M. Rüsseler

Accuracy of prehospital focused abdominal sonography for trauma after a 1-day hands-on training course

Objectives To establish a training course for Prehospital Focused Abdominal Sonography for Trauma (P-FAST) and to evaluate the accuracy of the participants after the course and at the trauma scene. Methods A training programme was developed to provide medical staff with the skills needed to perform P-FAST. In order to evaluate the accuracy of P-FAST performed by the students, nine participants (five emergency doctors and four paramedics) were followed during their course and in practice after the course. An assessment was made of 200 ultrasound procedures performed during the course in healthy volunteers and in patients with peritoneal dialysis or ascites. Regular P-FAST performed on-scene by the participants commenced immediately following the course. The results for the nine participants (C-group, course group) were compared with those members of medical staff with more than 3 years of experience in FAST (P-group, professional group). A group of physicians untrained in P-FAST served as a control (I-group, indifferent group). P-FAST findings were further verified by subsequent FAST and CT scans in the emergency department. Results After the training programme the C-group performed 39 P-FAST procedures without any false negative or false positive findings (100% accuracy). In the P-group, 112 procedures were performed with one false positive case. In the I-group there were 2 false negative cases among the 46 procedures performed. Conclusion Following completion of a 1-day P-FAST course, participants were able to perform ultrasound procedures at the scene of an accident with a high level of accuracy.

Entwicklung des Lernzielkatalogs „Muskuloskelettale Erkrankungen, Verletzungen und traumatische Notfälle“ für Orthopädie-Unfallchirurgie im Medizinstudium

