[Testing of practical surgical teaching at a distance-Experiences with a hybrid OSCE in surgery]. / Prüfung praktisch-chirurgischer Lehre auf Distanz ­ Erfahrungen mit einem Hybrid-OSCE in der Chirurgie.

BACKGROUND: The COVID-19 pandemic has changed medical teaching worldwide. Digital teaching and examinations are successful for cognitive learning objectives, whereas practical skills had to be carried out predominantly in person under strict hygiene standards. AIM: This study presents the opportunities and challenges of using a presence objective structured clinical examination (OSCE) at a distance with digital support. METHOD: Following surgical practical teaching an OSCE was conducted in presence, where students demonstrated practical skills in one room while the examiners were connected via videoconference from another room. Students were surveyed about the OSCE and sustained learning via a standardized online questionnaire after completion of the surgical teaching. Additionally, examiners were surveyed on their experiences. RESULTS: In the online survey 40 students participated (25% of n = 157 students contacted) and 36 completed questionnaires were analyzed. Overall, the implementation of an OSCE even under pandemic conditions was perceived as very positive by the students (92% of students n = 33). In particular, the acquisition of practical skills was rated as very high. For 78% (n = 28) of the students, the acquisition of competencies through the practical examination was particularly sustainable. The vast majority of students and examiners felt safe regarding infection control because of the hygiene concept (92%, n = 33). Overall, 80 students achieved grade 1 (51%), 71 students grade 2 (45.2%) and 6 students grade 3 (3.8%) (grade 1 = very good, grade 6 = very bad). CONCLUSION: Practical examinations are essential for checking practical learning objectives and can be implemented at a distance with a well-developed hygiene concept and digital support.

Dealing with resistance and negative attitudes as barriers to the implementation of a longitudinal communication curriculum - a field report.

Background: The aim of the project "Communicative Competences of Physicians" (BMG) was the pilot implementation of a longitudinal model communication curriculum. For the Mainz project location, the task was to integrate courses offered in the clinical subjects into a communication curriculum and to expand it longitudinally. In this process, which was both content-related and social, resistance and negative attitudes regarding the continued development of the communication curriculum became apparent at an early stage. How these manifested and which measures were taken to overcome them is laid out in this reflective field report. Method/approach: At the beginning of the project, a SWOT analysis was used to identify the strengths and weaknesses that the faculty presented for the continued development of the communication curriculum. This assessment by the project staff included, among other things, an evaluation of the motivation levels of the faculty's lecturers and senior teaching staff. The subsequent specific, strategic and content-related planning of the further implementation steps in accordance with change-management concepts made it possible to take this aspect into account. For a more reliable assessment of the situation, the project was first presented to the faculty's teaching committee. In this situation it was possible to identify individuals with favourable and unfavourable attitudes. With the insight that was gained, the following course of action was decided upon: Contact advocates to gain their support. Contact the individuals with negative attitudes with the aim of building a relationship and arranging a personal meeting. Identify resistances and negative attitudes in one-on-one meetings and employ targeted countermeasures.Develop an action plan with a particular focus on gaining the cooperation of those who are essential to the success of integrating communication-related content into the major clinical disciplines. Results/experiences: In one-on-one meetings, it was possible to first clarify which learning objectives of communication training are already covered in the respective subject and which expertise is therefore available. Furthermore, it was possible to clarify which areas that were still absent in the overall communication curriculum should be taught in this clinical subject in particular. It became possible to involve the lecturers in the development in the spirit of participatory design. In accordance with the action plan, offers to support the development and organisation of as-yet absent portions of the curriculum were presented to the affected departments. Discussion/conclusion: Resistance and negative attitudes often do not represent a rejection of communicative competences - they rather express that teachers fear they do not have the expertise and resources to teach them. With the selected approach of outreach, personal conversation, and action plan, it was possible to provide the individuals in question with goal-oriented support.

[Cross-sectional field pain medicine Q14 - the Mainz model : Development of the pain medicine curriculum in the standard study course at the University Medical School of the Johannes Gutenberg University Mainz]. / Querschnittsfach Schmerzmedizin Q14 ­ das Mainzer Modell : Die Entwicklung des Curriculums Schmerzmedizin im Regelstudiengang Humanmedizin an der Universitätsmedizin der Johannes Gutenberg-Universität Mainz.

