Unlike other healthcare professionals, veterinarians are often required to perform euthanasia as part of their work. How veterinarians determine what constitutes a “good” killing, in a normative sense, needs to be explored. (2) 17 interviews with veterinarians were conducted and analyzed in detail. (3) The study found that veterinarians have different perspectives on what they consider ethically acceptable regarding euthanasia. They distinguish between farm animals and companion animals. Economic and emotional factors also influence their decisions. Ethical boundary work describes how veterinarians define what they consider normatively legitimate in these areas of veterinary medicine. (4) In conclusion, this study shows that veterinarians face difficult decisions and use ethical boundary work to meet these challenges. They must balance sometimes conflicting interests and adapt to multiple situations. By understanding the complexity of ethical boundary work, we can better understand the moral aspects of veterinary practice. This knowledge can improve veterinary care and help veterinarians make ethical decisions that benefit both animals and society.(1) Veterinarians are regularly required to euthanize their “objects of care” as part of their work, which distinguishes them from other healthcare professionals. This paper examines how veterinarians navigate the ethical tensions inherent in euthanasia, particularly the collision between the routine practice of killing animals within their profession and the broader social and moral implications. (2) Using the sociological concept of ethical boundary work as a theoretical framework, this research observes how veterinarians draw boundaries by positioning their euthanasia practices on the ethical “good” spectrum. A grounded theory study of 17 qualitative interviews with veterinarians was conducted. (3) The findings highlight differences in ethical boundary work within veterinary medicine, particularly in the distinction between farm animals and companion animals. Economic and emotional reasoning play differing roles in explanation and justification. Ethical boundary work is a tool for distinguishing normative frameworks in different areas of veterinary medicine. (4) In conclusion, veterinarians grapple with the realities of an imperfect world and often rely on boundary work to assert diverse interests and navigate multiple contexts. By exploring the complexities of ethical boundary work, this study contributes to a more comprehensive understanding of the moral landscape within veterinary practice. Fischer] (The names mentioned in the text have been pseudonymized to protect the interviewees’ privacy).reasonably justified decision” (Dr. Fischer) by veterinarians. The evolving normative self-image of veterinarians has increased awareness of ethical considerations in their professional roles, resulting in the emergence of veterinary ethics as a distinct discipline For her, it was important to justify the killing, but not so much with a concrete, exact medical reason. Therefore, she refers to the explanation of the responsible veterinarian:“Anyway, she explained the case to me. And with it a little bit, uh, justified why we do it: so that the dog is somehow chronically ill, and has no more life worth living, and that it has a long medical history and that somehow there is no other therapy.”[Vet Treiber]long medical history” and chronic illness without further specifying the dog’s medical condition. The necessity is presented to her via the lack of medical alternatives (“somehow there is no other therapy”) and the assumed interest of the animal (“a life worth living”).As shown above, the explanation is based on the dog’s “This is a release from a life that I no longer find worth living”.The justification narratives involve assessing whether an animal is in pain and suffering and has no quality of life. These classic physiological-pathological reasons point to a necessity where death is presented as the only alternative or better solution. As Vet. Treiber puts it, “release”? And how does this discourse become medical? The narratives of euthanasia have two dimensions: (1) the purported interest of the animal and (2) the medical necessity of the action. The justification narratives involve assessing whether an animal is in pain and suffering and has no quality of life. As such, it is embedded in a medical discourse that relates to medical actions such as diagnosis, prognosis, and deciding on a therapeutic goal and treatment. For example, Dr. Bauer, a veterinarian working in companion and farm animal medicine, states, “Now would be the time to euthanize the animal before there is more suffering”. Therefore, she justifies the killing with (1) the best interest of the supervised animal (“more suffering”) and (2) her particular task as a veterinarian of determining, classifying (“greater”), and evaluating (“what I … feel”) the animal’s interest and suffering. These classic physiological-pathological considerations are linked to a moral necessity in which death is presented as the only alternative or better solution. Thus, veterinarian Dr. Kaufmann’s concept of “absolute release” emphasizes that euthanasia is a necessary evil that liberates the animal with a “good” death.But how do veterinarians understand the concept of “There are irreparable injuries, such as a proximal leg fracture in a horse, where no therapy is possible. Um, where the horse must be put out of its misery”. Similarly, she mentions euthanasia in the case of critically ill dairy cows: “with the dairy cows, or something like that when they were critically ill, and there was no hope of recovery”. In both companion and farm medicine, the release narrative refers to medical necessity in addition to alleged animal interests, and euthanasia is seen as necessary in the case of “hopeless injuries” or a “critically ill” animal with “no hope of recovery”.The release narrative is found in both companion and farm animal medicine. For example, Dr. Bauer describes a situation with a horse in which euthanasia is necessary due to a proximal leg fracture that cannot be treated: “release” narrative. Veterinarians legitimize euthanasia when it is medically necessary and in the animal’s best interest. But the decision-making process involves stakeholders other than the animal and the veterinarian, such as the client and the government. In the next part, the article explores what happens when a conflict of interest occurs, particularly with the client, and how veterinarians use this as an explanatory reason .In summary, medical reasoning is a justification strategy embedded in a “Veterinary medicine has some peculiarities compared to other health professions. One is the way the work is organized. In Germany, for example, many veterinarians are still self-employed, and there is no national health insurance system as there is in human medicine. As a result, veterinarians refer to themselves as entrepreneurs ,58. CurrFor example, Dr. Schmidt, a farm animal veterinarian, describes how he sometimes must euthanize a farmer’s dog. For him, there is a significant difference between this and what he considers his daily euthanasia work (euthanizing a cow):“But of course, these are dogs that I have known for a long time. And they are usually euthanised because of their old age. (…) And these are then also euthanasia, where the farmer has already prepared for it, so to speak. Because he knows: ‘Oh, the dog, he won’t make it! And one way or another, it must stop.’ That’s basically more difficult with dogs, uh, to somehow get the owner to realise that the animal is so, that this is no longer a life for the dog.”