Improving competence and safety in pain medicine: a practical clinical teaching strategy for students combining simulation and bedside teaching

[Use of Video Online Seminars During Clinical Phase of Medical Study from the Perspective of Teachers and Students]

AIM OF THE STUDY

The aim of this study was to investigate the opportunities and challenges of using video online seminars (VOS) in the clinical phase of medical studies from the perspective of teachers and students.

METHODOLOGY

Teachers and medical students from the 5th to the 10th semester completed questionnaires about their attitudes towards and experiences with VOS. Recommended procedures for VOS were derived from the results.

RESULTS

A total of 19 teachers and 108 students participated in this study; 67% of students found VOS helpful in the clinical phase of the degree course. Cognitive learning objectives (91% agreement) should be taught more often in the VOS format than affective learning objectives (71% agreement). However, 83% stated that VOS did not prepare them for future practical activities. Teachers indicated that cognitive (77% agreement) could be significantly better communicated than affective learning objectives (only 27% agreement). For two-thirds of the teachers, support or trainings were important. Good technical conditions were important for both groups.

DISCUSSION/CONCLUSIONS

The study shows the option of individual learning regardless of location to be an advantage of VOS. A teaching format is considered to be particularly useful if successful interaction between teacher and student takes place. In the context of blended learning concepts with preceding lectures and subsequent practical exercises, the learning success of VOS is greatest. Cognitive and some affective learning objectives can be achieved by this method. VOS can prepare for practical exercises, but they are not suitable in medical education for comprehensive teaching of practical learning objectives.

The Pain Medicine Curriculum Framework-structured integration of pain medicine education into the medical curriculum

Medical practitioners play an essential role in preventing pain, conducting comprehensive pain assessments, as well as promoting evidence-based practices. There is a need for the development of innovative, interprofessional and integrated pain medicine curricula for medical students. The Pain Medicine Curriculum Framework (PMCF) was developed to conceptualise a purposeful approach to the complex process of curriculum change and to prioritise the actions needed to address the gaps in pain medicine education. The PMCF comprises four dimensions: (1) future healthcare practice needs; (2) competencies and capabilities required of graduates; (3) teaching, learning and assessment methods; and (4) institutional parameters. Curricula need to meet the requirements of registration and accreditation bodies, but also equip graduates to serve in their particular local health system while maintaining the fundamental standards and values of these institutions. The curriculum needs to connect knowledge with experience and practice to be responsive to the changing needs of the increasingly complex health system yet adaptable to patients with pain in the local context. Appropriate learning, teaching and assessment strategies are necessary to ensure that medical practitioners of the future develop the required knowledge, skills and attitudes to treat the diverse needs of patients' experiencing pain. The historical, political, social and organisational values of the educational institution will have a significant impact on curriculum design. A more formalised approach to the development and delivery of a comprehensive pain medicine curriculum is necessary to ensure that medical students are adequately prepared for their future workplace responsibilities.

[Testing of practical surgical teaching at a distance-Experiences with a hybrid OSCE in surgery]

BACKGROUND

The COVID-19 pandemic has changed medical teaching worldwide. Digital teaching and examinations are successful for cognitive learning objectives, whereas practical skills had to be carried out predominantly in person under strict hygiene standards.

AIM

This study presents the opportunities and challenges of using a presence objective structured clinical examination (OSCE) at a distance with digital support.

METHOD

Following surgical practical teaching an OSCE was conducted in presence, where students demonstrated practical skills in one room while the examiners were connected via videoconference from another room. Students were surveyed about the OSCE and sustained learning via a standardized online questionnaire after completion of the surgical teaching. Additionally, examiners were surveyed on their experiences.

RESULTS

In the online survey 40 students participated (25% of n = 157 students contacted) and 36 completed questionnaires were analyzed. Overall, the implementation of an OSCE even under pandemic conditions was perceived as very positive by the students (92% of students n = 33). In particular, the acquisition of practical skills was rated as very high. For 78% (n = 28) of the students, the acquisition of competencies through the practical examination was particularly sustainable. The vast majority of students and examiners felt safe regarding infection control because of the hygiene concept (92%, n = 33). Overall, 80 students achieved grade 1 (51%), 71 students grade 2 (45.2%) and 6 students grade 3 (3.8%) (grade 1 = very good, grade 6 = very bad).

CONCLUSION

Practical examinations are essential for checking practical learning objectives and can be implemented at a distance with a well-developed hygiene concept and digital support.

[The cross-sectional field "pain medicine" in medical studies at the University of Leipzig-What has been achieved? : An analysis of self-estimation of students before, during and 5 years after establishment of the cross-sectional field]

BACKGROUND

The field of pain medicine was established as an obligatory subject area of medical schools in Germany in 2016. No prior study has evaluated the effects of this curricular change on students' competences in the field of pain medicine.

OBJECTIVE

The aim of this study was to find out to what extent the introduction of the additional subject "pain medicine" positively influenced the students' acquisition of competences measured via a self-assessment.

