Influence of medical didactic training on the self-efficacy and motivation of clinical teachers.

Objectives: Due to increasing workload and rising expectations for both undergraduate and speciality training in medicine, teaching in a clinical environment can be challenging. The "Train the Trainer" course, developed by CAL (Chirurgische Arbeitsgemeinschaft Lehre, Deutsche Gesellschaft für Chirurgie (DGCH)), aims to assist clinical teachers in their task. This study investigates the effect the course has on participants' self-efficacy and teaching motivation. Methods: Prior to attending the course, participants anonymously completed a 50-question pre-course questionnaire using standardised questions to gather information on biographical data teaching experience, and validated tools measuring teaching motivation and self-efficacy (PRE). Directly after completing the course, participants evaluated it using a 25-question post-course questionnaire (POST1). At least 12 months after the course, participants received a follow-up questionnaire (POST2) by mail. This 44-question form aimed to gather biographical data, review the teaching methods participants had used since their training, and reassess their teaching motivation and self-efficacy. Results: Between June 2016 and October 2019, 20 TTT courses were held across six German medical faculties. Data were gathered from 241 participants. After the course, 182 POST2 questionnaires were mailed, 61 of which were returned (equals a 39 % return rate). The findings revealed significant increases in teacher self-efficacy (p=0.0025), identified regulation (p=0.0000), and career motivation (p=0.0044). In contrast, there was a significant decrease in introjected regulation (p=0.0048). When comparing the participants to a reference sample selected from literature, significant differences emerged in intrinsic motivation (p=0.0000) and amotivation (p=0.0025). Conclusions: Course participants already showed strong intrinsic motivation and self-efficacy before taking the course. After completing it, their confidence to meet specific teaching demands based on their abilities had increased. Notably, changes in motivational dimensions identified and introjected regulation point towards a shift in motivational sources, indicating a more self-regulated approach towards participants' teaching activities. Further research is needed to determine how much of this change was due to course participation.

Impact of simulated patient-based communication training vs. real patient-based communication training on empathetic behaviour in undergraduate students - a prospective evaluation study.

BACKGROUND: Empathy is a key competency and is essential for doctor-patient relationships. Studies have proven a continuous reduction of empathy in medical students during their study period. The use of SPs is positively evaluated for competency acquisition and real patient communication training has positive effects on empathy empowerment. Therefore, the present study focusses on the impact of simulated patient (SP) vs real patient (RP) communication training on empathetic behaviour in undergraduate medical students. METHODS: The prospective evaluation took place during a 210-minute skills lab unit on medical communication for 3rd year medical students. Study participants were allocated in advance to one of three groups: one group trained with an SP (SP-group) and was informed about the fact that it was an SP; another group trained with an SP but assumed to encounter an RP (incognito patient group (IP-group)); the last group trained with an RP and was correctly informed about it (real patient group (RP-group). Self-assessed empathy was measured by using Jefferson Scale of Physician Empathy (JSPE) and Interpersonal Reactivity Index (IRI), as these are the most commonly used instruments for assessing empathy. Study participants were evaluated on empathetic behaviour by their group-associated patient using the Consultation and Relational Empathy (CARE) scale. RESULTS: 146 students participated. There was no significant difference in self-assessed empathy between groups for JSPE and IRI. External assessment via CARE showed a statistically significant difference between SP-group and IP-group , as well as between SP-group and RP-group. There was no significant difference between IP-group and RP-group. This means that students training with real patients (or who believed them to be real) did receive significantly lower performance ratings on their empathy. CONCLUSION: The results demonstrate a significant lower external empathy rating for students who had trained with a real patient or if they were in the belief of having encountered a real patient; this may be due to inhibitions and a lack of routine. Therefore, we recommend implementing SPs in the early study period with the gradual integration of RPs in the student's further course of study.

Evaluation of a 3D-printed hands-on radius fracture model during teaching courses.