BACKGROUND AND OBJECTIVES: Following the amendment of the Medical Licensure Act (ÄAppO) in 2012, pain medicine was introduced as a mandatory subject for students during undergraduate medical training. Medical schools were required to define and to implement adequate curricular and formal teaching structures based on interdisciplinary and multiprofessional requirements according to the curriculum for pain medicine of the German Pain Society. These aspects were considered in the new interdisciplinary curriculum for pain medicine, the so-called Mainz model. STUDY DESIGN AND METHODS: A new curriculum based on the Kern cycle was developed and implemented at the Medical Center of the Johannes Gutenberg University in Mainz. Different teaching methods (lectures, interprofessional tutorials and bedside coaching in small groups) were used to impart professional expertise in pain medicine to medical students in an interdisciplinary clinical context. RESULTS: The new curriculum was put into practice and evaluated starting from the winter semester 2014/2015. Before and after the first implementation, medical students were asked about the relevance of pain medicine and their perception of personal competence. CONCLUSION: The interdisciplinary course in pain medicine was successfully introduced into the degree program based on the curriculum of the German Pain Society and the Kern cycle. With educational support, interdepartmental and multiprofessional collaboration the process of implementation of new interdisciplinary courses can be facilitated. In the future, the question how to increase the amount of practical lessons without increasing the load on teaching resources has to be resolved. Blended learning modules, such as a combination of E­learning and practical lessons are currently being studied in smaller cohorts.

[Simulation-based training and OR apprenticeship for medical students : A prospective, randomized, single-blind study of clinical skills]. / Simulationsbasiertes Training und Lehre im OP für Studierende : Eine prospektive randomisierte, einfach verblindete Studie klinischer Fertigkeiten.

BACKGROUND: Simulation-based training (SBT) has developed into an established method of medical training. Studies focusing on the education of medical students have used simulation as an evaluation tool for defined skills. A small number of studies provide evidence that SBT improves medical students' skills in the clinical setting. Moreover, they were strictly limited to a few areas, such as the diagnosis of heart murmurs or the correct application of cricoid pressure. Other studies could not prove adequate transferability from the skills gained in SBT to the patient site. Whether SBT has an effect on medical students' skills in anesthesiology in the clinical setting is controversial. To explore this issue, we designed a prospective, randomized, single-blind trial that was integrated into the undergraduate anesthesiology curriculum of our department during the second year of the clinical phase of medical school. OBJECTIVES: This study intended to explore the effect of SBT on medical students within the mandatory undergraduate anesthesiology curriculum of our department in the operating room with respect to basic skills in anesthesiology. MATERIALS AND METHODS: After obtaining ethical approval, the participating students of the third clinical semester were randomized into two groups: the SIM-OR group was trained by a 225 min long SBT in basic skills in anesthesiology before attending the operating room (OR) apprenticeship. The OR-SIM group was trained after the operating room apprenticeship by SBT. During SBT the students were trained in five clinical skills detailed below. Further, two clinical scenarios were simulated using a full-scale simulator. The students had to prepare the patient and perform induction of anesthesia, including bag-mask ventilation after induction in scenario 1 and rapid sequence induction in scenario 2. Using the five-point Likert scale, five defined skills were evaluated at defined time points during the study period. 1) application of the safety checklist, 2) application of basic patient monitoring, 3) establishment of intravenous access, 4) bag-and-mask ventilation, and 5) adjustment of ventilatory parameters after the patients' airways were secured. A cumulative score of 5 points was defined as the best and a cumulative score of 25 as the worst rating for a defined time point. The primary endpoint was the cumulative score after day 1 in the operating room apprenticeship and the difference in cumulative scores from days 1 to 4. Our hypothesis was that the SIM-OR group would achieve a better score after day 1 in the operating room apprenticeship and would gain a larger increase in score from day 1 to day 4 than the OR-SIM group. RESULTS: 73 students were allocated to the OR-SIM group and 70 students to the SIM-OR group. There was no significant difference between the two groups after day 1 of the operating room apprenticeship and no difference in increase of the cumulative score from day 1 to day 4 (median of cumulative score on day 1: 'SIM-OR' 11.2 points vs. 'OR-SIM' 14.6 points; p = 0.067; median of difference from day 1 to day 4: 'SIM-OR' -3.7 vs. 'OR-SIM' -6.4; p = 0.110). CONCLUSION: With the methods applied, this study could not prove that 225 min of SBT before the operating room apprenticeship increased the medical students' clinical skills as evaluated in the operating room. Secondary endpoints indicate that medical students have better clinical skills at the end of the entire curriculum when they have been trained through SBT before the operating room apprenticeship. However, the authors believe that simulator training has a positive impact on students' acquisition of procedural and patient safety skills, even if the methods applied in this study may not mirror this aspect sufficiently.

