BACKGROUND: The learning objectives in the current cross-sectional subject \"Rehabilitation, Physical Medicine, Naturopathic Medicine\" have been revised as part of the further development of the National Competency-Based Catalogue of Learning Objectives for Medicine (NKLM) to its new version 2.0. Since the NKLM is designed as an interdisciplinary catalogue, a subject assignment seemed necessary from the point of view of various stakeholders. Thus, the German Association of Scientific Medical Societies (AWMF) and the German medical faculties initiated a subject assignment process. The assignment process for the subject \"Physical and Rehabilitative Medicine, Naturopathic Medicine\" (PRM-NHV; according to the subject list of the first draft of the planned novel medical license regulations from 2020) is presented in this paper.
METHODS: The AWMF invited its member societies to participate in the assignment of learning objectives of chapters VI, VII, and VIII of the NKLM 2.0 to the individual subjects to which they consider to contribute in teaching. For \"PRM-NHV\", representatives of the societies for rehabilitation sciences (DGRW), physical and rehabilitation medicine (DGPRM), orthopaedics and traumatology (DGOU), as well as for naturopathy (DGNHK) participated. In a structured consensus process according to the DELPHI methodology, the learning objectives were selected and consented. Subsequently, subject recommendations were made by the AWMF for each learning objective.
RESULTS: From the NKLM 2.0, a total of 100 competency-based learning objectives of chapters VII and VIII for the subject \"PRM-NHV\" were consented by the representatives of the involved societies for presentation on the NKLM 2.0 online platform.
CONCLUSIONS: In the context of the revision process of medical studies in Germany and under the umbrella of the AWMF and the German medical faculties, a broad consensus of competency-based learning objectives in the subject \"PRM-NHV\" could be achieved. This provides an important orientation for all medical faculties both for the further development of teaching in the cross-sectional subject \"Rehabilitation, Physical Medicine, Naturopathic Medicine\" according to the 9th revision of the medical license regulations, which has been valid for twenty years, and for the preparation of the corresponding subjects in the draft bill of the novel license regulations.
UNASSIGNED: Im Rahmen der Weiterentwicklung des Nationalen Kompetenzbasierten Lernzielkatalogs (NKLM) zur Version 2.0 erfolgte auch eine Überarbeitung der Lernziele im bisherigen Querschnittsfach „Rehabilitation, Physikalische Medizin, Naturheilverfahren“. Da der NKLM grundsätzlich fächerübergreifend angelegt ist, von verschiedenen Seiten aber eine Fächerzuordnung notwendig schien, initiierten die Arbeitsgemeinschaft wissenschaftlich-medizinischer Fachgesellschaften (AWMF) und der Medizinische Fakultätentag einen Fächerzuordnungsprozess. Der Zuordnungsprozess für das Fach „Physikalische und Rehabilitative Medizin, Naturheilverfahren“ (PRM-NHV; laut Fächerliste des ersten Referentenentwurfes der geplanten Approbationsordnung aus dem Jahr 2020) wird in dieser Arbeit dargestellt.
UNASSIGNED: Die AWMF lud ihre Mitgliedsgesellschaften ein, sich an der Zuordnung von Lernzielen der Kapitel VI, VII und VIII des NKLM 2.0 zu den einzelnen Fächern zu beteiligen, zu denen sie nach eigener Einschätzung einen Beitrag in der Lehre leisten. Für „PRM-NHV“ beteiligten sich Vertreter*innen der DGRW, DGPRM, DGOU sowie der DGNHK. In einem strukturierten Konsensprozess nach der DELPHI-Methodik erfolgten Auswahl und Konsentierung der Lernziele. Anschließend erfolgte durch die AWMF eine Fächerempfehlung.
UNASSIGNED: Aus dem NKLM 2.0 wurden insgesamt 100 kompetenzbasierte Lernziele der Kapitel VII und VIII für das Fach „PRM-NHV“ von den Vertreter*innen der beteiligten Fachgesellschaften zur Darstellung auf der NKLM 2.0-Online-Plattform konsentiert.