OBJECTIVE: This study aimed to evaluate the effectiveness of a 3D-printed hands-on radius fracture model for teaching courses. The model was designed to enhance understanding and knowledge of radius fractures among medical students during their clinical training. METHODS: The 3D models of radius fractures were generated using CT scans and computer-aided design software. The models were then 3D printed using Fused-Filament-Fabrication (FFF) technology. A total of 170 undergraduate medical students participated in the study and were divided into three groups. Each group was assigned one of three learning aids: conventional X-ray, CT data, or a 3D-printed model. After learning about the fractures, students completed a questionnaire to assess their understanding of fracture mechanisms, ability to assign fractures to the AO classification, knowledge of surgical procedures, and perception of the teaching method as well as the influence of such courses on their interest in the specialty of trauma surgery. Additionally, students were tested on their ability to allocate postoperative X-ray images to the correct preoperative image or model and to classify them to the AO classification. RESULTS: The 3D models were well received by the students, who rated them as at least equal or better than traditional methods such as X-ray and CT scans. Students felt that the 3D models improved their understanding of fracture mechanisms and their ability to explain surgical procedures. The results of the allocation test showed that the combination of the 3D model and X-ray yielded the highest accuracy in classifying fractures according to the AO classification system, although the results were not statistically significant. CONCLUSION: The 3D-printed hands-on radius fracture model proved to be an effective teaching tool for enhancing students' understanding of fracture anatomy. The combination of 3D models with the traditional imaging methods improved students' ability to classify fractures and allocate postoperative images correctly.

The semiconstrained DRUJ prosthesis: blessing or curse?

PURPOSE: There are numerous operative procedures to treat osteoarthritic changes or a significant instability of the distal radioulnar joint (DRUJ). The key problem of most methods is the destabilization of the forearm leading to secondary painful impingement between the radius and ulna, as well as a significant limitation of forearm rotation. The Aptis-Prosthesis designed by Scheker represents a complete substitute for the DRUJ. It is mostly used after the failure of various treatment options to solve the primary problems (arthritis, instability). We have used this type of prosthesis mostly after multiple operative treatments for more than 25 years. METHODS: In the following retrospective study, we analyzed the data of patients that received an Aptis-prosthesis between 2016 and 2021. We have implanted this prosthesis in 13 cases (11 female, 2 male). Routinely, we document the clinical outcome concerning range of motion (ROM), grip strength, and pain according to numeric rate scaling (NRS) after more than 12 months (month 12-24). In addition, complications, osseous changes, and the rate of loosening of the prosthesis were registered. Furthermore, DASH-Score and patients ' satisfaction were evaluated. Also-as with other implants-follow-up x-rays were performed. RESULTS: Removal or significant revision of any of the prostheses was not needed. The ROM was 68.1° ± 19.7° for pronation and 72.3° ± 20.9° for supination, grip strength amounted to 27.7 kg ± 11.0 kg equaling 83% of the contralateral side. NRS was 0 at rest and 1.2 (0-2) under weight-bearing. A lysis margin of the radial tap was noted in the radiological examination in 2 patients but without any signs of loosening. The DASH-Score added up to 31.8 ± 13.8 (13-55). All patients were satisfied or very satisfied having this implant. CONCLUSION: The semiconstrained Aptis-prosthesis is a safe and efficient treatment option after failed DRUJ surgeries. It is striking that of the 20 implanted prostheses no significant revision or explantations were necessary over a period of 25 years.

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.

Various effects of 11,12 EET rescue wound healing in a combined model of diabetes and ischemia.

Chronic non healing wounds in diabetic patients still impose a major problem in modern medicine. Especially additional peripheral vascular disease complicates treatment success in these patients. Thus, we analyzed the effects of 11,12 epoxyeicosatrienoic acid (EET) in a combined model of hyperglycemia and ischemia in mice. Hyperglycemia was induced by Streptozotozin 2 weeks prior to wounding. 3 days before wound creation 2 of the 3 suppling vessels of the moue ear were cautherized for ischemia. Either 11,12 EET or solvent for control was applied. Wound closure as well as TNF-α, TGF-ß, SDF-1α, VEGF, CD31, and Ki67 were measured. The wounds closed on day 14.4 ± 0.4 standard deviation (SD). 11,12 EET treatment enhanced healing to 9.8 ± 0.6 SD. TNF-α level was augmented on day 9 compared to control and receded on day 18. TGF-ß seemed to be elevated all days observed after 11,12 EET treatment. SDF-1α was enhanced on day 6 and 9 by 11,12 EET, and VEGF on day 6 and 18 as well as CD13 on day 3, 6, and 18. 11,12 EET did not alter Ki67. 11,12 EET are able to rescue deteriorated wound healing in a combined model of hyperglycamia and ischemia by resolution of inflammation, augmentation of neovascularization and increasing expression of TGF-ß as well as SDF-1α.

