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Abstract
ZusammenfassungDieser Beitrag stellt drei wesentliche Aspekte zum lebenslangen Lernen in der Medizin vor: (1) die Orientierung der Ausbildungsziele an beruflichen Kompetenzen (Kompetenzbasierung, unterstützt durch „entrustable professional activities“), (2) Befunde zur Entwicklung von beruflicher Expertise (Dreyfus-Modell und „dual process theory“) sowie (3) das CanMEDS(Canadian-Medical-Education-Directives-for-Specialists)-Rollenmodell zur Beschreibung der ärztlichen Handlungsfelder, das auch auf andere medizinische Berufe anwendbar ist. Alle drei Aspekte beeinflussen einander wechselseitig und müssen daher in einem gemeinsamen Kontext gesehen werden.
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Abstract
Entrustable professional activities (EPAs) are characterized as self-contained units of work in a given typical clinical context, which may be entrusted to a trainee for independent execution at a certain point of training. An example could be the intraoperative anesthesia management of an ASA 1 patient for an uncomplicated surgical intervention as an EPA in early postgraduate anesthesia training. The EPAs can be described as an evolution of a competency-based medical educational concept, applying the concept of the competencies of a person to specific workplace contexts. In this way the expected level of skills and supervision at a certain stage of training have a more practical meaning and the danger of fragmentation of individual competencies in the competence-based model is avoided. It is a more holistic view of a trainee. Experience with this new concept is so far limited, therefore, further studies are urgently needed to determine whether and how EPAs can contribute to improvements in further training.
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Haugland H, Uleberg O, Klepstad P, Krüger A, Rehn M. Quality measurement in physician-staffed emergency medical services: a systematic literature review. Int J Qual Health Care 2019; 31:2-10. [PMID: 29767795 PMCID: PMC6387994 DOI: 10.1093/intqhc/mzy106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 02/14/2018] [Accepted: 04/25/2018] [Indexed: 12/14/2022] Open
Abstract
Purpose Quality measurement of physician-staffed emergency medical services (P-EMS) is necessary to improve service quality. Knowledge and consensus on this topic are scarce, making quality measurement of P-EMS a high-priority research area. The aim of this review was to identify, describe and evaluate studies of quality measurement in P-EMS. Data sources The databases of MEDLINE and Embase were searched initially, followed by a search for included article citations in Scopus. Study selection The study eligibility criteria were: (1) articles describing the use of one quality indicator (QI) or more in P-EMS, (2) original manuscripts, (3) articles published from 1 January 1968 until 5 October 2016. The literature search identified 4699 records. 4543 were excluded after reviewing title and abstract. An additional 129 were excluded based on a full-text review. The remaining 27 papers were included in the analysis. Methodological quality was assessed using an adapted critical appraisal tool. Data extraction The description of used QIs and methods of quality measurement was extracted. Variables describing the involved P-EMSs were extracted as well. Results of data synthesis In the included papers, a common understanding of which QIs to use in P-EMS did not exist. Fifteen papers used only a single QI. The most widely used QIs were ‘Adherence to medical protocols’, ‘Provision of advanced interventions’, ‘Response time’ and ‘Adverse events’. Conclusion The review demonstrated a lack of shared understanding of which QIs to use in P-EMS. Moreover, papers using only one QI dominated the literature, thus increasing the risk of a narrow perspective in quality measurement. Future quality measurement in P-EMS should rely on a set of consensus-based QIs, ensuring a comprehensive approach to quality measurement.
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Affiliation(s)
- Helge Haugland
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway.,Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Oddvar Uleberg
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway.,Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Klepstad
- Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Anaesthesiology and Intensive Care, St. Olav University Hospital, Trondheim, Norway
| | - Andreas Krüger
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway.,Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marius Rehn
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway.,Department of Health Studies, University of Stavanger, Stavanger, Norway.,Division of Emergencies and Critical Care, Department of Anaesthesia, Oslo University Hospital, Oslo, Norway
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Ischaemic heart disease: accuracy of the prehospital diagnosis-a retrospective study. Emerg Med Int 2013; 2013:754269. [PMID: 23606969 PMCID: PMC3625610 DOI: 10.1155/2013/754269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 02/25/2013] [Indexed: 12/18/2022] Open
Abstract
Purpose. Correct prehospital diagnosis of ischaemic heart disease (IHD) may accelerate and improve the treatment. We sought to evaluate the accuracy of prehospital diagnoses of ischemic heart diseases assigned by physicians. Methods. The Mobile Emergency Care Unit (MECU) in Odense, Denmark, services a population of 260.000. All admissions in 2009 concerning patients diagnosed in the IHD category were assessed. Outcome and diagnosis of each patient were manually validated in accordance to the final diagnosis established following admission to hospital, using the discharge summary from the relevant department as reference. Results. 428 MECU runs with a prehospital diagnosis of IHD were registered. 422 of these were included in the study and 354 of those patients were suitable for this analysis. 73,4% of the patients hospitalized with a prehospital diagnosis of IHD were initially admitted to the relevant ward. Of these patients, 40,0% had their preliminary diagnosis of IHD confirmed. 14,1% of all patients admitted to the hospital were diagnosed with nonheart conditions. Preliminary diagnoses of STEMI had an accuracy of 87,5%. Conclusions. The preliminary IHD diagnoses assigned by the MECU physicians were acceptable. In case of STEMI patients the diagnostic accuracy was excellent. In this study there was an apparent overtriage.
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[Therapy of acute myocardial infarction in the prehospital setting]. Internist (Berl) 2008; 49:1023-30. [PMID: 18629465 DOI: 10.1007/s00108-008-2073-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The time period from symptom onset to hospital admission is of outstanding importance for the prognosis of a patient with an acute myocardial infarction. He is threatened by sudden cardiac death triggered by ventricular fibrillation on the one hand and on the other hand this period offers the chance for a timely decision on the optimal reperfusion strategy. A broad spectrum of therapeutic opportunities regarding thrombolysis, antiplatelets and anticoagulation has been proven to be effective in large randomised trials and registries. These results should influence the individual decision on reperfusion treatment as well as the patient's conditions, time lines, logistics and local resources.
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