Short-time mentoring - enhancing female medical students' intentions toward surgical careers.

BACKGROUND: Women pursuing a career in surgery or related disciplines are still in the minority, despite the fact that women compose at least half of the medical student population in most Western countries. Thus, recruiting and retaining female surgeons remains an important challenge to meet the need for surgeons and increase the quality of care. The participations were female medical students between their third and fifth academic year. In this study, we applied the well-established psychological theory of planned behavior (TPB) which suggests that the intention to perform a behavior (e.g. pursuing a career in surgery) is the most critical and immediate predictor of performing the behavior. We investigated whether a two-part short-mentoring seminar significantly increases students' intention to pursue a career in a surgical or related specialty after graduation. METHOD: The mentoring and role-model seminar was conducted at 2 days for 90 minutes by six inspiring female role models with a remarkable career in surgical or related disciplines. Participants (N = 57) filled in an online survey before (T0) and after the seminar (T1). A pre-post comparison of central TPB concept attitude towards the behavior, 2) occupational self-efficacy and 3) social norm) was conducted using a paired sampled t-test. A follow-up survey was administered 12 months later (T2). RESULTS: The mentoring seminar positively impacted female students' attitude towards a career in a surgical specialty. Female students reported a significantly increased positive attitude (p < .001) and significantly higher self-efficacy expectations (p < .001) towards a surgical career after participating in the mentoring seminar. Regarding their career intention after the seminar, female students declared a significantly higher intention to pursue a career in a surgical specialty after graduating (p < .001) and this effect seems to be sustainable after 1 year. CONCLUSION: For the first time we could show that short-mentoring and demonstrating role models in a seminar surrounding has a significant impact on female medical student decision´s to pursue a career in a surgery speciality. This concept may be a practical and efficient concept to refine the gender disparity in surgery and related disciplines.

Hospital resource endowments and nosocomial infections: longitudinal evidence from the English National Health Service on Clostridioides difficile between 2011 and 2019.

OBJECTIVES: To identify key factors associated with Clostridioides difficile infections (CDIs) in healthcare at the hospital organization level. DESIGN: Longitudinal study covering the period 2011-2019. Hospital reports were analysed to determine the number of CDIs and several hospital-related environmental factors: financial resources (i.e., cleaning expenditure), spatial resources (i.e., number of single rooms with a private bathroom), human resources (i.e., number of physicians and nursing staff) and cultural resources (i.e., error reporting climate). The relationships between the environmental factors and CDIs were analysed in a hybrid within- and between-hospital random-effect model. SETTING: A total of 129 general hospital Trusts operating in the English National Health Service (NHS). PARTICIPANTS: All inpatients in 129 general hospital trusts of the NHS in the years 2011-2019, covering 120,629 cases of CDI. MAIN OUTCOME MEASURE: Annual number of CDIs per hospital trust. RESULTS: Single rooms were associated with fewer CDIs at the within-hospital level, but not at the between-hospital level. Similarly, more nursing staff was associated with fewer CDIs at the within-hospital level, but not at the between-hospital level. This effect was not observed for physician staffing. A different picture emerged for the protective effect of cultural resources, with a weakly significant effect of between-hospital differences, but no within-hospital effect. Financial resources were not associated with CDIs either between hospitals or within them over time. CONCLUSIONS: The present study identified hospital resources with a beneficial influence on CDI rates. Healthcare organizations can use this knowledge for active CDI prevention.

Crisis as a chance. A digital training of social competencies with simulated persons at the Medical Faculty of RWTH Aachen, due to the lack of attendance teaching in the SARS-Cov-2 pandemic.

Objective: The AIXTRA Competence Center for Training and Patient Safety at RWTH Aachen University has developed a concept to enable learning of communication skills with simulated persons (SP) digitally. Methodology: Existing SP cases in curricular teaching were checked for digital applicability and modified. Digital seminars with the methodology of simulated conversations with SP, for planned 690 students for the courses "history taking", 6th semester, conversations in psychiatry, 8th semester, and in the clinical competence course, 10th semester, were conducted via video conferencing software. The structure is similar to SP-seminars in classroom teaching with a case presentation, a doctor/patient dialogue and a feedback session. In the 6th and 10th semester, the seminars were evaluated anonymously by the students using an online questionnaire. SP were asked by e-mail for their assessment. The lecturers were asked about their experience with the digital seminars by means of qualitative interviews. Results: The survey of students with 92 completed questionnaires indicates a high level of acceptance. Digital teaching with SP was rated "very good" by 63% of the students and "good" by 37% as an overall mark for the course. The digital implementation is well practicable, the retention and accessibility of all learning goals is rated as given. Conclusion: Digital teaching with SP can be well realized with appropriate preparation. Specific aspects of digital implementation (e.g. role and data protection) must be taken into account. The differentiated evaluation of the surveys will bring further results and deductive questions.

[Preventable mistakes during endotracheal intubation. Overview and concepts]. / Vermeidbare Fehler bei der Intubation. Überblick und Konzepte.

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.

Practical skills training influences knowledge and attitude of dental students towards emergency medical care.

