Sasa Sopka

Anaesthesiology as a compulsory subject in the new German medical school curriculum. Evaluation of a curricular model at the University Hospital Aachen

ZusammenfassungHintergrundSeit 2003 fordert die Approbationsordnung (AO) für Ärzte erstmalig die Einführung einer Pflichtveranstaltung für die „Anästhesiologie“ an den medizinischen Fakultäten. Erforderlich wurde somit eine Umstellung fakultativ angebotener Lehre für wenige hin zur Implementierung von Pflichtkursen für alle Studierende.MethodikEs wurden eigene Evaluationsdaten und organisatorische Rahmenbedingungen bei der Entwicklung eines Curriculums an der Klinik für Anästhesiologie des Universitätsklinikums Aachen berücksichtigt: Auf zwei Vorlesungsreihen folgen drei weitere Bestandteile im Block: Seminar mit „basic skill training“, OP-Praktikum und Simulationstraining. Eine Bewertung der Studierenden erfolgte mit dem Onlinebewertungssystem „EvaLuna“; beteiligte Lehrende füllten einen standardisierten Fragebogen aus.ErgebnisseDer Kurs erhielt die besten Bewertungen aller Pflichtkurse des Sommersemesters 2005: Am besten wurde das Simulationstraining mit im Mittel 1,4 bewertet (Seminar 1,9; OP-Praktikum 1,9). Die Akzeptanz der Lehrenden wurde zudem bestätigt.SchlussfolgerungDie Evaluationsergebnisse der Studierenden und der Lehrenden bestätigen den gewählten Ansatz zur Einbringung anästhesierelevanter Fragestellungen in das medizinische Pflicht-Curriculum. Das Onlinebewertungssystems EvaLuna gab dennoch Aufschluss über weiterhin verbesserungsfähige Bereiche des neu gestalteten Curriculums.AbstractBackgroundSince October 2003 new regulations for qualifications to practice medicine in Germany now require compulsory courses in anaesthesiology. Therefore, existing curricular activities had to be changed from facultative courses for a small number of interested students to compulsory activities for all students.MethodsPrevious data of the department of anaesthesiology at the University Hospital Aachen (Germany) were collected and taken into consideration for the development of a new curriculum: The result was a course consisting of a tutorial with integrated „basic skill training“, practical training in the operating theatre and a simulation-based session, in addition to two series of lectures. An evaluation by the students was carried out using EvaLuna as a tool for web-based on-line evaluation and faculty members had to fill out a standardized questionnaire.ResultsThe different parts of the curriculum received the highest scores of all courses in the undergraduate medical school curriculum. Best results were achieved by the anaesthesia-simulation session followed by the tutorial and the practical training.ConclusionThe feedback of faculty members as well as the results of students’ evaluation approved the developed concept of integrating anaesthesia-relevant issues into the formal medical school curriculum. Nevertheless, the on-line evaluation system EvaLuna provided additional suggestions for future improvements in the newly created curriculum.

Evaluation of a newly developed media-supported 4-step approach for basic life support training

ObjectiveThe quality of external chest compressions (ECC) is of primary importance within basic life support (BLS). Recent guidelines delineate the so-called 4“-step approach” for teaching practical skills within resuscitation training guided by a certified instructor. The objective of this study was to evaluate whether a “media-supported 4-step approach” for BLS training leads to equal practical performance compared to the standard 4-step approach.Materials and methodsAfter baseline testing, 220 laypersons were either trained using the widely accepted method for resuscitation training (4-step approach) or using a newly created “media-supported 4-step approach”, both of equal duration. In this approach, steps 1 and 2 were ensured via a standardised self-produced podcast, which included all of the information regarding the BLS algorithm and resuscitation skills. Participants were tested on manikins in the same mock cardiac arrest single-rescuer scenario prior to intervention, after one week and after six months with respect to ECC-performance, and participants were surveyed about the approach.ResultsParticipants (age 23 ± 11, 69% female) reached comparable practical ECC performances in both groups, with no statistical difference. Even after six months, there was no difference detected in the quality of the initial assessment algorithm or delay concerning initiation of CPR. Overall, at least 99% of the intervention group (n = 99; mean 1.5 ± 0.8; 6-point Likert scale: 1 = completely agree, 6 = completely disagree) agreed that the video provided an adequate introduction to BLS skills.ConclusionsThe “media-supported 4-step approach” leads to comparable practical ECC-performance compared to standard teaching, even with respect to retention of skills. Therefore, this approach could be useful in special educational settings where, for example, instructors’ resources are sparse or large-group sessions have to be prepared.

