Assessing competence is a tremendous challenge in medical education. There are two contrasting approaches in competence assessment: an
analytic
approach that aims to precisely measure observable ...constituents and facets of competence and a holistic approach that focuses on a comprehensive assessment of competences in complex real situations reflecting actual performance. We would like to contribute to the existing discourse about medical competence and its assessment by proposing an approach that can provide orientation for the development of competence-based assessment concepts in undergraduate and postgraduate medical education. The approach follows Kane's framework of an “argument-based approach” to validity and is based on insights into task complexity, testing and learning theories as well as the importance of the learning environment. It describes a continuum from analytic to holistic approaches to assess the constituents and facets of competence to performance. We conclude that the complexity of a task should determine the selection of the assessment and suggest to use this approach to reorganize and adapt competence assessment.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
A Mechanism for Cancer-Associated Membranous Nephropathy Hoxha, Elion; Wiech, Thorsten; Stahl, Phillip R ...
New England journal of medicine/The New England journal of medicine,
05/2016, Volume:
374, Issue:
20
Journal Article
Peer reviewed
Open access
The cause of paraneoplastic membranous nephropathy is unclear. In the current case, new expression of THSD7A in a gallbladder carcinoma and the development of membranous nephropathy may indicate a ...potential mechanism for the association between cancer and this nephropathy.
To the Editor:
An association between membranous nephropathy and malignant tumors has been known for decades.
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It was hypothesized that circulating, preformed immune complexes containing tumor antigens deposit in the glomeruli and induce membranous nephropathy; however, this hypothesis no longer appears to explain how subepithelial immune deposition occurs.
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The in situ binding of antibodies to endogenous antigens, which is strongly supported by the characterization of phospholipase A
2
receptor 1 and thrombospondin type-1 domain-containing 7A (THSD7A) as podocyte antigens in membranous nephropathy, constitutes the most probable established mechanism for the formation of subepithelial deposits of immune complexes.
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,
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It is . . .
Verbal and non-verbal aspects of communication as well as empathy are known to have an important impact on the medical encounter. The aim of the study was to analyze how well final year undergraduate ...medical students use skills of verbal and non-verbal communication during history-taking and whether these aspects of communication correlate with empathy and gender.
During a three steps performance assessment simulating the first day of a resident 30 medical final year students took histories of five simulated patients resulting in 150 videos of physician-patient encounters. These videos were analyzed by external rating with a newly developed observation scale for the verbal and non-verbal communication and with the validated CARE-questionnaire for empathy. One-way ANOVA, t-tests and bivariate correlations were used for statistical analyses.
Female students showed signicantly higher scores for verbal communication in the case of a female patient with abdominal pain (p < 0.05), while male students started the conversations significantly more often with an open question (p < 0.05) and interrupted the patients significantly later in two cases than female students (p < 0.05). The number of W-questions asked by all students was significantly higher in the case of the female patient with abdominal pain (p < 0.05) and this patient was interrupted after the beginning of the interview significantly earlier than the patients in the other four cases (p < 0.001). Female students reached significantly higher scores for non-verbal communication in two cases (p < 0.05) and showed significantly more empathy than male students in the case of the female patient with abdominal pain (p < 0.05). In general, non-verbal communication correlated significantly with verbal communication and with empathy while verbal communication showed no significant correlation with empathy.
Undergraduate medical students display differentiated communication behaviour with respect to verbal and non-verbal aspects of communication and empathy in a performance assessment and special differences could be detected between male and female students. These results suggest that explicit communication training and feedback might be necessary to raise students' awareness for the different aspects of communication and their interaction.
The association between perfectionism and depression in the medical profession can ultimately influence physicians' performance negatively. In medical students, especially maladaptive perfectionism ...is connected with distress and lower academic performance. The expression of perfectionism and symptoms of depression at the time of medical school application is not known. Therefore, we explored perfectionism and symptoms of depression in participants of multiple mini-interviews for medical school admission and investigated possible differences between applicants who were eventually admitted or rejected.
After the multiple mini-interviews admission procedure at Hamburg Medical School in August 2018, 146 applicants filled out a questionnaire including sociodemographic data and the following validated instruments: Multidimensional Perfectionism Scale by Hewitt and Flett (MPS-H), Multidimensional Perfectionism Scale by Frost (MPS-F), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and a 10-item version of the Big Five Inventory (BFI-10). The two groups of admitted and rejected applicants were compared and the correlation between symptoms of depression and perfectionism further explored.
