State of implementation of the Corona-Virus-Disease-2019 resuscitation guidelines : An online-based survey one year after publication in Germany

BACKGROUND

The present study evaluated the implementation of the European Resuscitation Council Corona-Virus-Disease 2019 (COVID-19) resuscitation guidelines in Germany 1 year after publication.

AIM OF THE WORK

To evaluate the practical implementation of the COVID-19 resuscitation guidelines in Germany one year after their publication.

MATERIAL AND METHODS

In an online survey between April and May 2021 participants were asked about awareness of COVID-19 resuscitation guidelines, corresponding training, the resuscitation algorithm used and COVID-19 infections of emergency medicine personnel associated with COVID-19 resuscitation.

RESULTS

A total of 961 (8%) of the 11,000 members took part in the survey and 85% (818/961) of questionnaires were fully completed. While 577 (70%) of the respondents were aware of the COVID-19 guidelines, only 103 (13%) had received respective training. A specific COVID-19 resuscitation algorithm was used by 265 respondents (32%). Adaptations included personal protective equipment (99%), reduction of staff caring for the patient, or routine use of video laryngoscopy for endotracheal intubation (each 37%), securing the airway before rhythm analysis (32%), and pausing chest compressions during endotracheal intubation (30%). Respondents without a specific COVID-19 resuscitation algorithm were more likely to use mouth-nose protection (47% vs. 31%; p < 0.001), extraglottic airway devices (66% vs. 55%; p = 0.004) and have more than 4 team members close to the patient (45% vs. 38%; p = 0.04). Use of an Filtering-Face-Piece(FFP)-2 or FFP3 mask (89% vs. 77%; p < 0.001; 58% vs. 70%; p ≤ 0.001) or performing primary endotracheal intubation (17% vs. 31%; p < 0.001) were found less frequently and 9% reported that a team member was infected with COVID-19 during resuscitation.

CONCLUSION

The COVID-19 resuscitation guidelines are still insufficiently implemented 1 year after publication. Future publication strategies must ensure that respective guideline adaptations are implemented in a timely manner.

[Case-based learning in thoracic surgery : A comparison between online and face-to-face teaching]

BACKGROUND

In modern medical education, traditional face-to-face teaching is increasingly being supplemented by innovative teaching methods, such as case-based learning or e‑learning.

AIM OF THE WORK

Design and evaluation of a new course concept in thoracic surgery to motivate students and at the same time find ways to relieve the medical staff in their teaching activities.

MATERIAL AND METHODS

All students of the third clinical semester at the University of Regensburg completed a case-based course on the topic of pulmonary nodules in the summer semester 2016 and winter semester 2016/2017 as part of the practical course in thoracic surgery. This involved a moderated face-to-face seminar for one group of students and a purely online event for the other group. The knowledge gain and the subjective learning experience of the students were evaluated via questionnaires.

RESULTS

A total of 190 students took part in the courses, 88 in the face-to-face course and 102 in the online course. Although both groups recorded a significant increase in knowledge as a result of the course intervention, the students in the face-to-face course showed significantly higher subjective satisfaction compared to their peers in the online course.

CONCLUSION

Case-based learning was shown to be a promising concept in thoracic surgery education, although establishing online learning procedures proved to be more challenging than presence-based teaching.

[Teaching otorhinolaryngology in times of COVID-19: to what extent can digital formats replace face-to-face teaching?]

OBJECTIVE

Due to the coronavirus disease 19 (COVID-19) pandemic, postgraduate training in otorhinolaryngology in 2020 was transferred completely from face-to-face to digital teaching. This paper assesses whether this change was possible without a reduction in the quality of teaching and learning.

METHODS

Results of final written examinations were compared for the years 2016-2020, and the results of the teaching evaluation by the students for 2017-2020. The evaluation by students in 2020 included additional questions related to the switch from face-to-face to digital teaching. Additionally, the lecturers and teachers were asked for their assessments.

RESULTS

Results of the final written examination did not show any significant differences between 2016-2019 and 2020. Students were highly satisfied with the digital format, but values did not reach the level of former years with face-to-face-teaching. Especially the interaction with patients and the teaching of manual skills were rated lower in the digital format. Lecturers emphasized the additional workload for preparation of digital teaching.