Designing Learning Outcomes for Handover Teaching of Medical Students using Group Concept Mapping

Purpose To develop, by consultation with an expert group, agreed learning outcomes for the teaching of handoff to medical students using group concept mapping. Method In 2013, the authors used group concept mapping, a structured mixed-methods approach, applying both quantitative and qualitative measures to identify an expert group’s common understanding about the learning outcomes for training medical students in handoff. Participants from four European countries generated and sorted ideas, then rated generated themes by importance and difficulty to achieve. The research team applied multidimensional scaling and hierarchical cluster analysis to analyze the themes. Results Of 127 experts invited, 45 contributed to the brainstorming session. Twenty-two of the 45 (48%) completed pruning, sorting, and rating phases. They identified 10 themes with which to select learning outcomes and operationally define them to form a basis for a curriculum on handoff training. The themes “Being able to perform handoff accurately” and “Demonstrate proficiency in handoff in workplace” were rated as most important. “Demonstrate proficiency in handoff in simulation” and “Engage with colleagues, patients, and carers” were rated most difficult to achieve. Conclusions The study identified expert consensus for designing learning outcomes for handoff training for medical students. Those outcomes considered most important were among those considered most difficult to achieve. There is an urgent need to address the preparation of newly qualified doctors to be proficient in handoff at the point of graduation; otherwise, this is a latent error within health care systems. This is a first step in this process.

Influence of pre-course assessment using an emotionally activating stimulus with feedback: a pilot study in teaching Basic Life Support.

BACKGROUND Cardiopulmonary resuscitation (CPR) mastery continues to challenge medical professionals. The purpose of this study was to determine if an emotional stimulus in combination with peer or expert feedback during pre-course assessment effects future performance in a single rescuer simulated cardiac arrest. METHODS First-year medical students (n=218) without previous medical knowledge were randomly assigned to one of the study groups and asked to take part in a pre-course assessment: Group 1: after applying an emotionally activating stimulus an expert (instructor) gave feedback on CPR performance (Ex). Group 2: after applying the same stimulus feedback was provided by a peer from the same group (Pe); Group 3: standard without feedback (S). Following pre-course assessment, all subjects received a standardized BLS-course, were tested after 1 week and 6 months later using single-rescuer-scenario, and were surveyed using standardized questionnaires (6-point-likert-scales: 1=completely agree, 6=completely disagree). RESULTS Participants exposed to stimulus demonstrated superior performance concerning compression depth after 6 months independent of feedback-method (Ex: 65.85% [p=0.0003]; Pe: 57.50% [p=0.0076] vs. 21.43%). The expert- more than the peer-group was emotionally more activated in initial testing, Ex: 3.26 ± 1.35 [p ≤ 0.0001]; Pe: 3.73 ± 1.53 [p=0.0319]; S: 4.25 ± 1.37) and more inspired to think about CPR (Ex: 2.03 ± 1.37 [p=0.0119]; Pe: 2.07 ± 1.14 [p=0.0204]; S: 2.60 ± 1.55). After 6 months this activation effect was still detectable in the expert-group (p=0.0114). CONCLUSIONS The emotional stimulus approach to BLS-training seems to impact the ability to provide adequate compression depth up to 6 months after training. Furthermore, pre-course assessment helped to keep the participants involved beyond initial training.

