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Zusammenfassung Hintergrund Im Medizinstudium in Deutschland ist seit 2016 ein gesonderter Leistungsnachweis auf dem Gebiet der Schmerzmedizin zu erwerben. Bislang fehlen Untersuchungen über die Effekte dieser Einführung auf Kompetenzen von Studierenden im Themengebiet Schmerzmedizin. Ziel der Arbeit Ziel war es herauszufinden, inwieweit die Einführung des Fachgebiets Schmerzmedizin als Querschnittsbereich 14 den Kompetenzerwerb der Studierenden im Bereich Schmerzmedizin gemessen über eine Selbsteinschätzung positiv beeinflusst. Material und Methoden Die Entwicklung des longitudinalen Curriculums wurde mithilfe des Kern-Zyklus durchgeführt. Parallel erfolgte die Erstellung eines Fragebogens zur Selbsteinschätzung der Studierenden auf einer 5‑stufigen Likert-Skala bzgl. des eigenen Wissensstands und der Bedeutung schmerzmedizinischer Lehrinhalte. Die Befragungen wurden vor Einführung der Veranstaltungsreihe (2014), nach Abschluss der ersten Kohorte (2016) und 5 Jahre nach Einführung (2019) durchgeführt und mittels Kruskal-Wallis-Tests verglichen. Ergebnisse Die Einführung des Curriculums hat zu einer signifikanten Verbesserung in relevanten Punkten geführt. So fühlen sich die Studierenden insgesamt besser auf die Behandlung von Schmerzpatienten vorbereitet (2,67 im Jahr 2014 vs. 3,18 im Jahr 2019). Teilaspekte wie die Erhebung einer Schmerzanamnese (3,63 vs. 4,10) oder die Erstellung eines Analgesieschemas (3,56 vs. 4,14) werden nun subjektiv deutlich besser beherrscht. Diskussion Trotz erfreulicher Ergebnisse besteht in Teilbereichen noch Verbesserungspotenzial. Beispielsweise ist die Bewertung der Studierenden zur Frage nach der Vorbereitung auf die Behandlung von Schmerzpatienten noch nicht zufriedenstellend. Hier gilt es, das Curriculum mit Fokus auf die Kompetenzorientierung weiterzuentwickeln. Dabei können digitale Lehrformate ebenso integriert werden wie interprofessionelle Einheiten und Simulationspatienten. Zudem sind jedoch gleichzeitig auch die Prüfungsformate hin zu standardisierten praktischen Prüfungen weiterzuentwickeln.

Secondary transports of patients from one hospital to another are indicated for medical reasons or to address local constraints in capacity. In particular, interhospital transports of critically ill infectious patients present a logistical challenge and can be key in the effective management of pandemic situations. The state of Saxony in Germany has two characteristics that allow for an extensive evaluation of secondary transports in the pandemic year 2020/2021. First, all secondary transports are centrally coordinated by a single institution. Second, Saxony had the highest SARS-CoV-2 infection rates and the highest COVID-19 associated mortality in Germany. This study evaluates secondary interhospital transports from March 2019 to February 2021 in Saxony with a detailed analysis of transport behaviour during the pandemic phase March 2020 to February 2021. Our analysis includes secondary transports of SARS-CoV-2 patients and compares them to secondary transports of non-infectious patients. In addition, our data show differences in demographics, SARS-CoV-2- incidences, ICU occupancy of COVID-19 patients, and COVID-19 associated mortality in all three regional health clusters in Saxony. In total, 12,282 secondary transports were analysed between March 1st, 2020 and February 28th, 2021, of which 632 were associated with SARS-CoV-2 (5.1%) The total number of secondary transports changed slightly during the study period March 2020 to February 2021. Transport capacities for non-infectious patients were reduced due to in-hospital and out-of-hospital measures and could be used for transport of SARS-CoV-2 patients. Infectious transfers lasted longer despite shorter distance, occurred more frequently on weekends and transported patients were older. Primary transport vehicles were emergency ambulances, transport ambulances and intensive care transport vehicles. Data analysis based on hospital structures showed that secondary transports in correlation to weekly case numbers depend on the hospital type. Maximum care hospitals and specialized hospitals show a maximum of infectious transports approximately 4 weeks after the highest incidences. In contrast, standard care hospitals transfer their patients at the time of highest SARS-CoV-2 case numbers. Two incidence peaks were accompanied by two peaks of increased secondary transport. Our findings show that interhospital transfers of SARS-CoV-2 and non-SARS-CoV-2 patients differ and that different hospital care levels initiated secondary transports at different times during the pandemic.

Background The transfer of classic concepts of competency-based medical education into clinical practice has been proven to be difficult in the past, being described as partially fragmented, misleading and inadequate. At the beginning of training, novice doctors commonly feel overwhelmed, overloaded and exposed to extreme time pressure. The discrepancy between expected and actual clinical competence of doctors at the start of their speciality training jeopardizes patient safety. The framework of Entrustable Professional Activities (EPAs) is a promising instrument to effectively integrate competency-based training into clinical practice and may help to close this gap and consequently to improve patient safety. Methods For anaesthesiology, we developed 5 EPAs for final-year medical students. The EPAs comprised the following seven categories: 1. Title, 2. Specifications, 3. Limitations, 4. Competency domains, 5. Knowledge, abilities and skills, professional attitudes, 6. Assessment and 7. Entrustment. Based on a modified, online-based Delphi study, we further developed and refined these EPAs. Education experts were recruited from the alumni network of the Master of Medical Education (MME) degree course from the University of Heidelberg, Germany. Results 28 data sets were evaluated in three Delphi rounds. 82% of study participants had previous experience with EPAs. Qualitative and quantitative data formed the basis during the iterative process and resulted in complete descriptions of 5 EPAs for final-year medical students in anaesthesiology. Conclusions Our study including the associated description of 5 EPAs represent a further step and starting point for EPA-based curricula in medical training in Germany linking undergraduate training, to residency training and continuous medical education.