[Dr. Schmidt]that it is no longer a life for the dog”. This is part of the medical reasoning described above, but he bases the difference on another aspect: the (more) emotional bond between the farmer and the animal, which makes the decision “harder” for the farmer.Dr. Schmidt focuses on the animal and its quality of life: “family members” [Vet Treiber] in companion animal medicine while being perceived as food producing livestock (in German law as Lebensmittellieferndes Tier) in the context of farm animal medicine  strongly discourage requests for euthanasia based solely on the client’s economic considerations. This example draws attention to two critical points: the influence of economic factors on animal utility and the different ethical boundaries drawn depending on how animals are categorized.In the past, clients occasionally requested the euthanasia of horses that no longer served a sporting purpose or had diminished economic value. However, as horses have transitioned from being perceived as mere farm animals to highly valued companion animals, the evaluation of economic factors has taken on a different meaning ,25. Dr. but what I judge differently is killing for economic reasons”. She goes on to describe her experience during an internship in the field:Vet. Treiber, another companion animal veterinarian, connects agriculture and economics. For her, this is exemplified by the differences in the decision-making process between farm and companion animals. She has no moral problem with killing an animal for the right reasons see . Still, “It happened that we had cattle that, uh, were not terminally ill, as I know it from the small animal sector. But once there was a cow that had a severe, how do I know, an injury to the carpal joint and could no longer stand. And there is, of course, no surgical intervention planned that costs, how do I know, several hundred euros; and takes a long, uh, time to heal. But there, the costs are weighted: ‘This cow doesn’t give so much milk, anyway; that goes away.’ And that was for me after a while, of course, also normal: It’s a farmer who lives from it. And that is just an economic area. But as a vet, I find that really difficult, and I realise that that wouldn’t be my area. So I won’t make that decision and support it, … I found this economy in that area of, uh, that is difficult for me.”[Vet. Treiber]as a vet”).This quote shows Vet Treiber criticizing the field because of the importance of economic constraints and drawing a line at “good” killing when economic circumstances prevail. She describes this experience as a reason not to work in the field. For her, it is inconsistent with her understanding of what it means to be a veterinarian , actions are explained not only by financial but also by the emotional interests of clients. Emotions and how to deal with them are of central importance to veterinarians, especially when there is a close emotional bond between the client and the animal, which is often the case in small animal medicine . But howSome veterinarians are concerned about the excessive emotionalization and subsequent overuse of medical interventions in companion animal medicine. For them, the situation raises ethical questions about whether animals are being kept alive primarily to satisfy the client’s emotional needs rather than to prioritize the animals’ interests. These critiques highlight a departure from the concept of “good” killing. By exploring how emotional reasoning is critiqued and legitimized in companion animal medicine, we can better understand the spatial ethical boundaries around euthanasia. For example, Dr. Wagner, a former farm animal veterinarian who now works in a slaughterhouse, critiques the following:“Veterinary medicine has some of the same standards as human medicine. A vet could probably give Grandma a new hip. But first of all, I think it’s a bit bad that in a world where people are starving, you do something like that, that you spend thousands of euros on an animal that doesn’t get much better afterwards, because, I mean, then it has a new hip, then its shoulder hurts at some point. An old animal is just old, and you must do to it what you do to us old people. It would be best to keep an animal alive until it dies of old age, and it must fight for years with some things; I don’t know what. And then they get painkillers, of course, but I know how it is with broken bones. (…) And I think it’s a sin to torture animals so that people don’t have to say goodbye to them. Yeah, what are you doing to the animals? That’s all sentimentality, and that comes from the fact that people have a nonsensical fear of death, so if you have a relaxed relationship with death, you can send your animal to its death. You can say, ‘Guy, you can’t go on; you can go now.’”[Dr. Wagner]sentimentality” and the prioritization of the client over animal interests. She questions allocating resources for extensive medical interventions on animals when humans are starving. For her, prolonging an animal’s life in the face of suffering is unnecessary and even cruel because of societal fear of death. Instead, a peaceful and timely euthanasia decision is more important to them for the “good” end. And a social opportunity for an accepting attitude towards death would be beneficial. This critique challenges the ethical boundaries of companion animal practice, particularly regarding emotional reasoning in euthanasia decisions.She critically views the ethical justification for euthanasia in companion animal medicine on the grounds of “Dr. Fisher’s critique is consistent with the earlier discussion and emphasizes the need to balance the interests of the animal with those of the client:“Whereby I also have to say, when I sometimes see what our small animal colleagues do, uh, I am not always convinced whether this is still in the best interest of the animal. When, as I recently experienced when I was in practice, a dog with a liver tumour and metastases is kept alive for ten days because someone must come back from vacation or something, (1) then I have a stomachache, too. I have to say, ‘I’m not satisfied.’”[Dr. Fischer]sentimentality” (Dr. Wagner) and client preferences can override the best interest principle.Here, Dr. Fischer questions whether certain treatments are really in the animal’s best interest. For example, she recounts the case of a terminally ill dog that was kept alive simply because someone had to return from vacation. While Dr. Fischer finds these cases troubling, she does not classify them as ethical issues but rather as personal opinions or observations. In sum, the critique of farm animal veterinarians highlights instances where “But what about emotional reasoning and its associated ethical boundaries from a companion animal perspective? Dr. Sander, who has experience working in a large research facility and assisting in a small animal practice, highlights the evolving perception of companion animals  and the advances in medical technology in these areas. This sheds light on the ethical boundary work involved in justifying euthanasia and the changing dynamics surrounding the emotional connection to companion animals:“So, the way away from the animal as a thing, even if, let’s say, in the mid-1980s, the animal may have had a high value for the individual owner of, let’s say, the clinic, I don’t think you can compare that with what’s happening today. It starts with the whole range of equipment available for examinations, where people pay six or 700 euros for an MRI of their dog or horse, even if it’s hard for them, yes? I think animals are seen more as full family members than they used to be. In the past, but I can only speak from my own experience, people dealt with it more professionally. According to the motto, the dog will be nine, ten or twelve years old; if you’re lucky, it’s over, and then it’s euthanised, right? And the therapy options were not like that either. When I started, people were more willing to put a dog or cat to sleep before they would try again.”[Dr. Sander]family members” has influenced the way euthanasia is approached This example illustrates the importance of providing alternative solutions and facilitating a better understanding of the animal’s condition and well-being. It shows that veterinarians can help clients make more informed decisions in the animal’s best interest through emotional support, practical interventions, and open communication. However, Dr. Grimm also acknowledges the challenges in such cases. Sometimes clients are not open to considering euthanasia or accepting the veterinarian’s recommendations. In these situations, they may seek another veterinarian’s opinion or terminate the relationship altogether. This highlights the complexity of navigating the intersection of emotions, ethical boundaries, and the client-veterinarian relationship.sentimentality” (Dr. Wagner) or client demands. Veterinarians have to deal with the emotional relationship between clients and animals. At the same time, they must put the animal’s welfare first. The goal is to balance emotional and medical considerations.These contrasting perspectives highlight the complexity of ethical boundary work regarding emotional reasoning. While advocating a compassionate approach that upholds the animal’s best interests, some critics in veterinary medicine caution against the potential