A prospective, blinded evaluation of a video-assisted ‘4-stage approach’ during undergraduate student practical skills training

BACKGROUND: The 4-stage approach (4-SA) is used as a didactic method for teaching practical skills in international courses on resuscitation and the structured care of trauma patients. The aim of this study was to evaluate objective and subjective learning success of a video-assisted 4-SA in teaching undergraduate medical students. METHODS: The participants were medical students learning the principles of the acute treatment of trauma patients in their multidiscipline course on emergency and intensive care medicine. The participants were quasi- randomly divided into two groups. The 4-SA was used in both groups. In the control group, all four steps were presented by an instructor. In the study group, the first two steps were presented as a video. At the end of the course a 5-minute objective, structured clinical examination (OSCE) of a simulated trauma patient was conducted. The test results were divided into objective results obtained through a checklist with 9 dichotomous items and the assessment of the global performance rated subjectively by the examiner on a Likert scale from 1 to 6. RESULTS: 313 students were recruited; the results of 256 were suitable for analysis. The OSCE results were excellent in both groups and did not differ significantly (control group: median 9, interquantil range (IQR) 8–9, study group: median 9, IQR 8–9; p = 0.29). The global performance was rated significantly better for the study group (median 1, IQR 1–2 vs. median 2, IQR 1–3; p < 0.01). The relative knowledge increase, stated by the students in their evaluation after the course, was greater in the study group (85% vs. 80%). CONCLUSION: It is possible to employ video assistance in the classical 4-SA with comparable objective test results in an OSCE. The global performance was significantly improved with use of video assistance

Use of the GlideScope®-Ranger for pre-hospital intubations by anaesthesia trained emergency physicians – an observational study

Background: Pre-hospital endotracheal intubation is more difficult than in the operating room (OR). Therefore, enhanced airway management devices such as video laryngoscopes may be helpful to improve the success rate of pre-hospital intubation. We describe the use of the Glidescope®-Ranger (GS-R) as an alternative airway tool used at the discretion of the emergency physician (EP) in charge. Methods: During a 3.5 year period, the GS-R was available to be used either as the primary or backup tool for pre-hospital intubation by anaesthesia trained EP with limited expertise using angulated videolaryngoscopes. Results: During this period 672 patients needed pre-hospital intubation of which the GS-R was used in 56 cases. The overall GS-R success rate was 66 % (range of 34–100 % among EP). The reasons for difficulties or failure included inexperience of the EP with the GS-R, impaired view due to secretion, vomitus, blood or the inability to see the screen in very bright environment due to sunlight. Conclusion: Special expertise and substantial training is needed to successfully accomplish tracheal intubation with the GS-R in the pre-hospital setting. Providers inexperienced with DL as well as video-assisted intubation should not expect to be able to perform tracheal intubation easily just because a videolaryngoscope is available. Additionally, indirect laryngoscopy might be difficult or even impossible to achieve in the pre-hospital setting due to impeding circumstances such as blood, secretions or bright sun-light. Therefore, videolaryngoscopes, here the GS-R, should not be considered as the “Holy Grail” of endotracheal intubation, neither for the experts nor for inexperienced providers. Electronic supplementary material The online version of this article (doi:10.1186/s12873-016-0069-2) contains supplementary material, which is available to authorized users

Multi-capillary column-ion mobility spectrometry (MCC-IMS) as a new method for the quantification of occupational exposure to sevoflurane in anaesthesia workplaces: an observational feasibility study

BACKGROUND: Occupational exposure to sevoflurane has the potential to cause health damage in hospital personnel. Workplace contamination with the substance mostly is assessed by using photoacoustic infrared spectrometry with detection limits of 10 ppbv. Multi-capillary column-ion mobility spectrometry (MCC-IMS) could be an alternative technology for the quantification of sevoflurane in the room air and could be even more accurate because of potentially lower detection limits. The aim of this study was to test the hypothesis that MCC-IMS is able to detect and monitor very low concentrations of sevoflurane (<10 ppbv) and to evaluate the exposure of hospital personnel to sevoflurane during paediatric anaesthesia and in the post anaesthesia care unit (PACU). METHODS: A MCC-IMS device was calibrated to several concentrations of sevoflurane and limits of detection (LOD) and quantification (LOQ) were calculated. Sevoflurane exposure of hospital personnel was measured at two anaesthesia workplaces and time-weighted average (TWA) values were calculated. RESULTS: The LOD was 0.0068 ppbv and the LOQ was 0.0189 ppbv. During paediatric anaesthesia the mean sevoflurane concentration was 46.9 ppbv (8.0 - 314.7 ppbv) with TWA values between 5.8 and 45.7 ppbv. In the PACU the mean sevoflurane concentration was 27.9 ppbv (8.0 – 170.2 ppbv) and TWA values reached from 8.3 to 45.1 ppbv. CONCLUSIONS: MCC-IMS shows a significantly lower LOD and LOQ than comparable methods. It is a reliable technology for monitoring sevoflurane concentrations at anaesthesia workplaces and has a particular strength in quantifying low-level contaminations of sevoflurane. The exposure of the personnel working in these areas did not exceed recommended limits and therefore adverse health effects are unlikely

