Friederike Holderried

Communication training for advanced medical students improves information recall of medical laypersons in simulated informed consent talks – a randomized controlled trial

BackgroundInformed consent talks are mandatory before invasive interventions. However, the patients’ information recall has been shown to be rather poor. We investigated, whether medical laypersons recalled more information items from a simulated informed consent talk after advanced medical students participated in a communication training aiming to reduce a layperson’s cognitive load.MethodsUsing a randomized, controlled, prospective cross-over-design, 30 5th and 6th year medical students were randomized into two groups. One group received communication training, followed by a comparison intervention (early intervention group, EI); the other group first received the comparison intervention and then communication training (late intervention group, LI). Before and after the interventions, the 30 medical students performed simulated informed consent talks with 30 blinded medical laypersons using a standardized set of information. We then recorded the number of information items the medical laypersons recalled.ResultsAfter the communication training both groups of medical laypersons recalled significantly more information items (EI: 41 ± 9% vs. 23 ± 9%, p < .0001, LI 49 ± 10% vs. 35 ± 6%, p < .0001). After the comparison intervention the improvement was modest and significant only in the LI (EI: 42 ± 9% vs. 40 ± 9%, p = .41, LI 35 ± 6% vs. 29 ± 9%, p = .016).ConclusionShort communication training for advanced medical students improves information recall of medical laypersons in simulated informed consent talks.

Does doctors’ workload impact supervision and ward activities of final-year students? A prospective study

BackgroundHospital doctors face constantly increasing workloads. Besides caring for patients, their duties also comprise the education of future colleagues. The aim of this study was to objectively investigate whether the workload arising from increased patient care interferes with student supervision and is associated with more non-medical activities of final-year medical students.MethodsA total of 54 final-year students were asked to keep a diary of their daily activities over a three-week period at the beginning of their internship in Internal Medicine. Students categorized their activities – both medical and non-medical - according to whether they had: (1) only watched, (2) assisted the ward resident, (3) performed the activity themselves under supervision of the ward resident, or (4) performed the activity without supervision. The activities reported on a particular day were matched with a ward specific workload-index derived from the hospital information system, including the number of patients treated on the corresponding ward on that day, a correction factor according to the patient comorbidity complexity level (PCCL), and the number of admissions and discharges. Both students and ward residents were blinded to the study question.ResultsA total of 32 diaries (59 %, 442 recorded working days) were handed back. Overall, the students reported 1.2 ± 1.3 supervised, 1.8 ±1.6 medical and 3.6 ± 1.7 non-medical activities per day. The more supervised activities were reported, the more the number of reported medical activities increased (p < .0001). No relationship between the ward specific workload and number of medical activities could be shown.ConclusionsThere was a significant association between ward doctors’ supervision of students and the number of medical activities performed by medical students. The workload had no significant effect on supervision or the number of medical or non-medical activities of final-year students.

Portfolios Enhance Clinical Activity in Surgical Clerks

OBJECTIVES A change in German licensing legislation imposed a portfolio for surgical clerks. We aimed to analyze whether the implementation of the portfolio changed the amount of clinical exposure and activities during surgical clerkships. DESIGN The study was conducted with a modified pre-post design at the University Hospital of Tuebingen, Germany. Before and after the implementation of the portfolio on April 1, 2013, final-year students (n = 557) who had just finished their surgical clerkship were interviewed with an online questionnaire. A total of 21 basic surgical skills were evaluated. RESULTS Overall, 230 questionnaires were returned and analyzed; 51% were preintervention. Overall clinical activity for the whole study cohort varied for different activities between 98% and 32%. For 16 of 21 parameters, there was more clinical activity in the postintervention (portfolio) group. This difference was statistically significant for the following 7 activities: discharge, analgesia, local infiltration, patient positioning, drain in, blood transfusion, and emergency diagnostics. CONCLUSION The implementation of the portfolio did enhance clinical activity for surgical clerks in the study cohort. Nevertheless, overall exposure is still unsatisfactory low for some activities. Additional changes and studies are necessary to further improve surgical education.

Problem-Based Training Improves Recognition of Patient Hazards by Advanced Medical Students during Chart Review: A Randomized Controlled Crossover Study

Background Patient chart review is the gold standard for detection of potential patient hazards (i.e. medication errors or failure to follow up actionable results) in both routine clinical care and patient safety research. However, advanced medical students’ ability to read patient charts and to identify patient hazards is rather poor. We therefore investigated whether it is possible to teach advanced medical students how to identify patient hazards independent of context (i.e. cancer versus cardiac failure) in patient charts. Methods All fifth-year medical students in one semester (n = 123) were randomized into two groups. One group (IC) received a patient chart review-training first and then a control-intervention and the other group (CI) received the control-intervention first and then the patient chart review-training. Before and after the teaching sessions, students reviewed different scenarios with standardized fictional patient charts containing 12 common patient hazards. Two blinded raters rated the students’ notes for any patient hazard addressed in the notes using a checklist. The students were blinded to the study question and design. There was no external funding and no harm for the participating students. Results A total of 35 data sets had to be excluded because of missing data. Overall, the students identified 17% (IQR 8–29%) of the patient hazards before the training and 56% (IQR 41–66%) of the patient hazards after the training. At the second assessment students identified more patient hazards than at the first. They identified even more in the third. The effect was most pronounced after the patient chart review training (all p<.01). Conclusion Patient chart review exercises and problem-based patient chart review training improve students’ abilities to recognize patient hazards independent of context during patient chart review.

