Publications by authors named "Jan Breckwoldt"

47 Publications

2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group.

Circulation 2021 Nov 11:CIR0000000000001017. Epub 2021 Nov 11.

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.
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http://dx.doi.org/10.1161/CIR.0000000000001017DOI Listing
November 2021

2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.

Resuscitation 2021 Nov 11. Epub 2021 Nov 11.

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.
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http://dx.doi.org/10.1016/j.resuscitation.2021.10.040DOI Listing
November 2021

2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces.

Resuscitation 2021 Nov 5. Epub 2021 Nov 5.

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.
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http://dx.doi.org/10.1016/j.resuscitation.2021.10.040DOI Listing
November 2021

[Education for resuscitation].

Notf Rett Med 2021 Jun 2:1-23. Epub 2021 Jun 2.

Emergency Department, Antwerp University Hospital and University of Antwerp, Edegem, Belgien.

These European Resuscitation Council education guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidance to citizens and healthcare professionals with regard to teaching and learning the knowledge, skills and attitudes of resuscitation with the ultimate aim of improving patient survival after cardiac arrest.
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http://dx.doi.org/10.1007/s10049-021-00890-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8170459PMC
June 2021

Real-world stress resilience is associated with the responsivity of the locus coeruleus.

Nat Commun 2021 04 15;12(1):2275. Epub 2021 Apr 15.

Division of Experimental Psychopathology and Psychotherapy, Dept of Psychology, University of Zurich, Zurich, Switzerland.

Individuals may show different responses to stressful events. Here, we investigate the neurobiological basis of stress resilience, by showing that neural responsitivity of the noradrenergic locus coeruleus (LC-NE) and associated pupil responses are related to the subsequent change in measures of anxiety and depression in response to prolonged real-life stress. We acquired fMRI and pupillometry data during an emotional-conflict task in medical residents before they underwent stressful emergency-room internships known to be a risk factor for anxiety and depression. The LC-NE conflict response and its functional coupling with the amygdala was associated with stress-related symptom changes in response to the internship. A similar relationship was found for pupil-dilation, a potential marker of LC-NE firing. Our results provide insights into the noradrenergic basis of conflict generation, adaptation and stress resilience.
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http://dx.doi.org/10.1038/s41467-021-22509-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8050280PMC
April 2021

European Resuscitation Council Guidelines 2021: Education for resuscitation.

Resuscitation 2021 04 24;161:388-407. Epub 2021 Mar 24.

Emergency Department, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.

These European Resuscitation Council education guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidance to citizens and healthcare professionals with regard to teaching and learning the knowledge, skills and attitudes of resuscitation with the ultimate aim of improving patient survival after cardiac arrest.
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http://dx.doi.org/10.1016/j.resuscitation.2021.02.016DOI Listing
April 2021

Family presence during resuscitation in paediatric and neonatal cardiac arrest: A systematic review.

Resuscitation 2021 05 9;162:20-34. Epub 2021 Feb 9.

North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada.

Context: Parent/family presence at pediatric resuscitations has been slow to become consistent practice in hospital settings and has not been universally implemented. A systematic review of the literature on family presence during pediatric and neonatal resuscitation has not been previously conducted.

Objective: To conduct a systematic review of the published evidence related to family presence during pediatric and neonatal resuscitation.

Data Sources: Six major bibliographic databases was undertaken with defined search terms and including literature up to June 14, 2020.

Study Selection: 3200 titles were retrieved in the initial search; 36 ultimately included for review.

Data Extraction: Data was double extracted independently by two reviewers and confirmed with the review team. All eligible studies were either survey or interview-based and as such we turned to narrative systematic review methodology.

Results: The authors identified two key sets of findings: first, parents/family members want to be offered the option to be present for their child's resuscitation. Secondly, health care provider attitudes varied widely (ranging from 15% to >85%), however, support for family presence increased with previous experience and level of seniority.

Limitations: English language only; lack of randomized control trials; quality of the publications.

Conclusions: Parents wish to be offered the opportunity to be present but opinions and perspectives on the family presence vary greatly among health care providers. This topic urgently needs high quality, comparative research to measure the actual impact of family presence on patient, family and staff outcomes.

Prospero Registration Number: CRD42020140363.
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http://dx.doi.org/10.1016/j.resuscitation.2021.01.017DOI Listing
May 2021

Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.

Resuscitation 2020 Nov 21;156:A188-A239. Epub 2020 Oct 21.

For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.
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http://dx.doi.org/10.1016/j.resuscitation.2020.09.014DOI Listing
November 2020

Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.

