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The basic purposes of developing a simulation center come from the fact that practicing in a realistic resuscitation situation is ethically unacceptable, that exercise after suspended resuscitation is ethically considered controversial and that skills and knowledge in clinical medicine cannot be fully mastered during a stay in different departments. Due to the impossibility of learning these procedures on patients, simulation centers allow the possibility for students and course participants to practice them on „models” in places built exclusively for that purpose. The aim of this lecture is to present the Skill lab – a teaching base of the Faculty of Medicine, the Faculty of Health Studies and the Faculty of Dental Medicine. Our first Skill lab was constructed 2001 and the first equipment included teaching models for cardiopulmonary resuscitation procedures, including „Airway“, „Basic Life Support“ and „Advanced Life Support“. In 2013, the Skill lab moved to a new, adapted space within the University Campus of the University of Rijeka. It extends to 160 m2 and is equipped with the latest simulation equipment that can be used to train both lay people and highly specialized health professionals. The main principles of education in Skill lab include working in small groups, individual approach, active exercises on models while respecting the predetermined exercise structure and time limits, preparation of the skill station, creation of scenery – simulation of reality and preparation of the scenarios of certain medical conditions. The teaching staff follows the doctrine and algorithms of the European Resuscitation Council and includes 46 ALS instructors, 21 ETC instructors and 8 students demonstrators. At the Ultrasound Skills lab we offer several courses, including „Airway, thorax and abdomen ultrasound in emergency medicine”, „Ultrasound guided regional anesthesia”, „Summer school“, „Ultrasound in intensive care and emergency medicine”, „Focus Assessed Transthoracic Echocardiography – basic and advanced Heart US“, „US guided Percutaneous Dilatative Tracheostomy“. [ABSTRACT FROM AUTHOR]

Purpose: To provide an overview of the discovery, presentation, and management of Rapid-onset Obesity with Hypothalamic dysfunction, Hypoventilation, and Autonomic Dysregulation (ROHHAD). To discuss a search for causative etiology spanning multiple disciplines and continents. Methods: The literature (1965–2022) on the diagnosis, management, pathophysiology, and potential etiology of ROHHAD was methodically reviewed. The experience of several academic centers with expertise in ROHHAD is presented, along with a detailed discussion of scientific discovery in the search for a cause. Results: ROHHAD is an ultra-rare syndrome with fewer than 200 known cases. Although variations occur, the acronym ROHHAD is intended to alert physicians to the usual sequence or unfolding of the phenotypic presentation, including the full phenotype. Nearly 60 years after its first description, more is known about the pathophysiology of ROHHAD, but the etiology remains enigmatic. The search for a genetic mutation common to patients with ROHHAD has not, to date, demonstrated a disease-defining gene. Similarly, a search for the autoimmune basis of ROHHAD has not resulted in a definitive answer. This review summarizes current knowledge and potential future directions. Conclusion: ROHHAD is a poorly understood, complex, and potentially devastating disorder. The search for its cause intertwines with the search for causes of obesity and autonomic dysregulation. The care for the patient with ROHHAD necessitates collaborative international efforts to advance our knowledge and, thereby, treatment, to decrease the disease burden and eventually to stop, and/or reverse the unfolding of the phenotype. [ABSTRACT FROM AUTHOR]

Background: Severe traumatic brain-injured (TBI) patients should be primarily admitted to a hub trauma center (hospital with neurosurgical capabilities) to allow immediate delivery of appropriate care in a specialized environment. Sometimes, severe TBI patients are admitted to a spoke hospital (hospital without neurosurgical capabilities), and scarce data are available regarding the optimal management of severe isolated TBI patients who do not have immediate access to neurosurgical care. Methods: A multidisciplinary consensus panel composed of 41 physicians selected for their established clinical and scientific expertise in the acute management of TBI patients with different specializations (anesthesia/intensive care, neurocritical care, acute care surgery, neurosurgery and neuroradiology) was established. The consensus was endorsed by the World Society of Emergency Surgery, and a modified Delphi approach was adopted. Results: A total of 28 statements were proposed and discussed. Consensus was reached on 22 strong recommendations and 3 weak recommendations. In three cases, where consensus was not reached, no recommendation was provided. Conclusions: This consensus provides practical recommendations to support clinician's decision making in the management of isolated severe TBI patients in centers without neurosurgical capabilities and during transfer to a hub center. [ABSTRACT FROM AUTHOR]

The preparation of the first Objective Structured Clinical Examination (OSCE) introduced at the University of Split School of Medicine Pharmacy program will be described. OSCE is held as the last or sixth partial exams of the 6-month Professional training course of pharmacy students. This OSCE comprises of seven stations, five of which are interactive. Starting point was to define the skills that will be examined for which we used the Croatian Competency Framework for Pharmacists as template. Furthermore, it was necessary to ensure adequate number of rooms in which the examination will be held in the way that communication among students is not possible and to prepare adequate number of qualified professors and staff members that was needed to conduct the examination. For this, support from the Faculty was critical. Duration of exam was taken into consideration as it should not be too overwhelming for students, actors or examiners. Finally, predicting possible problems that may occur during the examination and means to overcome them were developed. This OSCE was first pilottested and this pilot led to some modifications in number of tasks per station as well as the point threshold at some stations. Finally, it was necessary to make substantial changes in the program to ensure students were prepared for this type of exam. Areas in which todays OSCE is limited and where it may be improved will also be presented and analysed. [ABSTRACT FROM AUTHOR]

Emergency medicine is a very complex and unique medical specialty and very often emergency medicine departments are the only entrance for many patient into the healthcare system. Specialists in emergency medicine have to have broad knowledge in acute illnessess, special medical conditions as intoxications, injuries and more complex as politraumatic patients or resuscitation. In emergency medicine, decisions for the patient’s life and health are made based on limited informations in a short period of time, which requires a high level of competence and skills from medical to communication ones. Medical students have their first encounter with emergency medicine during college. Following the internship abolition in 2019 and the introduction of mentoring program from our Ministry of Health, an opportunity has been created for newly graduated physicians to start initial education and acquire practical skills in highly “busy” enviroment such as emergency departments. In November 2019, Clinical Hospital Center Rijeka admitted first group of young doctors for the “Work under supervision program”. We started with the education program from the first generation and gradually improved it. It is carried out through four educational modules, and after each module there is a written and oral test followed by mentor’s meeting. Currently we are under developing proces of completely new module, Module V (5th module), that will be dedicated to mastering basic skills in the point-of-care ultrasound in emergency medicine. We take the education of young physicians seriously, which is why we conducted an evaluation of our work and program through a survey - the opinion of young physicians about the training method and their work with positive feedback which gave us reasure to continue in the same direction. In the presentation Modules and survey analysis will be showed and explained in more details. [ABSTRACT FROM AUTHOR]

In Croatia, not a single Faculty of Medicine has a standardized multidisciplinary simulation centre. Simulation is present throughout all the years of studying but significantly varies between Faculties and between Departments. Students unfortunately, for the most time throughout all the years of study, do not practise simulation systematically. Due to the lack of simulation experience, trying to copy simulation protocols from different curriculums usually means problems and hardly achieves wanted goals. The author provides the experience of Kabinet vještina (Skills Lab), a small simulation centre of the Department of Anaesthesiology, Reanimatology, Intensive Care and Emergency Medicine at the Faculty of Medicine at the University of Rijeka in creating classes for such students and the ongoing evolution of advanced simulation courses for final year medical students with minor experience in simulation. [ABSTRACT FROM AUTHOR]