[Case-based learning with practical exercises in the course hygiene and microbiology as a model for the implementation of the new medical licensing regulations]. / Ein fallbasiertes Unterrichtskonzept mit praktischen Übungen im Fach Hygiene und Mikrobiologie: ein nachhaltiges Unterrichtskonzept zur Umsetzung der neuen Approbationsordnung in klinisch-theoretischen Fächern.

BACKGROUND: Within the scope of an educational improvement project, the teaching concept of the course hygiene and microbiology at the Goethe-University in Frankfurt was transferred from an organ system-based teaching concept into a case-based teaching concept. Concomitantly, this transformation was qualitatively reviewed to evaluate self-perceived learning success. METHODS: 54 participants were included in this qualitative study. 45 students were interviewed in homogeneous focus groups of up to five. Nine physicians were interviewed individually. Following anonymization and transcription, a structured and qualitative text analysis was conducted. RESULTS: Both groups, students and physicians, prefer a case-based teaching concept in hygiene and microbiology, especially in combination with a hands-on approach to learn practical skills. Students taught with the case-based approach were more satisfied and reported better knowledge retention. The practical elements of the course hygiene and microbiology were positively remembered by all participants. Regardless of the teaching concept, the individual lecturer is considered most essential in shaping motivation. CONCLUSIONS: Overall, the implementation of a case-based teaching concept with practical elements in the course hygiene and microbiology increases the ability of medical students to understand the relevance of core knowledge and improves self-perceived learning. The fusion of theoretical and clinical contents elements in the course hygiene and microbiology meets the new national medical licensing regulations in Germany and promises to be a sustainable concept for clinical-theoretical subjects like hygiene and microbiology.

[Costs-revenue deficit of outpatient treatment of minor injuries in the emergency department]. / Kosten-Erlös-Defizit der ambulanten Versorgung von Bagatellverletzungen in der Notaufnahme.

BACKGROUND: Many patients with minor injuries hastily present in the emergency department and tie up resources and personnel there. OBJECTIVE: To establish the cost-revenue relationship of outpatient care of minor injuries in the traumatology emergency department. MATERIAL AND METHODS: The calculation was based on the uniformly billed emergency flat rates of the uniform assessment standard (EBM). Using the current collective bargaining agreements for physicians and nurses, per minute costs were calculated. The time required for treatment was determined on the basis of 100 reference patients with minor injuries. The case cost calculation with the respective resources was carried out with the operational controlling of the University Hospital Frankfurt. RESULTS: A total of 4088 patients with minor injuries who presented in 2019 were included. Most common reasons for presentation were contusions of the lower (31.9%; n = 1303) and upper extremities (16.6%; n = 677). A time expenditure of 166.7 min per day for the medical staff and 213.8 min per day for nursing staff was calculated. A total revenue of 29,384.31 € and total costs of 69,591.22 € were calculated. Thus, a revenue deficit of -40,206.91 € can be calculated for the year 2019. This corresponds to a monetary deficit of 9.84 € per patient. CONCLUSION: There is a shortage of the medical resource "personnel" to satisfactorily and economically manage the nowadays high volume of self-presenting pedestrian patients with minor injuries. The current remuneration of the treatment of minor injuries by the uniform assessment scale is insufficient for the hospital sector.

Implementation and evaluation of a Tele-OSCE in oral and maxillofacial surgery - a pilot report.

Background: The ongoing changes in learning and education towards digitalisation have been rapidly accelerated by the COVID-19 pandemic. Especially in dental education where contact to the oral cavity is an integral part of training the chosen digital examination methods and training formats must undergo high requirements to full fill the goal of a real alternative to face-to-face exams. Therefore, this study compared student performance in a newly developed Tele-OSCE with a prior OSCE examinations in presence within an oral- and maxillofacial surgery curriculum. Methods: Study participants were fourth-year (in a five year curriculum) dental students and board certified maxillofacial surgeons (examiners) that took part in a newly developed Tele-OSCE that comprised three five-minute stations (structured facial examination, management mandibular fracture and squamous cell carcinoma) using the zoom® software. Student performance was measured using validated OSCE-Checklists and compared to a previous OSCE examination from the winter term 2019 with the same OSCE stations that was conducted in presence. Significant differences were tested using the Mann-Whitney U test. Furthermore, the new Tele-OSCE was evaluated by students and examiners using previously developed questionnaires. Results: Sixty-six dental students (study group: n=34, summer term 2021, control group: n=32 winter term 2019) and nine examiners participated in the study. Compared to previous non-pandemic OSCEs, there were no significant (p=0.53) differences in overall student performance. Evaluation of the Tele-OSCE showed that the demonstration and rating of practical skills was limited due to missing standard patients or phantoms, however, students did not fear to be misjudged. The demonstration and rating of anamnestic and consultation competencies was seen as unproblematic by students and examiners. Discussion: This pilot-study showed the feasibility of a Tele-OSCE as a formative examination in dental education. However, both students and examiners felt that the demonstration and assessment of practical skills was limited due the new examination format. Nevertheless, Tele-OSCEs might offer an alternative to enable students to complete their dental training.