The admitted applicants were significantly more extrovert and had lower depression scores compared to the rejected applicants. In both groups, the composite scales of Adaptive Perfectionism (r = .21, p = .011) and Maladaptive Perfectionism (r = .43, p < .001) as well as their components correlated significantly with the PHQ-9 results. Maladaptive Perfectionism accounted for about 18% of variance in the PHQ-9 score.
Rejected medical school applicants who participated in a multiple mini-interviews admission procedure showed higher levels of depression symptoms than admitted applicants. The degree of depressive symptoms can be partly explained by Maladaptive Perfectionism scores. Since coping in medical school and in postgraduate medical education require robust mental health, perfectionism questionnaires could be an additional tool in medical school selection processes.
Medical school admission procedures have the common goal to select applicants with the greatest potential of becoming successful physicians. Hamburg Medical Faculty selects medical students by grade ...point average (GPA) and employs a two-step selection process of a natural sciences test (HAM-Nat), in some cases followed by multiple mini-interviews (HAM-Int). Multiple mini-interviews can predict non-cognitive outcomes, while GPA has predictive validity for cognitive outcomes. The aim of our study was to explore communication skills and clinical knowledge of advanced medical students according to their respective admission procedure.
In July 2019, 146 students grouped according to their admission procedure into GPA-only (19.2 %), HAM-Nat (33.6 %), HAM-Int (30.8 %), and Waiting List (16.4 %) participated in four OSCE stations which equally assessed students' communication skills (OSCE part 1) and clinical knowledge (OSCE part 2) in simulated patient encounters, rated by physicians with checklists. Additionally, psychosocial assessors ranked communication skills with a global rating scale (GR). The students also participated in a multiple choice (MC) exam testing clinical knowledge. Kruskal-Wallis analyses of variance of test performance and Spearman correlation of instruments were calculated.
Students from the Waiting List group performed significantly worse on the MC exam compared to GPA-only and HAM-Int (adjusted p = .029 and 0.018, respectively). No significant differences were found between the admission groups with respect to communication skills. Global Rating and OSCE part 1 (communication) correlated significantly (ρ = 0.228, p = .006) as did OSCE part 2 (clinical knowledge) and MC exam (ρ = 0.242, p = .003), indicating criterion validity. Constructs did not overlap, indicating divergent validity.
Advanced medical students selected for undergraduate studies by multiple mini-interviews assessing psychosocial skills showed similar communication skills compared to students admitted to medical school by other entryways. It is unclear whether these similarities are due to an effective undergraduate longitudinal communication curriculum. Assessing baseline communication skills of all medical students at entry-level may aid with this question.
Society expects physicians to perform perfectly but high levels of perfectionism are associated with symptoms of distress in medical students. This study investigated whether medical students ...admitted to medical school by different selection criteria differ in the occurrence of perfectionism.
Newly enrolled undergraduate medical students (n = 358) filled out the following instruments: Multidimensional Perfectionism Scale (MPS-H), Multidimensional Perfectionism Scale (MPS-F), Big Five Inventory (BFI-10), General Self-Efficacy Scale (GSE), Patient Health Questionnaire 9 (PHQ-9), and Generalized Anxiety Disorder 7 (GAD-7). Sociodemographic data such as age, gender, high school degrees, and the way of admission to medical school were also included in the questionnaire.
The 298 participating students had significantly lower scores in Socially-Prescribed Perfectionism than the general population independently of their way of admission to medical school. Students who were selected for medical school by their high school degree showed the highest score for Adaptive Perfectionism. Maladaptive Perfectionism was the strongest predictor for the occurrence symptoms of depression and anxiety regardless of the way of admission.
Students from all admission groups should be observed longitudinally for performance and to assess whether perfectionism questionnaires might be an additional useful instrument for medical school admission processes.
Thrombospondin type 1 domain-containing 7A (THSD7A) is a target antigen identified in adult membranous nephropathy (MN) along with the major antigen phospholipase A
receptor 1 (PLA
R1). The ...prevalence of THSD7A-Ab-positive patients is unknown, and it is unclear whether the clinical presentation differs between patients positive for PLA
R1-Ab or THSD7A-Ab. We screened serum samples of 1276 patients with MN from three different cohorts for the presence of THSD7A-Ab by Western blot analysis and a newly developed indirect immunofluorescence test (IFT). Compared with Western blot analysis, the IFT had a 92% sensitivity and a 100% specificity. The prevalence of THSD7A-associated MN in a prospective cohort of 345 patients with MN was 2.6%, and most were women. In this cohort, the percentage of patients with THSD7A-associated MN and malignant disease significantly exceeded that of patients with PLA
R1-associated MN and malignant disease. In all cohorts, we identified 40 patients with THSD7A-associated MN, eight of whom developed a malignancy within a median time of 3 months from diagnosis of MN. In one patient with THSD7A-associated MN and metastases of an endometrial carcinoma, immunohistochemistry showed THSD7A expression on the metastatic cells and within follicular dendritic cells of the metastasis-infiltrated lymph node. We conclude that the IFT allows sensitive and specific measurement of circulating THSD7A-Ab in patients with MN. Patients with THSD7A-associated MN differ in their clinical characteristics from patients with PLA
R1-associated MN, and more intensive screening for the presence of malignancies may be warranted in those with THSD7A-associated MN.
