Effects of the "ICU Support" team meeting concept on patient-centered and staff-centered outcomes: study protocol for a randomized controlled multicenter study.

BACKGROUND: Providing optimal care for critically ill patients is an extremely important but also highly demanding task, both emotionally and physically. The "ICU Support" team meeting concept aims to support intensive care unit (ICU) teams by promoting interprofessional communication, peer support, and patient safety by providing a structure for daily team meetings. This protocol describes a study to explore the effectiveness of "ICU Support" for patient- and staff-centered outcomes. METHODS: ICU Support will be implemented at nine university hospitals located in Germany, following a two-arm randomized parallel group design with an intervention and a control condition and three data collection periods. In the intervention arm, leading ICU personnel (physicians and nurses) will be trained in ICU Support and implement the ICU Support elements into the daily work routine of their units upon completion of data collection period T0 (baseline). In the control arm, ICU Support will not be implemented until the completion of the data collection period T1 (1 month after study start). Until then, the regular daily schedule of the ICU teams will be maintained. The final data collection period (T2) will take place 4 months after the start of the study. Primary outcomes include the number of intensive care complications per patient during their ICU stay during T1 and the sick-related absence of ICU staff during T1. Secondary outcomes include, among others, the average severity of intensive care complications per patient and employee self-reported data regarding their teamwork and patient safety behaviors. DISCUSSION: The need for healthy and well-trained ICU staff is omnipresent; thus, structured and evidence-based interventions aimed at supporting ICU teams and facilitating patient safety are required. This multicenter study aims to explore the effectiveness of ICU Support for patient- and staff-centered outcomes. The insights derived from this study have the potential to significantly improve ICU patient safety, staff communication, and connectedness and decrease sickness-related expenses and social costs associated with high work demands among ICU staff. TRIAL REGISTRATION: German Clinical Trials Register DRKS00028642 . Registered on 4 April 2022.

An integrative review on the acceptance of artificial intelligence among healthcare professionals in hospitals.

Artificial intelligence (AI) in the domain of healthcare is increasing in prominence. Acceptance is an indispensable prerequisite for the widespread implementation of AI. The aim of this integrative review is to explore barriers and facilitators influencing healthcare professionals' acceptance of AI in the hospital setting. Forty-two articles met the inclusion criteria for this review. Pertinent elements to the study such as the type of AI, factors influencing acceptance, and the participants' profession were extracted from the included studies, and the studies were appraised for their quality. The data extraction and results were presented according to the Unified Theory of Acceptance and Use of Technology (UTAUT) model. The included studies revealed a variety of facilitating and hindering factors for AI acceptance in the hospital setting. Clinical decision support systems (CDSS) were the AI form included in most studies (n = 21). Heterogeneous results with regard to the perceptions of the effects of AI on error occurrence, alert sensitivity and timely resources were reported. In contrast, fear of a loss of (professional) autonomy and difficulties in integrating AI into clinical workflows were unanimously reported to be hindering factors. On the other hand, training for the use of AI facilitated acceptance. Heterogeneous results may be explained by differences in the application and functioning of the different AI systems as well as inter-professional and interdisciplinary disparities. To conclude, in order to facilitate acceptance of AI among healthcare professionals it is advisable to integrate end-users in the early stages of AI development as well as to offer needs-adjusted training for the use of AI in healthcare and providing adequate infrastructure.

Reflective practice improves Basic Life Support training outcomes: A randomized controlled study.

INTRODUCTION: Practical skills training is an essential part of medical education. An important example is the training of Basic Life Support (BLS) skills, which are key to improve patient outcomes in life-threatening situations. However, despite practical training, BLS performance is often sub-optimal even among healthcare professionals and medical students. Finding more effective training methods is therefore of high importance. A promising method to enhance learning outcomes is reflective practice. The goal of the present study was to evaluate whether a short reflective practice intervention following standard BLS training (Peyton's 4-step approach) improves BLS training outcomes, reflected in higher BLS performance and higher self-confidence to perform BLS. METHOD: 287 first-year medical students were randomly assigned to one of two BLS training conditions: 1) standard BLS training (ST), 2) ST followed by a 15-minute reflective practice exercise. Outcome parameters included objective BLS performance data assessed by a resuscitation manikin, and students' self-reported confidence in their BLS skills. Outcomes were assessed directly after the training (T0) and re-assessed one week later (T1). A two-way mixed model analysis of variance (ANOVA) was conducted to examine the effect of the intervention on BLS performance and self-reported confidence. Significance was determined by two-sided 95% confidence intervals. RESULTS: The intervention group performed significantly more effective compressions at T1 and began significantly faster with performing their first chest compression at T0 and T1, in comparison to the control group. No significant differences between study groups regarding their self-reported confidence to perform BLS were observed. CONCLUSION: This research shows that standard BLS training accompanied with a simple, cost-effective reflective practice exercise can improve learners' BLS skill acquisition and retention. This shows that reflective practice has the potential to enhance practical skills training in medicine; yet, more empirical studies are needed to examine its broader applicability.

