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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.

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.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.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.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.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.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.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.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.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.

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.

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 scoregt;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 (

Hintergrund Der Nationale Kompetenzbasierte Lernzielkatalog Chirurgie (NKLC) wurde von allen chirurgischen Fachgesellschaften gemeinsam formuliert. Er bildet ein Verbindungsglied zwischen den chirurgischen Lehrstuhlen und dem fachubergreifenden Nationalen Kompetenzbasierten Lernzielkatalog Medizin (NKLM), der kunftig als Grundlage fur die Inhalte der studentischen Lehre und letztlich der Staatsexamina dienen soll. Der NKLC enthalt 230 chirurgische Lernziele. Die durchgefuhrte Analyse ermittelte den Anteil an herzchirurgisch relevanten Lernzielen im NKLC und vergleicht die Ergebnisse mit den tatsachlich bislang gestellten Prufungsfragen im schriftlichen Teil des 2. Staatsexamens (M2).

Objective Even though objective structured clinical examination (OSCE) is a well-investigated format for competency-based practical examination, only a few studies have explored the motivations of OSCE examiners and their opinions, both positive and negative, toward being an examiner. The aim of this study was to gain insights into the views of OSCE examiners using semi-structured interviews. Design Surgical OSCE examiners were queried at two medical faculties in Germany via semi-structured interviews. The interviews were transcribed verbatim and analyzed using the techniques of structured qualitative content analysis. Setting This study was conducted at the medical faculties of the Goethe University, Frankfurt, Germany and of the Otto-von-Guericke University, Magdeburg, Germany. Participants All of the study participants were surgeons working at the university hospital of one of the faculties. Results A total of 29 examiners were queried until a saturation of content was achieved. A critical reflection of one's own teaching was described as a major benefit by most participants. Furthermore, they noted that the standards and competences examined during the OSCE boosted the detail of their teaching sessions in the wards. However, the examiners criticized missed operations due the examination and were not appreciated by superiors for being an examiner. Most of the examiners (22/29) preferred to be an examiner themselves rather than appointing student peer examiners. If they had appointed someone else, that would mean they would miss valuable experiences useful for their own teaching. Conclusions Being an OSCE examiner confers several advantages, notably the reflection of one's own teaching, which was described as highly valuable by the examiners.

OBJECTIVE The instructional approach used to teach skills and competencies seems to have a critical impact on retaining and performing the learned skills/competencies. However, for most of them, the effect of different instructional approaches as well as evidence for appropriate approaches is unknown. The aim of the present study was to analyze and compare the impact of different instructional approaches in the acquisition of basic skills during undergraduate surgical training. DESIGN Randomized controlled cohort study. For the intervention, four instructional approaches (‘See one - Do one’, ‘Video 4-Step Approach’, ‘Mental Group Mapping’, and ‘Control’) were compared in six basic skills. Students completed a six-station OSCE (one for each skill) during their skills lab training week after the intervention. SETTING This study was conducted at the medical faculty of the Goethe University, Frankfurt, Germany. PARTICIPANTS Medical students in their fourth year completing their four week of obligatory surgical training. RESULTS A total of 151 students were included. The group ‘Mental Group Mapping’ scored significantly higher in comparison to ‘See one – Do one’ in four of the six skills and ‘Control’ in five skills. The group ‘Video 4-Step Approach’ scored significantly higher in comparison to ‘See one – Do one’ (three skills) in comparison to ‘Control’ (two skills). There were no significant differences between the approaches ‘Mental Group Mapping’ and ‘Video 4-Step Approach’ as well as between the approaches ‘See one – Do one’ and ‘Control’. CONCLUSION Activating instructional approaches such as the ‘4-Step Approach’ and ‘Mental Group Mapping’ have a significant impact on performing the learned skills and competencies.

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.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.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.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.Das hier vorliegende Video stellt die üblichen Untersuchungstechniken des Schultergelenks an einen Patienten mit einer instabilen Schulter dar. Die jeweiligen Techniken wurden, wenn vorhanden, mit der jeweiligen Evidenz unterlegt.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.

Surgical departments are discredited as guardians of traditional structures of hierarchy. Hierarchy and working climate have a large share in human factor, being made responsible for 70% of avoidable errors in medicine. Aim of this study was the assessment of these topics amongst physicians in the field of orthopedics and traumatology.A questionnaire of 10 questions was digitally handed to DGOU members. 799 questionnaires were answered.We found significant differences in the assessment of hierarchy and working atmosphere amongst the physician groups. Working atmosphere was perceived as not appreciative by registrars only. All groups were in favor of a hierarchy rather close to, but nut absolutely on equal terms. All groups attach high influence of working atmosphere on quality of daily work.Literature shows that hierarchic differentiation can increase performance of a team, while rigid hierarchy structures can lead to mistakes. Although hierarchy in orthopedics and traumatology seems to be less pronounced than assumed, hierarchy has great influence on daily work.In order to achieve a safety oriented medical environment, it will be of great importance to define hierarchy structures in clinics and to utilize them efficiently as a part of safety culture.Insbesondere chirurgische Abteilungen stehen im Ruf, überkommene hierarchische Strukturen zu pflegen. Hierarchie und Arbeitsatmosphäre haben wesentlichen Anteil am Human Factor, der im medizinischen Bereich für 70% der vermeidbaren Zwischenfälle verantwortlich ist. Ziel der Studie ist eine Statuserhebung zum subjektiven Empfinden von Hierarchie und Arbeitsatmosphäre unter Ärzten in Orthopädie und Unfallchirurgie (O und U).799 Fragebögen wurden digital durch Mitglieder der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU) beantwortet, von diesen wurden je 10 Fragen zur Hierarchie und Arbeitsatmosphäre ausgewertet.Es waren signifikante Unterschiede in der Bewertung der Atmosphäre und der Hierarchie am Arbeitsplatz zwischen den Ärztegruppen festzustellen. Die Fachärzte empfanden die Atmosphäre am Arbeitsplatz als einzige Gruppe nicht wertschätzend. Allen Gruppen war gemein, dass sie sich eine Hierarchie eher, aber nicht gänzlich, auf Augenhöhe wünschten. Alle Gruppen maßen der Arbeitsplatzatmosphäre großen Einfluss auf die Qualität der täglichen Arbeit bei.Es ist bekannt, dass hierarchische Differenzierung ein Team leistungsfähiger machen kann, während eine zu starre Hierarchie zu Fehlern führen kann. Zwar scheinen die hierarchischen Strukturen in O und U weniger ausgeprägt zu sein als angenommen, Hierarchie hat jedoch im Empfinden der Befragten einen erheblichen Einfluss auf das Arbeitsklima und das tägliche Arbeiten.Für eine sicherheitsorientierte Medizin wird es immer wichtiger sein, hierarchische Strukturen in den Kliniken zu definieren und als Teil einer gelebten Sicherheitskultur im Sinne bestmöglicher Effizienz nutzbar zu machen.

