Rise of public e-learning opportunities in the context of COVID-19 pandemic-induced curtailment of face-to-face courses, exemplified by epidural catheterization on YouTube.

BACKGROUND: In the context of the coronavirus pandemic, countless face-to-face events as well as medical trainings were cancelled or moved to online courses, which resulted in increased digitalization in many areas. In the context of medical education, videos provide tremendous benefit for visualizing skills before they are practised. METHODS: Based on a previous investigation of video material addressing epidural catheterization available on the YouTube platform, we aimed to investigate new content produced in the context of the pandemic. Thus, a video search was conducted in May 2022. RESULTS: We identified twelve new videos since the pandemic with a significant improvement in the new content in terms of procedural items (p = 0.03) compared to the prepandemic video content. Video content released in the course of the COVID-19 pandemic was more often created by private content creators and were significantly shorter in total runtime than those from university and medical societies (p = 0.04). CONCLUSION: The profound changes in the learning and teaching of health care education in relation to the pandemic are largely unclear. We reveal improved procedural quality of predominantly privately uploaded content despite a shortened runtime compared to the prepandemic period. This might indicate that technical and financial hurdles to producing instructional videos by discipline experts have decreased. In addition to the teaching difficulties caused by the pandemic, this change is likely to be due to validated manuals on how to create such content. The awareness that medical education needs to be improved has grown, so platforms offer specialized sublevels for high-quality medical videos.

Comparing video-based versions of Halsted's 'see one, do one' and Peyton's '4-step approach' for teaching surgical skills: a randomized controlled trial.

BACKGROUND: Teaching complex motor skills at a high level remains a challenge in medical education. Established methods often involve large amounts of teaching time and material. The implementation of standardized videos in those methods might help save resources. In this study, video-based versions of Peyton's '4-step Approach' and Halsted's 'See One, Do One' are compared. We hypothesized that the video-based '4-step Approach' would be more effective in learning procedural skills than the 'See One, Do One Approach'. METHODS: One-hundred-two naïve students were trained to perform a structured facial examination and a Bellocq's tamponade with either Halsted's (n = 57) or Peyton's (n = 45) method within a curricular course. Steps 1 (Halsted) and 1-3 (Peyton) were replaced by standardized teaching videos. The performance was measured directly (T1) and 8 weeks (T2) after the intervention by blinded examiners using structured checklists. An item-analysis was also carried out. RESULTS: At T1, performance scores significantly differed in favor of the video-based '4-step Approach' (p < 0.01) for both skills. No differences were found at T2 (p < 0.362). The item-analysis revealed that Peyton's method was significantly more effective in the complex subparts of both skills. CONCLUSIONS: The modified video-based version of Peyton's '4-step Approach' is the preferred method for teaching especially complex motor skills in a large curricular scale. Furthermore, an effective way to utilize Peyton's method in a group setting could be demonstrated. Further studies have to investigate the long-term learning retention of this method in a formative setting.

Do they teach what they need to? An analysis of the impact of curriculum mapping on the learning objectives taught in a lecture series in surgery.

Introduction: Curriculum mapping shows concordances and differences between the intended and the taught curriculum. To our knowledge, no previous studies describe the effects that this mapping has on the curriculum. The aim of the present study is to map the content of a lecture series in surgery to the National Catalogue of Learning Objectives in Surgery and analyze the effects this mapping has on the content of the following lecture series. Methods: All lecturers in the lecture series were directly observed by a minimum of two reviewers and learning objectives and the level of competence were documented. After the lecture series, the results were visualized within the catalog of learning objectives and were sent to the lecturers. In the following lecture series, learning objectives were documented correspondingly. Results: In the first lecture series, 47% of the learning objectives were taught. After the mapping, the number of learning objectives that were taught increased to 59% (p < 0.001). The increase was found in all surgical disciplines and in all levels of competences without any changes in the average duration of the lectures. Conclusions: The presented method for mapping a curriculum effectively increased the number of taught learning objectives without requiring longer lecture durations.

Conveying practical clinical skills with the help of teaching associates-a randomised trial with focus on the long term learning retention.