overuse or misuse of interventions driven solely by “In conclusion, veterinarians process emotional and economic justifications in addition to medical ones when drawing boundaries around what constitutes “good” killing. It was possible to show how spatial ethical boundary work was used in the interviews. Companion animal veterinarians criticized the overemphasis on the economic interests of clients. On the other hand, the farm animal veterinarians criticized the boundary extension as being too emotional. This requires veterinarians to skillfully navigate ethical boundaries and balance emotional compassion, financial constraints, and medical reasons to keep the practice within the bounds of “good” killing.Understanding these different viewpoints and the spatial ethical boundary work within veterinary medicine is essential to understanding the moral infrastructure. It enables the profession and society at large to reflect ethically on the decision-making processes and legitimacy of animal euthanasia.This article addresses the topic of ethical boundary work in veterinary practice. It focuses on euthanasia in companion and farm animal medicine and provides a valuable understanding of the complex dynamics involved. While there are variations in context, location, and stakeholders , the method (injection) and purpose (to end suffering) are the same in all cases discussed ,13. FurtIn summary, veterinarians consider both the animal and the client as objects of care, which leads them to consider not only medical justifications but also economic and emotional reasons in their decision-making. The extent to which these factors should be considered becomes part of the negotiation within and between different fields of veterinary medicine. This juxtaposition leads to significant differences between the two fields. Therefore, veterinarians perform ethical boundary work on two levels. First, veterinarians establish internal ethical boundaries within their profession by using medical reasoning as the primary justification for euthanasia. This allows them to distinguish euthanasia from other forms of killing and present it as morally justifiable. Second, veterinarians engage in boundary work between different fields by using economic and emotional reasoning to explain and justify the ethical boundaries in their own field while criticizing the other .These two lines of demarcation can be seen hand in hand. They reflect the ambivalent relationship between humans and animals today. The different norms are seen as part of the profession through the spatial form of critique and counter-critique, and a constant negotiation about “good” killing occurs. This happens not only in the narrative of each veterinarian but also in the profession as a whole. The spatial ethical boundary work of veterinarians is crucial for legitimizing different moral positions and maintaining normative boundaries within the profession.It is important to note that this article’s narrative reflects societal expectations of farm versus companion animal categorization by omitting the relevance of economic considerations in small animal medicine . The situation is even more complex, as emotions and finances play a role in both fields ,59,60. HFinally, this discussion highlights the importance of openness in empirical study design. We gain valuable insights into this complex process by examining ethical boundary work in practice. In practice, clear boundaries are often absent. As empirical observations show, veterinary medicine boundaries are inherently messy ,18. DiscIn summary, this article argues for a more open approach that explores the moral and ethical challenges within the veterinary profession while incorporating the perspectives and knowledge of veterinarians. Such an approach allows for a deeper understanding of the moral infrastructure of the profession and its implications for practice.In conclusion, this article empirically explores ethical boundary work within veterinary medicine, focusing on euthanasia practices in companion and farm animal medicine. For veterinarians, euthanasia is both a routine practice and an issue that raises significant ethical questions in light of the changing human-animal relationship. By investigating the criteria and levels that shape these intra-professional boundaries, the study highlights the diverse moral landscape within veterinary medicine. The interplay between forms of reasoning and ethical boundary work is crucial to understanding veterinary practice.Veterinary ethics is challenged by the diversity and empirical messiness of veterinary practice, where animals are used in different ways and take several social-moral positions in modern society. In addition, veterinarians have multiple objects of care to consider, including the animal, the client, the broader context, and themselves. The empirical exploration of ethical boundary work in euthanasia practice allows the moral infrastructure of veterinary medicine to be subjected to social discussion and normative evaluation. However, the findings presented here represent only the beginning of studying this complex topic. Further research and ongoing dialogue are needed to advance our understanding of ethical boundary work in veterinary medicine and its implications in practice.


Is retrograde amnesia associated with an ability to know who we are and imagine what we will be like in the future? To answer this question, we had S.G., a patient with focal retrograde amnesia following hypoxia, two brain-damaged (control) patients with no retrograde memory deficits, and healthy controls judge whether each of a series of trait adjectives was descriptive of their present self, future self, another person, and that person in the future, and later recognize studied traits among distractors. Healthy controls and control patients were more accurate in recognizing self-related compared to other-related traits, a phenomenon known as the self-reference effect (SRE). This held for both present and future self-views. By contrast, no evidence of (present or future) SRE was observed in SG, who concomitantly showed reduced certainty about his personality traits. These findings indicate that retrograde amnesia can weaken the self-schema and preclude its instantiation during self-related processing. In memory of Francesca FrassinettiPhilosophers and psychologists have long recognized the strong link between our ability to recollect past experiences and our sense of self-continuity over time, or self-sameness Erikson , which iOne interesting question in this respect is what remains of personal identity and the sense of self after severe retrograde memory loss, such as is observed in focal retrograde amnesia  representations, with time become detached from episodic memories , we asked him to judge, for each trait, how certain he was to possess (or not possess) that trait, and how important it was for him to possess that trait, separately for the present and future self. The fact that SG describes himself as ‘a new me’, has lost most of his past personal experiences, and recounts the few he still has as someone else’s, would lead to predict a reduced SRE in SG. Indeed, personal memories are a powerful source of information on our behavior, hence a major source of input to the self-schema. In order to ascribe the lack of SRE in SG to his retrograde memory impairment, and not, for example, to memory encoding deficits due to brain damage, we contrasted SG’s performance to that of two patients (AT and MR) with neurological memory disorders who had weak anterograde but normal retrograde memory, and with age-matched heathy controls. If, as we predict, retrograde memory plays a crucial role in imparting a preferential status to self-related information in memory, then the SRE should be reduced in SG but preserved in brain damaged patients with weak anterograde memory but preserved retrograde memory. Whether or not the purported reduction in the SRE in SG also extends to the future self will inform on the relation between retrograde memory and future-based cognition and qualify the clinical presentation of FRA.Case SG. SG has been described extensively in De Luca et al. , and, at a reduced threshold , in the hippocampus, the anterior thalamus, and several regions of the autobiographical memory network, including the angular and supramarginal gyrus bilaterally . Structural magnetic resonance imaging (MRI) revealed a perisylvian ventricular expansion, but no signal changes in the brain parenchyma