Jan Breckwoldt

Schoolchildren as lifesavers in Europe - training in cardiopulmonary resuscitation for children.

Sudden cardiac arrest is a major contributor to avoidable deaths in Europe. Immediate initiation of basic life support (BLS) by lay bystanders is among the most successful strategies in its treatment. Despite the fact that more than half of all cardiac arrests are witnessed in a number of European countries, layperson resuscitation is initiated in only one-fifth of all cases. One strategy to promote bystander BLS is to establish cardiac resuscitation training in schools. BLS instructions for schoolchildren - including the use of automatic external defibrillators (AEDs) - have been shown to be feasible independently of the childrens age or physical ability. Nonetheless, it appears reasonable to implement age-adjusted curricula. The earlier in the course of life-long learning BLS instruction begins, the more sustainable training may be.

Does clinical teacher training always improve teaching effectiveness as opposed to no teacher training? A randomized controlled study

BackgroundTeacher training may improve teaching effectiveness, but it might also have paradoxical effects. Research on expertise development suggests that the integration of new strategies may result in a temporary deterioration of performance until higher levels of competence are reached. In this study, the impact of a clinical teacher training on teaching effectiveness was assessed in an intensive course in emergency medicine. As primary study outcome students’ practical skills at the end of their course were chosen.MethodsThe authors matched 18 clinical teachers according to clinical experience and teaching experience and then randomly assigned them to a two-day-teacher training, or no training. After 14 days, both groups taught within a 12-hour intensive course in emergency medicine for undergraduate students. The course followed a clearly defined curriculum. After the course students were assessed by structured clinical examination (SCE) and MCQ. The teaching quality was rated by students using a questionnaire.ResultsData for 96 students with trained teachers, and 97 students with untrained teachers were included. Students taught by untrained teachers performed better in the SCE domains ‘alarm call’ (pu2009<u20090.01) and ‘ventilation’ (pu2009=u20090.01), while the domains ‘chest compressions’ and ‘use of automated defibrillator’ did not differ. MCQ scores revealed no statistical difference. Overall, teaching quality was rated significantly better by students of untrained teachers (pu2009=u20090.05).ConclusionsAt the end of a structured intensive course in emergency medicine, students of trained clinical teachers performed worse in 2 of 4 practical SCE domains compared to students of untrained teachers. In addition, subjective evaluations of teaching quality were worse in the group of trained teachers. Difficulties in integrating new strategies in their teaching styles might be a possible explanation.

The simulated patient's view on teaching: results from a think aloud study.

Purpose This study explored third-year clinical teaching encounters from the perspective of the simulated patient (SP) participants. Method In August through December 2008, to obtain data from SPs, the authors used retrospective Think Aloud (rTA) methodology on video recordings of teaching sessions in which the respective SPs had participated. While watching the video, SPs were instructed to speak aloud their thoughts in response to the question “What made you feel comfortable or uncomfortable during the session?” Recordings of rTA exercises were analyzed by qualitative content analysis. Results From 27 teaching sessions with 23 different teachers, 269 relevant comments were extracted and categorized. SPs felt comfortable if the atmosphere was calm (10 comments), appropriate physical contact was established (8), the student attended to the patient (8), the student acted in a well-structured manner (7), and the role-play was well structured by the clinical teacher (7). SPs felt uncomfortable if they were excluded from communication (16), actions were not properly explained (14), students did not attend to the patient (10), students did not stay in their role (10), and everyone talked at the same time (8). Conclusions SPs highly valued a clear structure of the teaching setting and appropriate preparation and good communication skills on the students part. Many of the aspects of teaching quality were found to be under the influence of the clinical teacher and may, therefore, be important for teacher training.

Cardiac resuscitation: Epinephrine to treat cardiac arrest--a double-edged sword.