BACKGROUND: Ensuring that all medical students achieve adequate clinical skills remains a challenge, yet the correct performance of clinical skills is critical for all fields of medicine. This study analyzes the influence of receiving feedback by teaching associates in the context of achieving and maintaining a level of expertise in complex head and skull examination. METHODS: All third year students at a German university who completed the obligatory surgical skills lab training and surgical clerkship participated in this study. The students were randomized into two groups. CONTROL GROUP: lessons by an instructor and peer-based practical skills training. Intervention group: training by teaching associates who are examined as simulation patients and provided direct feedback on student performance. Their competency in short- and long-term competence (directly after intervention and at 4 months after the training) of head and skull examination was measured. Statistical analyses were performed using SPSS Statistics version 19 (IBM, Armonk, USA). Parametric and non-parametric test methods were applied. As a measurement of correlation, Pearson correlations and correlations via Kendall's-Tau-b were calculated and Cohen's d effect size was calculated. RESULTS: A total of 181 students were included (90 intervention, 91 control). Out of those 181 students 81 agreed to be videotaped (32 in the control group and 49 in the TA group) and examined at time point 1. At both time points, the intervention group performed the examination significantly better (time point 1, p = <.001; time point 2 (rater 1 p = .009, rater 2 p = .015), than the control group. The effect size (Cohens d) was up to 1.422. CONCLUSIONS: The use of teaching associates for teaching complex practical skills is effective for short- and long-term retention. We anticipate the method could be easily translated to nearly every patient-based clinical skill, particularly with regards to a competence-based education of future doctors.

Examiner effect on the objective structured clinical exam - a study at five medical schools.

BACKGROUND: The Objective Structured Clinical Examination (OSCE) is increasingly used at medical schools to assess practical competencies. To compare the outcomes of students at different medical schools, we introduced standardized OSCE stations with identical checklists. METHODS: We investigated examiner bias at standardized OSCE stations for knee- and shoulder-joint examinations, which were implemented into the surgical OSCE at five different medical schools. The checklists for the assessment consisted of part A for knowledge and performance of the skill and part B for communication and interaction with the patient. At each medical faculty, one reference examiner also scored independently to the local examiner. The scores from both examiners were compared and analysed for inter-rater reliability and correlation with the level of clinical experience. Possible gender bias was also evaluated. RESULTS: In part A of the checklist, local examiners graded students higher compared to the reference examiner; in part B of the checklist, there was no trend to the findings. The inter-rater reliability was weak, and the scoring correlated only weakly with the examiner's level of experience. Female examiners rated generally higher, but male examiners scored significantly higher if the examinee was female. CONCLUSIONS: These findings of examiner effects, even in standardized situations, may influence outcome even when students perform equally well. Examiners need to be made aware of these biases prior to examining.

The effect of written standardized feedback on the structure and quality of surgical lectures: A prospective cohort study.

BACKGROUND: Lectures remain an important teaching method to present and structure knowledge to many students concurrently. Adequate measures are necessary to maintain the quality of the lectures. The aim of this study was to determine the impact on the lecture quality using written structured feedback and to compare the ratings of surgical lectures between students and surgical peers. METHODS: Prospective analysis of two consecutive surgical lecture series for undergraduate students at Goethe-University Medical School was performed before and after evaluation of the lecturers via independent written feedback from trained undergraduate students and surgeons. The 22-item feedback instrument covered three areas of performance: content, visualization, and delivery. Additional suggestions for improvement were provided from both students and surgical peers who anonymously attended the lectures. The lecturers, experienced surgeons, as well as the student and peer raters were blinded in terms of the aim and content of the study. Their response to the feedback was collected using a web-based 13-item questionnaire. The Kendall's-W coefficient was computed to calculate inter-rater reliability (IRR). Differences between ratings before and after feedback were analyzed using Student's t-test for dependent samples. The Kolmogorov-Smirnov-test was used for independent samples. RESULTS: A total of 22 lectures from a possible 32 given by 13 lecturers were included and analyzed by at least three surgeons and two students. There were significant improvements in overall score as well as in the details of 9 of the 13 items were found. The average inter-rater reliability was 0.71. There were no differences in the ratings as a function of the rater's level of expertise (peers vs. students). We found that 13/23 lecturers (56.5%) answered the questionnaire, and 92% strongly agreed that the written feedback was useful. 76.9% of the lecturers revised their lecture based on the written feedback requiring on average 112.5 min (range from 20 to 300 min). CONCLUSIONS: Overall, this study indicates that structured written feedback provided by trained peers and students that is subsequently discussed by the lecturers concerned is a highly effective and efficient method to improve aspects of lecturing. We anticipate that structured written feedback by trained students that is discussed by the lecturers concerned will improve lecturing.