Effects of xenon and isoflurane on apoptosis and inflammation in a porcine myocardial infarction model

Volatile anaesthetics can reduce the infarction size in myocardial tissue when administered before and during experimentally induced ischaemia. The aim of this study was to investigate whether xenon is beneficial compared to isoflurane in limiting myocardial tissue apoptosis and inflammation induced by experimental ischaemia-reperfusion injury in a porcine right ventricular infarction model. Twenty-one animals used for this study randomly received isoflurane, xenon or thiopental, (n=6-8 per group). Myocardial infarction was induced for 90min, followed by reperfusion for 120min. Tissues from the left and right ventricles were removed from the sites of infarction, reperfusion and remote areas, and processed for immunohistochemistry. Apoptosis (caspase-3 staining) and neutrophilic infiltration (naphthol AS-D chloroacetate-specific esterase) were assessed and evaluated. Statistical analysis was performed using an ANOVA of repeated measures. Density of apoptotic cells were higher in tissues from animals that were anesthetized with xenon. This effect was significant in comparison to isoflurane (p=0.0177). Neutrophilic infiltration was significantly higher in the right compared to the left ventricle (p<0.001), whereas no significant differences in the number of granulocytes based on the anaesthetic regime or the different tissue areas were found. We conclude that xenon, in the early phase of ischaemia and reperfusion, induces a significant increase in apoptosis compared to isoflurane. Therefore, clinical use of this anaesthetic in cardiocompromised patients should be taken with care until more long-term studies have been carried out. The increased neutrophilic infiltration in the right vs. the left ventricle indicates the right ventricle being more susceptible to ischaemia-reperfusion injury.

Influence of learning styles on the practical performance after the four-step basic life support training approach – An observational cohort study

Background Learning and training basic life support (BLS)—especially external chest compressions (ECC) within the BLS-algorithm—are essential resuscitation training for laypersons as well as for health care professionals. The objective of this study was to evaluate the influence of learning styles on the performance of BLS and to identify whether all types of learners are sufficiently addressed by Peyton’s four-step approach for BLS training. Methods A study group of first-year medical students (n = 334) without previous medical knowledge was categorized according to learning styles using the German Lernstilinventar questionnaire based on Kolb’s Learning Styles Inventory. Students’ BLS performances were assessed before and after a four-step BLS training approach lasting 4 hours. Standardized BLS training was provided by an educational staff consisting of European Resuscitation Council-certified advanced life support providers and instructors. Pre- and post-intervention BLS performance was evaluated using a single-rescuer-scenario and standardized questionnaires (6-point-Likert-scales: 1 = completely agree, 6 = completely disagree). The recorded points of measurement were the time to start, depth, and frequency of ECC. Results The study population was categorized according to learning styles: diverging (5%, n = 16), assimilating (36%, n = 121), converging (41%, n = 138), and accommodating (18%, n = 59). Independent of learning styles, both male and female participants showed significant improvement in cardiopulmonary resuscitation (CPR) performance. Based on the Kolb learning styles, no significant differences between the four groups were observed in compression depth, frequency, time to start CPR, or the checklist-based assessment within the baseline assessment. A significant sex effect on the difference between pre- and post-interventional assessment points was observed for mean compression depth and mean compression frequency. Conclusions The findings of this work show that the four-step-approach for BLS training addresses all types of learners independent of their learning styles and does not lead to significant differences in the performance of CPR.

»Assessment drives Learning«: Konzepte zur Erfolgs- und Qualitätskontrolle

Die Arztliche Approbationsordnung (AAppO) von 2002 forderte die Medizinischen Fakultaten in Deutschland auf, ihre Prufungskonzepte besser an die tatsachlich erforderlichen Fertigkeiten der arztlichen Tatigkeit abzustimmen [1]. Traditionell eingesetzte Prufungsverfahren wie schriftliche und mundliche Prufungen konnen den Dimensionen der arztlichen Kompetenzen nur teilweise gerecht werden. Aus diesem Grund spielt das Assessment im Bereich der medizinischen Aus-, Weiter- und Fortbildung sowie in der Lehr- und Lernforschung eine besondere Rolle [2], [3]. Prufungen konnen Lernenden helfen, individuelle Bedurfnisse und Schwachen zu erkennen und darauf zu reagieren [4].

