key: cord-1034027-zaomqf7f authors: Winzer, Andrea; Jansky, Michael title: Digital lesson to convey the CanMEDS roles in general medicine using problem-based learning (PBL) and peer teaching date: 2020-12-03 journal: GMS J Med Educ DOI: 10.3205/zma001357 sha: abd6a7d6510948c616735b0e3336640087af26f8 doc_id: 1034027 cord_uid: zaomqf7f The CanMEDS roles has conveyed through a digital videoconference supported teaching format in which the students develop their own case-based, interactive e-learning units. The learning forms used are problem-based learning and peer-teaching. After a quality check by the lecturer the e-learning units are made available to further general medicine lessons. Due to the limitation of classroom teaching caused by Covid-19 the Centre of General Medicine at the University of Medicine Mainz was faced with the challenge of teaching in virtual learning and teaching environments, staying in line with media-didactic concepts whilst at the same time remaining compliant with the licensing regulations in medical education. When switching to online teaching, not only should practice and patient oriented knowledge, abilities and, skills of general medicine be conveyed. Lesson concepts must also consider factors such as user friendliness, interactivity, motivation and use of multimedia. One particular challenge was the timely modification of the two elective compulsory modules "General Medicine Practice" and "Natural Medicine" in a one-week internship format. These modules mainly consist of practical exercises on patients in classroom teaching. In order to enable all students who were already enrolled to participate, both courses have been combined into an online elective compulsory module for students from the 3rd clinical semester onwards. With a problembased teaching focus, knowledge of the CanMEDS roles should be transferred whilst the students develop their own interactive e-learning units, based on case vignettes of typical GP consultations. The superordinate learning objective of the new online elective module, with its pragmatism-based and creationcentred [1] , [2] approach , is that students learn and apply the CanMEDS roles "Medical Expert", "Communicator", "Member of a Team" and "Scholar" [3] , [http:// www.nklm.de]. For this purpose, students should adopt the positions of reflective observers [4] as well as active practitioners in various teaching settings [5] . Subordinate specific learning objectives on a knowledge and comprehension level consist of acquiring knowledge about "general practices", "practices of natural medicine" and "medical communication". On the application and analysis level, students are required to develop a doctor-patient dialogue in a general practitioner context, taking into account therapy options of general and natural medicine. The design of interactive e-learning units takes place on the synthesis level [6] . In accordance with the university's guidelines for pure distance learning, the videoconferencing method was chosen for learning tasks in plenary sessions and small groups [7] , [8] . Problem-based learning (PBL) [9] , [10] , [11] , cooperative and collaborative learning [12] , [13] , peer teaching [14] , [15] , [16] and independent learning by self-study [17] , [18] were to be combined as didactic methods in order to achieve the intended increase in competence at the superordinate learning objective level [19] , [20] . To determine whether the subordinate specific learning objectives had been achieved, the procedural task given to the students of designing interactive elearning units [21] , [22] . All interactive e-learning units should include a conclusive doctor-patient dialogue referring to a GP consultation. For this purpose, case vignettes with patient information (gender/age/occupation) and background information (aetiology, diagnostics, therapy) are provided. In order to design the dialogue, students must put themselves in the patient's role (including the formulation of the patient's requests) as well as analyse the role of the GP (while bearing in mind a GP's duties). By the end of the internship, each workgroup should have developed an interactive e-learning unit that can theoretically be used in further general medicine lessons. The online elective compulsory module was evaluated using the standardized online questionnaire provided by the University of Medicine Mainz for the digital courses of the summer semester 2020, available in Moodle. Table 1 shows the schedule for the case-based