Republished: Simulation training improves ability to manage medical emergencies.

OBJECTIVE: In the case of an emergency, fast and structured patient management is crucial for a patient's outcome. Every physician and graduate medical student should possess basic knowledge of emergency care and the skills to manage common emergencies. This study determines the effect of a simulation-based curriculum in emergency medicine on students' abilities to manage emergency situations. METHODS: A controlled, blinded educational trial of 44 final-year medical students was carried out at Frankfurt Medical School; 22 students completed the former curriculum as the control group and 22 the new curriculum as the intervention group. The intervention consists of simulation-based training with theoretical and simulation-based training sessions in realistic encounters based on the Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and adapted Advanced Trauma Life Support (ATLS) training. Further common emergencies were integrated corresponding to the course objectives. All students faced a performance-based assessment in a 10 station Objective Structured Clinical Examination (OSCE) using checklist rating within a maximum of 4 months after completion of the intervention. RESULTS: The intervention group performed significantly better at all of the 10 OSCE stations in the checklist rating (p<0.0001 to p=0.016). CONCLUSIONS: The simulation-based intervention offers a positively evaluated possibility to enhance students' skills in recognising and handling emergencies. Additional studies are required to measure the long-term retention of the acquired skills, as well as the effect of training in healthcare professionals.

Arthroscopy or ultrasound in undergraduate anatomy education: a randomized cross-over controlled trial.

BACKGROUND: The exponential growth of image-based diagnostic and minimally invasive interventions requires a detailed three-dimensional anatomical knowledge and increases the demand towards the undergraduate anatomical curriculum. This randomized controlled trial investigates whether musculoskeletal ultrasound (MSUS) or arthroscopic methods can increase the anatomical knowledge uptake. METHODS: Second-year medical students were randomly allocated to three groups. In addition to the compulsory dissection course, the ultrasound group (MSUS) was taught by eight, didactically and professionally trained, experienced student-teachers and the arthroscopy group (ASK) was taught by eight experienced physicians. The control group (CON) acquired the anatomical knowledge only via the dissection course. Exposure (MSUS and ASK) took place in two separate lessons (75 minutes each, shoulder and knee joint) and introduced standard scan planes using a 10-MHz ultrasound system as well as arthroscopy tutorials at a simulator combined with video tutorials. The theoretical anatomic learning outcomes were tested using a multiple-choice questionnaire (MCQ), and after cross-over an objective structured clinical examination (OSCE). Differences in student's perceptions were evaluated using Likert scale-based items. RESULTS: The ASK-group (n = 70, age 23.4 (20-36) yrs.) performed moderately better in the anatomical MC exam in comparison to the MSUS-group (n = 84, age 24.2 (20-53) yrs.) and the CON-group (n = 88, 22.8 (20-33) yrs.; p = 0.019). After an additional arthroscopy teaching 1% of students failed the MC exam, in contrast to 10% in the MSUS- or CON-group, respectively. The benefit of the ASK module was limited to the shoulder area (p < 0.001). The final examination (OSCE) showed no significant differences between any of the groups with good overall performances. In the evaluation, the students certified the arthroscopic tutorial a greater advantage concerning anatomical skills with higher spatial imagination in comparison to the ultrasound tutorial (p = 0.002; p < 0.001). CONCLUSIONS: The additional implementation of arthroscopy tutorials to the dissection course during the undergraduate anatomy training is profitable and attractive to students with respect to complex joint anatomy. Simultaneous teaching of basic-skills in musculoskeletal ultrasound should be performed by medical experts, but seems to be inferior to the arthroscopic 2D-3D-transformation, and is regarded by students as more difficult to learn. Although arthroscopy and ultrasound teaching do not have a major effect on learning joint anatomy, they have the potency to raise the interest in surgery.

Influence of using simulated or real patients on undergraduate medical students acquiring competencies in medical conversations in surgery: A prospective, controlled study.

