Seminar "Orthopädie" 2018

Thursday, January 18th 2018

On January 18th 2018 we began our little journey to the Albanian capital of Tirana. We, the students Eleni, Franz, Luca and Philine, studying medicine in the first, second and fifth semester, started the trip early in the morning in Witten. Soon we were being joined by Dr. Hubertus Bergermann and his wife Mariele in Düsseldorf Airport and were able to take off right before the storm ‘Friederike’ raged over whole Nordrheinwestfalia that day. After a short layover in Vienna, we landed in Tirana in the early afternoon to a breath taking scenery of sun illuminated mountains.

As Franz has already been part of the Emergency Medicine seminar the previous year, finding our way to the Hotel Alen, near the University Hospital, was fast and easy. Just to be welcomed warmly by the owner, who, later that day, also led our way to an excellent organic restaurant nearby. Communication here, as well as in the hotel, worked perfectly fine – even without sharing a mutual language.

In the evening, we met with a group of Albanian students, all being members of our partner organisation LMA, to get to know the new tutors and to fresh up long held ties with the elder students like Kea and Sabina. Most importantly, we planned to have a conversation about the future of our organisations. After a long discourse about sustainability of our work back in Witten within FDN, and already having developed a concept paper, we were excited to now share our ideas with our partners in Tirana. This conversation ought to be in the most respectful way, valuing the thoughts and visions of the Albanian students and developing this reform together in order to overcome cultural hierarchies.

It has been a fruitful conversation in which we as FDN members were able to make clear how urgent a change towards a more sustainable program is. However, we were not able to make any decisions about the concrete implementation of the modifications at this point.

One should also take account of the fact that right now there is a generation shift within the organisation of LMA happening. Kea, Sabina and others will be finishing med school this summer and therefore no longer be the main persons in charge. But younger students like Raela, Marjola and Matteo are highly motivated and committed to the organisation.

On this first evening we were able to create a basis of mutual understanding and a productive, amicable cooperation the following days.

Friday, January 19th 2018

The Seminar started at 1 pm on Friday, that gave us some time to go a little sightseeing, visit some museums or check our presentation one last time. We arrived at the university a bit before the seminar was going to start. At the beginning we had some IT-problems, but we managed them quickly and could start the seminar with only a few minutes delay.

Dr. Hubertus Bergermann gave the introduction and started with some basics about examination and behavior towards patients. The plan was to get through with the themes of the upper body on this day, which means the spine, the shoulder, the elbow and the hand. Therefore Dr. Bergermann gave a theoretic introduction about the current joint, which contained the inspection, palpation, range of motion and special tests of the joint as well as a few tips. After the theoretical part we made smaller groups to teach the practical skills. The smaller groups consisted of a German and an Albanian tutor as well as seven Albanian students. We repeated this method for every joint. At 7 pm we finished the seminar for this day, because the students were not receptive anymore. They have had classes before that day. As we saw how exhausted they were, we decided to postpone the hand to the next day. We went to the Hotel to get fresh and went to eat something. Afterwards we fell tired into bed.

Saturday, January 20th 2018

The day bade us welcome with a continuous rainfall and stormy clouds. After a quick breakfast we started the seminar at 9.00 am. The first topic of examination was the hand and elbow. The repetition of the complicated anatomy took some time, so we started the examinations at 10.00 am. All participants were allowed to try specific tests in suspicion of carpal tunnel syndrom, epicondylitis and other nerve lesions. The teaching with a tandem system between german and albanian tutors were pretty useful. The restraint in the beginning, which we sometimes noticed at the seminars before was almost over. With much effort the students were trying out, how much pressure they needed to fix and irritate the joints correctly.

We and the albanian tutors spent our lunch break with some coffee and sandwiches. The second part of the seminar included hip, knee and foot. Hubertus started to explaining some disorders of the hip joint and differentiating these with problems of the lumbal spine. The practical part afterwards was dominated by examining important tests like Lasegue, Braguard and Menell.

Small fictional cases with examples of orthopaedic disorders enhanced the experience of examining. The seminar ended at 5.00 pm with a photo of the whole group.

After the long day we had to organise and prepare the OSCE for the next day but the sun was back and lifted our mood. For the night we had time to go out for the traditional dinner and meet with the albanian tutors. It was a pleasure to eat a classic albanian meal in a restaurant near to our hotel. We enjoyed the opportunity for interesting conversations about the personal expectations, goals and dreams of our albanian tutors. Finally the day was completed with a walk through the lighted streets of Tirana in a wonderful nippy night.

