1 Interdisciplinary Simulation Centre, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden University of Technology, Germany. 2 Department of Pharmacology and Toxicology, Medical Faculty, Dresden University of Technology, Germany. 3 Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Dresden University of Technology, Germany
* Corresponding author. Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Fetscherstraße 74, D-01307 Dresden, Germany. E-mail: michael.mueller{at}uniklinikum-dresden.de
Accepted for publication May 16, 2005.
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Abstract |
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Methods. A total of 234 students were randomly allocated to receive instructions with (Group S) or without (Group C [control]) the use of a simulator. After a lecture on antiarrhythmic drugs, arrhythmias were presented to Group S using an advanced life support (ALS) manikin. The students were asked to administer a drug or to defibrillate, and the outcome was shown on the monitor. The students in Group C were presented with ECG charts without a simulator. The course was evaluated by a questionnaire and multiple-choice questions (MCQ) about arrhythmias.
Results. We received 222 questionnaires. The contenttime ratio was rated almost perfect in both groups, but the students in Group S rated the course better suited to link theory and practice. Students in Group S considered the simulator helpful and a good tool for teaching, and the extra effort to be worthwhile. A significantly higher number of students in Group S preferred electric cardioversion as therapy for ventricular tachycardia.
Conclusions. An ALS manikin can be an effective tool in teaching clinical pharmacology.
Keywords: education, medical students ; heart, arrhythmia
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Introduction |
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With the support of Harvard Medical International the Medical Faculty of the University of Dresden started to reform the curriculum in 1998, combining traditional teaching methods such as lectures and practical courses with problem-based learning. In the meantime, the complete 6 year programme has been reorganized and all subjects are incorporated in interdisciplinary block courses (Dresden integrative problem-based learning [DIPOL]). In the courses related to anaesthesia, simulators are part of lectures and seminars.1
As one possibility for interdisciplinary cooperation between non-clinical and clinical specialties, a seminar for third-year (first clinical year) medical students on Antiarrhythmic Therapy and ECG was incorporated in the 6 week course Basics of Drug Therapy. In this 2 h seminar, life-threatening arrhythmias and the treatment options were presented to students. We evaluated the seminar, in which students were randomly allocated into two groups, one using an advanced life support (ALS) manikin with arrhythmia simulator and the other receiving a traditional lecture. The objectives of this study were to evaluate the use of the simulator in this new interdisciplinary course.
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Methods |
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Five of the nine subgroups were taught using an ALS-training unit Laerdal Heartsim 4000TM (Laerdal, Munich, Germany) (Group S), and the remainder were taught without it (Group C [control]). One pharmacologist and one anaesthetist served as instructors and conducted all the teaching in both groups. The course began with a 45 minute lecture on the pharmacological effects of antiarrhythmic drugs followed by the presentation of preselected clinical cases of life-threatening arrhythmia. In Group C, this was done using PowerPointTM (Microsoft, Washington, USA); the ECG charts had been produced with a Heartsim 4000TM simulator and projected onto a video screen. Students were asked to make a diagnosis and suggest therapy that could include pharmacological intervention, use of a defibrillator or application of a pacemaker, where applicable. After a therapeutic method had been decided upon and carried out, the resulting ECGs were again presented in the above manner.
In Group S the same clinical cases were presented using PowerPointTM. Instead of projecting the ECG charts, an ALS manikin which was connected to a defibrillator was used to show the running ECGs on the monitor. After administering an antiarrhythmic drug the ECG changes could be observed online on the monitor. Participants in this group were also given the opportunity to defibrillate or to use an external pacemaker. Again, the results were projected live on the monitor screen.
After the course, having been assured of anonymity and given written consent, participants were asked to complete and hand in a questionnaire immediately. The questionnaire for Group C started with eight questions answerable on a scale from 1 (disagree strongly) to 6 (agree completely) (Table 1). Two additional questions concerned the ratio of study content vs time answerable on a scale from 1 to 7 (1=too much content, 4=exactly right, 7=too much time) and theory vs practice on a scale from 1 (too much theory) to 7 (too much practice). Finally, the students were asked to grade the seminar (1=worst, 6=best).
