1
|
Ohlenburg H, Arnemann PH, Hessler M, Görlich D, Zarbock A, Friederichs H. Flipped Classroom: Improved team performance during resuscitation training through interactive pre-course content - a cluster-randomised controlled study. BMC MEDICAL EDUCATION 2024; 24:459. [PMID: 38671434 PMCID: PMC11046966 DOI: 10.1186/s12909-024-05438-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Resuscitation is a team effort, and it is increasingly acknowledged that team cooperation requires training. Staff shortages in many healthcare systems worldwide, as well as recent pandemic restrictions, limit opportunities for collaborative team training. To address this challenge, a learner-centred approach known as flipped learning has been successfully implemented. This model comprises self-directed, asynchronous pre-course learning, followed by knowledge application and skill training during in-class sessions. The existing evidence supports the effectiveness of this approach for the acquisition of cognitive skills, but it is uncertain whether the flipped classroom model is suitable for the acquisition of team skills. The objective of this study was to determine if a flipped classroom approach, with an online workshop prior to an instructor-led course could improve team performance and key resuscitation variables during classroom training. METHODS A single-centre, cluster-randomised, rater-blinded study was conducted on 114 final year medical students at a University Hospital in Germany. The study randomly assigned students to either the intervention or control group using a computer script. Each team, regardless of group, performed two advanced life support (ALS) scenarios on a simulator. The two groups differed in the order in which they completed the flipped e-learning curriculum. The intervention group started with the e-learning component, and the control group started with an ALS scenario. Simulators were used for recording and analysing resuscitation performance indicators, while professionals assessed team performance as a primary outcome. RESULTS The analysis was conducted on the data of 96 participants in 21 teams, comprising of 11 intervention groups and 10 control groups. The intervention teams achieved higher team performance ratings during the first scenario compared to the control teams (Estimated marginal mean of global rating: 7.5 vs 5.6, p < 0.01; performance score: 4.4 vs 3.8, p < 0.05; global score: 4.4 vs 3.7, p < 0.001). However, these differences were not observed in the second scenario, where both study groups had used the e-learning tool. CONCLUSION Flipped classroom approaches using learner-paced e-learning prior to hands-on training can improve team performance. TRIAL REGISTRATION German Clinical Trials Register ( https://drks.de/search/de/trial/DRKS00013096 ).
Collapse
Affiliation(s)
- Hendrik Ohlenburg
- Institute of Education and Student Affairs, Studienhospital Münster, University of Münster, 48149, Münster, Germany.
| | - Philip-Helge Arnemann
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Münster University Hospital, Münster, Germany
| | - Michael Hessler
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Münster University Hospital, Münster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Münster University Hospital, Münster, Germany
| | - Hendrik Friederichs
- Medical Education Research Group, Medical School OWL, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
2
|
Jung P, Brenner S, Bachmann I, Both C, Cardona F, Dohna-Schwake C, Eich C, Eifinger F, Huth R, Heimberg E, Landsleitner B, Olivieri M, Sasse M, Weisner T, Wagner M, Warnke G, Ziegler B, Boettiger BW, Nadkarni V, Hoffmann F. Mehr als 500 Kinder pro Jahr könnten gerettet werden! Zehn Thesen zur Verbesserung der Qualität pädiatrischer Reanimationen im deutschsprachigen Raum. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01546-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
3
|
Mohr M, Schillings J, Mohren J. „Feel confident and know what to do?“ Wissensstand und Handlungssicherheit von Rettungsdienstfachpersonal zur präklinischen Erwachsenenreanimation. Notf Rett Med 2022. [DOI: 10.1007/s10049-021-00841-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
4
|
Brunner BS, Thierij A, Jakob A, Tengler A, Grab M, Thierfelder N, Leuner CJ, Haas NA, Hopfner C. 3D-printed heart models for hands-on training in pediatric cardiology - the future of modern learning and teaching? GMS JOURNAL FOR MEDICAL EDUCATION 2022; 39:Doc23. [PMID: 35692357 PMCID: PMC9174069 DOI: 10.3205/zma001544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 10/05/2021] [Accepted: 01/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND This project aims to develop a new concept in training pediatric cardiologists to meet the requirements of interventional cardiac catheterizations today in terms of complexity and importance. This newly developed hands-on training program is supposed to enable the acquisition of certain skills which are necessary when investigating and treating patients in a catheter laboratory. METHODS Based on anonymous CT-scans of pediatric patients' digital 3D heart models with or without cardiac defects were developed and printed three-dimensionally in a flexible material visible under X-ray. Hands-on training courses were offered using models of a healthy heart and the most common congenital heart defects (CHD). An evaluation was performed by quantifying fluoroscopy times (FL-time) and a questionnaire. RESULTS The acceptance of theoretical and practical contents within the hands-on training was very positive. It was demonstrated that it is possible to master various steps of a diagnostic procedure and an intervention as well as to practice and repeat them independently which significantly reduced FL-time. The participants stated that the hands-on training led to more confidence in interventions on real patients. CONCLUSION With the development of a training module using 3D-printed heart models, basic and advanced training in the field of diagnostic cardiac examinations as well as interventional therapies of CHD is possible. The learning effect for both, practical skills and theoretical understanding, was significant which underlines the importance of integrating such hands-on trainings on 3D heart models in education and practical training.