Telemedicine in medical education: An example of a digital preparatory course for the clinical traineeship - a pre-post comparison.

Introduction: Telemedicine is a significant component of healthcare in most disciplines, giving great importance to the education of young physicians in this field. However, the topic of telemedicine has not yet been implemented in medical schools' curricula. This paper makes an important contribution to closing this gap by designing, implementing and evaluating a course with telemedical components. Using the example of a clinical traineeship preparation course, we investigated the extent to which integrated telemedical modules can contribute to the subjective confidence of students with regard to knowledge and confidence in performing practical telemedical skills, such as doctor-patient communication, taking medical histories, and applying handover techniques. Project description: The course evaluation was descriptive. Subjective confidence in clinical telemedicine skills was assessed before and after completion of the course using an online questionnaire and calculated in a pre-post design using Wilcoxon's signed-rank test. Results: The course was rated "very good" (31%) and "good" (54.2%) by the vast majority of students. The results of the Wilcoxon test show significant increases in students' feelings of confidence in performing practical telemedicine skills for all items. Discussion: This study shows that telemedicine modules integrated in a digital preparatory course contribute positively to students' subjective confidence in terms of knowledge and confidence in performing practical telemedicine skills. Specifically, this paper illustrates that professional digital doctor-patient communication, digital documentation of a medical history, and handoff techniques can be learned through telemedicine course content. Conclusion: Telemedicine modules increase students' subjective confidence in performing practical telemedicine skills. Practical telemedicine course content can thus reduce uncertainty in the use of telemedicine and prepare future physicians for its use.

Safety management in times of crisis: Lessons learned from a nationwide status-analysis on German intensive care units during the COVID-19 pandemic.

Background: The status of Safety Management is highly relevant to evaluate an organization's ability to deal with unexpected events or errors, especially in times of crisis. However, it remains unclear to what extent Safety Management was developed and sufficiently implemented within the healthcare system during the COVID-19 pandemic. Providing insights of potential for improvement is expected to be directional for ongoing Safety Management efforts, in times of crisis and beyond. Method: A nationwide survey study was conducted among healthcare professionals and auxiliary staff on German Intensive Care Units (ICUs) evaluating their experiences during the first wave of the COVID-19 pandemic. Error Management and Patient Safety Culture (PSC) measures served to operationalize Safety Management. Data were analyzed descriptively and by using quantitative content analysis (QCA). Results: Results for n = 588 participants from 53 hospitals show that there is a gap between errors occurred, reported, documented, and addressed. QCA revealed that low quality of safety culture (27.8%) was the most mentioned reason for errors not being addressed. Overall, ratings of PSC ranged from 26.7 to 57.9% positive response with Staffing being the worst and Teamwork Within Units being the best rated dimension. While assessments showed a similar pattern, medical staff rated PSC on ICUs more positively in comparison to nursing staff. Conclusion: The status-analysis of Safety Management in times of crisis revealed relevant potential for improvement. Human Factor plays a crucial role in the occurrence and the way errors are dealt with on ICUs, but systemic factors should not be underestimated. Further intensified efforts specifically in the fields of staffing and error reporting, documentation and communication are needed to improve Safety Management on ICUs. These findings might also be applicable across nations and sectors beyond the medical field.

At the limits of digital education. The importance of practical education for clinical competencies learning in the field of emergency medicine: A controlled non-randomized interventional study.