Circulation 2020 10 21;142(16_suppl_1):S222-S283. Epub 2020 Oct 21.

For this , the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.
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http://dx.doi.org/10.1161/CIR.0000000000000896DOI Listing
October 2020

In out-of-hospital cardiac arrest, is the positioning of victims by bystanders adequate for CPR? A cohort study.

BMJ Open 2020 09 23;10(9):e037676. Epub 2020 Sep 23.

University Hospital Zurich, Institute of Anesthesiology, University of Zurich Faculty of Medicine, Zurich, Switzerland

Objectives: Outcome from out-of-hospital cardiac arrest (OHCA) highly depends on bystander cardiopulmonary resuscitation (CPR) with high-quality chest compressions (CCs). Precondition is a supine position of the victim on a firm surface. Until now, no study has systematically analysed whether bystanders of OHCA apply appropriate positions to victims and whether the position is associated with a particular outcome.

Design: Prospective observational cohort study.

Setting: Metropolitan emergency medical services (EMS) serving a population of 400 000; dispatcher-assisted CPR was implemented. We obtained information from the first EMS vehicle arriving on scene and matched this with data from semi-structured interviews with witnesses of the arrest.

Participants: Bystanders of all OHCAs occurring during a 12-month period (July 2006-July 2007). From 201 eligible missions, 200 missions were fully reported by EMS. Data from 138 bystander interviews were included.

Primary And Secondary Outcome Measures: Proportion of positions suitable for effective CCs; related survival with favourable neurological outcome at 3 months.

Results: Positioning of victims at EMS arrival was 'supine on firm surface' in 64 cases (32.0%), 'recovery position (RP)' in 37 cases (18.5%) and other positions unsuitable for CCs in 99 cases (49.5%). Survival with favourable outcome at 3 months was 17.2% when 'supine position' had been applied, 13.5% with 'RP' and 6.1% with 'other positions unsuitable for CCs'; a statistically significant association could not be shown (p=0.740, Fisher's exact test). However, after 'effective CCs' favourable outcome at 3 months was 32.0% compared with 5.3% if no actions were taken. The OR was 5.87 (p=0.02).

Conclusion: In OHCA, two-thirds of all victims were found in positions not suitable for effective CCs. This was associated with inferior outcomes. A substantial proportion of the victims was placed in RP. More attention should be paid to the correct positioning of victims in OHCA. This applies to CPR training for laypersons and dispatcher-assisted CPR.
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http://dx.doi.org/10.1136/bmjopen-2020-037676DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513596PMC
September 2020

Improving the assessment of communication competencies in a national licensing OSCE: lessons learned from an experts' symposium.

BMC Med Educ 2020 May 26;20(1):171. Epub 2020 May 26.

Institute of Medical Education, Department of Assessment and Evaluation, University of Bern, Bern, Switzerland.

Background: As the communication competencies of physicians are crucial for providing optimal patient care, their assessment in the context of the high-stakes Objective Structured Clinical Examination (OSCE) is of paramount importance. Despite abundant literature on the topic, evidence-based recommendations for the assessment of communication competencies in high stakes OSCEs are scarce. As part of a national project to improve communication-competencies assessments in the Swiss licensing exam, we held a symposium with national and international experts to derive corresponding guidelines.

Methods: Experts were invited on account of their recognized expertise either in teaching or assessing communication competencies, or in conducting national high-stakes OSCEs. They were asked to propose concrete solutions related to four potential areas for improvement: the station design, the rating tool, the raters' training, and the role of standardized patients. Data gene.rated in the symposium was available for analysis and consisted of video recordings of plenary sessions, of the written summaries of group work, and the cards with participants' personal take-home messages. Data were analyzed using a thematic analysis approach.

Results: Nine major suggestions for improving communication-competencies assessments emerged from the analysis and were classified into four categories, namely, the roles of the OSCE scenarios, rating tool, raters' training, and simulated patients.

Conclusion: In the absence of established evidence-based guidelines, an experts' symposium facilitated the identification of nine practical suggestions for improving the assessment of communication competencies in the context of high-stakes OSCEs. Further research is needed to test effectiveness of the suggestions and how they contribute to improvements in the quality of high-stakes communication-competencies assessment.
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http://dx.doi.org/10.1186/s12909-020-02079-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249637PMC
May 2020

Agreement between trainees and supervisors on first-year entrustable professional activities for anaesthesia training.

Br J Anaesth 2020 07 16;125(1):98-103. Epub 2020 May 16.

Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland. Electronic address:

Background: Entrustable professional activities (EPAs) are commonly developed by senior clinicians and education experts. However, if postgraduate training is conceptualised as an educational alliance, the perspective of trainees should be included. This raises the question as to whether the views of trainees and supervisors on entrustability of specific EPAs differ, which we aimed to explore.

Methods: A working group, including all stakeholders, selected and drafted 16 EPAs with the potential for unsupervised practice within the first year of training. For each EPA, first-year trainees, advanced trainees, and supervisors decided whether it should be possible to attain trust for unsupervised practice by the end of the first year of anaesthesiology training (i.e. whether the respective EPA qualified as a 'first-year EPA').

Results: We surveyed 23 first-year trainees, 47 advanced trainees, and 51 supervisors (overall response rate: 68%). All groups fully agreed upon seven EPAs as 'first-year EPAs' and on four EPAs that should not be entrusted within the first year. For all five remaining EPAs, a significantly higher proportion of first-year trainees thought these should be entrusted as first-year EPAs compared with advanced trainees and supervisors. We found no differences between advanced trainees and supervisors.

Conclusions: The views of first-year trainees, advanced trainees, and supervisors showed high agreement. Differing views of young trainees disappeared after the first year. This finding provides a fruitful basis to involve trainees in negotiations of autonomy.
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http://dx.doi.org/10.1016/j.bja.2020.04.009DOI Listing
July 2020

Does the tutors' academic background influence the learning objectives in problem-based learning?

GMS J Med Educ 2020 17;37(1):Doc8. Epub 2020 Feb 17.

Medical University of Vienna, Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Clinical Biometrics, Vienna, Austria.

Problem-based learning (PBL) is an essential element of the curriculum of the Medical University of Vienna (MUV) and is performed in an eight steps model with: clarifying, defining, analysing, shifting & sorting, identifying learning objectives, going to learn and coming back to talk and feedback. With an annual intake of up to 740 students the MUV has to recruit PBL tutors from various academic backgrounds including undergraduate near-peer students. Therefore, we were interested to see whether a tutor's academic background had an influence on the resulting PBL sessions as reflected by the percentage of learning objectives (LOs) which were actually achieved in relation to the intended LOs. For each PBL session "intended learning objectives" (ILOs) were defined. ILOs were communicated to all tutors by means of PBL session guides in order to provide homogenous learning opportunities to all students. However, it was not mandatory to reach all ILOs. The PBL coordination regarded a range of two thirds to three quarters of ILOs as a desirable goal. For analysis we retrieved data concerning ILOs, characteristics of tutors and PBL groups from the institution's PBL quality assurance system. From 2012-2014, 216 PBL groups were facilitated by 106 tutors with different academic backgrounds. On average, 70.8% (95% CI: 69.2-72.5%) of the ILOs were achieved; MUV clinicians reached 74.3% (70.8-77.8%), MUV non-clinicians 74.2% (71.7-76.6%), external faculty (clinicians and non-clinicians) 68.6% (64.4-72.8%), and near-peer students 64.7% (61.8-67.7%). Statistically significant differences were found between near-peer students and MUV clinicians (p<.001) as well as MUV non-clinicians (p<.001). ILOs were reached within a satisfactory range. However, groups taught by near-peer students reached significantly fewer ILOs than groups taught by MUV faculty tutors. This finding raises the question whether tutor training for near-peer students should be intensified. Also, further research is needed to explore the group dynamics of student-led PBL groups.
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http://dx.doi.org/10.3205/zma001301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7105758PMC
October 2020

Comparing Classroom Instruction to Individual Instruction as an Approach to Teach Avatar-Based Patient Monitoring With Visual Patient: Simulation Study.

JMIR Med Educ 2020 Apr 23;6(1):e17922. Epub 2020 Apr 23.

University Hospital Zurich, Zurich, Switzerland.

Background: Visual Patient is an avatar-based alternative to standard patient monitor displays that significantly improves the perception of vital signs. Implementation of this technology in larger organizations would require it to be teachable by brief class instruction to large groups of professionals. Therefore, our study aimed to investigate the efficacy of such a large-scale introduction to Visual Patient.

Objective: In this study, we aimed to compare 2 different educational methods, one-on-one instruction and class instruction, for training anesthesia providers in avatar-based patient monitoring.