Abstract
Background
Matching between undergraduate students and their chosen specialty has implications for their personal job satisfaction and performance as well as societies’ needs regarding ...health care quality. Knowledge regarding student-specialty fit can help improve students’ decisions and detect potential deficiencies in specific competences. In this study, we compare self-assessed competence profiles of medical students close to graduation with the competence profiles of their specialty of choice for postgraduate training.
Methods
Self-assessed competence profiles were collected with the modified requirement-tracking (R-Track) questionnaire from 197 final-year medical students close to graduation in 2022. To determine student-specialty fit, difference scores between students’ self-assessed competences and physicians’ requirements for specific specialties were calculated across the R-Track’s six competence areas “Motivation”, “Personality traits”, “Social interactive competences”, “Mental abilities”, “Psychomotor & multitasking abilities”, and “Sensory abilities”, which were assessed on a 5-point Likert scale (1: “very low” to 5: “very high”). Mean difference scores across competence areas were calculated and compared between specialties with multivariate analysis of variance. Student-specialty fit was also calculated independent of students’ choices.
Results
The competence area “Motivation” scored highest for both students and physicians across specialties. However, students’ scores were lower than physicians’ requirements for “Motivation” as well as “Personality traits” across all specialties. Difference scores for “Social interactive competences” were either close to zero or showed higher scores for students. A similar competence pattern for internal medicine, general medicine, paediatrics, and gynaecology was identified with higher than required student scores for “Mental abilities”, “Psychomotor & multitasking abilities”, and “Sensory abilities”. All other specialties showed higher physicians’ requirements for at least one of these competence areas. Independent of students’ specialty choice, we found the highest difference score in favour of student scores for general medicine (0.31) and the lowest difference score for internal medicine (-0.02).
Conclusions
Students’ competence profiles overall show better fit with person-oriented specialties. “Mental abilities”, “Psychomotor & multitasking abilities”, and “Sensory abilities” show higher requirement scores for more technique-oriented specialties. Students interested in such specialties could focus more on basic skill development in undergraduate training or will develop specific skills during residency.
Different guidelines and frameworks like the CanMEDs model or entrustable professional activities (EPAs) describe competencies required for successful and professional work of residents. Not all ...competencies are of equal importance for graduates when they start their residency. The aim of this study was to evaluate the relevance of different competencies for a first year resident from the perspective of physicians and medical students.
In an online study, 178 of 475 surgeons and internists including residents and attendings and 102 of 728 first and last year undergraduate medical students from the University Medical Center Hamburg-Eppendorf ranked 25 competencies according to their relevance for entrustment decisions in first year residents. The rankings of the competencies by residents and attendings and by first year and last year medical student were compared. Additionally, the rankings were also compared to the literature.
Physicians and medical students rated 'Responsibility' as the most important competency for first year residents. Physicians ranked 'Teamwork and collegiality' and 'Structure, work planning and priorities' within the top 10 competencies significantly higher than medical students. The competency ranks between attendings and residents only showed one significant difference between attendings and residents, where 'Coping with mistakes', was ranked significantly higher by residents. Medical students ranked 'Active listening to patients', 'Advising patients' and 'Handling emotions of patients and their relatives' significantly higher than physicians. Final year students ranked 'Structure, work planning and priorities', 'Coping with mistakes', and 'Verbal communication with colleagues and supervisors' significantly higher than first year students.
Even though physicians and medical students agree that 'Responsibility' is the most important competency for entrustment decisions in the first year of residency, medical students rate competencies regarding patient communication very highly while physicians rate competencies required for patient managements significantly higher for entrustment decision. Undergraduate medical curricula seem to prepare students well with respect to patient-centeredness but need to be developed more specifically to prepare students equally well for patient management competencies which are required in the first year of residency for entrustment decisions from the attendings perspective.
Highlights • Our cohort study revealed severe communication deficiencies at graduation. • Inappropriate history taking and communication skills causing costs became evident. • Individual ...communication deficiencies could barely be eliminated over time. • Patient-centeredness and empathy were rather low at graduation. • Graduates are inadequately prepared for clinical practice regarding communication.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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