Third-year students in the Dresden Medical School Programme undergo a 6 week course ‘Basics of Drug Therapy’ in a problem-based learning curriculum. As part of this course a practical seminar about antiarrhythmic drugs and ECG was set up. This study was conducted to evaluate the use of a simulator in this course.Methods. A total of 234 students were randomly allocated to receive instructions with (Group S) or without (Group C control) the use of a simulator. After a lecture on antiarrhythmic drugs, arrhythmias were presented to Group S using an advanced life support (ALS) manikin. The students were asked to administer a drug or to defibrillate, and the outcome was shown on the monitor.

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The students in Group C were presented with ECG charts without a simulator. The course was evaluated by a questionnaire and multiple-choice questions (MCQ) about arrhythmias.Results. We received 222 questionnaires. The content–time ratio was rated almost perfect in both groups, but the students in Group S rated the course better suited to link theory and practice. Students in Group S considered the simulator helpful and a good tool for teaching, and the extra effort to be worthwhile. A significantly higher number of students in Group S preferred electric cardioversion as therapy for ventricular tachycardia.Conclusions. An ALS manikin can be an effective tool in teaching clinical pharmacology.

Undergraduate medical education in Germany consists of a 6 year programme divided into 2 years of preclinical and 4 years of clinical studies. Only the final year is, in its entirety, spent in a hospital setting. Since 2003 German federal guidelines on the structure of medical education have been relaxed, and it is now possible for medical faculties to design their own curriculum. Anaesthesiology is now a core subject and is involved in the interdisciplinary teaching of courses such as emergency medicine.With the support of Harvard Medical International the Medical Faculty of the University of Dresden started to reform the curriculum in 1998, combining traditional teaching methods such as lectures and practical courses with problem-based learning. In the meantime, the complete 6 year programme has been reorganized and all subjects are incorporated in interdisciplinary block courses (Dresden integrative problem-based learning DIPOL).

In the courses related to anaesthesia, simulators are part of lectures and seminars.As one possibility for interdisciplinary cooperation between non-clinical and clinical specialties, a seminar for third-year (first clinical year) medical students on ‘Antiarrhythmic Therapy and ECG’ was incorporated in the 6 week course ‘Basics of Drug Therapy’. In this 2 h seminar, life-threatening arrhythmias and the treatment options were presented to students. We evaluated the seminar, in which students were randomly allocated into two groups, one using an advanced life support (ALS) manikin with arrhythmia simulator and the other receiving a traditional lecture. The objectives of this study were to evaluate the use of the simulator in this new interdisciplinary course. MethodsThe course ‘Basics of Drug Therapy’ is mandatory for third-year students in the medical school in Dresden.

After approval by the local ethics committee, 234 students (all the third-year students) were allocated into nine subgroups for the seminar ‘Antiarrhythmic Therapy and ECG’. Before the start of the seminar, the subgroups were randomly allocated to receive instructions with or without the use of a simulator.Five of the nine subgroups were taught using an ALS-training unit Laerdal Heartsim 4000™ (Laerdal, Munich, Germany) (Group S), and the remainder were taught without it (Group C control). One pharmacologist and one anaesthetist served as instructors and conducted all the teaching in both groups. The course began with a 45 minute lecture on the pharmacological effects of antiarrhythmic drugs followed by the presentation of preselected clinical cases of life-threatening arrhythmia. In Group C, this was done using PowerPoint™ (Microsoft, Washington, USA); the ECG charts had been produced with a Heartsim 4000™ simulator and projected onto a video screen. Students were asked to make a diagnosis and suggest therapy that could include pharmacological intervention, use of a defibrillator or application of a pacemaker, where applicable. After a therapeutic method had been decided upon and carried out, the resulting ECGs were again presented in the above manner.In Group S the same clinical cases were presented using PowerPoint™.

Instead of projecting the ECG charts, an ALS manikin which was connected to a defibrillator was used to show the running ECGs on the monitor. After administering an antiarrhythmic drug the ECG changes could be observed online on the monitor. Participants in this group were also given the opportunity to defibrillate or to use an external pacemaker. Again, the results were projected live on the monitor screen.After the course, having been assured of anonymity and given written consent, participants were asked to complete and hand in a questionnaire immediately.

The questionnaire for Group C started with eight questions answerable on a scale from 1 (disagree strongly) to 6 (agree completely). Two additional questions concerned the ratio of study content vs time answerable on a scale from 1 to 7 (1=too much content, 4=exactly right, 7=too much time) and theory vs practice on a scale from 1 (too much theory) to 7 (too much practice). Finally, the students were asked to grade the seminar (1=worst, 6=best). QuestionAThe content is of relevance for a physician's jobBThe content was presented in an understandable wayCThe teaching has clinical relevanceDThe spatial setting was adequate (e.g. Size of seminar room)EThe course is suitable to link theory and practiceFThe teaching enables me to acquire further knowledge on my ownGA practical training regarding the field of antiarrhythmic drugs makes senseHThe instructors are competentIThe use of the simulator helped me understand the subject matterJThe technical effort required is justified because it is to the benefit of the practical courseKThe simulator's use is suitable for the pharmacological courseLStudy content versus timeMTheory versus practice. QuestionAThe content is of relevance for a physician's jobBThe content was presented in an understandable wayCThe teaching has clinical relevanceDThe spatial setting was adequate (e.g. Size of seminar room)EThe course is suitable to link theory and practiceFThe teaching enables me to acquire further knowledge on my ownGA practical training regarding the field of antiarrhythmic drugs makes senseHThe instructors are competentIThe use of the simulator helped me understand the subject matterJThe technical effort required is justified because it is to the benefit of the practical courseKThe simulator's use is suitable for the pharmacological courseLStudy content versus timeMTheory versus practice.