Methods: We presented 42 anesthesia providers with 30 minutes of class instruction on Visual Patient (class instruction group). We further selected a historical sample of 16 participants from a previous study who each received individual instruction (individual instruction group). After the instruction, the participants were shown monitors with either conventional displays or Visual Patient displays and were asked to interpret vital signs. In the class instruction group, the participants were shown scenarios for either 3 or 10 seconds, and the numbers of correct perceptions with each technology were compared. Then, the teaching efficacy of the class instruction was compared with that of the individual instruction in the historical sample by 2-way mixed analysis of variance and mixed regression.

Results: In the class instruction group, when participants were presented with the 3-second scenario, there was a statistically significant median increase in the number of perceived vital signs when the participants were shown the Visual Patient compared to when they were shown the conventional display (3 vital signs, P<.001; effect size -0.55). No significant difference was found for the 10-second scenarios. There was a statistically significant interaction between the teaching intervention and display technology in the number of perceived vital signs (P=.04; partial η=.076). The mixed logistic regression model for correct vital sign perception yielded an odds ratio (OR) of 1.88 (95% CI 1.41-2.52; P<.001) for individual instruction compared to class instruction as well as an OR of 3.03 (95% CI 2.50-3.70; P<.001) for the Visual Patient compared to conventional monitoring.

Conclusions: Although individual instruction on Visual Patient is slightly more effective, class instruction is a viable teaching method; thus, large-scale introduction of health care providers to this novel technology is feasible.
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http://dx.doi.org/10.2196/17922DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206517PMC
April 2020

The modular curriculum of medicine at the Charité Berlin - a project report based on an across-semester student evaluation.

GMS J Med Educ 2019 15;36(5):Doc54. Epub 2019 Oct 15.

Charité - Universitätsmedizin Berlin, Prodekanat für Studium und Lehre, Dieter Scheffner Fachzentrum für medizinische Hochschullehre und Ausbildungsforschung, Berlin, Germany.

The introduction of a reform clause into the German licensing laws for medical doctors has enabled German faculties to pilot alternative designs for medical degree programmes. The aim of this project report is to outline the curricular features of the modular curriculum of medicine (MCM) at the Charité and to assess the results of its implementation based on a student evaluation across semesters. The MCM was planned and implemented in a competency- and outcome-based manner from 2010-2016 in a faculty-wide process. The curriculum is characterised by a modular structure, longitudinal teaching formats and the integration of basic and clinical science. In the winter semester 2017, evaluations by students in semesters 1-10 were carried out. The results were analysed descriptively, and the coverage of overarching learning outcomes was compared to the results of a survey carried out amongst students on the traditional regular curriculum of medicine track in 2016. A total of 1,047 students participated in the across-semester evaluation (return rate 35%). A high percentage of the respondents positively rated the achieved curricular integration and longitudinal teaching formats. The majority of the respondents agreed with the relevance of the overarching learning outcomes. Students' evaluations of the coverage of learning outcomes showed a differentiated picture for the MCM. Compared to the regular curriculum track, the coverage in the MCM programme showed substantial improvements in all aspects. Students found themselves to be better prepared for the M2 state examination and the practical year. The students' overall satisfaction with their decisions to study in the MCM was high. The results of the student evaluation show that a significant improvement in medical education has been achieved at the Charité with the new integrated, outcome-oriented design and the implementation of the MCM. At the same time, ongoing weaknesses have been revealed that serve as a basis for the continued development of the curriculum. This report aims to contribute to the discussion of the future of undergraduate medical education in Germany.
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http://dx.doi.org/10.3205/zma001262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883251PMC
June 2020

2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.

Resuscitation 2019 12 14;145:95-150. Epub 2019 Nov 14.

The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research.
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http://dx.doi.org/10.1016/j.resuscitation.2019.10.016DOI Listing
December 2019

2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.

Circulation 2019 12 14;140(24):e826-e880. Epub 2019 Nov 14.

The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research.
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http://dx.doi.org/10.1161/CIR.0000000000000734DOI Listing
December 2019

Shared Decision-Making Training in Internal Medicine: A Multisite Intervention Study.

J Grad Med Educ 2019 Aug;11(4 Suppl):146-151

Background: Research shows that when patients and health care providers share responsibility for clinical decisions, both patient satisfaction and quality of care increase, and resource use decreases. Yet few studies have assessed how to train residents to use shared decision-making (SDM) in their practice.

Objective: We developed and evaluated a SDM training program in internal medicine.

Methods: Senior internal medicine residents from 3 hospitals in Switzerland were assessed shortly before and 2 months after completing a program that included a 2-hour workshop and pocket card use in clinical practice. Encounters with standardized patients (SPs) were recorded and SDM performance was assessed using a SDM completeness rating scale (scores ranging from 0 to 100), a self-reported questionnaire, and SPs rating the residents.

