1
|
Sterz J, Tückmantel PR, Bepler L, Stefanescu MC, Gramlich Y, Flinspach A, Rüsseler M. [Development and validation of a checklist for evaluating videos for learning resuscitation measures]. Med Klin Intensivmed Notfmed 2021; 117:525-530. [PMID: 34468770 PMCID: PMC9553819 DOI: 10.1007/s00063-021-00857-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/22/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Well-performed resuscitation measures can improve the outcome in the event of cardiovascular arrest. Medical students often use teaching videos to learn practical skills. Studies confirmed the often inadequate quality of the videos on resuscitation available on the Internet. An evaluation using a validated checklist based on the current guidelines has so far been lacking. OBJECTIVE The development and validation of a checklist for evaluating instructional videos on resuscitation. MATERIAL AND METHODS In an expert workshop, checklist items were formulated based on the current guidelines. The checklist was tested by emergency physicians in a 4-step review process. The evaluations were analyzed and the items adjusted and specified if necessary. After the review process was completed, the checklist was applied to 74 videos on the topic of resuscitation. RESULTS The checklist consists of 25 items in 4 categories (initial measures, chest compression, AED use, breathing), which are rated on a 3-level Likert scale. A total of 16 emergency doctors participated in the study and rated an average of 9.3 ± 5.7 videos each. The reviewers agreed in 65.1 ± 12.6% of the cases. The highest agreement was achieved in the subtopic AED, with the item "do not touch patients in shock" having the highest agreement. The items in the thoracic compression category were most often rated differently. CONCLUSION For the first time, a checklist for evaluating instructional videos for resuscitation was created and validated for German-speaking countries.
Collapse
Affiliation(s)
- J Sterz
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
- Frankfurter Interdisziplinäres Simulationstraining, Fachbereich 16, Goethe-Universität, Frankfurt am Main, Deutschland
| | - P R Tückmantel
- Frankfurter Interdisziplinäres Simulationstraining, Fachbereich 16, Goethe-Universität, Frankfurt am Main, Deutschland
| | - L Bepler
- Frankfurter Interdisziplinäres Simulationstraining, Fachbereich 16, Goethe-Universität, Frankfurt am Main, Deutschland
| | - M C Stefanescu
- Frankfurter Interdisziplinäres Simulationstraining, Fachbereich 16, Goethe-Universität, Frankfurt am Main, Deutschland
| | - Y Gramlich
- Abteilung für Unfallchirurgie und Orthopädische Chirurgie, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Deutschland
| | - A Flinspach
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt, Deutschland
| | - M Rüsseler
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland.
- Frankfurter Interdisziplinäres Simulationstraining, Fachbereich 16, Goethe-Universität, Frankfurt am Main, Deutschland.
| |
Collapse
|
2
|
Sterz J, Britz V, Carstensen P, Kollewe T, Voß SH, Stefanescu MC, Schreckenbach T, Verboket RD, Rüsseler M. [The surgeon's balancing act-Teaching in the clinical routine]. Chirurg 2021; 93:286-291. [PMID: 34297149 PMCID: PMC8894151 DOI: 10.1007/s00104-021-01470-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Thus medical students must be inspired to undertake this specialty. Students complain that the teaching is subordinate to patient care and limited by a lack of time and medical personnel. Although there are many studies assessing student perceptions, few exist that focus on the issues that teachers face. OBJECTIVE To analyse student teaching in the daily routine and its potential' problems from the surgeon's perspectives. MATERIAL AND METHODS In this prospective study guidelines for semistructured interviews with formulated, open questions were created, which were specified with further questions. All interviews were conducted using these guidelines and recorded. The number of interviews were a function of the concept of content saturation. RESULTS All 22 participants perceived that the teaching in clinical practice is of paramount importance. Nevertheless, respondents described that learning goals in the clinical routine are not always achieved. The main reason is a lack of time; however, as clinical experience increases other factors will similarly become more important: Consultants and heads of departments complain about deficiencies in students' previous knowledge, including insufficient motivation. Most respondents described that they do not feel appreciated for teaching. Overall, student teaching was perceived as an additional burden but all respondents found the task to be extremely worthwhile. CONCLUSION In addition to the lack of personnel, a lack of appreciation is the most significant obstacle towards effective teaching. It is therefore important to increase the value of teaching by rewarding good achievements and the creation of effective transparency.