ZusammenfassungHintergrundMit der Entwicklung des gemeinsamen Faches Orthopädie-Unfallchirurgie bedarf es neben der Zusammenführung und Überarbeitung der Weiterbildungsinhalte des ärztlichen Nachwuchses auch der Erstellung eines für Deutschland einheitlichen Lernzielkatalogs, der die Grundlage der studentischen Lehre in der Orthopädie und Unfallchirurgie an den deutschen Fakultäten und Lehrkrankenhäusern bilden soll.Material und MethodeAusgehend vom Frankfurter Lernzielkatalog für Unfallchirurgie und dem Ulmer Lernzielkatalog für Orthopädie wurde von einer Expertenkommission der gemeinsame Katalog für das Fach Orthopädie und Unfallchirurgie entwickelt. Durch Vertreter beider Fächer erfolgte die Definition der Lernziele und anschließende Gliederung und Priorisierung in sog. Ebenen und Bereiche des kognitiven Wissens, Kompetenzstufen psychomotorischer Fertigkeiten (Skills) sowie emotionales Wissen und Kompetenz.ErgebnisInsgesamt wurden 283 Lernziele formuliert. Der „allgemeine Teil operativer Fachgebiete“ umfasst 120 Lernziele, die sich in 39 Items kognitiven Inhalts und 83 Skills unterteilen, 2 Lernziele beinhalten gleichzeitig sowohl Wissen als auch Skills. Der „spezielle Teil Orthopädie/Unfallchirurgie“ umfasst insgesamt 141 Lernziele unterteilt in 138 Lernziele mit Wissensinhalten sowie 6 Skills, 3 Lernziele beziehen sich auf Wissen sowie Skills. 22 Lerninhalte beziehen sich auf den Bereich „emotionales Wissen und Kompetenz“.SchlussfolgerungTrotz der erst jungen Verbindung der beiden Fächer Orthopädie und Unfallchirurgie konnte nicht nur eine „Themensammlung“, sondern ein gemeinsamer Lernzielkatalog für die studentische Lehre erarbeitet werden. Dieser hat nach der Verabschiedung durch die Ordinarienkonvente der Unfallchirurgen und Orthopäden bundesweiten Empfehlungscharakter. Mit der Konsentierung von Lernzielen sind die Weichen für eine zukunftorientierte moderne Lehre gestellt. Anhand der im Lernzielkatalog enthaltenen Empfehlungen zur Gewichtung der Inhalte, zur Verknüpfung mit anderen Fächern und zum Einsatz geeigneter Lehrmethoden, können die einzelnen Lernziele an den jeweiligen Fakultäten pragmatisch und unter Wahrung der Freiheit der Lehre umgesetzt werden.AbstractBackgroundThe development towards a combined speciality of orthopaedic and trauma surgery requires not only consolidation and revision of the postgraduate education training programme but also the development of a catalogue of learning objectives as a uniform basis for undergraduate medical training in the new speciality at German medical schools and teaching hospitals. Materials and methodsBased on the Frankfurt catalogue of learning objectives for trauma surgery and the Ulm catalogue of learning objectives for orthopaedics, a task force of experts developed a combined catalogue of learning objectives for the new speciality. Experts from both specialities classified the learning objectives into two levels of knowledge and four grades of skills competence, in addition to objectives for attitudes and social competence.ResultsThe section on general operative specialities contains 120 items classified into 39 learning objectives for knowledge and 83 for skills. Two learning objectives comprise both knowledge and skills. The section on orthopaedic and trauma surgery comprises 141 learning objectives, including six items for skills and 138 for knowledge, as well as three learning objectives for both knowledge and skills. In addition, 22 learning objectives deal with aspects of attitude and social competence.ConclusionAlthough this alliance of orthopaedics and trauma surgery is recent, the commission has developed not only a collection of topics but a joint catalogue of learning objectives for undergraduate training that can be used nationwide. This catalogue paves the way for modern education that looks to the future. The integrated recommendations for content prioritisation, links to other subjects and specialities, and the integration of didactic methods facilitate local implementation of the learning objectives without loss of academic freedom.BACKGROUND The development towards a combined speciality of orthopaedic and trauma surgery requires not only consolidation and revision of the postgraduate education training programme but also the development of a catalogue of learning objectives as a uniform basis for undergraduate medical training in the new speciality at German medical schools and teaching hospitals. MATERIALS AND METHODS Based on the Frankfurt catalogue of learning objectives for trauma surgery and the Ulm catalogue of learning objectives for orthopaedics, a task force of experts developed a combined catalogue of learning objectives for the new speciality. Experts from both specialities classified the learning objectives into two levels of knowledge and four grades of skills competence, in addition to objectives for attitudes and social competence. RESULTS The section on general operative specialities contains 120 items classified into 39 learning objectives for knowledge and 83 for skills. Two learning objectives comprise both knowledge and skills. The section on orthopaedic and trauma surgery comprises 141 learning objectives, including six items for skills and 138 for knowledge, as well as three learning objectives for both knowledge and skills. In addition, 22 learning objectives deal with aspects of attitude and social competence. CONCLUSION Although this alliance of orthopaedics and trauma surgery is recent, the commission has developed not only a collection of topics but a joint catalogue of learning objectives for undergraduate training that can be used nationwide. This catalogue paves the way for modern education that looks to the future. The integrated recommendations for content prioritisation, links to other subjects and specialities, and the integration of didactic methods facilitate local implementation of the learning objectives without loss of academic freedom.

Training praktischer Fertigkeiten in der Chirurgie – Ein Ausbildungskonzept für Studierende

BACKGROUND During undergraduate medical education, the trainee should not only gain theoretical knowledge but also acquire essential skills. Several studies have demonstrated that practical training can be improved. However, only single training concepts for solitary skills have been developed and evaluated. This work presents a training programme for basic surgical skills. MATERIALS AND METHODS A one-week training of practical skills has been integrated into the obligatory four-week surgical course. Students pass through twelve training units of surgical skills training using the skills lab, simulation and role playing. RESULTS Evaluations of our training programme were excellent (average grade 1.3). After skill training, students felt more comfortable and secure when actually performing skills on the ward. CONCLUSIONS A standardised training can help in the provision of basic surgical skills to all undergraduate medical students.

Five years experience of trauma care in a German urban level I university trauma center