The focus of medical-didactic research is the improvement of clinical-practical training. One way to support practical skills training in a time- and resource-saving way is to provide instructional videos. Often the freely available instructional videos do not meet didactic or content requirements. Creating your own videos can therefore be a useful alternative for teachers. There are a variety of instructions on the Internet for shooting instruction videos. To date, this does not include any concrete instructions/assistance for the production of medical instructional videos. However, the presentation of medical learning content in particular can contain many hurdles. The aim of this work was to design a checklist for the creation of instructional videos, which can be used as a guide.As a first step, a systematic literature search was carried out to identify works that deal with the creation and not the use of medical instructional videos. To date, corresponding publications do not exist. In a workshop, the participants, who already gained experience in creating this type of video, exchanged ideas. These were critically discussed and analyzed. As a result, a checklist was created. In a subsequent multi-step review process, the checklist was reviewed with regard to applicability, comprehensibility, completeness and quality of the items.Four phases in the creation of an instructional video could be differentiated: preliminary reflections, preparation, day of filming, post-production. The checklist is structured accordingly and should be actively processed phase by phase. The checklist is created in such a way that it can be used and edited without reading this text. Particular focus is placed on the patient and his needs.The checklist created provides useful help in the creation of medical instructional videos and can for the first time serve as a guide especially for orthopedic and accident surgical instructional videos.Im Fokus der medizindidaktischen Forschung steht die Verbesserung der klinisch-praktischen Ausbildung. Eine Möglichkeit, die Ausbildung in praktischen Fertigkeiten zeit- und ressourcensparend zu unterstützen, bieten Lehrvideos. Häufig genügen die frei verfügbaren Lehrvideos weder didaktischen noch inhaltlichen Ansprüchen. Die Erstellung eigener Videos kann daher für Lehrende eine sinnvolle Alternative sein. Im Internet existiert eine Vielzahl von Anleitungen zum Dreh von Unterrichtsvideos. Darunter sind bis dato keine konkreten Anleitungen/Hilfestellungen zur Erstellung medizinischer Lehrvideos. Jedoch insbesondere die Darstellung medizinscher Lerninhalte kann viele Hürden enthalten. Ziel der vorliegenden Arbeit war die Konzeptionierung einer Checkliste für die Erstellung von Lehrvideos, die als Leitfaden genutzt werden kann.Als 1. Schritt erfolgte eine systematische Literaturrecherche, um Arbeiten zu identifizieren, welche die Erstellung und nicht die Anwendung medizinischer Lehrvideos behandeln. Entsprechende Publikationen existieren bis dato nicht. In einem Workshop haben die Teilnehmenden, die bereits Erfahrung in der Erstellung dieser Art von Videos sammelten, sich ausgetauscht. Diese wurden kritisch diskutiert und analysiert. Resultierend entstand eine Checkliste. In einem nachfolgenden mehrstufigen Review-Prozess wurde die Checkliste in Hinblick auf Anwendbarkeit, Verständlichkeit, Vollständigkeit und Qualität der Items überprüft.Es konnten 4 Phasen bei der Erstellung eines Lehrvideos differenziert werden: Vorüberlegungen, Vorbereitung, Drehtag, Nachbearbeitung. Die Checkliste ist entsprechend gegliedert und sollte Phase für Phase aktiv abgearbeitet werden. Die Checkliste ist so erstellt, dass sie ohne Lektüre dieses Textes genutzt und bearbeitet werden kann. Besonderer Fokus wird auf den Patienten und seine Bedürfnisse gelegt.Die erstellte Checkliste biete eine sinnvolle Hilfe bei der Erstellung medizinischer Lehrvideos und kann erstmalig speziell für orthopädische und unfallchirurgische Lehrvideos als Leitfaden dienen.

Introduction: Curriculum mapping shows concordances and differences between the intended and the taught curriculum. To our knowledge, no previous studies describe the effects that this mapping has on the curriculum. The aim of the present study is to map the content of a lecture series in surgery to the National Catalogue of Learning Objectives in Surgery and analyze the effects this mapping has on the content of the following lecture series. Methods: All lecturers in the lecture series were directly observed by a minimum of two reviewers and learning objectives and the level of competence were documented. After the lecture series, the results were visualized within the catalog of learning objectives and were sent to the lecturers. In the following lecture series, learning objectives were documented correspondingly. Results: In the first lecture series, 47% of the learning objectives were taught. After the mapping, the number of learning objectives that were taught increased to 59% (p

