Blended learning for accredited life support courses - A systematic review.

Aim: To evaluate the effectiveness on educational and resource outcomes of blended compared to non-blended learning approaches for participants undertaking accredited life support courses. Methods: This review was conducted in adherence with PRISMA standards. We searched EMBASE.com (including all journals listed in Medline), CINAHL and Cochrane from 1 January 2000 to 6 August 2021. Randomised and non-randomised studies were eligible for inclusion. Study screening, data extraction, risk of bias assessment (using RoB2 and ROBINS-I tools), and certainty of evidence evaluation (using GRADE) were all independently performed in duplicate. The systematic review was registered with PROSPERO (CRD42022274392). Results: From 2,420 studies, we included data from 23 studies covering fourteen basic life support (BLS) with 2,745 participants, eight advanced cardiac life support (ALS) with 33,579 participants, and one Advanced Trauma Life Support (ATLS) with 92 participants. Blended learning is at least as effective as non-blended learning for participant satisfaction, knowledge, skills, and attitudes. There is potential for cost reduction and eventual net profit in using blended learning despite high set up costs. The certainty of evidence was very low due to a high risk of bias and inconsistency. Heterogeneity across studies precluded any meta-analysis. Conclusion: Blended learning is at least as effective as non-blended learning for accredited BLS, ALS, and ATLS courses. Blended learning is associated with significant long term cost savings and thus provides a more efficient method of teaching. Further research is needed to investigate specific delivery methods and the effect of blended learning on other accredited life support courses.

Development and national consensus finding on patient-centred high stakes communication skills assessments for the Swiss Federal Licensing Examination in Medicine.

OBJECTIVE: To describe and evaluate a consensus finding and expert validation process for the development of patient-centred communication assessments for a national Licensing Exam in Medicine. METHODS: A multi-professional team of clinicians and experts in communication, assessment and role-play developed communication assessments for the Swiss Federal Licensing Examination. The six-month process, informed by a preceding national needs-assessment, an expert symposium and a critical literature review covered the application of patient-centred communication frameworks, the development of assessment guides, concrete assessments and pilot-tests. The participants evaluated the process. RESULTS: The multiple-step consensus process, based on expert validation of the medical and communication content, led to six high-stakes patient-centred communication OSCE-assessments. The process evaluation revealed areas of challenge such as calibrating rating-scales and case difficulty to the graduates' competencies and integrating differing opinions. Main success factors were attributed to the outcome-oriented process and the multi-professional exchange of expertise. A model for developing high stakes patient-centred communication OSCE-assessments was derived. CONCLUSIONS: Consensus finding was facilitated by using well-established communication frameworks, by ensuring outcome-orientated knowledge exchange among multi-professional experts, and collaborative validation of content through experts. PRACTICE IMPLICATIONS: We propose developing high-stakes communication assessments in a multi-professional expert consensus and provide a conceptual model.

Medical students' knowledge and attitudes regarding vaccination against measles, influenza and HPV. An international multicenter study.

INTRODUCTION: Inaccurate information leads to increased scepticism concerning vaccinations among health care workers. Therefore, a proper education of medical students on vaccination is important. METHODS: During summer term 2015, we performed a paper-based survey to identify the knowledge and attitudes of medical students on vaccinations against measles, influenza and HPV in seven medical schools in Germany, Austria and Switzerland. RESULTS: Altogether, 3,652 questionnaires were analyzed. Knowledge of country-specific public recommendations increased significantly with the number of semesters of medical studies. Concerning the knowledge about vaccinations against measles, influenza and HPV, one third of the answers were given correctly. Again, a strong correlation between the knowledge and the semester of medical studies could be observed. The attitudes concerning vaccinations in general and especially for HCWs were highly positive. CONCLUSIONS: This study provides some important arguments for the development of a comprehensive vaccination education for medical students.

How do Swiss medical schools prepare their students to become good communicators in their future professional careers: a questionnaire and interview study involving medical graduates, teachers and curriculum coordinators.