Randomized studies and evaluations of large registries have repeatedly shown that epinephrine used as a standard vasopressor for cardiopulmonary resuscitation increases the rate of return of spontaneous circulation. By contrast, epinephrine might decrease long-term survival and impair neurological outcome.

Short structured feedback training is equivalent to a mechanical feedback device in two-rescuer BLS: a randomised simulation study

BackgroundResuscitation guidelines encourage the use of cardiopulmonary resuscitation (CPR) feedback devices implying better outcomes after sudden cardiac arrest. Whether effective continuous feedback could also be given verbally by a second rescuer (“human feedback”) has not been investigated yet. We, therefore, compared the effect of human feedback to a CPR feedback device.MethodsIn an open, prospective, randomised, controlled trial, we compared CPR performance of three groups of medical students in a two-rescuer scenario. Group “sCPR” was taught standard BLS without continuous feedback, serving as control. Group “mfCPR” was taught BLS with mechanical audio-visual feedback (HeartStart MRx with Q-CPR-Technology™). Group “hfCPR” was taught standard BLS with human feedback. Afterwards, 326 medical students performed two-rescuer BLS on a manikin for 8xa0min. CPR quality parameters, such as “effective compression ratio” (ECR: compressions with correct hand position, depth and complete decompression multiplied by flow-time fraction), and other compression, ventilation and time-related parameters were assessed for all groups.ResultsECR was comparable between the hfCPR and the mfCPR group (0.33 vs. 0.35, pu2009=u20090.435). The hfCPR group needed less time until starting chest compressions (2 vs. 8xa0s, pu2009<u20090.001) and showed fewer incorrect decompressions (26 vs. 33xa0%, pu2009=u20090.044). On the other hand, absolute hands-off time was higher in the hfCPR group (67 vs. 60xa0s, pu2009=u20090.021).ConclusionsThe quality of CPR with human feedback or by using a mechanical audio-visual feedback device was similar. Further studies should investigate whether extended human feedback training could further increase CPR quality at comparable costs for training.

KIDS SAVE LIVES: School children education in resuscitation for Europe and the world

Sudden cardiac death is the third leading cause of death in industrialised nations. It is estimated that in Europe and in the United States, more than 700u200a000 patients die annually following sudden cardiac death, even when the emergency medical service has been activated and started cardiopulmonary

Differences in procedural knowledge after a “spaced” and a “massed” version of an intensive course in emergency medicine, investigating a very short spacing interval

BackgroundDistributing a fixed amount of teaching hours over a longer time period (spaced approach) may result in better learning than delivering the same amount of teaching within a shorter time (massed approach). While a spaced approach may provide more opportunities to elaborate the learning content, a massed approach allows for more economical utilisation of teaching facilities and to optimise time resources of faculty. Favourable effects of spacing have been demonstrated for postgraduate surgery training and for spacing intervals of weeks to months. It is however unknown, whether a spacing effect can also be observed for shorter intervals and in undergraduate medical education. Therefore, we aimed to evaluate the effect of a short spacing intervention within an undergraduate intensive course in emergency medicine (EM) on students’ procedural knowledge.MethodsAn EM intensive course of 26 teaching hours was delivered over either 4.5xa0days, or 3.0xa0days. After the course students’ procedural knowledge was assessed by a specifically developed video-case based key-feature test (KF-test).ResultsData sets of 156 students (81.7xa0%, 191 students eligible) were analysed, 54 from the spaced, and 102 from the massed version. In the KF-test students from the spaced version reached a mean of 14.8 (SD 2.0) out of 22 points, compared to 13.7 (SD 2.0) in the massed version (pu2009=u2009.002). Effect size was moderate (Cohen’s d: 0.558).ConclusionA significant spacing effect was observable even for a short spacing interval in undergraduate medical education. This effect was only moderate and may be weighed against planning needs of faculty and teaching resources.