UNASSIGNED: Im Rahmen des grundlegend geplanten Reformprozesses des Medizinstudiums und unter dem Dach der AWMF und des Medizinischen Fakultätentags gelang die breite Konsentierung von Lernzielen des NKLM 2.0 für die kompetenzbasierte Lehre im Fach „PRM-NHV“ durch die beteiligten Fachgesellschaften. Damit wird eine für alle medizinischen Fakultäten wichtige Orientierung sowohl für die Weiterentwicklung der Lehre im Querschnittsbereich „Rehabilitation, Physikalische Medizin, Naturheilverfahren“ gemäß der seit zwanzig Jahren gültigen 9. Revision der ÄApprO als auch für die Vorbereitung der entsprechenden Fächer im Referentenentwurf der neuen ÄApprO gegeben.

Introduction: In Germany, foreign physicians are a fixed component of the medical profession. According to the German Medical Licensure Act, physicians having completed their qualification in another country are required to pass a knowledge examination which falls within the competence of examination offices or the regional governments. Project outline: The preparatory course consists of 10 modules. On Fridays, individual cases are discussed in small groups and specific examination techniques are trained. On Saturdays, illnesses are simulated by simulated patients. After each encounter, faculty experts, psychologists and peer group members provide the participants with 360° feedback. Due to the COVID-19 pandemic, the course which had been established 2 years beforehand has now been switched to an online class within one week. Friday units were visualized in power-point presentations and tutorial videos were discussed. On Saturdays, the cases were simulated by simulated patients and transmitted via a telemedicine platform. Results: The course could be conducted without interruptions (75 hours of in-class tuition and 75 hours of online tuition). In the oral evaluation the participants criticized telemedicine as a medium for imparting of practical skills. 7/22 (32%) of the participants underwent the knowledge examination and 6/7 (86%) of them passed it (versus 18/19 of the participants of in-class tuition (95%)). Discussion: There was a clear preference for in-class tuition. It was noted that the telemedical setting entailed some restrictions. However, the switch to online classes did not affect the pass rate. Conclusion: The switch from in-class to online units was feasible. The gained insights were taken into account when conceiving the online semester at our faculty and especially the tuition with the support of simulated patients.
Einleitung: Ausländische ÄrztInnen sind in Deutschland fester Bestandteil der Ärzteschaft. ÄrztInnen mit einer Ausbildung aus einem Drittstaat müssen laut der Approbationsordnung für Ärzte eine Kenntnisprüfung ablegen, für die die Landesprüfungsämter oder die Bezirksregierungen zuständig sind. Projektbeschreibung: Der Vorbereitungskurs besteht aus 10 Modulen. Freitags werden Fälle in Kleingruppen besprochen und fachspezifische Untersuchungstechniken geübt. Samstags werden mit SimulationspatientInnen bestimmte Krankheiten simuliert. Nach der Interaktion bekommen die TeilnehmerInnen ein 360°-Feedback von FachdozentInnen, PsychologInnen und KollegInnen aus der Gruppe.Durch die Corona-Pandemie wurde der schon seit 2 Jahren bestehende Kurs innerhalb von einer Woche auf ein Onlineformat umgestellt. Die Freitagseinheiten wurden mit Power-Point visualisiert und Lernvideos besprochen. Samstags wurden die Fälle mit SimulationspatientInnen telemedizinisch simuliert. Ergebnisse: Der Kurs konnte ohne Unterbrechung durchgeführt werden (75 Stunden als Präsenz-, 75 Stunden als Online-Unterricht). In der mündlichen Evaluation der TeilnehmerInnen wurde die telemedizinische Vermittlung von praktischen Fertigkeiten bemängelt. 7/22 (32%) der TeilnehmerInnen haben an der Kenntnisprüfung teilgenommen, 6/7 (86%) haben die Prüfung bestanden (in Präsenzunterricht 18/19 (95%)).Diskussion: Der Präsenzunterricht wurde eindeutig präferiert. Es wurden Einschränkungen durch das telemedizinische Setting festgestellt. Die Bestehungsquote hat sich durch die Umstellung nicht verändert.Schlussfolgerung: Die Umstellung von Präsenzeinheiten auf Online war möglich. Die Erfahrungen flossen in die Entwicklung der Online-Semester an unserer Fakultät ein, insbesondere der Unterricht mit den SimulationspatientInnen.

