Skills Lab

Skills Lab = LuK + BLiTZ

The modern program for medicine with its interdisciplinary curriculum imposes different requirements on training, teachers and students than “normal” studies in medicine. The MHB created the  LuK (=Learning and Communication Centre) and the BLiTZ (= Brandenburg Centre of Interdisciplinary Learning and Training) to promote problem- and solution oriented thinking. The LuK in part of the campus in Neuruppin, the BLiTZ is part of the Brandenburg campus. Together, these training centers provide the university with its own Skills Lab.

The students are expected to train their practical skills as well as their soft skills and communication competencies. At the end of each semester these skills are tested as part of the OSCE exam or as part of a Workplace Based Assessment.

The Skills Lab is open to medical- and psychology students Mondays to Fridays from 7 a.m. until 9 p.m. During these times the students have the opportunity to use the skills lab for their individual studies. Not just students make use of  these training centers. Doctors in training also have the possibility of using the Skills Lab to improve their practical skills, for example by conducting a laparoscopic unit with the Lübecker Toolbox or preparing for their specialist examinations.

The Skills Lab concept is particular due to the decentral structure during the last part of the medical program. The students start their studies in Neuruppin, from semester 1-4, then continue to train in Brandenburg an der Havel for Semesters 5-7 and during the semesters 8-10 of the students are divided into small groups to learn and train in different clinics throughout the state of Brandenburg.

In the following, we would like to give you an impression of our Skills Lab and introduce the team. Should you require further information, please don’t hesitate to contact us: luk@mhb-fontane.de

Skills lab - Mission Statement

Remit

The Skills Lab ensures the teaching, broadening und examination of practical and communication skills in accordance with the study- and examination regulations of the MHB. It forms the interface between the theory taught and practical skills. We aspire to offer highly qualified, scientific education in line with state-of-the-art theory and research.

Offering

Our Skills Lab offers medical students integrated education and further training. Our educational offering, especially the curricular and extracurricular classes, meets the highest standards. The facilities and resources can also be used by psychology students, nurses in training, doctors in training and physiotherapists among others.

Methods

The Skills Lab actively advocates for cooperative learning. It is a popular and reliable employer. The teachers (tutors, psychologists and doctors) enthusiastically translate their educational remit into practice. They work closely together to cross-link their knowledge, thereby increasing teaching quality and efficiency. Participants enjoy and appreciate the education they receive there.

Leadership

We adhere to the principle of a situational leadership structure combined with a leadership concept which can be adapted to specific needs. This enables us to respond quickly, flexibly and efficiently to requests or changes in our remit.

Approach

The Skills Lab works in accordance with the university’s mission statement and the principles of health promotion. MHB’s Skills Lab has a unique, distinctive Skills Lab culture.

Central site for teaching and learning

Curricular Learning

The LuK offers the following curriculum to medical students.

  • Problem-Oriented Learning (POL)
  • Seminars
  • Interdisciplinary Seminars
  • Seminars on Human- and Health-Science (HGW)
  • Seminars on the fundamentals of being a doctor (Grundlagen des ärztlichen Denkens und Handelns (GÄDH))
  • Seminars on Studium Fundamentale (StuFu)
  • Lectures
  • Tutorials for practical and communication skills
  • Practice Diagnostics and Therapy
  • Teamwork, Reflection, Interaction, Communication (TRIK)
  • Case presentations
  • Case reviews
  • Final Lectures
  • OSCE-Exams

The LuK offers the following curriculum to psychology students.

  • POL
  • TRIK
  • OSCE
  • Seminars on Studium Fundamentale (StuFu)

Extracurricular Learning

see PAL = Peer Assisted Learning

Self-Study

With the help of numerous anatomical models, Internet connected computer workstations and simulation devices, the students are able to freely develop their skills. Mondays to Fridays from 4 p.m. to 9 p.m. there is a tutor on site to answer questions or hand out required material.

At the BLiTZ the university library is in the campus building. This ensures a close connection between theory and practice, which in turn means that what has been taught, can immediately be practiced. The same setup is envisioned for the LuK in Neuruppin as of fall 2018.