Sunday, January 21st 2018

On our last day in Tirana we had to get up early to prepare our practical test. We had six stations where the Albanian students could show what they have learned in the seminar during the last two days. The students were really nervous, but they did very well. After they had finished they all got a certificate and filled in an evaluation paper. Our three Albanian co-tutors also got a tutors certificate and we took a final photo with all of them. Fortunately, we had time for a short breakfast with the Albanian co-tutors before we had to go to the airport. It was an enjoyable completion of our seminar. We had a pleasant flight back to Germany and arrived there in the evening.

All in all it was a very successful seminar. According to the evaluation papers the students were satisfied with the arrangement and learned some new practical examination methods in orthopaedics. The cooperation with the Albanian partner organization LMA worked very well and we all had a great time there.

Seminar "Notfallmedizin" 2018

Donnerstag, 31.05.2018

Am Donnerstag dem 31.05.2018 begannen drei wir als Mitglieder der studentischen Initiative FDN unsere Reise nach Tirana, Albanien. Begleitet wurden wir dabei von dem Notfallmediziner und Neurochirurgen Dr. Ralf Stroop.

Nachdem wir uns bereits im Vorfeld in Kooperation mit Herrn Dr. Stroop ein neues Konzept mit besonderem Fokus auf die Praxis überlegt hatten, trafen wir uns am Donnerstagabend um 18.00 für die letzten Seminarvorbereitungen mit den studentischen TutorInnen aus Albanien.

Dr. Ralf Stroop war bereits letztes Jahr mit unserer Initiative nach Albanien gereist und konnte somit seine Erfahrungen aus dem vergangenen Seminar in das neue Konzept mit einfließen lassen. Das Konzept fokussiert die Heranführung an das praktische Arbeiten und Reproduktion durch vielfältige Fallbeispiele und Minimierung des theoretischen Inputs auf das unbedingt Notwendige. So konnte die Möglichkeit geschafften werden, dass die Studierenden in einem geschützten Raum die praktischen Fertigkeiten zunächst an Modellen üben und im Verlauf an Fallbeispielen mit Simulationspatienten vertiefen können. Am Donnerstagabend wurde das neue Konzept nochmals mit den albanischen TutorInnen besprochen, sodass am Freitagnachmittag direkt gestartet werden konnte.

Freitag, 01.06.2018

Aufgrund der Tatsache, dass die albanischen Studierenden durch das Studium nur nachmittags freigestellt waren, begann das Notfallmedizinseminar um 14.00 mit ungefähr 40 Studierenden.

Zu Beginn hielt Herr Dr. Ralf Stroop eine kurze theoretische Einführung über die Schwerpunkte der Notfallmedizin. Thematisch befasste sich dieser Vortrag mit der Reanimation (Erwachsene, Kind, Neugeborenes), sowie weiteren ärztlichen Fertigkeiten: Endotracheale Intubation, Alternativer Atemweg, venöser und intraossärer Zugang.

Nach diesem Vortrag bildeten wir TutorInnen (albanische und deutsche) sechs verschiedene Stationen. Jede Station hatte einen anderen Schwerpunkt, sodass die Fertigkeiten aus dem theoretischen Vortrag an Modellen geübt werden konnten. Das Üben des Legens der venösen Zugänge erfolgte unter den KommilitonInnen. Wir studentischen TutorInnen unterstützen die Studierenden beim Erlernen der Fähigkeit und gingen auf Fragen ein. Dr. Ralf Stroop betreute im Wechsel alle Stationen und beantwortete als Experte noch offene Fragen der Studierenden.

Ziel dieser praktischen Übungen war die albanischen Studierenden, welche zuvor nur begrenzt bis keine praktische Ausbildung erhielten, an das praktische Arbeiten heranzuführen. Auffällig war, dass sich die meisten Studierenden sehr unsicher und zurückhaltend zeigten, da sie die verschiedenen ärztlichen Tätigkeiten zuvor nur theoretisch in ihrem Studium behandelt hatten. Diese anfängliche Scheu konnte während des ersten Seminartages deutlich reduziert werden und die Studierenden konnten sehr von den Stationen profitieren. Die Studierenden schätzen es ebenfalls sehr einen Ansprechpartner für offene Fragen zu haben, da es Ihnen in ihrem Studium nicht immer möglich ist den Dozierenden Fragen zu stellen. Auch hierfür bot das interaktive Seminar einen guten Rahmen. Der erste Tag des Seminares endete um ca. 19.00.

