[Teaching in orthopaedic and trauma surgery]. / Lehre in Orthopädie und Unfallchirurgie.

The scramble for available places to study medicine in Germany continues. One of the core points within the "Master Plan 2020", which has been recently adopted, is the reform of teaching concepts at German medical faculties. In the future, students of human medicine are to be trained primarily based upon competence-oriented, integrated curricula. The present paper is intended to present modern teaching concepts and methods, as well as current examination formats, which play a special role in student training in orthopaedics and traumatology. Knowledge in the field of medical and evidence-based treatment strategies, clinical examination techniques, diagnostic/therapeutic procedures and hygienic working conditions are especially important. Individual courses with a focus on research-, practice- and competence-orientation are intended to help the students grasp the depth of the subject.

[Teaching in Perspective - How Medical Students Assess Their Practical Clinical Training in Surgery]. / Lehre im Fokus ­ Wie beurteilen Studierende ihre praktisch-klinische Ausbildung in der Chirurgie?

Introduction: Practical clinical expertise is a crucial part of medical professionalism. Several studies have shown that medical students are poorly trained in practical skills during their undergraduate training. Even the students rated their own expertise in practical skills as poor. The amendments to the German Regulating Licenses in Practical Medicine are intended to strengthen practical clinical training. The aim of the present study is to use focus groups to analyse practical clinical training with respect to organisation, difficulties and problems from the learners' perspective. Methods: The present qualitative study uses the focus group approach. Each focus group was composed of a maximum of 6 students per group with the same level of training. Using a standardised interview manual, a total of 31 students and four first-year residents participated in the study. Data interpretation was performed using structured qualitative content analysis. Results: The present work demonstrates that students of all levels of training greatly value their training in practical clinical expertise, especially in clinical skills. Due to the lack of defined learning objectives for practical skills, students training in clinical internships and medical registrar positions are highly dependent on the motivation and interest of the individual clinical teacher and the learner himself. Students struggle to estimate their actual level of expertise due to the lack of defined learning objectives. This is exacerbated by the fact that students rarely receive feedback about their expertise. Students complain that many teachers do not know the level of training required of their students. Conclusion: The definition of basic and specific learning objectives and the communication of this between learners and teachers is an essential part of practical clinical training.

[Interpersonal competence in orthopedics and traumatology : Why technical and procedural skills alone are not sufficient]. / Interpersonelle Kompetenz in Orthopädie und Unfallchirurgie : Warum technische und prozedurale Fähigkeiten alleine nicht ausreichen.

Patient safety has increasingly gained significance as criterion which clinics and doctors will be measured against in terms of ethics and finances. The "human factor" moved into focus regarding the question of how to reduce treatment errors in clinical daily routine. Nevertheless, systematic mediation of interpersonal competences only plays a minor role in the catalogue of requirements for medical specialization and professional training. This is the case not only in orthopedics and traumatology, but in other medical fields as well. At the insistence of DGOU and in cooperation with Lufthansa Flight Training, a training model was initiated, comparable to training models used in aviation. In aviation, apart from the training of procedural and technical abilities, regular soft skills training has become standard in the training of all Lufthansa staff. Several studies confirm that by improving communication, interaction, and teamwork skills not only a reduction of intolerable incidents is observed, but also a positive economic effect. Interpersonal competences should be firmly anchored in orthopedics and traumatology and thus be implemented as third post in specialist training.

[TEAM®-G (Trauma Evaluation and Management Germany). Serves as a basis for an interdisciplinary training in the emergency room]. / TEAM®-G ("Trauma Evaluation and Management Germany"). Grundlage für ein interdisziplinäres und interprofessionelles Schockraumtraining.

BACKGROUND: The implementation of ATLS® in the daily routine of trauma management in the emergency department is a challenge. This goal cannot be reached by educating ATLS® to a few team members only. In order to enforce the implementation of ATLS® in a level I trauma centre, a generic in-house training was introduced in 2009 with inter-professional integration of all specialists of the trauma team. MATERIALS AND METHODS: The TEAM® course (trauma evaluation and management concept of the American College of Surgeons) was the theoretical basis of the training. This educational program was developed for medical students and multidisciplinary team members. Prior training, a questionnaire for self-assessment was completed by n=84 team members to assess their knowledge about ATLS® principles. The hands-on training time was 90 min. N=10 members of the trauma team worked out three scenarios of multiple injured patients. These were provided as near-reality manikin simulations by a specialist trainer. After the training participants re-evaluated and analysed improvement by the training. Duration of trauma management and the number of missed injuries were analysed one year prior and one year after the training and served as a marker of the process and outcome quality of trauma care. RESULTS: Prior the training, 57% of trainees specified their knowledge related to the ATLS® can be improved. Their expectations were generally satisfied by the training. The mean time of trauma management in the ED could not be reduced one year after the training (36±16 min) compared to one year prior the training (39±18 min), however, the detection of missed injuries (5.6% vs. 3.2%, p<0.05) was significantly diminished after the training. CONCLUSION: Apart form education of ATLS® providers the inauguration of an interdisciplinary and interprofessionel team training may enhance implementation of ATLS- algorithms into daily routine.