CONCLUSION

The results of written examinations showed no difference between digital and face-to-face teaching. Online communication and interaction were reduced and regarded as cumbersome by students and faculty. Digital solutions providing more interaction and active participation are required. The digital format is more appropriate for teaching basic knowledge than for teaching practical skills.

[Ophthalmic emergencies: training via interactive key feature cases for medical students]

BACKGROUND

Autonomous diagnosis and assessment of medical emergencies are important skills to acquire for medical students. Ophthalmology features certain specialty-specific "red flag" signs and symptoms, which pose a challenge for educators in ophthalmology. To support medical students in identifying those "red flags" we developed and implemented interactive cases for our e‑learning platform.

MATERIAL AND METHODS

A total of seven interactive cases with key feature problems regarding potentially dangerous signs and symptoms, such as painless loss of vision or red eye were developed. Medical students were guided through a case and performed formative assessments. The interactive cases were created with e‑learning authoring software and were available on the learning management system presence of the department of ophthalmology. They were mandatory for medical students in the ophthalmology course. Students evaluated the cases after the course.

RESULTS

The interactive cases were rated on average at 1.51 ± 0.68 (mean ± standard deviation; n = 163) on a grade scale (1 = best, 6 = worst). On a Likert scale they were perceived as helpful for individual learning at 1.60 ± 0.81 (1 = very helpful, 7 = not helpful at all; n = 164). The information provided on the cases and selection of scenarios was positively evaluated.

CONCLUSION

To support students in identifying and managing ophthalmic emergencies in the context of limited time in tightly packed curricula, interactive key feature cases can be part of corresponding e‑learning resources. An integration of such cases was evaluated as desirable.

[Online examination course instead of classroom teaching: adaptation of medical student teaching during the COVID-19 pandemic]

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic restricted face-to-face interactions of medical students and teachers.

OBJECTIVE

To develop and evaluate an online course for ophthalmology examination techniques for medical students and to determine the impact of the course on the practical objective structured clinical examination (OSCE).

MATERIAL AND METHODS

The online examination course was developed as a video-based tutorial according to the SMART (specific, measurable, activating, reasonable, time-bound) principle covering all topics of the National Competency-based Catalogue of Learning Objectives for Medical Education and made available to medical students in the ophthalmology course. At the end of the semester the students graded the online examination course on an ordinal scale from 1 (strongly agree) to 6 (strongly disagree) anonymously and were asked for comments. The grades of the OSCE (range 1-5) were compared with the OSCE results of the previous semester.

RESULTS

Of the 164 students 67 participated in the online evaluation (41%). The students reported to be well-prepared for the OSCE (mean grade 2.0; SD 1.0). In the future, 70% of the students would prefer combined online and on-site teaching (47 out of 67 students). Among all 164 students, the mean OSCE results were excellent (mean grade 1.1; SD 0.2) and comparable to the previous semester (mean grade among 166 students, 1.1; SD 0.2; two-sided t-test, p = 0.86).

CONCLUSION

The online course on ophthalmology examination techniques allowed medical students to prepare for the OSCE. Beyond the COVID-19 pandemic, online teaching options can support on-site teaching.

Gender differences in examination behavior of 4th grade medical students : Results from an observational study on ECG e-learning

Background

Computer-assisted teaching is becoming increasingly more important to acquire new knowledge and skills in medical curricula. The consequence of gender-characteristic personality traits on academic performance in e‑learning examinations are difficult to forecast. This study investigated gender-related differences in examination behavior among undergraduate medical students taking a web-based quiz.

Methods

A total of 1315 4th grade medical students at the Medical University of Vienna completing the compulsory online moodle-based ECG quiz 2017/2018 were enrolled into this observational study. Individual data of examination behavior and quiz results as well as results of the final annual exam were extracted. Students were grouped into 10 strata according to academic performance. Variables between both sexes were compared using a nonparametrical test. Examination variables were correlated to performance.