Collapse
Affiliation(s)
- J. Sterz
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklink Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590 Frankfurt, Deutschland
- Frankfurter Interdisziplinären Simulationstraining, Fachbereich 16, Goethe-Universität, Frankfurt am Main, Deutschland
| | - V. Britz
- Frankfurter Interdisziplinären Simulationstraining, Fachbereich 16, Goethe-Universität, Frankfurt am Main, Deutschland
| | - P. Carstensen
- Frankfurter Interdisziplinären Simulationstraining, Fachbereich 16, Goethe-Universität, Frankfurt am Main, Deutschland
| | - T. Kollewe
- Frankfurter Arbeitsstelle für Medizindidaktik, Fachbereich Medizin, Goethe-Universität, Frankfurt am Main, Deutschland
| | - S. H. Voß
- MVZ VOSS, Aschaffenburg, Deutschland
| | - M. C. Stefanescu
- Frankfurter Interdisziplinären Simulationstraining, Fachbereich 16, Goethe-Universität, Frankfurt am Main, Deutschland
| | - T. Schreckenbach
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt am Main, Deutschland
| | - R. D. Verboket
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklink Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590 Frankfurt, Deutschland
| | - Miriam Rüsseler
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklink Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590 Frankfurt, Deutschland
- Frankfurter Interdisziplinären Simulationstraining, Fachbereich 16, Goethe-Universität, Frankfurt am Main, Deutschland
| |
Collapse
|
3
|
Sterz J, Linßen S, Stefanescu MC, Schreckenbach T, Seifert LB, Ruesseler M. Implementation of written structured feedback into a surgical OSCE. BMC Med Educ 2021; 21:192. [PMID: 33823844 PMCID: PMC8022414 DOI: 10.1186/s12909-021-02581-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 02/26/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND Feedback is an essential element of learning. Despite this, students complain about receiving too little feedback in medical examinations, e.g., in an objective structured clinical examination (OSCE). This study aims to implement a written structured feedback tool for use in OSCEs and to analyse the attitudes of students and examiners towards this kind of feedback. METHODS The participants were OSCE examiners and third-year medical students. This prospective study was conducted using a multistage design. In the first step, an unstructured interrogation of the examiners formed the basis for developing a feedback tool, which was evaluated and then adopted in the next steps. RESULTS In total, 351 students and 51 examiners participated in this study. A baseline was created for each category of OSCE station and was supplemented with station-specific items. Each of these items was rated on a three-point scale. In addition to the preformulated answer options, each domain had space for individual comments. A total of 87.5% of the students and 91.6% of the examiners agreed or rather agreed that written feedback should continue to be used in upcoming OSCEs. CONCLUSION The implementation of structured, written feedback in a curricular, summative examination is possible, and examiners and students would like the feedback to be constant.
