Hendrik van Den Bussche

Background: Final-year undergraduate medical students often do not feel well prepared for their start of residency training. Self-assessment of competences is important so that medical trainees can take responsibility for their learning. In this study, we investigated how final-year medical students self-assessed their competences as they neared their transition to postgraduate training. The aim was to identify areas for improvement in undergraduate training. Methods: In the academic year 2019/2020, a national online survey was sent to final-year undergraduate medical students via their respective medical schools. The survey included ten facets of competence (FOC) most relevant for beginning residents. The participants were asked to self-assess their competence for each FOC on a 5-point Likert scale (1: strongly disagree to 5: strongly agree). We established an order of self-assessed FOC performance by means and calculated paired t-tests. Gender differences were assessed with independent t-tests. Results: A total of 1083 students from 35 medical schools completed the questionnaire. Mean age was 27.2 ± 3.1 years and 65.8% were female. Students rated their performance highest in the FOCs ‘Teamwork and collegiality’ and ‘Empathy and openness’ (97.1 and 95.0% ‘strongly agree’ or ‘agree’, respectively) and lowest in ‘Verbal communication with colleagues and supervisors’ and ‘Scientifically and empirically grounded method of working’ (22.8 and 40.2% ‘strongly disagree’, ‘disagree’, or ‘neither agree nor disagree’, respectively). Women rated their performance of ‘Teamwork and collegiality’, ‘Empathy and openness’, and ‘Knowing and maintaining own personal bounds and possibilities’ significantly higher than men did (Cohen’s d > .2), while men showed higher self-assessed performance in ‘Scientifically and empirically grounded method of working’ than women (Cohen’s d = .38). The FOCs ‘Responsibility’, ‘Knowing and maintaining own personal bounds and possibilities’, ‘Structure, work planning, and priorities’, ‘Coping with mistakes’, and ‘Scientifically and empirically grounded method of working’ revealed lower self-assessed performance than the order of FOC relevance established by physicians for beginning residents. Conclusions: The differences between the level of students’ self-assessed FOC performance and physicians’ ranking of FOC relevance revealed areas for improvement in undergraduate medical education related to health system sciences. Final-year students might benefit from additional or better training in management skills, professionalism, and evidence-based medicine. Surveys of self-assessed competences may be useful to monitor competence development during undergraduate training.

This study aimed to examine the association of alcohol and tobacco use with severity of depression in older age. Analyses were performed on a pooled data set (n = 3724) from two German old-age cohort studies (LEILA 75+, 6 follow-ups and AgeCoDe/AgeQualiDe, 9 follow-ups). Depressive symptoms were assessed via two screening scales for depression (CES-D and GDS-15) which were harmonized for pooled analysis. A mixed-effects linear regression model for the total sample and additional stratified models for men and women were used. Smoking at baseline was significantly associated with a higher level of depression severity (β = 0.142, 95% CI: 0.051–0.233, p = 0.002), whereas drinking was significantly associated with a decreased level of depression (β = −0.069, 95% CI: −0.119–−0.021, p = 0.005). Concurrent substance use at baseline increased longitudinal depression severity (β = 0.193, 95% CI: 0.011–0.375, p = 0.037). Analyses stratified by gender showed a significant inverse association between drinking and depressive symptoms in men (β = −0.138, 95% CI: −0.231–−0.045, p = 0.004), but not in women (β = −0.060, 95% CI: −0.120–0.001, p = 0.052). Given the burden of major depression, it is important that health care providers, especially primary care physicians, assess and monitor lifestyle factors, even at older ages.