IntroductionAccording to German regulations on licensing to practice medicine, the aim of undergraduate medical training is to produce a scientifically and practically trained physician who is able to work independently. More precisely, medical training has to impart the required knowledge and skills in diagnostics, therapy, health promotion, prevention, and rehabilitation. From the young residents’ point of view, this aim is not achieved, and they do not feel prepared to be a doctor. However, the literature on this subject relies mostly on data based on surveys, and there is a lack of deep analysis of the specific details of the topic. The aim of this study was to analyze in depth how junior doctors in their first and second years felt about their preparation for clinical practice as a doctor from their undergraduate training, as well as which teaching formats and factors influence their preparedness.MethodsThis semi-qualitative study is based on recorded interviews conducted using a structured interview manual. This serves to limit the subject matter of the interview and to target the topics. The study participants were 35 residents of general and visceral surgery, trauma surgery, and urology in their first and second years of medical specialty training. The number of participants was defined by the concept of saturation of the content. Basic data regarding age and the location and length of study were collected using a questionnaire. The audio recordings were transcribed word by word and analyzed with structured qualitative content analysis techniques.ResultsOnly 43% (n=15) of the 35 participating residents stated they were sufficiently prepared to be a doctor from undergraduate medical training, and 22.9% stated that they were not prepared for their work as a resident (8/35). However, 34.3% of the residents stated that undergraduate medical training did prepare them for some of the parts they were expected to master in daily clinical practice, but not other parts. Most of the participants described their first weeks as doctors as particularly stressful and exhausting. As major hurdles during their daily clinical work, participants described knowledge gaps regarding organizational and administrative pathways (71%), deficits in linking knowledge to clinical reasoning (71%), decision making (54%), and therapy planning (51%). Most participants stated that the practical placements during the semester, the clinical clerkships, and the last year internship were most effective as preparation for clinical residency. To be better prepared for clinical practice, participants suggested providing a clearer structure and that the course subjects bear better relations to each other. Nearly all participants proposed increasing patient encounters directly from the beginning of medical training as a longitudinal approach.DiscussionEven though we were able to demonstrate an increase in residents’ preparedness, 57% of the study participants still felt unprepared for their job to some extent. One might argue that starting a new profession will always result in a feeling of being unprepared to some extent. However, this unpreparedness can increase the risk for patients’ well being due to medical errors, which actually represents the third leading cause of death in the US after malignant tumors and cardiovascular diseases. Structured on-the-job adjustment, structured qualification training, and guided professional training are becoming increasingly important for future doctors as selection criteria for career choice and choice of employer. Thus, the surgical disciplines that are struggling with new young residents have to improve their concepts.

Purpose: In daily clinical practice, sterile working conditions, as well as patient safety and self-protection, are essential. Thus, these skills should be taught appropriately during undergraduate training. Receiving constructive feedback can significantly improve future performance. Furthermore, reviewing one’s performance using video tools is a useful approach. This study investigates the impact of different modes of video feedback on the acquisition of practical surgical skills, including wound management and a bedside test. Methods: Third-year medical students completed a structured training of practical skills as part of their mandatory surgery rotation. All students received the same practical skills training for performing wound management and a bedside test. However, for feedback regarding their performance, students were assigned to one of four study groups: expert video feedback (receiving feedback by an expert after reviewing the recorded performance), peer video feedback (receiving feedback by a fellow student after reviewing the recorded performance), standard video (giving feedback to a standardized video of the skill), or oral feedback (receiving feedback by an expert without a video record). Afterwards, students completed two 5-minute OSCE stations in which they were assessed with respect to their acquired competencies. Effects on long-term retention were measured at two further measurement points. Results: A total of 199 students were included in the study (48 for expert video feedback, 49 for peer video feedback, 52 for standard video feedback, and 50 for oral feedback). All teaching methods were feasible in the given timeframe of 210 minutes for each module. There were nearly no statistically significant differences among the groups with regard to the technical and non-technical ratings for the three measurement points. Conclusion: In the present study, video-assisted feedback in various forms offered no significant benefit over oral feedback alone during simulation-based patient encounters.

Zusammenfassung Hintergrund Muskuloskeletale Erkrankungen sind weltweit die häufigste Ursache für lang anhaltende Schmerzen und körperliche Behinderungen. In Hinblick auf ihre zahlenmäßige und auch finanzielle Bedeutung im Gesundheitssystem ist eine wissenschaftlich fundierte, strukturierte medizinische Ausbildung aller angehenden Ärzte zu fordern. In der vorliegenden Arbeit wird anhand einer Statuserhebung die aktuelle medizinische Lehre in Orthopädie und Unfallchirurgie dargestellt und mit dem Status der Lehrsituation in 2008 verglichen. Material und Methoden Ein Fragebogen mit 56 Items wurde an alle Lehrstuhlinhaber der Fächer Orthopädie und Unfallchirurgie der 37 medizinischen Fakultäten verschickt. Ergebnisse Es konnte eine Rücklaufquote von 81,1% von orthopädischen Lehrstuhlinhabern und 73,0% von unfallchirurgischen Lehrstuhlinhabern erreicht werden. Die Lehre in Orthopädie und Unfallchirurgie wird in 34,4% vollständig getrennt voneinander organisiert, 2008 noch in 64%. Der Umfang an Lehrveranstaltungsstunden in den Vorlesungen und Praktika hat sich im Vergleich zu 2008 kaum verändert. Schlussfolgerung Es ist eine noch engere Zusammenarbeit der Lehrenden in Orthopädie und Unfallchirurgie anzustreben, um das gemeinsame Fach in angebrachtem Umfang und der volkswirtschaftlichen Bedeutung von muskuloskeletalen Verletzungen und Erkrankungen entsprechend zu repräsentieren und auch, um gemeinsame Ressourcen zu nutzen.

Background Evaluations are important for teaching courses and contribute to educational quality assurance. CMF surgery provides a module in the skills-lab week in preparation for surgical clerkship. Even though the CMF module receives positive evaluations, the students report deviating content. Subsequently, exams skills were often not mastered correctly. The aim of this study is to gather the contents taught within the course and to revise the module accordingly. Methods A structured evaluation sheet was used to evaluate the CMF modules. The detailed time frame used, teaching methods integrated, and learning objectives taught were documented. Based on the results, the module was restructured and re-evaluated twice. Results There were substantial fluctuations among the taught learning objectives in the first evaluation (21%–47% of the objectives were totally covered). The deployed time (160.50 ± 32.55 min) for the module was much shorter than scheduled (210 min). After restructuring, more learning objectives were totally covered (44%–100%), which corresponds to a significant gain (p = .024). The deployed teaching time for the modules was used more efficiently (183.65 ± 21.10 min/p = .005), and the additional time (51.89 ± 21.23 min vs. 37.55 ± 16.06 min before/p = .011) was used mainly for practical exercises. Conclusion Structured evaluations are a meaningful tool for gaining valuable insights regarding the contents and quality of teaching courses and pinpointing potential for improvement. Key factors for the improvement of an educational module are the definition of learning goals within the context of a transparent and structured module.