[Development and validation of a checklist for evaluating videos for learning resuscitation measures]. / Entwicklung und Validierung einer Checkliste zur Bewertung von Videos zum Erlernen von Reanimationsmaßnahmen.

BACKGROUND: Well-performed resuscitation measures can improve the outcome in the event of cardiovascular arrest. Medical students often use teaching videos to learn practical skills. Studies confirmed the often inadequate quality of the videos on resuscitation available on the Internet. An evaluation using a validated checklist based on the current guidelines has so far been lacking. OBJECTIVE: The development and validation of a checklist for evaluating instructional videos on resuscitation. MATERIAL AND METHODS: In an expert workshop, checklist items were formulated based on the current guidelines. The checklist was tested by emergency physicians in a 4-step review process. The evaluations were analyzed and the items adjusted and specified if necessary. After the review process was completed, the checklist was applied to 74 videos on the topic of resuscitation. RESULTS: The checklist consists of 25 items in 4 categories (initial measures, chest compression, AED use, breathing), which are rated on a 3-level Likert scale. A total of 16 emergency doctors participated in the study and rated an average of 9.3 ± 5.7 videos each. The reviewers agreed in 65.1 ± 12.6% of the cases. The highest agreement was achieved in the subtopic AED, with the item "do not touch patients in shock" having the highest agreement. The items in the thoracic compression category were most often rated differently. CONCLUSION: For the first time, a checklist for evaluating instructional videos for resuscitation was created and validated for German-speaking countries.

[Mandatory elective course in emergency medicine with instructions by paramedics improves practical training in undergraduate medical education]. / Praktikum im Rettungsdienst mit Anleitung durch Rettungsassistenten.

BACKGROUND: Due to the complexity of medical emergencies undergraduate medical training in the integrative course on emergency medicine requires education combining knowledge, practical skills, algorithm-driven behavior and soft skills. New State board regulations on education and licensing of physicians demand a practical implementation of these objectives. MATERIALS AND METHODS: The medical faculty of Frankfurt medical school has implemented an obligatory prehospital elective course. A retrospective questionnaire assessed the organization, instructional competence of the paramedics and integration of students in the emergency medical teams. RESULTS: Out of a total of 486 students the majority rated the longitudinal curriculum as positive (66% very good and 28% good). The practical experience at a scene was evaluated to be reasonable by 86% and 95% of the students stated that integration into the emergency team was rendered without any difficulties. CONCLUSION: A prehospital experience supported by paramedics can serve as a valuable tool in an emergency medicine curriculum.

[Practical skills training : How suitable is Peyton's four-step approach for residents in urology?] / Vermittlung praktischer Fertigkeiten : Wie geeignet ist Peytons Vier-Schritte-Ansatz für urologische WeiterbildungsassistentInnen?

INTRODUCTION: The aim of residency is to acquire medical skills and abilities. One didactic model is "Peyton's four-step approach". The aim of the present study was to develop and evaluate a modified Peytonian approach for group interactions. The aim was to develop a course for the acquisition of practical skills and training assistants in suture techniques for urology. METHODS: A prospective study was conducted with a total of 38 participants and 6 tutors. In a modified four-step Peytonian approach, various suturing and knotting techniques were taught in a structured manner. Tutors evaluated the procedural activity using observation sheets. In addition, the learning method was evaluated by the participants and the tutors at the end of the course. In order to check the long-term learning success, a renewed survey of the participants was conducted after 6 months. RESULTS: 80% of the participants rated the modified teaching method as useful and 83% of the tutors rated the procedural implementation as good. Fluid movement sequences were difficult independent of the technique taught. After 6 months, the participants significantly improved their procedural skills in all techniques that were taught. CONCLUSION: This paper defines a four-step Peyton-based approach to teaching practical skills such as suturing and knotting used in urological training. The modified teaching method improved practical skills used in urology. This method should be considered in continuing education to promote self-confidence and increase the competence in surgical skills.

[Training of practical clinical skills in surgery - a training concept for medical students]. / Training praktischer Fertigkeiten in der Chirurgie - Ein Ausbildungskonzept für Studierende.

BACKGROUND: During undergraduate medical education, the trainee should not only gain theoretical knowledge but also acquire essential skills. Several studies have demonstrated that practical training can be improved. However, only single training concepts for solitary skills have been developed and evaluated. This work presents a training programme for basic surgical skills. MATERIALS AND METHODS: A one-week training of practical skills has been integrated into the obligatory four-week surgical course. Students pass through twelve training units of surgical skills training using the skills lab, simulation and role playing. RESULTS: Evaluations of our training programme were excellent (average grade 1.3). After skill training, students felt more comfortable and secure when actually performing skills on the ward. CONCLUSIONS: A standardised training can help in the provision of basic surgical skills to all undergraduate medical students.

