Background: The German clerkship (“Famulatur”) is the first phase in medical education, in which students learn from a physician’s perspective. According to the German Licensing Regulations for Physicians, students shall “familiarise” with providing care. However, specific learning objectives for the clerkship are not defined, although the acquisition of different competencies is implicitly demanded. Therefore, an additional understanding of the clerkship students’ learning experience is needed. The goal of this study is to explore the student’s learning perspective and experiences in the clerkship. Methods: Twelve guideline-based interviews were conducted with third year medical students. All participants completed their first clerkship. A qualitative content analysis was performed. The inductively identified categories were transferred into a quantitative questionnaire using a 5-point Likert-scale to explore their relevance in a validation cohort. The questionnaire was completed by 222 clinical students of the Otto-von-Guericke-Universität Magdeburg. Results: The qualitative analysis led to 26 individual items assigned to 4 main categories that describe the clerkship experience: 1) “coping with insecurities”, 2) “the clerkship as a social arrangement”, 3) “the clerkship as a learning opportunity” and 4) “the clerkship as a teaching opportunity”. In the quantitative validation cohort, category one yielded a well-balanced result (median 3 = “neither agree nor disagree”; IQR 2–4), items addressed in categories 2–4 were generally supported by the students, predominantly selecting “strongly agree” or “agree” (Median 2; IQR 1–2 for each category). Students rated the role of the clinical team as especially important for their learning success and feared exclusion or negative reactions. Conclusions: The medical clerkship provides an institutional, professional, and social framework, in which students are learning. Insecurities arose from curricular inconsistencies, a high dependency on the clinical team as well as the absence of specific learning objectives. Therefore, a better curricular integration regarding the semester structure and the learning objectives of the German clerkship is needed.

Background: To analyse the nature of medical or technical emergency issues of ambulatory peritoneal dialysis (PD) patients calling a nurse-provided emergency PD support service of a reference centre that is provided all year in the after-hours. Methods: We retrospectively analysed patients’ chief complaint, urgency, resolution of and association to current PD treatment and modality directed to an on-call nurse-provided PD support service from 2015–2021 based on routinely collected health data. Calls were systematically categorized being technical/procedural-, medical-, material-related or type of correspondence. Call urgency was categorized to have “immediate consequence”, inquiry was eligible for “processing next working day” or whether there was “no need for further action”. Call outcomes were classified according to whether patients were able to initiate, resume or finalize their treatments or whether additional interventions were required. Unexpected adverse events such as patients’ acute hospitalization or need for nurses’ home visits were evaluated and quantified. Results: In total 753 calls were documented. Most calls were made around 7:30 a.m. (5:00–9:00; median, 25-75^th CI) and 6:30 p.m. (5:00–8:15). 645 calls were assigned to continuous ambulatory- (CAPD) or automated PD (APD). Of those, 430 calls (66.7%) had an “immediate consequence”. Of those 77% (N = 331) were technical/procedural-, 12.8% (N = 55) medical- and 6.3% (N = 27) material related issues. 4% (N = 17) were categorized as other correspondence. Issues disrupting the course of PD were identified in 413 cases. In 77.5% (N = 320) patients were able to initiate, resume or finalize their treatment after phone consultation. Last-bag exchange was used in 6.1% enabling continued therapy in 83.6%. In 35 cases a nurse visit at patients’ home or patients' visit to the practice at the earliest possible date were required, while hospitalization was required in seven medical category cases (5.4% and 1.09% of total assessed calls, respectively). Conclusion: The on-call PD-nurse provides patient support for acute and imminent issues enabling them to successfully initiate, resume or finalize their prescribed treatment. Nurses triage of acute conditions facilitated rapid diagnostics and therapy. Maintaining quality PD homecare, the provision of trained personnel is indispensable. The information gathered in this study may therefore be used as a foundation to tailor educational programs for nephrology nurses and doctors to further develop their competencies in PD.

Annemarie Albert, M.D., Sebastian Radtke, Cand.Med., Louisa Blume, Cand.Med., Rinaldo Bellomo, M.D., Michael Haase, M.D., Philipp Stieger, M.D., M.M.E., Ulrich Paul Hinkel, M.D., Rüdiger C. Braun-Dullaeus, M.D., and Christian Albert, M.D.. Ann Lab Med 2023;43:539-53. https://doi.org/10.3343/alm.2023.43.6.539

The decline of postgraduate medical researchers in Germany reflects fundamental gaps in undergraduate scientific education. Scientific competence (SC)—the integrated ability to think, act, and work scientifically—underpins the academic pipeline, yet its curricular implementation in frameworks such as NKLM 2.0 (National Competency-Based Learning Objectives Catalogue Medicine) and the revised ÄApprO (Approbationsordnung für Ärzte, German Licensing regulations for doctors), remains vague. German curricula do not distinguish Stokes’s “knowledge” vs. “utility” dimensions of research, nor Kölbl’s pedagogical refinements, reducing SC to a technical adjunct rather than an inquiry-driven competence vital for clinical decision-making. Student surveys reveal broad appreciation for scientific thinking but report scant structural support for independent research. Without clear, multidimensional learning objectives and longitudinal embedding—via modular research projects, protected research time, and continuous mentorship—interest in research-oriented careers will continue to wane. We call for SC to be redefined as a core, practice-integrated pillar of medical training, transcending its current role as a curricular checkbox and securing the future of academic medicine.

Background: Peritonitis is a relevant complication in peritoneal dialysis (PD). The initial empirical antibiotic therapy depends on the center-specific distribution of microorganisms and the microbial susceptibility profiles. However, data on the locoregional germ spectrum in Germany are insufficient regarding the current recommended empirical antibiotic regimens of either cefepime as monotherapy or the combination of cefazolin and ceftazidime. Methods: This retrospective single-center study of routine clinical patient data analyzes the range of infecting organisms causing PD-associated peritonitis and their corresponding antimicrobial resistances during the 2015 to 2022 timeframe. We used Ordinary Least-Squares regression to model trends in the detection of microbiological spectrum samples. The ‘reporting of studies conducted using observational routinely collected health data’ (RECORD) statement was acknowledged. Results: There were 80 documented peritonitis episodes with 99 causal etiologies sampled. Of those, eighty-seven were bacterial, three were fungi (3%), eight had no microbial growth (8%), and one more had missing data. The largest group of microorganisms detected were Gram-positive bacteria (N = 56, 56.6%), predominantly sampled as Staphylococcacea, Enterococcaceae, and Streptococcaceae (Staphylococcus aureus, 14.1%). Gram-negative bacteria were found in 31.3% of samples (N = 31), predominantly Enterobacteriaceae (Escherichia coli, 9%). In total, 34 different microorganisms were identified. On one occasion, methicillin-resistant Staphylococcus epidermidis and one sample of multi-resistant Serratia marcescens were identified. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci were not detected. Fungi were found in three peritonitis episodes. Regression analyses did not indicate changes in the general microbiological spectrum during the observational timeframe. The center-specific peritonitis rates were below the recommended rates of the International Society for Peritoneal Dialysis for all years studied. Conclusions: The recommended empiric therapy was suitable at our center, with a few exceptions for non-specific pathogens and for those with β-lactamases or enterococci. When there is no clinical response to empiric therapy, alternative antibiotics should be considered accordingly. The retrospective data are limited to the reported outcome measures.