and the structures of the posterior fossa. Voxel Based Morphometry .S.G.’s performance was contrasted with that of 10 healthy controls  matched to SG for age and education . Participants gave informed consent according to the Declaration of Helsinki  were compared to their healthy controls using individual modified hwaite’s  method fTable SG and AT performed well also in the “Divided attention” subtest from the TAP, whereas MR had reduced divided attention abilities. Executive functions were generally preserved across patients, as revealed by the normal scores in the Stroop test , which was written right above the adjective, and remained on the screen until the end of the trial. Across conditions, participants responded using a Likert scale from 1  to 4 , with no time limit for responding. Participants evaluated different adjectives in each rating condition , and the order of trials pertaining to the different conditions was randomized for each participant.About 15 min after the rating phase, which were filled with demographic questionnaires, participants underwent an unanticipated recognition memory task (recognition phase), in which the 90 previously rated adjectives were presented again, this time intermixed with 90 new trait adjectives. Each trial started with a fixation cross shown for 500 ms. Then subjects were presented with an adjective and had to state whether they remembered it from the previous session or not (old/new judgment). Finally, subjects were presented again with the trait adjectives they had previously evaluated with reference to the present or future self , and asked to report, for each trait, how sure they were that they possessed or did not possess that trait (epistemic judgment), and how important it was to them to possess or not possess that trait . In both cases, participants responded using a Likert scale from 1  to 4  except for the standard condition, in which SG rated adjectives as generally less positive than his controls . AT found trait adjectives to be less descriptive of his future self than the controls , but his ratings in the other conditions were not different from the controls . MR found trait adjectives to be more descriptive of the other than the controls , but his ratings in the other conditions were not different from the controls .Table Table t = − 2.52; p = 0.02), AT , and MR  all had weakened recognition accuracy compared to healthy controls  and Future Other conditions , but a significantly lower recognition accuracy in the present Self  and Future Self conditions , indicating he did not benefit from self-referencing in recognition memory. To quantify the SRE directly, we computed Present and Future SRE indices, by subtracting accuracy in the other condition from that in the Self condition, separately for the Present and Future time. We confirmed that both the Present SRE  and the Future SRE  were significantly reduced in SG compared to his controls , Present Self  and Future Self conditions , but a comparable recognition accuracy in the Future Other condition (p = 0.06). His Present SRE (p = 0.50) and Future SRE (p = 0.33), however, were comparable to the controls’. AT had a lower recognition accuracy in the Present Self  and Present Other conditions  but a comparable recognition accuracy in the Future Self and Future Other conditions (p > 0.14 in both cases). His Present SRE (p = 0.36) and Future SRE (p = 0.31), however, were comparable to the controls’ , indicating they benefited normally from self-referential encoding during a recognition memory task.t = − 2.11; p = 0.03), but his certainty about his personality traits in the Future (p = 0.44), as well as importance ratings (both ps > 0.08), did not differ from the controls’. AT gave certainty and importance ratings similar to the controls’ across conditions . MR was less certain about  and attributed less importance  to possessing (or not) given psychological traits in the Present, but his certainty and importance ratings concerning the Future were similar to the controls’ (p > 0.34 in both cases).To begin to investigate possible reasons for the lack of SRE in SG, we analysed the certainty and importance ratings he and the controls gave to personality traits  information, exhibiting a normal SRE, SG did not show any mnemonic advantage for self- over other-related traits. SG’s SRE deficit extended from knowledge about the characteristics of the present self to those anticipated for the future self, leading to a complete abolishment of both the present and future SRE. The lack of SRE in SG was accompanied by a reduced certainty about his current personality traits. Together, the findings of reduced SRE and reduced certainty for his own personality traits in SG (but not the control cases) are suggestive of a disruption of the self-schema following FRA, and not to general encoding deficits following brain damage.The evidence of reduced self-knowledge in SG accords with the previous finding of his selective deficit in imagining self-relevant future scenarios but not fictitious scenarios with no personal reference  knowledge, under-confidence on one’s own personality traits, and inability to envision our self in the future. This deficit is not merely the result of acquired brain damage and (anterograde) amnesia, and reinforce the view of a tight link between (retrograde) autobiographical memory and the sense of self. Together, these findings contribute to specify the cognitive components of mental time travel, and to enrich our understanding of the neuropsychology of FRA.


As demand for the automation of biological assays has increased over recent years, the range of measurement types implemented by multiwell plate readers has broadened and the list of published software packages that caters to their analysis has grown. However, most plate readers export data in esoteric formats with little or no metadata, while most analytical software packages are built to work with tidy data accompanied by associated metadata. ‘Parser’ functions are therefore required to prepare raw data for analysis. Such functions are instrument- and data type-specific, and to date, no generic tool exists that can parse data from multiple data types or multiple plate readers, despite the potential for such a tool to speed up access to analysed data and remove an important barrier for less confident coders. We have developed the interactive web application, Parsley, to bridge this gap. Unlike conventional programmatic parser functions, Parsley makes few assumptions about exported data, instead employing user inputs to identify and extract data from data files. In doing so, it is designed to enable any user to parse plate reader data and can handle a wide variety of instruments (10+) and data types (53+). Parsley is freely available via a web interface, enabling access to its unique plate reader data parsing functionality, without the need to install software or write code.https://gbstan.shinyapps.io/parsleyapp/. The source code is available at: https://github.com/ec363/parsleyapp and is archived on Zenodo: https://zenodo.org/records/10011752.The Parsley web application can be accessed at:  Most modern plate readers are capable of carrying out absorbance, fluorescence and luminescence readings using multiwell plates ranging from 6- to 384-well plates (with 96-well plates being the most common). Many come with additional features to enable spectrum scanning, timecourse measurements, as well as the ability to control temperature, tune wavelengths or implement reagent injection. As a result of this versatility, a diverse range of phenotypes may be assayed in these instruments in high-throughput, making plate readers essential tools for the average molecular or cell biology laboratory.A growing number of analytical packages have been developed in recent years to automate the analysis of plate reader data. A list of currently available packages is shown in As shown in Data parsing functions can be found in a variety of packages [Thus, none of the above tools tackle the generic problem of data extraction from diverse raw data structures, nor are they implemented as interactive parsing applications. As a result, prospective users of plate reader analysis software are likely to have to write one, or perhaps several, parser functions before being able to begin their analyses. This requirement for function writing poses a hurdle that impedes the take-up of software packages for data analysis, particularly for users who are less confident in