BACKGROUND: Since 2011, the Swiss Catalogue of Learning Objectives (SCLO) has provided the framework for assessing communication skills in the Swiss Medical Federal Licensing Examination (FLE). This study evaluates how far the communication curricula of five Swiss medical schools match the SCLO and international recommendations. It also explores their strengths, weaknesses, opportunities and threats (SWOT). METHODS: A mixed method approach was used. In a first step, curriculum coordinators/key communication skills teachers and medical graduates were asked to fill out a questionnaire based on communication related objectives from the SCLO and a review of European consensus statements on communication training. Second, information was collected from all Swiss medical schools to identify which communication skills were taught in which formats and at what time points within the 6-year curricula. Finally, 3-4 curriculum coordinators/key communication skills teachers from each medical school were interviewed about their communication curriculum, using SWOT analysis. RESULTS: Sixteen teachers/coordinators (response rate 100%) and 389 medical graduates (response rate 43%) filled out the questionnaire. Both the teachers/coordinators and the graduates considered that two thirds of the communication items listed in the questionnaire were covered in their curricula. Between sixty and two hundred structured hours were dedicated to communication, predominantly in small group and experiential formats. Assessment relied on both MCQs and OSCEs. Most of the training occurred during the first three years of medical school. Teachers felt that the need for communication skills training was now well-recognized by their institution and was taught with appropriate teaching methods. However, recruitment and training of teachers, continuity of communication skills training during clinical years, and the adoption of a common frame of reference among the five medical schools, remained a challenge. CONCLUSION: Although the Swiss medical schools all offered a partly longitudinal communication skills training, with appropriate teaching methods, this study indicates that the communication skills actually taught do not fully match the SCLO or international recommendations. There was less training for complex communication skills training during the clinical years, and ensuring quality and coherence in the teaching remained a challenge.

[Entrustable professional activities : Promising concept in postgraduate medical education]. / "Entrustable professional activities" : Zukunftsweisendes Konzept für die ärztliche Weiterbildung.

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.

[The supraglottic airway in the prehospital setting]. / Der supraglottische Atemweg in der Prähospitalphase.

The supraglottic airway (SGA) is increasingly considered as a more effective alternative for emergency ventilation compared to bag mask ventilation and is propagated as an "easily" manageable method, compared to endotracheal intubation especially under the often adverse out-of-hospital conditions. Since the skill can easily be acquired during mannequin training, more and more rescue services train their personnel in the use of SGA devices and allow or even recommend their application also by nonphysicians. This recommendation, however, is not unequivocally supported by properly designed and conducted trials. Moreover, the solely available observational studies show contradictory results. Neither superiority nor inferiority of SGAs has been shown. They may, however, be accepted as an addendum to other prehospital ventilation approaches. The SGA airway comprises various problems and inherited risks similar to other ventilation techniques. Randomized studies investigating different techniques for prehospital emergency ventilation are lacking, as are controlled studies comparing SGA devices.

[Resuscitation training for lay persons in first aid courses: Transfer of knowledge, skills and attitude]. / Reanimationstraining für Laien in Erste-Hilfe-Kursen: Vermittlung von Wissen, Fertigkeiten und Haltungen.