QuestionAThe content is of relevance for a physician's jobBThe content was presented in an understandable wayCThe teaching has clinical relevanceDThe spatial setting was adequate (e.g. Size of seminar room)EThe course is suitable to link theory and practiceFThe teaching enables me to acquire further knowledge on my ownGA practical training regarding the field of antiarrhythmic drugs makes senseHThe instructors are competentIThe use of the simulator helped me understand the subject matterJThe technical effort required is justified because it is to the benefit of the practical courseKThe simulator's use is suitable for the pharmacological courseLStudy content versus timeMTheory versus practice. QuestionAThe content is of relevance for a physician's jobBThe content was presented in an understandable wayCThe teaching has clinical relevanceDThe spatial setting was adequate (e.g.

Size of seminar room)EThe course is suitable to link theory and practiceFThe teaching enables me to acquire further knowledge on my ownGA practical training regarding the field of antiarrhythmic drugs makes senseHThe instructors are competentIThe use of the simulator helped me understand the subject matterJThe technical effort required is justified because it is to the benefit of the practical courseKThe simulator's use is suitable for the pharmacological courseLStudy content versus timeMTheory versus practice. The questionnaire for Group S included three additional questions concerning the use of the simulator.

Again, a six-point scale was provided for the answers.The 6 week course concluded with an oral examination. After this examination all students were asked to answer three multiple choice questions pertaining to the seminar which were not graded:The third five-part question concerned the introductory section of the course which was the same for both groups and in which a correct/incorrect response was required.A 63-year-old patient calls emergency complaining of chest pain. His ECG shows the following rhythm ventricular tachycardia, 180 beats min −1. Which measure would you take (only one answer)? Verapamil; (b) electric cardioversion; (c) i.v. Lidocaine; (d) i.v. Digoxin; (e) none of the above.A 54-year-old patient consults emergency because of an open head wound suffered in a fall.

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His ECG shows the following rhythm II° heart block. Which of the following might be useful (more than one answer)? (a) External pacemaker; (b) i.v. Metoprolol; (c) i.v.

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Atropine; (d) i.v. Amiodarone; (e) i.v. Orciprenaline.Beta-blockers are considered to be first-line therapy for the treatment of tachycardia in patients with hyperthyreosis.Class I antiarrhythmic drugs bind to the channel during its inactive state.In high-frequency tachycardia class I antiarrhythmic drugs are more efficient than in low frequency.Regarding drug therapy in atrial fibrillation it is easier to reduce the heart rate than to convert the rhythm.One side effect of class III antiarrhythmic drugs is long QT syndrome.Data from the questionnaires and the multiple-choice tests were processed using SPSS 11.5 for Windows™. Median and interquartile range ( iqr) were determined. Results were tested for significance by using the Wilcoxon rank–sum test. QuestionMarkMedianIQRP-value123456AStudy0.33ControlBStudy10.5Control1CStudy0.06Control1DStudy3420.21Control41EStudy10.04Control0.8FStudy10.46Control1GStudy10.21Control1HStudy10.64ControlIStudy1NAControlNAJStudy1NAControlNAKStudyNAControlNAOverall markStudy0.28Control1. QuestionMarkMedianIQRP-value123456AStudy0.33ControlBStudy10.5Control1CStudy0.06Control1DStudy3420.21Control41EStudy10.04Control0.8FStudy10.46Control1GStudy10.21Control1HStudy10.64ControlIStudy1NAControlNAJStudy1NAControlNAKStudyNAControlNAOverall markStudy0.28Control1.

QuestionMarkMedianIQRP-value123456AStudy0.33ControlBStudy10.5Control1CStudy0.06Control1DStudy3420.21Control41EStudy10.04Control0.8FStudy10.46Control1GStudy10.21Control1HStudy10.64ControlIStudy1NAControlNAJStudy1NAControlNAKStudyNAControlNAOverall markStudy0.28Control1. QuestionMarkMedianIQRP-value123456AStudy0.33ControlBStudy10.5Control1CStudy0.06Control1DStudy3420.21Control41EStudy10.04Control0.8FStudy10.46Control1GStudy10.21Control1HStudy10.64ControlIStudy1NAControlNAJStudy1NAControlNAKStudyNAControlNAOverall markStudy0.28Control1. Evaluation of theory vs practice ratio.

Absolute number in each category from too much theory to too much practice ( n=222). Wilcoxon rank–sum test. Question 1 of the multiple choice questionnaire (treatment of ventricular tachycardia: only one answer permitted). The percentage of the participants who chose each treatment is shown. Wilcoxon rank–sum test.