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Schmidbauer ML, Pinilla S, Kunst S, Biesalski AS, Bösel J, Niesen WD, Schramm P, Wartenberg K, Dimitriadis K. Fit for Service: Preparing Residents for Neurointensive Care with Entrustable Professional Activities: A Delphi Study. Neurocrit Care 2024; 40:645-653. [PMID: 37498455 PMCID: PMC10959831 DOI: 10.1007/s12028-023-01799-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Although the relevance of neurointensive medicine and high-quality training of corresponding physicians is increasingly recognized, there is high heterogeneity in the nature, duration, and quality of neurointensive care curricula around the world. Thus, we aimed to identify, define, and establish validity evidence for entrustable professional activities (EPAs) for postgraduate training in neurointensive care to determine trainees' readiness for being on-call. METHODS After defining EPAs through an iterative process by an expert group, we used a modified Delphi approach with a single-center development process followed by a national consensus and a single-center validation step. EPAs were evaluated by using the EQual rubric (Queen's EPA Quality Rubric). Interrater reliability was measured with Krippendorff's α. RESULTS The expert group defined seven preliminary EPAs for neurointensive care. In two consecutive Delphi rounds, EPAs were adapted, and consensus was reached for level of entrustment and time of expiration. Ultimately, EPAs reached a high EQual score of 4.5 of 5 and above. Interrater reliability for the EQual scoring was 0.8. CONCLUSIONS Using a multistep Delphi process, we defined and established validity evidence for seven EPAs for neurointensive medicine with a high degree of consensus to objectively describe readiness for on-call duty in neurointensive care. This operationalization of pivotal clinical tasks may help to better train clinical residents in neurointensive care across sites and health care systems and has the potential to serve as a blueprint for training in general intensive care medicine. It also represents a starting point for further research and development of medical curricula.
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Affiliation(s)
| | - Severin Pinilla
- University Hospital for Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Institute for Medical Education (IML), University of Bern, Bern, Switzerland
| | - Stefan Kunst
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Anne-Sophie Biesalski
- Department of Neurology, Ruhr-Universität Bochum, St. Josef Hospital, Bochum, Germany
| | - Julian Bösel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolf-Dirk Niesen
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, Freiburg, Germany
| | - Patrick Schramm
- Department of Neurology, Universitätsklinikum Giessen und Marburg, Standort Giessen, Justus-Liebig-University, Giessen, Germany
| | - Katja Wartenberg
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Konstantinos Dimitriadis
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany.
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany.
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Ernst AK, Zupanic M, Ellrichmann G, Biesalski AS. Germany-wide evaluation of residency in neurological intensive care medicine. BMC Med Educ 2022; 22:364. [PMID: 35549942 PMCID: PMC9096768 DOI: 10.1186/s12909-022-03441-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 05/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Neurointensive medicine is an important subspecialization of neurology. Its growing importance can be attributed to factors such as demographic change and the establishment of new therapeutic options. Part of the neurological residency in Germany is a six-month rotation on an intensive care unit (ICU), which has not yet been evaluated nationwide. The aim of this study was to evaluate kind and feasibility of neurointensive care training in Germany and to discover particularly successful training concepts. METHODS In a preliminary study, ten residents and ten instructors were interviewed. Using content analysis, two questionnaires were created, which contained questions about specific teaching methods as well as individual satisfaction. The questionnaires were sent to 187 neurological clinics in Germany, and residents and instructors were asked to participate in the study. The data analysis was performed using SPSS and content analysis for the free-text data. RESULTS Seventy of the 187 clinics contacted did not offer ICU-rotation. At 59,8% (n = 70) of the remaining hospitals, a total of 154 participants (84 residents, 70 educators) could be recruited. General satisfaction with the neurointensive medical training is high in both groups (residents: 3.34 ± 0.54; instructors: 3.79 ± 0.41, evaluated on the basis of a Likert scale from 1 = "not satisfied" to 5 = "fully satisfied"). Specific teaching methods (e.g. simulation trainings, feedback sessions) are perceived as very useful by residents, but rarely take place. Instructors are interested in educational opportunities such as didactic courses. CONCLUSION This study provides an overview of the ICU-rotation as part of the five-year neurological residency. Neurointensive care rotations usually take place at maximum care hospitals and last at least seven months. Despite frequent time and personnel restrictions, motivation of trainers and residents is high. Nevertheless, teaching methods as simulation training and educational opportunities for instructors must be expanded.