Reanimationstraining für Laien in Erste-Hilfe-Kursen

ZusammenfassungHintergrundDie effektivste Maßnahme zur Verbesserung der Überlebensqualität beim prähospitalen Herz-Kreislauf-Stillstand ist die Ersthelfer-Reanimation. Demzufolge werden seit Jahrzehnten Erste-Hilfe-(EH-)Kurse für Laien angeboten. Trotzdem liegen die Ersthelfer-Reanimation-Quoten in Deutschland im Vergleich zu anderen Industrieländern alarmierend niedrig. Eine mögliche Ursache könnte in der Unterrichtsqualität liegen, mit der die Ausbilder Wissen, Fertigkeiten und Haltungen vermitteln.Material und MethodeWir analysierten die Basic-Life-Support(BLS)-Module in 20 offiziell anerkannten EH-Kursen in Berlin mithilfe eines teilnehmenden Beobachters, der sich erst nach Ende des Kurses gegenüber Ausbildern und Teilnehmern zu erkennen gab. Die Unterrichtsqualität wurde anhand einer standardisierten Checkliste mit 21xa0Beobachtungsmerkmalen erfasst (10xa0Merkmale für „Wissen“, 8 für „Fertigkeiten“ und 3 für „Haltungen“), unter Verwendung von Likert-Skalen vonu2009+u20092 (sehr gut) bis −u20092 (sehr schlecht).ErgebnisseDie durchschnittliche Bewertung aller Kurse für den Transfer von Wissen war +u20090,47 (SD u2009±u20090,46), für die Vermittlung von Fertigkeiten +u20090,03 (SD ±u20090,61) und für Haltungen −u2009u20091,08 (SD ±u20090,73). Die Werte für die „Verminderung von Angst vor Fehlern“ lagen bei −u20090,90, für die „positive Belegung/Attribution von praktischem Üben“ bei −u20091,25 und für die „Darlegung des Kursnutzens für die Teilnehmer“ bei −u20091,10.SchlussfolgerungFür die beobachteten EH-Kurse zeigten sich signifikante Defizite, insbesondere bei der Vermittlung einer positiven Haltung gegenüber der Reanimation. Dies könnte ein wichtiger Faktor sein, der zu niedrigen Ersthelfer-Reanimation-Quoten in Deutschland beiträgt.AbstractBackgroundBystander cardiopulmonary resuscitation (CPR) is the most effective intervention for out of hospital sudden cardiac arrest; therefore, basic life support (BLS) courses for lay persons have become well established in industrialized countries, often since decades. Despite this favorable situation bystander CPR rates still remain low in some countries (e.g. in Germany), indicating serious implementation problems. The quality of instruction in these courses could be one reason for low bystander CPR rates. We therefore analyzed official lay BLS courses in terms of the teaching quality in the domains of knowledge, skills and attitudes (according to Bloom’s taxonomy).Material and methodsA total of 20 officially accredited lay BLS courses in Berlin, Germany, were analyzed by a participating observer, who remained blinded to the instructor and course participants until the end of the course. Courses were offered by German rescue organizations and private providers according to European Resuscitation Council (ERC) guidelines. Teaching quality was rated by a standardized checklist including 21 observable criteria of teaching quality for transfer of knowledge (nu2009=u200910), skills (nu2009=u20098) and attitudes (nu2009=u20093). In order to achieve comparability between items the results of each criterion were quantified by Likert scales ranging from +u20092 (very good) to −u20092 (very poor).ResultsThe average score of all courses was +u20090.47 (SD ±u20090.46) for transfer of knowledge, +u20090.03 (SD ±u20090.61) for skills and −u20091.08 (SD ±u20090.73) for attitudes. In the domain of knowledge transfer, learning atmosphere and course structure were rated to be generally good, whilst marked deficits were found with respect to correctness of content. In the domain of skills the more positive ratings were given for teaching of single BLS elements (e.g. compressions and ventilation), in contrast to the training of BLS context, where e.g. realistic scenarios were only used by 3 out of 20 instructors. The domain of attitude transfer had the worst rating. Detailed ratings were −u20090.90 for “reducing fear of doing harm to the victim”, −u20091.25 for “positive attribution of practical training” and −u20091.10 for “explaining course relevance from the learners’ perspective”.ConclusionWithin the observed BLS courses the teaching quality revealed significant deficits, especially for the transfer of positive attitudes to learners. Also, the use of meaningful realistic scenario teaching was very scarce. These findings can significantly contribute to low bystander CPR rates because transfer of learned content into practice may be hampered.BACKGROUNDnBystander cardiopulmonary resuscitation (CPR) is the most effective intervention for out of hospital sudden cardiac arrest; therefore, basic life support (BLS) courses for lay persons have become well established in industrialized countries, often since decades. Despite this favorable situation bystander CPR rates still remain low in some countries (e.g. in Germany), indicating serious implementation problems. The quality of instruction in these courses could be one reason for low bystander CPR rates. We therefore analyzed official lay BLS courses in terms of the teaching quality in the domains of knowledge, skills and attitudes (according to Blooms taxonomy).nnnMATERIAL AND METHODSnA total of 20 officially accredited lay BLS courses in Berlin, Germany, were analyzed by a participating observer, who remained blinded to the instructor and course participants until the end of the course. Courses were offered by German rescue organizations and private providers according to European Resuscitation Council (ERC) guidelines. Teaching quality was rated by a standardized checklist including 21 observable criteria of teaching quality for transfer of knowledge (nu2009=u200910), skills (nu2009=u20098) and attitudes (nu2009=u20093). In order to achieve comparability between items the results of each criterion were quantified by Likert scales ranging from +2 (very good) to -2 (very poor).nnnRESULTSnThe average score of all courses was +0.47 (SD ±0.46) for transfer of knowledge, +0.03 (SD ±0.61) for skills and -1.08 (SD ±0.73) for attitudes. In the domain of knowledge transfer, learning atmosphere and course structure were rated to be generally good, whilst marked deficits were found with respect to correctness of content. In the domain of skills the more positive ratings were given for teaching of single BLS elements (e.g. compressions and ventilation), in contrast to the training of BLS context, where e.g. realistic scenarios were only used by 3 out of 20 instructors. The domain of attitude transfer had the worst rating. Detailed ratings were -0.90 for reducing fear of doing harm to the victim, -1.25 for positive attribution of practical training and -1.10 for explaining course relevance from the learners perspective.nnnCONCLUSIONnWithin the observed BLS courses the teaching quality revealed significant deficits, especially for the transfer of positive attitudes to learners. Also, the use of meaningful realistic scenario teaching was very scarce. These findings can significantly contribute to low bystander CPR rates because transfer of learned content into practice may be hampered.

