Monday, January 3rd, 2011
Berlin
On Monday the team went to Charite doctor skill training center. The hospital was very nice and provided a good atmosphere for learning. My previous experience at a similar facility was in Egbe Nigeria. The contrast goes without mentioning. Our two student guides were tutors. They explained the way the medical school program works. There have been two systems in place in the past years with a newer hybrid system that is also being implemented. The older program took about 6+ years with 2 years of basics, an exam, then 3 yearsish of medical school and then another exam before the students went to the practical residency type training for a year. It basically made an H shape with the preliminary course work on the bottom and the latter on the top. The newer track is called the reformed track and looks more like an N. The idea was that the students weren’t getting enough hands on experience up through the preliminary course work, and so a more practical integrated system was put in place. Rather than having preliminary course work void of practicals for two years and then getting into practical, the students would do both at the same time. The older students who had to go through the rigor of the previous system didn’t find the newer that fair because the test without a lot of practical was tough. The third and final system is a hybrid of the two and incorporate a little of both. The problem with incorporating practical course work with theoretical course work is having trained professionals who are knowledgeable enough to facilitate hands on experience with real patients. There are a lot of students and there is a fear that having too many students with one patient isn’t very effective, that some get left behind. Plus these are real patients and need real professional care.
After we learned about the German medical curriculum we went to do some practical skills training ourselves. We went into a room with a CPR dummy, an intubation dummy, and an ear nose and throat device and dummy. I found this very interesting because I have only learned CPR before. The experience of getting to intubate was pretty cool and educational. We had to tip the dummy’s head back, load the tube with a metal rod, inflate a smaller bubble with a syringe, use a prying device to depress the tongue and open the throat and then insert the tube into the trachea as to inflate the lungs. The bubble helps hold the esophagus closed so no stomach fluids flow into the lungs. The hard part was bypassing the esophagus as to not inflate the stomach. I also learned that one instance intubation is necessary is when a person’s stomach is in paralysis because liquid may flow back up the esophagus and into the lungs. I missed the trachea the first time and saw the stomach begin to inflate. It was very important to keep a close eye on the stomach and lungs. After a few minutes we rotated to a different station. The ear nose and throat device had a dummy doll that we could look into the ear with and see different slides of different conditions, but my group found it more entertaining to look at each other’s ears. The hairy canals reminded me of the magic school bus. The CPR station wasn’t anything new because I have been CPR trained several times. It had been about two years so I couldn’t remember the exact numbers of compressions to try and compare with the American class I took. That would be interesting to compare. I believe here we did 30 compressions to 5 pumps on the breathing device. Another difference was not using our actual mouths but a breathing bag. This is not unique to Germany however, just not something I had done in my previous course. An interesting fact that I learned about with CPR is that even people who have been doing it for 20 years aren’t very effective after two minutes and people must change out.
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