Ultrasound is an important diagnostic tool in patients with abdominal pain and after injury. However, it is highly dependent on the skills and training of the examiner. Thus, ultrasound competencies should be acquired early during medical education. The instructional approach affects the retention and performance of skills. A promising approach is "mastery learning." The aim of the study was to evaluate the effectiveness of "mastery learning" compared with the "see one, do one" approach by performing a focused assessment of sonography for trauma (FAST) in undergraduate medical students based using an academic assessment tool (Objective Structured Clinical Examination [OSCE]). In a prospective controlled trial, 146 participants were randomly allocated to two groups (see one, do one and mastery learning) and trained in a 90-min module. In the see one, do one group, the trainer demonstrated the complete FAST routine, and then the students trained each other on it under supervision and received direct oral feedback from the tutors. In the mastery learning group, each student received a routing slip. The routing slip contained five levels of competence for the FAST routine, each of which had to be achieved (e.g., choosing the correct probe) and verified by the trainer before working toward the next competency level. The acquired competencies were assessed after training using the OSCE, which is a standardized practical exam using checklists. The mastery learning group attained 40.69 ± 5.6 points on average (of a maximum of 46 points), and the see one, do one group, 33.85 ± 7.7 points (p < 0.001). Mastery learning is an effective teaching method for undergraduate medical students performing FAST and is superior to the see one, do one approach, as assessed with the OSCE.

Musculoskeletal diseases and injuries are the most common cause of long-term pain and physical disability. Thus, every medical graduate should be able to perform a structured examination of the musculoskeletal system. Besides the see-one-do-one principle, other teaching methods have been proposed to be effective. The use of teaching associates offers an established, proven pathway for teaching examination skills in urology and gynecology. During the patient experience method, students are examined first, thus giving them an opportunity to feel the examination before performing it themselves. The objective of this study was to compare the efficiency of 3 distinct teaching methods for both knee and shoulder examination.The study took place during obligatory knee and shoulder examination training. Participants received basic training, including a demonstration of the structured examination by a specialist in trauma surgery. Afterward, group 1 examined each other under professional supervision; group 2 students examined the teaching associates, followed by mutual examinations; and group 3 students were each examined by the instructor, followed by mutual examinations. The acquired competence was assessed in 5-minute practical assessments directly after training and again 5 weeks later.The study was conducted at the medical faculty of Goethe University, Frankfurt, Germany.Study participants were third-year undergraduate medical students completing their obligatory 3-week surgical training.One hundred and forty-four students [group 1 (N = 53), group 2 (N = 46), and group 3 (N = 45)] participated in the first measurement, 92 students in the second measurement of the study. Directly after the training, group 2 and group 3 performed significantly better than group 1 regarding overall score (p0.001) and all 4 checklist parts (p0.001). At the second measurement, group 2 performed significantly better than group 1 regarding shoulder examination (p = 0.003) and significantly better than group 3 (p = 0.025) regarding knee examination.The use of a teaching associate and the patient perspective can increase students' performance in knee and shoulder examinations.

Musculoskeletal conditions are the most frequent cause of long-term pain and disability. Scientifically funded, structured training would be highly desirable for all medical students and of great economic relevance for the health care system. The present article portrays the status quo of undergraduate training in orthopaedics and trauma surgery, with a comparison to the status quo of 2008.A 51-item questionnaire was sent to all heads of the departments of orthopaedics or trauma surgery at the 37 medical faculties in Germany.A return rate of 81.1% from orthopaedics and 73% from trauma surgery was attained. The organisation of undergraduate training in orthopaedics and trauma surgery is completely separated in 34.4% of hospitals. The corresponding figure in 2008 was 64%. The amount of training in lectures and practical training rarely changed during this period.Even closer collaboration between lecturers in orthopaedics and trauma surgery would be desirable. This would reflect the importance of the disciplines, as well as politico-economic relevance of musculoskeletal injuries and diseases, and would encourage the sharing of resources.Muskuloskeletale Erkrankungen sind weltweit die häufigste Ursache für lang anhaltende Schmerzen und körperliche Behinderungen. In Hinblick auf ihre zahlenmäßige und auch finanzielle Bedeutung im Gesundheitssystem ist eine wissenschaftlich fundierte, strukturierte medizinische Ausbildung aller angehenden Ärzte zu fordern. In der vorliegenden Arbeit wird anhand einer Statuserhebung die aktuelle medizinische Lehre in Orthopädie und Unfallchirurgie dargestellt und mit dem Status der Lehrsituation in 2008 verglichen.Ein Fragebogen mit 56 Items wurde an alle Lehrstuhlinhaber der Fächer Orthopädie und Unfallchirurgie der 37 medizinischen Fakultäten verschickt.Es konnte eine Rücklaufquote von 81,1% von orthopädischen Lehrstuhlinhabern und 73,0% von unfallchirurgischen Lehrstuhlinhabern erreicht werden. Die Lehre in Orthopädie und Unfallchirurgie wird in 34,4% vollständig getrennt voneinander organisiert, 2008 noch in 64%. Der Umfang an Lehrveranstaltungsstunden in den Vorlesungen und Praktika hat sich im Vergleich zu 2008 kaum verändert.Es ist eine noch engere Zusammenarbeit der Lehrenden in Orthopädie und Unfallchirurgie anzustreben, um das gemeinsame Fach in angebrachtem Umfang und der volkswirtschaftlichen Bedeutung von muskuloskeletalen Verletzungen und Erkrankungen entsprechend zu repräsentieren und auch, um gemeinsame Ressourcen zu nutzen.

Purpose:To compare the performance in oral, craniomaxillofacial, and facial plastic surgery (CMF)-specific surgical skills between medical students (MS) and dental students (DS) and hence adjust the current CMF training to student-specific needs. The investigators hypothesized that there would be no performance differences between MS and DS.Methods:The investigators implemented a comparative retrospective item-based analysis of student performance in a CMF-specific objective structured clinical examination (OSCE) from 2008 to 2015. The sample was composed of 1010 MS and 225 DS who completed a standardized CMF training and OSCE. Three OSCE scenarios [management mandible fracture (MMF), management zygomatic fracture (MZF), and structured facial examination (SFE)] were included in the study because learning objectives were equal. Descriptive and bivariate statistics were computed and the p value was set at 0.05.Results:In all of the analyzed OSCE scenarios, DS significantly outperformed MS (MMF pDiscussion and conclusion:DS overall seem to be perform better in typical CMF skills. The reasons for this performance gap could be a more profound knowledge of the facial anatomy as well as a higher awareness for CMF as a related specialty to dentistry. CMF should be included in medical curricula in a larger scale, and possible career paths should be highlighted to MS and DS to raise attraction for the specialty. Further studies should focus on the implementation of modern teaching methods in CMF education.