Results: Of 39 eligible residents, 27 (69%) participated. The mean (SD) score improved from 65 (SD 13) to 71 (SD 12; effect size [ES] 0.53; = .011). After training, participants were more comfortable with their SDM-related knowledge (ES 1.42, < .001) and skills (ES 0.91, < .001), and with practicing SDM (ES 0.96, < .001). Physicians applied SDM concepts more often in practice (ES 0.71, = .001), and SPs felt more comfortable with how participants discussed their care (ES 0.44, = .031).

Conclusions: The SDM training program improved the competencies of internal medicine residents and promoted the use of SDM in clinical practice. The approach may be of interest for teaching SDM to residents in other disciplines and to medical students.
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http://dx.doi.org/10.4300/JGME-D-18-00849DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697303PMC
August 2019

Challenging cases during clinical clerkships beyond the domain of the "medical expert": an analysis of students' case vignettes.

GMS J Med Educ 2019 16;36(3):Doc30. Epub 2019 May 16.

University Hospital Zurich, Institute of Anesthesiology, Zurich, Switzerland.

During clinical clerkships students experience complex and challenging clinical situations related to problems beyond the domain of the "Medical Expert". Workplace routine may leave little opportunity to reflect on these situations. The University of Zurich introduced a mandatory course directly after the clinical clerkship year (CCY) to work up these situations. Prior to the course each student submitted a vignette on a case he or she had perceived challenging during the CCY and which was not related to the domain of the "Medical Expert" role. In this paper we want to characterize these cases in respect to most prominent themes and related CanMEDS roles. The goal was to inform clinical supervisors about potential teaching demands during the CCY. All case vignettes submitted by a years' cohort were analysed by three researchers in two ways: for the clinical characteristics and the main theme of the underlying problem and the most prominent CanMEDS roles involved. Themes of the underlying problem were aggregated to overarching topics and subsequently to main categories by pragmatic thematic analysis. 254 case vignettes covered the whole spectrum of clinical disciplines. A wide range of underlying themes could be assigned to five main categories: "communication within team" (23.2%), "communication with patients and relatives" (24.8%), "patient behavior and attitudes" (18.5%), "clinical decision making" (24.0%), and "social and legal issues" (9.4%). Most frequent CanMEDS roles were "Communicator" (26.9%) and "Professional" (23.5%). Cases students perceived as challenging beyond the "Medical Expert" were reported from all clinical disciplines. These were mainly related to communicational and professional issues, mirrored by the CanMEDS roles "Communicator" and "Professional". Therefore, supervisors in clinical clerkships should put an additional teaching focus on communication and professionalism.
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http://dx.doi.org/10.3205/zma001238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6545608PMC
December 2019

Operating room technician trainees teach medical students - an inter-professional peer teaching approach for infection prevention strategies in the operation room.

Antimicrob Resist Infect Control 2019 14;8:75. Epub 2019 May 14.

5Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.

Background: Education is a cornerstone strategy to prevent health-associated infections. Trainings benefit from being interactive, simulation-based, team-orientated, and early in professional socialization. We conceived an innovative inter-professional peer-teaching module with operating room technician trainees (ORTT) teaching infection prevention behavior in the operating room (OR) to medical students (MDS).

Methods: ORTT delivered a 2-h teaching module to small groups of MDS in a simulated OR setting with 4 posts MDS and ORTT evaluated module features and teaching quality through 2 specific questionnaires. Structured field notes by education specialist observers were analyzed thematically.

Results: On Likert scales from - 2 to + 2, mean overall satisfaction was + 1.91 (±0.3) for MDS and + 1.66 (±0.6 SD) for ORTT while teaching quality was rated + 1.89 (±0.3) by MDS and self-rated with + 1.34 (±0.5) by ORTT. Students and observers highlighted that the training fostered mutual understanding and provided insight into the corresponding profession.

Conclusions: Undergraduate inter-professional teaching among ORTT and MDS in infection prevention and control proved feasible with high educational quality. Inducing early mutual understanding between professional groups might improve professional collaboration and patient safety.
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http://dx.doi.org/10.1186/s13756-019-0526-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518629PMC
May 2020

Moving a mountain: Practical insights into mastering a major curriculum reform at a large European medical university.