Collapse
Affiliation(s)
- Barbara S. Brunner
- LMU Klinikum, Department of Pediatric Cardiology and Pediatric Intensive Care, Munich, Germany
| | - Alisa Thierij
- LMU Klinikum, Department of Pediatric Cardiology and Pediatric Intensive Care, Munich, Germany
| | - Andre Jakob
- LMU Klinikum, Department of Pediatric Cardiology and Pediatric Intensive Care, Munich, Germany
| | - Anja Tengler
- LMU Klinikum, Department of Pediatric Cardiology and Pediatric Intensive Care, Munich, Germany
| | - Maximilian Grab
- LMU Klinikum, Clinic and Polyclinic for Cardiac Surgery, Munich, Germany
| | | | | | - Nikolaus A. Haas
- LMU Klinikum, Department of Pediatric Cardiology and Pediatric Intensive Care, Munich, Germany
| | - Carina Hopfner
- LMU Klinikum, Department of Pediatric Cardiology and Pediatric Intensive Care, Munich, Germany
| |
Collapse
|
5
|
Hopfner C, Jakob A, Tengler A, Grab M, Thierfelder N, Brunner B, Thierij A, Haas NA. Design and 3D printing of variant pediatric heart models for training based on a single patient scan. 3D Print Med 2021; 7:25. [PMID: 34463879 PMCID: PMC8406574 DOI: 10.1186/s41205-021-00116-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background 3D printed models of pediatric hearts with congenital heart disease have been proven helpful in simulation training of diagnostic and interventional catheterization. However, anatomically accurate 3D printed models are traditionally based on real scans of clinical patients requiring specific imaging techniques, i.e., CT or MRI. In small children both imaging technologies are rare as minimization of radiation and sedation is key. 3D sonography does not (yet) allow adequate imaging of the entire heart for 3D printing. Therefore, an alternative solution to create variant 3D printed heart models for teaching and hands-on training has been established. Methods In this study different methods utilizing image processing and computer aided design software have been established to overcome this shortage and to allow unlimited variations of 3D heart models based on single patient scans. Patient-specific models based on a CT or MRI image stack were digitally modified to alter the original shape and structure of the heart. Thereby, 3D hearts showing various pathologies were created. Training models were adapted to training level and aims of hands-on workshops, particularly for interventional cardiology. Results By changing the shape and structure of the original anatomy, various training models were created of which four examples are presented in this paper: 1. Design of perimembranous and muscular ventricular septal defect on a heart model with patent ductus arteriosus, 2. Series of heart models with atrial septal defect showing the long-term hemodynamic effect of the congenital heart defect on the right atrial and ventricular wall, 3. Implementation of simplified heart valves and addition of the myocardium to a right heart model with pulmonary valve stenosis, 4. Integration of a constructed 3D model of the aortic valve into a pulsatile left heart model with coarctation of the aorta. All presented models have been successfully utilized and evaluated in teaching or hands-on training courses. Conclusions It has been demonstrated that non-patient-specific anatomical variants can be created by modifying existing patient-specific 3D heart models. This way, a range of pathologies can be modeled based on a single CT or MRI dataset. Benefits of designed 3D models for education and training purposes have been successfully applied in pediatric cardiology but can potentially be transferred to simulation training in other medical fields as well.
Collapse
Affiliation(s)
- Carina Hopfner
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany.
| | - Andre Jakob
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Anja Tengler
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Maximilian Grab
- Department of Cardiac Surgery, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Nikolaus Thierfelder
- Department of Cardiac Surgery, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Barbara Brunner
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Alisa Thierij
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| |
Collapse
|
6
|
Jung P, Brenner S, Bachmann I, Both C, Cardona F, Dohna-Schwake C, Eich C, Eifinger F, Huth R, Heimberg E, Landsleitner B, Olivieri M, Sasse M, Weisner T, Wagner M, Warnke G, Ziegler B, Boettiger BW, Nadkarni V, Hoffmann F. More Than 500 Kids Could Be Saved Each Year! Ten Consensus Actions to Improve Quality of Pediatric Resuscitation in DACH-Countries (Austria, Germany, and Switzerland). Front Pediatr 2020; 8:549710. [PMID: 33117762 PMCID: PMC7575775 DOI: 10.3389/fped.2020.549710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/31/2020] [Indexed: 12/21/2022] Open
Abstract
• Quality and outcome of pediatric resuscitation often does not achieve recommended goals. • Quality improvement initiatives with the aim of better survival rates and decreased morbidity of resuscitated children are urgently needed. • These initiatives should include an action framework for a comprehensive, fundamental, and interprofessional reorientation of clinical and organizational structures concerning resuscitation and post-resuscitation care of children. • The authors of this DACH position statement suggest the implementation of 10 evidence-based actions (for out-of-hospital and in-house cardiac arrests) that should improve survival rates and decrease morbidity of resuscitated children with better neurological outcome and quality of life.