Background:A regionalized approach to trauma care with the implementation of designated level I trauma centers has been shown to improve survival after multiple injuries. Our study aimed to describe the current reality in an urban German level I university trauma center concerning the primary admission of patients into the emergency room.Materials and Methods:We performed a retrospective analysis of all multiple trauma patients that were prospectively documented in our documentation system TraumaWatch® from 2003 to 2007. Documentation included physiological findings as well as diagnostic and therapeutic procedures structured as: (A) preclinical phase; (B) emergency room treatment; (C) intensive care unit; and (D) final outcome according to the German Trauma Registry.Results:In total, 1,848 patients were completely documented and, thus, analyzed. The mean ± standard deviation (SD) Injury Severity Score (ISS) was 16.5 ± 14.1 points and the mean ± SD age was 38.7 ± 21.9 years. An increasing number of patients received whole-body computed tomography (48.8% in 2003 vs. 83.3%in 2007, p < 0.001) and, on average, the ISS increased over the years (14.4 points in 2003 vs. 17.9 points in 2007). The overall hospital mortality was 7.1%, without significant change over time. The completionofimagingdiagnostics became significantly faster for all of the documented procedures (X-ray pelvis, X-ray chest, whole-body CT, abdominal ultrasound) (p < 0.001).Discussion:Descriptive data on the current reality in urban level I trauma care can be derived from our study. Additionally, we achieved improved time intervals for emergency diagnostics and treatment, while hospital mortality remained constant, despite a higher injury severity. This is due to a standardized protocol which is applied during the 24-h in-house attending coverage.Conclusion:Regionalized trauma care with designated level I trauma centers is justified by the improvement of time intervals and outcome, but adequate resources are required.

Mandatory elective course in emergency medicine with instructions by paramedics improves practical training in undergraduate medical education

BACKGROUND Due to the complexity of medical emergencies undergraduate medical training in the integrative course on emergency medicine requires education combining knowledge, practical skills, algorithm-driven behavior and soft skills. New State board regulations on education and licensing of physicians demand a practical implementation of these objectives. MATERIALS AND METHODS The medical faculty of Frankfurt medical school has implemented an obligatory prehospital elective course. A retrospective questionnaire assessed the organization, instructional competence of the paramedics and integration of students in the emergency medical teams. RESULTS Out of a total of 486 students the majority rated the longitudinal curriculum as positive (66% very good and 28% good). The practical experience at a scene was evaluated to be reasonable by 86% and 95% of the students stated that integration into the emergency team was rendered without any difficulties. CONCLUSION A prehospital experience supported by paramedics can serve as a valuable tool in an emergency medicine curriculum.

Entwicklung des Lernzielkatalogs „Muskuloskeletale Erkrankungen, Verletzungen und traumatische Notfälle“ für Orthopädie – Unfallchirurgie im Medizinstudium

BACKGROUND The developments towards a combined specialty of orthopaedic and trauma surgery requires not only the consolidation and revision of the postgraduate education training programme but also the development of a catalogue of learning objectives as a uniform basis for undergraduate medical training in the new specialty at German medical schools and teaching hospitals. MATERIALS AND METHODS Based on the Frankfurt Catalogue of Learning Objectives for Trauma Surgery and the Ulm Catalogue of Learning Objectives for Orthopaedics, a task force of experts has developed a combined catalogue of learning objectives for the new specialty. The experts of both specialties classified the learning objectives into 2 levels for knowledge, into 4 grades of competence for skills, as well as attitudes and social competence. RESULTS The general part of the operative specialties contains 120 items classified into 39 learning objectives for knowledge and 83 for skills. Two learning objectives comprise both knowledge and skill. The part orthopaedic and trauma surgery comprises 141 learning objectives, six items for skills, 138 for knowledge, as well as three learning objectives for both knowledge and skills. In addition, 22 learning objectives deal with aspects of attitudes and social competence. CONCLUSION In spite of the only recent alliance of orthopaedics and trauma surgery, the commission has developed not only a collection of topics, but also a usable joint catalogue of learning objectives for undergraduate training with a nationwide recommendation character. The catalogue paves the way for a forward-looking, modern education. The integrated recommendations for the prioritisation, the linkage to other subjects and specialties, and the integration of didactic methods facilitate the local implementation of the learning objectives without loosing any academic freedom.