Einleitung: Praktische klinische Kompetenz ist aufgrund der Komplexitat der erforderlichen Fertigkeiten und der unmittelbaren Folgen ihrer ungenugenden Beherrschung von grundlegender Bedeutung in der universitaren Lehre. Jedoch konkurrieren im Klinikalltag kuratives Handeln, Forschung und Lehre oft zuungunsten der Vermittlung praktischer Fertigkeiten – eine Situation, die hohe Risiken birgt. Die Chirurgie bildet alle Studierenden in einem grosen Umfang wahrend des Studiums und im Pflichttertial im Praktischen Jahr aus und ist dementsprechend pradestiniert, beispielhaft ein schlussiges Ausbildungskonzept zu entwickeln, das von konsentierten Lernzielen uber Unterrichtsmedien, Lehr- und Prufungsmethoden bis hin zur Untersuchung der Evidenz des Konzepts reicht. Das Projekt: Im Rahmen des Bund-Lander-Projekts „Qualitatspakt Lehre“ wurde das vorgestellte Verbundprojekt der Universitaten Frankfurt, Giesen und Marburg, gemeinsam mit der Deutschen Gesellschaft fur Chirurgie (DGCH), der Gesellschaft fur medizinische Ausbildung (GMA) und der Bundesvertretung der Medizinstudierenden (bvmd) mit einem Umfang von 2 Millionen Euro bewilligt. Das Ziel des Verbundprojekts ist es, die praktische klinische Kompetenz zu starken. Neun Arbeitspakete sind in 3 Antragssaulen zu einem Ziel verwoben: Die bundesweite methodisch-didaktische und curriculare Optimierung des Studiums in einem nationalen Netzwerk. Jeder der Verbundpartner leistet aufgrund seiner spezifischen Erfahrungen und Kompetenzen in der Lehre einen systematischen Beitrag. Aufbauend auf den Lernzielen, die unter Federfuhrung der Chirurgischen Arbeitsgemeinschaft Lehre (CAL) in den chirurgischen Fachgesellschaften erarbeitet wurden, werden Lehrinhalte hinsichtlich didaktischer und inhaltlicher Qualitat im Projekt gepruft und Studierenden wie Lehrenden im Sinne eines mobilen Learning zuganglich gemacht (1. Saule). Parallel dazu werden die Curricula der beteiligten Universitaten erfasst, Lehr- und Prufungsmethoden fur praktische Fertigkeiten hinsichtlich ihrer Evidenz systematisch untersucht und die Curricula entsprechend optimiert (2. Saule). An den beteiligten Universitaten werden Qualifizierungsprogramme fur Arztinnen/Arzte durchgefuhrt, die sowohl die Lehre im klinischen Alltag optimieren als auch die Attraktivitat professioneller Lehre steigern. Die notwendige Lehrkompetenz wird in einem deutschlandweiten Train-the-Teacher-Programm vermittelt (3. Saule).

Background Lectures remain an important teaching method to present and structure knowledge to many students concurrently. Adequate measures are necessary to maintain the quality of the lectures. The aim of this study was to determine the impact on the lecture quality using written structured feedback and to compare the ratings of surgical lectures between students and surgical peers. Methods Prospective analysis of two consecutive surgical lecture series for undergraduate students at Goethe-University Medical School was performed before and after evaluation of the lecturers via independent written feedback from trained undergraduate students and surgeons. The 22-item feedback instrument covered three areas of performance: content, visualization, and delivery. Additional suggestions for improvement were provided from both students and surgical peers who anonymously attended the lectures. The lecturers, experienced surgeons, as well as the student and peer raters were blinded in terms of the aim and content of the study. Their response to the feedback was collected using a web-based 13-item questionnaire. The Kendall’s-W coefficient was computed to calculate inter-rater reliability (IRR). Differences between ratings before and after feedback were analyzed using Student’s t-test for dependent samples. The Kolmogorov-Smirnov-test was used for independent samples. Results A total of 22 lectures from a possible 32 given by 13 lecturers were included and analyzed by at least three surgeons and two students. There were significant improvements in overall score as well as in the details of 9 of the 13 items were found. The average inter-rater reliability was 0.71. There were no differences in the ratings as a function of the rater’s level of expertise (peers vs. students). We found that 13/23 lecturers (56.5%) answered the questionnaire, and 92% strongly agreed that the written feedback was useful. 76.9% of the lecturers revised their lecture based on the written feedback requiring on average 112.5 min (range from 20 to 300 min). Conclusions Overall, this study indicates that structured written feedback provided by trained peers and students that is subsequently discussed by the lecturers concerned is a highly effective and efficient method to improve aspects of lecturing. We anticipate that structured written feedback by trained students that is discussed by the lecturers concerned will improve lecturing. Electronic supplementary material The online version of this article (doi:10.1186/s12909-016-0806-y) contains supplementary material, which is available to authorized users.