Introduction: A high-quality education of future physicians is essential. Modern approaches interlock the acquisition of theoretical knowledge and practical skills in a spiral curriculum, leading to a mutual learning benefit for knowledge and application. This model was challenged by the elimination of hands-on trainings during the pandemic, which were often replaced by purely digital teaching models. Given the holistic nature of the spiral curriculum, we assumed that a purely digital model would have an impact on knowledge acquisition due to missing hands-on learning opportunities. The aim of the study was to investigate, using an emergency seminar as an example, whether purely digital training leads to a difference in theoretical knowledge compared to the traditional model. Materials and methods: Study design: We used a two-groups design comparing a sample of medical students taught in 2020 with a purely digital teaching format (DF; n = 152) with a historical control group taught with a traditional format (TF; n = 1060). Subject of investigation was a seminar on emergency medicine, taking place in the 4th year. Outcome parameters: The primary outcome parameter was the students' acquired knowledge, measured by the score achieved in the final exams. Students' evaluation of the seminar was used as a secondary outcome parameter. Results: Students in the DF group scored significantly lower than students in the TF group in the final exams. Students in the DF group rated the course significantly worse than students in the TF group. Discussion: The study results illustrate that purely digital education leads to inferior knowledge acquisition compared to the traditional spiral curriculum. A possible explanation may lie in a deeper processing of the information (e.g., understanding the information by experience and analysis) and accordingly a better memory recall. Moreover, the students' critical appraisal of the DF may have had an unfavorable effect on learning performance. Moderating factors may be lower learning motivation or the "zoom fatigue" effect. Conclusion: These study results clearly illustrate the importance of hands-on teaching for knowledge acquisition. The interlocking of theoretical knowledge and practical skills, as ensured by the spiral curriculum, is essential.

Innovative Tele-Instruction Approach Impacts Basic Life Support Performance: A Non-inferiority Trial.

Background: Sustaining Basic Life Support (BLS) training during the COVID-19 pandemic bears substantial challenges. The limited availability of highly qualified instructors and tight economic conditions complicates the delivery of these life-saving trainings. Consequently, innovative and resource-efficient approaches are needed to minimize or eliminate contagion while maintaining high training standards and managing learner anxiety related to infection risk. Methods: In a non-inferiority trial 346 first-year medical, dentistry, and physiotherapy students underwent BLS training at AIXTRA-Competence Center for Training and Patient Safety at the University Hospital RWTH Aachen. Our objectives were (1) to examine whether peer feedback BLS training supported by tele-instructors matches the learning performance of standard instructor-guided BLS training for laypersons; and (2) to minimize infection risk during BLS training. Therefore, in a parallel group design, we compared arm (1) Standard Instructor Feedback (SIF) BLS training (Historical control group of 2019) with arm (2) a Tele-Instructor Supported Peer-Feedback (TPF) BLS training (Intervention group of 2020). Both study arms were based on Peyton's 4-step approach. Before and after each training session, objective data for BLS performance (compression depth and rate) were recorded using a resuscitation manikin. We also assessed overall BLS performance via standardized instructor evaluation and student self-reports of confidence via questionnaire. Non-inferiority margins for the outcome parameters and sample size calculation were based on previous studies with SIF. Two-sided 95% confidence intervals were employed to determine significance of non-inferiority. Results: The results confirmed non-inferiority of TPF to SIF for all tested outcome parameters. A follow-up after 2 weeks found no confirmed COVID-19 infections among the participants. Conclusion: Tele-instructor supported peer feedback is a powerful alternative to in-person instructor feedback on BLS skills during a pandemic, where infection risk needs to be minimized while maximizing the quality of BLS skill learning. Trial registration: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00025199, Trial ID: DRKS00025199.

Are the World Health Organization's Patient Safety Learning Objectives Still Up-to-Date: A Group Concept Mapping Study.

BACKGROUND: The World Health Organization (WHO) Patient Safety Curriculum Guide defines learning objectives for patient safety. Current implementation in healthcare education is insufficient. Possible explanations may be obsolescence and/or a shift in needs. We investigated whether overarching topics and specific learning objectives of the WHO Patient Safety Curriculum Guide are still up-to-date, their attributed importance, and their perceived difficulty to achieve. METHODS: Experts on patient safety and medical education from 3 European countries were asked to suggest learning objectives concerning patient safety using group concept mapping. Following 3 successive steps, experts rated ideas by importance and difficulty to achieve. Correlation analyses investigated the relationship between those. Overarching topics of the learning goals (clusters) were identified with multivariate analysis. RESULTS: A total of 119 statements about intended learning objectives on patient safety were generated, of which 86 remained for sorting and rating. Based on multivariate analyses, 10 overarching topics (clusters) emerged. Both the learning objectives and the overarching topics showed high correspondence with the WHO Patient Safety Curriculum Guide. Strong correlations emerged between importance and difficulty ratings for learning objectives and overarching topics. CONCLUSIONS: The WHO Patient Safety Curriculum Guide's learning goals are still relevant and up-to-date. Remarkably, learning objectives categorized as highly important are also perceived as difficult to achieve. In summary, the insufficient implementation in medical curricula cannot be attributed to the content of the learning goals. The future focus should be on how the WHO learning goals can be implemented in existing curricular courses.

