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Objective: The psychological demands placed upon the emergency medical services, assures them of their place amongst High Responsib- ility Organizations. A high pressure to act and an irreversibility of situ- ations are integral features of their workplaces. After the emergency services' job profiles were restructured in Germany, the practical stage of paramedic training is now undertaken in these conditions. That is, they are trained by a supervising instructor whilst caring for critically ill patients. This paper aims to describe the requisite skills for such an instructor, formulate the associated competences as learning objectives, and develop a quality-measuring instrument for the description of training situations. Methods: The compilation of a competence catalogue was done via a two-step process: following a Delphi survey with an expert panel of practical trainers and trainees, a large cohort of parameters were valid- ated in terms of their relevance. Those factors that formed scales to- gether were identified. Results: After validating the results of the Delphi analysis, six scales (composed of 25 items in toto) were defined. They included the areas of "Training during times of action", "Training during periods of calm", "Background and practical relevance", "Character and personality traits", "Pedagogical competencies" and "Organizational behaviour". Conclusion: For the first time, a competency catalogue has been developed for instructors working in the emergency medical services from German-speaking countries. The catalogue focuses upon clinical training during the acute care of critically ill patients. The scales and items can be used for training-the-trainers, and also quality monitoring. Further research needs to focus on the application of the catalogue in clinical practice and evaluate the need for situational customization. [ABSTRACT FROM AUTHOR]

This paper uses the diary and other records of Liu Dapeng 劉大鵬 (1857-1942), a Shanxi village resident, to examine how people in rural China experienced and understood illness at an important time of transition for medical systems in China. It explains how Liu understood the illnesses that afflicted himself and members of his family in terms of providence. The healing methods he used ranged through self-medication with folk remedies and modern patent medicines; remedies provided by families friends and neighbours (including acupuncture and prescriptions based on classical Chinese medicine); remedies provided by gods and shamans; and prescriptions provided by professional doctors of Chinese medicine, whom Liu deeply distrusted. It also examines the arrival of Western medicine in Shanxi and argues that while this existed it was incorporated into networks of medicine provided by family and friends, rather than functioning as a separate institutional system. [ABSTRACT FROM AUTHOR]