Abstract

The 18 October, 2017 marked the 10-year anniversary of the day when, upon entering the domain name akutne.cz, educational content was displayed in the worldwide Internet network for the first time. It is rather unique that, throughout the ten years, this has been a strictly academic activity aimed to unify and modernize the education of acute medicine.

Recently, education in medical fields has undergone dynamic changes and a shift to modern teaching methods. The educational and publishing portal of AKUTNĚ.CZ (the AKUTNĚ.CZ Portal) reflects these changes and brings to light the modern forms of education for both under- and postgraduate candidates in Anaesthesiology and Intensive Medicine (AIM). It is a great appreciation and, at the same time, commitment to the future that a large part of more than 150 students of the Faculty of Medicine of Masaryk University who participated in its development have chosen AIM for their further professional grow.

This article aims to introduce the ten-year history of the AKUTNĚ.CZ Portal.

Keywords

AKUTNĚ.CZ; medical education; anaesthesiology; intensive care; emergency medicine

Portal support

The creation and development of the AKUTNĚ.CZ portal were strongly influenced by four grants from the Higher Education Development Fund (FRVŠ). The creation of the portal itself was initiated by the first grant in 2007 (FRVŠ 421/2007 F3d Training Portal of Acute Medicine). It was a great appreciation that, at the very beginning of its activity, the portal was assigned the International Standard Serial Number ISSN 1803-179X. Further direction of the portal towards its flagship – the implementation of Virtual Patient in the form of interactive algorithms in teaching – was made possible in 2009 (FRVŠ 1969/2009 F3d Multimedia Decision-Making Algorithms in the Teaching of Acute Medicine). Today, these Virtual Patients, the number of which has so far reached 80, represent an integral part of both undergraduate and postgraduate education in AIM. In the same year, another project enhancing the field education was addressed (FRVŠ 1893/2009 Aa Videoconferencing System for Operations and Anaesthesiology). By 2011, the latest grant from perishing FRVŠ (FRVŠ 2216/2011 Fd3 Unified Framework for Multimedia Interactive Algorithms in Professional Guaranteed Acute Medicine) was obtained which brought the portal into another dimension marked by clearly defined and professionally guaranteed professional content. The accent on the use of interactive algorithms in bilingual problem-oriented education focused on the decision-making process was further facilitated by the FRMU (the Development Fund of Masaryk University) project No. 1541/2015. In recent years, this project has been supporting the activities of the Nadační fond AKUTNĚ.CZ (the endowment fund) established at Masaryk University. Moreover, the AKUTNĚ.CZ portal has been granted a significant professional support by an international academic network of shared educational content, MEFANET (www.mefanet.cz). At the same time, the content of the portal is archived by the National Library of the Czech Republic within the WebArchiv project.

Brief structure of the portal

The structure of the portal has been stable over the years, allowing readers to navigate its content easily. It consists of the following sections: News, Education, Publications, and Reports. The history and development of portal structure are detailed in Table1.

Table 1. The firsts of the AKUTNĚ.CZ portal

News is the oldest and at the same time one of the most visited sections of the portal. Gradually, it had to be thematically divided for its scale and so nowadays, we have dominant news about expert events, feuilletons, but also news monitoring professional literature in the given field or reviews of current professional books. Reports section is filled with the entries by the reporters of AKUTNĚ.CZ, physicians and students, from national and international expert events. More than 100 reports have been created since the portal was founded and the team of reporters have visited over 13 countries. Frequently, the team members participated actively in the congresses as the authors of posters and/or lecturers making the portal unquestionably unique.

Education

Virtual patient on AKUTNĚ.CZ

The true showpiece of the portal are the modern bilingual teaching aids in the form of virtual patients, the co-called AKUTNĚ.CZ Interactive Algorithms, which currently number well over 80. Undoubtedly, this is one of the largest sets of Virtual Patients worldwide. Unlike most of other teaching aids, AKUTNĚ.CZ algorithms undergo a multiple-stage peer review with an expert, usually outside the FM MU, as the last referee. Therefore, it is no coincidence that the algorithms have been awarded at university (the best electronic teaching aid), national (ČSARIM award), and international level (highly cited publication in the Journal of Medical Internet Research which, with IF 5.1, is World 1 in this area). The best published algorithms for each year can be found in Table 2. All algorithms undergo regular reviews to stay up-to-date and to follow the latest recommendations. The uniqueness of the algorithms is underlined by original illustrations and videos added to each node. Subsequently, the acquired knowledge can be verified by test questions complementing each algorithm. It is worth mentioning that, with 18%, the algorithms rank the second in the number of visits, just behind the portal front page; see Figure 1.

