[Overview on research in the field of medical education]

Structure and quality of bedside teaching: A videographic analysis

Bedside teaching (BST) is a core element of medical education. In light of a reported decrease in BST, evidence on how to use BST time most efficiently should be developed. Given that little research into the tangible quality characteristics of good BST has been reported, we investigated the influence of various teacher and structural characteristics on the perceived quality of BST. We filmed and coded 36 BSTs involving 24 lecturers and 259 students. Structural characteristics of interest were: number of students and patients, overall duration, and the proportion of clinical examination. Lecturer questionnaires provided insight into teaching experience and intrinsic motivation, and student evaluations assessed the quality of BSTs in three dimensions. Correlations are reported using the Pearson r and a linear mixed model (LMM). The intrinsic motivation of lecturers was significantly positively correlated with perceived quality, but their experience was only weakly so correlated. In the LMM, a significant association was observed for the quality dimension of clinical teaching with the number of patients and the proportion of time spent on clinical examination. Based on our findings, we recommend including multiple patients in BSTs, and providing substantial opportunities for clinical examination. Regarding lecturers, motivation matters more than experience.

[Traumatology-an interdisciplinary task: exclusively for educational purposes?]

BACKGROUND

Traumatology of the head and neck region is not only a part of otorhinolaryngology, but also has a large overlap with neighboring disciplines of the head and neck region. In Freiburg, an interdisciplinary lecture on "ENT emergencies" was implemented in the 21/22 winter semester. The aim was to provide an even more realistic view on interdisciplinary patient care and to make evident the areas of intersection of four of the major head disciplines (otorhinolaryngology, neurosurgery, ophthalmology, and maxillofacial surgery).

MATERIALS AND METHODS

A new, special lecture in otorhinolaryngology was implemented as part of the regular online lecture series accompanying the semester. With reference to the clinical care of ENT emergencies, possible overlaps with neighboring disciplines were identified and explained by the discipline representatives or discussed in front of and with the auditorium. At the end of the semester, all participating students (n = 173) were invited to evaluate the seminar using the survey tool "EvaSys" (EvaSys GmbH, Lüneburg, Germany). In total, 78 students participated in the evaluation process.

RESULTS

The new lecture concept was very well accepted and immediately ranked top among the interdisciplinary lecture titles within the ENT lecture series. The clear communication of the term "interdisciplinarity" in the sense of a complementary clinical cooperation was also very successful and was appreciated accordingly by students during the evaluation process.

CONCLUSION

Pragmatic presentation of ideal clinical patient care using an interdisciplinary approach is possible within the regular ENT lecture series. This realistic portrayal, beyond any technical and/or professional differences, is of great interest to students and is considered clinically relevant. Thus, interdisciplinary lectures provide a valuable tool to teach the fundamental values of clinical interdisciplinary management for the best possible patient care.

How is modern bedside teaching structured? A video analysis of learning content, social and spatial structures

BACKGROUND

Bedside teaching (BST) is an essential and traditional clinical teaching format. It has been subject to various impediments and has transformed over time. Besides a decrease in bedside time, there has also been a didactic diversification. In order to use time at the bedside effectively and understand the current design of BST, we here offer an evidence-based insight into how BST is practiced. This may serve as a basis for a refinement of its didactic design.

METHODS

In the current study, we investigate the interrelationships between learning content and the social as well as spatial structures of BST. To this end, we have empirically analysed almost 80 hours of video material from a total of 36 BST sessions with good interrater reliability.

RESULTS

BST lasted on average 125 min, most of which was spent in plenary and less than a third of the time at the patient's bedside. History taking was primarily practiced at the bedside while case presentations, clinical reasoning and theoretical knowledge were largely taught away from the patient. Clinical examination took place to a similar extent in the patient's room and in the theory room.

CONCLUSIONS

Even though the filmed BSTs are not purely "bedside", the teaching format investigated here is a typical example of undergraduate medical education. In order to maximize the teaching time available, a suitable learning space should be provided in addition to the bedside. Moreover, the clinical examination should be revised in its general sequence prior to the BST, and conscious decisions should be made regarding the social structure so as to optimize the potential of small groups and plenary sessions.

