Action competence in obstetric emergencies-can this be achieved via e-learning? Interprofessional blended learning module on diagnostics and emergency treatment of shoulder dystocia.

BACKGROUND: Due to the rarity of shoulder dystocia, an obstetric emergency, it is difficult even for experts to develop the appropriate routine in this emergency. Regular further training is therefore recommended for obstetricians and midwives. Evidence is lacking on the extent to which e-learning as a teaching method can be successfully used to acquire these skills and put them into practice. The purpose of this study is to demonstrate how the learning objectives for shoulder dystocia, listed in the National Competence Based Learning Objectives Catalog for Medicine (NKLM, Germany) can be successfully taught in medical studies using a blended learning concept (e-learning and practical application on a birth simulator). METHODS: After completing an e-learning course, final year medical students and midwife trainees demonstrated their action competence for shoulder dystocia procedure on a birth simulator. This transfer of the theoretical knowledge to the case study was assessed using an evaluation form oriented to the recommendations for action. RESULTS: One hundred sixty medical students and 14 midwifery trainees participated in the study from April to July 2019. Overall, 95.9% of the study participants met the required standards, i.e. achieved very good to adequate performance (Ø good) in simulation training. CONCLUSIONS: E-learning with annotated high-quality learning videos is an excellent way to transfer theoretical knowledge about shoulder dystocia procedures into medical practice on a birth simulator. The learning objectives required by the NKLM for shoulder dystocia can be successfully conveyed to students via the applied blended learning concept.

[Use of Video Online Seminars During Clinical Phase of Medical Study from the Perspective of Teachers and Students]. / Einsatz von Video Online Seminaren im klinischen Abschnitt des Medizinstudiums aus Sicht von Lehrenden und Studierenden.

AIM OF THE STUDY: The aim of this study was to investigate the opportunities and challenges of using video online seminars (VOS) in the clinical phase of medical studies from the perspective of teachers and students. METHODOLOGY: Teachers and medical students from the 5th to the 10th semester completed questionnaires about their attitudes towards and experiences with VOS. Recommended procedures for VOS were derived from the results. RESULTS: A total of 19 teachers and 108 students participated in this study; 67% of students found VOS helpful in the clinical phase of the degree course. Cognitive learning objectives (91% agreement) should be taught more often in the VOS format than affective learning objectives (71% agreement). However, 83% stated that VOS did not prepare them for future practical activities. Teachers indicated that cognitive (77% agreement) could be significantly better communicated than affective learning objectives (only 27% agreement). For two-thirds of the teachers, support or trainings were important. Good technical conditions were important for both groups. DISCUSSION/CONCLUSIONS: The study shows the option of individual learning regardless of location to be an advantage of VOS. A teaching format is considered to be particularly useful if successful interaction between teacher and student takes place. In the context of blended learning concepts with preceding lectures and subsequent practical exercises, the learning success of VOS is greatest. Cognitive and some affective learning objectives can be achieved by this method. VOS can prepare for practical exercises, but they are not suitable in medical education for comprehensive teaching of practical learning objectives.

[Elective Course "Meaningfullness and Self-Care in Daily Clinical Practice"]. / Wahlfach "Sinnhaftigkeit und Selbstfürsorge im Klinikalltag".

How future physicians can learn about role models during their medical training - an approach on teaching personal skills as described in the new "National Competence-based Catalogue of Learning Objectives in Medicine 2.0".

Improving competence and safety in pain medicine: a practical clinical teaching strategy for students combining simulation and bedside teaching.

BACKGROUND: Pain is a devastating sensation and has to be treated immediately. Therefore, we developed a training program to improve the knowledge of medical students in the field of pain medicine. In the present study, the applicability and efficacy of this training program was tested. METHODS: Half of the students attended first a training with simulated patients (SP) followed by bedside teaching (Group 1). Group 2 performed the training programs in reverse order. The evaluation based on standardized questionnaires completed by students (self-assessment) and all students took part in two practical examinations after the learning interventions. RESULTS: This study included 35 students. The quality of the simulation was evaluated by the students with average grade 1.1 (1 = very good, 6 = very bad). The practical work on the ward with patients was rated with grade 1.4 of 6, the whole course with 1.1. Students of Group A were significantly better in the final examination (grade 1.7 vs. grade 2.2, p < 0.05). To rate the improvement of skills (self-assessment) we used a Likert Scale (1 = very certain, 5 = very uncertain). The following skills were similar in both groups and significantly better after the course: taking responsibility, expert knowledge, empathy, relationship building and communication. CONCLUSIONS: Training with simulated patients in combination with small-group teaching at the bedside with real patients achieves a dramatic increase in student competence. Students prefer learning from the simulation before bedside teaching and propose to include simulation into the curricular teaching of pain medicine.