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Affiliation(s)
- Ann-Kathrin Ernst
- Faculty of Medicine, Ruhr-University Bochum, Universitätsstrasse 150, 44801 Bochum, Germany
- Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
| | - Michaela Zupanic
- Faculty of Medicine, University Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58455 Witten, Germany
| | - Gisa Ellrichmann
- Faculty of Medicine, Ruhr-University Bochum, Universitätsstrasse 150, 44801 Bochum, Germany
- Department of Neurology, Klinikum Dortmund, Beurhausstrasse 40, 44137 Dortmund, Germany
| | - Anne-Sophie Biesalski
- Faculty of Medicine, Ruhr-University Bochum, Universitätsstrasse 150, 44801 Bochum, Germany
- Department of Neurology, St. Josef Hospital, Gudrunstrasse 56, 44791 Bochum, Germany
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3
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Biesalski AS, Tönges L, von Kirchbauer I, Gülke E, Eisenberg H, Ippen FM, Schmidt-Graf F. Residents as teachers in Neurology: a Germany-wide survey on the involvement of neurological residents in clinical teaching. Neurol Res Pract 2022; 4:17. [PMID: 35527309 PMCID: PMC9080961 DOI: 10.1186/s42466-022-00170-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/03/2022] [Indexed: 11/28/2022] Open
Abstract
Background Residents play an important role in the clinical training of medical students, spending up to 25% of their daily work teaching. In the US medical curriculum didactic courses for residents already exist and their role as a teacher is firmly anchored. In Germany, there are no fixed regulations or residents-as-teachers-programs. The aim of this study was to evaluate the activities of neurological residents in clinical teaching.
Methods We conducted a prospective cross-sectional online survey among neurological residents in Germany. The evaluation was carried out descriptively and by means of text analysis. Results 138 residents from 39 German neurological university hospitals answered the survey. Nearly half of them needed the teaching activity as part of their career planning. The residents are mostly involved in practical courses. More than 80% stated, that they enjoy teaching. 64% stated that there were no preparatory courses for teaching at their hospital/university. 78.4% of the respondents received no or merely insufficient feedback for their own teaching and 62.5% had only little or even no knowledge about the university curriculum. Conclusions By teaching medical students, residents play an outstanding role in recruiting students for neurology and, simultaneously, teaching leads an improvement in the residents’ own learning. To encourage young neurologists as teachers and—at the same time as learners—Clinic directors and universities should promote residents-as-teachers programs in neurology and reward the residents’ teaching activities. Supplementary Information The online version contains supplementary material available at 10.1186/s42466-022-00170-3.
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Affiliation(s)
- Anne-Sophie Biesalski
- Department of Neurology, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany.
| | - Lars Tönges
- Department of Neurology, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany.,Center for Protein Diagnostics (ProDi), Ruhr University Bochum, Bochum, Germany
| | | | - Eileen Gülke
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna Eisenberg
- Department of Neurology, Universität Medical Center Göttingen, Göttingen, Germany
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Biesalski AS, Hoffjan S, Schneider R, Nguyen HP, Dekomien G, Lücke T, Schneider-Gold C, Matusche B, Gold R, Ayzenberg I. Phoenix from the ashes: dramatic improvement in severe late-onset methylenetetrahydrofolate reductase (MTHFR) deficiency with a complete loss of vision. J Neurol 2021; 269:2206-2209. [PMID: 34657180 PMCID: PMC8940754 DOI: 10.1007/s00415-021-10841-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Anne-Sophie Biesalski
- Department of Neurology, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany.
| | - Sabine Hoffjan
- Department of Human Genetics, Ruhr-University, Bochum, Germany.,Center for Rare Diseases Ruhr (CeSER), Bochum, Germany
| | - Ruth Schneider
- Department of Neurology, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Huu Phuc Nguyen
- Department of Human Genetics, Ruhr-University, Bochum, Germany.,Center for Rare Diseases Ruhr (CeSER), Bochum, Germany
| | - Gabriele Dekomien
- Department of Human Genetics, Ruhr-University, Bochum, Germany.,Center for Rare Diseases Ruhr (CeSER), Bochum, Germany
| | - Thomas Lücke
- University Children's Hospital, St. Josef Hospital, Bochum, Germany.,Center for Rare Diseases Ruhr (CeSER), Bochum, Germany
| | | | - Britta Matusche
- Institute of Neuroradiology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany.,Department of Neurology, Sechenov First Moscow State Medical University, Moscow, Russia
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Biesalski AS, von Kirchbauer I, Schmidt-Graf F. Neurological teaching in times of crisis. GMS J Med Educ 2020; 37:Doc69. [PMID: 33364348 PMCID: PMC7740022 DOI: 10.3205/zma001362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 06/01/2023]
Abstract
Background/Objective: The changes to medical studies that became necessary as part of the Corona pandemic have also forced considerable adjustments in Neurology. Classroom teaching had to be converted almost entirely to digital formats within a short period of time. The present study provides an overview of the respective changes and associated complications as well as opportunities in teaching Neurology. Methodology: Lecturers in Neurology at all University hospitals in Germany were asked about their approach and the individual changes in their curriculum. Of a total of 39 locations, 23 answered the online questionnaire (see attachment 1). Results: While frontal teaching and lectures could be carried out digitally without any problems, difficulties arose especially in learning physical examination and bedside teaching. Most of the participants stated that they had not found satisfactory e-learning formats to replace teaching at the patients bed. Conclusion: The ad hoc changes in teaching Neurology resulted in significant additional effort for the part of lecturers, but were generally well accepted by students. The Corona pandemic thus ultimately offers an opportunity to enrich teaching in Neurology.