Collapse
Affiliation(s)
- J Sterz
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - S Linßen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - M C Stefanescu
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - T Schreckenbach
- Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - L B Seifert
- Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - M Ruesseler
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| |
Collapse
|
4
|
Ruesseler M, Sterz J, Bender B, Hoefer S, Walcher F. The effect of video-assisted oral feedback versus oral feedback on surgical communicative competences in undergraduate training. Eur J Trauma Emerg Surg 2016; 43:461-466. [DOI: 10.1007/s00068-016-0734-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/06/2016] [Indexed: 11/29/2022]
|
5
|
Rüsseler M, Schill A, Kalozoumi-Paisi P, Ganzert C, Arheilger L, Sterz J, Kollewe T, Hoefer SH, Adili F. [Teaching in Perspective - How Medical Students Assess Their Practical Clinical Training in Surgery]. Zentralbl Chir 2016; 142:46-53. [PMID: 27672739 DOI: 10.1055/s-0042-116326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Practical clinical expertise is a crucial part of medical professionalism. Several studies have shown that medical students are poorly trained in practical skills during their undergraduate training. Even the students rated their own expertise in practical skills as poor. The amendments to the German Regulating Licenses in Practical Medicine are intended to strengthen practical clinical training. The aim of the present study is to use focus groups to analyse practical clinical training with respect to organisation, difficulties and problems from the learners' perspective. Methods: The present qualitative study uses the focus group approach. Each focus group was composed of a maximum of 6 students per group with the same level of training. Using a standardised interview manual, a total of 31 students and four first-year residents participated in the study. Data interpretation was performed using structured qualitative content analysis. Results: The present work demonstrates that students of all levels of training greatly value their training in practical clinical expertise, especially in clinical skills. Due to the lack of defined learning objectives for practical skills, students training in clinical internships and medical registrar positions are highly dependent on the motivation and interest of the individual clinical teacher and the learner himself. Students struggle to estimate their actual level of expertise due to the lack of defined learning objectives. This is exacerbated by the fact that students rarely receive feedback about their expertise. Students complain that many teachers do not know the level of training required of their students. Conclusion: The definition of basic and specific learning objectives and the communication of this between learners and teachers is an essential part of practical clinical training.
Collapse
Affiliation(s)
- M Rüsseler
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Zentrum der Chirurgie, Deutschland
| | - A Schill
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Zentrum der Chirurgie, Deutschland
| | - P Kalozoumi-Paisi
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Zentrum der Chirurgie, Deutschland
| | - C Ganzert
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Zentrum der Chirurgie, Deutschland
| | - L Arheilger
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Zentrum der Chirurgie, Deutschland
| | - J Sterz
- Klinik für Allgemein-, Viszeral- und Tumorchirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Zentrum der Chirurgie, Deutschland
| | - T Kollewe
- Fachbereich Medizin, Frankfurter Arbeitsstelle für Medizindidaktik, Johann Wolfgang Goethe-Universität Frankfurt am Main, Deutschland
| | - S H Hoefer
- Klinik für Mund-. Kiefer- und plastische Gesichtschirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Zentrum der Chirurgie, Deutschland
| | - F Adili
- Klinik für Gefäßmedizin - Gefäß- und Endovascularchirurgie, Klinikum Darmstadt, Deutschland
| |
Collapse
|
6
|
Jakob C, Sterz J, Liebisch P, Mieth M, Rademacher J, Goerke A, Heider U, Fleissner C, Kaiser M, von Metzler I, Müller C, Sezer O. Incorporation of the bone marker carboxy-terminal telopeptide of type-1 collagen improves prognostic information of the International Staging System in newly diagnosed symptomatic multiple myeloma. Leukemia 2008; 22:1767-72. [PMID: 18580957 DOI: 10.1038/leu.2008.159] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Several prognostic markers, including parameters of tumor burden and cytogenetics, were adopted to identify high-risk patients in multiple myeloma (MM). Recently, the International Staging System (ISS), including beta2-microglobulin (beta2M) and albumin, was introduced for patients with symptomatic MM. As bone disease is a hallmark of MM, we investigated the prognostic impact of the bone resorption marker carboxy-terminal telopeptide of type-1 collagen (ICTP) in combination with ISS, beta2M, albumin, deletion of chromosome 13 and high-dose therapy (HDT) in 100 patients with newly diagnosed symptomatic MM. beta2M alone, albumin alone, ISS, HDT, del(13q14) and ICTP were significant prognostic factors for overall survival (OS). In a multivariate analysis, ICTP was the most powerful prognostic factor (log-rank P<0.001, hazard ratio: ninefold increase). ICTP clearly separated two subgroups with a good and a worse prognosis within each of the three ISS stages (ISS I: P=0.027, ISS II: P=0.022, ISS III: P=0.013). Incorporation of ICTP in a combined ICTP-ISS score significantly (P<0.001) separated four risk groups with a 5-year OS rate of 95, 64, 46 and 22%, [corrected] respectively. These data demonstrate for the first time that the inclusion of the collagen-I degradation product ICTP, as a biomarker of bone resorption, adds to the prognostic value of ISS.
