Nadjas Prüfung (German Edition)

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The students fear that the time on the ward might be too tight to sufficiently incorporate all of the foundations of the later medical profession. The students are afraid that they might be supervised too infrequently by their medical teachers, and therefore be left to their own devices if problems arise during their internships. The students worry that deficiencies might arise in terms of their integration into the ward team and into the daily routine on the ward. The students fear that they might be professionally under- or over-burdened during their internship due to their prior knowledge not being adequately taken into account.

The students are afraid that their personal insecurity might lead to learning deficits and shortcomings in dealing with patients. The students are concerned that physicians might treat them unfairly because of their insecurity and lack of competence or humiliate them in the presence of the patients. The students are concerned that boredom and periods without clearly defined and useful tasks might arise during their internship.

The students worry that the training groups on the ward may be too large, leading to a disregard for individual care and supervision. The students fear poor organization and coordination of their ward internship, leading to an inadequate integration into the ward team and insufficient supervision.

The students are worried that they might be psychologically unprepared for the demands of their clinical training, and might therefore be overburdened. The students fear that their direct contact with the patients might be insufficient. The students fear that during their internship, there might be a lack of regard for the dignity, privacy and wellbeing of the patients.

The results presented in our study clearly show that during their internal medicine rotation, students primarily wish to be integrated into the ward team and to be trained by motivated and reliable medical supervisors who accompany them continuously throughout their whole internship. The supervisors should support the students and deal with their uncertainties. In the course of this, the students would like to be trained in small groups.

Furthermore, they wish to learn about the most common diseases, to gather practical clinical experience and to train all of the most important and basic clinical skills. Last but not least, students wish to assume real responsibility for patients and clinical procedures, allowing them to gradually develop their own identity as future physicians. The students are concerned that the time frame for their internship will be too narrow, that they will have too little patient contact and insufficient medical supervision. They are worried about not being adequately integrated into the ward team, about a possibly inflexible organization of their internship, and about being professionally over- or under-burdened, and are afraid of generally feeling unprepared for their whole clinical training.

The presented findings are broadly in line with those of Schrauth et al. The timing of the internship and the level of training the number of semesters completed therefore appear to have little influence on the students' expectations and concerns about their internship even though, in the daily hospital routine, the differing level of medical education requires a differing degree of supervision by the medical teachers, and a differing extent of patient care is to be realized.

Students from both study populations wish in particular for reliable and continuous medical supervision and a positive relationship with their medical supervisor. It has already been shown that the prerequisites for high-quality medical guidance and supervision are usually not given due to the condensed workflows on the ward and the heavy workload of the supervising physicians.

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There is little time available and the internship in general proceeds with little structure or standardization [ 30 ], [ 31 ], [ 37 ]. The students are more likely to receive their feedback from junior physicians than from clinically experienced specialists [ 29 ], [ 37 ], [ 40 ]. For the development and standardization of effective student internships in medical education, the greatest relevance should be attributed to medical guidance, supervision and feedback, meaning a significant increase in staff and costs.

Based on the recommendations listed above, it can be concluded that the following general conditions should be in place: There is a need for a reasonable and well-structured time period for providing supervision. The elaboration of guidelines on the basis of solid didactical concepts coupled with clearly defined learning objectives should be given greater focus.

In this respect, it is necessary to appropriately integrate the learning objectives for the acquisition and training of clinical skills. Furthermore, the introduction of open communication about errors and guidance on dealing with difficult patients is essential. This would be an important contribution to the currently called for improvement of patient safety and to the development of a workplace culture which encourages young physicians to report on problems of patient care [ 1 ]. To this aim, it would be extremely desirable for medical supervisors to receive social skills training.

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A further area for student internships that should be promoted is the development of longitudinal care of patients by the students. In this way, the students are able to learn continuously at their future workplace, which, as mentioned at the outset, is of decisive importance in medical education. Didactic approaches like clinical education wards for final year students can provide directional impetus in this regard [ 23 ], [ 27 ], [ 32 ], [ 39 ].

Preparation courses for the student internships or clinical training programs held in parallel to the ward internship might complement the regular internship [ 20 ]. Potential difficulties in this respect can be targeted in advance, thus saving resources. Moreover peer-assisted learning programs with student tutors [ 18 ] who accompany students during their internships might represent a specific and economical implementation of the guidelines presented above.

Furthermore, interventions by specially trained external medical staff have been shown to be promising [ 7 ], enabling supervising physicians to be relieved of parts of their daily clinical duties.

In this context, the wish expressed by many students to be appropriately integrated into the ward team could be accomplished here if medical staff and nursing staff participate together at an introductory meeting with the students. In methodological terms, there are several limitations to this study: In terms of the selection of students who took part in the focus group interviews, it should be mentioned that predominantly females participated, possibly leading to a selection bias due to the voluntary nature of participation.

