Digital adaptation of teaching disaster and deployment medicine under COVID-19 conditions: a comparative evaluation over 5 years

BACKGROUND

The COVID-19 pandemic has not only brought many aspects of disaster medicine into everyday awareness but also led to a massive change in medical teaching due to the necessity of contact restrictions. This study aimed to evaluate student acceptance of a curricular elective module on disaster and deployment medicine over a 5-year period and to present content adjustments due to COVID-19 restrictions.

METHODS

Since 2016, 8 semesters of the curricular elective module took place in face-to-face teaching (pre-COVID-19 group). From the summer semester of 2020 to the summer semester of 2021, 3 semesters took place as online and hybrid courses (mid-COVID-19 group). Student attitudes and knowledge gains were measured using pretests, posttests, and final evaluations. These data were statistically compared across years, and new forms of teaching under COVID-19 conditions were examined in more detail.

RESULTS

A total of 189 students participated in the module from the summer semester of 2016 through the summer semester of 2021 (pre-COVID-19: n = 138; mid-COVID-19: n = 51). There was a high level of satisfaction with the module across all semesters, with no significant differences between the groups. There was also no significant difference between the two cohorts in terms of knowledge gain, which was always significant (p < 0.05). COVID-19 adaptations included online seminars using Microsoft Teams or Zoom, the interactive live-streaming of practical training components, and digital simulation games.

CONCLUSION

The high level of satisfaction and knowledge gained during the module did not change even under a digital redesign of the content offered. The curricular elective module was consistently evaluated positively by the students, and the adaptation to online teaching was well accepted. Experiences with digital forms of teaching should also be used after the COVID-19 pandemic to create digitally supported blended learning concepts in the field of deployment and disaster medicine and thus further promote the expansion of teaching in this important medical field.

Implementation of online video consultations in a regional health network: a management feasibility analysis from an orthopedic perspective

Introduction

Regional health care networks with interfaces between clinics, general practitioners and patients can act faster when utilizing digital measures. This manuscript describes the establishment of an online video consultation service in a clinic and its broad health care region to exemplify challenges and solutions for potential future approaches from a management perspective.

Method

The underlying pilot project was planned and implemented for follow-up monitoring and consultative presentation of orthopedic and trauma patients within the Bundeswehr Medical Service from 2018 to 2020. With predominantly positive evaluation results regarding quality and acceptance among users, this research investigated organizational and processual aspects including total quality management, strategic control and change management approaches.

Results

The affected main and subprocesses of patient treatment could be streamlined by the project, as physician recommendations and arrangements could be accelerated and patient travel could be significantly reduced. A SWOT and portfolio analysis showed a high potential for improving existing patient treatment processes for health care enterprises via the use of digital technology. The involved staff should be strategically included at an early stage and continuously involved. By means of a PDCA cycle, the processes of the given project could be exemplarily illustrated with an outlook in the future.

Discussion

It has proven successful to consciously use management approaches to establish telemedical integrated care structures in a health region. Recommendations for the strategic introduction of an online video consultation for regional network strengthening and care development for a patient-oriented increase in efficiency could be compiled.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08352-0.

The use of online video consultations in the aftercare of orthopedic patients: a prospective case-control study

Background

Video consultations have proven to be an efficient source of support for patient-doctor interactions and have become increasingly used in orthopedics, especially during the COVID-19 pandemic. This study analyzed both patients’ and doctors’ acceptance of an orthopedic telemedical consultation (OTC) and compared the results of OTC examinations to the results of live consultation (LC) to identify discrepancies.

Methods

The study was carried out in an orthopedic department of a German hospital between 2019 and 2020. After written informed consent was obtained, patients voluntarily presented for follow-up by OTC and LC. The experience with and attitudes toward OTC among both patients and doctors was evaluated (using Likert scale-scored and open questions, 26 to 28 items). The results of the OTC and LC examinations were compared using a 12-item checklist. The data were analyzed by quantitative and qualitative statistics.

Results

A total of 53 patients were included, each of whom completed an OTC and an LC. The OTC was rated as pleasant, and the experience was rated as very satisfying (average rating on a 5-point Likert scale, with 1 indicating strong agreement: doctors: 1.2; patients: 1.3). Various technical and organizational challenges were identified. Compared to LC, OTC showed no significant differences in patient history or in inspection, palpation, or active range of motion results. Only for the functional or passive joint assessment did LC show significantly higher suitability (p < 0.05) than OTC. Recommendations for further procedures did not differ significantly between OTC and LC.

Conclusions

Because of the high acceptance and the objective benefits of OTC and the similarity of clinical results with LC, OTC is recommendable for orthopedic follow-up examinations. To better assess joint functionality, meaningful digital alternatives for established examination methods should be further investigated.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04653-3.

[Digital OR]

BACKGROUND

Numerous processes are involved in the orthopedic and trauma surgery operating room (OR). Technical progress, particularly in the area of digitalization, is increasingly changing routine surgical procedures.

OBJECTIVE

This article highlights the possibilities and also limitations regarding this matter.