Development, reliability and objectivity of an „Objective Structured Clinical Examination“ in emergency medicine

Mit Einführung der neuen Approbationsordnung für Ärzte wurde in Göttingen für den Querschnittsbereich Notfall- und Intensivmedizin eine praktische Prüfung im Sinne einer Objektive Structured Clinical Examination (OSCE) entwickelt und eingeführt. Zunächst erfolgte die Planung einer validen Prüfung mittels Blueprint mit den vorhandenen Ressourcen. Prüfungsziele wurden festgelegt und Prüfungsbögen entworfen. Anschließend wurde die OSCE auf die beiden weiteren Qualitätskriterien einer Prüfung, Reliabilität und Objektivität, untersucht und eine Itemanalyse durchgeführt. Die OSCE-Prüfung wurde mittels eines Videoratings auf Reliabilität untersucht. Am Videorating nahmen neben ärztlichen Ratern auch studentische Rater teil. Die Reliabilität wurde mit Hilfe des Reliabilitätskoeffizienten Kappa berechnet. Eine Global- und eine Checklistenbewertung wurden miteinander verglichen. Die Untersuchung zur Objektivität fand mit 8 Teststudierenden statt. In der Untersuchung zeigte die OSCE mit einem κ=0,73 im Bereich der Checklistenbewertung eine gute Reliabilität. Die Globalbewertung zeigte eine insgesamt nicht zufriedenstellende Reliabilität κ=0,33-0,43. Allerdings ist in dieser Prüfung ausschließlich eine Globalbewertung pro Station erfolgt und nicht eine Globalbewertung für jedes Item. Der Vergleich studentischer Rater mit den ärztlichen Ratern zeigt gute Übereinstimmung mit der Originalprüfung für die Checklistenbewertung. Insgesamt wurden von den studentischen Prüfern weniger Punkte für die Leistungen der Prüflinge in der Checklistenbewertung vergeben als von den ärztlichen Prüfern. Bei der Globalbewertung dagegen haben die studentischen Rater bessere Noten vergeben als die ärztlichen Rater. Die Übereinstimmung ist an vier der fünf Prüfungsstationen bei den studentischen Prüfern besser als bei den ärztlichen Prüfern. Die Untersuchung zur Objektivität der Prüfung zeigte Verbesserungspotential in diesem Bereich. Die Itemanalyse ergab für 28 Ites eine adäquate Itemschwierigkeit sowie adäquate Trennschärfe. Somit ist die OSCE- Prüfung im Bereich Notfallmedizin in Göttingen ist eine reliable Prüfungsform. Im verwendeten Prüfungsbogen ist die Checklistenbewertung der Globalbewertung im Bereich Reliabilität überlegen. Studenten, die im Videorating eingesetzt wurden, konnten die Prüfung mit guter Übereinstimmung zur Originalprüfung bewerten

Multi-capillary column-ion mobility spectrometry (MCC-IMS) as a new method for the quantification of occupational exposure to sevoflurane in anaesthesia workplaces: an observational feasibility study

Background: Occupational exposure to sevoflurane has the potential to cause health damage in hospital personnel. Workplace contamination with the substance mostly is assessed by using photoacoustic infrared spectrometry with detection limits of 10 ppbv. Multi-capillary column-ion mobility spectrometry (MCC-IMS) could be an alternative technology for the quantification of sevoflurane in the room air and could be even more accurate because of potentially lower detection limits. The aim of this study was to test the hypothesis that MCC-IMS is able to detect and monitor very low concentrations of sevoflurane (<10 ppbv) and to evaluate the exposure of hospital personnel to sevoflurane during paediatric anaesthesia and in the post anaesthesia care unit (PACU). Methods: A MCC-IMS device was calibrated to several concentrations of sevoflurane and limits of detection (LOD) and quantification (LOQ) were calculated. Sevoflurane exposure of hospital personnel was measured at two anaesthesia workplaces and time-weighted average (TWA) values were calculated. Results: The LOD was 0.0068 ppbv and the LOQ was 0.0189 ppbv. During paediatric anaesthesia the mean sevoflurane concentration was 46.9 ppbv (8.0 - 314.7 ppbv) with TWA values between 5.8 and 45.7 ppbv. In the PACU the mean sevoflurane concentration was 27.9 ppbv (8.0 – 170.2 ppbv) and TWA values reached from 8.3 to 45.1 ppbv. Conclusions: MCC-IMS shows a significantly lower LOD and LOQ than comparable methods. It is a reliable technology for monitoring sevoflurane concentrations at anaesthesia workplaces and has a particular strength in quantifying low-level contaminations of sevoflurane. The exposure of the personnel working in these areas did not exceed recommended limits and therefore adverse health effects are unlikely

Additional file 1: of Use of the GlideScope®-Ranger for pre-hospital intubations by anaesthesia trained emergency physicians – an observational study

STROBE Statement—checklist of items that should be included in reports of observational studies. (PDF 94 kb