Development of a catalogue of undergraduate learning objectives for orthopaedics and traumatology

ZusammenfassungHintergrundMit der Entwicklung des gemeinsamen Faches Orthopädie-Unfallchirurgie bedarf es neben der Zusammenführung und Überarbeitung der Weiterbildungsinhalte des ärztlichen Nachwuchses auch der Erstellung eines für Deutschland einheitlichen Lernzielkatalogs, der die Grundlage der studentischen Lehre in der Orthopädie und Unfallchirurgie an den deutschen Fakultäten und Lehrkrankenhäusern bilden soll.Material und MethodeAusgehend vom Frankfurter Lernzielkatalog für Unfallchirurgie und dem Ulmer Lernzielkatalog für Orthopädie wurde von einer Expertenkommission der gemeinsame Katalog für das Fach Orthopädie und Unfallchirurgie entwickelt. Durch Vertreter beider Fächer erfolgte die Definition der Lernziele und anschließende Gliederung und Priorisierung in sog. Ebenen und Bereiche des kognitiven Wissens, Kompetenzstufen psychomotorischer Fertigkeiten (Skills) sowie emotionales Wissen und Kompetenz.ErgebnisInsgesamt wurden 283 Lernziele formuliert. Der „allgemeine Teil operativer Fachgebiete“ umfasst 120 Lernziele, die sich in 39 Items kognitiven Inhalts und 83 Skills unterteilen, 2 Lernziele beinhalten gleichzeitig sowohl Wissen als auch Skills. Der „spezielle Teil Orthopädie/Unfallchirurgie“ umfasst insgesamt 141 Lernziele unterteilt in 138 Lernziele mit Wissensinhalten sowie 6 Skills, 3 Lernziele beziehen sich auf Wissen sowie Skills. 22 Lerninhalte beziehen sich auf den Bereich „emotionales Wissen und Kompetenz“.SchlussfolgerungTrotz der erst jungen Verbindung der beiden Fächer Orthopädie und Unfallchirurgie konnte nicht nur eine „Themensammlung“, sondern ein gemeinsamer Lernzielkatalog für die studentische Lehre erarbeitet werden. Dieser hat nach der Verabschiedung durch die Ordinarienkonvente der Unfallchirurgen und Orthopäden bundesweiten Empfehlungscharakter. Mit der Konsentierung von Lernzielen sind die Weichen für eine zukunftorientierte moderne Lehre gestellt. Anhand der im Lernzielkatalog enthaltenen Empfehlungen zur Gewichtung der Inhalte, zur Verknüpfung mit anderen Fächern und zum Einsatz geeigneter Lehrmethoden, können die einzelnen Lernziele an den jeweiligen Fakultäten pragmatisch und unter Wahrung der Freiheit der Lehre umgesetzt werden.AbstractBackgroundThe development towards a combined speciality of orthopaedic and trauma surgery requires not only consolidation and revision of the postgraduate education training programme but also the development of a catalogue of learning objectives as a uniform basis for undergraduate medical training in the new speciality at German medical schools and teaching hospitals. Materials and methodsBased on the Frankfurt catalogue of learning objectives for trauma surgery and the Ulm catalogue of learning objectives for orthopaedics, a task force of experts developed a combined catalogue of learning objectives for the new speciality. Experts from both specialities classified the learning objectives into two levels of knowledge and four grades of skills competence, in addition to objectives for attitudes and social competence.ResultsThe section on general operative specialities contains 120 items classified into 39 learning objectives for knowledge and 83 for skills. Two learning objectives comprise both knowledge and skills. The section on orthopaedic and trauma surgery comprises 141 learning objectives, including six items for skills and 138 for knowledge, as well as three learning objectives for both knowledge and skills. In addition, 22 learning objectives deal with aspects of attitude and social competence.ConclusionAlthough this alliance of orthopaedics and trauma surgery is recent, the commission has developed not only a collection of topics but a joint catalogue of learning objectives for undergraduate training that can be used nationwide. This catalogue paves the way for modern education that looks to the future. The integrated recommendations for content prioritisation, links to other subjects and specialities, and the integration of didactic methods facilitate local implementation of the learning objectives without loss of academic freedom.BACKGROUND The development towards a combined speciality of orthopaedic and trauma surgery requires not only consolidation and revision of the postgraduate education training programme but also the development of a catalogue of learning objectives as a uniform basis for undergraduate medical training in the new speciality at German medical schools and teaching hospitals. MATERIALS AND METHODS Based on the Frankfurt catalogue of learning objectives for trauma surgery and the Ulm catalogue of learning objectives for orthopaedics, a task force of experts developed a combined catalogue of learning objectives for the new speciality. Experts from both specialities classified the learning objectives into two levels of knowledge and four grades of skills competence, in addition to objectives for attitudes and social competence. RESULTS The section on general operative specialities contains 120 items classified into 39 learning objectives for knowledge and 83 for skills. Two learning objectives comprise both knowledge and skills. The section on orthopaedic and trauma surgery comprises 141 learning objectives, including six items for skills and 138 for knowledge, as well as three learning objectives for both knowledge and skills. In addition, 22 learning objectives deal with aspects of attitude and social competence. CONCLUSION Although this alliance of orthopaedics and trauma surgery is recent, the commission has developed not only a collection of topics but a joint catalogue of learning objectives for undergraduate training that can be used nationwide. This catalogue paves the way for modern education that looks to the future. The integrated recommendations for content prioritisation, links to other subjects and specialities, and the integration of didactic methods facilitate local implementation of the learning objectives without loss of academic freedom.