[Medical students as helpers in the pandemic : Innovative concept for recruitment, training and assignment planning of medical students as medical personnel during the COVID-19 pandemic]. / Medizinstudierende als Helfende in der Pandemie : Innovatives Konzept zu Rekrutierung, Schulung und Einsatzplanung von Medizinstudierenden als medizinisches Personal während der COVID-19-Pandemie.

BACKGROUND: The COVID-19 pandemic posed enormous challenges to the German healthcare system and highlighted the need for strategies to recruit, train, and deploy medical personnel. Until now, no holistic concept existed to use medical students as support for professionals in intensive care units (ICU) to avoid staff shortages in medical care. METHOD: In a large-scale pilot project 265 medical students were trained for an ICU assignment. The innovative training module was accompanied by a pre-post questionnaire for self-assessment of the skills learned. 22 weeks after the training module and still during the pandemic deployment, another questionnaire was used to evaluate experiences in deployment and the efficiency of the training module with respect to preparation for ICU deployment. RESULTS: The analysis revealed significant mean differences for all COVID-19-specific variables (safety dimension) in favor of the training module (n = 168). The deployment evaluation showed that the training concept was inconsistently assessed as preparation for the work deployment for 69 of the 89 deployed students in total (53% agreement/47% disagreement). CONCLUSION: The results show a good feasibility of an innovative training concept for medical students with respect to a pandemic deployment as assistants in intensive care units. The concept is suitable for providing additional helpers in intensive care units during a pandemic; however, the inconsistent evaluation indicates that the concept can be expanded and needs to be adapted.

Video-Assisted Peer Teaching for Surgical Skills Training - Innovative Potential for the Medical Curriculum and Beyond: A Randomized Controlled Trial.

OBJECTIVE: Hygienic healthcare standards are essential for avoiding hospital infections. However, medical students and staff lack training in this field, which may be due to high personnel resources of present educational approaches. Thus, there is an urgent need for a novel and efficient approach. Aim of the study is to compare a newly developed video-assisted peer feedback (VAPF) method for teaching wound dressings to the traditional teaching method with qualified instructor feedback (QIF) with respect to essential learning outcomes. DESIGN, SETTING AND PARTICIPANTS: In this randomized controlled noninferiority trial, 251 medical undergraduates were randomly assigned to one of two interventions (QIF n = 127; VAPF n = 124). In QIF, participants received feedback from a qualified instructor. In VAPF, participants video-recorded each other while performing a wound dressing and gave each other feedback assisted by a standardized checklist. Outcome measures were participants' score in an objective structured practical examination (OSPE) and a written exam after the course. RESULTS: Noninferiority of VAPF (n = 123) compared to QIF (n = 127) was confirmed for both OSPE (QIF: 8.83 ± 1.30; VAPF: 8.88 ± 1.04; mean difference -0.04, 95% CI -0.34 to 0.25) and written exam (QIF: 8.99 ± 1.06; VAPF: 9.14 ± 1.05; mean difference -0.15, 95% CI -0.41 to 0.12). CONCLUSIONS: VAPF is a cost-efficient and viable alternative to QIF commonly used in medical education. It provides comparable training outcomes to the traditional training method with lower personnel investment. VAPF is a promising educational method for improving essential clinical competencies.

Virtual Reality Tour to Reduce Perioperative Anxiety in an Operating Setting Before Anesthesia: Randomized Clinical Trial.