their coding abilities.To confront this problem, we have developed Parsley , b, a weThere are three main steps to parsing plate reader data with Parsley . First, While raw data from plate readers is exported in a wide range of formats, there are some conventions to data export formats that can be used as starting points for a general parser. For example, the most common multiwell plate is the 96-well plate, in which rows are numbered ‘A’ to ‘H’, columns ‘1’ to ’12’, and wells ‘A1’ to ‘H12’. Most export functions will present this data in one of three formats: horizontal , vertical , or matrix format , where a reading refers to a measurement . For horizontal and vertical data, well order is typically ‘A1’, ‘A2’, ‘A3’, etc. For matrix data, the entire plate is typically represented as an 8 by 12 grid. For horizontal/vertical data, consecutive rows/columns are typically used for each respective measurement reading. Therefore, some assumptions can be made about data structures and built into a general parser. The rare exceptions can then be handled by adapting the default framework.Unlike a standard parser function, which may identify the location of data within a raw data file programmatically by instrument-specific context clues, Parsley identifies the location of data entirely from positional information. This is because Parsley makes few assumptions about the raw data structure and does not aim to provide automation capabilities. However, Parsley is intended to be generic to a wide range of formats. Positional information is also an easy and intuitive type of input to ask users to provide. To implement this, the app uses DataTables from the DT package , and makOnce the data is extracted from the raw data file, it is tidied and joined to user-specified metadata. There are few requirements for the metadata file, except that it needs to contain a variable called ‘well’, as this is the column that is used for joining the data and metadata together. All other columns are optional and will depend on downstream requirements. The parse function in Parsley builds a tidy dataframe consisting of the metadata on the left and the tidied data on the right, which can be downloaded as a CSV file and used in downstream analyses .Parsley is built to guide users through a predefined series of steps to specify the type and format of the data, the location of the data, and the number and name of readings and/or timepoints (for timecourse data) and/or wavelengths (for spectra). A number of checks are included in both the UI  and the server . For instance, each Data Specification step involves a user entered action  followed by a submission with a button labelled ‘Set’. Invalid entries are flagged by an error message that informs the user about the detected data entry problem. Similarly, a Data Specifications tab collects all the user inputs, which can be checked to verify that the program is using the values that the user intends Parsley to be using. Most errors should be caught with a combination of these methods. A complete guide to the use of the app is available in the ‘Guide’ tab in the main header, with a ‘Demos’ tab containing screen recording solutions for all three data types, as well as a ‘Help’ tab to troubleshoot common issues and provide definitions for the error messages.In completing the above steps, users not only parse a Raw Data file, but also effectively ‘build’ their own parser functions. To speed up the parsing of similar data files, Parsley allows users to save completed parser functions as .RDS (R data) files . A dedicParsley tackles an as-yet-unaddressed problem in the multiwell plate data analytics pipeline, namely the question of whether it is possible to write generic data parsing software that operates on raw data exported from any plate reader instrument. Compared to other parsing tools, Parsley is designed with as few assumptions as possible about the raw data and maximum flexibility to deal with unusual data types. These options allowed us to verify that Parsley can extract data successfully from at least 53 export formats from over 10 different instruments . It is ibtad733_Supplementary_DataClick here for additional data file.


SLEEP Advances to honor our living pioneers and to gain from them anew by inviting papers from those with early publications and sustained contributions in our field. I welcome Drs. Sonia Ancoli-Israel and Ralph Lydic as associate editors for this initiative and two SRS trainee members, Dr. Renske Lok and Katrina Rodheim, as editorial interns to assist authors and editors as needed.The Sleep Research Society is 60 years old, the American Academy of Sleep Medicine is preparing to celebrate its fiftieth year, and other sleep societies around the globe are also maturing! Our field has achieved a remarkable record of discoveries, yet these accomplishments come with harsh news as the lives of our pioneering members pass on. I have felt the pain deeply in recent months and years with the recurrent losses of such giants as Michel Jouvet, Christian Guilleminault, William Dement, Rosalind Cartwright, Allan Rechtschaffen, Barbara Jones, Irwin Feinberg. Our field’s recent losses are too numerous for me to list here; however, my personal distress has galvanized me to open an initiative at I am delighted to announce our first Living Legends publication, “Looking back at a life in sleep research—and some thoughts for the future”, by Wallace Mendelson, MD. A second manuscript from David Kupfer, MD, with Ellen Frank, PhD, “David J Kupfer: Long day’s journey into sleep” will follow soon, with others on their way. I have so enjoyed reading and learning from these contributions; I hope that all SRS members—especially trainees—will enjoy them, too.Mary A. Carskadon, PhDSLEEP Advances Editor in Chief15 October 2022


The aim of this study was to examine the perceptions and experiences of male patients with alcoholic pancreatitis after healing regarding alcohol withdrawal and life management.This study used a qualitative descriptive design, and participants were selected by purposive sampling from two tertiary care hospitals in Shandong Province, China. Semi-structured in-depth interviews were conducted with 18 male patients discharged from the gastroenterology department who had recovered from alcoholic pancreatitis. Colaizzi’s method was used to analyze the interview data, and the findings were reported using COREQ criteria.By analyzing the interview data, we summarized five themes, (1) the dilemma of sobriety, (2) role change, (3) illness status, (4) family influence, and (5) life management.By profiling the perceptions and experiences of post-healing alcoholic pancreatitis patients’ alcohol cessation and life management in men, it helps to grasp the details of alcohol cessation and health direction of patients’ home management, which provides more directional guidance to help patients maintain positive and good lifestyle habits and active management awareness, followed by targeted personalized interventions to provide patients with knowledge of disease care and health management. Men have the X-linked CLDN2 gene variant of the AP allele risk, which increases their susceptibility to acute alcoholic pancreatitis . Currentr = 0.04, p = 0.006), with a chronic pancreatitis incidence of 18.8% ; and had an AUDIT-C (Alcohol Use Disorders Identification Test) score ≥ 3. We excluded patients with cognitive impairment, hearing impairment, psychiatric disorders, and those with serious diseases, such as cancer or severe cardiopulmonary or liver disease.2.2.We used a descriptive qualitative research design with a semi-structured approach to interviewing based on purposive sampling, which facilitated the asking of new exploratory questions at the right time when new themes emerged during the interview and increased the detail and coherence of the interview. The research team members were registered nurses who had participated in training related to qualitative research and were certified to read all patients’ case histories in detail to grasp each patient’s condition before the interviews. We interviewed patients in five aspects: patients’ illness experience, drinking experience, social life, family influence, and psychological state. Three patients were pre-interviewed first, and then the interview outline was appropriately modified according to the specific interview format and content, with unlimited interview time until data saturation. The finalized interview outline is presented in 2.3.The patients