Praktikum im Rettungsdienst mit Anleitung durch Rettungsassistenten

BACKGROUND Due to the complexity of medical emergencies undergraduate medical training in the integrative course on emergency medicine requires education combining knowledge, practical skills, algorithm-driven behavior and soft skills. New State board regulations on education and licensing of physicians demand a practical implementation of these objectives. MATERIALS AND METHODS The medical faculty of Frankfurt medical school has implemented an obligatory prehospital elective course. A retrospective questionnaire assessed the organization, instructional competence of the paramedics and integration of students in the emergency medical teams. RESULTS Out of a total of 486 students the majority rated the longitudinal curriculum as positive (66% very good and 28% good). The practical experience at a scene was evaluated to be reasonable by 86% and 95% of the students stated that integration into the emergency team was rendered without any difficulties. CONCLUSION A prehospital experience supported by paramedics can serve as a valuable tool in an emergency medicine curriculum.

Entwicklung des Lernzielkatalogs „Muskuloskelettale Erkrankungen, Verletzungen und traumatische Notfälle“ für Orthopädie-Unfallchirurgie im Medizinstudium@@@Development of a catalogue of undergraduate learning objectives for orthopaedics and traumatology

ZusammenfassungHintergrundMit der Entwicklung des gemeinsamen Faches Orthopädie-Unfallchirurgie bedarf es neben der Zusammenführung und Überarbeitung der Weiterbildungsinhalte des ärztlichen Nachwuchses auch der Erstellung eines für Deutschland einheitlichen Lernzielkatalogs, der die Grundlage der studentischen Lehre in der Orthopädie und Unfallchirurgie an den deutschen Fakultäten und Lehrkrankenhäusern bilden soll.Material und MethodeAusgehend vom Frankfurter Lernzielkatalog für Unfallchirurgie und dem Ulmer Lernzielkatalog für Orthopädie wurde von einer Expertenkommission der gemeinsame Katalog für das Fach Orthopädie und Unfallchirurgie entwickelt. Durch Vertreter beider Fächer erfolgte die Definition der Lernziele und anschließende Gliederung und Priorisierung in sog. Ebenen und Bereiche des kognitiven Wissens, Kompetenzstufen psychomotorischer Fertigkeiten (Skills) sowie emotionales Wissen und Kompetenz.ErgebnisInsgesamt wurden 283 Lernziele formuliert. Der „allgemeine Teil operativer Fachgebiete“ umfasst 120 Lernziele, die sich in 39 Items kognitiven Inhalts und 83 Skills unterteilen, 2 Lernziele beinhalten gleichzeitig sowohl Wissen als auch Skills. Der „spezielle Teil Orthopädie/Unfallchirurgie“ umfasst insgesamt 141 Lernziele unterteilt in 138 Lernziele mit Wissensinhalten sowie 6 Skills, 3 Lernziele beziehen sich auf Wissen sowie Skills. 22 Lerninhalte beziehen sich auf den Bereich „emotionales Wissen und Kompetenz“.SchlussfolgerungTrotz der erst jungen Verbindung der beiden Fächer Orthopädie und Unfallchirurgie konnte nicht nur eine „Themensammlung“, sondern ein gemeinsamer Lernzielkatalog für die studentische Lehre erarbeitet werden. Dieser hat nach der Verabschiedung durch die Ordinarienkonvente der Unfallchirurgen und Orthopäden bundesweiten Empfehlungscharakter. Mit der Konsentierung von Lernzielen sind die Weichen für eine zukunftorientierte moderne Lehre gestellt. Anhand der im Lernzielkatalog enthaltenen Empfehlungen zur Gewichtung der Inhalte, zur Verknüpfung mit anderen Fächern und zum Einsatz geeigneter Lehrmethoden, können die einzelnen Lernziele an den jeweiligen Fakultäten pragmatisch und unter Wahrung der Freiheit der Lehre umgesetzt werden.AbstractBackgroundThe development towards a combined speciality of orthopaedic and trauma surgery requires not only consolidation and revision of the postgraduate education training programme but also the development of a catalogue of learning objectives as a uniform basis for undergraduate medical training in the new speciality at German medical schools and teaching hospitals. Materials and methodsBased on the Frankfurt catalogue of learning objectives for trauma surgery and the Ulm catalogue of learning objectives for orthopaedics, a task force of experts developed a combined catalogue of learning objectives for the new speciality. Experts from both specialities classified the learning objectives into two levels of knowledge and