Other

Both the LuK in Neuruppin and the BLiTZ in Brandenburg an der Havel have a cafe which is managed by the students. It is a common room, a place of exchange and a conference room for our student faculty (MedSI).

Lernprozess in unserem Skills Lab

Lernphasen LuK BLiTZ

Process of Learning in our Skills Lab

As of the first semester the students are taught practical skills in the weekly curricular course Practice for Diagnostic and Therapy, which is supervised by a doctor. These skills can subsequently be reviewed and practiced during tutorials and self-study.

Drawing on the experience and input of the Skills Lab Director, the Charite University training center and the recommendations of Michael St. Pierre and Georg Breuer, our Skills Lab offers a broad spectrum of practical skills (see „Simulation in der Medizin: Grundlegende Konzepte - Klinische Anwendung“, 2013).

The degree of reality is limited at the LuK/BLiTZ. Internships at the hospital and clinical traineeship increase the degree of reality in the course of the medical studies. This means the acquired basic skills can be further enhanced in later semesters; standards can be raised and the setting becomes more and more realistic in the sense of a learning spiral. This gradual increase in complexity is depicted/portrayed by the tutorials given during the semester and the list of practical skills meant to be acquired in accordance with the MHB curriculum. This list is based on national learning objectives and GMA recommendations.

Apart from tutorials students also have the possibility of “open” Skills Lab training. After practical classes/practices students can independently (without instructions or guidance) use the Skills Lab to practice or prepare for their practical exams.

The following gives an example of what a learning spiral can look like. Starting with basic skills and gradually increasing complexity. (see Glavin R, Maran N. “Low- to high-fidelity simulation – a continuum of medical education?”, Medical Education 2003;37(Suppl. 1):22–28)

The Learning process proceeds in stages

Modified for the LuK/BLiTZ in accordance with Nussbaumer&Reibnitz 2008, Clinical Reasoning, Thieme p. 193ff

Skills Lab Lernphasen LuK BLiTZ

[Quelle 8 in der Tabelle: Walker M, Peyton JWR. Teaching in the theatre. In: Peyton JWR, editor. Teaching and Learning in Medical Practice. Rickmansworth: Manticore Publishers Europe Ltd; 1998. pp. 171–180]

Peer Assisted Learning (PAL)

Teaching with head, heart and hand

The Job of a tutor

From the first to the fourth semester classes take place in Neuruppin. The LuK employs four tutors, who work for 14 weeks during semester and for 2 weeks during the exam-phase. This ensures weekly opening hours from 4 p.m. to 9 p.m. For this purpose they independently create a working schedule/roster. This procedure is equivalent to the BLiTZ-procedure in Brandenburg an der Havel.

Within the Peer Assisted Learning the third semester tutors teach the students from the first semester. When they reach the fourth semester they teach the second semester and so on.

During the semesters 5-7 classes take place in Brandenburg an der Havel. The LuK-Tutors turn into BLiTZ Tutors. To give the tutorials the tutors now need to travel 120 Km. Due to these circumstances tutorials are typically given on the “practice day”, which takes place once every two weeks. On rare occasions tutorials are given Saturdays.

Within this curricular setting the students of the higher semester always teach the lower semester. This means the persons in charge change every year. To ensure a certain standard of quality a manual has been developed for every tutorial, which the tutors can use for preparation. On top of that the tutors receive trainings from the Skills Lab Director or a doctor. The first tutorial is given by one of the more experienced tutors, thereby giving the younger tutors a chance to observe. The second tutorial is held by the younger tutorial and the older tutor now observes in the sense of a Peer Observation. All other tutorials on that topic are given solely by the “new” tutors. The Skills Lab Director may supervise. Subsequently manuals are reviewed and the feedback forms are analyzed.

By creating certain standards for the basic practical skills a common theme is facilitated. Detailed, time consuming descriptions are usually refrained from during the first semesters.

In addition to the actual content, for example “Examination of the lower extremities”, basic soft skills are also imparted. These soft skills are often hard to teach/learn on their own, whilst also being essential to becoming a good doctor, e.g. professional appearance, experiencing being in the role of the patient, hand disinfection etc.