Feedback can significantly improve future performance. Reviewing one’s performance by video is discussed as useful adjunct to debriefing, particularly for non-technical skills. Communicative competencies are an essential part of daily clinical practice; thus should be taught and assessed during undergraduate training. The aim of this study was to compare the educational value of video-assisted feedback versus oral feedback in communicative competencies in the surgical context. Fourth-year medical students completed a 210-min training unit of ‘taking patient’s history and obtaining informed consents prior to surgery’ using role plays. Oral feedback was received directly thereafter using agenda-led, outcome-based guidelines (ALOBA). In the study group, the role plays were video-taped and reviewed thereafter. Afterwards, students completed two OSCE stations, where they were assessed regarding their communicative competencies and the content of the clinical scenario. One-hundred students (49 receiving video-assisted feedback, 51 oral) participated in the study. Those receiving video-assisted feedback performed significantly better in overall score in both OSCE stations (p

Background Practical skills are often assessed using Objective Structured Clinical Skill Exams (OSCE). Nevertheless, in Germany, interchange and agreement between different medical faculties or a general agreement on the minimum standard for passing is lacking. Methods We developed standardized OSCE-stations for assessing structured clinical examination of knee and shoulder joint with identical checklists and evaluation standards. These were implemented into the OSCE-course at five different medical faculties. Learning objectives for passing the stations were agreed beforehand. At each faculty, one reference examiner scored independently of the local examiner. Outcome of the students at the standardized station was compared between faculties and correlated to their total outcome at the OSCE, to their results at the Part One of the National Medical Licensing Examination as a reference test during medical studies and to their previous amount of lessons in examining joints. Results Comparing the results of the reference examiner, outcome at the station differed significantly between some of the participating medical faculties. Depending on the faculty, mean total results at the knee-examination-station differed from 64.4% to 77.9% and at the shoulder-examination-station from 62.6% to 79.2%. Differences were seen in knowledge-based items and also in competencies like communication and professional manner. There was a weak correlation between outcome at the joint-examination-OSCE-station and Part One of the National Medical Licensing Examination, and a modest correlation between outcome at the joint-examination-station and total OSCE-result. Correlation to the previous amount of lessons in examining joint was also weak. Conclusion Although addressing approved learning objectives, different outcomes were achieved when testing a clinical skill at different medical faculties with a standardized OSCE-station. Results can be used as a tool for evaluating lessons, training and curricula at the different sites. Nevertheless, this study shows the importance of information exchange and agreement upon certain benchmarks and evaluation standards when assessing practical skills.

The European Society for Trauma and Emergency Surgery (ESTES) identified the need for general and trauma surgeons involved in the management of critically ill surgical patients to embrace and learn both basic and advanced US skills. A steering group was created to address this deficit. Modular UltraSound ESTES Course (MUSEC) is a modular blended-learning course. It incorporates pre-test/post-test examinations, pre-course online materials, didactic and interactive lectures, interactive case scenarios discussion with pathological US clips, hands-on practice on healthy volunteer models, and on original phantoms for simulating both pathological US findings and practicing US-guided interventional maneuvers. Four independent modules were provided. Surgical decision-making didactics were also included in the course curriculum. Learning gain (Δ of the rating of pre-test and post-test) was calculated for each module. An anonymous post-course satisfaction survey was also administered (16 questions with a Likert’s 5-point scale of evaluation). Twenty-three MUSEC Courses were run in a 30 months period, training 416 doctors from 29 countries. A total of 52 modules were delivered. The mean pre-test and post-test grades were 8.3/12 and 10.7/12, respectively, yielding a significant mean learning gain of 28.9 % (p = 0.001). Post-course satisfaction survey got an overall ranking of 4.5/5. MUSEC is an effective and original educational format, enjoyed by candidates, that fills an educational gap for tailored US education as a procedural skill to acute care surgeons. Ongoing revisions should reduce the current limitations and increase the educational value, in terms of number of modules and post-course credentialing.

Das European Resuscitation Council (ERC) empfiehlt, dass eine endotracheale Intubation nur von demjenigen durchzufuhren ist, der in dieser Masnahme erfahren ist und sie sicher anwenden kann. Ungeubte Anwender sollten auf alternative Atemwegshilfen zuruckgreifen. Nachfolgend wird daher ein Ausbildungskonzept vorgestellt, das dazu diente, nahezu 1100 Notarzte (NA) und Rettungsassistenten (RA) flachendeckend in der praklinischen Anwendung des Larynxtubus S Disposable (LTS-D) zu schulen. In 5 Rettungsdienstbereichen wurden 2006/2007 mithilfe eines standardisierten Kurskonzepts alle NA und RA theoretisch-praktisch in der Anwendung des LTS-D geschult. Schwerpunkte waren verschiedene Einfuhrtechniken sowie die Anwendung bei Kindern und Sauglingen. Alle praklinischen Anwendungen des LTS-D wurden von 2008–2010 prospektiv erfasst. Keiner der geschulten 762 RA und nur knapp 20% der 307 NA hatten Vorerfahrungen in der Anwendung des LTS-D am Patienten. Die subjektive Sicherheit in der Anwendung gaben die Teilnehmer nach dem Theorie-/(Praxis-)Seminar im Median mit 8 (bzw. 8) mit einer Spannweite von 2–10 (bzw. 1–10) von 10 Punkten an (1 Punkt: sehr schlecht, 10 Punkte: sehr gut). Es konnten 303 LTS-D-Anwendungen dokumentiert und ausgewertet werden; hiervon waren 296 Anwendungen erfolgreich. Wahrend im ersten Jahr nach Einfuhrung des LTS-D dieser noch in uber 50% der Falle als primare Atemwegshilfe – also ohne vorausgegangene Versuche einer endotrachealen Intubation – eingesetzt wurde, ging dieser Anteil auf etwa 40% in den Folgejahren zuruck (p: nicht signifikant). Statistisch signifikant nahm die Anzahl der Intubationsversuche ab, die unternommen wurden, bevor auf den LTS-D als alternative Atemwegshilfe zuruckgegriffen wurde (2008: 2,2 ± 0,3; 2009: 1,6 ± 0,4; 2010: 1,7 ± 0,3). Mithilfe eines standardisierten Kurskonzepts war es moglich, innerhalb von 2 Jahren knapp 1100 Rettungsdienstmitarbeiter in der Anwendung einer neuen alternativen Atemwegshilfe zu schulen und diese erfolgreich in die praklinische Notfallsituation zu implementieren. Durch die Akzeptanz des LTS-D werden erfolglose Intubationsversuche nunmehr rascher unterlassen und schneller eine alternative Atemwegshilfe eingesetzt.