Results

Of the total study population 686 (52%) were female and 629 (48%) were male. The time until the first attempt and number of attempts performed was comparable between both sexes, however female students spent more time on the first attempt compared to their male colleagues (1592 sec [Q1–Q3: 999–2536] vs 1405 sec [Q1–Q3: 828–2395], p = 0.002), suggesting a higher self-discipline and risk-aversity. There was no difference regarding quiz scores or final ECG examination scores between female and male students (p = 0.869 and p = 0.396). Students who accessed the quiz earlier and less time spent for the first attempt tended to perform better at the final examination (r_s = 0.20, p < 0.001 and r_s = −0.15, p < 0.001).

Conclusions

Gender-related differences in examination behavior already described for nononline based examinations are similarly observable in e‑learning. For this test, gender-immanent traits seem not to twist final examination results and impact academic performance.

[Virtual palliative care : Pilot study of an electronic tool to test cognitive, psychomotor and affective palliative medical and pain therapeutic learning contents during medical training]

BACKGROUND

This article describes a first use of an electronic case-based assessment tool in undergraduate palliative care education. It describes the development of the tool presenting strengths and shortcomings in order to contribute to an innovative design of assessment tools in medical education.

DESIGN AND METHOD

An electronic (virtual) case-based assessment tool (the virtual palliative patient, vPp) was developed. Palliative care levels of knowledge, skills and attitude of students were tested at a computer workplace as a voluntary and non-performance-relevant pilot project at four faculties.

RESULTS

On average the students achieved 80% of the points using the vPp tool, which is below the average score of 91% achieved in the regular examination. In particular, the free text task on reflection of dealing with the patient's death wish caused uncertainty, while multiple choice questions and an interactive conversation sequence were perceived as relatively easy. Technical problems were also identified in the evaluation but overall the concept was evaluated positively and establishment as a regular examination or e‑learning tool was desired.

CONCLUSION

The implementation of an innovative assessment tool in medical education is technically challenging. A coordination with contents of the individual faculties is necessary in order that students do not have a feeling of a lack of preparation. The development of the vPp describes an innovative assessment format. In the long term, all interested faculties could receive a form of toolbox containing the technical framework of the assessment tool, which can then be fed with new contents.

[Distance learning during the COVID-19-related school closings: the perspective of students from secondary schools]

In the course of the school closings as part of the protective measures against COVID-19, German schools historically for the first time had the task of ensuring comprehensive distance education for all their pupils. Schools, teachers and students met this challenge of distance education with different practices, without being able to draw on former experience. In the paper, a theoretical framework for analyzing school distance education is developed based on Helmke's "Angebots-Nutzungs-Modell" and research from the new situation. It serves as a base for an empirical analysis of the interrelationship between factors influencing the accomplishment of homework with data from a study with 1128 students from May 2020, with lays special emphasis on the use of digital media.

[Alice in the digital wonderland-pediatric teaching during the COVID-19 pandemic]

The COVID-19 pandemic led to a rapid switch from undergraduate classroom teaching to online-teaching; a challenging process for teachers and students. Based on a recent online survey among German pediatric university hospitals the "AG Lehre der DGKJ" (teaching working group of the German Society of Pediatrics and Adolescent Medicine) summarizes latest experiences with e‑learning during the summer term of 2020. The survey participants from 17 pediatric university hospitals report that the large spectrum of e‑learning formats could sufficiently replace classical lectures and seminars but could not fully replace teaching involving direct contact to patients. The introduction of new digital teaching formats is time-consuming, needs high-quality IT infrastructure, should be embedded in a continuous curriculum and provide the possibility of regular exchange between students and teachers. Teachers should be provided with the opportunity for training in didactic methods and IT skills. These results correspond to the literature on e‑learning in general and undergraduate medical education during the COVID-19 pandemic in particular. The experiences summarized here should not only facilitate the development of e‑learning tools during the ongoing pandemic but also stimulate to establish e‑learning as a valuable component of future pediatric medical education. New digital substitutes for teaching involving pediatric patients need to be developed.The statement was drafted by consensus by the German Society of Pediatrics and Adolescent Medicine Working Group on Teaching and approved by the DGKJ board.

Radiation oncology as part of medical education-current status and possible digital future prospects

Purpose

Education as part of medical education is currently changing rapidly. Not least because of the corona crisis, more and more digital teaching formats and innovative teaching concepts such as the flipped classroom model are finding their way into teaching. We analyzed the acceptance and effectiveness of traditional teaching methods as well as the interest in innovative e‑learning methods among medical students in the field of radiation oncology at the medical school of the Technical University of Munich.

