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      Evaluation of the current status of Rehabilitation, Physical Medicine and Naturopathy education 10 years after the reform of the Medical Licensure Act – a nationwide survey of German Medical Universities Translated title: Der Unterricht für Medizinstudierende in Rehabilitation, Physikalischer Medizin und Naturheilverfahren – eine deutschlandweite Bestandsaufnahme 10 Jahre nach Reform der ärztlichen Approbationsordnung

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          Abstract

          Introduction: After the reform of the German Medical Licensure Act of 2003, Rehabilitation, Naturopathy and Physical Medicine were integrated into one discipline to be taught in Medical University. The aim of this survey is to determine the outcome of this change by evaluating the current status of education of these three disciplines based on the experience and satisfaction reported by lecturers responsible for teaching these subjects to medical students.

          Methods: A questionnaire-based survey. A paper version of the questionnaire for each discipline was posted to each Medical University in Germany. The first part asked about the current status of teaching; the second part asked about facilities and requirements; the third part asked respondents to give information on their career and teaching experience in this subject

          Results: The response rate was 51.5% for Rehabilitation, 48.5% for Physical Medicine and 60.6% for Naturopathy. A vast range of people and faculties were involved in the curricula. The percentage of each discipline taught was unevenly distributed: the major proportion being rehabilitation (38%), then naturopathy 34% lastly physical medicine with less than a third (28%). The main delivery of these disciplines was through lectures in plenary sessions. Modern teaching methods were not in evidence. Lecturers were generally pleased to be working with the combination of the three disciplines.

          Conclusion: Future medical education should improve upon teaching coordination and aim towards a common curriculum for these three disciplines. Expected future changes to medical curricula will provide opportunities to improve the implementation of Rehabilitation, Physical Medicine and Naturopathy in teaching and research.

          Zusammenfassung

          Zielsetzung: Seit der Änderung der Approbationsordnung für Ärzte im Jahr 2003 sind Rehabilitation, Physikalische Medizin und Naturheilverfahren verpflichtende Fächer für Medizinstudierende in Deutschland, die in einen Querschnittsbereich zusammengefasst sind (QB12). Ziel der Studie war es, die Organisation des QB12 und die Erfahrungen der Verantwortlichen aller drei Themenbereiche an den Fakultäten zu evaluieren.

          Methodik: Es wurde ein Fragebogen erstellt und per Post an alle 37 medizinischen Fakultäten in Deutschland gesendet. Er sollte von allen Verantwortlichen für den QB12 ausgefüllt werden. Der erste Teil des Fragebogens enthielt Fragen zu Zuständigkeiten, Umfang und Format der Lehre, Organisation, Curriculum, Themenschwerpunkte und Zufriedenheit mit der Lehre. Im zweiten Teil der Umfrage wurde nach den Einschätzungen und Aussichten, der Ausstattung und dem Bedarf an Lehrmitteln und –personal gefragt. Am Schluss sollten die Verantwortlichen Informationen über ihre berufliche Situation, die Lehrerfahrung und Zusatzqualifikationen geben.

          Ergebnisse: Die Rücklaufquote der Fragebogen betrug für Rehabilitation 51,5%, für Physikalische Medizin 48,5% und für Naturheilverfahren 60,6%. Sehr unterschiedliche universitäre Einrichtungen waren für die Lehre im QB12 verantwortlich. Das Vorhandensein von Curricula wurde für Rehabilitation in 38%, für Physikalische Medizin in 28% und Naturheilverfahren in 34 % angegeben. Die Art des Unterrichts reichte von Vorlesung bis Exkursion, problemorientiertes Lernen wurde nicht angeboten. Die Kosten für die Lehre wurden in 45% voll von den Universitäten übernommen. Die Lehrenden zeigten sich mehrheitlich zufrieden mit der Lehrsituation. Der Hauptbedarf wurde für mehr Unterstützung in der Organisation angegeben.

          Schlussfolgerung: Die Heterogenität in der Lehre und der beteiligten Institutionen lässt vermuten, dass sich das Wissen der Medizinstudierenden in Rehabilitation, Physikalischer Medizin und Naturheilverfahren an den Universitäten in Deutschland erheblich unterscheidet. Die Koordination der Lehre sollte verbessert und Curricula vereinheitlicht werden.

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          Integration of Complementary and Alternative Medicine into Family Practices in Germany: Results of a National Survey

          More than two-thirds of patients in Germany use complementary and alternative medicine (CAM) provided either by physicians or non-medical practitioners (“Heilpraktiker”). There is little information about the number of family physicians (FPs) providing CAM. Given the widespread public interest in the use of CAM, this study aimed to ascertain the use of and attitude toward CAM among FPs in Germany. A postal questionnaire developed based on qualitatively derived data was sent to 3000 randomly selected FPs in Germany. A reminder letter including a postcard (containing a single question about CAM use in practice and reasons for non-particpation in the survey) was sent to all FPs who had not returned the questionnaire. Of the 3000 FPs, 1027 (34%) returned the questionnaire and 444 (15%) returned the postcard. Altogether, 886 of the 1471 responding FPs (60%) reported using CAM in their practice. A positive attitude toward CAM was indicated by 503 FPs (55%), a rather negative attitude by 127 FPs (14%). Chirotherapy, relaxation and neural therapy were rated as most beneficial CAM therapies by FPs, whereas neural therapy, phytotherapy and acupuncture were the most commonly used therapies in German family practices. This survey clearly demonstrates that CAM is highly valued by many FPs and is already making a substantial contribution to first-contact primary care in Germany. Therefore, education and research about CAM should be increased. Furthermore, with the provision of CAM by FPs, the role of non-medical CAM practitioners within the German healthcare system is to be questioned.
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            Implementation of palliative care as a mandatory cross-disciplinary subject (QB13) at the Medical Faculty of the Heinrich-Heine-University Düsseldorf, Germany

