Aim: The classical course structure for medicine in Germany is separated by three sections of the medical state examination. This structure is generally regarded as sensible and unchangeable. Because the special program structure at Hannover Medical School (MHH) has one integrated, rather than two separate study blocks, it is possible to examine the influence of structural modifications on the study success of different admission groups. Methods: The data was obtained from students admitted to the MHH between 2006 and 2008 in different admission quotas. Study success was defined as the successful completion of the entire program, but completion of the first section of the state examination was also analysed. Results: More students from the best "Abitur" (school leaving examinations) quota successfully completed their studies than those accepted via the selection process of the universities. The latter were more successful than students from the waiting list quota. However the successful graduates of this last group completed their studies more often within the prescribed period of study, although they needed more time for completing all parts of the first section of the state examination. Conclusion: The data shows that an integrated course structure can offer, in particular, students from the waiting list quota, the opportunity to compensate for delays in the first years of study. However, they do not provide any evidence which applicants are best suited to meet the social and professional requirements of trained doctors. Due to the complex structure of such longitudinal studies, our results allow more than one plausible interpretation.

Background: Medical students are exposed to high cognitive demands as well as to a high learning effort, which as a consequence can lead to a limited quality of life (Qol) with reduced physical performance and unhealthy eating behaviors. The aim of this retrospective analysis was to evaluate the abovementioned factors and their relationship to each other. Methods: We included 380 medical students (167 men, 213 women, age 22.2 ± 3.9 yrs) who participated in the sports medicine elective subject. Qol was measured with the SF-36 questionnaire, and endurance capacity was measured by using an incremental running test. Daily dietary intake was measured using a 7-day diary protocol. Depending on sex and the maximum speed achieved, students were divided into three performance groups. Results: Men achieved higher maximal speed, heart rate, and lactate. Carbohydrates and fat intake did not meet recommendations in either group. Dietary fibre intake differed significantly between the performance groups in men and women, with the better groups having higher intakes. Conclusions: Our data do not suggest increased risk or health-damaging behaviors in medical students compared with the general population. Irrespective of this, incentives should be set to enable a healthy life even during complex studies with a high learning effort.

Background: Students’ ratings of bedside teaching courses are difficult to evaluate and to comprehend. Validated systematic analyses of influences on students’ perception and valuation of bedside teaching can serve as the basis for targeted improvements. Methods: Six hundred seventy-two observations were conducted in different surgical departments. Survey items covered the categories teacher’s performance, student’s self-perception and organizational structures. Relevant factors for the student overall rating were identified by multivariable linear regression after exclusion of variable correlations > 0.500. The main target for intervention was identified by the 15% worst overall ratings via multivariable logistic regression. Results: According to the students the success of bedside teaching depended on their active participation and the teacher’s explanations of pathophysiology. Further items are both relevant to the overall rating and a possible negative perception of the session. In comparison, negative perception of courses (worst 15%) is influenced by fewer variables than overall rating. Variables that appear in both calculations show slight differences in their weighing for their respective endpoints. Conclusion: Relevant factors for overall rating and negative perception in bedside teaching can be identified by regression analyses of survey data. Analyses provide the basis for targeted improvement.

Aim: The subject-based model curriculum at the Hannover Medical School (MHH) is characterized by two major features: early and continuous contact with patients and the interconnection of theoretical and clinical content. The progressive adaptations to the internal medicine curriculum which is taught longitudinally over five years are presented. Methods: Looking back on 17 years of experience with our model curriculum and the events leading to its inception, we summarize the challenges and subsequent modifications to the longitudinal internal medicine curriculum. Some of these challenges are likely to occur in other subjects and can therefore be generalized. Results: Integrating preclinical and clinical content was more resource intensive than thought and unexpectedly led to capacity problems since the German courts ruled that the presence of more teachers brought with it an obligation to enroll more students. In response to this, teaching responsibilities were extended to both outpatient facilities and academic teaching hospitals. Major changes included a more even distribution of clinical content in the first year, a rigorous standardization of teaching content in clinical skills, increased adaptation of content to reflect prior knowledge in the third and fourth years, and a focus on clinical reasoning in the fifth year. Restructuring the academic year into three ten-week blocks (two in the winter term and one in the summer term) allowed the retention of small groups. Conclusion: These measures rely heavily on considering teaching responsibilities within rotation plans, curriculum development and continuous faculty engagement. Since teachers are not sufficiently familiar with the distinctions between teaching formats, they mostly consider how far students have advanced in their studies when choosing course content. This implies that the current nomenclature requires improvement.

In Objective Structured Clinical Examinations (OSCE), students have to demonstrate proficiency in a wide array of medical knowledge and different skills, ranging from physical examinations to medical-practical skills and doctor-patient interactions. In this study, we empirically test the concept ‘assessment drives learning’ and investigate whether an OSCE motivates extracurricular, voluntary free practice (FP) of specific skills in a Skills Lab, and whether this has positive treatment effects on exam success in the respective parts of the OSCE. To explore causal inference with observational data, we used Propensity Score Matching (PSM) to generate a control and a treatment group that only differed in their practice behavior. For internal examinations and practical skills such as venous catheter placement and IM injections, we find strong, positive effects of FP that can result in a grade-jump. We further show that the presence and strength of effects depends on the complexity and type of the task. For instance, we find no effect for practicing venipuncture, and performance in communicative skills is associated with the willingness to repeatedly engage with instructional contents inside and outside the Skills Lab, and not with targeted practice of specific skills. We conclude that the anticipation of the complex OSCE is effective in motivating students to engage with a wide range of competencies crucial to the medical profession, and that this engagement has positive effects on exam success. However, consistent practice throughout the study program is necessary to sustain and nurture the acquired skills.