Abstract Title
Advanced emergency skills training for first-year medical students using manifold simulation-based approaches


Lukas Peter Mileder
Thomas Wegscheider
Albrecht Schmidt
Hans Peter Dimai




Clinical Skills Center, Medical University of Graz


 Basi c and advanced life support (ALS) are extensively taught during the clinical period of medical study. Yet, the practical ALS competence of graduating students is still insufficient (Weller et al. 2004; Jensen et al. 2008). A possible solution may be to implement advanced emergency skills training in the pre-clinical period of study.

Summary of Work

  A two-hour course teaching  cardiopulmonary resuscitation, airway management procedures (e.g. oropharyngeal suctioning, use of supraglottic airway devices) and structured emergency assessment was implemented.


Central components are:

  • thorough theoretical pre-course preparation
  • student peer-teaching
  • small teaching groups
  • a hands-on concept.


Simulation technology is used throughout the entire course:

  • part-task trainers and static manikins for procedural training
  • a simulation software for the practice of patient assessment
  • high-fidelity patient simulators for emergency simulations.



Figure 1: Course structure


Summary of Results

  Betw een Nove mber 2011 and February 2013, 398 students have successfully completed the course. Initial student satisfaction is very high: 51 students have participated in a voluntary online-evaluation, with 45 students (88.2%) strongly agreeing/agreeing that they were satisfied with the course (mean grade of 1.4±1.0 on a six-point Likert scale).



Figure 2: Student satisfaction


By using an innovative simulation-based course design, advanced practical aspects of emergency medicine can be implemented successfully in pre-clinical student education. However, despite high student satisfaction (Kirkpatrick hierarchy level I), students’ post-course skills competence (Kirkpatrick hierarchy level II) and the long-term impact of this single training have to be further investigated (Kirkpatrick & Kirkpatrick 2006; ten Cate et al. 2010). 

Take-home Messages

1) P re-clinical students are highly satisfied with advanced emergency skills training.

2) Manifold simulation-based approaches are valuable in teaching first-year students emergency skills.



Weller J, Robinson B, Larsen P, Caldwell C. 2004. Simulation-based training to improve acute care skills in medical undergraduates. N Z Med J 117:U1119.

Jensen M L, Hesselfeldt R, Rasmussen MB, Mogensen SS, Frost T, Jensen MK, Muijtjens A, Lippert F, Ringsted C. 2008. Newly graduated doctors' competence in managing cardiopulmonary arrests assessed using a standardized Advanced Life Support (ALS) assessment. Resuscitation 77:63–68.



  Weller J, Robinson B, Larsen P, Caldwell C. 2004. Simulation-based training to improve acute care skills in medical undergraduates. N Z Med J 117:U1119.Weller J, Robinson B, Larsen P, Caldwell C. 2004. Simulation-based training to improve acute care skills in medical undergraduates. N Z Med J 117:U1119.Weller J, Robinson B, Larsen P, Caldwell C. 2004. Simulation-based training to improve acute care skills in medical undergraduates. N Z Med J 117:U1119.

Link to Weller et al. (2004): http://www.nzma.org.nz/journal/117-1204/1119/

Link to Jensen et al. (2008): http://www.ncbi.nlm.nih.gov/pubmed/18162280

Summary of Work

Course aim: The aim of the course is to teach students performance of basic emergency procedures and structured assessment of critically ill patients.


 Pre-course preparation: In or der to guarantee appropriate pre-course preparation, peer-teachers of our Clinical Skills Center have compiled the “Graz’ Skills Guide” under guidance and supervision of clinical teachers. Beginning with necessary anatomical and physiological knowledge, this handbook describes the performance of clinical skills and procedures by using written text, procedural algorithms, and high-quality image series specifically developed for the course.


Detailed course contents are: 

  • cardiopulmonary resuscitation
  • airway management procedures (jaw-thrust/chin-lift maneuver, oropharyngeal suctioning, bag-valve-mask ventilation)
  • use of supraglottic airway devices (larnyngeal tube)
  • structured assessment of critically ill patients (ABCDE approach)
  • emergency simulations.


Course structure:

For virtual simulation, MicroSimTM Inhospital (Laerdal Medical) is used. During this course part, students get to know characteristics of different medical emergencies (bronchial asthma, chest pain, hypoglycemia, cardiac arrest) and learn how to apply the ABCDE approach. Consequently, these medical emergencies are used as scenarios for simulation training.

The course structure is based on "The Circle of Learning" (Laerdal Medical - Available at: http://www.laerdal.com/at/docid/6681900/Der-Circle-of-Learning) 


Summary of Results

Quantitative methodology: Three course evaluations have been carried out in 2012 (February, May, and July). All students who had passed the course at the time of the respective evaluation were asked to complete an online questionnaire. The standard course questionnaires of the Medical University of Graz were used. Answers could be given on a six-point Likert-type scale, ranging from 1 (“I strongly agree”) to 6 (“I strongly disagree”). We combined the results of these evaluations. Statistical analysis was performed using IBM® SPSS Statistics, Version 20.


Free-text analysis: For a more detailed feedback, we included open questions in the questionnaire, asking for suggestions for course improvement. The only major student suggestion was to increase course time. As a result of these evaluations, course duration will be extended from two hours to three hours starting with the upcoming study year (October 2013).



Kirkpatrick DL, Kirkpatrick JD. 2006. Evaluating training programs: The four levels. Berrett-Koehler Publishers, Inc.: San Francisco, USA.

 ten Cate O, Snell L, Carraccio C. 2010. Medical competence: the interplay between individual ability and the health care environment. Med Teach 32:669–675. 


Link to ten Cate et al. (2010): http://www.ncbi.nlm.nih.gov/pubmed/20662579

Take-home Messages
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