MATERIAL AND METHODS

A longitudinal and interdisciplinary curriculum for pain medicine was developed according to the current recommendations for curriculum development for medical education. In parallel, a questionnaire was created for the students' self-assessment of their own level of knowledge and the importance of pain medicine teaching content on a 5-stage Likert scale. The surveys were conducted before the implementation of the curriculum (2014), directly after the first cohort finished (2016) and 5 years after the implementation (2019) and compared by Kruskal-Wallis test.

RESULTS

The implementation of the curriculum has led to significant improvement in relevant aspects. For example, students now feel better prepared overall for the treatment of pain patients (2.67 in 2014 vs. 3.18 in 2019). Individual sub-aspects such as taking a pain history (3.63 vs. 4.10) or drawing up an analgesia scheme (3.56 vs. 4.14) are now also subjectively better mastered.

CONCLUSION

Even though the results are encouraging, there is further potential for improvement in some sub-areas. For example, the students' rating regarding the question about their preparation for treating patients in pain is not yet satisfactory. Therefore, the curriculum should be developed further with a focus on competence orientation. Digital teaching formats can be integrated as well as interprofessional units and simulated patients. Additionally, the examination formats should be further developed towards standardized practical examinations.

[German national survey of lecturers in ophthalmology on student teaching in the 2020/21 corona pandemic]

Hintergrund

Die Corona-Pandemie hat einen erheblichen Einfluss auf die Bedingungen der universitären studentischen Lehre. Durch die pandemiebedingten Kontaktbeschränkungen kamen vielerorts digitale Lehrformate anstatt der bisherigen Präsenzlehre zum Einsatz. Diese wurde im Sommersemester 2020 durch die Studierenden in bisher vorliegenden Veröffentlichungen teils schon gut angenommen und positiv evaluiert. In dieser Arbeit wurde das Hauptaugenmerk auf die Erfahrungen und Einschätzungen der Lehrenden in der Augenheilkunde während des Wintersemesters 2020/21 gelegt.

Methodik

Anhand zweier anonymisierter Befragungen mittels Online-Fragebögen wurden zum einen die Lehrbeauftragten der Augenheilkunde der deutschen Universitätskliniken sowie zum anderen interne und externe Dozierende und Mitarbeitende in der studentischen Lehre der Augenklinik der Universitätsmedizin Mainz zu ihren Erfahrungen mit der Implementierung der digitalen Lehre befragt.

Ergebnisse

Hierbei gaben 95 % der Lehrbeauftragten der Augenkliniken der Universitätskliniken in Deutschland an, spätestens seit der Corona-Pandemie digitale Lehrkonzepte etabliert zu haben. Bei 68 % kamen Hybridformate mit anteiliger Präsenzlehre zum Einsatz. Es wurden vielfältige Lehrformate angewendet. Hierbei traten auch Schwierigkeiten, insbesondere in der Interaktion mit den Studierenden sowie durch unzureichende technische Ausstattung der Kliniken, auf. Trotz überwiegend digitaler Lehre wurden weiterhin erprobte Prüfungskonzepte in Präsenzform angewendet, nur 18 % der Befragten gaben an, Online-Prüfungen durchgeführt zu haben. Künftig wollen 86 % der Befragten digitale Formate in ihre Lehrkonzepte integrieren und als Ergänzung der bisherigen Präsenzlehre etablieren.

Diskussion

Die Entwicklung der studentischen Lehre während der Corona-Pandemie kann als Chance für die Gestaltung der zukünftigen Ausbildung von Medizinstudierenden in der Augenheilkunde dienen.

Enhanced learning strategies of undergraduate medical students with a structured case presentation format

BACKGROUND

Improvement of the learning in undergraduate bedside teaching needs to be promoted through innovative interventions. Changes in the structured format (SF) for bedside case discussion may help students improve their learning experience and gain insights into collaborative self-directed learning. The aim of the present study was to encourage collaborative and self-directed learning strategies by MBBS undergraduate students through a new case presentation format structured for this purpose.

MATERIALS AND METHODS

This was an interventional study carried out in the year 2010-2011. A new SF for bedside cases presentation was developed. A comparison with the traditional format was done by holding one session in each format. Uniformity of topic and teaching style was ensured by having the sessions on pulmonary medicine cases with the same teacher. The student perspective of the educational process was analyzed using evaluation pro forma, Likert scale, and narratives.

RESULTS

Ninety final year and prefinal year MBBS students participated in this study. There was significantly higher participation in history taking (50.7%) and clinical examination (60%) in the SF. A higher statistically significant number of clinical possibilities were considered in the SF (85.3% vs. 66.6%). Similarly, significantly higher number of students indulged in self-directed learning and referred to learning resources in the SF. The SF provided students an active role (96.9%), encouraged access to resources (93.9%), and control of learning (75.7%). The additional interactive session was productive (90.9%), discussions were streamlined (66.6%), and the role of a teacher was considered important (75.7%).

CONCLUSION

The SF generated higher participation in the aspects of history taking, clinical examination, and consideration of differential diagnoses. It led to a perceived improvement in self-directed and collaborative learning among students.