Table 2. Winners of the best algorithm competition published on the AKUTNĚ.CZ portal in the given year

Recordings from video conferencing and other teaching aids of AKUTNĚ.CZ

AKUTNĚ.CZ team monitors the latest best practices of professional societies. They succeeded in publishing the Manuál kritických stavů (the “Manual of Critical Situations”) written by Dr Stern, a senior consultant, as well as several domestic and foreign aids, mainly for clinical practice. Highly used and visited are the records of lectures from expert events. Eager readers may already watch their parts online in the course of the lectures. The records often become a part of the post-conference proceedings of the event. Being traditional partners, there are also the events organized by the AKUTNĚ.CZ portal (AKUTNĚ.CZ Conference, Urgent Medicine Course), Ostrava’s Colours of Sepsis and the International Congress of Traumatology and Forensic Medicine in Mikulov.

AKUTNĚ.CZ Conference, Urgent Medicine Course and Contact Teaching

The activities of the portal are not only the virtual ones. Each year, the implementation team prepares the AKUTNĚ.CZ Conference which, according to the number of participants, ranks among the largest one-day events in AIM. Traditionally, the AKUTNĚ.CZ Conference takes place in November when the Bohunice campus fills with almost 1,000 participants from among the experts and students alike. Every year, they may choose from a number of lectures held in several parallel sections (non-medical, Young Anaesthesiologists, themed blocks held in a parallel section). We also provide the greatest opportunity for practical training in individual workshops found elsewhere in the Czech Republic. The workshops have traditionally included, for example, an internationally certified Essential Pain Management course, a legendary workshop ...jde o čas… (“... time matters...”), PBL/TBL lessons with AKUTNĚ.CZ Virtual Patient, the basics of ultrasonic technique and viscoelastic coagulation methods, and others. The AKUTNĚ.CZ Conference has also pioneered the implementation of workshops using an advanced patient simulator. The progress of the Conference can be seen in Table 3. What is more, all the time since its inception, the conference is exempt from the registration fee.

Table 3. The development of the AKUTNĚ.CZ Conference

Additionally, the AKUTNĚ.CZ team organizes a weekly Emergency Medicine course for FM MU students, which is intended for the students of the 4^th-6^th years of General Medicine and, in the last year, also of Dentistry. Supervised by experienced specialists, students practice the basic and advanced resuscitation, airways management and access to the vascular system, on-site traffic accident and much more. Students’ interest in this event is enormous, which is attested to by the fact that every year, the capacity of the course fills up within 2 minutes after the beginning of the registration. Furthermore, AKUTNĚ.CZ organizes some other, also very popular, courses – Workshop Airway Academy within the framework of Colours of Sepsis and/or First Aid Station at Masaryk Junior University.

Impact on the experts

Domestic

The AKUTNĚ.CZ portal has become visible not only on the academic and clinical grounds, where it enjoys a significant support from, among others, both FM MU and the University Hospital Brno, but it is also supported by professional companies, namely the Czech Society of Anaesthesiology, Resuscitation and Intensive Medicine, the Czech Society of Intensive Medicine, the Czech-Slovak Forum for Sepsis and, last but not least, the Czech Medical Chamber. Throughout its many years of existence, the portal and its activities have been awarded several times at university, national, and international level. This happened at the ČSARIM National Congress already in 2009. In 2012, the Virtual Patients were awarded the best published works and aids of the FM MU. A great appreciation is the use of AKUTNĚ.CZ algorithms in undergraduate education at the Third Faculty of Medicine of the Charles University (FM CU) whose educational materials appear reciprocally on AKUTNĚ.CZ website.

International

During the first year of its activity, the AKUTNĚ.CZ portal was already presented at the University of Basel. International activities of the portal are most often reflected in the form of presentations at foreign conferences. These are lectures and posters about portal's activities as well as presentations of the scientific work of the AKUTNĚ.CZ team. The first presentations of the AKUTNĚ.CZ portal abroad were given, quite symbolically, at the largest AMEE conference on medical education, by associate professors, doc. Štourač and doc. Schwarz, in 2012 in Lyon, France. Following were more detailed insights into the portal and its activities at IAMSE 2013 (St Andrews, UK), AMEE 2014 (Milan, Italy), and Anesthesiology 2015 (San Diego, US). Similarly successful was the presentation of Dr Klincová at the Euroanaesthesia 2016 Congress in London (UK).