BACKGROUND: Perioperative anxiety is a major burden to patients undergoing surgeries with general anesthesia. OBJECTIVE: This study investigated whether a virtual operating room tour (VORT) before surgery can be used to ameliorate perioperative anxiety. METHODS: We employed a randomized parallel-group design with 2 study arms to compare VORT to the standard operation preparation procedure. The study included 84 patients. A validated inventory (state-trait operation anxiety-state) was used to assess perioperative state anxiety before (T1) and after (T2) surgery. In addition, trait operation anxiety was evaluated with an additional validated inventory (state-trait operation anxiety-trait). Moreover, user ratings on the usefulness of VORT were assessed with an evaluation questionnaire. Study arms were compared for perioperative state anxiety with two-tailed independent samples t tests. Subjective ratings were correlated with STOA-Trait values to investigate possible associations between perioperative anxiety with perceived usefulness. RESULTS: There were no significant differences in perioperative state anxiety between VORT and standard operation preparation procedures before and after the surgery. Nonetheless, patients' ratings of VORT overall were positive. The tour was perceived as useful and, therefore, showed acceptance for VR use. These ratings were unrelated to the degree of perioperative anxiety. CONCLUSIONS: The subjective benefit of VORT could not be explained by a reduction of perioperative anxiety. Instead, VORT appears to serve the need for information and reduce uncertainty. In addition, VORT is perceived as beneficial regardless of the age of the patients. Considering this effect and the manageable organizational and financial effort toward implementation, the general use of VORT can be recommended. TRIAL REGISTRATION: ClinicalTrials.gov NCT04579354; https://clinicaltrials.gov/ct2/show/NCT04579354.

Peer video feedback builds basic life support skills: A randomized controlled non-inferiority trial.

INTRODUCTION: Training Basic Life Support saves lives. However, current BLS training approaches are time-consuming and costly. Alternative cost-efficient and effective training methods are highly needed. The present study evaluated whether a video-feedback supported peer-guided Basic Life Support training approach achieves similar practical performance as a standard instructor-guided training in laypersons. METHODS: In a randomized controlled non-inferiority trial, 288 first-year medical students were randomized to two study arms with different Basic Life Support training methods: 1) Standard Instructor Feedback (SIF) or 2) a Peer Video Feedback (PVF). Outcome parameters were objective data for Basic Life Support performance (compression depth and rate) from a resuscitation manikin with recording software as well as overall Basic Life Support performance and subjective confidence. Non-inferiority margins (Δ) for these outcome parameters and sample size calculation were based on previous studies with Standard Instructor Feedback. Two-sided 95% confidence intervals were employed to determine significance of non-inferiority. RESULTS: Results confirmed non-inferiority of Peer Video Feedback to Standard Instructor Feedback for compression depth (proportion difference PVF-SIF = 2.9%; 95% CI: -8.2% to 14.1%; Δ = -19%), overall Basic Life Support performance (proportion difference PVF-SIF = 6.7%; 95% CI: 0.0% to 14.3%; Δ = -27%) and subjective confidence for CPR performance (proportion difference PVF-SIF = -0.01; 95% CI: -0.18-0.17; Δ = -0.5) and emergency situations (proportion difference PVF-SIF = -0.02; 95% CI: -0.21-0.18; Δ = -0.5). Results for compression rate were inconclusive. DISCUSSION: Peer Video Feedback achieves comparable results as standard instructor-based training methods. It is an easy-to-apply and cost-efficient alternative to standard Basic Life Support training methods. To improve performance with respect to compression rate, additional implementation of a metronome is recommended.

Do Digital Handover Checklists Influence the Clinical Outcome Parameters of Intensive Care Unit Patients? A Randomized Controlled Pilot Study.

