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      The future of graduate medical education in Germany – Position paper of the committee on graduate medical education of the Society for Medical Education (GMA)

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          Abstract

          The German graduate medical education system is going through an important phase of changes. Besides the ongoing reform of the national guidelines for graduate medical education (Musterweiterbildungsordnung), other factors like societal and demographic changes, health and research policy reforms also play a central role for the future and competitiveness of graduate medical education.

          With this position paper, the committee on graduate medical education of the Society for Medical Education (GMA) would like to point out some central questions for this process and support the current discourse.

          As an interprofessional and interdisciplinary scientific society, the GMA has the resources to contribute in a meaningful way to an evidence-based and future-oriented graduate medical education strategy.

          In this position paper, we use four key questions with regards to educational goals, quality assurance, teaching competence and policy requirements to address the core issues for the future of graduate medical education in Germany. The GMA sees its task in contributing to the necessary reform processes as the only German speaking scientific society in the field of medical education.

          Translated abstract

          Die ärztliche Weiterbildung in Deutschland befindet sich im Umbruch. Neben der aktuellen Reform der Musterweiterbildungsordnung spielen gesellschaftliche, demographische, gesundheits- und forschungspolitische Faktoren eine wichtige Rolle für die Zukunft und Konkurrenzfähigkeit der ärztlichen Weiterbildung.

          Der Ausschuss für Weiterbildung der Gesellschaft für Medizinische Ausbildung (GMA) möchte mit diesem Positionspapier auf zentrale Fragen in diesem Prozess aufmerksam machen und Impulse für den aktuellen Diskurs geben.

          Dabei kann die GMA als interdisziplinäre und interprofessionelle Fachgesellschaft wichtige Beiträge zu einer evidenzbasierten und zukunftsorientierten Weiterbildungsstrategie liefern.

          Im vorliegenden Papier werden anhand von vier Leitfragen zu Weiterbildungszielen, Qualitätssicherung, Kompetenzvermittlung und gesundheitspolitischen Rahmenbedingungen die wesentlichen Punkte für die Zukunft der medizinischen Weiterbildung in Deutschland angesprochen. Die GMA sieht ihre Aufgabe darin, die Weiterbildungsreform als medizindidaktische Fachgesellschaft mit zu gestalten.

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          Most cited references 14

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          Nationaler Kompetenzbasierter Lernzielkatalog Medizin (NKLM) für Deutschland: Zusammenarbeit der Gesellschaft für Medizinische Ausbildung (GMA) und des Medizinischen Fakultätentages (MFT)

          The Framework for Qualifications of the European Higher Education Area (FQ-EHEA; Bologna Process) and the European Qualifications Framework for Lifelong Learning (EQF-LLL; Lisbon Process) are competence-driven frameworks for vocational and higher education programmes in need for defined learning objectives. In the field of medical education, The Netherlands and Switzerland have developed national catalogues for undergraduate medical training, which are competence-based and compatible with a two-cycle curriculum comprised of a Bachelor in Medicine and a Master in Medicine. In Germany, virtually all medical organizations, last not least the Association of Medical Faculties (MFT), have voted against the application of the two-cycle (and the three-cycle) curriculum to medical undergraduate education. A standstill of the European processes will not be accepted in the political arena, and a proposition was made by the Conference of German Ministers of Higher Education to develop a medical qualification framework for Germany, asking the Association for Medical Education (GMA) and the MFT to join forces. This is not possible without consented national learning objectives derived from the professional context of physicians. The GMA has teamed up with the MFT to develop National Competence-Based Learning Objectives for Undergraduate Medical Education (NKLM) in Germany (see Figure 1[img:Bild 2]) to fulfill these needs. GMS Zeitschrift für Medizinische Ausbildung; 26(3):Doc35; ISSN 1860-3572
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            Tomorrow’s Doctors: Recommendations on Undergraduate Medical Education

            (1993)
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              The effectiveness of portfolios for post-graduate assessment and education: BEME Guide No 12.