At the end of each tutorial the students (who received the tutorial) evaluate it. At the end of each semester the evaluation results are entered into an excel sheet by one of the tutors. Sylvia Vogel, who works in evaluation then receives this data so she can generate a statistical report. We receive the results of the analyses in between terms, which leaves enough time to readjust the tutorials for the next semester.

Medical didactic qualification for the tutors

To be able to conduct standardized tutorials, the four new tutors receive a one-day-training during their first week at work. This training consists of the fundamentals of medical didactics. This training is given by the older tutors. Together they develop/establish the do’s and don’ts when it comes to teaching practical skills. In addition to that, examples of peer-to-peer-teachings, context based learning, group development and study types are practiced and talked about in small groups, e.g. role play or Peyton’s 4-Step-Teaching.

Furthermore once or twice during the semester „Meet the Experts“ sessions take place. These are meant to last for about 1,5 hours. We have a great team of specially qualified teachers, psychologists, doctors whose expertise we can draw on. We have already held trainings/sessions on topics such as “giving achievement oriented feedback” or “presentation technics”. For the upcoming semester didactic configuration of Practice for Diagnostics and Therapy and writing the role of a simulation patient are envisioned expert-sessions.

Prior to every “Meet the Expert“ session, which usually all tutors are part of, we discuss which organizational processes need adjusting and what kind of conflicts might have occurred. In this context we come up with a mutual solution. All this takes place as part of internal supervision.

The highly motivated tutors have respective previous experiences in the medical field, e.g. as nurses, paramedics or physiotherapists. In addition to learning about didactics they also receive medical back ground information in different trainings held by lecturers and supervision sessions with their fellow tutors.

Sources:

  • ¹Nikendei C, Zeuch A, Dieckmann P, Roth C, Schafer S, Volkl M, Schellberg D, Herzog W, Jünger J: “Role-playing for more realistic technical skills training”. Med Teach 2005, 27(2):122–126
  • ²Krautter M et al: „Effects of Peyton’s four-step approach on objective performance measures in technical skills training: a controlled trial.” Teach Learn Med 2011, 23(3):244–250

Overview of the tutorials offered at the LuK and BLiTZ in correlation with the individual modules. We are a developing Skills Lab so that our offering changes with each semester.

PAL at LuK und BLiTZ

Stand 02/2018


Tandem Practice for Diagnostics and Therapy

As of the first semester the students are divided into small groups of max 8 people. Active physicians teach these groups practical examination skills. The skills taught are in accordance with the specific module being covered. These practical courses are called "Übung zu Diagnostik und Therapie" which translates to “Practice for Diagnostics and Therapy” short ÜDT.

During the semester there are six curricular practices a week on a specific topic in each POL Group. Two weeks after an ÜDT, the according/related tutorial is held. The ÜDTs are designed as Tandem-ÜDTs. To maximize the know-how each ÜDT held by a doctor is accompanied by a tutor.  In each case two POL groups are pooled together for one tÜDT. The doctor takes the lead, the tutor demonstrates an exemplary examination on a test person in real time, based on the Peyton-4-Step-Approach (*Krautter et al., 2011). Following this the doctor outlines the theoretical/medical background of the examination and comments on the individual steps. After that the group is divided into two and the students have the opportunity of practicing on each other. The doctor and tutor support the students and answer any questions that arise. The added value of a tutor accompanying this course increases simultaneously with the complexity of the content being taught.

The tutors that accompanied the tÜDT also give the matching tutorial. That way the tutors already get a feeling for possible difficulties and set priorities in the tutorials. In the end this also increases the quality of the tutorials.

