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      Initial Results of the Master's Degree Programme in "Leadership in Medicine" – Impact on hospital-based follow-on training of doctors Translated title: Erste Ergebnisse eines Weiterbildungsmasters „Führung in der Medizin“ – Auswirkungen auf die ärztliche Weiterbildung eines Krankenhauses

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          Abstract

          Objective: This pilot project, which was jointly conducted by a hospital and a university, describes the development of the Master's Degree Programme in Leadership in Medicine, a course designed to supplement medical specialty training. The aim of the pilot project is to demonstrate how hospital-based projects on personnel and organisational development undertaken under academic supervision can be used to increase leadership responsibility among doctors whose duties include providing initial and follow-on training and to professionalise medical specialty training as a leadership task. This need arose from the nationwide requirements and an internal audit regarding follow-on training. The version of the degree programme described below aims to further the personnel development of the participants in the field of didactics.

          Method: Each of the nine modules is made up of two classroom-based phases and one distance learning phase. The distance learning phase involves undertaking hospital-based projects on personnel and organisational development under academic supervision. The pilot phase participants were hospital doctors who, as part of their duties, hold leadership responsibility or are involved in the follow-on training of doctors.

          Results: The 17 participants successfully implemented more than 30 hospital-based projects during the distance learning phases of the nine modules. These projects included the development of medical specialty curricula, relevant didactic methods and evaluation design and were subsequently presented and subjected to reflection in interdisciplinary groups. The project presentation together with the project report were regarded as proof of competency.

          Conclusion: In addition to enhancing participant competency, the degree model described, which interlinks theory and practice, promotes organisational development through the implementation of projects undertaken under academic supervision. This has a double impact on the quality of medical follow-on training at the hospital where the participant is based, for not only is the individual's didactic competency enhanced, but so is the "learning organisation" as a whole as a result of continuous project orientation.

          Zusammenfassung

          Zielsetzung: Das vorliegende Pilotprojekt eines Krankenhauses und einer Hochschule beschreibt die Entwicklung eines die Facharztweiterbildung ergänzenden Weiterbildungsmasters „Führung in der Medizin“ (M-FIM). Es soll zeigen, wie durch wissenschaftlich begleitete Projekte zur Personal- und Organisationsentwicklung einer medizinischen Einrichtung die Führungsverantwortung von Aus- und Weiterbildern gestärkt und die Facharztweiterbildung als Führungsaufgabe professionalisiert werden kann. Die Notwendigkeit dazu ergab sich aus den bundesweiten Vorgaben und der hauseigenen Evaluation zur Weiterbildung. In der hier beschriebenen Studiengangsvariante wird eine didaktische Personalentwicklung der Teilnehmenden angestrebt.

          Methodik: Jedes der 9 Studienmodule besteht aus zwei Präsenz- und einer Fernlernphase. In dieser werden Projekte zur Personal- und Organisationsentwicklung innerhalb des Krankenhauses erarbeitet und wissenschaftlich begleitet. Die Teilnehmer der Pilotphase rekrutierten sich aus Ärzten des Krankenhauses, die im Rahmen ihrer Tätigkeit Führungsverantwortung oder Aufgaben in der ärztlichen Weiterbildung wahrnehmen.

          Ergebnisse: Von den 17 Teilnehmern konnten während der Fernlernphasen der 9 Module mehr als 30 Projekte im Krankenhaus umgesetzt werden. Es wurden unter anderem Facharztcurricula, entsprechende didaktische Methoden und Evaluationsdesigns entwickelt, in der interdisziplinären Gruppe präsentiert und reflektiert. Als Kompetenznachweis dienen dabei die Projektpräsentation und ein Projektbericht.

          Schlussfolgerung: Das dargestellte Studienmodell der Theorie-Praxis-Verzahnung fördert neben dem Kompetenzzuwachs der Teilnehmenden über das wissenschaftlich begleitete Arbeiten die Organisationsentwicklung durch die erarbeiteten Projekte. Dies hat doppelten Einfluss auf die Qualität der ärztlichen Weiterbildung der entsendenden Einrichtung. Denn es wird nicht nur die didaktische Kompetenz des einzelnen gestärkt, sondern durch den kontinuierlichen Projektbezug die „lernende Organisation“ insgesamt.