BACKGROUND: Bystander cardiopulmonary resuscitation (CPR) is the most effective intervention for out of hospital sudden cardiac arrest; therefore, basic life support (BLS) courses for lay persons have become well established in industrialized countries, often since decades. Despite this favorable situation bystander CPR rates still remain low in some countries (e.g. in Germany), indicating serious implementation problems. The quality of instruction in these courses could be one reason for low bystander CPR rates. We therefore analyzed official lay BLS courses in terms of the teaching quality in the domains of knowledge, skills and attitudes (according to Bloom's taxonomy). MATERIAL AND METHODS: A total of 20 officially accredited lay BLS courses in Berlin, Germany, were analyzed by a participating observer, who remained blinded to the instructor and course participants until the end of the course. Courses were offered by German rescue organizations and private providers according to European Resuscitation Council (ERC) guidelines. Teaching quality was rated by a standardized checklist including 21 observable criteria of teaching quality for transfer of knowledge (n = 10), skills (n = 8) and attitudes (n = 3). In order to achieve comparability between items the results of each criterion were quantified by Likert scales ranging from +2 (very good) to -2 (very poor). RESULTS: The average score of all courses was +0.47 (SD ±0.46) for transfer of knowledge, +0.03 (SD ±0.61) for skills and -1.08 (SD ±0.73) for attitudes. In the domain of knowledge transfer, learning atmosphere and course structure were rated to be generally good, whilst marked deficits were found with respect to correctness of content. In the domain of skills the more positive ratings were given for teaching of single BLS elements (e.g. compressions and ventilation), in contrast to the training of BLS context, where e.g. realistic scenarios were only used by 3 out of 20 instructors. The domain of attitude transfer had the worst rating. Detailed ratings were -0.90 for "reducing fear of doing harm to the victim", -1.25 for "positive attribution of practical training" and -1.10 for "explaining course relevance from the learners' perspective". CONCLUSION: Within the observed BLS courses the teaching quality revealed significant deficits, especially for the transfer of positive attitudes to learners. Also, the use of meaningful realistic scenario teaching was very scarce. These findings can significantly contribute to low bystander CPR rates because transfer of learned content into practice may be hampered.

[Live-threatening bronchospasm during anesthesia induction : when pure routine becomes a nightmare]. / Lebensbedrohlicher Bronchospasmus bei Narkoseeinleitung : Wenn reine Routine zum Albtraum wird.

This article reports a case of live-threatening respiratory failure during induction of anesthesia. An 18-year-old female was admitted to hospital for an axillary abscess incision on a public holiday. The patient had a history of asthmatic episodes and an allergy to milk protein and 2 years previously an asthmatic attack had possibly been treated by mechanical ventilation. Retrospectively, this event turned out to be a cardiac arrest with mechanical ventilation for 24 h. During induction of anesthesia the patient suddenly developed massive bronchospasms and ventilation was impossible for minutes. Oxygen saturation fell below 80% over a period of 12 min with a lowest measurement of 13%. The patient was treated with epinephrine, prednisolone, antihistamine drugs, ß(2)-agonists, s-ketamine and methylxanthines and 15 min later the oxygen saturation returned to normal values. After mild therapeutic hypothermia for 24 h mechanical ventilation was still required for another 4 days. The patient recovered completely and was discharged home on day 19. Initially propofol was suspected of having caused an anaphylactic shock but in retrospect, the diagnosis of near fatal asthma was more likely. The onset of the event was facilitated by the patient playing down the history of asthmatic episodes due to a strong wish for independency and negation of the severity of the disease.

[Antihypertensive drug treatment and renal function in geriatric emergency patients]. / Antihypertensive Pharmakotherapie und Nierenfunktion bei geriatrischen Notfallpatienten.

OBJECTIVE: The aim of this study was to assess drug prescriptions and renal function in a cohort of geriatric emergency patients with a focus on antihypertensive drug treatment. PATIENTS AND METHODS: The one-year observational study was conducted among patients from nursing and retirement homes or outpatient care who were treated by the emergency medical service. Overall, 109 patients (85 women, mean age 85+/-8 years) were studied. Glomerular filtration rate was estimated (eGFR) on the basis of creatinine and cystatin C serum concentrations. RESULTS: The most common emergency admission diagnosis was syncope (n = 23), while the most common clinical diagnoses were dementia (n = 61) and hypertension (n = 60). Overall, 603 drugs were prescribed (mean 5.5 +/- 3, range 0 - 13), with 65 patients (60 %) receiving >/= 5 drugs per day. Of 60 patients with the known diagnosis of hypertension 55 (92 %) were being treated, while 71 % received at least 2 antihypertensive drugs. ACE-inhibitors (n = 33), loop diuretics (n = 28), beta-blockers (n = 22) and hydrochlorothiazide (n = 15) were the most frequently prescribed drugs. Mean creatinine (1.33 +/- 0.66 mg/dl) and cystatin C (1.78 +/- 0.83 mg/l) concentrations were elevated. Overall, up to two thirds of patients had eGFR values of < 60 ml/min/1.73 m (2). In up to 31 % of patients dosages were too high in relation to renal dysfunction. CONCLUSIONS: The prescription of antihypertensive drugs contributes significantly to polypharmacy in geriatric emergency patients. About two thirds of these patients had clinically relevant impairment of renal function. The latter, together with the high number of prescribed drugs, may expose geriatric patients to an increased risk of adverse drug reactions requiring emergency treatment.