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.

Empathy, personality traits, and emotional management in 2nd and 4th-year dentistry students: a single-center study.

BACKGROUND: Patients fearing dental interventions are at risk of delaying or skipping much-needed treatments. Empathic communication could lead to a higher rate of compliance from patients within this group. Empathy, the big five personality traits, and emotion management abilities are all known to influence the quality of communication between dentists and patients. This study was conducted to analyze whether there is a correlation between these factors in dentistry students. METHODS: Dentistry students in their 2nd and 4th year of study were asked to complete questionnaires assessing empathy, emotion management, and personality traits. Out of a total of 148 eligible participants, 53 students (34%) volunteered to participate. For empathy, the Jefferson Scale of Physician Empathy (students' version; JSPE-S) and the Interpersonal Reactivity Index (IRI) were used. Personality traits were assessed using the Short Big Five Inventory (BFI-s), and the Situational Test of Emotional Management (STEM) to measure emotional management ability. RESULTS: Higher scores for emotion management were significantly correlated with the female gender (p ≤ 0.005) and with higher scores in openness (p ≤ 0.05). Students with higher scores in openness also achieved higher scores on the IRI subscales: Perspective taking (p ≤ 0.05), Fantasy (p ≤ 0.01), Empathic concern (p ≤ 0.05), and Personal distress (p ≤ 0.05). For JSPE-S, no correlation with emotion management and personality traits was found. CONCLUSION: Empathy and emotion management might not be significantly related in dentistry students. Regarding personality traits, students who scored higher on openness also indicated higher abilities in emotion management. These findings should be taken into consideration when planning communication courses for dentistry students, as it might be possible to independently train empathy and emotion management as part of emotional intelligence.

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.

[Online Teaching in Surgery]. / Online-Lehre in der Chirurgie.

For quite some time, the development and implementation of online teaching has been a controversial issue in surgical education for the degree in medicine. This has become more important with the progression of digitalisation and not least as a result of the current pandemic. It is becoming increasingly urgent to establish the opportunities and limits of online teaching, which has already proved successful under the current developmental pressure, and there are promising concepts. This article addresses the framework and the various online teaching formats in surgery, and illustrates the interplay between technical feasibility, practical experience, and didactic objectives.

11,12 Epoxyeicosatrienoic Acid Rescues Deteriorated Wound Healing in Diabetes.

Epoxyeicosatrienoic acids (EET) facilitate regeneration in different tissues, and their benefit in dermal wound healing has been proven under normal conditions. In this study, we investigated the effect of 11,12 EET on dermal wound healing in diabetes. We induced diabetes by i.p. injection of streptozotocin 2 weeks prior to wound creation on the dorsal side of the mouse ear. 11,12 EET was applied every second day on the wound, whereas the control groups received only solvent. Epithelialization was monitored every second day intravitally up to wound closure. Wounds were stained for VEGF, CD31, TGF-ß, TNF-α, SDF-1α, NF-κB, and Ki-67, and fibroblasts were counted after hematoxylin-eosin stain on days 3, 6, 9, and 16 after wounding. After induction of diabetes, wounds closed on day 13.00 ± 2.20 standard deviation (SD). Local 11,12 ETT application improved wound closure significantly to day 8.40 ± 1.39 SD. EET treatment enhanced VEGF and CD31 expression in wounds on day 3. It also seemed to raise TNF-α level on all days investigated as well as TGF-ß level on days 3 and 6. A decrease in NF-κB could be observed on days 9 and 16 after EET application. The latter findings were not significant. SDF-1α expression was not influenced by EET application, and Ki-67 was significantly less in the EET group on day 9 after EET application. The number of fibroblasts was significantly increased on day 9 after the 11,12 EET application. 11,12 EET improve deteriorated wound healing in diabetes by enhancing neoangiogenesis, especially in the early phase of wound healing. Furthermore, they contribute to the dissolution of the initial inflammatory reaction, allowing the crucial transition from the inflammatory to proliferative phase in wound healing.