Collapse
Affiliation(s)
- C Jakob
- Department of Hematology and Oncology, Charité-Universitätsmedizin, Berlin, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
von Metzler I, Krebbel H, Hecht M, Manz RA, Fleissner C, Mieth M, Kaiser M, Jakob C, Sterz J, Kleeberg L, Heider U, Sezer O. Bortezomib inhibits human osteoclastogenesis. Leukemia 2007; 21:2025-34. [PMID: 17581612 DOI: 10.1038/sj.leu.2404806] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In multiple myeloma, the overexpression of receptor activator of nuclear factor kappa B (NF-kappaB) ligand (RANKL) leads to the induction of NF-kappaB and activator protein-1 (AP-1)-related osteoclast activation and enhanced bone resorption. The purpose of this study was to examine the molecular and functional effects of proteasome inhibition in RANKL-induced osteoclastogenesis. Furthermore, we aimed to compare the outcome of proteasome versus selective NF-kappaB inhibition using bortezomib (PS-341) and I-kappaB kinase inhibitor PS-1145. Primary human osteoclasts were derived from CD14+ precursors in presence of RANKL and macrophage colony-stimulating factor (M-CSF). Both bortezomib and PS-1145 inhibited osteoclast differentiation in a dose- and time-dependent manner and furthermore, the bone resorption activity of osteoclasts. The mechanisms of action involved in early osteoclast differentiation were found to be related to the inhibition of p38 mitogen-activated protein kinase pathways, whereas the later phase of differentiation and activation occurred due to inhibition of p38, AP-1 and NF-kappaB activation. The AP-1 blockade contributed to significant reduction of osteoclastic vascular endothelial growth factor production. In conclusion, our data demonstrate that proteasomal inhibition should be considered as a novel therapeutic option of cancer-induced lytic bone disease.
Collapse
Affiliation(s)
- I von Metzler
- Department of Hematology and Oncology, Charité - Universitätsmedizin Berlin, and Deutsches Rheumaforschungszentrum, Berlin, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
The 26S proteasome is a multicatalytic intracellular protease expressed in eukaryotic cells. It is responsible for selective degradation of intracellular proteins that are responsible for cell proliferation, growth, regulation of apoptosis and transcription of genes involved in execution of key cellular functions. Thus proteasome inhibition is a potential treatment option for cancer and diseases due to aberrant inflammation condition. Treatment with proteasome inhibitors results in stabilization and accumulation proteasome substrates, a phenomenon that may result in confounding signals in cells, cell cycle arrest and activation of apoptotic programs. The inhibition of the transcriptional factor nuclear factor kappaB (NF-kappaB) activation was found as one of crucial mechanisms in induction of apoptosis, overcoming resistance mechanisms and inhibition of immune response and inflammation mechanisms. Bortezomib (PS-341) and PS-519 are the first proteasome inhibitors that have entered clinical trials. In multiple myeloma, both the FDA (United States Food and Drug Administration) and EMEA (European Medicine Evaluation Agency) granted an approval for the use of bortezomib (Velcade) for the treatment of relapsed multiple myeloma. At present, several phase II and phase III trials in hematological malignancies and solid tumors are ongoing. PS-519 that focuses on inflammation, reperfusion injury and ischemia is currently under evaluation for the indication of acute stroke.
Collapse
Affiliation(s)
- I Zavrski
- Department of Hematology and Oncology, Charité--Universitätsmedizin Berlin, Germany
| | | | | | | | | | | | | | | |
Collapse
|