Ziel Es werden die Ergebnisse der KarMed-Studie für die Fachdisziplinen der Inneren Medizin nach 6-jähriger Weiterbildung dargestellt. Untersucht wurde, wie viele Ärztinnen und Ärzte die Innere Medizin für ihre Weiterbildung auswählten und wie sich dieses Sample über die weiteren 6 Untersuchungsjahre entwickelte. Zudem wurde geprüft, ob die Weiterbildung mit sich verändernden Präferenzen bezüglich des künftigen Versorgungssektors und der Arbeitszeit einhergeht und wie sich Innere Medizin mit und ohne Schwerpunkt unterscheiden. Einen Schwerpunkt der Untersuchung bildet die geschlechtsspezifische Betrachtung. Methodik Die KarMed-Studie basiert auf den jährlichen postalischen Befragungen einer Kohorte von PJ-Studierenden des Jahrgangs 2008/09 (n=1012), die gegen Ende des Studiums und bis 6 Jahre danach während der Weiterbildung befragt wurde. Es wurden eine explorative Datenanalyse mit deskriptiven statistischen Methoden und logistische Regressionen durchgeführt. Ergebnisse Die Untersuchung zeigt, dass die Innere Medizin eine gefragte medizinische Fachrichtung ist. Allerdings verschiebt sich im Verlauf der 6 Weiterbildungsjahre die Attraktivität von den Schwerpunktdisziplinen zur Inneren Medizin ohne Schwerpunkt, v. a. bei den Ärzten. Die Attraktivität der Inneren Medizin ohne Schwerpunkt ist – unabhängig von dieser zeitlichen Entwicklung – v. a. bei Ärztinnen gegeben, die nach der fachärztlichen Anerkennung in Teilzeit arbeiten möchten. Schlussfolgerungen Die Innere Medizin in Deutschland ist nach wie vor die am meisten gewählte fachärztliche Richtung. Zugleich sinkt der Anteil der zukünftigen Internistinnen und Internisten, der nach der fachärztlichen Anerkennung im Krankenhaus arbeiten möchte. Dies gilt es bei der Personalplanung in den Krankenhäusern zu beachten und hier auch die abnehmende Attraktivität der Spezialdisziplinen in dieser Fachrichtung zu berücksichtigen. Objective The aim of the present study was to examine the number of physicians who chose internal medicine for their postgraduate training, their development over the 6-year period of training and whether there were changes in their preferences regarding future work sector and working hours, with a focus on gender-specific differences. Methodology Annual postal surveys were conducted of a cohort of undergraduate students (N=1.012) in their final year of study 2008/09, and during the six years of their postgraduate training. Descriptive statistics were used for analysis. Results The study showed that internal medicine was a sought-after medical discipline, which recruited up to 25% of medical graduates. However, over the course of the six years of postgraduate training, the attractiveness shifted from the specialized sub-disciplines of internal medicine to general internal medicine, especially among male physicians. General internal medicine was particularly attractive to female physicians who intended to work part-time after completion of their specialization. Conclusions Internal medicine in Germany is still the most frequently chosen field of specialization. However, the proportion of physicians intending to work ina hospital after specialization is decreasing. This fact, together with the decreasing attractiveness of sub-disciplines in this field, must be taken into account when planning the staff in hospitals.

In Germany there is a threat of a shortage of junior general practitioners (GPs). One third of currently employed GPs are 60 years and older. Every year, 1700 GPs leave the profession, while only about 1350 new GP-specialist approvals are issued. The Advisory Council on the Assessment of Developments in the Health Care Sector estimates that there will be around 20,000 unmet replacement needs by 2025. By 2017, 2600 GP seats were already vacant.Based on the results of the KarMed study, this paper examines the questions as to how many residents intend to become general practitioners after graduation and how they develop during postgraduate training. Furthermore, the consequences of the increasing proportion of female physicians in primary care in terms of the possible volume of work will be investigated. Finally, measures that could reduce a possible personnel shortage are discussed.The attractiveness of general practice has increased considerably during residency over the last six years of observation. The preference for GP work is linked to parenthood. More female doctors strive for part-time work and an employment contract instead of a private practice. On this basis, it can be estimated that the volume of work performed by these female GPs will be half that of the traditional (male) working model in private practice.The forecasted numbers of new recruits are unlikely to be sufficient to cover the demand for GP care in Germany. Possible effective measures would be, for example, the introduction of a gatekeeper system, creation of multi-professional centers, a quota system for access to postgraduate training of specialists, a reformed national planning of GP supply in the country, and a shortening and flexibilization of postgraduate training for general practice.