Currently we can provide the following tÜDT:

  • Anatomy in vivo, inspection and palpation of the lower extremities
  • Mobility tests of the lower extremities
  • Examination and mobility tests of the shoulder and upper arms
  • The basics of a cardiovascular examination (BP and Pulse)
  • Basics: internistic examination part 1: heart
  • Drawing blood from a model and on fellow students
  • Basics: internistic examination part 2: lung
  • Basics: internistic examination part 3: abdomen
  • Nutritional status
  • Rectal examination

Source: Krautter M, Weyrich P, Schultz JH, Buss SJ, Maatouk I, Jünger J, Nikendei C. Effects of Peyton's four-step approach on objective performance measures in technical skills training: a controlled trial. Teach Learn Med. 2011;23(3):244–250. DOI: 10.1080/10401334.2011.586917

Tutorials – Module accompanied

Based on the Peer-Teaching-Concept, a ten member team of medicine- and psychology students offers different tutorials corresponding with the curriculum during the semester.

Being able to practice the knowledge gained in the ÜDTs is the main goal of the tutorials, especially because the initial phases of study practicing under supervision is important. Students can make mistakes without the fear of them having serious consequences for the patient. In order to avoid these mistakes repeating themselves in the future the students receive performance oriented feedback. The students systematically gain confidence and feel secure in their work and thus meet the minimal requirements expected of them. Coherent to the semester targets a transfer from theoretical knowledge to standard practice is achieved. After the tutorials are approved by the study committee, they are offered as extracurricular teachings during self-study-time. This enables the students to internalize medical contents and practical skills, whilst gaining self-confidence and impressions of different specialties. 

Two weeks after the "ÜDTs" are taught, the tutorials are held.

The tutorials are offered in small groups to all students of the semester, independently of content. This ensures individual guidance. The class size varies between 6 and 10 students, and one or two tutors, depending on content.

This offer was recognized by 92% of the students, meaning the tutorials were used to a capacity of 80-100% (data second year).

Currently the following tutorials are being offered:

  1. Semester
  • Simulation-OSCE, during orientation week
  • Basic Life Support
  • Anatomy in Vivo: drawing and medical vocabulary
  • Mobility tests lower extremities
  • Functional examination: Knee
  • Mobility tests upper extremities
  • Reflexes and motoric function
  • Drawing blood from a model/establishing a periphery vascular access i.v.
  • Basics: internistic examination part 1: heart
  1. Semester
  • Basics: internistic examination part 2: lung
  • X-ray thorax diagnostic – Basics
  • Basics: internistic examination part 3: abdomen
  • Examination of the liver: Anamnesis/Examination/Sonography
  • Fundamentals for the practical day: Anamnesis training with the aid of case studies and video-briefing
  1. Semester
  • Imaging – Basics
  • Examination of the coordination
  • Sensory and motoric function
  • Signs of inflammation incl. status of lymph nodes
  • Lymph nodes/Spleen: Anamnesis/Examination/Sonography
  1. Semester
  • Kidneys: Anamnesis/ Examination/Sonography
  • Transurethral bladder catheter on model
  • Suture course for beginners
  • 3x3 Dermatological examination
  1. Semester (being planed)
  • Status of cranial nerves
  • Eye examination
  • Gynecological examination on model
  1. Semester (being planed)
  • Clinical thinking - Skills Training Compact Parcours

In this special tutorial we would like to satisfy the requirements of the scholars CanMed-Role. The idea is learning by teaching. Be surprised!

OSCE-Tutorial

  • Semester, 2.Semester, 3.Semester, 4.Semester, 5.Semester
Tutorials – extra curricular

Really fit for Internship I - Curriculum for 10 LVS:

  • „Admission-Skills“= Anamnesis, survey internal status incl. rectal examination
  • „Ward-Skills“ = interdisciplinary case work,
  • „Drug-Skills“ = Hygiene, handling of ampoules, application s.c./i.m./i.v., preparing infusions, handling of perfusors,
  • „Heart-Skills“ = Examination, SAM II-Training, evaluate EKG

Really Fit for Internship II - Mini Curriculum (24 LVS)

Obtaining CAJC-Degree “Student OR Assistant” in cooperation with visceral surgical ward Immanueldiakonie Bernau, Städtisches Klinikum Brandenburg and Ruppiner Kliniken