            Background: By means of the revision of the Medical Licensure Act for Physicians (ÄAppO) in 2009, undergraduate palliative care education (UPCE) was incorporated as a mandatory cross sectional examination subject (QB13) in medical education in Germany. Its implementation still constitutes a major challenge for German medical faculties. There is a discrepancy between limited university resources and limited patient availabilities and high numbers of medical students. Apart from teaching theoretical knowledge and skills, palliative care education is faced with the particular challenge of imparting a professional and adequate attitude towards incurably ill and dying patients and their relatives. Project description: Against this background, an evidence-based longitudinal UPCE curriculum was systematically developed following Kern’s Cycle [1] and partly implemented and evaluated by the students participating in the pilot project. Innovative teaching methods (virtual standardised/simulated patient contacts, e-learning courses, interdisciplinary and interprofessional collaborative teaching, and group sessions for reflective self-development) aim at teaching palliative care-related core competencies within the clinical context and on an interdisciplinary and interprofessional basis. Results: After almost five years of development and evaluation, the UPCE curriculum comprises 60 teaching units and is being fully implemented and taught for the first time in the winter semester 2014/15. The previous pilot phases were successfully concluded. To date, the pilot phases (n=26), the subproject “E-learning in palliative care” (n=518) and the blended-learning elective course “Communication with dying patients” (n=12) have been successfully evaluated. Conclusion: All conducted development steps and all developed programmes are available for other palliative care educators (Open Access). The integrated teaching formats and methods (video, e-learning module, interprofessional education, group sessions for reflexive self-development) and their evaluations are intended to make a contribution to an evidence-based development of palliative care curricula in Germany.
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              Dangerous combinations: Ingestible CAM supplement use during chemotherapy in patients with ovarian cancer.

              Some ingestible complementary and alternative medicine (CAM) supplements, including herbal remedies, teas, and vitamins, have biological activities that make them likely to interact poorly with conventional chemotherapeutic treatments. This study surveyed women with ovarian cancer to document the extent to which women use ingestible CAM supplements and conventional chemotherapeutic treatments that are believed to be of potential concern when used together. A total of 219 patients with ovarian cancer who received care from 1 of 2 participating conventional oncology practices were surveyed about CAM use during and after ovarian cancer treatment. A total of 200 women reported having chemotherapy to treat their ovarian cancer. Of those, 79 (40%) reported using 1 or more CAM supplements that could be cause for concern when taken with 1 or more of the chemotherapy medications they were receiving. Many patients took multiple supplements of potential concern. Of these women, 42% (n=33) consulted with a conventional provider and 24% (n=19) consulted with a CAM provider about the contraindicated supplements they used. Although it is not clear that any of these contraindicated combinations of CAM and conventional therapy actually caused adverse outcomes, increased toxicities, or reduced the effectiveness of primary therapies, all these effects are possible given the substances being used in combination. Research is needed to understand the real risk associated with CAM and conventional polypharmacy. If risks associated with CAM use prove substantial, then improved systems to assure that all women get advice regarding supplement use during ovarian cancer treatment will be needed.
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                Author and article information

                Journal
                GMS J Med Educ
                GMS J Med Educ
                GMS J Med Educ
                GMS Journal for Medical Education
                German Medical Science GMS Publishing House
                2366-5017
                15 February 2017
                2017
                : 34
                : 1
                : Doc3
                Affiliations
                [1 ]Karl and Veronica Carstens-Foundation, Essen, Germany
                [2 ]University Medical Centre Freiburg, Centre for Complementary Medicine, Institute for Environmental Health Sciences and Infection Control, Freiburg, Germany
                [3 ]University of Tuebingen, Medical Faculty, Tübingen, Germany
                [4 ]University Hospital Tuebingen, Institute for General Practice, Tübingen, Germany
                [5 ]University of Duisburg-Essen, Faculty of Medicine, Essen, Germany
                [6 ]Kliniken Essen-Mitte, Department of Internal and Integrative Medicine, Essen, Germany
                Author notes
                *To whom correspondence should be addressed: Beate Stock-Schröer, Karl and Veronica Carstens-Foundation, Am Deimelsberg 36, 45276 D-Essen, Germany, E-mail: b.stock.schroeer@ 123456carstens-stiftung.de
                Article
                zma001080 Doc3 urn:nbn:de:0183-zma0010806
                10.3205/zma001080
                5327655
                28293670
                30005758-74db-45d7-8049-146f5710b846
                Copyright © 2017 Stock-Schröer et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

                History
                : 29 April 2016
                : 15 December 2016
                : 12 December 2016
                Categories
                Article

                cross sectional area qb 12,rehabilitation medicine,physical medicine,naturopathy,evaluation,survey,teaching

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