Moreover, as the allocation to the focus groups was oriented to the principle of convenience sampling, the focus groups were practical and efficient to implement. The participants possess the knowledge which the researchers need, the ability to reflect, time for the research, and willingness to participate. These criteria would not have been met if participation had been mandatory. The focus group interviews were conducted according to the concept of theoretical saturation [ 4 ], [ 9 ], [ 26 ], meaning that focus groups were conducted until no new findings could be expected through further interviews.

This implies that regardless of the quantity, all contributions — including those of the male participants — were sufficiently recorded. However, in the context of qualitative studies, the proper and desirable intention is to depict excerpts of subjective and therefore limited perception. Another limiting aspect is the delay with which the focus group analysis was published, as different responses in the interviews might have arisen at the current time point. However, with regard to the general conditions of internships for students and faculty today, little has changed in the interim.

The findings presented here and the derived guidelines regarding the relevance of quality and continuity of supervision by medical teachers, the significance of defined learning objectives on the ward, the importance of early transfer of responsibility to the students, and the benefit of appropriate integration of the students into the ward teams, can all make a significant contribution to developing student ward internships which have the best possible learning outcome and provide medical students with the optimum preparation for their future work. Further research efforts should focus on the differential acceptance and effectiveness of different teaching formats for student training on the ward.

National Center for Biotechnology Information , U. Published online Nov You are free to copy, distribute and transmit the work, provided the original author and source are credited. This article has been cited by other articles in PMC. Workplace learning, undergraduate medical education, clinical training, focus groups, grounded theory.

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Introduction Learning on the job within medical education is of crucial importance for future physicians. Open in a separate window.

Accompanying internal medicine curriculum Besides their training on the ward, the students attended lectures, interactive small group seminars on various internal medicine disciplines and lessons in problem-based learning [ 11 ], skills-lab training [ 21 ], [ 22 ] as well as communication training with standardized patients [ 34 ]. Focus group interviews The aim of the focus group interviews was to shed light on the personal perception, judgment and experience of students with regard to the upcoming clinical internship in internal medicine with as wide a range as possible [ 13 ], [ 25 ].

The discussions were recorded and subsequently transcribed. Results Main categories and topics Within the structured focus group discussions, we detected a total of relevant individual statements. From these individual statements, three main categories were derived: Professionalism in patient management Definition: Availability of a reliable supervisor Definition: Small training groups on the ward Definition: Motivated teachers and motivated students Definition: Consideration for the patient Definition: Independent patient care from admission to discharge, assuming medical tasks which correspond to their level of medical education Definition: Effective and flexible organization and coordination of the internship Definition: Knowledge of the most important diseases in internal medicine Definition: Interpreting clinical findings, recognizing pathologies and making differential diagnoses Definition: Acquisition of basic medical skills Definition: Confidence in dealing with patients Definition: Developing self-confidence and identity as a physician Definition: Limited time frame Definition: Insufficient supervision by medical teachers Definition: Inadequate integration on the ward Definition: Too low or too high professional demands Definition: Uncertainty in dealing with patients Definition: Unfair and humiliating treatment by the supervising physicians Definition: Boredom and unfilled time Definition: Large training groups Definition: Poor organization and coordination of the student internship Definition: Lack of preparation and psychological preparedness for their clinical training Definition: Insufficient patient contact Definition: Lack of consideration for the patients Definition: Discussion The results presented in our study clearly show that during their internal medicine rotation, students primarily wish to be integrated into the ward team and to be trained by motivated and reliable medical supervisors who accompany them continuously throughout their whole internship.

Planning and coordinating the introduction and integration of the students on the ward e. These objectives will serve as guidelines for the medical supervisors and should cover all relevant diseases as well as the training in all major clinical skills.

Stilspringprüfung Kl.L /

Transferring responsibility to the students for treatment of patients in accordance with their current level of studies. Introducing a clearly structured time frame for the continuous medical supervision of the students with the aim of reducing the workload of the supervising physicians through successful coordination and sufficient staff. Competing interests The authors declare that they have no competing interests. Junior doctors' reflections on patient safety.

Introducing first-year medical students to clinical practice by having them "shadow" third-year clerks. The exercise of control. Corbin J, Strauss A. Procedures, Canons, and Evaluative Criteria. Effectiveness of clinical rotations as a learning environment for achieving competences.

An innovative model for the structured on-ward supervision of final year students. The effect of an extended hospital induction on perceived confidence and assessed clinical skills of newly qualified pre-registration house officers. The Discovery of Grounded Theory: Direct Observation of Students during Clerkship Rotations: A Multiyear Descriptive Study.

PBL in der medizinischen Ausbildung: Konzepte, Werkzeuge und Fallbeispiele aus dem deutschsprachigen Raum. Krueger R, Casey M. A Practical Guide for Applied Research. The transition from medical student to doctor: Write a product review. Feedback If you need help or have a question for Customer Service, contact us.

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