PBL-oriented teaching project, the application of the peerteaching format and the CanMEDS role adoption by the students. Upon completion of the elective compulsory module, the interactive e-learning units were reviewed with regard to their ability to be used further and, where necessary, revised by the course instructor based of his expertise as a professor for general medicine and as a general practitioner. All interactive e-learning units were still in use at the end of the summer semester within the digital handson training course in general medicine (8 th semester). The new online teaching format was implemented without any problems in terms of organization and technology. According to the course administrator, the students' willingness to actively participate seemed to be more pronounced than in regular face-to-face teaching. In the concluding feedback session, the students reported a high level of comprehensibility with regard to the teaching concept and the learning objectives. The response rate of the online survey was 47% (9 of 19 participants). The course, the support, and the teaching format were rated as being very conducive to learning. The amount of subject matter was graded to be adequate. The evaluation of the digital hands-on training course in general medicine had a response rate of 20.5% (36 of 175). In the free text comments the interactive e-learning units were rated as conducive to learning and requests for further such learning resources were expressed [23] , [24] . Final conclusions cannot be drawn due to the small number of students attending the course and the response rate to the evaluation. Nevertheless, the feedback from students and the experiences of lecturers indicate that although the online teaching described cannot replace the process of acquiring competence by patient contact it can be a practical supplement. The digital teaching format is suitable to teach students the various CanMEDS roles with regard to family doctor activity, deepening available knowledge and expanding new competences at the application level. According to current data this is the result of its pragmatism-based and creation-centred approach as well as the opportunity related to acquire complex and sustainable competences via problem-based learning and peer-teaching [25] , [26] . Thus, a learning transfer into practice can be achieved [27] . Furthermore, it allows the testing of innovative teaching-learning scenarios. The experiences identified with the online teaching format presented here will be incorporated into the development of our general medicine online teaching concept and encourage us to integrate online teaching formats more strongly in the future in the form of a teaching method mix. Thereby, the primary focus will remain on creating more room for teaching practical skills to patients in a face-to-face teaching environment. In addition, the level of transferability of the online teaching format presented should be part of an interdisciplinary review in the faculty, as well as in the exchange of experience with other chairs in general practice. Übergeordnetes Lernziel des neu konzipierten und pragmatistisch-gestaltungsorientierten [1] , [2] Online-Wahlpflichtmoduls ist die Aneignung und Anwendung der CanMEDS-Rollen "Medizinischer Experte", "Kommunika-tor", "Teamarbeiter" und "Lehrender" [3] , [http:// www.nklm.de]. Dazu sollen die Studierenden in verschiedenen Unterrichtssettings die Positionen sowohl der reflektierenden Beobachter [4] als auch der aktiv Ausübenden einnehmen [5] . Die untergeordneten Feinlernziele bestehen auf der Wissens-und der Verständnisebene im Erwerb von Kenntnissen zu "Allgemeinmedizinischer Praxis", "Naturheilverfahren" und "Ärztlicher Kommunikation". Auf der Anwendungs-und der Analyseebene ist die Ausarbeitung eines Arzt-Patienten-Dialoges im hausärztlichen Kontext unter Betrachtung allgemeinmedizinischer und naturheilkundlicher Therapiemöglichkeiten verortet. Die Konzeption interaktiver Online-Lerneinheiten findet auf der Syntheseebene statt [6] . Entsprechend der universitären Vorgabe des ausschließlichen Fernstudiums wurde die Arbeitsform der Videokonferenz zur Bearbeitung der Lernaufgaben in Plenumsund Kleingruppenarbeiten gewählt [7] , [8] . Dabei sollten problemorientiertes Lernen (POL) [9] , [10] , [11] , kooperatives und kollaboratives Lernen [12] , [13] , Peer Teaching [14] , [15] , [16] sowie eigenständiges Lernen durch Selbststudium [17] , [18] als didaktische Methoden miteinander kombiniert werden, um