Entrustable professional activities

ZusammenfassungAls „entrustable professional activity“ (EPA) wird eine in sich abgeschlossene klinische Arbeitseinheit bezeichnet, die für den jeweiligen Arbeitsbereich typisch ist und die im Verlauf der Weiterbildung schrittweise dem Weiterzubildenden zur selbstständigen Durchführung anvertraut wird. Das könnte z.u202fB. die intraoperative Narkoseführung bei einem ASA-1-Patienten für einen unkomplizierten operativen Eingriff sein. Die EPA kann als Weiterentwicklung eines „kompetenzbasierten“ Ausbildungskonzepts verstanden werden, indem die vorhandenen Kompetenzen einer Person auf die konkrete Arbeitssituation bezogen werden. Damit werden die auf einer bestimmten Weiterbildungsstufe erwarteten Fähigkeiten und Fertigkeiten für alle Beteiligten klarer fassbar, und der Gefahr der Fragmentierung von Einzelkompetenzen im „kompetenzbasierten“ Modell wird vorgebeugt. Erfahrungen mit dem Konzept sind derzeit noch begrenzt, sodass dringend Studien notwendig sind, die zeigen, ob und wie EPA zu einer Verbesserung der Weiterbildung beitragen.AbstractEntrustable professional activities (EPAs) are characterized as self-contained units of work in axa0given typical clinical context, which may be entrusted to axa0trainee for independent execution at axa0certain point of training. An example could be the intraoperative anesthesia management of an ASAxa01 patient for an uncomplicated surgical intervention as an EPA in early postgraduate anesthesia training. The EPAs can be described as an evolution of a competency-based medical educational concept, applying the concept of the competencies of a person to specific workplace contexts. In this way the expected level of skills and supervision at axa0certain stage of training have a more practical meaning and the danger of fragmentation of individual competencies in the competence-based model is avoided. It is axa0more holistic view of axa0trainee. Experience with this new concept is so far limited, therefore, further studies are urgently needed to determine whether and how EPAs can contribute to improvements in further training.

