Implementation of a structured learning environment

zma000055 Project Implementation of a structured learning environment a structured OT visit for preclinical students Implementierung einer strukturierten Lernumgebung ein strukturierter OP-Besuch für vorklinische Studierende Oechsner Oechsner Wolfgang W Dr. med. et. cand. MME, D.E.A.A.

Department of Cardiac Anesthesia, University Hospital of Ulm, Steinhoevelstraße 9, D-89075 Ulm, Germany, Tel.: +49 (0)731/500-21521, Fax: +49 (0)731/500-26757Department of Cardiac Anesthesia, University Hospital of Ulm, Ulm, Germany

wolfgang.oechsner@medizin.uni-ulm.de author Gelzenlichter Gelzenlichter Michael M Dr. med.

Department of Cardiac Anesthesia, University Hospital of Ulm, Ulm, Germany

michael.gelzenlichter@medizin.uni-ulm.de author Schirmer Schirmer Uwe U PD Dr. med.

Department of Cardiac Anesthesia, University Hospital of Ulm, Ulm, Germany

uwe.schirmer@medizin.uni-ulm.de author German Medical Science

Düsseldorf, Köln

610 structured learning environment vertical integration cardiac anesthesia operating theatre courses Strukturierte Lernumgebung Vertikale Integration Kardioanästhesie OP-Hospitation Humanmedizin 20050408 20050815 engl 1860-3572 22 3 GMS Zeitschrift für Medizinische Ausbildung GMS Z Med Ausbild 55 Hintergrund: Im vorklinischen Abschnitt haben Medizinstudierende in Deutschland kaum Gelegenheit, OP-Erfahrungen zu machen; später werden diese meist in unstrukturierter Form vermittelt. Vorhaben: Der Kurs "OP Besuch für Vorkliniker" soll die vertikale Integration in strukturierter Lernumgebung verbessern. Wir prüften Machbarkeit, Akzeptanz und mögliche Schwachpunkte. Methode: Der Kurs besteht aus 3 Teilen. 1. Vorbereitungsaufgaben. 2. OP-Besuch. 3. Kurze Reflexion und Feedback. Ergebnisse: 36 vorklinische Studierende nahmen teil, wir erhielten mündliches Feedback von allen und schriftliches Feedback von 24 Studierenden. Insgesamt war die Akzeptanz gut bis sehr gut. Die Machbarkeit für Studierende wie für Lehrer ist gegeben. Einige Studierende fanden die Vorbereitungsaufgaben nur "zufrieden stellend", und einige fanden die Anforderungen "etwas zu hoch". Schlussfolgerung: Aufgrund seiner Akzeptanz und Machbarkeit sollte der Kurs im Curriculum regelmäßig angeboten werden. Die Vorbereitungsaufgaben müssen noch optimiert werden. Wir müssen Hilfestellung anbieten, damit die große Menge neuer Eindrücke im OP besser verarbeitet werden kann. Wir sollten den Kurs einer größeren Studierendenzahl anbieten können. Background: During the preclinical period German medical students have little or no opportunities to make experiences in the operating theatre (OT); later these experiences are often provided in an unstructured way. Purpose: The course "OT visit for preclinical students" is planned to improve vertical integration within a structured learning environment. We checked the project for feasibility, acceptance and flaws. Method: The course consists of 3 parts: 1. Pre-course assignments. 2. The OT visit. 3. A short reflection and feedback. Results: 36 preclinical students participated in the course, we received oral feedback from all students and 24 written evaluation forms. Overall acceptance both by teachers and students was good or very good. We found the course to be feasible both for teachers and students. Some students found the pre-course assignments only "satisfactory" and some found the demands "slightly excessive". Conclusion: In terms of acceptance and feasibility, we should implement the course into our regular curriculum. We have to improve our pre-course assignments and offer some help for handling the huge amount of new impressions in the OT. We should look for a way to offer structured OT visits for a higher number of students. Introduction Integration of basic sciences and clinical application is a demand in modern medical curricula , , . Basic sciences like anatomy or physiology are applied in the operating theatre (OT), but clinical learning environments are often not well structured. Students appreciate more structured learning environments , , , , and consequently our "structured OT visit for preclinical students" aims at the integration of selected basic science topics and their clinical application within a structured learning environment. Method Structure of the course and target population The high standardization of our cardiac procedures has been an important prerequisite. With the consent of the surgical collegues we taught the students in the OT in groups of 2. The structure of the course is described in table 1 . All phases of the course are well aligned, since alignment is also a demand in curriculum development . We announced the course as an elective for first-year students, because then lectures in physiology and anatomy are offered, both of them teaching relevant topics for cardiac procedures. 