              Portfolios in post-graduate healthcare education are used to support reflective practice, deliver summative assessment, aid knowledge management processes and are seen as a key connection between learning at organisational and individual levels. This systematic review draws together the evidence on the effectiveness of portfolios across postgraduate healthcare and examines the implications of portfolios migrating from paper to an electronic medium across all professional settings. A literature search was conducted for articles describing the use of a portfolio for learning in a work or professional study environment. It was designed for high sensitivity and conducted across a wide range of published and unpublished sources relevant to professional education. No limits for study design or outcomes, country of origin or language were set. Blinded, paired quality rating was carried out, and detailed appraisal of and data extraction from included articles was managed using an online tool developed specifically for the review. Findings were discussed in-depth by the team, to identify and group pertinent themes when answering the research questions. Fifty six articles from 10 countries involving seven healthcare professions met our inclusion criteria and minimum quality threshold; mostly uncontrolled observational studies. Portfolios encouraged reflection in some groups, and facilitated engagement with learning. There was limited evidence of the influence of a number of factors on portfolio use, including ongoing support from mentors or peers, implementation method, user attitude and level of initial training. Confounding variables underlying these issues, however have not been fully investigated. A number of authors explored the reliability and validity of portfolios for summative assessment but reports of accuracy across the disparate evidence base varied. Links to competency and Quality Assurance frameworks have been demonstrated. There were conflicting reports about whether the different purposes of portfolios can be combined without compromising the meaningfulness of the contents. There was good evidence that the flexibility of the electronic format brought additional benefits to users, assessors and organisations, and encouraged more enthusiastic use. Security of data remained a high priority issue at all levels, and there was emerging evidence of successful transfer between electronic portfolio systems. The evidence base is extensive, but contains few high quality studies with generalisable messages about the effectiveness of portfolios. There is, however, good evidence that if well implemented, portfolios are effective and practical in a number of ways including increasing personal responsibility for learning and supporting professional development. Electronic versions are better at encouraging reflection and users voluntarily spend longer on them. Regular feedback from a mentor enhances this success, despite competing demands on users' time and occasional scepticism about the purpose of a portfolio. Reports of inter-rater reliability for summative assessments of portfolio data are varied and there is benefit to be gained from triangulating with other assessment methods. There was insufficient evidence to draw conclusions on how portfolios work in interdisciplinary settings.
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                Author and article information

                Journal
                GMS Z Med Ausbild
                GMS Z Med Ausbild
                GMS Z Med Ausbild
                GMS Zeitschrift für Medizinische Ausbildung
                German Medical Science GMS Publishing House
                1860-7446
                1860-3572
                15 May 2013
                2013
                : 30
                : 2
                Affiliations
                [1 ]Düsseldorf, Deutschland
                [2 ]cme web akademie GmbH, Berlin, Deutschland
                [3 ]Klinikum der LMU München, Lehrstuhl für Didaktik und Ausbildungsforschung in der Medizin, München, Deutschland
                [4 ]Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
                [5 ]Klinikum Barnim GmbH Werner Forßmann Krankenhaus, Klinik für Allgemein- Viszeral- und Gefäßchirurgie, Eberswalde, Deutschland
                [6 ]Krankenhaus Hedwigshöhe, Klinik für Allgemein- und Viszeralchirurgie, Berlin, Deutschland
                [7 ]Leipzig, Deutschland
                [8 ]Philipps-Universität Marburg, Marburg, Deutschland
                [9 ]Universitätsklinikum Ulm, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Ulm, Deutschland
                [10 ]Klinikum der LMU München, Lehrstuhl für Didaktik und Ausbildungsforschung in der Medizin, MeCuM-Mentor, München, Deutschland
                [11 ]Nervenärztliche Gemeinschaftspraxis, Nürnberg, Deutschland
                [12 ]Universitätsklinikum Freiburg, Freiburg, Deutschland
                Author notes
                *To whom correspondence should be addressed: Eckhart G. Hahn, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Deutschland, E-mail: eckhart.hahn@ 123456uk-erlangen.de
                Article
                zma000869 Doc26 urn:nbn:de:0183-zma0008696
                10.3205/zma000869
                3671322
                23737923
                Copyright © 2013 David et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by-nc-nd/3.0/). You are free to copy, distribute and transmit the work, provided the original author and source are credited.

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