Med Teach 2018 05 5;40(5):453-460. Epub 2018 Mar 5.

a Dieter Scheffner Center for Medical Education and Educational Research Charité, Dean's Office of Student Affairs Universitätsmedizin Berlin, Free and Humboldt University Berlin , Germany.

Aim: Undergraduate medical education is currently in a fundamental transition towards competency-based programs around the globe. A major curriculum reform implies a dual challenge: the change of the curriculum and the delivering organization. Both are closely interwoven. In this article, we provide practical insights into our approach of managing such a fundamental reform of the large undergraduate medical program at the Charité - Universitätsmedizin Berlin.

Methods: Members of the project management team summarized the key features of the process with reference to the literature.

Results: Starting point was a traditional, discipline-based curriculum that was reformed into a fully integrated, competency-based program. This change process went through three phases: initiation, curriculum development and implementation, and sustainability. We describe from a change management perspective, their main characteristics, and the approaches that were employed to manage them successfully.

Conclusions: Our report is intended to provide practical insights and guidance for those institutions which are yet considering or have already started to undergo a major reform of their undergraduate programs towards competency medical education.
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http://dx.doi.org/10.1080/0142159X.2018.1440077DOI Listing
May 2018

How the Start into the Clinical Elective Year Could be Improved: Qualitative Results and Recommendations from Student Interviews.

GMS J Med Educ 2018;35(1):Doc14. Epub 2018 Feb 15.

University of Zurich, Faculty of Medicine, Dean's Office, Zurich, Switzerland.

Entering the Clinical Elective Year (CEY) is a challenging transition phase for undergraduate medical students. Students become members of a professional team, thereby taking over certain tasks, which are executed more or less independently. Factors which facilitate (or impede) this transition in the perception of students are not well described. We therefore wanted to explore, what students perceived to be helpful during the first phase of the CEY and possibly derive respective recommendations. We conducted semi-structured interviews with 5th year medical students after they had completed the first two months of their CEY. Students were asked which problems they had faced and how they felt prepared for the CEY. Interviews were audio-recorded, transcribed, and analysed by qualitative content analysis. From 34 interviews, we included 28 into analysis. Overall, 24 students were satisfied or very satisfied with their start into the CEY. Satisfaction was expressed with respect to workplace experiences, learning progress, responsibilities and team integration. Especially, students appreciated if they were integrated as active members of the team, were given responsibility for certain units of work, and received well-structured formal teaching and supervision. Students had divergent opinions about the quality of teaching and supervision, about their own achievements, and the recognition they received. Students recommended improvements in respect to formal teaching and supervision by clinical supervisors, preparation of the CEY by university, and supporting structures in the hosting institution. Students in this study were generally satisfied with the first two months of their CEY. Facilitating factors were active and responsible involvement into routine patient care, and high quality formal teaching and supervision. Findings may inform universities, teaching hospitals, and students how to better shape the first phase of the CEY.
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http://dx.doi.org/10.3205/zma001161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5827187PMC
November 2018

KIDS SAVE LIVES: School children education in resuscitation for Europe and the world.

Eur J Anaesthesiol 2017 12;34(12):792-796

From the Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany (BWB, SW), Department of Anaesthesia and Intensive Care Medicine, Maggiore Hospital, Bologna, Italy (FS), Saarbrücken, Germany (KHA), Faculty of Medicine, University of Zürich, Zürich, Switzerland (JB), Department of Anaesthesiology, University Hospital of Munich (LMU), Munich, Germany (UK), Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany (GR), Department of Anaesthesiology and Intensive Therapy, Jagiellonian University Hospital, Krakow, Poland (JA), Emergency Department, Calderdale Royal Hospital, Halifax, UK (AL), Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark (FL) and American Medical Center Cyprus, Nicosia, Cyprus (MG).

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http://dx.doi.org/10.1097/EJA.0000000000000713DOI Listing
December 2017

Conditions for excellence in teaching in medical education: The Frankfurt Model to ensure quality in teaching and learning.

GMS J Med Educ 2017 16;34(4):Doc46. Epub 2017 Oct 16.

Universität Zürich, Medizinische Fakultät, Dekanat, Stab Forschung und Entwicklung, Zürich, Switzerland.