Background: Clinical handovers have been identified as high-risk situations for medical treatment errors. It has been shown that handover checklists lead to a reduced rate of medical errors and mortality. However, the influence of handover checklists on essential patient outcomes such as prevalence of sepsis, mortality, and length of hospitalization has not yet been investigated in a randomized controlled trial (RCT). Objectives: The aim of the present pilot study was to estimate the effect of two different handover checklists on the 48 h sepsis-related organ failure assessment (SOFA) score and the feasibility of a respective clinical RCT. Methods: Outcome parameters and feasibility were investigated implementing and comparing an intervention with a control checklist. Design: Single center two-armed cluster randomized prospective crossover pilot study. Setting: The study took place over three 1-month periods in an intensive care unit (ICU) setting at the University Hospital Aachen. Patients/Participants: Data from 1,882 patients on seven ICU wards were assessed, of which 1,038 were included in the analysis. Intervention: A digital standardized handover checklist (ISBAR3) was compared to a control checklist (VICUR). Main Outcome Measures: Primary outcome was the 2nd 24 h time window sepsis-related organ failure assessment (SOFA) score. Secondary outcomes were SOFA scores on the 3rd and 5th 24 h time window, mortality, reuptake, and length of stay; handover duration, degree of satisfaction, and compliance as feasibility-related outcomes. Results: Different sepsis scores were observed only for the 1st 24 h time window after admission to the ICU, with higher values for ISBAR3. With respect to the patient-centered outcomes, both checklists achieved similar results. Average handover duration was shorter for VICUR, whereas satisfaction and compliance were higher for ISBAR3. However, overall compliance was low (25.4% for ISBAR3 and 15.8% for VICUR). Conclusions: Based on the results, a stratified randomization procedure is recommended for following RCTs, in which medical treatment errors should also be investigated as an additional variable. The use of control checklists is discouraged due to lower acceptance and compliance among healthcare practitioners. Measures should be undertaken to increase compliance with the use of checklists. Clinical outcome parameters should be carefully selected. Trial Registration: ClinicalTrials.gov, Identifier [NCT03117088]. Registered April 14, 2017.

Demonstrating equivalence and non-inferiority of medical education concepts.

CONTEXT: In medical education, there are often several didactic methods for teaching and learning a specific medical skill. For educators, there are often pragmatic reasons to decide for one or another of them, such as costs, infrastructural requirements, time expenditure or qualification of the teacher. However, a central aspect to consider is the learning outcome: Does a new method achieve a similar learning success as an established standard method? To answer this question, we need an appropriate method to assess comparability of learning outcomes. METHODS: In this paper, we present two essential statistical concepts that can address the issue of comparability of learning outcomes: Equivalence and non-inferiority testing. We explain the ideas behind these concepts and illustrate them with an example data set. To clarify several concepts, we use theoretical examples from one selected field: the teaching and assessment of Basic Life Support (BLS). CONCLUSIONS: Equivalence and non-inferiority tests can be powerful tools for comparing teaching and assessment methods. However, their correct application requires adequate knowledge about their strengths, pitfalls and application fields. The aim of this paper is to deliver this knowledge and to provide clinician researchers with a practical guidance to a successful application of these methods.

Going the extra mile - cross-border patient handover in a European border region: qualitative study of healthcare professionals' perspectives.

BACKGROUND: Cross-border healthcare is complex, increasingly frequent and causes potential risks for patient safety. In this context, cross-border handovers or the transfer of patients from one country to another deserves particular attention. Although general handover has been the topic of extensive research, little is known about the challenges of handover across national borders, especially as perceived by stakeholders. In this study, we aimed to gain insight into healthcare professionals' perspectives on cross-border handover and ways to support this. METHODS: We conducted semistructured interviews with healthcare professionals (physicians, nurses, paramedics and administrative staff) in a European border region to investigate their perspectives on cross-border handover. The interviews were aimed to investigate settings of acute and planned handover. Informed by the theory of planned behaviour (TPB), interviews focused on participant perspectives. We summarised all interviews and inductively identified healthcare professionals' perspectives. We used elements of the TPB as sensitising concepts. RESULTS: Forty-three healthcare professionals participated. Although respondents had neutral to positive attitudes, they often did not know very well what was expected of them or what influence they could have on improving cross-border handover. Challenges covered five themes: information transfer, language barriers, task division and education, policy and financial structures and cultural differences. To overcome these challenges, we proposed strategies such as providing tools and protocols, discussing and formalising collaboration, and organising opportunities to meet and get to know each other. CONCLUSION: Healthcare professionals involved in cross-border handovers face specific challenges. It is necessary to take measures to come to a shared understanding while paying special attention to the above-mentioned challenges. Meeting in person around meaningful activities (eg, training and case discussions) can facilitate sharing ideas and community building.

The role of a checklist for assessing the quality of basic life support performance: an observational cohort study.