INTRODUCTION: Practical training on clinical cases and work with patients is one of the most important steps within the educational programme of undergraduates. Until now a general programme with specific learning targets for undergraduate training in orthopedic and trauma surgery is lacking. MATERIAL AND METHOD: In this article we present an educational skills programme developed by a national committee composed of specialists in the field of orthopaedic and trauma surgery. This programme is based on existing guidelines of German medical universities. RESULTS: The facultative and obligatory guidelines developed by the national committee are presented. CONCLUSION: The presented learning programme contains chapters regarding the increasing requirements within the field of orthopaedic and trauma surgery and provides reproducible contents with the possibility for learning control.

BACKGROUND Due to recent changes in the medical licencing act as well as to the introduction of a new model-course programme for medical studies, careers in medicine have become increasingly more attractive. However, there is still a dramatic shortage in younger generation physicians, especially within the surgical fields. The goal of this cross-sectional study was the gender-specific assessment of the ideal career wishes of students during medical school, with a focus being placed in orthopaedic trauma surgery. MATERIALS AND METHODS During the winter semester of 2010/2011 an online questionnaire (www.surveymonkey.com) was created for students enrolled in their 3rd to 12th semester (n=887). The questionnaire consisted of 50 questions [Likert scale (LS); 5 = agree, 1 = disagree] along with 10 free response questions. The scope of these questions ranged from personal career goals, within the context of their learning environment, to general life goals and planning. With regard to career choice, a differentiation was made between students' ideal career choices/subjects (IS), which were based solely on personal affinity, and so-called reality-based subjects (RS), which students considered more practical and to which they were more likely to apply in the future. RESULTS The response rate was 36,4% (n=323, 23,4 years, 6.3 semesters, 226 [70.0%] female [f] and 97 [30.0%] male [m]). A total of 206 students (63.8%; m=55.7% vs. f=66.7%; p=0.047) were able to pinpoint an IS, this percentage increased with increasing semester number (p=0.048). Overall, 29.1% of students indicated that their IS lay in the field of orthopaedic trauma, while 20.0% of men and 19.1% of women saw it as a realistic career path (RS). Throughout the course of their studies, from the 3rd semester to their practical year, a declining tendency was observed regarding the agreement between ideal and realistic career paths. Particularly evident was a decreasing interest in the field of orthopaedic trauma, beginning around the 9th semester and during the practical year, especially among the female student population. The reason for this shift seems multifactorial, ranging from concerns about family planning as well as the work load in a male-dominated field. By the time students enter their practical year, 13.5% of women and 15.4% of men were still certain in their choice to pursue a career in orthopaedic trauma (RS). CONCLUSIONS It seems that there is great interest in the fields of orthopaedic trauma among both female and male students in the middle portion of their studies. Women, especially, tend to prefer a specialisation in this operative field early in the course of their studies. However, this pool of potential successors decreases dramatically with time, due to personal experiences garnered on the wards, expectations regarding career paths (male-dominated, long hours) as well as concerns about family planning. The most dramatic shift seems to occur during the practical year.

Endotracheal intubation (ETI) is considered to be the "gold standard" of prehospital airway management of trauma patients. However, ETI requires substantial technical skills and ongoing experience. Because failed prehospital ETI is common and associated with a higher mortality, reliable airway devices are needed to be used by rescuers who are less experienced in ETI.To prospectively evaluate the feasibility of the use of laryngeal tubes by paramedics and emergency physicians for out-of-hospital airway management in trauma patients.During a 40-month period, data for all cases of prehospital use of the laryngeal tube suction disposable (LTS-D) within a large metropolitan area were recorded by a standardized questionnaire. We determined indications for laryngeal tube use, placement success, number of placement attempts, placement time, and personal level of experience. All patients admitted to our institution also underwent in-hospital follow-up.Fifty-six of 57 prehospital intubations attempts with the LTS-D were successfully performed by paramedics (n = 19) or emergency physicians (n = 37) within one (n = 50) or two (n = 6) placement attempts. The device was used as initial airway (n = 27) or rescue device after failed ETI (n = 30). The placement time was ≤ 45 seconds (n = 42), 46-90 seconds (n = 13), and90 seconds (n = 1). The majority of users (n = 44) were relative novices with no more than 10 previous laryngeal tube placements on actual patients. Of 33 patients eligible for follow-up, one underwent urgent LTS-D removal and subsequent ETI upon hospital admission, six underwent ETI after primary survey, and 26 underwent both primary and secondary survey or even damage-control surgery with the LTS-D.The LTS-D represents a promising alternative to ETI in the hands of both paramedics and emergency physicians. It can be used as an initial tool to secure the airway until ETI is prepared, as a definitive airway by rescuers less experienced in ETI, or as a rescue device when ETI has failed.

Objective In the case of an emergency, fast and structured patient management is crucial for a patient9s outcome. Every physician and graduate medical student should possess basic knowledge of emergency care and the skills to manage common emergencies. This study determines the effect of a simulation-based curriculum in emergency medicine on students9 abilities to manage emergency situations. Methods A controlled, blinded educational trial of 44 final-year medical students was carried out at Frankfurt Medical School; 22 students completed the former curriculum as the control group and 22 the new curriculum as the intervention group. The intervention consists of simulation-based training with theoretical and simulation-based training sessions in realistic encounters based on the Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and adapted Advanced Trauma Life Support (ATLS) training. Further common emergencies were integrated corresponding to the course objectives. All students faced a performance-based assessment in a 10 station Objective Structured Clinical Examination (OSCE) using checklist rating within a maximum of 4 months after completion of the intervention. Results The intervention group performed significantly better at all of the 10 OSCE stations in the checklist rating (p Conclusions The simulation-based intervention offers a positively evaluated possibility to enhance students9 skills in recognising and handling emergencies. Additional studies are required to measure the long-term retention of the acquired skills, as well as the effect of training in healthcare professionals.

AIM The fusion of orthopaedic and trauma surgery into a combined specialty requires a new evaluation of postgraduate and undergraduate training. This study presents a structured analysis of the implementation possibilities for undergraduate training. METHOD After defining 3 implementation alternatives for both clinical training and last year electives, SWOT analyses were performed. RESULTS. The SWOT analysis demonstrates for each of these 6 implementation models the strengths, weaknesses, opportunities and threats. CONCLUSION In order to strengthen undergraduate training in the “new” specialty all medical faculties should discuss and define their implementation concepts.

