The results of the reviewed studies, especially those with longitudinal data, suggest that empathy decline during medical school and residency compromises striving toward professionalism and may threaten health care quality. Theory-based investigations of the factors that contribute to empathy decline among trainees and improvement of the validity of self-assessment methods are necessary for further research.

We propose a conceptual framework which may guide research on fostering diagnostic competences in simulations in higher education. We first review and link research perspectives on the components and the development of diagnostic competences, taken from medical and teacher education. Applying conceptual knowledge in diagnostic activities is considered necessary for developing diagnostic competences in both fields. Simulations are considered promising in providing opportunities for knowledge application when real experience is overwhelming or not feasible for ethical, organizational or economic reasons. To help learners benefit from simulations, we then propose a systematic investigation of different types of instructional support in such simulations. We particularly focus on different forms of scaffolding during problemsolving and on the possibly complementary roles of the direct presentation of information in these kinds of environments. Two sets of possibly moderating factors, individual learning prerequisites (such as executive functions) or epistemic emotions and contextual factors (such as the nature of the diagnostic situation or the domain) are viewed as groups of potential moderators of the instructional effects. Finally, we outline an interdisciplinary research agenda concerning the instructional design of simulations for advancing diagnostic competences in medical and teacher education.

BackgroundProblem-based Learning (PBL) has been suggested as a key educational method of knowledge acquisition to improve medical education. We sought to evaluate the differences in medical school education between graduates from PBL-based and conventional curricula and to what extent these curricula fit job requirements.MethodsGraduates from all German medical schools who graduated between 1996 and 2002 were eligible for this study. Graduates self-assessed nine competencies as required at their day-to-day work and as taught in medical school on a 6-point Likert scale. Results were compared between graduates from a PBL-based curriculum (University Witten/Herdecke) and conventional curricula.ResultsThree schools were excluded because of low response rates. Baseline demographics between graduates of the PBL-based curriculum (n = 101, 49% female) and the conventional curricula (n = 4720, 49% female) were similar. No major differences were observed regarding job requirements with priorities for "Independent learning/working" and "Practical medical skills". All competencies were rated to be better taught in PBL-based curriculum compared to the conventional curricula (all p < 0.001), except for "Medical knowledge" and "Research competence". Comparing competencies required at work and taught in medical school, PBL was associated with benefits in "Interdisciplinary thinking" (Δ + 0.88), "Independent learning/working" (Δ + 0.57), "Psycho-social competence" (Δ + 0.56), "Teamwork" (Δ + 0.39) and "Problem-solving skills" (Δ + 0.36), whereas "Research competence" (Δ - 1.23) and "Business competence" (Δ - 1.44) in the PBL-based curriculum needed improvement.ConclusionAmong medical graduates in Germany, PBL demonstrated benefits with regard to competencies which were highly required in the job of physicians. Research and business competence deserve closer attention in future curricular development.

Our results demonstrate that the case-based, worked example approach is effective and efficient.

BackgroundLittle is known about the characteristics of mentoring relationships formed between faculty and medical students. Individual mentoring relationships of clinical medical students at Munich Medical School were characterized quantitatively and qualitatively.MethodsAll students signing up for the mentoring program responded to a questionnaire on their expectations (n = 534). Mentees were asked to give feedback after each of their one-on-one meetings (n = 203). A detailed analysis of the overall mentoring process and its characteristics was performed. For qualitative text analysis, free-text items were analyzed and categorized by two investigators. Quantitative analysis was performed using descriptive statistics and Wilcoxon-test to assess differences in grades between students with and without mentors.ResultsHigh-performing students were significantly more likely to participate in the mentoring program (p<0.001). Topics primarily discussed include the mentee's personal goals (65.5%), career planning (59.6%), and experiences abroad (57.6%). Mentees mostly perceived their mentors as counselors (88.9%), providers of ideas (85.0%), and role models (73.3%). Mentees emphasized the positive impact of the mentoring relationship on career planning (77.2%) and research (75.0%).ConclusionsMedical students with strong academic performance as defined by their grades are more likely to participate in formal mentoring programs. Mentoring relationships between faculty and medical students are perceived as a mutually satisfying and effective instrument for key issues in medical students’ professional development.Practical implicationsMentoring relationships are a highly effective means of enhancing the bidirectional flow of information between faculty and medical students. A mentoring program can thus establish a feedback loop enabling the educational institution to swiftly identify and address issues of medical students.