[Comparison of GlideScope® Cobalt and McGrath® Series 5 video laryngoscopes with direct laryngoscopy in a simulated regurgitation/aspiration scenario]. / Vergleich der Videolaryngoskope GlideScope® Cobalt und McGrath® Series 5 mit konventioneller Laryngoskopie bei simulierter Regurgitation/Aspiration.

BACKGROUND: Video laryngoscopy has become increasingly important in airway management in the pre- and intrahospital settings. However, using video laryngoscopes in the presence of body fluids can make visualization of the airway difficult. A simulated regurgitation model was used to compare two video laryngoscopes (VL) with direct laryngoscopy. MATERIALS AND METHODS: A total of 72 physicians participated in this randomized trial. The hypopharynx from an Airway Management Trainer was filled with artificially warmed turbid liquid. In addition, the cervical spine of the manikin was immobilized. The VL GlideScope® (GS) and McGrath® Series 5 (McG) were examined with the laryngoscope with Macintoshspatel (DL). Fogging of the camera optics in percent (0 %= clear view, 100 %= no view), the visibility of the glottis by Cormack and Lehane classification (C&L), and the POGO Score (percentage of glottic opening), the time until the endotracheal tube placement, and the success rate were evaluated. RESULTS: No fogging (median 0 %) was present using the GS (interquartile range [IQR]: 0-4), in contrast 45 % fogging was found in the McG group (IQR: 30-60; p < 0.001). Glottic visualization using C&L was better using VL (p < 0.001). A similar result was observed using the POGO Scale: GS 90 % (IQR: 76-100), McG 80 % (IQR: 70-90), and DL 20 % (IQR: 0-50). The time for correct placement was in the DL with 27.6 s (IQR: 22.5-35) faster (p < 0.001), with the GS 48.5 s (IQR: 34.3-65.1) and the McG 66.3 s (IQR: 45.4-90). Successful placement was possible with GS in all cases (72/72), with DL in 71/72 cases, and with the McG in 70/72 cases. CONCLUSION: Using a video laryngsocope with an "anti-fogging" system improved visualization in a simulated aspiration model. In this scenario, VL showed no advantage to direct laryngoscopy in terms of success rate and speed of intubation.

[Upper gastrointestinal bleeding and haemorrhagic shock at the end of the holidays: pre-hospital and in-hospital management of a gastrointestinal emergency]. / Obere gastrointestinale Blutung mit hämorrhagischem Schock am Ende einer Urlaubsreise: Präklinische und innerklinische Versorgung eines gastrointestinalen Notfalls.

Upon returning from holidays, a 55-year-old patient presenting with melena and haemorrhagic shock was admitted to a University hospital after receiving first emergency medical care in a German InterCity train. In an interdisciplinary effort, haemodynamics were stabilised and the airway and respiratory function were secured. Under emergency care conditions the patient then underwent an emergency upper GI endoscopy where a spurting arterial upper gastrointestinal bleeding (Forrest 1a) was found. While the bleeding could not be controlled with endoscopic techniques, definitive haemostasis was achieved with a surgical laparotomy. While not commonly established for patients with severe GI bleeding, by spontaneous implementation of an interdisciplinary trauma room approach following established trauma algorithms the team was able to achieve stabilisation of vital functions and final control of bleeding in this highly unstable patient. Although the majority of upper gastrointestinal bleedings spontaneously cease, emergency care algorithms should be developed and implemented for patients with severe gastrointestinal bleedings in shock. Following the case vignette, we discuss a potential approach and develop an exemplary protocol for shock room management in this patient subgroup.