There is general consensus that the organizational and administrative aspects of academic study programs exert an important influence on teaching and learning. Despite this, no comprehensive framework currently exists to describe the conditions that affect the quality of teaching and learning in medical education. The aim of this paper is to systematically and comprehensively identify these factors to offer academic administrators and decision makers interested in improving teaching a theory-based and, to an extent, empirically founded framework on the basis of which improvements in teaching quality can be identified and implemented. Primarily, the issue was addressed by combining a theory-driven deductive approach with an experience based, "best evidence" one during the course of two workshops held by the GMA Committee on Personnel and Organizational Development in Academic Teaching (POiL) in Munich (2013) and Frankfurt (2014). Two models describing the conditions relevant to teaching and learning (Euler/Hahn and Rindermann) were critically appraised and synthesized into a new third model. Practical examples of teaching strategies that promote or hinder learning were compiled and added to the categories of this model and, to the extent possible, supported with empirical evidence. Based on this, a checklist with recommendations for optimizing general academic conditions was formulated. The covers six categories: and These categories have been supplemented by the interests, motives and abilities of the actual teachers and students in this particular setting. The categories of this model provide the structure for a checklist in which recommendations for optimizing teaching are given. The checklist derived from the Frankfurt Model for ensuring quality in teaching and learning can be used for quality assurance and to improve the conditions under which teaching and learning take place in medical schools.
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http://dx.doi.org/10.3205/zma001123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654116PMC
November 2018

10 years of didactic training for novices in medical education at Charité.

GMS J Med Educ 2017 16;34(4):Doc39. Epub 2017 Oct 16.

Universität Zürich, Medizinische Fakultät, Dekanat, Zürich, Switzerland.

Many medical faculties are introducing faculty development programmes to train their teaching staff with the aim of improving student learning performance. Frequently changing parameters within faculties pose a challenge for the sustainable establishment of such programmes. In this paper, we aim to describe facilitating and hindering parameters using the example of the basic teacher training (BTT) course at the Charité - Universtitätsmedizin Berlin (Charité). After sporadic pilot attempts for university education training, basic teacher training was finally established at the Charité in 2006 for all new teaching staff. An interdisciplinary taskforce at the office for student affairs designed the programme according to the Kern cycle of curriculum development, while the Charité advanced training academy provided the necessary resources. Within ten years more than 900 faculty members have completed the BTT (9% of current active teaching staff at the Charité). The BTT programme underwent several phases (piloting, evaluation, review, personnel and financial boosting), all of which were marked by changes in the staff and organizational framework. Evaluations by participants were very positive, sustainable effects on teaching could be proven to a limited extent. Success factors for the establishment of the programme were the institutional framework set by the faculty directors, the commitment of those involved, the support of research grants and the thoroughly positive evaluation by participants. More challenging were frequent changes in parameters and the allocation of incentive resources for other, format-specific training courses (e.g. PBL) as part of the introduction of the new modular curriculum of the Charité. The sustainment of the programme was enabled through strategic institutional steps taken by the faculty heads. Thanks to the commitment and input by those at a working level as well as management level, the basic teacher training course is today an established part of the faculty development programme at the Charité.
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http://dx.doi.org/10.3205/zma001116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654120PMC
November 2018

GMA Annual Conference 2016 in Bern - Conference Report.

GMS J Med Educ 2017 15;34(1):Doc2. Epub 2017 Feb 15.

Universität Zürich, Med. Fakultät, Dekanat, Stabsleiter, Zürich, Schweiz.

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http://dx.doi.org/10.3205/zma001079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5327654PMC
November 2018

Differences in procedural knowledge after a "spaced" and a "massed" version of an intensive course in emergency medicine, investigating a very short spacing interval.

BMC Med Educ 2016 Sep 26;16(1):249. Epub 2016 Sep 26.

Dieter Scheffner Centre for Medical Education, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.

Background: Distributing a fixed amount of teaching hours over a longer time period (spaced approach) may result in better learning than delivering the same amount of teaching within a shorter time (massed approach). While a spaced approach may provide more opportunities to elaborate the learning content, a massed approach allows for more economical utilisation of teaching facilities and to optimise time resources of faculty. Favourable effects of spacing have been demonstrated for postgraduate surgery training and for spacing intervals of weeks to months. It is however unknown, whether a spacing effect can also be observed for shorter intervals and in undergraduate medical education. Therefore, we aimed to evaluate the effect of a short spacing intervention within an undergraduate intensive course in emergency medicine (EM) on students' procedural knowledge.

Methods: An EM intensive course of 26 teaching hours was delivered over either 4.5 days, or 3.0 days. After the course students' procedural knowledge was assessed by a specifically developed video-case based key-feature test (KF-test).

Results: Data sets of 156 students (81.7 %, 191 students eligible) were analysed, 54 from the spaced, and 102 from the massed version. In the KF-test students from the spaced version reached a mean of 14.8 (SD 2.0) out of 22 points, compared to 13.7 (SD 2.0) in the massed version (p = .002). Effect size was moderate (Cohen's d: 0.558).

