TIP - Training of Intensive medical support in the case of a Pandemic.

The COVID-19 pandemic has led to a short-term sharp increase in the demand for auxiliary staff in emergency rooms and intensive care units. Against this background student tutors of the Medical Faculty Erlangen have developed a training concept. The aim was to familiarize students in the clinical section quickly and effectively with skills that are particularly important in a clinical assignment as (student) assistant in the care of corona patients (e.g.: personal protective equipment, intubation assistance, arterial blood collection, assessment of blood gas values and ventilation parameters). In a blended learning concept, learning materials were prepared in advance and then implemented and deepened in a presence phase. The selection of learning materials and the low supervision ratio (1:2) made it possible to realize an internally differentiated approach. The offer met with great interest among students of all clinical semesters and was evaluated very positively. The skills learned can be applied widely even independently of a pandemic.

[Learning how to learn for specialist further education]. / Für die Facharztweiterbildung Lernen lernen.

The world of medicine is becoming from year to year more complex. This necessitates efficient learning processes, which incorporate the principles of adult education but with unchanged periods of further education. The subject matter must be processed, organized, visualized, networked and comprehended. The learning process should be voluntary and self-driven with the aim of learning the profession and becoming an expert in a specialist field. Learning is an individual process. Despite this, the constantly cited learning styles are nowadays more controversial. An important factor is a healthy mixture of blended learning methods, which also use new technical possibilities. These include a multitude of e­learning options and simulations, which partly enable situative learning in a "shielded" environment. An exemplary role model of the teacher and feedback for the person in training also remain core and sustainable aspects in medical further education.

[Briefing improves the management of a difficult mask ventilation in infants : Simulator study using Web-based decision support]. / Briefing verbessert das Management einer schwierigen Maskenbeatmung beim Säugling : Simulatorstudie unter Verwendung einer webbasierten Entscheidungshilfe.

BACKGROUND: Unanticipated airway problems in infants can rapidly develop into severe hypoxemia. Team members can provide support and suggest steps of action if a shared mental model of the next steps exists. Briefing prior to induction of anaesthesia may create such a shared mental model among all team members. OBJECTIVES: The aim of the study was to assess whether a short briefing on the recommendations for an unexpected difficult airway, developed by the Working Group on Paediatric Anaesthesia of the German Society for Anaesthesiology and Intensive Care Medicine, would influence the management of an unexpected difficult mask ventilation in an infant. The study also aims to assess whether a shared mental model would encourage the anaesthesia nurse to speak up and foster implicit coordination. METHODS: Nineteen teams consisting of an anaesthesia resident and an anaesthesia nurse participated in a scenario of an urgent induction of anaesthesia in an infant. Teams were randomized to either conduct a briefing on the recommendations for an unexpected difficult airway prior to induction of anaesthesia or to have access to a Web-based cognitive aid with an emergency manual page containing the identical algorithm if needed. Induction of anaesthesia triggered upper airway obstruction and desaturation. The time course of desaturation followed published physiologic modelling. The time until the obstruction was relieved was recorded. Video recordings of the scenarios were analysed with respect to coordination patterns prior to induction as well as to coordination forms (implicit vs. explicit) during the emergency. At the end of the course, participants were asked to fill out a questionnaire. RESULTS: Teams of both groups checked on the availability of airway equipment, but teams in the briefing group talked more often about treatment steps to relieve airway obstruction (p < 0.005). The time until the obstruction was relieved was significantly shorter in the briefing group (median: 80 s vs. 126 s; p < 0.005). In 45 % of the intervention scenarios the nurse suggested the solution to the airway problem whereas only 10 % of the nurses in the control group proposed a measure to relieve the obstruction (n.s.). Both groups showed no difference in the frequency of implicit vs. explicit coordination patterns. Nurses from the intervention group found the situation to be less an emergency and felt better prepared than nurses from the control group (p < 0.05). CONCLUSION: Briefings prior to anaesthesia induction in paediatric anaesthesia should include management of unanticipated problems. In a simulation setting, a briefing on treatment steps for an unexpected difficult airway improves management of an upper airway obstruction. Explicit communication of intended actions by the anaesthesiologist may foster speaking up by team members.