[Interactive intraoperative annotation of surgical landmarks in student education to support learning efficiency and motivation]

BACKGROUND

The development of technological innovations has not only changed social life and the healthcare system, but also affects medical education. The aim of this pilot study was to evaluate whether students, when observing a microsurgical procedure of the temporal bone, gain an additional understanding of the anatomical structures and surgical site when visualization is used that provides identical views for the surgeon and viewer in 3D.

MATERIALS AND METHODS

During regular attendance tutorials, students were randomly assigned to three different groups: control group, 2D group, or 3D group. Evaluation questionnaires and intraoperative student annotation of the surgical view were used to assess the subjective didactic value of different visualization formats and resultant learning experiences for the students.

RESULTS

A total of 47 students were included in the investigations during conventional attendance tutorials. The majority indicated a high added value of the 3D visualization in terms of method (70%) and vividness (80%) compared to the 2D group and self-study; 69% of the students fully agreed with the statement that 2D and 3D visualization increases learning motivation and is a very good way to improve recognition of anatomical topography and structures.

CONCLUSION

New interactive visualization options in teaching promote learning efficiency and motivation among students. Especially 3D visualization and intraoperative annotation of the surgical view by the student is a useful didactic tool and increases the quality of clinical teaching. It supports the perception of anatomical topography and enables more focused surgical training.

[The diagnostic course : A new form of teaching in otorhinolaryngology education]

Hintergrund

Fehlende praktische Übungen sowie Anstieg der Studierendenzahlen führen zu der Notwendigkeit innovativer Lehrmethoden. Wir etablierten einen Diagnostik-Parcours zur Darstellung der Sinne unseres Faches.

Ziel der Arbeit

Das vorwiegende Ziel der Einführung des Diagnostik-Parcours war die kompakte Darstellung der Funktionsdiagnostik einer HNO(Hals-Nasen-Ohrenheilkunde)-Abteilung sowie die praktische und abwechslungsreiche Gestaltung des bestehenden Blockpraktikums.

Material und Methoden

Am ersten Tag des fünftägigen Blockpraktikums wird ein „HNO-Spiegelkurs“ durchgeführt, bei dem die Studierenden lernen, einen HNO-Spiegelbefund zu erheben. Nach der Einteilung auf den HNO-Stationen, in der Poliklinik sowie in den Operationssälen erfolgt am 5. Tag der Diagnostik-Parcours, bei dem vier verschiedene Stationen der Diagnostik einer HNO-Klinik in praktischen Übungen durchlaufen werden.

Ergebnisse

In der Evaluation des Blockpraktikums konnten wir unsere Bewertung durch Einführung des Diagnostik-Parcours signifikant verbessern. So lag im Sommersemester 2019 die Note bei 1,4 bei 38 % von n = 105. Auch persönliche Rückmeldungen sowie mehrere Famulaturanfragen verdeutlichen das positive Feedback.

Schlussfolgerung

Der Vorteil des Diagnostik-Parcours ist die Möglichkeit, praktische Fertigkeiten direkt anzuwenden. Außerdem ist die kleine Gruppengröße von maximal fünf Studierenden als positiv zu werten. Somit kann das Fach der Hals-Nasen-Ohren-Heilkunde mit seinem abwechslungsreichen Charakter attraktiv dargestellt werden. Auch wenn der vorgestellte Parcours einen hohen personellen Aufwand bedeutet, sollte dies in der universitären Lehre ermöglicht werden.

["Online from tomorrow on please": comparison of digital framework conditions of curricular teaching at national university ENT clinics in times of COVID-19 : Digital teaching at national university ENT clinics]

Hintergrund

Die Corona-Krise beeinflusst nicht nur das professionelle Handeln, sondern auch die Lehre an den Universitäten. Schlagworte wie „E-Learning“ und „Digitalisierung“ suggerieren die Möglichkeit innovativer, ad hoc verfügbarer Lösungsansätze für die Lehre in der aktuellen COVID-19-Situation. Die aktuelle Umstellung auf digitale Lehre ist aber nicht primär durch eine didaktische Sinnhaftigkeit oder institutionelle Strategie, sondern durch äußere Notwendigkeit geprägt.

