Search

AIMS While TAVI is the treatment of choice in patients with aortic stenosis considered inoperable or at high risk, interventional replacement of the mitral valve is still in the preclinical or early clinical phase. Our aim was to report on the first transcatheter double valve replacement into native valves from a transapical access. METHODS AND RESULTS A 67-year-old, highly symptomatic female patient considered inoperable due to severe calcification of the mitral annulus and comorbidities was scheduled for transcatheter double valve replacement by the local Heart Team. Preoperative planning was carried out by multiplanar reconstruction from cardiac CT. Through a transapical access, the mitral valve was replaced first by an inverted 29 mm Edwards SAPIEN 3 prosthesis, then the aortic valve by a 23 mm SAPIEN 3, both during rapid pacing. Both prostheses revealed excellent function in angiography and echocardiography. The patient was extubated early after surgery and transferred to the normal ward the following day. After five months, she exhibited signs of cardiac failure again. Migration of the mitral prosthesis was detected, and the mitral valve was replaced surgically. CONCLUSIONS Transcatheter double valve replacement can be performed through a transapical access. The key to success is thorough preoperative planning based on CT, not only for sizing, but also for estimating the anatomical relationship of the prostheses. However, late migration can be expected and may lead to LVOT obstruction.

Objective: Competence orientation, often based on the CanMEDS model, has become an important goal for modern curricula in medical education. The National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM) has been adopted in Germany. However, it is currently unknown whether the vision of competence orientation has also reached the licensing examination procedures. Methods: Therefore, a prospective, descriptive, single-centre, exemplary study design was applied to evaluate 4051 questions/tasks (from 28 examiners at 7 two-day licensing oral-practical exams) for undergraduate medical students at the University of Ulm. The oral and practical questions/tasks as well as the real bedside assessment were assigned to specific competence roles (NKLM section I), categories (NKLM section II) and taxonomy levels of learning domains. Results: Numerous questions/tasks were set per candidate (day 1/2: 70±24/86±19 questions) in the licensing oral-practical exam. Competence roles beyond the “medical expert” were scarcely considered. Furthermore, practical and communication skills at the bedside were hardly addressed (less than 3/15 min). Strikingly, there was a significant predominance of questions with a low-level taxonomy. Conclusions: The data indicate a misalignment of competence-oriented frameworks and the “real world” licensing practical-oral medical exam, which needs improvement in both evaluation and education processes., Zielsetzung: Kompetenzorientierung basierend auf dem CanMEDS Model hat sich zu einem wichtigen Bildungsinhalt innerhalb der medizinischen Ausbildung entwickelt. Im Nationalen kompetenzbasierten Lernzielkatalog Medizin (NKLM) wurde diese als Ziel festgeschrieben. Es ist jedoch bisher nicht bekannt, inwiefern in den Prüfungen des medizinischen Staatsexamens tatsächlich kompetenzbasierend geprüft wird. Methoden: In dieser prospektiven, deskriptiven, monozentrischen, exemplarischen Studie wurden 4051 Fragen/Aufgaben (gestellt von 28 Prüfer in n=7 zweitägigen mündlich-praktischen Prüfungen) an Medizinstudierende der Universität Ulm evaluiert. Die mündlichen und praktischen Fragen/Aufgaben wurden, ebenso wie die Prüfung am Patientenbett, auf die spezifischen Kompetenzrollen (gemäß NKLM Abschnitt I), die unterschiedlichen Kategorien (gemäß NKLM Abschnitt II) und die Taxonomielevel der unterschiedlichen Fragen/Aufgaben analysiert. Ergebnisse: Im mündlich-praktischen Prüfungsteil wurden den Kandidaten zahlreiche Fragen/Aufgaben gestellt (Tag 1/2: 70±24/86±19 Fragen). Die Kompetenzrollen außerhalb des “Medizinischen Experten” wurden dabei selten adressiert. Zudem wurden praktische und kommunikative Fertigkeiten in der Prüfung am Patientenbett kaum geprüft (weniger als 3/15 min). Auffallend war die Dominanz an Fragen auf niedrigem taxonomischem Niveau. Schlussfolgerungen: Die Daten zeigen ein deutliches Missverhältnis zwischen den Vorgaben zur Kompetenzorientierung und den tatsächlich geprüften Inhalten der mündlich-praktischen Prüfungen. Diese Diskrepanz sollte zukünftig mit einer verstärkten Prüfer-Schulung und -Evaluation begegnet werden., GMS Journal for Medical Education; 34(2):Doc25