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          Introducing competency-based postgraduate medical education in the Netherlands.

          Medical boards around the world face the challenge of creating competency-based postgraduate training programs. Recent legislation requires that all postgraduate medical training programmes in The Netherlands be reformed. In this article the Dutch Advisory Board for Postgraduate Curriculum Development shares some of their experiences with guiding the design of specialist training programs, based on the Canadian Medical Educational Directives for Specialists (CanMEDS). All twenty-seven Dutch Medical Specialty Societies take three steps in designing a curriculum. First they divide the entire content of a specialty into logical units, so-called 'themes'. The second step is discussing, for each theme, for which tasks trainees have to be instructed, guided, and assessed. Finally, for each task an assessment method is chosen to focus on a limited number of CanMEDS roles. This leads to a three step training cycle: (i) based on their in-training assessment and practices, trainees will gather evidence on their development in a portfolio; (ii) this evidence stimulates the trainee and the supervisor to regularly reflect on a trainee's global development regarding the CanMEDS roles as well as on the performance in specific tasks; (iii) a personal development plan structures future learning goals and strategies. The experiences in the Netherlands are in line with international developments in postgraduate medical education and with the literature on workplace-based teaching and learning.
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            Finally finished! National Competence Based Catalogues of Learning Objectives for Undergraduate Medical Education (NKLM) and Dental Education (NKLZ) ready for trial

