gms | German Medical Science

More and more medical training centers, so-called skills-labs, have been founded since the request of a practically oriented education in the latest German Medical Licensure Act in 2002 [1]. The close cooperation between these institutions as a chance for better utilization of resources is recommended [2].

Since October of 2008, ‘Marburg’s Interdisciplinary skills-lab’ (Maris) (see Figure 1 [Fig. 1]) is a part of the curricular education of students at the medical faculty of the Philipps-university Marburg. The ‘Student’s trainingscenter of medical practice and simulation’ (STÄPS) (see Figure 2 [Fig. 2]) at Georg-August-university Goettingen started its activities in october of 2009.

In January of 2010 tutors of these rather young skills-labs met for a first workshop in Marburg in order to exchange their experiences in peer-teaching of medical students. The second workshop took place in Goettingen in October of 2010.

Prior to the two-day workshops an agenda was prepared by students with administrative functions in both skills-labs including the following topics:

1^st workshop Marburg

After an introducing session comparing both skills-labs there was a seminar on the ground rules of didactics for peer-teaching of practical medical skills. The participation and evaluation of curricular and extra-curricular peer-teachings followed. Afterwards the participants were separated in two task groups working on the priory determined subjects ‘peer-teaching in ophthalmology’ and ‘training of peer-teachers’. At a final plenum the results of both work groups were presented and discussed.

2^nd workshop Goettingen:

Current administrative problems and special issues such as the production and integration of e-learning concepts in both skills-labs were important points of the second workshop. Two lectures on the ‘National Competence-Based Learning Objectives for Undergraduate Medical Education (NKLM) in Germany’ and about dissertations in the field of medical educational science gave justice to the fast growing scientific side of medical education. The participation in peer-teaching courses of the STÄPS such as ‘bedside basic skills in ophthalmology’ as well as the work on new teaching concepts accounted for the major part of the workshop.

The most important findings and experiences of the participants will be summarized according to the agenda of the two workshops.

Both skills-labs show conceptual similarities such as a concept of three columns of teaching: Curricular courses, extracurricular tutorials and free practice (see Figure 3 [Fig. 3]). Objectives of curricular courses are examined in both Skills-Labs by OSCE - Objective Structured Clinical Examination. However, the institutions have infrastructural and multimedia based differences due to different financing.

An overview on both institutions shows Table 1 [Tab. 1]. Maris and STÄPS have differences in their training possibilities and equipment. Basic medical skills can be trained in both skills-labs but specially orientated teaching concepts and training equipment differ due to individual preference of faculty members or student tutors.

It has to be considered, that curricular courses at Maris are mainly held by peer-teachers, whereas such courses at STÄPS are taught by medical professionals.

The participants noted the still unanswered question whether or not the profession of the head of a skills-lab has influence on courses, equipment or concepts of a skills-lab – General practitioner in Goettingen versus educationalists in Marburg.

Seminar on didactics: just practice is not enough (1^st workshop)

‘Learning at the limit’ is a concept from educational sciences, describing the constant exchange between (peer-) teacher and student in order to learn effectively. Mrs. Dipl. päd. Christina Stibane constitutes that this concept can be projected to the teaching of medical skills. The connection of educational objectives, teaching method and the kind of examination are important: Teaching concepts are defined by the objectives and should be linked to certain educational methods and examinations. The participants acknowledged the importance of ‘knowing your audience’ in order to ensure a positive learning outcome for the students. Especially so called Fresh-Up-Courses (like Fit-For-Famulatur/Fit-For-PJ in Marburg) demonstrate differences between medical students and are a chance to even them out.

A dissertation in educational sciences (2^nd workshop)

Mrs. Simmenroth-Nayda MD, head of the skills-lab Goettingen, demonstrated advantages as well as disadvantages of a dissertation in educational sciences. With the uprising field of medical educational sciences, dissertations in this area become more frequent but also more challenging. Aside from general difficulties of a dissertation a clear hypothesis and a valid collection of data set the biggest hurdles for a dissertation in educational sciences.

‘National Competence-Based Learning Objectives for Undergraduate Medical Education (NKLM) in Germany’ (2^nd workshop)

Alexander Damanakis, tutor at the ‘Marburg’s Interdisciplinary skills-lab’ (Maris) and a member of the task group practical skills for the NKLM gave a lecture about the progress of the NKLM since 2009 [3]. With examples of a few practical skills he explained the basic method of the NKLM: defining skills and also the level of certainty for medical students at a certain points during their medical education. This catalogue is supposed to make the medical education in Germany more structured and more comparable. The participants agreed that this catalogue is to be considered when teaching concepts are created or revised.