were all men with a mean age of 43.11 years . The 10 family members included the patients’ wives, children. Considering that the purpose of this study was to explore the experience and perception of alcohol cessation and life management in men with AP, no demographic information was collected for the family members. We collected patients’ demographic characteristics and baseline data, including age, sex, occupation, education, marital status, monthly income, and children. Twenty-two semi-structured interviews were conducted from January 17 to February 18, 2023, and family members were encouraged to participate in the interviews to reduce patient tension and increase their involvement in managing patients’ lives. Informed consent was obtained from patients and families for the interviews and audio recordings, and the interviews were transcribed verbatim within 24 h after each interview. The detailed demographic characteristics of all participants are presented in 2.4.We used the Colaizzi qualitative analysis procedure in this study . The int2.5.This study followed the Declaration of Helsinki   the dilemma of sobriety, (2) role change, (3) illness status, (4) family influence, and (5) life management .3.1.3.1.1.Patients who had alcohol addiction before the disease were suddenly asked to stop drinking due to illness and physical reasons. They could not attend their usual drinking parties and gatherings and felt idle. The alcohol craving and inability to drink made them suffer and find it difficult to bear the situation and even doubt the value of their lives.“I’ve been drinking for 20 years, and when I suddenly quit drinking, I felt simply unprepared, did not know what to do with my free time, and felt so uninspired to live” (N1).“I cannot stand it, I cannot drink, I’m almost jumping up and down at home, I feel like I do not even know myself anymore!” (N6).3.1.2.In China, the hospitality of meeting friends with alcohol has a long history of being a lubricant for human interaction. Advocates of alcohol believe that the amount of alcohol consumed reflects how much you respect others and how much they value you. The greater the amount of alcohol consumed, the greater the engagement, sense of being needed, pride, self-satisfaction, and value. Therefore, alcohol is often linked to good relationships and workplace atmosphere, making people feel needed and valued . The tra“China has drinking etiquette, and if you want to quit drinking, it can be difficult. As part of my job to attract investment, I often meet with clients. Sometimes they invite me to drink, but what if I choose not to? Would the customers feel that I’m not being respectful?” (N1).“I want to control it properly, although it is said to have the intention to quit drinking, but it is likely to encounter again to push off the drinking scene, and we make friends basically first drink, now suddenly quit drinking, which is equal to get out of the circle, slowly are not taking you to play” (N2).3.1.3.Some patients accidentally learned that they had been named “alcoholics” or “addicts” after their illness, which hurt their self-esteem. They felt discriminated against and humiliated and felt a lot of pressure and psychological burden, disappointment, discomfort, and frustration.“My friends call me an addict and it makes me feel ashamed, aggrieved, I do not feel the same as everyone else and I’m in pain every day!” (N11).3.1.4.Some patients were uncertain about the outcome, even after life management. They considered living in the present rather than dwelling on uncertainties. However, they were sometimes eager to recover from their illness and implemented a regular lifestyle in stages. Possibly, they could not predict their next action.“Is it that I cannot get well in the future, I cannot get well even if I am happy for 1 day, I think I want to drink enough before I die” (N9).“Will I be able to live well in the future, I sometimes want to go to a regular life properly, but will that work? Will I still be able to live my life properly?” (N11).3.2.3.2.1.Some patients stated they needed to recuperate at home and could not participate in work due to their health. They remained skeptical and distrustful of their subordinates’ progress and ability to handle important issues. They were uncertain about their subordinates’ capabilities but could not intervene due to their illness. Thus had a sense of anxiety and frustration.As employees, they were unable to complete their work tasks in time because of illness; they felt that their personal work value could not be realized, and they were worried that their careers would be affected, which increased their uncertainty and anxiety about their future career development.“Since being hospitalized, my business is basically left to the people below me, and I am very uneasy and anxious, and I feel very annoyed inside” (N4).“Originally said to go to work at the beginning of the year, the leadership has not seen me so far, delayed work, now layoffs are very strong, really afraid of being fired” (N6).3.2.2.Patients had to give more time and energy in the workplace to keep their families financially stable. They realized the importance of sobriety and life management. However, work demands diminished their patience and determination, making change difficult. Therefore, they had to sacrifice their health to make ends meet.“I cannot bring myself to manage myself, I have a mortgage and a car payment to pay, and I have to work or there is no way to support my family” (N7).3.2.3.After the illness, patients did not value their status as “patients” because their quality of life and status quo were not greatly affected, and they felt they only needed rest. Even if they suffered for a short period because of hospitalization, they recovered from the experience and did not feel a need to undergo life management, and decided to retain the status quo. Many patients even chose to numb themselves with alcohol due to the stress of their work life.“There’s no thought of quitting drinking or exercising, I do not feel the need to because I need to work Monday through Friday and I run a couple of supermarkets and engineering firms, and you are asking me to exercise in my free time? I do not think I can do that, it’s good to keep it as it is” (N1).“I originally also ate breakfast, now I do not eat at all, I eat irregularly, love to drink, love to eat late night snacks, and I am particularly good at cooking, want to eat at 10 pm I also go to do” (N17).“I’m so tired, drinking relaxes me the most, and I do not know anything when I’m drunk” (N1).3.3.3.3.1.Some patients observed that their friends who share their drinking habits did not develop the disease. Thus, they believed that their illness was related to other factors, such as diet and not alcohol consumption, and that the relationship, if any, was minimal. Adequate knowledge of the disease and health education may change their minds, depending on the patient’s correction of the disease and self-perception; however, the process may be slow.“I’ve been drinking for 18 years, and although I drink a lot each time, I only drink intermittently, sometimes not more than a few times a month, and that’s what I do with my friends, so the illness is definitely not due to drinking” (N12).3.3.2.Many patients, knowing that they could not drink alcohol, still did not refuse alcohol at compulsory drinking parties. They intended to attend the party without drinking but easily resumed drinking, neglecting the disease risk.“I thought there should be no problem ah, I feel quite well nourished this time, the last attack was 7 months ago, last time I drank five glasses of white wine, this time I just drank two glasses, I did not expect to have another offense” (N6).3.3.3.Some patients were discharged from the hospital in poor physical condition, losing weight daily. Their experience of repeated admissions and ICU (Intensive Care Unit) stays due to recurrent pancreatitis caused by alcohol consumption made them have palpitations. They lived carefully, controlling their symptoms with medications to maintain their basic living condition. They felt that pancreatic cancer could separate them from their families.“After a long time of recuperating at home and feeling better, I accidentally drank some cold water, then the pain and swelling started again, but it came and went quickly, and it got better again after resting for a while. What should I do, can I get well, and will I get sick again?” (N3).