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.

Comparison of 'Mental training' and physical practice in the mediation of a structured facial examination: a quasi randomized, blinded and controlled study.

BACKGROUND: The correct performance of a structured facial examination presents a fundamental clinical skill to detect facial pathologies. However, many students are not adequately prepared in this basic clinical skill. Many argue that the traditional 'See One, Do One' approach is not sufficient to fully master a clinical skill. 'Mental Training' has successfully been used to train psychomotor and technical skills in sports and other surgical fields, but its use in Oral and Maxillofacial Surgery is not described. We conducted a quasi-experimental to determine if 'Mental Training' was effective in teaching a structured facial examination. METHODS: Sixty-seven students were randomly assigned to a 'Mental Training' and 'See One, Do One' group. Both groups received standardized video instruction on how to perform a structured facial examination. The 'See One, Do One' group then received 60 min of guided physical practice while the 'Mental Training' group actively developed a detailed, stepwise sequence of the performance of a structured facial examination and visualized this sequence subvocally before practicing the skill. Student performance was measured shortly after (T1) and five to 10 weeks (T2) after the training by two blinded examiners (E1 and E2) using a validated checklist. RESULTS: Groups did not differ in gender, age or in experience. The 'Mental Training' group averaged significantly more points in T1 (pE1 = 0.00012; pE2 = 0.004; dE1 = 0.86; dE2 = 0.66) and T2 (pE1 = 0.04; pE2 = 0.008, dE1 = 0.37; dE2 = 0.64) than the 'See One, Do One' group. The intragroup comparison showed a significant (pE1 = 0.0002; pE2 = 0.06, dE1 = 1.07; dE2 = 0.50) increase in clinical examination skills in the 'See One, Do One' group, while the 'Mental Training' group maintained an already high level of clinical examination skills between T1 and T2. DISCUSSION: 'Mental Training' is an efficient tool to teach and maintain basic clinical skills. In this study 'Mental Training' was shown to be superior to the commonly used 'See One, Do One' approach in learning how to perform a structured facial examination and should therefore be considered more often to teach physical examination skills.

[Inpatient treatment costs, cost-driving factors and potential reimbursement problems due to epileptic seizure-related injuries and fractures]. / Stationäre Versorgungskosten, kostenverursachende Faktoren und potenzielle Vergütungsprobleme bei Verletzungen und Frakturen im Rahmen epileptischer Anfälle.

BACKGROUND: The systematic analysis of disease-specific costs is becoming increasingly more relevant in an economically oriented healthcare system. Chronic diseases are of particular interest due to the long duration as well as frequent hospitalization and physician visits. Epilepsy is a frequent neurological disorder affecting all age groups with the clinical hallmark of paroxysmal epileptic seizures, which are often associated with injuries. OBJECTIVE: The aim of this work was to process the inpatient treatment costs due to seizure-related injuries and fractures. Moreover, relevant cost-causing factors were addressed. Using an alternative calculation of the costs of care, the question of potential reimbursement problems in the current German diagnosis-related groups (G-DRG) system was additionally assessed. METHODS: For this monocentric retrospective analysis the actual proceeds of 62 inpatients who were treated at the University Hospital Frankfurt between January 2010 and January 2018 for injuries and fractures due to epileptic seizures were used. The analysis of potential cost-causing factors was carried out with respect to relevant sociodemographic and clinical aspects. The alternative calculation of the costs of treatment was carried out using established health economic methods. RESULTS: The average DRG revenue was 7408€ (±8993€, median 5086€, range 563-44,519€), the average calculated costs were 9423€ (±11,113€, 5626€, range 587-49,830€). A length of stay ≥7 days (p = 0.014) was identified as a significant cost-driving factor. Due to the significant difference (p < 0.001) between revenue and calculated costs, an analysis was made according to factors for potential reimbursement problems, which remained significant for a length of stay of ≥7 days (p = 0.014) and for treatment in the intensive care unit (p = 0.019). CONCLUSION: The inpatient treatment costs for patients with injuries and fractures due to epileptic seizures are high and therefore relevant from a health economic perspective. In general, reimbursement according to the G­DRG appears to cover the actual costs, but there may be reimbursement problems for patients with a long period of hospitalization or a stay in an intensive care ward.