Preventable mistakes during endotracheal intubation. Overview and concepts

Endotracheal intubation is a standard procedure in anesthesiology as well as in intensive care medicine in many forms of assisted spontaneous breathing or controlled ventilation. In addition it continues to be the gold standard for airway protection in prehospital and in-hospital emergency medicine settings. Approaches will have to be considered to help prevent errors before they occur not only in the non-elective use of endotracheal intubation. The most common preventable situations are summarized in this paper.ZusammenfassungDie endotracheale Intubation ist ein Standardverfahren in der Anästhesiologie und Intensivmedizin bei vielen Formen der assistierten Spontanatmung oder der kontrollierten Beatmung und nach wie vor der Goldstandard für die Sicherung der Atemwege in der Notfallmedizin. Nicht nur bei der nichtelektiven Anwendung der endotrachealen Intubation gilt es, verschiedene Umstände und Hinweise zu berücksichtigen, die Fehler bereits im Vorfeld zu vermeiden helfen. Dazu werden häufige vermeidbare Situationen in diesem Beitrag zusammengestellt.AbstractEndotracheal intubation is a standard procedure in anesthesiology as well as in intensive care medicine in many forms of assisted spontaneous breathing or controlled ventilation. In addition it continues to be the gold standard for airway protection in prehospital and inhospital emergency medicine settings. Approaches will have to be considered to help prevent errors before they occur not only in the non-elective use of endotracheal intubation. The most common preventable situations are summarized in this paper.

Comparison of a newly established emotional stimulus approach to a classical assessment-driven approach in BLS training: a randomised controlled trial

Objective The study objective was to implement two strategies (short emotional stimulus vs announced practical assessment) in the teaching of resuscitation skills in order to evaluate whether one led to superior outcomes. Setting This study is an educational intervention provided in one German academic university hospital. Participants First-yearmedical students (n=271) during the first3 weeks of their studies. Interventions Participants were randomly assigned to one of two groups following a sequence of random numbers: the emotional stimulus group (EG) and the assessment group (AG). In the EG, the intervention included watching an emotionally stimulating video prior to the Basic Life Support (BLS) course. In the AG, a practical assessment of the BLS algorithm was announced and tested within a 2 min simulated cardiac arrest scenario. After the baseline testing, a standardised BLS course was provided. Evaluation points were defined 1 week and 6 months after. Primary outcome measures Compression depth (CD) and compression rate (CR) were recorded as the primary endpoints for BLS quality. Results Within the study, 137 participants were allocated to the EG and 134 to the AG. 104 participants from EG and 120 from AG were analysed1 week after the intervention, where they reached comparable chest-compression performance without significant differences (CR P=0.49; CD P=0.28). The chest-compression performance improved significantly for the EG (P<0.01) and the AG (P<0.01) while adhering to the current resuscitation guidelines criteria for CD and CR. Conclusions There was no statistical difference between both groups’ practical chest-compression-performance. Nevertheless, the 2 min video sequence used in the EG with its low production effort and costs, compared with the expensive assessment approach, provides broad opportunities for applicability in BLS training.

Handover training for medical students: a controlled educational trial of a pilot curriculum in Germany

Objective The aim of this study was to implement and evaluate a newly developed standardised handover curriculum for medical students. We sought to assess its effect on students’ awareness, confidence and knowledge regarding handover. Design A controlled educational research study. Setting The pilot handover training curriculum was integrated into a curriculum led by the Departments of Anesthesiology and Intensive Care (AI) at the University Hospital. It consisted of three modules integrated into a 4-week course of AI. Multiple types of handover settings namely end-of-shift, operating room/postanaesthesia recovery unit, intensive care unit, telephone and discharge were addressed. Participants A total of n=147 fourth-year medical students participated in this study, who received either the current standard existing curriculum (no teaching of handover, n=78) or the curriculum that incorporated the pilot handover training (n=69). Outcome measures Paper-based questionnaires regarding attitude, confidence and knowledge towards handover and patient safety were used for pre-assessment and post-assessment. Results Students showed a significant increase in knowledge (p<0.01) and self-confidence for the use of standardised handover tools (p<0.01) as well as accurate handover performance (p<0.01) among the pilot group. Conclusion We implemented and evaluated a pilot curriculum for undergraduate handover training. Students displayed a significant increase in knowledge and self-confidence for the use of standardised handover tools and accuracy in handover performance. Further studies should evaluate whether the observed effect is sustained across time and is associated with patient benefit.