[Prehospital care of acute coronary syndrome by anaesthetists. Prospective comparison with the care standards of cardiologists]. / Prähospitale Versorgung des akuten Koronarsyndroms durch Anästhesisten. Prospektiver Vergleich mit dem Versorgungsstandard durch Kardiologen.

BACKGROUND: Prehospital treatment of acute coronary syndrome (ACS) by anaesthetists acting in physician staffed emergency medical service (EMS) was compared with that of the gold standard of cardiologists. METHODS: Prospectively 599 patients with assumed ACS were traced. Prehospital diagnosis and therapy were compared with re-evaluation of ECGs and diagnosis on hospital discharge. RESULTS: In the case of ST-segment elevating myocardial infarction (STEMI) anaesthetists diagnosed 84% of cases correctly and cardiologists in 94% (p=0.048). False positive diagnoses were given in 11% by anaesthetists versus 5% by cardiologists (p=0.31). Anaesthetists accompanied all patients with instable angina versus 94% by cardiologists (p=0.06). Anaesthetists achieved 82% of patients to be pain-free versus 73% of cardiologists (p=0.01). Mortality until discharge was identical for the two groups (8.2%). CONCLUSION: In prehospital management of ACS cardiologists showed higher diagnostic competence, whereas anaesthetists revealed a greater degree of therapeutic caution. Patient mortality was not influenced.

[Perioperative cardiovascular reactions and the noradrenaline plasma level in patients on chronic antidepressant medication]. / Perioperative Kreislaufreaktionen und Noradrenalin-Plasmaspiegel bei antidepressiver Dauermedikation.

UNLABELLED: It is still controversial whether the perioperative incidence of cardiovascular complications is increased in patients on chronic treatment with cyclic antidepressants (AD) and whether AD medication should be discontinued prior to surgery. METHODS. We measured perioperative cardiovascular variables in 31 patients on chronic treatment with tri- and tetracyclic AD and 31 patients without AD medication. Heart rate, blood pressure, and noradrenaline plasma concentrations were compared between the two groups at nine points in time. During induction of anaesthesia, the ECG was recorded continuously. After the administration of 0.01 mg/kg atropine i.v., all patients received opiate-supplemented enflurane anaesthesia. RESULTS: Re-uptake inhibition of noradrenaline by AD resulted in significantly higher noradrenaline plasma concentrations before and during anaesthesia in the AD-treated group. The incidence of arrhythmias, blood pressure elevations, and tachycardia was not increased in patients in AD treatment. Arrhythmias during induction of anaesthesia were seen in 6 of the AD-treated patients and 5 of the controls. Blood pressure elevations by more than 35% were seen in 10 patients on AD treatment and 8 controls. The heart rate prior to induction of anaesthesia and 2 h after the end of surgery was significantly higher in the AD-treated group. During anaesthesia the heart rate was higher at two points in time only. The incidence of tachycardia was similar in both groups. Intravenous administration of 0.01 mg/kg atropine prior to induction of anaesthesia increased the heart rate of the patients on chronic AD medication by 11.4%. This increase was significantly higher in the control group (16.2%), suggesting that patients with chronic AD treatment do not have a higher sensitivity to atropine. CONCLUSION: The elevated noradrenaline plasma levels in patients on chronic AD treatment did not result in a higher incidence of arrhythmias, blood pressure elevations, or tachycardia perioperatively. Taking these results into account, we do not consider it necessary to discontinue chronic AD medication prior to surgery in patients without cardiovascular disease.