Abdominal trauma in combination with pelvic injuries is a major cause of death in patients with multiple injuries in the first 24 h after trauma. In blunt abdominal trauma (BAT), determining which patients should be triaged to laparotomy is important, even more, when these patients are unstable. A rapid, accurate triage and initiation of resuscitation and specific therapy are crucial as delayed treatment is associated with increased morbidity and mortality.

Objective In the case of an emergency, fast and structured patient management is crucial for a patient's outcome. Every physician and graduate medical student should possess basic knowledge of emergency care and the skills to manage common emergencies. This study determines the effect of a simulation-based curriculum in emergency medicine on students' abilities to manage emergency situations. Methods A controlled, blinded educational trial of 44 final-year medical students was carried out at Frankfurt Medical School; 22 students completed the former curriculum as the control group and 22 the new curriculum as the intervention group. The intervention consists of simulation-based training with theoretical and simulation-based training sessions in realistic encounters based on the Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and adapted Advanced Trauma Life Support (ATLS) training. Further common emergencies were integrated corresponding to the course objectives. All students faced a performance-based assessment in a 10 station Objective Structured Clinical Examination (OSCE) using checklist rating within a maximum of 4 months after completion of the intervention. Results The intervention group performed significantly better at all of the 10 OSCE stations in the checklist rating (p Conclusions The simulation-based intervention offers a positively evaluated possibility to enhance students' skills in recognising and handling emergencies. Additional studies are required to measure the long-term retention of the acquired skills, as well as the effect of training in healthcare professionals.

BMC medical education 12, 85 (2012). doi:10.1186/1472-6920-12-85, Published by BioMed Central, London

Aim Musculoskeletal conditions consume enormous resources and costs, and their incidence is increasing worldwide. Therefore, an appropriate education of medical students about these conditions is required. This study examines the extent of medical education in orthopaedic and trauma surgery in Germany. Material and methods A questionnaire comprising 7 topics (curriculum design, lecture, practical training, e-learning, examination, evaluation, resources) with a total of 44 items was sent to all assistant lecturers in orthopaedic and trauma surgery at the 37 medical schools in Germany. Results The survey attained a return rate of 76 % for orthopaedic surgery and 81 % for trauma surgery, respectively. Medical training in musculoskeletal conditions represents with an average of 38.4 hours of lectures and further 55.9 hours of practical training less than 6 % of the entire undergraduate medical education. This study demonstrates a high inhomogeneity regarding the curriculum design when comparing the different German medical schools not only in total training time but also regarding its contents. E-learning as additional teaching method is only offered in 39 % of orthopaedic training and in 47 % of the trauma surgery training. Practical examinations like the OSCE are offered at 8 medical schools for orthopaedic training and 15 schools for trauma surgical training, respectively. Conclusion Medical training in musculoskeletal conditions is very inhomogeneous and requires further improvement and standardisation regarding quantity and implementation.

Teaching in the clinical setting is challenging; however, it is the location where students apply their learned facts and learn skills and attitudes most effectively. In order to improve clinical teaching, it is important to know and implement the principles of adult learning. The clinical teacher should know or assess the learners’ prior knowledge and skills, as well as their stage of learning, before starting a new teaching session. The learners should be actively involved in the clinical processes. Questions to probe students’ deeper understanding and capability to analyze, synthesize, and apply medical knowledge should be an important part of clinical teaching. Regular structured feedback is an important part of any learning experience.

Teaching is an important part of our medical role as physicians. Though all doctors are usually well prepared for their clinical roles, few are trained to teach. It can be demonstrated that improved teaching performance leads to better learning outcomes for students and doctors. However, clinical teaching faces many challenges and problems. The series “Teaching in daily clinical practice,” which commences with this article, will describe basic educational principles that are applicable in all phases of the learning and teaching of students, junior doctors and speciality trainees.

Echocardiography performed in an ALS-compliant manner provides a tool whereby some of the potentially reversible causes of cardiac arrest can be diagnosed in real time by minimally trained practitioners. One of the major concerns this raises is how to deliver effective training to the required standard. The objective of this study was to determine the effectiveness of number of different educational methods used teach echocardiography to novices. This involved assessment of cognitive, psychomotor skills and affective aspects in five key areas.The study population was a convenience sample from participants attending standardised structured one-day training courses in peri-resuscitation echocardiography (n=204). Subjects were assessed for five learning outcomes including knowledge and image interpretation, practical performance of echocardiography including time taken to obtain a diagnostic view, integration into the ALS algorithm and overall compliance with established resuscitation guidelines.There was a significant improvement in knowledge and interpretation of echocardiographic images before and after completion of the one-day course (pre 62%, post 78%, p0.01). Skills acquisition resulted in 100% of participants being able to obtain a subcostal view of diagnostic quality by the end of the course, and 86% with a mean time to acquisition of10s. On completion of the training programme, incorporation of echocardiography into current resuscitation practice did not compromise ALS-compliance.Novice echocardiographers can obtain knowledge and skills relevant to ALS-compliant peri-resuscitation echocardiography using a range of educational techniques. In addition to the standard one-day training courses available, continued mentored practice and didactic adherence to ALS algorithms is required.

Blunt abdominal trauma is a challenging aspect of trauma management. Early detection has a major impact on patient outcome. In contrast to physical examination, computed tomography is known to be a sensitive and specific test for blunt abdominal injuries. However, it is time-consuming and thus contraindicated in hemodynamically unstable patients. Therefore, focused assessment with sonography for trauma (FAST) offers a fast and easily applicable screening method to identify patients for urgent laparotomy without any further diagnostics. FAST detects, with high sensitivity, intraperitoneal fluid that accumulates in dependent areas indicating blunt abdominal trauma. FAST has been established as a gold standard early screening method for blunt abdominal trauma when performing trauma management in the emergency department (ED) based on the Advanced Trauma Life Support(®) algorithm. The development of hand-held ultrasound devices facilitated the introduction of FAST into prehospital trauma management. It was demonstrated that prehospital FAST (p-FAST) can be performed with high sensitivity and specificity, and can lead to significant changes in prehospital trauma therapy and management. Standardized training with both theoretical and hands-on modules is mandatory in order to gain the skills required to perform FAST or p-FAST well.