The
course:
At the German Heart Institute Berlin, perfusion students are trained in a
non-academic, practice-oriented course for two years. The program was initiated
in 1988 as one of the first perfusion schools in Europe. The course was
state-approved in 1991. Entry requirements are a minimum of 10 school years with
intermediate leaving certificate, completed vocational training as nurse or
medical technician (three years) and two years work experience in that
profession. Theoretical training consists of 1200 hours in 23 subjects, mainly
clinical and technical. A total of 1600 hours of practical work experience are
performed in 8 areas of clinical work, including perfusion, cardiology,
anesthesiology, intensive care, hemodialysis, cardiac pacemaker, medical
technology and laboratory technology.
Levels
of competencies:
A theoretical model describing different levels of competencies in nursing
science (P. Benner, 1984) may be adapted to match the development of students in
the perfusion course. 5 different levels are described. The Beginner benefits
from a combination of theoretical knowledge and practical experience.
Theoretical subjects are divided into context-independent factors that can be
learnt without previous knowledge in that area. Rules of action are being taught
by instructors and applied to clinical situations. The Advanced Beginner
experiences an improvement of performance with ongoing exposure to practical
situations, tasks seem to become more difficult as higher complexity and more
rules have to be integrated. Competent Professionals possess a structured view
of actions to compensate for more complex situations, where important features
are selected. Also, responsibility for actions and emotional involvement are key
issues. As the next level of Experienced Professional is reached, an intuitive
approach to situations instead of mere application of rules leads to a more
flexible pattern. Many different possible actions have to be considered, active
decision making takes place. Finally, the Expert experiences continuous
intuitive action with the availability of different perspectives. Meditative
reflection leeds to further expertise. However, new situations or new fields of
activities require advice from other experts.
For
Perfusion Education, early exposition to clinical practice seems beneficial, a
combination of structured perfusion tuition and practical work experience may be
required. Enough room for independent actions with the availability of expert
advice as well as continuous student assessment and documentation of developed
skills may enhance maturation of student capabilities.
EBCP
Logbook:
A tool to document student progress is the EBCP Logbook for practical work
experience. Work was begun by D. Wheeldon and R. Hobbs and continued by K.
Graves. A scoring system with 5 grades was developed to characterize student
abilities. 4 different pages are part of the assessment process: Page 1 lists
the daily student activities and gives an overview of obtained scores for
practical work. The Procedure Scoring Sheet (page 2) breaks down the mean score
into 20 different categories, which are evaluated individually if applicable. On the third page, Laboratory Simulation, such as wet lab, setting up in
vitro etc. are documented. To complete the Logbook, the Record of Continuing
Perfusion Education and Seminars from Collaborating Institutions lists
activities outside of the training program.
Conclusion:
The EBCP Logbook is an excellent tool for evaluation and documentation of
student performance. When student difficulties in adjusting to the clinical
environment and tasks are evident, appropriate actions may be taken at an early
point. The Logbook makes student performance comparable between institutions and
is also of importance when training is accomplished in more than one hospital.
For correct documentation and
assessment, a perfusion instructor/mentor training would best be implemented, as
evaluation of practical capabilities with a scoring system is a complex task
which needs reflection and some theoretical background.