Participation in peer-teaching: learning how to teach practical skills (1^st workshop)

Peer-teachers did not only give their lectures in certain practical skills but also explained their teaching concept and discussed critical notes of the participants from the other university. While the goal of the first workshop was the support for the tutors from Goettingen with new ideas for their new skills-lab, the second meeting was dominated by the exchange and feedback on concepts between the two institutions. The sharing of experience with different simulators was one of the key points of the meetings. It became clear that this kind of exchange can avoid false investment. It was stated that it is difficult to determine whether or not a simulator can reproduce reality appropriately because the knowledge of peer-teachers is limited to their own clinical experience in curricular courses with patient interaction or medical clerkships. On the other hand the teaching and learning of the procedure, e.g. for venous puncture is sometimes more important than the correct simulation of the anatomy. It is important to make the decision for one or another simulator according to the institutions needs and the educational objectives. From our point of view it is necessary to include the student tutors when simulators are acquired since they are usually the ones that work with them and often develop the course concepts.

The members of this work group developed this concept in conformity with the didactical background discussed above. It seemed important to focus on basic ophthalmologic skills. In October of 2010 tutors from Marburg were able to participate in the afterwards generated course ‘Basic bedside skills in ophthalmology’ at the STÄPS in Goettingen.

Training peer-teachers in skills-labs (1^st workshop):

In order to ensure an adequate training of peer-teachers, Marburg developed a three-step training for curricular courses called ‘TPH’ – Theorie, Praxis, Hospitation. The ‘Theorie’ (theory) part is a block of seminars held by clinicians and pedagogues, ‘Praxis’ (practical training) stands for the training of the skills with a fellow of the chosen specialty including a visit of the ward of the trained specialty to get clinical experience. The training is completed with the introduction of a new tutor to the course concept and the technical details of the simulators by an experienced peer-teacher and a ‘Hospitation’ (hospitation) of a teaching unit, watching an experienced peer-teacher. The new tutors thus get to know the concepts and the simulators and are supervised by a peer-teacher who tries to elaborate strengths and difficulties. There is also the chance for an optional supervision of an experienced peer-teacher after some courses have been held (see Figure 4 [Fig. 4]).

E-learning by podcasts (2^nd workshop)

All participants agree that from their own experience e-learning has a growing role in medical education and that skills-lab should also try to integrate these learning techniques. Ways to achieve this were elaborated in this working group. The ‘National Competence-Based Learning Objectives for Undergraduate Medical Education (NKLM) in Germany’ differentiates skills into three levels of achievement. The first level could be reached by watching a standardized video or ‘podcast’ of a performed skill. Level two can be taught through an educational unit in the skills-lab. The involved participants also clearly state that watching a video cannot replace the contact to real patients or seeing a procedure in reality. These kinds of ’podcasts’ can function as a kind of digital handout in order to learn procedures.

Development of a peer-teaching “diagnostic radiology” (2^nd workshop)

A task group developed a peer-teaching for this topic focusing on the teaching of anatomical structures and the identification of abnormalities in a chest x-ray. This concept is implemented in an extracurricular course in Goettingen since the summer term of 2011.

Both workshops were a huge benefit for both institutions. This is obvious since the results of the first workshop ‘peer-teaching in ophthalmology’ and ‘training peer-teachers’ were implemented at the time of the second workshop. The lectures educated the participants and lead to interesting discussions about teaching concepts and educational objectives of both institutions. In comparison to more established meetings like ‘Skills Lab Symposium’ or the ‘Annual meeting of the GMA’ we see an advantage of our workshops since topics and discussions are adjusted to current and financial needs and resources of personnel of the two facilities Marburg and Goettingen.

In agreement with the faculties there is a chance to start long-term projects such as e-learning databases or educational science projects. The goal is to continue with this kind of workshops between Marburg and Goettingen at least once a year.

A workshop between peer-teachers of skills-labs is rather easy to organize. We see the gain of new insights is huge in comparison to the effort. Thus we can only recommend cooperation like this between skills-labs especially when they are just getting started.

Further information on both skills-labs is available at:

• STÄPS Göttingen: http://www.staeps.med.uni-goettingen.de
• Maris Marburg: http://www.uni-marburg.de/fb20/maris

We want to thank all involved student tutors as well as Mrs. Anne Simmenroth-Nayda MD, Mrs. Dipl. päd. Christina Stibane and Mrs. Dipl. mot. Andrea Schönbauer.

The authers declare that they have no competing interests.