Samstag, 02.06.2018

Der nächste Tag des Notfallmedizinseminars startete Samstagmorgen um 9:00 mit einer 60-minütigen theoretischen Einführung in das ABCDE-Schema durch unseren Arzt Herrn Dr. Ralf Stroop. Da das ABCDE-Schema den albanischen Studierenden bereits aus ihrem Studium grob bekannt war, konnten wir im Anschluss direkt in die praktische Phase übergeben, welche mit diversen Fallbeispielen den restlichen Tag füllen sollte. Aufgrund der Tatsache, dass einige albanische Studierenden verhindert waren, konnten wir in einer großen geschlossenen Gruppe verschiedene Fallbeispiele am Simulationspatienten oder Puppen durchführen. Dabei stellte sich heraus, dass es für die Studierenden schwierig war die verschiedenen Phasen des Schemas abzuarbeiten, da einige Unsicherheiten bei der praktischen Durchführung der Untersuchung von Patienten auffielen. Deshalb teilten wir die Studierenden nach dem ersten einführenden Fallbeispiel (Hypoglykämie) in zwei Gruppen auf, um mit ihnen grundlegende Untersuchungstechniken, wie den Bodycheck und das ABCDE-Schema in Kombination mit dem Bodycheck, erneut zu vertiefen. Nach dieser einstündigen Vertiefungsphase, bei der die Unsicherheiten geklärt und einige Berührungsängste genommen werden konnte, folgten weitere Fallbeispiele. Für jedes Fallbeispiel wurde ein Team aus jeweils drei albanischen Studierenden gebildet. Das Team wurde als Rettungspersonal an einen fiktiven Einsatzort gerufen, wo sie ihre erlernten praktischen Fähigkeiten erproben konnten. Die verschiedenen Fallbeispiele wurden angeleitet von unserem Arzt, welcher während den Fallbeispielen Hilfestellung leistete und zusätzliche Fragen an die Studierenden stellte, um abgesehen von der praktischen Arbeit auch weitere Themengebiete zu vertiefen, wie z. B. Medikamentengabe und Dosierung oder Selbstschutz am Einsatzort. Unser Ziel war es die Studierenden für verschiedene Situationen zu sensibilisieren und Hilfestellungen bei der individuellen Behandlung der Simulationspatienten zu geben. Die albanischen Studierenden hielten sich zunächst sehr an ihrem im Studium erlernten theoretischen Wissen und Richtwerten fest, welche jedoch je nach Situation an den Patienten angepasst werden müssen. Die Studierenden konnten von den Fallbeispielen und unseren persönlichen Erfahrungen aus dem Rettungsdienst sehr profitieren, da die Arbeit im Rettungsdienst häufig kreatives und improvisierendes Denken und Handeln erfordert. Das theoretische Wissen der Studierenden konnte ihnen als Grundlage während der Fallbeispiele dienen, jedoch wurden sie durch die unterschiedlichen simulierten Notfallsituationen gefordert das theoretische Wissen individuell auf den Patienten anzupassen und dem Patienten ohne Zeitverlust zu helfen. Zudem konfrontierten wir die Studierenden mit für sie völlig neuen Situationen in den Fallbespielen, sodass sie während eines Fallbeispieles nicht nur ein Kind mit Pseudo-Krupp als Patienten behandeln musst, sondern zusätzlich dazu eine aufgelöste Mutter. Die verschiedenen Fallbeispiele versuchten die Komplexität der täglich anfallenden Arbeit im Rettungsdienst zu skizzieren. Während der Fallbeispiele nutzen wir ebenfalls die Darstellung von EKG Bildern, um die Fallbeispiele besonders spannend und fordernd zu gestalten. Bei dem Lesen der EKG-Bilder und der Diagnose von einer supraventikulären Tachykardie (stabil und instabil) und Torsade de Points legte unser Arzt besonderen Wert auf das Training der Medikamentengabe und Dosierung. Des Weiteren wurde am Simulationspatienten das kleben eines EKGs geübt und das Messen des Blutdrucks, was zuvor auch nicht alle Seminarteilnehmer beherrschten. Durch die abwechslungsreichen Fallbeispiele konnten die Studierenden ihre praktischen Fähigkeiten direkt anwenden, sowie an der Reanimationspuppe ihre Fertigkeiten abrufen. Der zweite Tag des Seminares endete um ca. 18.00.