Background: Communication with patients and their relatives as well as with colleagues and students is an essential part of every physician's daily work. An established method for teaching communication skills is using simulated patients (SPs). However, teaching with SPs is often subjectively perceived by medical students as less instructive than teaching with real patients (RPs). Studies that analyze the influence of SPs compared to RPs for acquiring competencies are lacking. The aim of the present study was therefore to investigate the impact of SPs on long-term learning success for communication skills compared to RPs. Material and Methods: Study participants were undergraduate third-year medical students who attended a communication unit and were randomized into three groups. The first group trained the role-play part with a SP (SP-group). The second group trained with a SP but thought that the patient was a RP because the students and the tutors were told that they were a RP by the principal investigator (incognito patient group [IP-group]). The third group and their tutors trained with a RP and were told that the patient was a RP (real patient group [RP-group]). Five to 12 weeks after completing the training, the study participants completed a curricular summative objective standardized clinical examination. Results: There were 146 students who participated in the study. There were no significant differences between the three study groups at the informed consent stations and for those conducting anamnesis interviews. Conclusion: Communication skills training with SPs appears to be equivalent to training with RPs in terms of competency development in communication-based assessments in surgery. Therefore, SPs should be used in these curricula, especially at an early stage, to enable the students to practice adequate communication skills.

Epidural Catheterization in Obstetrics: A Checklist-Based Video Assessment of Free Available Video Material.

Epidural catheterization has become an indispensable part of modern pain therapy, for example, in obstetrics. Learning how to master this skill is an important competency. Videos are among the information sources with the highest information content for learning such skills. The present study aims to analyze videos regarding epidural catheter placement provided on the YouTube platform based on a validated checklist. An expert workshop selected crucial items for learning epidural catheterization in obstetrics. Items were identified and optimized in a five-step testing process. Using this checklist, videos from YouTube were evaluated by eleven health care professionals. Sixteen videos were identified and analyzed. Concerning the catheterization-specific part of the checklist, only two videos showed satisfactory quality. In the didactic part, eleven out of 21 items reached a mean score >50% of the points. Regarding interrater reliability, the catheterization-specific checklist was shown to be substantial (Fleiss' kappa = 0.610), and the didactic part was shown to be fair (Fleiss' kappa = 0.401). Overall, standard monitoring and appropriate aseptic technique were followed in only 42% and 49% for the procedure. There was a significant correlation between the runtime and the content quality (p < 0.001). No correlation could be found in terms of platform rating parameters. The video quality varied highly in terms of the requirements of this practical skill. The majority appear unsuitable for self-study due to serious errors and deficiencies regarding patient safety. However, there is no quality control on free platforms. Accordingly, it is difficult to identify suitable videos for educational purposes.

Manikins versus simulated patients in emergency medicine training: a comparative analysis.

PURPOSE: Every physician must be able to sufficiently master medical emergencies, especially in medical areas where emergencies occur frequently such as in the emergency room or emergency surgery. This contrasts with the observation that medical students and young residents often feel insufficiently prepared to handle medical emergencies. It is therefore necessary to train them in the treatment of emergency patients. The aim of this study is to analyze the influence of the assignment of manikin versus simulated patients during a training for undergraduate medical students on learning outcomes and the perceived realism. METHODS: The study had a prospective cross-over design and took place in a 3-day emergency medicine training for undergraduate medical students. Students completed three teaching units ('chest pain', 'impaired consciousness', 'dyspnea'), either with manikin or simulated patient. Using a questionnaire after each unit, overall impression, didactics, content, the quality of practical exercises, and the learning success were evaluated. The gained competences were measured in a 6-station objective structured clinical examination (OSCE) at the end of training. RESULTS: 126 students participated. Students rated simulated patients as significantly more realistic than manikins regarding the possibility to carry out examination techniques and taking medical history. 54.92% of the students would prefer to train with simulated patients in the future. Regarding the gained competences for 'chest pain' and 'impaired consciousness', students who trained with a manikin scored less in the OSCE station than the simulated patients-group. CONCLUSION: Simulated patients are rated more realistic than manikins and seem to be superior to manikins regarding gained competence.

Emergency airway management in trauma patients using laryngeal tube suction.