Reanimationstraining für Laien in Erste-Hilfe-Kursen: Vermittlung von Wissen, Fertigkeiten und Haltungen

ZusammenfassungHintergrundDie effektivste Maßnahme zur Verbesserung der Überlebensqualität beim prähospitalen Herz-Kreislauf-Stillstand ist die Ersthelfer-Reanimation. Demzufolge werden seit Jahrzehnten Erste-Hilfe-(EH-)Kurse für Laien angeboten. Trotzdem liegen die Ersthelfer-Reanimation-Quoten in Deutschland im Vergleich zu anderen Industrieländern alarmierend niedrig. Eine mögliche Ursache könnte in der Unterrichtsqualität liegen, mit der die Ausbilder Wissen, Fertigkeiten und Haltungen vermitteln.Material und MethodeWir analysierten die Basic-Life-Support(BLS)-Module in 20 offiziell anerkannten EH-Kursen in Berlin mithilfe eines teilnehmenden Beobachters, der sich erst nach Ende des Kurses gegenüber Ausbildern und Teilnehmern zu erkennen gab. Die Unterrichtsqualität wurde anhand einer standardisierten Checkliste mit 21xa0Beobachtungsmerkmalen erfasst (10xa0Merkmale für „Wissen“, 8 für „Fertigkeiten“ und 3 für „Haltungen“), unter Verwendung von Likert-Skalen vonu2009+u20092 (sehr gut) bis −u20092 (sehr schlecht).ErgebnisseDie durchschnittliche Bewertung aller Kurse für den Transfer von Wissen war +u20090,47 (SD u2009±u20090,46), für die Vermittlung von Fertigkeiten +u20090,03 (SD ±u20090,61) und für Haltungen −u2009u20091,08 (SD ±u20090,73). Die Werte für die „Verminderung von Angst vor Fehlern“ lagen bei −u20090,90, für die „positive Belegung/Attribution von praktischem Üben“ bei −u20091,25 und für die „Darlegung des Kursnutzens für die Teilnehmer“ bei −u20091,10.SchlussfolgerungFür die beobachteten EH-Kurse zeigten sich signifikante Defizite, insbesondere bei der Vermittlung einer positiven Haltung gegenüber der Reanimation. Dies könnte ein wichtiger Faktor sein, der zu niedrigen Ersthelfer-Reanimation-Quoten in Deutschland beiträgt.AbstractBackgroundBystander cardiopulmonary resuscitation (CPR) is the most effective intervention for out of hospital sudden cardiac arrest; therefore, basic life support (BLS) courses for lay persons have become well established in industrialized countries, often since decades. Despite this favorable situation bystander CPR rates still remain low in some countries (e.g. in Germany), indicating serious implementation problems. The quality of instruction in these courses could be one reason for low bystander CPR rates. We therefore analyzed official lay BLS courses in terms of the teaching quality in the domains of knowledge, skills and attitudes (according to Bloom’s taxonomy).Material and methodsA total of 20 officially accredited lay BLS courses in Berlin, Germany, were analyzed by a participating observer, who remained blinded to the instructor and course participants until the end of the course. Courses were offered by German rescue organizations and private providers according to European Resuscitation Council (ERC) guidelines. Teaching quality was rated by a standardized checklist including 21 observable criteria of teaching quality for transfer of knowledge (nu2009=u200910), skills (nu2009=u20098) and attitudes (nu2009=u20093). In order to achieve comparability between items the results of each criterion were quantified by Likert scales ranging from +u20092 (very good) to −u20092 (very poor).ResultsThe average score of all courses was +u20090.47 (SD ±u20090.46) for transfer of knowledge, +u20090.03 (SD ±u20090.61) for skills and −u20091.08 (SD ±u20090.73) for attitudes. In the domain of knowledge transfer, learning atmosphere and course structure were rated to be generally good, whilst