Another important way of realizing international cooperation is the involvement of the AKUTNĚ.CZ portal in the MEFANET international network, a project supporting the cooperation of Czech and Slovak medical faculties in the development of modern and e-learning methods of teaching.

The world-wide visibility of the AKUTNĚ.CZ portal is best documented by the world map below with country-by-country views (Figure 2).

Recruiting students for AIM

It is a great appreciation for the AKUTNĚ.CZ portal and its authors from among teachers that over one third of more than 150 FM MU graduates who cooperated with the AKUTNĚ.CZ portal remained faithful to AIM. Professional specialization of our graduates is dealt with in detail by Dr Klincová in her publications. A lot of the graduates remain external collaborators of the portal long after completing their studies. Some have even become members of the portal Management.

Interest of the experts

We have documented the interest in the portal quite convincingly in the previous paragraphs. But let the numbers speak. Throughout the entire period of the existence of the portal, its website has reached the number of 14,297,509 visitors. The accompanying chart even shows how the portal traffic increases each year (Figure 3).

Looking at statistics in more detail, we find that the average traffic per month exceeds 2,300 users. Their priority is clear – interactive algorithms, our flagship, sweep the board. The next chart shows that the traffic increases significantly in October and November (Figure 4), which is undoubtedly due to the interest in the AKUTNĚ.CZ Conference and the activities around the Congress. Our Facebook page already boasts more than 3,200 fans whose number continues to grow. Not only do we appear on Facebook and our website, we also have accounts on Instagram, Twitter, and Google+.

Publishing activities of AKUTNĚ.CZ members

It has already been mentioned above that AKUTNĚ.CZ motivates students towards AIM. Many of them engage themselves in teaching and, patiently enough, build their academic and scientific careers. One of such graduates/doctors is Dr Hana Harazim who worked on the use of remifentanil in obstetric analgesia during her student years. Not only did she rank 2^nd at the Students' Scientific Conference of the FM MU, she also won 1^st place in the category of free communication at the national ČSARIM Congress 2011. There is also Martina Kosinová, MD whose works were published in prestigious European Journal of Anaesthesiology and the International Journal of Obstetric Anesthesia.

Lots of work have been based on the activities of the AKUTNĚ.CZ portal. Internationally, the most visible one was published in the Journal of Medical Internet Research which, according to the Web of Science, has repeatedly been No. 1 in the Medical Informatics category. The article has been widely quoted by prestigious publications. You can find a more detailed summary of the publishing activities related to the AKUTNĚ.CZ portal in Table 4. Our important publishing partner is the MEFANET Journal (mj.mefanet.cz) which is indexed, for example, in the ERIH+ international database.

Table 4. The publications on the AKUTNĚ.CZ portal

Since 2016, the motivation of young authors in their scientific efforts has been encouraged by the Jiří Mach Prize which is awarded by the Nadační fond AKUTNĚ.CZ for the best original work in acute medicine published in the previous year by an author younger than 35 years of age. The first laureates were Kateřina Růžková, MD and Jozef Klučka, MD.

Implementation team

What remains to be answered is who stands behind the portal. No activities of the portal would be possible without the volunteer work of so many doctors, students, and even lay enthusiasts, often recruiting from the families of AKUTNĚ.CZ supporters. The top management currently consists of an eight-member team providing the portal’s ongoing operation and taking care of its economy. The IT support is provided by the team of the Institute of Biostatistics and Analyses of the Medical Faculty of MU. Support to videoconferencing is provided by the team of the Institute of Computer Science of MU. Linguistic (albeit not content) correctness is supervised by a linguist/proofreader. And a large group of remarkably motivated people is made up by our reviewers.

Conclusion

Over the past 10 years, the AKUTNĚ.CZ portal has become an important meeting place for those interested in acute medicine, both nationally and internationally. And undoubtedly, many students have successfully been motivated to choose anaesthesia and intensive medicine as their field of study.

… let’s meet on AKUTNĚ.CZ