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Background The working party of the German Society for Surgery (DGCH) on undergraduate surgical education has developed a national expertise-based catalogue of learning goals in surgery (NKLC). This study analyses the extent to which the questions of the German second medical licensing examination compiled by the IMPP are congruent with the NKLC and which thematic focus is emphasised. Materials and Methods Firstly, a guideline and evaluation sheet were developed in order to achieve documentation of the individual examination questions of the second licensing examination with respect to the learning goals of the NKLC. In a retrospective analysis from autumn 2009 to autumn 2014, eleven licensing examinations in human medicine were screened independently by three different reviewers. In accordance with the guideline, the surgical questions were identified and subsequently matched to the learning goals of the NKLC. The analysis included the number of surgical learning goals as well as the number of surgical questions for each examination, learning goal, and different levels of expertise (LE). Results Thirteen reviewers from six surgical disciplines participated in the analysis. On average, reviewers agreed on the differentiation between surgical and non-surgical questions in 79.1% of all 3480 questions from 11 licensing examinations. For each examination (n = 320 questions), 98.8 ± 22.6 questions (min.: 69, max.: 150) were rated as surgical. For each surgical learning goal addressed, 2.2 ± 0.3 questions (min.: 1, max.: 16) were asked. For each examination, 23.5 ± 6.3 questions (min.: 11; max.: 31) referred to learning goals of LE 3, 52.5 ± 16.7 questions (min.: 34; max.: 94) addressed learning goals of LE 2 and 22.8 ± 7.7 questions (min.: 9; max.: 34) were related to learning goals of LE 1. 64 learning goals (27.8% of all learning goals of the NKLC) were not reflected in the examinations. With a total of 70 questions, the most frequently examined surgical topic was \"disorders of the rheumatic spectrum\". Conclusion The number of surgical examination questions in the German second medical licensing examination seems to be sufficient. However, the questions seem to be unevenly distributed between different surgical areas of undergraduate education. In order to achieve a more homogenous representation of relevant surgical topics, improved alignment is needed between the state examination with existing catalogues of learning goals by the IMPP.
Hintergrund Die Chirurgische Arbeitsgemeinschaft Lehre der Deutschen Gesellschaft für Chirurgie (CAL) hat den Nationalen Kompetenzbasierten Lernzielkatalog Chirurgie (NKLC) entwickelt. Der NKLC definiert für jedes der 230 Lernziele eine Kompetenzebene (KE) von „KE 1: Faktenwissen“ bis zu „KE 3: selbstständige Handlung“. Die vorliegende Studie untersucht, inwiefern sich die Prüfungsfragen des 2.Staatsexamens mit den Lernzielen des NKLC decken und welche thematische Gewichtung dabei vom Institut für Medizinische und Pharmazeutische Prüfungsfragen (IMPP) vorgenommen wurde. Material und Methoden Zunächst wurden ein Leitfaden und ein Auswertungsbogen entwickelt, um die standardisierte Zuordnung und Dokumentation einzelner Prüfungsfragen des 2. Staatexamens zu Lernzielen des NKLC zu ermöglichen. In einer retrospektiven Analyse wurden dann 11 Staatsexamina (Herbst 2009 bis Herbst 2014) von mindestens 3 Reviewern unabhängig voneinander analysiert. Die Chirurgie-Fragen wurden identifiziert und einem Lernziel des NKLC zugeordnet. In die Analyse gingen die Anzahl der chirurgischen Lernziele sowie die Anzahl der chirurgischen Fragen pro Examen, pro Lernziel und pro festgelegte KE ein. Ergebnisse Es analysierten 13 Reviewer aus 6 chirurgischen Disziplinen. Durchschnittlich wurden 79,1% aller 3480 Fragen aus 11 Examina übereinstimmend als chirurgisch oder nicht chirurgisch gewertet. Pro Examen (aus je max. 320 Fragen) wurden 98,8 ± 22,6 Fragen (Min.: 69, Max.: 150) als chirurgisch eingestuft. Pro Lernziel wurden 2,2 ± 0,3 Fragen (Min.: 1, Max.: 16) gestellt. Pro Examen wurden 23,5 ± 6,3 Fragen (Min.: 11; Max.: 31) zu Lernzielen mit der KE 3 (selbstständige Durchführung), 52,5 ± 16,7 (Min.: 34; Max.: 94) zu Lernzielen mit KE 2 (Anwendungs- und Entscheidungswissen) und 22,8 ± 7,7 Fragen (Min.: 9; Max.: 34) zu Lernzielen mit KE 1 (reines Faktenwissen) pro Examen gestellt. 64 Lernziele (27,8% der insgesamt 230 Lernziele des NKLC) wurden gar nicht geprüft. Das am häufigste geprüfte chirurgische Lernziel stammte mit 70 Fragen aus dem Bereich „Erkrankungen des rheumatischen Formenkreises“. Schlussfolgerung Die Anzahl der Fragen im 2. Staatsexamen aus dem Fach Chirurgie erscheint ausreichend, jedoch thematisch ungleichmäßig verteilt. Um eine inhaltlich homogenere Repräsentation relevanter chirurgischer Lernziele zu gewährleisten, ist eine bessere Abstimmung der Staatsprüfungen mit den existierenden Lernzielkatalogen durch das IMPP zu wünschen.