“My pancreatic function is much damaged and I feel very uncomfortable every day. Usually I have to use insulin to maintain my blood sugar and the doctor also told me to supplement pancreatic enzymes, which are good for me to control my disease, but can they fight cancer? My daughter just finished her college entrance exams this year, can I last until she graduates from college?”(N7).3.4.3.4.1.Some patients’ families expressed their views that their sick family members were dismissive of sobriety and life management and ignorant of the condition. They stated that they could not make any decisions or efforts in their families’ place, initially with anger, which slowly became profound helplessness. Sometimes they were too busy taking care of their children and dealing with other family matters to take care of their patients, who had to take care of themselves most of the time.“I know what’s at stake, but he does not listen, and I cannot keep an eye on him, and I’m afraid he’ll still do what he wants when he gets home (sigh)” (F7).“They can not help me ah, we have two children, my love has to take care of the children, I have to cook for myself, and sometimes I am very busy, can not return home, how to manage life? I do not know (said with a bitter smile)” (N2).3.4.2.Individual patients’ families described how the patient was young and immature. They believed it was a bit overwhelming to ask someone who was not yet capable of disciplining himself properly to accomplish the tasks of sobriety and health management, and that he needed to be well protected and needed more family help to accomplish these onerous management tasks when in reality, the so-called “little friend “was 42 years old.Some patients believed that they were incapable of managing their lives and needed to rely on their family (parents). They believed that the key to achieving sobriety was discipline from family members. They were wrongly focused; possibly, they needed the right knowledge of self first.“He’s still young and I do not think he can do it on his own” (N4).“My mom wants to come over to my house to spy on me and keep me from drinking, and I actually feel the need for my mom to come over” (N10).3.5.3.5.1.Many patients stated that they were physically and mentally exhausted; the physical fatigue was due to life activities, and the psychological aspect was also substantial. They stated that resisting the temptation of alcohol, tobacco, and food was exhausting them and caused great distress; the effect of life management was not good, and their physical state did not improve, which made them feel caught in a foggy life dilemma and at a loss.“I cannot hold on anymore, it’s not easy for me to maintain such a state of life, I feel so tired of living, I really do not know what to do next!” (N15).3.5.2.Some patients took advantage of their illness to put off all meaningless drinking parties and took the initiative to change their social style, for example, from drinking alcohol to tea and changing the venue of certain business meetings to a sports field, which produced good social results. Thus, they were better adapted to life, in a positive state, and more flexible in the world. This was mostly observed in younger patients, who were generally more educated and with better cognitive capabilities, confident in a good life and healthy body, and hopeful for the future; thus, they could make positive changes.“From now on, just take this disease and put off the drinking game, try not to drink any more, just drink tea” (N11).“I was very aware of my condition, I had to stop drinking for myself, and I changed a lot of business meeting places, and the other person was able to understand and accept it” (N3).3.5.3.Some patients had the courage to change, the determination to overcome difficulties, and the fearlessness to sacrifice. They reconciled with themselves, found a balance between life and management after moving away from the “paper life,” stabilized their illness, rediscovered the meaning of life, created another career, and rediscovered their values. They increased their companionship and mutual understanding with their families. They were increasingly involved in family affairs and children’s education, resulting in increasingly harmonious family relationships, greatly increasing their happiness and satisfaction.“I have confidence in myself, I have succeeded in quitting drinking, my family is very attached to me, and this admission has given me a wake up call to take more care of myself in the future” (N4).“My lover says I’ve been much more diligent lately and do a lot of housework well, before I did not like to do housework” (N11).4.In this study, a subset of patients who made attempts to quit alcohol experienced significant alcohol withdrawal symptoms and struggled to overcome their addiction. Unfortunately, their efforts to quit were hampered by a lack of willpower. Alcoholism led to the development of various severe health conditions such as pancreatic disease, liver disease, cancer, brain damage, anxiety, and depression, among others. Despite the potential life-threatening consequences, a majority of these patients still did not choose to stop drinking. In addition to a weakened willpower, it remains unclear why men in particular find it challenging to quit alcohol consumption. Studies state that alcohol often plays an important role in male-dominated religions or rituals. Drinking is also an important channel for men to achieve social cohesion and involvement in the workplace and is pivotal in men’s social and political careers . In addiSome patients in this study were called “alcoholics” and “addicts” by others. The stigmatization of people with substance use disorders is a common phenomenon today, and some mass media even label people with alcohol problems as such. Studies have revealed that patients affected by alcohol use problems are perceived as having more negative effects than patients with other medical-like disorders ; this peSome of the patients in this study were caught up in varying degrees of occupational role struggles in the early stages of healing. They remain attached to the work progress of employees, or they are in a dilemma because they cannot finish their work in time. They feel that their degree of accomplishment of goals and sense of conviction is greatly reduced; this situation is described as reduced self-efficacy and is the main reason they lack the motivation to change their lives and fall into a professional role struggle, eventually leading to role change failure. Self-efficacy is centered on personal agency, is triggered by actions taken by the individual, and it both influences and is influenced by behavioral and environmental factors of the patient . When thSome patients are unaware of pancreatitis and stubbornly judge the disease as unrelated to alcohol consumption based on their life experiences. The lack of health education about the disease is the reason for their misjudgment and ignorance. A study examining the attribution of alcohol consumption claimed that men with higher education levels had lower alcohol consumption and prevalence . In a stSome patients in the study were worried and fearful about disease recurrence or cancer because they felt they could not accurately predict disease progression. Some discomforting symptoms from the disease interfered with their correct judgment and affected their cognitive abilities. An anatomical study discussed the interaction between emotion and cognition, first explaining the influence of brain structure on emotion. They claimed that the extensive connectivity of brain structures amplifies the potential for cognitive and emotional interactions and later elaborated on functionality, proposing the existence of a dual competing architecture for emotion processing, one that views emotion and motivation as combined with perception and cognition, and that these effectively combined interactions allow people to incorporate perceptual values into behavioral patterns effectively . This isPositive long-term encouragement and care from family are essential in the recovery process. Research reveals that having the care and support of family members in sobriety and life management often makes all the difference . AccordiSelf-motivation and self-determination theories that emerge in sobriety are important reasons why patients experience behavioral changes and adapt to life; motivation is expressed through an individual’s readiness for change, and higher levels of autonomous motivation imply the