  • OP-Technic 8xACH, 2, UCH, 1xGyn,
  • MIC (Lübecker Toolbox + D.I.Y. Laps-Trainer) incl. Training in OR with Pelvi Trainer,
  • FAST (Focusses Assessment with Sonography for Trauma),
  • Practical skills and surviving in OR: OR rules, material/knots-/suture-course ,
  • Surviving on ward 1 (parcours 120 min)patient documentation (Kurven-Arbeit) , Apply intravenous access. Apply gastric tube on model or on fellow students, Transition to normal diet after  visceral surgical OP (Hausstandard), subcutaneous (e.g. low molecular Heparin) and intra muscular injections (e.g. Tetanus-Vaccine) on model
  • Surviving on ward 2: Admission situation first aid station: Apply organ specific status DD: Acute Abdomen
  • Then 5 appointments of free training under tutorial surveillance

Gynecology

  • Spontaneous labor: birthing mechanisms, hands-on course birth-simulation-model

IMPRESSIONS

 

Enrollments in tutorials

Each tutorial has a short description and recommendation for which semester it is suitable in our online learning platform Moodle. This recommendation is in line with the content of the Brandenburg Medical School program.

Due to the restricted amount of participants in each tutorial, an enrollment via Moodle is necessary. The tutors plan their tutorials independently and send out e-mails as soon as they have uploaded the schedule. Therefore it is recommended to regularly log on to Moodle and check your e-mails.

The LuK and BLiTZ team regularly adjusts the offered tutorials in coherence to the needs of the students. In order to be in accordance with the current state of science we supervise scientific projects and present them every half year: in the spring at the international Skills Lab Symposium (iSLS) and in fall at the conference for the Society for Medical Education.

Simulation Patient – Program

Since 2010/15 the MHB uses simulation patients for communication training in TRIK and during exams. So far we have been able to acquire 50 SP in Neuruppin and 30 SP Brandenburg. In the following paragraph we would like to give you a better understanding of our work with the simulation patients. The SP-program is autonomous however closely linked to the Skills Lab.

Recruiting new simulation patients

With the help of our press officer Dr. Eric Hoffmann, we advertised in the local newspapers and radio stations in the districts of Ostprignitz Ruppin (Neuruppin) and Brandenburg/Havel. This way we managed to recruit several simulation patients. On top of that employees called attention to our cause in their circle of friends and hung up notices at local schools, the gym etc.

Enjoying and having a talent for role play, as well as being motivated to help young students improve their motivation are prerequisites for being a simulation patient. Other important skills are: the ability for self-reflection, reliability, punctuality, flexibility, resilience and the courage to share your identity with the group.

Dr. Henrike Hölzer (MME, Bern) and her student assistants conduct about 2 interviews a year, in the style of standardized castings. The castings are a mixture of orientation, selection and health check-up and consist of several sub steps:

At first the applicants receive an introduction as to what is expected of them and what their function will be. Thereafter they are shown a role play on video tape and their personal motivation for being a SP is explored and personal data collected (age, sex, body physic, height, weight, professional experience). The last step is the inquiry about their health, plus a general medical examination. When examining the prospective patients any physical characteristics that could influence or make a difference in exams, are recorded and photographed (e.g. tattoos).

A team decides on based on the casting results which candidates and in what way would be suitable for the job.

In order for the applicants to be enlisted in our SP-program, we require further personal information, such as contact information (email-addresses, phone numbers etc.) and disbursement data (e.g. IBAN). This data is, of course, treated strictly confidential. At the same time we expect discretion from the simulation patients, which is why they must sign a non-disclosure agreement when we hire them.

Our secretary updates this data every half year.

Especially during the practical OSCE (= Objective Structured Clinical Examination) discretion is essential. It is of the utmost importance to treat the information given to them (about their role or the students being tested) strictly confidential. Occasionally the role plays are video taped for the purpose of peer observation, supervisions or trainings. If so the participant’s approval is obtained in advance.

Employment of simulation patients

The simulation patients are mainly called into action for the training of our psychology and medical students, as well as during exams.