[Training in emergency sonography for trauma. Concept of a 1-day course program]. / Schulung in Notfallsonographie bei Trauma. Konzept eines eintägigen Kursprogramms.

In the last decade prehospital focused abdominal sonography for trauma (P-FAST) could be established as a valid on-site diagnostic tool for both air and ground rescue medical services in Germany. An appropriate use of P-FAST demands a standardized training concept. Therefore a 1-day training program was developed by the working group "emergency ultrasound" in Frankfurt/Main and was introduced in 2003. The training consists of lectures on general and specific aspects of emergency ultrasound techniques with demonstrations of numerous pathological findings, intensive hands-on training with patients and volunteers, as well as simulated on-site training. After completing the P-FAST course the participants gained competency to perform prehospital emergency ultrasound with high accuracy. Strict application of the exact technique as well as appropriate integration of the adjunct into the algorithm of prehospital care are the most important prerequisites for successful use of P-FAST. From February 2003 to March 2008 540 participants were trained in P-FAST in the 1-day course.

[Development of a catalogue of undergraduate learning objectives for orthopaedics and traumatology]. / Entwicklung des Lernzielkatalogs "Muskuloskelettale Erkrankungen, Verletzungen und traumatische Notfälle" für Orthopädie-Unfallchirurgie im Medizinstudium.

BACKGROUND: The development towards a combined speciality of orthopaedic and trauma surgery requires not only consolidation and revision of the postgraduate education training programme but also the development of a catalogue of learning objectives as a uniform basis for undergraduate medical training in the new speciality at German medical schools and teaching hospitals. MATERIALS AND METHODS: Based on the Frankfurt catalogue of learning objectives for trauma surgery and the Ulm catalogue of learning objectives for orthopaedics, a task force of experts developed a combined catalogue of learning objectives for the new speciality. Experts from both specialities classified the learning objectives into two levels of knowledge and four grades of skills competence, in addition to objectives for attitudes and social competence. RESULTS: The section on general operative specialities contains 120 items classified into 39 learning objectives for knowledge and 83 for skills. Two learning objectives comprise both knowledge and skills. The section on orthopaedic and trauma surgery comprises 141 learning objectives, including six items for skills and 138 for knowledge, as well as three learning objectives for both knowledge and skills. In addition, 22 learning objectives deal with aspects of attitude and social competence. CONCLUSION: Although this alliance of orthopaedics and trauma surgery is recent, the commission has developed not only a collection of topics but a joint catalogue of learning objectives for undergraduate training that can be used nationwide. This catalogue paves the way for modern education that looks to the future. The integrated recommendations for content prioritisation, links to other subjects and specialities, and the integration of didactic methods facilitate local implementation of the learning objectives without loss of academic freedom.

[Development of a catalogue of undergraduate learning objectives for orthopaedics and traumatology]. / Entwicklung des Lernzielkatalogs "Muskuloskeletale Erkrankungen, Verletzungen und traumatische Notfälle" für Orthopädie--Unfallchirurgie im Medizinstudium.

BACKGROUND: The developments towards a combined specialty of orthopaedic and trauma surgery requires not only the consolidation and revision of the postgraduate education training programme but also the development of a catalogue of learning objectives as a uniform basis for undergraduate medical training in the new specialty at German medical schools and teaching hospitals. MATERIALS AND METHODS: Based on the Frankfurt Catalogue of Learning Objectives for Trauma Surgery and the Ulm Catalogue of Learning Objectives for Orthopaedics, a task force of experts has developed a combined catalogue of learning objectives for the new specialty. The experts of both specialties classified the learning objectives into 2 levels for knowledge, into 4 grades of competence for skills, as well as attitudes and social competence. RESULTS: The general part of the operative specialties contains 120 items classified into 39 learning objectives for knowledge and 83 for skills. Two learning objectives comprise both knowledge and skill. The part orthopaedic and trauma surgery comprises 141 learning objectives, six items for skills, 138 for knowledge, as well as three learning objectives for both knowledge and skills. In addition, 22 learning objectives deal with aspects of attitudes and social competence. CONCLUSION: In spite of the only recent alliance of orthopaedics and trauma surgery, the commission has developed not only a collection of topics, but also a usable joint catalogue of learning objectives for undergraduate training with a nationwide recommendation character. The catalogue paves the way for a forward-looking, modern education. The integrated recommendations for the prioritisation, the linkage to other subjects and specialties, and the integration of didactic methods facilitate the local implementation of the learning objectives without loosing any academic freedom.