywords: Anesthesiology; Competence; Curriculum development; Medical education; Medical studies.