Collapse
Affiliation(s)
- Philipp Jung
- University Children's Hospital, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Sebastian Brenner
- Neonatology and Pediatric Intensive Care, University Hospital Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - Iris Bachmann
- University Children's Hospital Zürich, Zurich, Switzerland
| | - Christian Both
- University Children's Hospital Zürich, Zurich, Switzerland
| | - Francesco Cardona
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Christoph Eich
- Department of Anaesthesia, Pediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hanover, Germany
| | | | - Ralf Huth
- University Children's Hospital, Mainz, Germany
| | - Ellen Heimberg
- Department of Pediatric Cardiology, Pulmology and Intensive Care Medicine, University Children's Hospital, Tuebingen, Germany
| | | | - Martin Olivieri
- Dr. von Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Sasse
- University Children's Hospital, Medical School Hannover, Hanover, Germany
| | - Thomas Weisner
- University Children's Hospital, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Michael Wagner
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Gert Warnke
- University Children's Hospital Graz, Graz, Austria
| | | | - Bernd W Boettiger
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Vinay Nadkarni
- Children's Hospital of Philadelphia, University of Pennsylvania Perlman School of Medicine, Philadelphia, PA, United States
| | - Florian Hoffmann
- Dr. von Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| |
Collapse
|
7
|
Häske D, Beckers SK, Hofmann M, Lefering R, Preiser C, Gliwitzky B, Grützner PA, Stöckle U, Münzberg M. Performance Assessment of Emergency Teams and Communication in Trauma Care (PERFECT checklist)-Explorative analysis, development and validation of the PERFECT checklist: Part of the prospective longitudinal mixed-methods EPPTC trial. PLoS One 2018; 13:e0202795. [PMID: 30142204 PMCID: PMC6108494 DOI: 10.1371/journal.pone.0202795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/09/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Trainings in emergency medicine are well structured, but examinations are rarely validated. We are evaluating the impact of pre-hospital emergency trainings on participants and patient care and developed and validated a checklist to assess emergency trainings. METHODS We used videos recorded at the time points directly before (t0), directly after (t1), and one year after (t2) training to develop the PERFECT checklist (Performance Assessment of Emergency Teams and Communication in Trauma Care). The videos were assessed using semi-qualitative/linguistic analysis as well as expert panel appraisal and recommendations using the Delphi method. The checklist was tested for validity and reliability. RESULTS The inter-rater reliability (ICC = 0.99) and internal consistency (α = 0.99) were high. Concurrent validity was moderate to high (r = 0.65 -r = 0.93 (p<0.001)). We included scales for procedures, non-technical skills, technical skills and global performance. The procedures were done faster in the mean over the timeline (t0: 2:29, 95%CI 1:54-3:03 min., t1: 1:11, 95%C 0:53-1:30 min, t2: 1:14, 95%CI 0:56-1:31 min.). All experts rated the recorded scenarios at t0 with the lowest sum score (mean 31±8), with a significantly better performance of the teams at t1 (mean 69±7). The performance at t2 (mean 66 ± 13) was slightly lower than at t1, but still better than at t0. At t1 and t2, linguistic analysis showed a change in the team leaders communication behaviour, which can be interpreted as a surrogate parameter for reduced stress. CONCLUSION The PERFECT checklist has a good validity and high reliability for assessing trauma procedures and teamwork.
Collapse
Affiliation(s)
- David Häske
- Faculty of Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
- DRK Rettungsdienst Reutlingen, Reutlingen, Germany
| | - Stefan K. Beckers
- Department of Anaesthesiology, Faculty of Medicine, University Hospital RWTH, Aachen, Aachen, Germany
- Emergency Medical Service, Fire Department, City of Aachen, Aachen, Germany
| | | | - Rolf Lefering
- Institute for Research in Operative Medicine, University of Witten/Herdecke, Cologne, Germany
| | - Christine Preiser
- Coordination Centre for Health Services Research, University Hospital Tübingen, Tübingen, Germany
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany
| | | | - Paul Alfred Grützner
- Department of Trauma and Orthopaedic Surgery, BG Hospital Ludwigshafen, Ludwigshafen, Germany
| | - Ulrich Stöckle
- Department of Traumatology and Reconstructive Surgery, BG Hospital Tübingen, Tübingen, Germany
| | - Matthias Münzberg
- Department of Trauma and Orthopaedic Surgery, BG Hospital Ludwigshafen, Ludwigshafen, Germany
- Centre of interdisciplinary Rescue- and Emergency Medicine, BG Hospital Ludwigshafen, Ludwigshafen, Germany
- * E-mail:
| |
Collapse
|
8
|
Böttiger BW, Semeraro F, Altemeyer KH, Breckwold J, Kreimeier U, Rücker G, Wingen S. KIDS SAVE LIVES – Schülerausbildung in Wiederbelebung. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0286-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
9
|
Marung H, Höhn M, Gräsner JT, Adler J, Schlechtriemen T. NASIM 25 – eine Option zur Verbesserung der Ausbildung von Notärzten. Notf Rett Med 2016. [DOI: 10.1007/s10049-016-0204-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|