Seminar "Neurologie" 2018

Thursday, December 6th 2018

On thursday morning our group consisting of a doctor and two medical students started the journey from Düsseldorf to Tirana Airport via Frankfurt am Main. For Dr. Ralf Stroop, who is a neurosurgeon and an emergency doctor, it was the third time to travel with FDN to Albania and we were very happy to have him in our team once again. During the flights we went through the presentation Dr. Stroop prepared for the seminar. Around midday we arrived in Tirana, then we headed to our accommodation for the following days. After a short break we took a walk around the city center and to the new bazaar. In the evening we met up with some LMA members and those who would participate in the seminar as tutors. We talked about the program for the seminar, updated each other about FDN’s and LMA’s work and got to know each other better. It was very nice because for us German tutors, Julian and Alessandra, it was the second time to be in Albania and we got to catch up with our friends and make new ones.

Friday, December 7th 2018

The next morning we met up with the tutors at the university and we went through the subjects before the seminar started. We were very happy to welcome about 20 students and young doctors, some who participated for the first time and some who had been in other in FDN/LMA seminars. We started the seminar with a little insight into what Future Doctor’s Network stands for and how we work. We showed our introduction film, gave a small presentation about key facts and held a welcoming speech. This was a nice start and when Dr. Stroop continued and started with his presentation, everybody was focused and in a good mood.

Dr. Stroop made an introduction to clinical neurology for which he used lively case studies. Therefore, used images, videos and detailed information. Then the participants had some time to discuss about what they could ask the patient or what they would like to examinate.

Each case led to a new subject and a new examination technique. The focus of the day laid especially on the cranial nerves. Once the theoretical part was over we had a short break. The following part consisted in applying the new taught skills practically. For this the group divided in four small groups, each under supervision of a FDN or LMA tutor. The goal at the end of the day was to be able to do a structured and precise examination of the cranial nerves. For this we used pupil lights, mouth spatulas, tuning forks, cotton swabs and most importantly our communication skills. The tools handed out for this where mostly brought from FDN to Albania for the purposes of the seminar. Working in small groups was very successful and both FDN and LMA tutors were happy with the results at the end of the afternoon.

After the seminar we had a short break at our accommodation before meeting up with our friends from LMA to share a traditional Albanian dinner. We had a variety of different food, tried new flavors and discovered the diversity of the Albanian cuisine, it’s culture and its traditions. It was very nice for our friends to teach us about their traditions and to get to know more about the country. We ended the day with a brief insight into Tirana’s nightlife before getting some rest.

Saturday, December 8th 2018

After a quick breakfast we headed to the seminar room located in the university hospital of Tirana to prepare ourselves for the rest of the lessons. Before the students arrived, we held up a short team briefing to make sure everybody knew about their range of tasks. Once the students arrived, Dr. Stroop asked if there was a volunteer who would like to show a complete examination of the cranial nerves in front of the audience settle the learning content of the prior day. After enjoying a perfectly performed examination, Dr. Stroop continued his theoretical presentation about the next topic: the motoric system. By presenting not only the theoretical basics but also showing many examples of pathologies, Dr. Stoop stayed in interaction with the students. This was very welcomed by everyone present. In small groups we examined the myotonus, the muscular strength and all the reflexes.

Accompanied by some students we went to a local restaurant for our lunch break where we got to hear how the health care system in Albania works. After that interesting excurse of healthcare policy, Dr. Stroop continued his presentation about the sensibility, coordination, paralysis signs of meningism. By the end of the day all participants had the theoretical base and the practical skills to perform a complete neurological examination. An intensive day of studying and practicing was drawing to an end. Since we had to prepare the exam for the last day of the seminar, we finished the day by sitting together with the members of the team sharing ideas how to construct the last day.

Sunday, December 9th, 2018

Since we were booked on a return flight leaving around noon, our last day in Tirana started very early. After leaving our accommodation we went directly to the university hospital. For the closure of the seminar we decided to perform a role play. Each of the tutor chose a neurological disorder. The students split up into small groups. By doing a complete neurological examination, the task of the students was to figure out what disease the tutors where simulating. Since we took turns, every student got to see every single role play performed by the tutors. After finishing the examinations, Dr. Stroop explained the different syndromes in detail and gave constructive feedback to the different groups. Using the new acquired knowledge in a practical way seemed to bring a lot of pleasure while highlighting the strengths and weaknesses regarding neurological skills in a self-reflective way. After delivering the certificates of attendance to the students we took a few group photos and took our leave. Looking out of the taxis window, slightly tired but especially heart warmed and happy about an awesome seminar, the FDN-Team from Witten/Herdecke enjoyed the beautiful view of Tirana and the mountains before flying back to Germany.