Ziel der Arbeit

Ziel der Arbeit war die Erfassung der Lehrsituation an nationalen Universitäts-HNO-Kliniken und akademischen Lehrkrankenhäusern zu Beginn des virtuellen Corona-Sommersemesters 2020.

Material und Methode

Ein eigens erstellter Fragebogen zur jeweiligen lokalen Situation, den örtlichen Rahmenbedingungen sowie zu bundesweiten Szenarien wurde an alle 39 nationalen Universitäts-HNO-Kliniken und 20 akademischen Lehrkrankenhäuser mit HNO-Hauptabteilung versandt.

Ergebnisse

Die ausgefüllten Fragebögen von 31 Universitätskliniken (UK) und 10 akademische Lehrkrankenhäuser (ALK) gingen in die Auswertung ein. Es zeigten sich offensichtliche Diskrepanzen zwischen verfügbaren Ressourcen und tatsächlich verfügbaren digitalisierten Lehrinhalten. Weitere Kritikpunkte offenbarten sich in Bezug auf die Kommunikation mit der Medizinischen Fakultät, die digitale Infrastruktur und insbesondere in der oftmals mangelnden Kollaboration mit den zentralen Supportstrukturen, wie Medien‑, Didaktik- und Rechenzentren.

Schlussfolgerung

Es gibt durchaus positive Beispiele für eine gelungene Überführung der Präsenzlehre in das ausschließlich virtuelle Sommersemester 2020 innerhalb der Universitäts-HNO-Kliniken. Mehrheitlich aber überwiegen kritische Einschätzungen der Lehrbeauftragten bzw. Ärztlichen Direktoren gegenüber der aktuellen Lehrsituation. Eine zeitkritische strategische Weiterentwicklung ist dringend erforderlich.

Evaluating the didactic value of 3D visualization in otosurgery

Introduction

Improvements of surgical visualization add value to the quality of clinical routine and offer the opportunity to improve surgical education of medical staff. The aim of this study was to determine whether otorhinolaryngology trainees gain additional comprehension of the anatomical structures and the surgical site when 3D visualization is used.

Methods

Data were collected from ENT trainees of microsurgical courses of the middle ear, inner ear and lateral skull base at four university ENT departments (Charité (Berlin), Martin Luther University Halle-Wittenberg (Halle/Saale), Ludwig Maximilian University (Munich) and Rostock University Medical Center). Participants were asked to complete a questionnaire assessing the subjective value of identical surgical field visualization in 3D for surgeon and observer.

Results

A total of 112 participants completed the questionnaire. The majority of participants stated a high additional value of 3D visualization compared to 2D visualization, with 75% fully agreeing to the statement that 3D visualization of the surgical field is superior to perceive the anatomical topography and structures compared to 2D representation. Participants encouraged the storage of data in online learning platforms.

Conclusion

The results show that 3D visualization with identical imaging for surgeon and observer is a useful tool in teaching of microsurgery. It addresses perception of anatomical topography and structures as well as conception of the surgical workflow.

Electronic supplementary material

The online version of this article (10.1007/s00405-020-06171-9) contains supplementary material, which is available to authorized users.

Is it time for transition from the subject-based to the integrated preclinical medical curriculum?

In the 60s of the last century, a number of new universities in the world began to apply an integrated program of medical education, the cornerstone of which was problem-oriented education. Thus, the Flexner model of higher education adopted by that time in most countries of the world, with its characteristic segregation of teaching of the theoretical and clinical disciplines, which had ceased to satisfy the needs of modern healthcare, was gradually replaced by a new system that put the student in the center of the educational process and opened the way to active methods of teaching being focused on the end result – training of graduates whose qualifications most fully satisfy the needs of society. Over the half-century history of its existence, this system has been adopted by most medical universities in different countries of the world, in many of which it has undergone significant modifications in accordance with the needs of national educational standards. Many medical universities in Russia and other countries of the former Soviet Union showed interest in this system, some of the medical faculties of our country accepted certain elements of it. However, up to date no integrated preclinical medical education program has been applied in any of the Russian universities. Hereby we are undertaking an attempt to analyze the reasons and assess the possible perspectives for the transition of medical universities in Russia to teaching of fundamental and biomedical disciplines using the integrated curriculum.