MATERIAL AND METHODS

Based on the current literature this article provides insights into innovations in the areas of digitalization of surgical devices, hybrid OR, machine-2-machine networking, management systems for perioperative efficiency improvement, 3D printing technology and robotics.

RESULTS

The technical possibilities for the use of digital applications in the surgical environment are rapidly increasing. Close cooperation with industrial partners is important in this context. Technologies from the automotive, gaming and mobile phone industries are being adopted.

CONCLUSION

Digital technology in the OR can improve treatment quality, patient and staff safety and cost efficiency; however, the networking of devices, implementation of innovations in existing structures and the sometimes high acquisition costs are still limiting factors.

[Relevance of disaster and deployment medicine for medical students : A pilot study based on an interdisciplinary lecture series]

BACKGROUND

The global rise of conflicts and catastrophes causes new challenges for western healthcare systems. There are obvious parallels between civilian disaster medicine and military combat care. The integration of disaster and deployment medicine into the medical curriculum thus seems necessary.

OBJECTIVE

What do medical students think about disaster and deployment medicine as part of the curriculum? Does participation in a voluntary disaster medicine course affect their view?

MATERIAL AND METHODS

While participating in an extracurricular lecture series on disaster and deployment medicine students (group 1) were asked about their personal views and prior experience in disaster medicine (20 questions). Students who did not attend the lecture (group 2) functioned as the control group. The statistical evaluation was performed descriptively and using Student's t test for independent subgroups.

RESULTS

The questionnaire was completed by 152 students (group 1: n = 78, group 2: n = 74). Only 10 students in group 1 and none in group 2 felt they had received an adequate amount of teaching in the field of disaster medicine. Medical students in both groups considered disaster medicine to be inadequately represented in the medical curriculum (group 1: 64% and group 2: 66%). Both groups were in favor of further expanding teaching in the field of disaster medicine (group 1: 72%, group 2: 54%, p = 0.001) and the development of e‑learning tools (group 1: 73%, group 2: 72%).

DISCUSSION

The medical students questioned considered disaster and deployment medicine to be an integral part of the curriculum. Despite some statistical differences between the two groups, the survey showed that medical students possess a great interest in disaster medicine. Both groups were in favor of further integrating e‑learning tools. A regular inclusion of disaster and deployment medicine into the spectrum of medical student teaching is warranted.

Social media and e-learning use among European exercise science students

With the rise of digital technologies, electronic learning and communication tools are becoming a firm part of academia to promote knowledge of health sciences. This study sought to analyse the attitude of students regarding social media and digital learning for study purposes in sport and exercise science. A survey was carried out with a questionnaire (20 main items) in six sport science faculties, equally spread across Germany (G), Italy (I) and the United Kingdom (UK) between February and October 2017. The focus areas were students' usage of social media (Facebook, Google+, Instagram, LinkedIn, Skype, Twitter, WhatsApp, YouTube) for academic purposes and their use of e-learning. Data were analysed by quantitative and qualitative methods. 229 students participated in the study (G: 68, I: 121, UK: 40). While YouTube was mostly used for receiving knowledge, WhatsApp and Facebook showed additional preferences for peer contacts for learning purposes and knowledge discussions. Preferred online data sources were PubMed (77%), free access journals (67%), YouTube (66%) and Wikipedia (63%). Often used digital learning materials were own universities' PowerPoints (77%), scripts (59%) and scientific articles (53%). However, some preferences showed national differences. The evaluated participants showed an overall high use of social media and e-learning tools for their studies. Students would like more digital learning sources made available to them by their institutions. However, some differences in preferences of digital learning or communication tools may exist and this should be considered for international approaches to promote health knowledge among students.

[Acute therapeutic measures for limb salvage Part 1 : Haemorrhage control, emergency revascularization, compartment syndrome]

The primary care of Gustilo-Anderson type IIIC extremity injuries with relevant vessel lacerations is decisive for the success of a limb salvage procedure. This article shall present substantial emergency procedures for the salvage of the nutritive perfusion of a mangled extremity, based on the current literature. After provisory control of a peripheral haemorrhage (e. g. by manual pressure or tourniquet), an immediate decision must be made about the kind of emergency revascularization to be implemented as the limb salvage procedure. Here, the temporary intravascular shunt will be the fastest technique that can ensure a sufficient tissue perfusion in the case of vessel lacerations. Regarding the treatment of a fracture versus perfusion recovery, a shortening of ischemia time should have priority over fracture stabilization.If an acute compartment syndrome is suspected, a documented monitoring has to be performed in the limb salvage situation for 24 hours with clinical controls every 4 hours. Disproportional pain that does not respond to analgesics, and passive muscle stretching pain can be seen as cardinal symptoms. The positive predictive value of clinical findings is <15 %. During the observation period with an impending but not manifest compartment syndrome, an elevation of the extremity above heart level or its cooling are contraindicated. An intracompartmental pressure measurement is the most important instrument-based supplemental diagnostic method. The open fasciotomy of the affected compartments is the only causal therapy and should be performed as fast as possible. A decision against fasciotomy in cases of non-explicit clinical signs should not be made without a documented intracompartmental pressure measurement.

