Abstract:

Treatment of cardiac arrhythmias is established using implantable electronic devices. Their handling and individual parameter optimisation needs expertise and training. In this field, over 7 years, we studied the effectiveness of hands-on training for students of a specialised medical engineering study path. Gender-specific differences were found.

Introduction:
In pacemaker and defibrillator therapy, preoperatively and during follow-ups, extensive measurements and programming of numerous device parameters must be performed individually. This requires special expertise of both, the attending physicians and the supporting technical staff. There is only one University in Europe offering a medical engineering bachelor and master study path with a specialty in cardiac electrophysiology and pacing. It consists of 490 hours lectures and seminars completed by one semester of weekly 1.5 hours elective in-vitro hands-on training to provide students with skills essential in professional settings such as heart centers and medical device suppliers.
We aimed to study the effectiveness of the practical in-vitro hands-on training and to clarify if gender-specific differences can be observed.

Methodology:
Hands-on training in pacemaker measurements and programming was performed on heart rhythm simulators. Each of six learning stations consists of a programmer and pacemakers explanted due to end of life status and refurbished for in-vitro experiments. The pacemaker is mounted into special connection box and linked to a master-slave teaching system with the InterSim II USB heart rhythm simulator. The elective addresses device implantation, follow-up and troubleshooting. To assess the effectiveness of the hands-on training we compared grades in the mandatory final written exam on “electrocardiography and pacing” between students participating in the elective with those who did not. Grades range between 1 (= excellent) to 5 (= poor). To check for selection bias, we compared the average grades of all previous exams of both groups. We used Exam data of the years 2012 to 2018.

Results:
A total of 128 students participated in hands-on training (=intervention group, ig), and 93 did not (=control group, cg). The final examination results in the subjects “electrocardiography and pacing” of these 221 students were compared. Both groups were similar in age (ig: 23.7±4.6 vs. cg: 23.4±2.6 years; p = 0.433) and sex (ig: 87m/41f; cg: 58m/35f). Regarding grades prior to elective, intervention group performed on average 0.2 grades better than control group (2.2 vs. 2.4, p<0,027). Students who participated in the elective hands-on trainings achieved highly significant better grades in the final written exam, than students not participating (1.9±1.0 vs 2.4±1.1; p < 0.001). Comparing both groups by gender, there are considerable differences: While mean results of female students did not significantly differ in both groups (1.9 ± 1.1 vs. 2.0 ± 1.0; p = 0.63), male students with elective hands-on training resulted highly significant better exam results by 0.8 points (1.9 ± 0.9 vs. 2.7 ± 1.12; p = 0.0004).

Conclusion:
Despite of slight selection bias, hands-on-training increases students’ performance level in their final written examination and was significantly more effective in male students.

Keywords:

Pacemaker, Defibrillator, In-vitro Simulation, Gender-specific Differences, Cardiac Arrhythmias.