There are different jobs/roles that the SP can take over:

  • For communication training in the role of a patient, family member or in an interprofessional setting
  • As a model for a physical examination with or without a script
  • For the production of teaching-films
TRIK - (Teamwork, Reflection, Interaction and Communication training)

TRIK takes place in the small POL-groups incl. 8-9 members, plus a trainer. As part of the curriculum the students conduct a patient consultation with a SP every two weeks, e.g. Anamnesis or medical education, addressing taboo-subjects and the delivery of bad news.

This protected environment enables the students to practice professional consultations. The students have the possibility of practicing professional consultations and different situations. Different types of communication, understanding for the organization, efficiency and rules for clinical trials are part of the training.

Before the SP-discussion/consultation takes place, then trainer gives an introduction on the weekly topic. During the consultation all the others students (non participating) get an observation task. Subsequently the student performing the consultation receives feedback from the simulation patient him-/herself, from the fellow observing students and trainer. If wanted the students may have their consultation video taped, in order to able to watch it again at a later point in time.

Before any feedback is given the student must reflect on his/her own performance and explore where they had difficulties and ask for specific feedback. Only then does the SP give their feedback.

Both positive and negative aspects of the student’s performance are discussed in line with feedback rules and further feedback in regard to the future work is given.  A certain professionalism especially in regard to negative feedback is essential to avoid outbursts of negative emotions. Feedback should always refer to a concrete situation in the discussion or a medical examination. To ensure constructive feedback the SP are given regular feedback trainings. After the simulation patient has given his/her response the student’s peers and the trainer give their feedback.

Practical exam: OSCE + Workplace Based Assessments

OSCE stands for Objective Structured Clinical Examination and is applied to the exams of the medical students from the 1st to the 7th semester as well as the psychology students in their 4th semester.

During the OSCE the students pass through 8-10 different tests and have 2-minute breaks in between. Each test has a time constriction of 8-10 minutes. The examiners receive structured checklists in order to objectively evaluate the students.

The simulation patient receives a fixed position/role, while the students rotate through each test. Hereby the SP have various roles to play with different degrees of complexity, e.g. conduct a physical examination of the heart or a complex medical consultation incl. a diagnosis or suggestions for therapy.

When testing the student’s practical skills it is important to create the same conditions for everyone. To implement this, the situation/role is discussed and practiced in advance. When the students ask specific questions certain answers are given or body postures assumed. For the purpose of quality management video feedback is used during the training for these exam situations.

As of the 8th semester medical students begin the decentral part of their studies which means they are divided amongst different clinics in the state of Brandenburg. We are planning to assess the obtained practical skills in form of Workplace-Based Assessments (WPBAs). Different formats are used during clinical internships: DOPs (=Direct Observation of Clinical Skills), CBDs (Case-Based Discussions), NOTSS (Non-Technical Skills for Surgeons), as well as mini-CEX (mini Clinical Evaluation Exercise) in that case simulation patients will be used also.

Training

Role play:

Before the simulation patients can play their first role, they are collectively trained in small groups. As an introduction the SP receive their role description as well as SP documents and further material (e.g. band aids, make up). To create a simulation situation as authentic as possible the SP practice their role at home and in further training. Each situation is simulated at least twice with a trainer. With the help of peer-observation, trainer feedback and video analysis the role play is perfected.

Giving feedback:

Every SP receives regular feedback training, during which feedback rules, self-reflection and verbalizing is practiced and the standardized procedure is discussed. The emphasis is put on feedback given from the perspective of the simulation patient (not personal opinions). In addition to that they are specifically asked not to compare with fellow students or doctors. All this is practiced many times.

Organization

Currently the number of SP is not that high, so that appointments can be arranged via phone or e-mail.

Age and sex of the patient are usually defined within the role so that suitable candidates are chosen for certain roles. The simulation patients should not have any diseases or physical alterations that could be related to the illness portrayed. Being able to identify with the role to a certain extend is preferable.

Due to the fact that not all cases are required every semester limited number of SP are regularly needed.
Interested?

Should you have any further questions and/or are interested in getting involved as a simulation patient, don’t hesitate to get in touch with our secretary Mrs. Kramer-Poß, 03391/39-14310

Or else get in touch with the SP director Dr. Henrike Hölzer: henrike.hoelzer@mhb-fontane.de