Summary Introduction Peer teaching is widely applied in medical education, anatomists having a notably long tradition in cooperating with student tutors in the dissection course. At Ulm University we established an intensified concomitant didactic training program for student tutors and investigated possible effects on their tutees’ academic performance and tutor evaluation. Methods In winter semester 2012/13 all student tutors of the dissection course were invited to participate in the “Train-the-Tutor” educational program. 1 Test results and failure rates of 149 tutees who had been supervised by program participants (n = 14) and 136 tutees of not participating tutors (n = 13) were analyzed, as well as data on tutor evaluation and learning behavior of 235 (82%) of these tutees. Results Overall, both groups of tutees showed equal learning behavior and evaluated their tutors’ performances similarly. However, tutees of program participants consistently obtained better examination results (median: 1.9 versus 2.2 in overall scores) and lower ultimate failure rates (13.4 versus 17.6% of students failed, respectively). Discussion An intensified didactic training program for student tutors may help their tutees to pass the gross anatomy course. Additional studies are necessary to objectify and further investigate this effect in order to optimize the concept regarding time expenditure and costs.

Introduction Peer teaching is a well-established teaching method in medical education. During the 2012/13 winter term, the Institute of Anatomy and Cell Biology in Ulm, Germany, introduced a longitudinal didactics program (“Train the Tutor”: TtT) to train student tutors as near-peer teachers (NPT) in the dissection course (DC). Twenty-three of 38 tutors participated in the programme. Our study describes the educational concept and the NPTs’ activities in the dissection course. Methods NPTs documented their activities on a daily basis in the form of semi-structured reports. A total of 575 reports were quantitatively and qualitatively analysed. Free-text analysis was performed using Grounded Theory followed by code quantification of all indications (n = 1868). Results NPTs spend 61% of their time dissecting by themselves or supervising the tutee’s dissection process. Organisational tasks had a larger share at the beginning of the course. Just before examinations the proportion of time spent giving feedback rose. Of all positive indications, 45% described experiences working with the tutees. In contrast, 68% of all negative indications were characterized by a self-critical reflection on their own activities. NPTs included all learning domains in their teaching, substantially functioning as teachers and role models to convey particular attitudes. Conclusion TtT-Trained Tutors (NPT) clearly met the requirements of a practical course and adjusted their activities in response to the course’s progress. NPTs were concerned about their tutees’ attitudes and may need more professional support within the TtT program regarding this.

Background Oral examinations have been a crucial format in ancient and modern assessment to evaluate and guarantee quality of medical education and thereby to secure patient safety. To achieve a high level of quality in the oral part of the final examination of medical students, a training program for oral examiners at the Medical Faculty of Ulm (Germany) has been established since 2007. However, little is known about the attitude of the examiners in regard to the impact of this training program and of oral examinations as instruments to ensure patient safety. Methods All 367 academic clinicians from operative and non-operative disciplines, attending the one-day examiner training program at the University of Ulm between 2007 and 2012 have been asked to answer an online survey (EvaSys 5.0). Focus of the survey was to find out in which respect the examiners profited from the trainings, if the training effects were discipline-dependent, and to which degree the oral examinations could contribute to patient safety. Statistical analysis was performed using the t-test for independent samples. Results were considered statistically significant when p