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The 6 week course concluded with an oral examination. After this examination all students were asked to answer three multiple choice questions pertaining to the seminar which were not graded:
Data from the questionnaires and the multiple-choice tests were processed using SPSS 11.5 for WindowsTM. Median and interquartile range (IQR) were determined. Results were tested for significance by using the Wilcoxon ranksum test. A P-value <0.05 was considered to be significant. The different frequencies of answers to each question of the multiple-choice tests were subjected to a 2-test for significance. The number of correct answers to the third question was tested for group differences using a MannWhitney U-test.
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Results |
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The overall course was well evaluated by both groups (Group S, 5.0 [IQR 1.0], n=111; Group C, 5.0 [1.0], n=107) (P=0.28).
The results from the individual questions on the questionnaire are given in Table 2. Both groups considered the course setting to be average. Compared with Group C, Group S considered that the course was better in linking theory to practice. The content vs time ratio of the course was equally rated by both groups (Fig. 1). The theory vs practice ratio was rated near perfect, but Group S gave a significantly better rating than Group C (Fig. 2).
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In choosing a therapy for ventricular tachycardia, significantly more students in Group S than in Group C chose electric cardioversion (53% vs 38%, P<0.05). Accordingly, the answer Lidocaine application was given more often by Group C than by Group S (42% vs 34%, P=0.246), although the level of statistical significance was not reached (Fig. 3).
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Discussion |
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The 6 week block course Basics of Drug Therapy was established as part of the PBL curriculum at Dresden Medical School.4 6 This was done by a planning committee consisting of teachers from different specialties including anaesthesiology, internal medicine and pharmacology. The emphasis has been on reducing factual knowledge, encouraging self-teaching and creating interdisciplinary courses.6 Anaesthesiologists are under-represented in undergraduate medical education,7 although they have been found to be good teachers in pharmacology.8 In this course, the aim was to incorporate practical training as this has been preferred by junior doctors.9 Simulators have been available for teaching ECG10 11 even in combination with ALS training software.12 We decided to use the Heartsim 4000TM training system which offers a real-time ECG and, as hands-on treatment options, defibrillation and an external pacemaker. The main disadvantage of this system is its lack of realistic cardiovascular reactions to drug therapy. The running ECG rhythm has to be changed manually by the tutor after drug administration.
We have shown that, in general, student appreciation of the course was positive, except for the spatial setting. The room in which the seminar was held was too small. Because of the overall positive rating, only a few differences were seen between Groups S and C. The combination of theory and practice were rated higher by Group S. Although statistically significant, the difference was only small. The good results seen in Group C may be explained by the interdisciplinary concept of the course, the fact that two tutors, one with a clinical and the other with a theoretical background, were present in this group and that ECG pictograms were used to demonstrate clinical cases.
In the three additional questions that were used specifically to evaluate the use of the simulator in Group S the students found the use of the simulator beneficial; unfortunately, no comparison can be made with Group C. The technical effort necessary for the additional use of the simulator was also evaluated, but only from the student's point of view. It would be interesting to evaluate further the costs of this training with and without the simulator. Our ALS simulators are not in everyday use; integration in new courses increases their usage rate and, considering the results of our study, the effort is useful.
This course was the first of its kind. The effects of both the interdisciplinary teaching and the use of the ALS simulator accounted for the positive evaluation. Unfortunately, there was no third non-simulator and non-interdisciplinary group for further comparison. The results of the multiple choice tests showed a significant difference in the frequency with which the answer electric cardioversion was given in the case of ventricular tachycardia. Because of the practical aspects of simulated ventricular tachycardia and its treatment with either cardioversion or drug therapy in Group S, this result reached our expectations. Use of electrotherapy as an alternative to pharmacological therapy in treating arrhythmia was a major course goal. We only briefly assessed the students' knowledge shortly after the course; a more detailed assessment would have been helpful. We tried to keep the content similar in both groups, but the different teaching methods may have affected the way that students appreciated the course.