            Note Finally finished! Earlier this June, the National Competence Based Catalogues of Learning Objectives for Undergraduate Medical Education (NKLM) and Dental Education (NKLZ) were passed with overwhelming agreement at the annual meeting of the Association of Medical Faculties in Germany (MFT) [http://www.mft-online.de/files/pm_nklm-nklz_2015-07-27.pdf, cited 2015-08-03] after nearly six years of development. The catalogues describe the competencies students of medical or dental degrees in Germany should have acquired by the time they graduate. They were made freely available online not long ago at www.nklm.de (www.nklz.de respectively). What were the starting points for the development process? On the one hand the institute tasked with the execution of the written licensing examinations (Institut für Medizinische und Pharmazeutische Prüfungsfragen, IMPP) has long provided catalogues which list topics to be assessed via multiple choice tests. But much remained unclear. They list diseases and leading symptoms relevant for the clinical subjects but without elucidating what knowledge and which abilities a newly licensed physician should have exactly – i.e. listing diabetes without mentioning interdisciplinary tasks in secondary prevention, communication with patients and relatives, and collaboration with diabetes educators. The NKLM does not order its content by subject or organ; subjects associated with an item are considered suggestions, leaving the mapping of competencies and local departments responsible for their mediation to the individual faculties. To what extent should doctor-patient communication be mastered and in which contexts? Working in professional teams? Skills of scholarship and critical appraisal of studies? Experience in conducting research including literature searches, developing research questions and hypotheses? All this content and competencies indeed had already been identified by faculties and were being conveyed to a certain extent. Many countries already provide competence-based descriptions of medical programs - most notably Canada, the Netherlands and Switzerland. These served as reference and a basis for discussion in the development of NKLM. In 2009, the Society for Medical Education (Gesellschaft für Medizinische Ausbildung, GMA) and the Association of Medical Faculties in Germany (Medizinischer Fakultätentag, MFT) were commissioned by the Standing Conference of Ministers of Education and Cultural Affairs’s Higher Education Committee (Hochschulausschuss der Kultusministerkonferenz der Länder) to develop a competence-based catalogue of learning objectives for medicine to aid faculties in the advancement and modernization of their curricula [1]. The NKLM was to define the foundations for students moving on to postgraduate clinical education. The road to completion was longer and more complicated than originally anticipated though. 21 teams incorporating over 200 medical experts worked out a draft, then presented to a steering committee that included all major stakeholders in medical education and postgraduate training, in particular the German Medical Association (Bundesärztekammer), the National Association of Medical Students in Germany (Bundesvereinigung der Medizinstudierenden Deutschlands, bvmd), and the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen medizinischen Fachgesellschaften, AWMF). The draft was discussed and a version agreed upon which then underwent systematic revision by all scientific medical societies of the AWMF (over 160) via an online platform. Over two years, 98 societies participated in a two-step Delphi consensus process continuously improving and commenting the drafts (with over 4000 comments submitted in the first Delphi round alone). With success. Eventually, all 234 competencies and 281 sub-competencies reached strong agreement or consensus and were included in the catalogue’s final version. Just two of the proposed 1958 learning objectives that further operationalize and describe the competencies could not be agreed upon. The NKLM office at the GMA coordinated this process (with the kind support of the Robert Bosch Foundation) and compiled the catalogue’s final version in close cooperation with the MFT. Competencies and sub-competencies listed in the catalogues in their present form have the status of recommendations for medical faculties while the library of learning objectives provided will have to be trialed. It can be assumed that with time the catalogue’s volume will decrease – based on the Swiss experience, where the Swiss Catalogue of Learning Objectives’ content was reduced by 30% from the first to the revised second edition [http://sclo.smifk.ch/, cited 2015-08-04]. From IT infrastructure to concept design for competence-based assessment, challenges remain and will have to be faced. Time will show what kind of support faculties and individual teachers will need in the implementation of the NKLM. An expert group has been set up by the MFT to support this implementation process. Until 2020 the faculties’ experiences with the catalogues are to be regularly exchanged and discussed, and will give insights into what future revisions and developments should address. It will be interesting to see to what extent medical education in Germany will turn competence-based and what impact this will have on the federal government’s Master Plan 2020 on Medical Education (Masterplan Medizinstudium 2020). Published in 2014, the Science Council (Wissenschaftsrat)’s much-discussed paper on the advancement of medical education in Germany, based on experiences from reformed medical programs, prominently and repeatedly points at the NKLM as an important basis for future medical education in Germany [http://www.wissenschaftsrat.de/download/archiv/4017-14.pdf, cited 2015-08-04]. The path to completion of NKLM and NKLZ was tedious and accompanied by controversy over the desirability and feasibility of competency-based medical education. Indeed the catalogues’ implementation and real-life trials at the medical faculties will not be less arduous but point the way to the future of medical education in Germany. It is about nothing less than ensuring future doctors are trained as well as humanly possible to face the health system’s challenges and to adequately carry out their various professional roles for the benefit of their patients. Many thanks to all who contributed to the critical discussion and development of NKLM and NKLZ! Competing interests The authors declare that they have no competing interests.
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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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                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 November 2017
                2017
                : 34
                : 5 , Postgraduate education/Weiterbildung
                : Doc52
                Affiliations
                [1 ]Federal Armed Forces Hospital Hamburg, Department of General, Visceral and Thoracic Surgery, Hamburg, Germany
                [2 ]Federal Armed Forces Hospital Hamburg, Hamburg, Germany
                [3 ]Helmut Schmidt University/Bundeswehr University, Centre for Postgraduate Education, Hamburg, Germany
                [4 ]TU Dortmund University, Higher Education, Dortmund, Germany
                Author notes
                *To whom correspondence should be addressed: Chris-Henrik Wulfert, Federal Armed Forces Hospital Hamburg, Department of General, Visceral and Thoracic Surgery, Lesserstr. 180, D-22049 Hamburg, Germany, Phone: +49 (0)40/694-712833, E-mail: cwulfert@ 123456me.com
                Article
                zma001129 Doc52 urn:nbn:de:0183-zma0011291
                10.3205/zma001129
                5704609
                7a626e46-8145-4c06-befa-c9a24c7a1115
                Copyright © 2017 Wulfert 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
                : 26 September 2016
                : 26 June 2017
                : 19 May 2017
                Categories
                Article

                postgraduate medical education,competency-based education,interpersonal and communication skills,professional competency,leadership,academic training,curricula,teaching methods

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