[Emergency medical training through simulation : Always the same for everyone?] / Notfallmedizinische Ausbildung durch Simulation : Immer das Gleiche für alle?

Simulation assumes a growing importance in the field of emergency medical education. Many rescue service schools work with simulators or even have their own simulation center. Classic resuscitation training in the classroom is increasingly being replaced by realistic case scenarios. But simulators themselves do not train! Using a simulator in emergency medical training does not necessarily mean achieving sustained learning success among the participants. Depending on the skills, abilities or competences being taught, there seems to be different requirements for simulation. However, there is no scientific evidence about how strong learners should be stressed in order to achieve the best learning effect. However, it can be stated that for training purely technical skills, simulators that represent the anatomical or physiological reality as accurately as possible should be used. If soft skills, practical knowledge and decision-making are the learning objectives, a scenario with extremly realistic conditions needs to be embedded. Mid-fidelity simulators seem to be able to cover the widest range of imparting skills for emergency medical training. No matter what simulator is used, the following applies: The selected scenario must be realistic and the simulation as well as technical capabilities of the simulator must be coordinated. A well-presented scenario with a well-trained teacher using a simple resuscitation doll appears to be better than a highly complex, however unrealistic, amateur simulation scenario for successful learning.

[Variation in closeness to reality of standardized resuscitation scenarios : Effects on the success of cognitive learning of medical students]. / Variation der Realitätsnähe standardisierter Reanimationsszenarien : Auswirkungen auf den kognitiven Lernerfolg von Medizinstudierenden.

INTRODUCTION: Simulation often relies on a case-based learning approach and is used as a teaching tool for a variety of audiences. The knowledge transfer goes beyond the mere exchange of soft skills and practical abilities and also includes practical knowledge and decision-making behavior; however, verification of knowledge or practical skills seldom unfolds during simulations. Simulation-based learning seems to affect many learning domains and can, therefore, be considered to be multifactorial in nature. At present, studies examining the effects of learning environments with varying levels of reality on the cognitive long-term retention of students are lacking. AIM: The present study focused on the question whether case scenarios with varying levels of reality produce differences in the cognitive long-term retention of students, in particular with regard to the learning dimensions knowledge, understanding and transfer. MATERIAL AND METHODS: The study was conducted on 153 students in the first clinical semester at the Justus-Liebig University of Giessen. Students were randomly selected and subsequently assigned, also in a random fashion, to two practice groups, i.e. realistic and unrealistic. In both groups the students were presented with standardized case scenarios consisting of three case studies, which were accurately defined with a case report containing a detailed description of each scenario and all relevant values so as to ensure identical conditions for both groups. The unrealistic group sat in an unfurnished practice room as a learning environment. The realistic group sat in a furnished learning environment with various background pictures and ambient noise. Students received examination questions before, immediately following and 14 days after the practice. Examination questions were identical at each of the three time points, classified into three learning dimensions following Bloom's taxonomy and evaluated. Furthermore, examination questions were supplemented by a questionnaire concerning the individual perception of reality and own learning success, to be filled in by students immediately after the practice. Examination questions and questionnaires were anonymous but associated with each other. RESULTS: Even with less experienced participants, realistic simulation design led to a significant increase of knowledge immediately after the end of the simulation. This effect, however, did not impact the cognitive long-term retention of students. While the realistic group showed a higher initial knowledge after the simulation, this "knowledge delta" was forgotten within 14 days, putting them back on par with the unrealistic comparison group. It could be significantly demonstrated that 2 weeks after the practice, comprehension questions were answered better than those on pure knowledge. Therefore, it can be concluded that even vaguely realistic simulation scenarios affect the learning dimension of understanding. CONCLUSION: For simulation-based learning the outcome depends not only on knowledge, practical skills and motivational variables but also on the onset of negative emotions, perception of own ability and personality profile. Simulation training alone does not appear to guarantee learning success but it seems to be necessary to establish a simulation setting suitable for the education level, needs and personality characteristics of the students.

[Stocked medications in emergency physician-based medical services in Germany. Reality and requirements according to guidelines]. / Vorgehaltene Medikamente auf notarztbesetzten Rettungsmitteln in Deutschland. Realität und Erfordernis nach Leitlinien.

BACKGROUND: The emergency medical service (EMS) should work according to criteria of evidence-based medicine. In Germany the EMS of each state is under the control of at least one medical supervisor known as emergency medical directors (EMD) and most states have several different EMDs responsible for one or more provinces of the state. The German Medical Association advises these supervisors to specify the pharmacological resources in store for use in physician powered EMSs. This study examines the pharmacological resources in EMSs which is provided by the EMDs in Germany. Furthermore, a comparison of the inventory analysis of stored drugs was carried out with the requirements according to guidelines for selected tracer diagnoses. METHOD: In the period of May 2008 to January 2009 a total of 148 EMDs were contacted and asked to supply drug storage lists for emergency physician-staffed rescue vehicles in their respective jurisdiction. The addresses of all EMDs who could be identified by the federal office of the National Association of Emergency Medical Director, Germany were used over the period. The evaluation was conducted anonymously. The tracer diagnoses "cardiopulmonary resuscitation", "acute coronary syndrome", "status generalized tonic-clonic seizure," "severe asthma attack", "acute exacerbation of chronic obstructive pulmonary disease", "supraventricular tachycardia", "severe brain trauma" and "acute heart failure with signs of hypoperfusion" were selected. Current and established guidelines have been identified with the homepage of the Scientific Medical Societies in Germany and supported by the leading European and International guidelines. RESULTS: The corresponding lists were returned by 95 different emergency service areas (response rate 64.2%). With a total of 39 groups of substances 142 different drugs could be identified, an average of 54±9.6 and median 55 (range 31-77). Listed are agents giving the provision in percent, for which the comparison with guidelines for tracer diagnoses could show deficits: sodium bicarbonate 75.8%, calcium 50.5%, magnesium 45.3%, noradrenaline 65.3%, adenosine 58.9%, dobutamine 57.9%, lorazepam iv 13.7%, salbutamol 41.1%, ipratropium bromide 13.7% (the last two as liquid preparations for inhalation). With a frequency of about 30-80%, depending on the respective tracer diagnosis, no medical emergency treatment according to the highest level of evidence is possible. CONCLUSION: Due to recent treatment recommendations provision with sodium bicarbonate, calcium, magnesium, noradrenaline, adenosine, lorazepam iv, dobutamine and as well with ipratropium bromide and salbutamol (both as liquid preparations for inhalation) should be improved. For the future, a federal uniform minimum standard due to evidence-based principles is desirable.