marked deficits were found with respect to correctness of content. In the domain of skills the more positive ratings were given for teaching of single BLS elements (e.g. compressions and ventilation), in contrast to the training of BLS context, where e.g. realistic scenarios were only used by 3 out of 20 instructors. The domain of attitude transfer had the worst rating. Detailed ratings were −u20090.90 for “reducing fear of doing harm to the victim”, −u20091.25 for “positive attribution of practical training” and −u20091.10 for “explaining course relevance from the learners’ perspective”.ConclusionWithin the observed BLS courses the teaching quality revealed significant deficits, especially for the transfer of positive attitudes to learners. Also, the use of meaningful realistic scenario teaching was very scarce. These findings can significantly contribute to low bystander CPR rates because transfer of learned content into practice may be hampered.BACKGROUNDnBystander cardiopulmonary resuscitation (CPR) is the most effective intervention for out of hospital sudden cardiac arrest; therefore, basic life support (BLS) courses for lay persons have become well established in industrialized countries, often since decades. Despite this favorable situation bystander CPR rates still remain low in some countries (e.g. in Germany), indicating serious implementation problems. The quality of instruction in these courses could be one reason for low bystander CPR rates. We therefore analyzed official lay BLS courses in terms of the teaching quality in the domains of knowledge, skills and attitudes (according to Blooms taxonomy).nnnMATERIAL AND METHODSnA total of 20 officially accredited lay BLS courses in Berlin, Germany, were analyzed by a participating observer, who remained blinded to the instructor and course participants until the end of the course. Courses were offered by German rescue organizations and private providers according to European Resuscitation Council (ERC) guidelines. Teaching quality was rated by a standardized checklist including 21 observable criteria of teaching quality for transfer of knowledge (nu2009=u200910), skills (nu2009=u20098) and attitudes (nu2009=u20093). In order to achieve comparability between items the results of each criterion were quantified by Likert scales ranging from +2 (very good) to -2 (very poor).nnnRESULTSnThe average score of all courses was +0.47 (SD ±0.46) for transfer of knowledge, +0.03 (SD ±0.61) for skills and -1.08 (SD ±0.73) for attitudes. In the domain of knowledge transfer, learning atmosphere and course structure were rated to be generally good, whilst marked deficits were found with respect to correctness of content. In the domain of skills the more positive ratings were given for teaching of single BLS elements (e.g. compressions and ventilation), in contrast to the training of BLS context, where e.g. realistic scenarios were only used by 3 out of 20 instructors. The domain of attitude transfer had the worst rating. Detailed ratings were -0.90 for reducing fear of doing harm to the victim, -1.25 for positive attribution of practical training and -1.10 for explaining course relevance from the learners perspective.nnnCONCLUSIONnWithin the observed BLS courses the teaching quality revealed significant deficits, especially for the transfer of positive attitudes to learners. Also, the use of meaningful realistic scenario teaching was very scarce. These findings can significantly contribute to low bystander CPR rates because transfer of learned content into practice may be hampered.