Conclusion: A significant spacing effect was observable even for a short spacing interval in undergraduate medical education. This effect was only moderate and may be weighed against planning needs of faculty and teaching resources.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037615PMC
http://dx.doi.org/10.1186/s12909-016-0770-6DOI Listing
September 2016

Evaluation of the free, open source software WordPress as electronic portfolio system in undergraduate medical education.

BMC Med Educ 2016 Jun 3;16:157. Epub 2016 Jun 3.

Dieter Scheffner Center for Medical Education and Educational Research, Charité -Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10098, Germany.

Background: Electronic portfolios (ePortfolios) are used to document and support learning activities. E-portfolios with mobile capabilities allow even more flexibility. However, the development or acquisition of ePortfolio software is often costly, and at the same time, commercially available systems may not sufficiently fit the institution's needs. The aim of this study was to design and evaluate an ePortfolio system with mobile capabilities using a commercially free and open source software solution.

Methods: We created an online ePortfolio environment using the blogging software WordPress based on reported capability features of such software by a qualitative weight and sum method. Technical implementation and usability were evaluated by 25 medical students during their clinical training by quantitative and qualitative means using online questionnaires and focus groups.

Results: The WordPress ePortfolio environment allowed students a broad spectrum of activities - often documented via mobile devices - like collection of multimedia evidences, posting reflections, messaging, web publishing, ePortfolio searches, collaborative learning, knowledge management in a content management system including a wiki and RSS feeds, and the use of aid tools for studying. The students' experience with WordPress revealed a few technical problems, and this report provides workarounds. The WordPress ePortfolio was rated positively by the students as a content management system (67 % of the students), for exchange with other students (74 %), as a note pad for reflections (53 %) and for its potential as an information source for assessment (48 %) and exchange with a mentor (68 %). On the negative side, 74 % of the students in this pilot study did not find it easy to get started with the system, and 63 % rated the ePortfolio as not being user-friendly. Qualitative analysis indicated a need for more introductory information and training.

Conclusions: It is possible to build an advanced ePortfolio system with mobile capabilities with the free and open source software WordPress. This allows institutions without proprietary software to build a sophisticated ePortfolio system adapted to their needs with relatively few resources. The implementation of WordPress should be accompanied by introductory courses in the use of the software and its apps in order to facilitate its usability.
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http://dx.doi.org/10.1186/s12909-016-0678-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4891874PMC
June 2016

Short structured feedback training is equivalent to a mechanical feedback device in two-rescuer BLS: a randomised simulation study.

Scand J Trauma Resusc Emerg Med 2016 May 13;24:70. Epub 2016 May 13.

Federal Ministry of the Interior and Sigmund Freud University Vienna, Vienna, Austria.

Background: Resuscitation guidelines encourage the use of cardiopulmonary resuscitation (CPR) feedback devices implying better outcomes after sudden cardiac arrest. Whether effective continuous feedback could also be given verbally by a second rescuer ("human feedback") has not been investigated yet. We, therefore, compared the effect of human feedback to a CPR feedback device.

Methods: In an open, prospective, randomised, controlled trial, we compared CPR performance of three groups of medical students in a two-rescuer scenario. Group "sCPR" was taught standard BLS without continuous feedback, serving as control. Group "mfCPR" was taught BLS with mechanical audio-visual feedback (HeartStart MRx with Q-CPR-Technology™). Group "hfCPR" was taught standard BLS with human feedback. Afterwards, 326 medical students performed two-rescuer BLS on a manikin for 8 min. CPR quality parameters, such as "effective compression ratio" (ECR: compressions with correct hand position, depth and complete decompression multiplied by flow-time fraction), and other compression, ventilation and time-related parameters were assessed for all groups.

Results: ECR was comparable between the hfCPR and the mfCPR group (0.33 vs. 0.35, p = 0.435). The hfCPR group needed less time until starting chest compressions (2 vs. 8 s, p < 0.001) and showed fewer incorrect decompressions (26 vs. 33 %, p = 0.044). On the other hand, absolute hands-off time was higher in the hfCPR group (67 vs. 60 s, p = 0.021).

Conclusions: The quality of CPR with human feedback or by using a mechanical audio-visual feedback device was similar. Further studies should investigate whether extended human feedback training could further increase CPR quality at comparable costs for training.
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http://dx.doi.org/10.1186/s13049-016-0265-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866361PMC
May 2016
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