four grades of skills competence, in addition to objectives for attitudes and social competence.ResultsThe section on general operative specialities contains 120 items classified into 39 learning objectives for knowledge and 83 for skills. Two learning objectives comprise both knowledge and skills. The section on orthopaedic and trauma surgery comprises 141 learning objectives, including six items for skills and 138 for knowledge, as well as three learning objectives for both knowledge and skills. In addition, 22 learning objectives deal with aspects of attitude and social competence.ConclusionAlthough this alliance of orthopaedics and trauma surgery is recent, the commission has developed not only a collection of topics but a joint catalogue of learning objectives for undergraduate training that can be used nationwide. This catalogue paves the way for modern education that looks to the future. The integrated recommendations for content prioritisation, links to other subjects and specialities, and the integration of didactic methods facilitate local implementation of the learning objectives without loss of academic freedom.BACKGROUND The development towards a combined speciality of orthopaedic and trauma surgery requires not only consolidation and revision of the postgraduate education training programme but also the development of a catalogue of learning objectives as a uniform basis for undergraduate medical training in the new speciality at German medical schools and teaching hospitals. MATERIALS AND METHODS Based on the Frankfurt catalogue of learning objectives for trauma surgery and the Ulm catalogue of learning objectives for orthopaedics, a task force of experts developed a combined catalogue of learning objectives for the new speciality. Experts from both specialities classified the learning objectives into two levels of knowledge and four grades of skills competence, in addition to objectives for attitudes and social competence. RESULTS The section on general operative specialities contains 120 items classified into 39 learning objectives for knowledge and 83 for skills. Two learning objectives comprise both knowledge and skills. The section on orthopaedic and trauma surgery comprises 141 learning objectives, including six items for skills and 138 for knowledge, as well as three learning objectives for both knowledge and skills. In addition, 22 learning objectives deal with aspects of attitude and social competence. CONCLUSION Although this alliance of orthopaedics and trauma surgery is recent, the commission has developed not only a collection of topics but a joint catalogue of learning objectives for undergraduate training that can be used nationwide. This catalogue paves the way for modern education that looks to the future. The integrated recommendations for content prioritisation, links to other subjects and specialities, and the integration of didactic methods facilitate local implementation of the learning objectives without loss of academic freedom.

A nationwide survey of undergraduate training in oral and maxillofacial surgery

PurposeTo investigate the current status of undergraduate training in oral and maxillofacial (OMF) surgery in Germany using a nationwide survey and hence contribute to an educational improvement in the field.MethodsA 39-item questionnaire was sent to all university clinics with an OMF surgery chair in Germany (n = 34).ResultsNinety-two percent of OMF clinics are involved in the curricular training in medicine and 100% in dentistry. Eighty-one percent of OMF clinics perform curricular examinations and, respectively, 86% in dentistry. Examinations are mainly performed written with multiple-choice tests (62% medicine, 76% dentistry) and using non-structured oral examinations (57% medicine, 86% dentistry). Objective structured clinical examinations (OSCEs) are only used in 19% of all faculties.ConclusionOMF surgery with its involvement both in medical and dental education has a special position as a surgical discipline. Our results show that OMF as a specialty is underrepresented in dental and especially in medical education considering the numerical and health economic importance of OMF consultations. Enhancing curricular integration and developing more structured examination forms is necessary to guarantee a high quality of OMF education.