BACKGROUND: Medical emergencies in dental practice are generally perceived as being rare. Nonetheless, recent studies have shown that incidents occur on a regular basis. Therefore, patients have the right to expect necessary skills to manage life-threatening situations from every dentist. OBJECTIVE: To observe students' attitude and self-assessment towards emergency medical care (EMC) and its practical appliance. MATERIAL AND METHODS: Students of dentistry took part in small group sessions for adult and paediatric basic life support. Participants filled out pre-post questionnaires regarding knowledge and attitude towards EMC (6, respectively, 10-point Likert scale). Additionally, feedback was asked for the quality of course and tutors. RESULTS: Forty dental students in their last 2 years of study registered for the EMC courses. The majority had never attended any first-aid course; the mean age was 25% and 75% were women. A comparison between pre- and post-evaluation showed that the participation in practical training easily enhances the students' awareness of EMC importance as well as self-confidence in managing emergencies. After the course, 71% shared the opinion that retraining should be obligatory for all medical personnel. At the same time, students' self-assessment of confidence for specific tasks got significant upgrades in every aspect. CONCLUSION: The evaluation data clearly show the participants' needs to deal with topics of EMC within the curriculum of dentistry. The proposed course is able to change participants' attitudes towards EMC and its importance for their daily practice. The considerable enhancement of self-confidence in performing EMC-techniques might also lead to more willingness to manage emergency situations.

[Undergraduate curricular training in musculoskeletal ultrasound: the impact of preexisting anatomic knowledge]. / Kurrikulare Ultraschallausbildung am Bewegungsapparat: Einfluss der anatomischen Vorbildung auf die Weitergabe von Basis-Skills an der Schulter.

OBJECTIVE: The aim of this study was to evaluate the impact of students preexisting anatomic proficiency to address the fundamental problems related to musculoskeletal ultrasound (MSUS) training by assessing the peer-assisted learning (PAL) system. METHODS: Students without anatomic knowledge (first semester, n = 38) and students in their fourth semester of medical school (n = 49) were randomly assigned to two groups: 1) The PAL group - teaching by a group of three minimally trained student-teachers and 2) the Staff group - students were taught by a group of three ultrasound-experienced operators. Sessions included both a theoretical and a praxis component (DEGUM/EULAR, Toshiba Nemio™ XG, 10 MHz). A multiple choice questionnaire (MCQ) and an objective structured clinical examination (OSCE) were performed. Qualitative differences were evaluated by the Likert scale. RESULTS: Exposure included three separate lessons (each 120 minutes, 65 minutes of active scanning). The results of the MCQ were better among the fourth semester students than among those without anatomic knowledge (p < 0.001). Among first semester students, the MCQ results were better for those who had been taught by medical staff than for those who had been instructed by means of PAL (4.3 vs. 3.1; p = 0.045). At no point during the practical evaluation did significant differences arise between students of fourth and first semesters after medical staff tutoring (19.6 vs. 19.7 points; p = 0.978). PAL did result in worse results with regard to practical MSUS competence levels in the students possessing no previous knowledge (OSCE score 16.1; p = 0.042). CONCLUSIONS: Although deficits in theoretical knowledge cannot be compensated for, basic MSUS content appears to be adequately transferable to students with limited anatomic knowledge. Thus, an early implementation of MSUS during medical school education would be prudent, provided that the training is performed by an experienced MSUS operator.

[Intensive care medicine as a component of the compulsory medical curriculum. Evaluation of a pilot curriculum at the University Hospital Aachen]. / Intensivmedizin als Bestandteil des Pflicht-Curriculums: Evaluation eines Pilot-Curriculums am Universitätsklinikum Aachen.

BACKGROUND: In order to provide early achievement of practical experience during medical education, the medical faculty of the university Aachen has developed a new medical school curriculum which was offered in 2003 for the first time. In this curriculum anaesthesiology became a compulsory subject with practical training both in the operation theatre and in emergency medicine. Accordingly, a practical course in the field of intensive care medicine has also been designed with respect to the planned schedule and personnel resources. This course was evaluated by both students and teaching staff in a written, anonymous form as a quality control. METHODS: A dedicated course was developed for medical students of the 8th and 9th semesters. In this course comprised of 6 students and lasting 1 week, practical training is provided by intensive care physicians and accompanied by theoretical lessons focusing on the definition, diagnosis, therapy and prophylaxis of sepsis, essentials of mechanical ventilation and patient presentation at the bedside during daily rounds. On the last day of training students were required to present patients by themselves thereby recapitulating the acquired knowledge. In the summer semester 2007 this intensive care training course was offered for the first time. All participating 83 students and 23 physicians involved in teaching evaluated the course with marks from 1 to 6 according to the standard German school grading system using an online questionnaire. RESULTS: Students rated the course with 1.6+/-0.7 (mean +/- SD) for comprehensibility, with 1.6+/-0.7 for structural design, and with 1.7+/-0.7 for agreement between teachers. They graded their personal learning success with 1.7+/-0.7. With a cumulative mark of 1.7+/-0.6, the course was ranked as 1 of the top 3 courses of the medical faculty from the very beginning. The majority of the teaching staff (80%) appreciated the focus on few selected teaching subjects. However, comprehensibility, structural design, agreement between teachers and personal learning success were graded one mark worse than by the students. CONCLUSIONS: According to the results, efficiency and acceptance of intensive care training courses were high. Major criteria for the high grading were a limited number of participants, the focus on few subjects, and a clear structural design. However, according to several personal notes from the students, simulation-based sessions and written teaching material might further improve success of this course.

[Anaesthesiology as a compulsory subject in the new German medical school curriculum. Evaluation of a curricular model at the University Hospital Aachen]. / Anästhesiologie als Pflichtfach in der neuen Approbationsordnung. Evaluation eines Modell-Curriculums am Universitätsklinikum Aachen.

BACKGROUND: Since 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. METHODS: Previous 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. RESULTS: The 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. CONCLUSION: The 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.