European Resuscitation Council Guidelines were used as the basis for this course and were implemented in subsequent courses in emergency treatment. As pharmacology is taught before emergency medicine in our curriculum, we consider that it is important for students to become acquainted with different treatments for antiarrhythmia regarding ALS guidelines. However, increasing practical knowledge alone should not be the primary goal of establishing teaching methods or curricula as it has been shown that problem-based teaching does not significantly enhance the acquisition of knowledge, but is enjoyed more than traditional methods.13 Our studies have shown that that those students taking PBL courses devote more time to studying on their own.14 Moreover, they are more inclined to extend their independent studies to other fields as well. The consistent improvement of medical education in all areas was one major argument in favour of establishing the DIPOL curriculum in Dresden.
In recent years the prevalence of simulators in medical education has been increasingly driven by enormous technical developments with anaesthesiology playing a leading role.15 Therefore anaesthesiologists should share their experiences as well as their teaching tools with other medical specialties and in turn have the chance to strengthen their position within the medical curriculum. Given current developments, simulator courses will be increasingly supplemented by online instruction as part of computer-based training. Simulation centres, of which several more are expected to be founded in the next few years in Germany, should be used in an interdisciplinary manner. The use of simulators in preclinical basic courses, such as pharmacology and physiology, can help to link theory and practice in medical education.
In conclusion, the present paper describes an interdisciplinary practical course in pharmacology, in which anaesthesiology played a major role as a partner. An ALS simulator, which can probably be found in most anaesthetic departments, was used. The study provides justification for the use of simulators in education programmes designed for undergraduate medical students.
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References |
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2 Peters AS, Greenberger-Rosovsky R, Crowder C, Block SD, Moore GT. Long-term outcomes of the New Pathway Program at Harvard Medical School: a randomized controlled trial. Acad Med 2000; 75: 4709
3 Woodward CA, Ferrier BM. The content of the medical curriculum at McMaster University: graduates' evaluation of their preparation for postgraduate training. Med Educ 1983; 17: 5460[ISI][Medline]
4 Ravens U, Nitsche I, Haag C, Dobrev D. What is a good tutorial from the student's point of view? Evaluation of tutorials in a newly established PBL block course Basics of Drug Therapy. Naunyn Schmiedebergs Arch Pharmacol 2002; 366: 6976[CrossRef][ISI][Medline]
5 Ravens U, Dobrev D, Haag C. Problem-based learning: a new pathway to competence? Trends Pharmacol Sci 2002; 23: 1623
6 General Medical Council Education Committee. Tomorrow's Doctors: Recommendation on Undergraduate Medical Education, 2003. Available online at: http://www.gmc-uk.org/med_ed/tomdoc.htm as assessed on 31.05.2005
7 Brull R, Bradley JW. The role of anesthesiologists in Canadian undergraduate medical education. Can J Anaesth 2001; 48: 14752
8 Cooper GM, Hutton P. Anaesthesia and the undergraduate medical curriculum. Br J Anaesth 1995; 74: 35
9 Jolly BC, Macdonald MM. Education for practice: the role of practical experience in undergraduate and general clinical training. Med Educ 1989; 23: 18995[ISI][Medline]
10 Bergeron BP, Greenes RA. Clinical skill-building simulations in cardiology: HeartLab and EkgLab. Comput Methods Programs Biomed 1989; 30: 11126[CrossRef][ISI][Medline]
11 Bourlas P, Giakoumakis E, Koutsouris D, Papakonstantinou G, Tsanakas P. The CARDIO-LOGOS system for ECG training and diagnosis. Technol Health Care 1996; 3: 27985[Medline]
12 Christensen UJ, Heffernan D, Andersen SF, Jensen PF. ResusSim 98a PC advanced life support trainer. Resuscitation 1998; 39: 814[CrossRef][ISI][Medline]
13 Antepohl W, Herzig S. Problem-based learning versus lecture-based learning in a course of basic pharmacology: a controlled, randomized study. Med Educ 1999; 33: 10613[CrossRef][ISI][Medline]
14 Koch T, Frank MD, Graupner A, Holch M, Müller M, Wendisch J. Konzeption und Evaluation des POL-Kurses Akute Notfälle. Med Ausbild 2002; 19: 17882
15 Gaba DM. Anaesthesiology as a model for patient safety in health care. Br Med J 2000; 320: 7858