• M Lipp.
• Klinik für Anüsthesiologie der Johannes Gutenberg-Universität Mainz.
• Anaesthesist. 1996 Apr 1; 45 (4): 363-71.

AbstractMedical performance is subject to quality control. Continuous advanced training (CAT) and continuous medical education (CME) are essential, and quality must be checked and assured: structure (contents, organizational form, framework, term, demands on teachers), process (term of the CAT, interaction between teachers and participants) and results (satisfaction and acceptance, increased knowledge, influence on medical treatment, improvement of the success rate of medical treatment. In emergency medicine one must differentiate between the necessity for CAT (e.g., certified proof required for working as an emergency physician) and a desire for CME (the individual task of the physician). The diversity of forms of CAT/CME reflects the different individual requirements. Using the new German guidelines to obtain qualification as an emergency physician, "Fachkundenachweises Rettungsdienst" offers measures for quality assessment and assurance can be obtained. STRUCTURE QUALITY: The recommendations for obtaining the "Fachkundenachweis Rettungsdienst" which have been valid until now date from the year 1983 and were set fourth explained very differently in the individual countries medical boards. This led to problems in the comparability of the essential CAT. The quality of the structure has now been improved by establishing new minimum requirements for clinical activity, specification of particular knowledge, number of supervised calls for the emergency car as well as participation in interdisciplinary CAT courses, dealing with general and special aspects of emergency medicine. The aim of these measures is not the (senseless) regimentation of CAT training measures, but the qualified transfer of specific medical knowledge and treatment guidelines. PROCESS QUALITY: On qualifying, hardly any physician has any didactic and/or rhetorical education; the physician must make a personal effort to obtain a qualification of this kind. Conventional and commonly practised forms of learning must therefore be set aside in favour of modern teaching methods (e.g. problem-orientated learning). This will lead to a better acceptance of CAT/CME measures. It is essential for the process quality that the teachers' education meets the following requirements: relevant knowledge of preclinical emergency medicine, rhetorical and didactic abilities, employment of relevant teaching techniques, flexibility in presentation, extensive experience in emergency medicine as well as enthusiasm for high-quality education. RESULT QUALITY: Questionnaires can be used to evaluate the satisfaction and acceptance of the participants, as well as their rating of individual speakers. The results are decisive for planning future CAT/CME measures. The transfer of knowledge can be estimated at the end of advanced training by questionnaire. However, this makes allowance for previous knowledge/skills and how much is forgotten. The influence of advanced training on further medical treatment can be seen in the quality of a given CAT/CME measure, but not in the success rate of medical treatment. The result desired can only be achieved by linking all system components of medical quality control and assurance. Advanced training provides a fundamental contribution to this end.

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