dem angestrebten Kompetenzzuwachs auf der übergeordneten Lernzielebene gerecht zu werden [19] , [20] . Das Erreichen der untergeordneten Feinlernziele wurde über die prozessuale Aufgabenstellung an die Studierenden kontrolliert, interaktive Online-Lerneinheiten zu konzipieren [21] , [22] . [27] . Darüber hinaus erlaubt es die Erprobung innovativer Lehr-Lern-Szenarien. Die Erfahrungen mit dem dargestellten digitalen Lehrformat werden in die Ausgestaltung unserer allgemeinmedizinischen Online-Lehre einfließen und ermutigen uns zukünftig zu einer stärkeren Einbindung digitaler Lehrformate in Form eines Lehrmethoden-Mix. Dabei wird es übergeordnetes Ziel bleiben, im Präsenzunterricht der Vermittlung praktischer Fertigkeiten am Patienten mehr Raum zu gegeben. Zudem sollte das Potenzial der Übertragbarkeit des dargestellten digitalen Lehrformates interdisziplinär innerhalb der Fakultät überprüft werden, ebenso wie im Erfahrungsaustausch mit anderen Lehrstühlen für Allgemeinmedizin. Handlungsorientiertes Lernen und eLearning: Grundlagen und Praxisbeispiele. München: De Gruyter Oldenbourg Frank JR. The CanMEDS 2005 physician competency framework. Better standards. Better physicians. Better care. Ottawa: Royal College of Physicians and Surgeons of Canada Konstruktivistische Ansätze in der Erwachsenenbildung und Weiterbildung A Revision of Bloom's Taxonomy: An Overview Entwurf einer Didaktik für die Entwicklung vollständiger Handlungskompetenzen in der Berufsbildung Gruppenarbeiten und Peer-Review-Verfahren in der onlinebasierten Fernlehre Essential Readings in Problem-Based Learning: Exploring and Extending the Legacy of Howard S Deep and surface learning in problem-based learning: a review of the literature Online lernen und lehren Kooperatives Lernen mit Videokonferenzen: Gemeinsame Wissenskonstruktion und individueller Lernerfolg Dimensions and psychology of peer teaching in medical education Peer teaching in higher education: A review Deep Thinking, Interest and Cognitive Learning Gains Game Design as a Complex Problem Solving Process Ein schwieriger Patient mit einer Nasennebenhöhlen-Problematik -Ein E-Learning-Fall aus der Klinik für Hals-Nasen-Ohren-Heilkunde an der Medizinischen Fakultät der Universität Duisburg-Essen Lehren und Lernen online: Lehr-und Lernerfahrungen im Kontext akademischer Online-Lehre Digitale Lehr-und Lernangebote in der medizinischen Ausbildung: Schon am Ziel oder noch am Anfang? Kollegiale Beratung in der Hochschule Handlungsorientiertes Lernen und eLearning: Grundlagen und Praxisbeispiele. München: De Gruyter Oldenbourg Geht das zusammen? -Pragmatistische Ansätze in erwachsenenbildnerischen und mediendidaktischen Perspektiven The CanMEDS 2005 physician competency framework. Better standards. Better physicians. Better care. Ottawa: Royal College of Physicians and Surgeons of Canada Konstruktivistische Ansätze in der Erwachsenenbildung und Weiterbildung A Revision of Bloom's Taxonomy: An Overview Entwurf einer Didaktik für die Entwicklung vollständiger Handlungskompetenzen in der Berufsbildung Gruppenarbeiten und Peer-Review-Verfahren in der onlinebasierten Fernlehre Essential Readings in Problem-Based Learning: Exploring and Extending the Legacy of Howard S Deep and surface learning in problem-based learning: a review of the literature Online lernen und lehren Kooperatives Lernen mit Videokonferenzen: Gemeinsame Wissenskonstruktion und individueller Lernerfolg Dimensions and psychology of peer teaching in medical education Peer teaching in higher education: A review Association for the Study of Higher Education Lehren an Hochschulen -Eine Hochschuldidaktik für den Aufbau von Wissen und Kompetenzen. 2nd Selbstreguliertes Lernen in der Hochschule fördern -Lernkulturen gestalten Defining characteristics of educational competencies Lehren und Lernen mit digitalen Medien Deep Thinking, Interest and Cognitive Learning Gains Game Design as a Complex Problem Solving Process Ein schwieriger Patient mit einer Nasennebenhöhlen-Problematik -Ein E-Learning-Fall aus der Klinik für Hals-Nasen-Ohren-Heilkunde an der Medizinischen Fakultät der Universität Duisburg-Essen Lehren und Lernen online: Lehr-und Lernerfahrungen im Kontext akademischer Online-Lehre Digitale Lehr-und Lernangebote in der medizinischen Ausbildung: Schon am Ziel oder noch am Anfang? Kollegiale Beratung in der Hochschule The authors declare that they have no competing interests. Die Autor*innen erklären, dass sie keinen Interessenkonflikt im Zusammenhang mit diesem Artikel haben.