[Acute therapeutic measures for limb salvage Part 2 : Debridement, lavage techniques and anti-infectious strategies]

The quality of the primary care of Gustilo-Anderson (GA) type IIIB and IIIC extremity injuries is crucial to the success of the limb salvage procedure. This article provides a compilation of consistent, but often controversially discussed aspects of initial debridement, modern techniques of lavage and wound closure, in addition to current issues on the application of antibiotics and antiseptics, based on our own experiences and the latest literature. The following points should be stressed. Severe extremity injuries with gross contamination (GA IIIA, B, and C) will still be associated with an infection rate of up to 60 %. The initial debridement should be performed as soon as an experienced trauma surgeon is available. Tissue that is definitely avital will have to be removed, whereas traumatized but potentially surviving tissue will have to be re-evaluated during a second-look operation after 36-48 h. Given a high enough level of contamination, biofilms will form after as few as 6 h. The perioperative antibiotic prophylaxis has to be initiated early and should be continued for at least 24 h (GA I/II) or up to 5 days (GA III). In cases of bacterial contamination, wound irrigation will be useful with additives such as polyhexanide, octenidine or superoxidized water. Rinsing of the wound should be performed with 3-9 L and only slight manual pressure (no jet lavage). The definitive primary closure of a wound should be achieved in the initial operation, but only in the case of certain "decontamination" and overall vitality of the wound (GA I and II). In the presence of high-grade injuries, a temporary vacuum sealing technique can be used until the earliest possible definitive plastic surgical wound closure.

[Evaluation of interest in research among surgically active medical officers in the German Armed Forces]

BACKGROUND

Research in military medicine and in particular combat surgery is a broad field that has gained international importance during the last decade. In the context of increased NATO missions, this also holds true for the Bundeswehr (German Armed Forces); however, medical officers in surgery must balance research between their clinical work load, missions, civilian and family obligation.

MATERIAL AND METHODS

To evaluate engagement with and interest in research, a questionnaire was distributed among the doctors of the surgical departments of the Bundeswehr hospitals by the newly founded working group Chirurgische Forschung der Bundeswehr (surgical research of the Bundeswehr). Returned data were recorded from October 2013 to January 2014 and descriptive statistics were performed.

RESULTS

Answers were received from 87 out of 193 military surgeons (45 %). Of these 81 % announced a general interest in research with a predominance on clinical research in preference to experimental settings. At the time of the evaluation 32 % of the participants were actively involved in research and 53 % regarded it as difficult to invest time in research activities parallel to clinical work. Potential keys to increase the interest and engagement in research were seen in the implementation of research coordinators and also in a higher amount of free time, for example by research rotation.

CONCLUSION

Research can be regarded as having a firm place in the daily work of medical officers in the surgical departments of the Bundeswehr; however, the engagement is limited by time and structural factors. At the departmental level and in the command structures of the military medical service, more efforts are recommended in the future in order to enhance the engagement with surgical research. This evaluation should be repeated in the coming years as a measuring instrument and data should be compared in an international context.

[E-learning in orthopedics and traumatology. A comparative pilot study on acceptance and knowledge acquisition among users and non-users]

BACKGROUND

Additional internet-based learning tools (e-learning) are successfully used in the curricula of many disciplines and are highly accepted among students. However, in orthopedics and traumatology e-learning is underrepresented and scientific papers are rare. The aim of the present pilot study was to evaluate the acceptance of the e-learning module network for students in traumatology and orthopedics (NESTOR) among users and non-users and to analyze the effect of this additional learning tool on knowledge acquisition.

MATERIAL AND METHODS

A total of 544 students were asked to complete evaluation questionnaires at the end of two semesters using different ones for NESTOR users and non-users. The gain of knowledge was analyzed by two written knowledge tests (pre-post test, 20 multiple choice questions) at the beginning and end of the semester comparing these two groups.

RESULTS

A total of 191 students took part in the evaluation and 152 completed both written tests. The NESTOR users showed a high acceptance of the e-learning system and non-users considered e-learning beneficial as well. Reasons given for not using NESTOR were lack of time, lack of information about the existence of NESTOR and a lack of interest in this discipline and e-learning in general. Both groups significantly increased their level of knowledge during the course of the semester (p < 0.01), whereas users scored significantly higher in the post-test (p < 0.05).

CONCLUSION

The presented data support the high acceptance among users and the benefit of the e-learning project NESTOR in teaching students in orthopedics and traumatology. Based on experience and these results the permanent implementation of an additional e-learning module in the curriculum can be recommended for other faculties. In this process the critical comments of the non-users determined in the present study should be addressed.

[Knee dislocation--a simple diagnosis? Compartment syndrome with occlusion of the popliteal artery and lesion of the peroneal nerve after inadequate trauma]

Knee dislocations are rare and often associated with damage to the surrounding structures. We present a case where a soldier sustained a complex knee dislocation during routine training. This trauma was associated with a compartment syndrome, occlusion of the popliteal artery, lesion of the peroneal nerve and multiple lesions of ligaments and tendons of the knee.