Evaluation of a new approach to implement structured, evidence-based emergency medical care in undergraduate medical education in Germany.

Since June 2002, revised regulations in Germany allow medical faculties to implement new curricular concepts. The medical faculty of the Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Germany, decided to start a major reform experiment in winter 2003, focussing on an interdisciplinary integration of organs and organ systems such as the cardiovascular or respiratory system. Furthermore, students will have contact with patients at an early stage of their studies. Thus, re-organisation of course contents should lead to a chance to improve practical experience. With the public having the right to expect that physicians and all physicians in training possess a basic knowledge of emergency medical care and the necessary skills to manage acute problems, it was decided to start the first year of the Medical Reform Curriculum Aachen with 3 weeks interdisciplinary introduction into emergency medical care. The task consisted of defining interdisciplinary core objectives and the need to implement teaching and learning principles necessary for further education. Due to this, the content of this course should have practical relevance for the students concerning their practical experiences in the future. The result is an introductory course in emergency medical care in the first semester, coordinated with the lectures. Besides skill training on basics of emergency medical care (basic life support (BLS), early defibrillation), practical training in other lifesaving techniques (e.g., immobilisation skills) and basic principles of daily clinical care are included. In addition, personal safety and a standard algorithm for assessing the patient are covered by problem-based learning sessions. The course evaluation data clearly showed acceptance of the new approach and enhances possibilities of extending implementation of relevant topics concerning emergency medical care within the Medical Reform Curriculum Aachen.

Use of an Amplatzer ductal occluder to close a persistent left superior caval vein which reopened after a total cavopulmonary anastomosis.

A 7-year-old boy developed increasing cyanosis after a total cavopulmonary connection with a 3 mm fenestration in the baffle. Catheterisation performed 4 years and 7 months after the operation showed reopening of a left superior caval vein draining into the pulmonary venous atrium. Due to the large size of the left superior caval vein, and the absence of intrinsic stenosis, we chose to use an Amplatzer ductal device to occlude the reopened vein. The procedure was safe and successful.