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In the United States, recent judicial interpretation of interstate licensure laws has found pathologists guilty of malpractice and, more importantly, the criminal practice of medicine without a license. These judgments against pathologists highlight the need for a timely and comprehensive survey of licensure requirements and laws regulating the interstate practice of pathology. For all 50 states, each state medical practice act and state medical board website was reviewed. In addition, each medical board was directly contacted by electronic mail, telephone, or US registered mail for information regarding specific legislation or guidelines related to the interstate practice of pathology. On the basis of this information, states were grouped according to similarities in legislation and medical board regulations. This comprehensive survey has determined that states define the practice of pathology on the basis of the geographic location of the patient at the time of surgery or phlebotomy. The majority of states (n=32) and the District of Columbia allow for a physician with an out-of-state license to perform limited consultation to a physician with the specific state license. Several states (n=5) prohibit physicians from consultation without a license for the specific state. Overall, these results reveal the heterogeneity of licensure requirements between states. Pathologists who either practice in multiple states, send cases to out-of-state consultants, or serve as consultants themselves should familiarize themselves with the medical licensure laws of the states from which they receive or send cases.

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BACKGROUND: The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibility to spend one quarter of the internship, in the last year of their academic studies, in a practice of family medicine. The demonstrated teaching method aims at giving feedback to the student based on video recordings of patient consultations (student-patient) with the help of a checklist. Video-feedback is already successful used in medical teaching in Germany and abroad. This feasibility study aims at assessing the practicability of video-assisted feedback as a teaching method during internship in general practice.
UNASSIGNED: First of all, the general practice chooses a guideline as the learning objective. Secondly, a subsequent patient - student - consultation is recorded on video. Afterwards, a video-assisted formative feedback is given by the physician. A checklist with learning objectives (communication, medical examination, a structured case report according to the guideline) is used to structure the feedback content.
RESULTS: The feasibility was assessed by a semi structured interview in order to gain insight into barriers and challenges for future implementation. The teaching method was performed in one general practice. Afterwards the teaching physician and the trainee intern were interviewed. The Following four main categories were identified: feasibility, performance, implementation in daily routine, challenges of the teaching concept.The results of the feasibility study show general practicability of this approach. Installing a video camera in one examination room may solve technical problems. The trainee intern mentioned theoretical and practical benefits using the guideline. The teaching physician noted the challenge to reflect on his daily routines in the light of evidence-based guidelines.
CONCLUSIONS: This teaching method supports quality control and standardizing of learning objectives during the internship in general practice by using general practice guidelines. The use of a checklist enhances this method in general practice. We consider the presented teaching method in the context of the planned modification of the Medical Licenses Act is part of quality control and standardisation of medical teaching during general practice internships. In order to validate these presumptions, further, evaluation of this method concerning the learning objectives using the guidelines of general practice need to be carried out.

Graded exams are prerequisites for the admission to the medical state examination. Accordingly the exams must be of good quality in order to allow benchmarking with the faculty and between different universities. Criteria for good quality need to be considered - namely objectivity, validity and reliability. The guidelines for the processing of exams published by the GMA are supposed to help maintaining those criteria. In 2008 the Department of General Medicine at the University of Munich fulfils only 14 of 18 items. A review process, appropriate training of the staff and the introduction of the IMSm software were the main changes that helped to improve the \'GMA-score\' to 30 fulfilled items. We see the introduction of the IMSm system as our biggest challenge ahead. IMSm helps to streamline the necessary workflow and improves their quality (e.g. by the detection of cueing, item analysis). Overall, we evaluate the steps to improve the exam process as very positive. We plan to engage co-workers outside the department to assist in the various review processes in the future. Furthermore we think it might be of value to get into contact with other departments and faculties to benefit from each other\'s question pools.