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Affiliation(s)
- Anne-Sophie Biesalski
- Ruhr-Universität Bochum, Neurologische Klinik St. Josef Hospital Bochum, Bochum, Germany
| | - Isabelle von Kirchbauer
- Technische Universität München, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
| | - Friederike Schmidt-Graf
- Technische Universität München, Klinikum rechts der Isar, Klinik und Poliklinik für Neurologie, Munich, Germany
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Beyer L, Günther R, Koch JC, Klebe S, Hagenacker T, Lingor P, Biesalski AS, Hermann A, Nabers A, Gold R, Tönges L, Gerwert K. TDP-43 as structure-based biomarker in amyotrophic lateral sclerosis. Ann Clin Transl Neurol 2020; 8:271-277. [PMID: 33263951 PMCID: PMC7818221 DOI: 10.1002/acn3.51256] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/11/2022] Open
Abstract
Pathologic alterations of Transactivation response DNA‐binding protein 43 kilo Dalton (TDP‐43) are a major hallmark of amyotrophic lateral sclerosis (ALS). In this pilot study, we analyzed the secondary structure distribution of TDP‐43 in cerebrospinal fluid of ALS patients (n = 36) compared to Parkinson´s disease patients (PD; n = 30) and further controls (Ctrl; n = 24) using the immuno‐infrared sensor technology. ALS patients could be discriminated from PD and Ctrl with a sensitivity/specificity of 89 %/77 % and 89 %/83 %, respectively. Our findings demonstrate that TDP‐43 misfolding measured by the immuno‐infrared sensor technology has the potential to serve as a biomarker candidate for ALS.
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Affiliation(s)
- Léon Beyer
- Center for Protein Diagnostics (ProDi), Ruhr University Bochum, Bochum, Germany.,Faculty of Biology and Biotechnology, Department of Biophysics, Ruhr University Bochum, Bochum, Germany
| | - René Günther
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
| | - Jan Christoph Koch
- Department of Neurology, University Medicine Göttingen, Göttingen, Germany
| | - Stephan Klebe
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Tim Hagenacker
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Paul Lingor
- Department of Neurology, University Medicine Göttingen, Göttingen, Germany.,School of Medicine, Klinikum rechts der Isar, Department of Neurology, Technical University of Munich, Munich, Germany
| | - Anne-Sophie Biesalski
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Andreas Hermann
- Translational Neurodegeneration Section "Albrecht-Kossel", Department of Neurology, University Medical Center Rostock, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Andreas Nabers
- Center for Protein Diagnostics (ProDi), Ruhr University Bochum, Bochum, Germany.,Faculty of Biology and Biotechnology, Department of Biophysics, Ruhr University Bochum, Bochum, Germany
| | - Ralf Gold
- Center for Protein Diagnostics (ProDi), Ruhr University Bochum, Bochum, Germany.,Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Lars Tönges
- Center for Protein Diagnostics (ProDi), Ruhr University Bochum, Bochum, Germany.,Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Klaus Gerwert
- Center for Protein Diagnostics (ProDi), Ruhr University Bochum, Bochum, Germany.,Faculty of Biology and Biotechnology, Department of Biophysics, Ruhr University Bochum, Bochum, Germany
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Kühn E, Averdunk P, Huckemann S, Müller K, Biesalski AS, Hof Zum Berge F, Motte J, Fisse AL, Schneider-Gold C, Gold R, Pitarokoili K, Tönges L. Correlates of polyneuropathy in Parkinson's disease. Ann Clin Transl Neurol 2020; 7:1898-1907. [PMID: 32940017 PMCID: PMC7545593 DOI: 10.1002/acn3.51182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/17/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
Objective Previous studies in Parkinson’s disease (PD) patients have demonstrated a high prevalence of polyneuropathy (PNP) and pronounced alpha‐Synuclein pathology in dermal nerve fibers already at early disease stages. The aim of this study was to analyze associations between the prevalence and severity of PNP with nonmotor and motor symptoms in PD patients. Methods Fifty PD patients were characterized comprehensively for the presence of clinical symptoms (nonmotor and motor), electrophysiologic alterations and – for the first time – using high‐resolution ultrasound of peripheral nerves. Results Sixty‐two percent of PD patients showed electrophysiological pathology of PNP. The prevalence of patient‐reported PNP symptoms was 86% and was particularly present in patients with longer disease duration, compromised scores of nonmotor and motor symptoms as well as with a negative evaluation of quality of life. Seventy‐five percent of patients showed morphologic alterations similar to axonal PNP in high‐resolution ultrasound compared to healthy controls. Interpretation The study demonstrates the high burden of peripheral nervous system disease in Parkinson's disease. It advocates further studies to delineate the underlying pathophysiological mechanisms in order to optimize treatment approaches for PD, including the associated PNP.
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Affiliation(s)
- Eva Kühn
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| | - Paulina Averdunk
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| | - Sophie Huckemann
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| | - Katharina Müller
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| | | | | | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| | | | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany.,Neurodegeneration Research, Centre for Protein Diagnostics (ProDi), Ruhr-University, Bochum, Germany
| | | | - Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany.,Neurodegeneration Research, Centre for Protein Diagnostics (ProDi), Ruhr-University, Bochum, Germany
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