greatest likelihood of being prepared for sobriety and are likely to portend success . Self-deOur study had some limitations. Only men with AP and no women were involved in this study, probably because of the small group of women with AP due to alcohol abuse in China. There may also be a risk of recall bias, as in other studies; for example, patients may not remember the specifics of the onset of the disease.In conclusion, each patient was actively aware of the need to quit drinking and maintain good lifestyle habits. However, due to life’s compulsions, lack of will, or the influence of stigma, they failed to quit drinking, and their disease relapsed or worsened. We provided guidance to help patients correct their roles and improve their self-efficacy. We provided timely knowledge of disease care and life management, psychological guidance, and correct thinking and cognitive guidance to stimulate motivation for change and overcome negative emotions. A positive concept of recovery can inspire patients to perform coping acceptance measures, adopt a new sense of self, and facilitate a reduction in drinking behavior. In addition, we believe it is important to provide individualized management plans that fully integrate the patient’s condition and family relationships. Our findings provide experiential and cognitive insights into the abstinence experience and life management of men with AP, which captures the details of patients’ lives and health pathways for home management and provides a reference for further research to assess aspects of home life management and quality of life after healing in patients with AP.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Medical Ethics Committee of Binzhou Medical University. The patients/participants provided their written informed consent to participate in this study.RC, QW, and DW performed most of the writing. XYL, HW, JG, and XHL performed data acquisition, writing, and prepared the tables. RC designed the outline and coordinated the writing of the paper. RC and DW contributed to the conception of the study. All authors contributed to the article and approved the submitted version.This work was supported by Natural Science Foundation of Shandong Province (ZR2022MH117), Binzhou Medical University School of Nursing Postgraduate Scientific Research Innovation Support Program (2023-171).XHL is employed by Shandong Vheng Data Technology Co., Ltd.The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Götz FabryMedizindidakitik – Für eine kompetenzorientierte, praxisrelevante und wissenschaftlich fundierte AusbildungPublisher: Hogrefe VerlagYear of publication: 2023, 350 pages, price: € 59,95ISBN: 978-3-456-85852-4Why, What, and How of teaching and learning in the respective subject, establishes references to general didactic principles, and encourages reflection on the individual and social relevance of the learning content and competencies to be taught. The question is: Does the author satisfy these requirements?Medical didactics – do they exist at all? If so, what should they cover? As a specialized area of teaching, they could claim to be an educational science that pursues the central pedagogical questions about the The first chapter addresses what kind of training future physicians actually need. The question is dealt with from different perspectives: from the university alumni point of view, from the field of patient care and from the field of higher education. Historical and international references are made, current studies are cited. The subject of medicine is placed in the context of scientific theory and the discourse of professionalization. The critical scrutiny of the author points out weaknesses in medical education, but leaves it to the reader to form his or her own opinions. The scope is initially broad, and ample impetus is given for reflection on the social relevance of successful medical education. The second chapter examines generally applicable concepts such as motivation, cognition and learning with regard to their significance for medical education. The author’s tone is not instructional, but rather he argues, substantiates and proves. If you want to teach, you have to understand how learning takes place – and this can vary greatly from individual to individual. So, learning strategies are differentiated, learning activity analyzed, clinical thinking categorized. In tables and using practical examples, concrete possibilities are shown how different activity levels can be addressed in teaching and how different teaching methods can support the development of professionalism in students. References to general didactics are made.Why, What and How are answered, again theoretically grounded, scientifically substantiated, and hermeneutically justified. Basic questions are first clarified, e.g., “What are competencies, really?” or “How can goals for medical education be defined?” and “What role does the National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education play here?” Particularly noteworthy are the learning goal taxonomies. Bloom’s taxonomy is familiar to  every savvy educator, but did you know that it only covers the cognitive domain? And are you also aware of the learning goal categories for the affective and psychomotor domains? As annoying as it may be for teachers to first deal with competencies and learning objectives, this is then ultimately useful for further planning and instructional design, up to and including the development of a customized learning objective assessment. For the reader, the effort is worth it, even here. The real tips for teaching and learning are then finally found in chapter four “Teaching methods”. This chapter is sorted into “Formats for large groups”, “Learning in small groups”, and “Clinical teaching”, following the logic of the teaching formats at German medical schools. Here, the new edition benefits in particular from newly added topics and subchapters such as “Lecture Recordings”, “Flipped Classroom”, and “Feedback”. In the third chapter it all finally becomes concrete: “Lesson planning”. Or so I thought. In any case, the questions of Chapters five “Examining: information and results monitoring” and six “Teaching evaluation” have also benefited from the revision of the earlier edition (2008). For example, the subchapter “Competence-oriented testing – what does that mean?” has been added. The question “What can/should be examined?” shows that we are looking far beyond the current state of affairs. Examinations are considered in their interaction at the curricular level, but are also scrutinized in detail, for example, with regard to their formal requirements and possible uses. The final chapter, as is often the case in teaching, is “Teaching evaluation”, which is mandatory under the German medical licensure regulations , but the potential of which is often not fully exploited. Yes, valid statements on the quality of teaching can indeed be made. In return, however, the question is also asked “Can students judge the quality of teaching at all?” This weighing, contrasting, looking underneath the surface characterizes all of the chapters and invites more in-depth grappling with individual questions. The comprehensive subject index and effective organization of the material makes looking up specific information convenient.Each individual chapter ends with a conclusion and, in addition to an extensive bibliography, also with recommendations for more in-depth reading. So-called toolboxes, 17 in total, include checklists, strategies and assessment sheets and provide a high level of practical relevance. The verdict? Medical didactics fulfill all of the requirements of a specialized area of teaching, and even more. The precision with which individual aspects are examined provides ample starting points for further development of teaching in research and pedagogy. Remarkable is the clarity and, at the same time, cautiousness with which criticism of the current state of education is exercised, constructively and concretely. The focus is on what has already been scientifically tested, what could be and what is feasible. It makes you want to do more.If you are looking for a quick fix to brighten up your teaching, you will be disappointed. Good teaching is a complex undertaking with many influencing variables. Teachers, learners and researchers who want to look at teaching and learning in medicine in depth will find a real treasure chest here. It’s worth it.The author declares that she has no competing interests.