BACKGROUND: Endotracheal intubation (ETI) is considered to be the "gold standard" of prehospital airway management of trauma patients. However, ETI requires substantial technical skills and ongoing experience. Because failed prehospital ETI is common and associated with a higher mortality, reliable airway devices are needed to be used by rescuers who are less experienced in ETI. OBJECTIVE: To prospectively evaluate the feasibility of the use of laryngeal tubes by paramedics and emergency physicians for out-of-hospital airway management in trauma patients. METHODS: During a 40-month period, data for all cases of prehospital use of the laryngeal tube suction disposable (LTS-D) within a large metropolitan area were recorded by a standardized questionnaire. We determined indications for laryngeal tube use, placement success, number of placement attempts, placement time, and personal level of experience. All patients admitted to our institution also underwent in-hospital follow-up. RESULTS: Fifty-six of 57 prehospital intubations attempts with the LTS-D were successfully performed by paramedics (n = 19) or emergency physicians (n = 37) within one (n = 50) or two (n = 6) placement attempts. The device was used as initial airway (n = 27) or rescue device after failed ETI (n = 30). The placement time was ≤ 45 seconds (n = 42), 46-90 seconds (n = 13), and >90 seconds (n = 1). The majority of users (n = 44) were relative novices with no more than 10 previous laryngeal tube placements on actual patients. Of 33 patients eligible for follow-up, one underwent urgent LTS-D removal and subsequent ETI upon hospital admission, six underwent ETI after primary survey, and 26 underwent both primary and secondary survey or even damage-control surgery with the LTS-D. CONCLUSION: The LTS-D represents a promising alternative to ETI in the hands of both paramedics and emergency physicians. It can be used as an initial tool to secure the airway until ETI is prepared, as a definitive airway by rescuers less experienced in ETI, or as a rescue device when ETI has failed.

"Quod licet Chefarzt  ": The Impact of Perceived Hierarchy on Working Atmosphere and Quality of Work in Orthopaedic and Trauma Surgery. Results of a Survey Among 799 Orthopaedic and Trauma Surgeons in Germany. / "Quod licet Chefarzt  ": Der Einfluss der empfundenen Hierarchie auf Arbeitsklima und Arbeitsqualität in O und U. Ergebnisse einer Umfrage unter 799 Orthopäden und Unfallchirurgen in Deutschland.

INTRODUCTION: Surgical departments are discredited as guardians of traditional structures of hierarchy. Hierarchy and working climate have a large share in human factor, being made responsible for 70% of avoidable errors in medicine. Aim of this study was the assessment of these topics amongst physicians in the field of orthopedics and traumatology. MATERIAL AND METHODS: A questionnaire of 10 questions was digitally handed to DGOU members. 799 questionnaires were answered. RESULTS: We found significant differences in the assessment of hierarchy and working atmosphere amongst the physician groups. Working atmosphere was perceived as not appreciative by registrars only. All groups were in favor of a hierarchy rather close to, but nut absolutely on equal terms. All groups attach high influence of working atmosphere on quality of daily work. DISCUSSION: Literature shows that hierarchic differentiation can increase performance of a team, while rigid hierarchy structures can lead to mistakes. Although hierarchy in orthopedics and traumatology seems to be less pronounced than assumed, hierarchy has great influence on daily work. CONCLUSION: In order to achieve a safety oriented medical environment, it will be of great importance to define hierarchy structures in clinics and to utilize them efficiently as a part of safety culture.

Checklist Focused on Patients for Making of Teaching Videos in Orthopedic Surgery. / Patientenorientierte Checkliste für die Erstellung von Lehrvideos für Orthopädie und Unfallchirurgie.