[Surgical Education of Medical Students in Times of COVID-19 - Necessary Adjustments are Chances for the Future]. / Chirurgische Lehre in Zeiten von COVID-19: Aus notwendigen Kompromissen werden Chancen für die Zukunft.

BACKGROUND: Education of medical students in surgery not only consists of knowledge about diseases and their treatment but also of practical skills like i.e. suturing. In the clinical training of medical students, professional interaction and communication with patients is a key component. Due to the circumstances of distancing and reduced exposure to patients during the COVID-19 pandemic, clinical training of medical students has been challenging. To combat these restrictions, digital modern teaching concepts had to be implemented. MATERIAL AND METHODS: Surgical education of medical students was reorganised during the summer semester 2020 and winter semester 2020/2021 and the necessary adjustments, as well as their evaluation by students, were analysed. Results were compared to the pre-COVID evaluations of the summer semester 2019. Furthermore a survey of all university surgical departments in Germany (n = 39) was conducted to compare the different approaches to handling this very new situation. RESULTS: All participating centres were performing surgical education with medical students during the COVID-19 pandemic. Overall, digital teaching methods were well accepted by students and teachers, even though short-term changes were necessary during the second wave of the pandemic. Both students and teachers missed the direct mutual interaction as well as with patients (summer semester 2020 36%, winter semester 2020/2021 40%). Modern and digital teaching concepts were assessed positively (summer semester 2020 45%, winter semester 2020/2021 40%) and long term implementation was desired by students and teachers (winter semester 2020/2021 60%). CONCLUSION: Training of practical surgical skills, as well as communication skills, can only be taught in presence. Digital learning concepts can support, but not replace, surgical courses held in presence, including contact to patients and manual training. Blended learning concepts facilitate a leap towards modern teaching concepts and increase the quality of classes spent in presence.

Outcome of Antiviral Immunity in the Liver Is Shaped by the Level of Antigen Expressed in Infected Hepatocytes.

The liver bears unique immune properties that support both immune tolerance and immunity, but the mechanisms responsible for clearance versus persistence of virus-infected hepatocytes remain unclear. Here, we dissect the factors determining the outcome of antiviral immunity using recombinant adenoviruses that reflect the hepatropism and hepatrophism of hepatitis viruses. We generated replication-deficient adenoviruses with equimolar expression of ovalbumin, luciferase, and green fluorescent protein driven by a strong ubiquitous cytomegalovirus (CMV) promoter (Ad-CMV-GOL) or by 100-fold weaker, yet hepatocyte-specific, transthyretin (TTR) promoter (Ad-TTR-GOL). Using in vivo bioluminescence to quantitatively and dynamically image luciferase activity, we demonstrated that Ad-TTR-GOL infection always persists, whereas Ad-CMV-GOL infection is always cleared, independent of the number of infected hepatocytes. Failure to clear Ad-TTR-GOL infection involved mechanisms acting during initiation as well as execution of antigen-specific immunity. First, hepatocyte-restricted antigen expression led to delayed and curtailed T-cell expansion-10,000-fold after Ad-CMV-GOL versus 150-fold after Ad-TTR-GOL-infection. Second, CD8 T-cells primed toward antigens selectively expressed by hepatocytes showed high PD-1/Tim-3/LAG-3/CTLA-4/CD160 expression levels similar to that seen in chronic hepatitis B. Third, Ad-TTR-GOL but not Ad-CMV-GOL-infected hepatocytes escaped being killed by effector T-cells while still inducing high PD-1/Tim-3/LAG-3/CTLA-4/CD160 expression, indicating different thresholds of T-cell receptor signaling relevant for triggering effector functions compared with exhaustion. Conclusion: Our study identifies deficits in the generation of CD8 T-cell immunity toward hepatocyte-expressed antigens and escape of infected hepatocytes expressing low viral antigen levels from effector T-cell killing as independent factors promoting viral persistence. This highlights the importance of addressing both the restauration of CD8 T-cell dysfunction and overcoming local hurdles of effector T-cell function to eliminate virus-infected hepatocytes.

Ethics education in pediatrics: Implementation and evaluation of an interactive online course for medical students.