BACKGROUND: Training lay rescuers in Basic Life Support (BLS) is essential to improve bystander cardiopulmonary resuscitation (CPR) rates; in addition, simple methods are needed to provide feedback on CPR performance. This study evaluated whether a simple observational checklist can be used by BLS instructors to adequately measure the quality of BLS performance as an alternative to other feedback devices. METHODS: The BLS performances of 152 first-year medical students (aged 21.4 ± 3.9 years) were recorded on video, and objective data regarding the quality of the BLS were documented using Laerdal PC SkillReporting software. The performances were categorized according to quality. Ten BLS instructors observed the videos and completed a ten-point checklist based on the Cardiff Test of BLS (version 3.1) to assess the performances. The validity of the checklist was reviewed using interrater reliability as well as by comparing the checklist-based results with objective performance data. RESULTS: Matching the checklist-based evaluation with the objective performance data revealed high levels of agreement for very good (82%) and overall insufficient (75%) performances. Regarding the checklist-based evaluation, interrater reliability depended on the checklist item; thus, some items were more easily identified correctly than others. The highest and lowest levels of agreement were observed for the items "undressed torso" and "complete release between compressions" (mean joint-probability 95 and 67%, respectively). CONCLUSIONS: The observational checklist adequately distinguished sufficient from insufficient BLS performances and offered an assessment of items not incorporated by SkillReporting software such as the initial assessment or undressing the chest. Although its usefulness was reduced for scaling intermediate performance groups, the checklist may be overall a useful rating tool in BLS-training if objective feedback devices are not available, for example, due to large groups of participants or limited training time.

Handover training for medical students: a controlled educational trial of a pilot curriculum in Germany.

OBJECTIVE: The aim of this study was to implement and evaluate a newly developed standardised handover curriculum for medical students. We sought to assess its effect on students' awareness, confidence and knowledge regarding handover. DESIGN: A controlled educational research study. SETTING: The pilot handover training curriculum was integrated into a curriculum led by the Departments of Anesthesiology and Intensive Care (AI) at the University Hospital. It consisted of three modules integrated into a 4-week course of AI. Multiple types of handover settings namely end-of-shift, operating room/postanaesthesia recovery unit, intensive care unit, telephone and discharge were addressed. PARTICIPANTS: A total of n=147 fourth-year medical students participated in this study, who received either the current standard existing curriculum (no teaching of handover, n=78) or the curriculum that incorporated the pilot handover training (n=69). OUTCOME MEASURES: Paper-based questionnaires regarding attitude, confidence and knowledge towards handover and patient safety were used for pre-assessment and post-assessment. RESULTS: Students showed a significant increase in knowledge (p<0.01) and self-confidence for the use of standardised handover tools (p<0.01) as well as accurate handover performance (p<0.01) among the pilot group. CONCLUSION: We implemented and evaluated a pilot curriculum for undergraduate handover training. Students displayed a significant increase in knowledge and self-confidence for the use of standardised handover tools and accuracy in handover performance. Further studies should evaluate whether the observed effect is sustained across time and is associated with patient benefit.

[Patient handoffs in undergraduate medical education: A systematic analysis of training needs]. / Patientenübergaben in der Ausbildung? Eine systematische Analyse des Trainingsbedarfs unter Medizinstudierenden.

BACKGROUND: Insufficient handoffs lead to an increase in the risk of complications and malpractice, treatment delays, prolonged hospital stays, costs and patient complaints. The German Society for Anesthesiology and Intensive Care (DGAI) and the European Resuscitation Council (ERC) recommend the implementation of a communication procedure according to the SBAR concept. So far, there have been few curricular requirements in Germany regarding handoffs. METHODS: As part of the EU-funded PATIENT project an online-based cross-sectional needs analysis was conducted in three countries. In Aachen, 237 medical students answered 45 items concerning handoffs in three sections: A: skills (relevance and self-assessment), B: clinical experience (agreement), C: curricula content (presence and relevance). Data was recorded using a Likert scale (0-7). RESULTS: The students rated an adequate handoff performance as highly important (M=6.8; SD: ±0.6) and their own expertise as low (M=4.0; SD: ±1.3). A high training need was identified for writing discharge letters and performing accurate handoffs. The students were aware of the link between adequate handoffs and patient safety (M=6.5; SD: ±0.9). They considered standardized handoff procedures as an important curricular component (M=6.1; SD: ±1.1). From their point of view, the handling of medical errors is underrepresented in the curriculum (61.7 %). CONCLUSION: A need for handoff training was revealed, especially regarding transfers and discharges. Accordingly, learning objectives were determined and training modules developed and integrated into the curriculum in Aachen.