INTRODUCTION: The focus of medical-didactic research is the improvement of clinical-practical training. One way to support practical skills training in a time- and resource-saving way is to provide instructional videos. Often the freely available instructional videos do not meet didactic or content requirements. Creating your own videos can therefore be a useful alternative for teachers. There are a variety of instructions on the Internet for shooting instruction videos. To date, this does not include any concrete instructions/assistance for the production of medical instructional videos. However, the presentation of medical learning content in particular can contain many hurdles. The aim of this work was to design a checklist for the creation of instructional videos, which can be used as a guide. METHODS: As a first step, a systematic literature search was carried out to identify works that deal with the creation and not the use of medical instructional videos. To date, corresponding publications do not exist. In a workshop, the participants, who already gained experience in creating this type of video, exchanged ideas. These were critically discussed and analyzed. As a result, a checklist was created. In a subsequent multi-step review process, the checklist was reviewed with regard to applicability, comprehensibility, completeness and quality of the items. RESULTS: Four phases in the creation of an instructional video could be differentiated: preliminary reflections, preparation, day of filming, post-production. The checklist is structured accordingly and should be actively processed phase by phase. The checklist is created in such a way that it can be used and edited without reading this text. Particular focus is placed on the patient and his needs. CONCLUSION: The checklist created provides useful help in the creation of medical instructional videos and can for the first time serve as a guide especially for orthopedic and accident surgical instructional videos.

Evidence-Based Examination Techniques for the Shoulder Joint. / Evidenzbasiertes Lehrvideo für Untersuchungstechniken am Schultergelenk.

OBJECTIVE: Digitalisation now almost covers all areas of medical student teaching. Teaching videos are a good way to help students learn practical skills. The existing evidence is a recognised aid for the classification of the respective technology. METHOD: This video presents the usual examination techniques of the shoulder joint on a patient with an unstable shoulder. The respective techniques, if available, were backed up with appropriate evidence. CONCLUSION: The examination techniques presented allow students to view them in a standardized manner on a patient. The evidence for the examination techniques can help with the classification of the respective technique.

Evidence-Based Examination Techniques for the Knee. / Evidenzbasiertes Lehrvideo für Untersuchungstechniken am Kniegelenk.

OBJECTIVE: Digitalisation now almost covers all areas of medical student teaching. Teaching videos are a good way to help students learn practical skills. The existing evidence is a recognised aid for the classification of the respective technology. METHOD: This video presents the usual examination techniques of the knee joint on a patient with an unstable knee. The respective techniques, if available, were backed up with the appropriate evidence. CONCLUSION: The examination techniques presented allow students to view the examination techniques in a standardised manner on a patient. The evidence for the examination techniques can help with the classification of the respective technique. ZIELSETZUNG: Die Digitalisierung erfasst inzwischen alle Bereiche der studentischen Lehre. Um die Studierenden im Erlernen praktischer Fertigkeiten zu unterstützen, sind Lehrvideos eine gute Methode. Für die Einordnung der jeweiligen Technik ist die vorhandene Evidenz eine anerkannte Hilfestellung. METHODE: Das hier vorliegende Video stellt die üblichen Untersuchungstechniken des Kniegelenkes an einer Patientin mit einem instabilen Knie dar. Die jeweiligen Techniken wurden, wenn vorhanden, mit der jeweiligen Evidenz unterlegt. SCHLUSSFOLGERUNG: Die dargestellten Untersuchungstechniken ermöglichen es Studierenden, sich die Untersuchungstechniken standardisiert an einem Patienten anzuschauen. Die eingeblendete Evidenz für die Untersuchungstechniken kann hierbei eine Hilfestellung bei der Einordnung der jeweiligen Technik leisten.

Increased authenticity in practical assessment using emergency case OSCE stations.

In case of an emergency, a fast and structured patient management is crucial for patient's outcome. The competencies needed should be acquired and assessed during medical education. The objective structured clinical examination (OSCE) is a valid and reliable assessment format to evaluate practical skills. However, traditional OSCE stations examine isolated skills or components of a clinical algorithm and thereby lack a valid representation of clinical reality. We developed emergency case OSCE stations (ECOS), where students have to manage complete emergency situations from initial assessment to medical treatment and consideration of further procedures. Our aim was to increase the authenticity and validity in the assessment of students' capability to cope with emergency patients. 45 students participated in a 10-station OSCE with 6 ECOS and 4 traditional OSCE stations. They were assessed using a case-specific checklist. An inter-station and post-OSCE-questionnaire was completed by each student to evaluate both ECOS and traditional OSCE. In this study, we were able to demonstrate that ECOS are feasible as time-limited OSCE stations. There was a high acceptance on both students and examiners side. They rated ECOS to be more realistic in comparison to the traditional OSCE scenarios. The reliability estimated via Crohnbach's alpha for the 6 ECOS is high (0.793). ECOS offer a feasible alternative to the traditional OSCE stations with adequate reliability to assess students' capabilities to cope with an acute emergency in a realistic encounter.