Zusammenfassung: Zielsetzung In diesem Aufsatz wird untersucht, wie lange die ärztliche Weiterbildung tatsächlich dauert, welche Gründe bei einer Überschreitung der vorgeschriebenen Mindestzeiten eine Rolle spielen und wie hoch die Unterbrecherquote bzw. die Abbruchquote ist. Methodik Multizentrische jährliche postalische Befragung des PJ-Jahrganges 2008/09 von 7 deutschen medizinischen Fakultäten. Für die Analysen wurden deskriptive Statistiken verwendet. Ergebnisse Mehr als die Hälfte der Ärzte und Ärztinnen in Weiterbildung (58 %) gab im 5. Jahr der Weiterbildung an, für den Abschluss (deutlich) länger als die als Mindestdauer vorgeschriebene Zeit zu brauchen. Bei Ärztinnen (65 %) war dieser Anteil höher als bei Ärzten (43 %), bei Ärztinnen mit Kind erreichte er mit ca. 91 % den höchsten Wert. Ärztinnen, die eine vermutliche Verlängerung voraussahen, schätzten diesen Zeitraum im Mittel auf 19,6 Monate (SD = 14,7), Ärzte auf 11,5 Monate (SD = 8,6).Bei Ärztinnen spielte der Faktor Kind/Eltern die wichtigste Rolle. Die Hälfte aller Angaben der Ärzte (und 31 % der Ärztinnen) beziehen sich auf organisatorische und curriculare Probleme der Weiterbildung. Schlussfolgerung Es ist einerseits erforderlich, Maßnahmen zu ergreifen, um die Erschwernisse der Weiterführung der Weiterbildung im Zusammenhang mit Elternwerden zu minimieren bzw. eine Wiederaufnahme der Berufstätigkeit zu erleichtern. Hierzu sollten curriculare und organisatorische Maßnahmen, beispielsweise verbindlichere Rotationspläne bzw. bessere Möglichkeiten der Weiterbildung in Teilzeit, implementiert werden.

Background: Evidence whether single “cognitive health” foods could prevent cognitive decline is limited. We investigated whether dietary intake of red wine, white wine, coffee, green tea, olive oil, fresh fish, fruits and vegetables, red meat and sausages, assessed by a single-food-questionnaire, would be associated with either incident Alzheimer’s dementia (AD) or verbal memory decline. Methods: Participants aged 75+ of the German Study on Aging, Cognition and Dementia in Primary Care Patients (AgeCoDe) cohort were regularly followed over 10 years (n = 2622; n = 418 incident AD cases). Multivariable-adjusted joint modeling of repeated-measures and survival analysis was used, taking gender and Apolipoprotein E4 (APOE ε4) genotype into account as possible effect modifiers. Results: Only higher red wine intake was associated with a lower incidence of AD (HR = 0.92; P = 0.045). Interestingly, this was true only for men (HR = 0.82; P < 0.001), while in women higher red wine intake was associated with a higher incidence of AD (HR = 1.15; P = 0.044), and higher white wine intake with a more pronounced memory decline over time (HR = −0.13; P = 0.052). Conclusion: We found no evidence for these single foods to be protective against cognitive decline, with the exception of red wine, which reduced the risk for AD only in men. Women could be more susceptible to detrimental effects of alcohol.

Die ärztliche Ausbildung findet an medizinischen Fakultäten der Universitäten statt. Die ärztliche Weiterbildung findet hingegen in nahezu allen Krankenhäusern statt und ist de facto eine ausschließliche Angelegenheit der Ärztekammern. Zwischen beiden Phasen – und deren Verantwortlichen – gibt es keine institutionalisierte Form der Zusammenarbeit. Die vielen Reformen der letzten Jahrzehnte betreffen ausschließlich die ärztliche Ausbildung, während die Weiterbildung ohne öffentliche Aufmerksamkeit abläuft.

Der Mangel an Ärztinnen und Ärzten in der hausärztlichen Versorgung (speziell in ländlichen Regionen) und im Öffentlichen Gesundheitswesen nimmt seit mehreren Jahrzehnten zu. Gefragt und gesucht wird nach Strategien zur Milderung dieser Probleme.