gms | German Medical Science

“How to... train your skills!” is a Medical Education Center (MEC) program at the Technical University of Munich (TUM) for training of clinical-practical skills by and with peer tutors (TUTs) [1], [2], [3]. It was established in the Medical Training Center (MTC) in the winter semester of 2019/20. Since curricular courses with medical lecturers for team and skills training have been predominantly held at the MTC till now, this optional program constitutes a unique offer. It was developed and implemented by the TUTs themselves at the request of the students.

Given the provisional restrictions [4] during the Corona pandemic [5], “How to... train your skills” could not be held in the summer semester of 2020. The TUTs, who are also authors of this project report, developed “How to... train your skills goes digital!” to address this short-fall and offer their fellow students functional training in clinical-practical skills in this period of involuntary passivity and social distancing, while at the same time promoting a lively and motivating opportunity for exchange [6], [7]. To what extent this objective was achieved is critically assessed in the following.

One particular challenge lay in designing a method for teaching practical skills without being able to rely on the infrastructure of the MTC with its simulators and models as well as the physical presence of instructors and learners [8]. At the beginning of the development process, the focus was on both analysis of the learning objectives of the existing tutorials and the search for a suitable exchange platform through which learning content could be conveyed and its correct implementation ensured.

Subsequently, four topics were selected and developed as digital tutorials: “Placement of a bladder catheter”, “Placement of an intravenous peripheral cannula”, “Evaluation of an electrocardiogram”, and “Practice of surgical suturing and knotting techniques”. In terms of teaching methodology, the flipped classroom approach [9] formed a common basis for all digital tutorials in terms of the targeted linking of asynchronous and synchronous content. In addition, the tutorials were designed according to Peyton's 4-step method [10]: first, the correct application was demonstrated in videos, followed by deconstruction (and reconstruction) of an improvised model. Finally, once the PTs had confirmed their understanding, the procedure was carried out. The factual knowledge was imparted to the PTs in advance via partly self-produced content (e.g. video tutorials, literature, quizzes) on the Moodle learning management platform. Afterwards, the PTs met with the TUTs for a virtual meeting in order to clarify open questions and to practice under supervision. The successful small-group approach, with up to eight PTs [11] from the in person tutorials, was retained. Within the digital format, the PTs created a model surrogate at home, on which they practiced with centrally distributed materials. It was not possible to issue training models due to their insufficient number and for reasons of hygiene.

In the in-person tutorial, the “insertion of a bladder catheter” was practiced on a model. The focus of the digital tutorial was initially on the TUTs' innovative, supervised demonstration of the urethra and bladder using everyday items to simulate their complex anatomy (see figure 1 [Fig. 1]). The simulation was supported by different training videos [12], specially designed by the TUTs and made available via Moodle. Following this, the individual steps in the sterile “insertion of a bladder catheter” were practiced in a virtual meeting under supervision and observation by the TUT (see figure 2 [Fig. 2]). The PTs thus received direct feedback and were thus armed with the skills to avoid mistakes identified by the TUT.

Following the announcement of the teaching offer via the faculty-internal platform mediTUM, further communication took place directly between PTs and TUTs: the PTs established personal contact via e-mail. They were then registered on the Moodle course and, after arranging an appointment for a virtual meeting, were able to pick up the exercise materials at a central location.

So far, digital tutorials have been conducted on 23 dates since July 2020, which were attended by 64 PTs (M=2.8, min 1, max 7). In particular, the tutorials with only 1 PT presented the TUT with the challenge of having to assume two roles at the same time, i.e., both to exchange information about their own experiences and teach competencies.

All tutorials conducted were reviewed and optimized for quality with the help of an online questionnaire-based evaluation (see table 1 [Tab. 1]). The 24 completed questionnaires reflected an overall positive response: on a scale of 1 (“do not agree at all”) to 6 (“agree completely”), the average rating was 5.2. The PTs rated both training delivery and their own progress as “good” to “very good”; it was only in the area of independent performance of the respective procedure on patients that the PTs felt only moderately well-prepared. The optional free text responses revealed a clear appreciation of the instruction offer as well as the implementation by the TUTs.

Starting from the winter semester 2020/21, in-person tutorials can again take place in compliance with the hygiene regulations of the Faculty of Medicine at the Klinikum rechts der Isar, see [https://www.lehren.tum.de/downloads/]. The long-term plan, even once the pandemic has passed, is to combine them with the digital tutorials. For example, the Moodle course could be serve as the flipped classroom by providing information materials and forums as theoretical preparation for practical application during in-person tutorials [13]. In addition, the improvised models can be used during in-person tutorials to map more parallel practical practice. From the free text responses in the evaluation of the digital format, it is clear that the PTs would like to have the opportunity to work on the models at the simulation center. The fact that there were 278 registrations within a few hours for the 72 slots available for the very limited 14 in-person appointments reflects the high level of student need for physical presence on the courses. The offer of digital appointments is well-accepted and appreciated by students, but not nearly to the same extent.

The hybrid form of the course now envisaged should be assessed in terms of effectiveness and sustainability as part of accompanying research with the initial presence-only event. It is already clear that the still fledgling student tutorial program “How to... train your skills!” has undergone significant and promising further development. This is the result not only of the combination of digital and in-person tutorials, but also of the situational change of perspective and being constrained to apply practical skills at a distance and with the simplest improvised means.

The authors declare that they have no competing interests.