Simulation training improves ability to manage medical emergencies.

OBJECTIVE: In the case of an emergency, fast and structured patient management is crucial for a patient's outcome. Every physician and graduate medical student should possess basic knowledge of emergency care and the skills to manage common emergencies. This study determines the effect of a simulation-based curriculum in emergency medicine on students' abilities to manage emergency situations. METHODS: A controlled, blinded educational trial of 44 final-year medical students was carried out at Frankfurt Medical School; 22 students completed the former curriculum as the control group and 22 the new curriculum as the intervention group. The intervention consists of simulation-based training with theoretical and simulation-based training sessions in realistic encounters based on the Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and adapted Advanced Trauma Life Support (ATLS) training. Further common emergencies were integrated corresponding to the course objectives. All students faced a performance-based assessment in a 10 station Objective Structured Clinical Examination (OSCE) using checklist rating within a maximum of 4 months after completion of the intervention. RESULTS: The intervention group performed significantly better at all of the 10 OSCE stations in the checklist rating (p<0.0001 to p=0.016). CONCLUSIONS: The simulation-based intervention offers a positively evaluated possibility to enhance students' skills in recognising and handling emergencies. Additional studies are required to measure the long-term retention of the acquired skills, as well as the effect of training in healthcare professionals.

Influence of the Instructional Approach "Mastery Learning" versus "See One, Do One" on Acquiring Competencies in Abdomen Sonography: A Comparative Effectiveness Analysis.

Ultrasound is an important diagnostic tool in patients with abdominal pain and after injury. However, it is highly dependent on the skills and training of the examiner. Thus, ultrasound competencies should be acquired early during medical education. The instructional approach affects the retention and performance of skills. A promising approach is "mastery learning." The aim of the study was to evaluate the effectiveness of "mastery learning" compared with the "see one, do one" approach by performing a focused assessment of sonography for trauma (FAST) in undergraduate medical students based using an academic assessment tool (Objective Structured Clinical Examination [OSCE]). In a prospective controlled trial, 146 participants were randomly allocated to two groups (see one, do one and mastery learning) and trained in a 90-min module. In the see one, do one group, the trainer demonstrated the complete FAST routine, and then the students trained each other on it under supervision and received direct oral feedback from the tutors. In the mastery learning group, each student received a routing slip. The routing slip contained five levels of competence for the FAST routine, each of which had to be achieved (e.g., choosing the correct probe) and verified by the trainer before working toward the next competency level. The acquired competencies were assessed after training using the OSCE, which is a standardized practical exam using checklists. The mastery learning group attained 40.69 ± 5.6 points on average (of a maximum of 46 points), and the see one, do one group, 33.85 ± 7.7 points (p < 0.001). Mastery learning is an effective teaching method for undergraduate medical students performing FAST and is superior to the see one, do one approach, as assessed with the OSCE.

Surgeons' participation in the development of collaboration and management competencies in undergraduate medical education.

The teaching of professional roles in medical education is an interdisciplinary concern. However, surgeons require specific standards of professionalism for certain context-based situations. In addition to communication, studies require collaboration, leadership, error-/conflict-management, patient-safety and decision-making as essential competencies for surgeons. Standards for corresponding competencies are defined in special chapters of the German National Competency-based Learning Objectives for Undergraduate Medical Education (NKLM; chapter 8, 10). The current study asks whether these chapters are adequately taught in surgical curricula. Eight German faculties contributed to analysing mapping data considering surgical courses of undergraduate programs. All faculties used the MERlin mapping platform and agreed on procedures for data collection and processing. Sub-competency and objective coverage, as well as the achievement of the competency level were mapped. Overall counts of explicit citations were used for analysis. Collaboration within the medical team is a strongly represented topic. In contrast, interprofessional cooperation, particularly in healthcare sector issues is less represented. Patient safety and dealing with errors and complications is most emphasized for the Manager/Leader, while time management, career planning and leadership are not addressed. Overall, the involvement of surgery in teaching the competencies of the Collaborator and Manager/Leader is currently low. However, there are indications of a curricular development towards explicit teaching of these roles in surgery. Moreover, implicitly taught roles are numerous, which indicates a beginning awareness of professional roles.