Methods

We carried out an online-based survey as well as a knowledge test on all students from two terms who had completed the seminar series of radiation oncology. The survey comprised seven questions on the frequency of participation, acceptance, and judgment of the effectiveness in terms of learning and on a potential use of e‑learning methods using a six-point Likert scale. The test consisted of 10 multiple-choice questions.

Results

Traditional teaching methods are largely accepted by students and most students consider the current learning format to be effective in terms of the teaching effect in the field of radiation oncology. However, only about 50% of all knowledge questions were answered correctly. The possible use of e‑learning methods was judged critically or desired in roughly equal parts among the students.

Conclusion

Traditional seminars enjoy a high level of acceptance among students. Effectiveness with regard to the internalization of content taught, however, should be increased. After all, the future seems to lie in the integration of e‑learning in the form of educational videos and practical seminars.

Case-based blended eLearning scenarios-adequate for competence development or more?

BACKGROUND

Learning, competence development and scientific thinking in medicine need several strategies to facilitate new diagnostic and therapeutic ways. The optimal collaboration between creative thinking and biomedical informatics provides innovation for the individual patient and for a medical school or society. Utilizing the flexibilities of an e‑learning platform, a case based blended learning (CBBL) framework consisting of A) case based textbook material, B) online e‑CBL with question driven learning scenarios and C) simulated patient (SP) contact seminars was developed and implemented in multiple medical fields. Real-life clinical cases were anonymized and transferred into an interactive and an interdisciplinary eLearning platform.

METHODS

As an example of the offered clinical teaching-case collection, an example of a psychiatric case for the disease "posttraumatic stress disorder (PTSD)" is presented: a 30-year-old man with a history of insomnia with difficulties in falling asleep and sleeping through, nightmares, nervousness and psychomotor restlessness. The students are challenged to identify possible differential diagnoses and further get to know the patient's personal history (loss of relatives due to war, torture and flight from home country). Further, the students are guided through the principles of fear conditioning including translational aspects like neurotransmitter signaling of PTSD pathomechanism (translational and research aspects like dopamine transporter gene polymorphism, long term potentiation and synaptic signaling).

RESULTS/CONCLUSION

The case presentation comprises different learning aspects: First, declarative knowledge has to be acquired and collected in basic medical sciences, knowledge that is in fact available and can be accessed on the conscious and preconscious level in long-term memory. Second, associative learning leads to the formation of neuronal connections and is an important way of learning and discovering, founded in neural associations. Third, polythematic-crosslinking thinking is needed as ability to link information in a meaningful way. These steps are a typical intellectual ability of gifted learners and researchers that combine previously seemingly unrelated areas to each other and drive innovation.

[Implementation and evaluation of a revised curriculum for psychiatry and psychotherapy]

BACKGROUND

Medical education in the discipline of psychiatry and psychotherapy at the University of Münster was traditionally focused on the transfer of knowledge via lectures. According to the current guidelines, the medical curriculum was modified as from the winter semester 2016/2017 to be more competency-based and the changes were evaluated.

OBJECTIVE

Lectures and seminars were reduced to achieve a better linkage between theoretical and practical knowledge. Moreover, learning goals were formulated based on the German National Competence-based Catalogue of Learning Objectives in Medicine (NKLM) and entrustable professional activities (EPAs).

MATERIAL AND METHODS

Almost all previous lectures are now replaced by an inverted classroom concept with e‑learning. Theoretical knowledge is deepened by immediate multiple choice (MC) examinations and a seminar, which now focusses on specific practical EPAs. At the end of the semester, the students now undergo a practical, formative examination with simulated patients (actors) in addition to the former MC test. For evaluation, a representative sample of a semester cohort which took part in the previous curriculum and a similar cohort which attended the revised curriculum were investigated. Moreover, variables which might have an impact on the results were assessed, e. g. pre-existing psychiatric knowledge and motivation.

RESULTS

Students taught by the modified curriculum showed a significantly better practical performance and no reduction of theoretical knowledge. Relevant influencing factors were not identified.

CONCLUSION

The results show that a competency-based modification of the curriculum in the discipline of psychiatry and psychotherapy leads to more practical abilities and thus helps future physicians to be more self-determined.