Introduction: The COVID-19 pandemic has catalyzed the development of online learning formats in virtually all areas of medical education. In pediatric ethics, online learning may not only substitute but also offer specific advantages over traditional classroom teaching. Many pediatricians rate their ethics education as poor and medical ethics education lacks evaluation, especially regarding the students' needs. The aim of this project was to implement and evaluate a novel interactive distance learning approach to engage medical students in pediatric ethics education. Methods: An online ethics course was designed and delivered between May and June 2020. Core item of this course was a moderated, written forum discussion spanning several days. Evaluation was mixed methods. We evaluated the effectiveness of the course in terms of quality of the learning environment with a particular focus on relevance to students as well as interactive learning and reflective thinking. The Constructivist On-Line Learning Environment Survey (COLLES) was used to evaluate six different domains of the course. Data are presented as mean (standard deviation [SD]). The respective score range is 1-5, whereby a score of 4 or 5 means that the participants indicated the corresponding item as frequently or almost always present. Results: Responses were available from 104 (78.3%) of the 133 participating students. "Relevance" yielded a score of 4.17 (0.83), "reflective thinking" a score of 4.22 (0.83). "Interactivity" was scored 3.76 (0.99) and "tutor support" 4.72 (0.53). "Peer support" and "interpretation" scored 3.87 (0.98) and 4.49 (0.60), respectively. In qualitative analysis, students particularly valued the structure of the course, the relevance for their professional practice, their active participation and the incentive to reflective thinking. Students also indicated that this was an innovative and exciting format, which fills a current educational gap and should hence be continued beyond the pandemic. Conclusion: In conclusion, students actively engaged in online learning and perceived this ethics course as highly relevant for their professional practice.

[German national survey of lecturers in ophthalmology on student teaching in the 2020/21 corona pandemic]. / Deutschlandweite Befragung der Lehrbeauftragten in der Augenheilkunde zur studentischen Lehre in der Corona-Pandemie 2020/21.

BACKGROUND: The corona pandemic has had a significant impact on the conditions of university student teaching. Due to the pandemic-related contact restrictions, digital teaching formats were widely used instead of the previous face-to-face teaching. In the summer semester of 2020 students received this well and evaluated it positively in recent publications. In this work, the main focus was on the experiences and assessments of teachers in ophthalmology during the winter semester 2020/2021. METHODS: By means of two anonymous surveys via online questionnaires, the lecturers in ophthalmology of German university hospitals as well as internal and external lecturers and staff members of the student teaching of the Department of Ophthalmology of the University Medical Center Mainz were asked about their experiences with the implementation of digital teaching. RESULTS: In this context 95% of the teaching staff of ophthalmology departments of university hospitals in Germany stated that they had established digital teaching concepts at the latest since the corona pandemic. Hybrid formats with a proportion of face-to-face teaching were used by 68%. A wide variety of teaching formats were used. Difficulties were also encountered, particularly in interaction with students. Despite predominantly digital teaching, examinations continued to be held in face-to-face settings; only 18% of respondents stated that they had conducted online examinations. In the future, 86% of respondents want to integrate digital formats into their teaching concepts and establish them as a supplement to existing face-to-face teaching. CONCLUSION: The development of student teaching during the corona pandemic can serve as an opportunity for shaping the future education of medical students in ophthalmology.

Single organelle analysis to characterize mitochondrial function and crosstalk during viral infection.

Mitochondria are key for cellular metabolism and signalling processes during viral infection. We report a methodology to analyse mitochondrial properties at the single-organelle level during viral infection using a recombinant adenovirus coding for a mitochondrial tracer protein for tagging and detection by multispectral flow cytometry. Resolution at the level of tagged individual mitochondria revealed changes in mitochondrial size, membrane potential and displayed a fragile phenotype during viral infection of cells. Thus, single-organelle and multi-parameter resolution allows to explore altered energy metabolism and antiviral defence by tagged mitochondria selectively in virus-infected cells and will be instrumental to identify viral immune escape and to develop and monitor novel mitochondrial-targeted therapies.

High degree of realism in teaching percutaneous coronary interventions by combining a virtual reality trainer with a full scale patient simulator.

The virtual reality coronary angiography simulator "CATHI" (Catheter Instruction System, Mannheim, Germany) simulates coronary arteries with implemented vessel lesions in virtual patients. Like similar systems the software model runs on common PC systems, which are linked to the mechanical device for manual training. We combined the advantages of this skill trainer with the near to reality assembly of a cardiac catheterization laboratory (Cath-lab) by connecting it to a full scale simulator (HPS, METI, Sarasota, FL). We present two methods of synchronizing the heartbeat between both simulation devices. Method A-the hardware solution-uses the electrocardiogram-synchronization signal of the HPS as a pacemaker for CATHI's heartbeat. Method B, a more sophisticated software solution, uses a communication protocol between the HPS software and the CATHI system to realize bi-directional data exchange. In 14 identical courses we performed four different scenarios using the above described setup, all of which had to be undergone by the 143 participants (including nursing staff, experienced- and inexperienced cardiologists). The synchronization of the two systems contributed to a close to reality situation. Scenario control was accomplished via commercially available HPS-software. Tachycardic and bradycardic arrhythmias were predetermined by predefined scenarios of the HPS-software, the trainee's intervention resulting in realistic treatment outcomes. Using either method, the transmitted signals resulted in the same heartbeat in the CATHI-system, making the cardiologic interventions more difficult but more realistic.