2 of our anesthetists, both of them experienced clinical teachers, participated as tutors. By offering the course only once a week we could compensate for course dates we had to cancel because of "unsuitable" operations or other reasons. We asked the patients for oral consent during the preoperative visit or immediately before the operation. Theoretical framework for the course concept In order to offer more than just a "sightseeing tour", we used some elements of cognitive psychology : Activating prior knowledge, giving relevance, and elaborating on the learning material in the professional context. The pre-course assignments together with the first-year lectures in anatomy and physiology safeguard the knowledge base; the OT visit activates the knowledge, imparts clinical relevance and helps elaborating on the knowledge in the clinical context. Building up a prior knowledge base is rated positively by students ; but the transfer of the knowledge into the practical situation is in no way guaranteed . The tutor has to support the transfer, e. g. by means of open questions. The students´ sensitivity to role models has also to be kept in mind by the tutors , . Content aspects, pre-course assignments, learning objectives and reflection questions The content aspects are chosen from the lectures in anatomy or physiology, all of them with practical relevance in the OT (see table 2 ). The obligatory pre-course assignments (readings and questions) serve as theoretical basis for the OT visit. As readings we offer the surgical and the anesthesiological patient information forms and some relevant chapters from basic science standard books. The written questions refer to the readings (see table 3 ). The learning objectives are described in table 4 ; here, the demands must not become overdemanding neither for the tutors nor for the students. The formative reflection questions are to be answered in written form at the end of the visit. We proposed two pre-formulated questions (see table 5 ), but in fact the tutor is free to formulate questions that fit best to the focus of each OT visit. The tutor should give a short feedback to the students´ work. Results 36 first-year students participated from December 2003 until June 2004. The overall oral feedback given by the students was enthusiastic. Some students suggested to make, already in the pre-course assignments, the link between theory and practice more transparent . We got back 24 written evaluation forms. In the beginning we asked to send them back to the secretary (and 12 students didn´t); later we collected the forms at the end of the visit. The results are summarized in table 6 and table 7 . Both tutors have been satisfied with the course. They consider the course to be feasible in terms of additional stress during the procedure they performed. None of our patients refused his consent to the students´ participation. Discussion and perspective Our project shows that it is possible to create structured learning environments in the context of highly standardized operating procedures, and that the preclinical students appreciate such an offer. The outstanding evaluation might be biased by factors like: very enthusiastic clinical teachers, the high motivation of preclinical students to get into the "real life" and the wish to appreciate this type of curricular innovation; and last but not least the small number of students involved. The "satisfactory" grade only given by some students for the contribution of the pre-course assignments could possibly be improved by making more transparent the practical implication of the assignments in a little "preparation guide". The fear that the demands of such a course would be excessive proved to be not justified. The majority ranked them as "adequate"; the "slightly too high" rank from some students might be caused by the overwhelming impressions of the OT, beyond the learning objectives we actually aimed at. In an improved "preparation guide" we should indicate that it is not expected to understand the procedure in all its details, and that concentrating on the learning objectives is helpful to handle the huge amount of new impressions. It seems to be worthwhile to offer the course for a higher number of students. So we should invite other collegues performing OT procedures with high frequency and high standardization. Having in mind the importance of "alignment" and of "common ownership" , , , we then should be ready to train the collegues and to create a common steering function for the course. Conclusion We should offer the course on a regular basis within the elective part of our first-year curriculum. To compensate for some minor flaws in the pre-course phase and in the intraoperative demands we should offer a "preparation guide", showing the relevance of the pre-course assignments and preparing the students to concentrate on the learning objectives. To be able to offer the course for a higher number of students we should include other disciplines performing procedures with a high degree of frequency and standardization. To safeguard the course´s quality we have to train the new tutors, focussing on two main points: integration of basic sciences and clinical application on one hand, and keeping "aligned structuring" within the course on the other. 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