Future doctors practice for the real thing

17 December 2012

At the Skills Lab of the Mainz University Medical Center students learn from fellow students what is often covered all too briefly in standard study programs. Whether it be intubation or catheter placement, ultrasound examinations or medical history-related aspects, the courses on offer are diverse and help fill gaps in the curriculum.

There is a gaping wound that will require stitches. Five students try to stitch it up. Their actions appear somewhat insecure as they hold the forceps with the curved needle in their left hands and guide the thread using the tweezers with their right hands. Direct contact with the wound is not allowed.

"This is important to reduce the risk of infection," explains Sebastian Altmann as he stands behind his fellow students giving them pointers. "It is important that the knot is not directly on the suture," he recommends. "The best thing is to draw it away from the edges of the wound."

Pigs' trotters in the operating room

Fortunately, it is not patients who are under the knife here. "Let's play together" is the maxim of the Skills Lab at the Mainz University Medical Center and all this involves is practice – on dummies or butcher's waste. "Do you like pigs' trotters but have none yourself?" is a slogan on one of the group's witty advertising posters. "Join us to practice on pigs' trotters daily from 10 am to 6 pm, in addition to attending the official suturing course."

"In the Skills Lab, we are our own bosses," tells Till Kämmerer. He is one of the twelve students who keep the Skills Lab operating. "No one is in charge of us. We work as a kind of collective." His voice resonates with a little pride.

In 2003, the Dean's Office of the Faculty of Medicine launched a competition to improve teaching. In response, students submitted their concept for a skills lab. They felt that they had insufficient opportunities to train in the practical skills they would necessarily need later in their profession. They wanted to change that – and won with their idea. Since then, the Skills Lab has been operating with considerable success. The Faculty of Medicine assumes the annual operating costs of EUR 30,000.

Taking blood samples, inserting catheters, intubation

"When you are an intern, i.e., a physician in training, you will be asked if you already know how to suture," said Kämmerer, outlining the common practice. "If you say no, they simply won't let you have a go." So students take the opportunity to practice in the Skills Lab. In all, 23 suturing courses are being offered this semester. And there is much more: students can also practice taking blood samples, inserting catheters, intubation, etc. Currently, 27 different courses are available. In all, there are some 200 related sessions.

It is very busy in the Skills Lab's small office. Each of the twelve students is on duty here for three hours per week. Add to that eleven assistants, including Sebastian Altmann, who is currently explaining how to suture. And volunteers like Peter Lamaarck. He thrusts a toy gun into his holster.

"I play a stressed-out cop who complains he has become impotent," the former paramedic explains. In the medical history course, students role-play an interview with the staged policeman and thus experience an important stage on the route to making an accurate diagnosis. Lamaarck does not make it easy for them because students also need to gain sufficient experience of working in situations like this.

Four rubber arms waiting for the needle

Till Kämmerer gives us a tour of the rooms of the Skills Lab. Four rubber arms stand ready and waiting to be used in blood sampling practice. The intubation busts are a little further on. Kämmerer grabs a laryngoscope and demonstrates how a tube is inserted into the trachea. "You shouldn’t use any downward pressure or you risk breaking the patient's teeth. Would you like to have a try?"

In addition to attending the courses, students can also practice here on their own. The Self-Learning Center in the Skills Lab is open daily from 10 am to 6 pm. "People simply hand over their ID card and then they can take advantage of everything we have here." This form of safeguard is necessary. After all, there are not just rubber arms on offer, but also very expensive devices. There is even an ultrasound machine that students can use for practice.

Meanwhile, the concept of the Skills Lab has successfully spread across the whole of Germany. But it was Mainz in 2003 that was the true pioneer in this field. Kämmerer is already a fourth generation member of the Mainz Skills Lab's team.

Peer teaching is catching on

The concept is being continually refined. In the past, courses were often given by qualified physicians. The trend is increasingly towards peer teaching, in which students explain to other students what to do. "Thus, the disparity between those teaching and those learning is much smaller than it would be between doctor and student," says Kämmerer.

A unique feature of the Mainz Skills Lab remains the way that it is organized by students. "Organizational matters can be a bit of bore sometimes," Kämmerer admits. However, aspects like this will be something that they will later have to deal with once qualified, so Kämmerer and his colleagues are also gaining experience that will help them in their future careers.

Back to the suturing course, where the five students are still practicing how to best use needle and thread and forceps and tweezers. "Let’s now try to do a Donati suture," says Altmann. His pupils knead their shoulders. This is a physically demanding task.

The surprising popularity of pigs' trotters

"But it's fun," says Katharina Lederer. She has been studying medicine for five semesters and has managed to land one of the coveted places on the suturing course. During course registration, all of the available places were taken up within a few minutes. "You need luck to get on this course."

Lederer is pleased that she has got the opportunity to practice with the needle. "I think that it will give me a head start when it comes to my medical internship." The course lasts one and a half hours, during which the participants learn about four different knots. But Donati's suture is a real challenge. "Always stay in the red skin tissue," advises Altmann. Five pairs of hands work away carefully, gradually closing the wounds. There are no openings and no knots on the sutures. Looks like these pigs' trotters are going to make it after all!