Clerkships do not improve recognition of patient hazards by advanced medical students during chart review

Patient safety has been receiving increasingly more attention in the last two decades. However, research on patient safety issues during medical school training is scarce. Some patterns of patient hazards (especially diagnostic errors, medication errors, nosocomial infections) constitute a large fraction of patient hazards. Chart review by specially trained physicians is the gold standard for identification of some of these common patient hazards. Thus, a routine screening for common patient hazards during ward rounds might improve patient safety. Since chart review is not commonly taught in most medical schools, we investigated whether advanced medical students acquire the skill to identify patient hazards during chart review en passant (in passing) during clerkships. A total of 128 fifth-year medical students were asked to review fictional standardized patient charts with 12 common patient hazards. The students’ notes were rated by two blinded raters using a checklist. We asked the students how many weeks they had spent in clerkships in various specialties, particularly internal medicine, surgery and general medicine. The students reported to have spent 11 4 weeks in clerkships so far. In our study, the students identified only 17%, IQR1⁄4 8–30% of the patient hazards. There was no significant correlation between the number of weeks spent in clerkships and identified patient hazards. Only students who reported to have completed at least one chart review previously on their own (n1⁄4 13, 10.2% of our study sample) identified more patient hazards than students who had never completed a chart review (29%, IQR1⁄4 19–43% versus 17%, IQR1⁄4 8–25%, p1⁄4 0.02). It is unclear, whether these students improved their recognition of patient hazards during the clerkship or whether the students who perform chart review during clerkships constitute a different sample compared to students who do not perform chart review. We therefore conclude that unstructured clerkships do not contribute significantly to identification of patient hazards by advanced medical students during chart review. A specific training may be warranted.

Approaches to family-friendliness at the Medical Faculty of Tübingen (MFT).

The feminization of the medical profession, demographic change with an impending shortage of physicians, Generation Y - these issues are new challenges for medical schools in terms of their social responsibility and the training of the next generation of highly qualified scientists. This study, conducted by the University Hospital of Ulm throughout Baden-Württemberg via an online survey provides a valuable data basis which can be used to optimise support activities. A disproportionately high percentage of students with children in Tübingen must, as an additional challenge, cope with a lower than average monthly income. Students with children need organisational support in this doubly challenging situation. The Deans Office can provide valuable assistance as an advocate (contact with the departments/institutions), provide organisational help (course guidance, individual support) and infrastructure (childcare/changing rooms, etc.). In Tübingen, high intrinsic motivation (willingness to engage in self-managed care networks) is also found amongst students, something that needs to be integrated into the development of the existing support networks.

BusinessIntelligencebasiertes Performance Measurement – Automatisiertes Prozesscontrolling zur Sicherung und Verbesserung von Qualität und Wirtschaftlichkeit von Gesundheitsdienstleistern

Sektorenubergreifend wird der Bedarf wachsen, die organisationsinterne Prozesstransparenz und Innovationskompetenz der Gesundheitsdienstleister kontinuierlich zu verbessern, um Optimierungspotenziale fur die Verbesserung von Qualitat, Sicherheit und Wirtschaftlichkeit unternehmensintern zu generieren. Das Teamlernen basierend auf Performance Measurement via Business Intelligence ist ein innovativer Weg, um dies in Gesundheitsorganisationen zu erreichen, und damit eine wesentliche Grundlage dafur, den zukunftigen Herausforderungen im Gesundheitsmarkt erfolgreich zu begegnen. Die psychologische Sicherheit in den Teams und die standige Weiterentwicklung des automatisierten Performance Measurements fur ein automatisiertes, objektives und gut nachvollziehbares Feedback ermoglichen es, trotz knapper Liquiditat der Gesundheitsdienstleister, diesen Strukturwandel aus der jeweiligen Organisation heraus zu gestalten.

Aus der Praxis für die Praxis: Potenziale und Herausforderungen auf dem Weg zur Digitalisierung interprofessioneller stationärer Gesundheitsdienstleitungen

Seit einigen Jahren ist eine zunehmende Digitalisierung der Dokumentation und Kommunikation von medizinischen Informationen in stationaren Gesundheitseinrichtungen zu beobachten. Vielerorts werden auf spezielle medizinische Fachbereiche oder konkrete Anwendungsbereiche spezialisierte Softwaresysteme implementiert, die aufgrund ihres hohen Spezialisierungsgrades nur eine eingeschrankte interprofessionelle und interdisziplinare Nutzung ermoglichen und daher weiterhin eine papiergebundene Dokumentation und Kommunikation medizinischer Informationen erfordern. Mit dem Ziel die interprofessionelle und interdisziplinare Zusammenarbeit der Gesundheitsdienstleister zu verbessern wird in dem folgenden Beitrag – aus der Praxis fur die Praxis – das methodische Vorgehen, die Herausforderungen sowie die Lessons Learned im Zusammenhang mit der Einfuhrung einer Digitalen Akte am Beispiel eines Universitatsklinikums aufgezeigt.

eHealth in otorhinolaryngology: a disruptive innovation

Thank you very much for your interest and your valuable comments on our article ‘‘The potential of eHealth in otorhinolaryngology-head and neck surgery: patients’ perspectives’’ [1]. The authors strongly believe that further integration of eHealth in the field of otorhinolaryngology (ORL) will follow the typical characteristics of a disruptive innovation. This is the reason why we assume that eHealth has the fundamental potential to improve quality and safety as well as efficacy and efficiency of care and patient engagement. An essential basis for this is that the use of eHealth applications may allow not only the patients, but also the otorhinolaryngologists to get a better understanding of the ORL diseases and therefore can support the diagnostic decision-making and treatment processes. These positive effects of eHealth have already been shown in other medical fields [2, 3]. Because many eHealth applications are developed by young information technology (IT) savvy and healthy people, they often fail to show continuous use and improvement in intersectoral patient care [4]. Therefore, we recommend that eHealth applications in the field of ORL be developed by interdisciplinary and interprofessional teams based on the users’—the patients’ and health-care providers’—needs. Furthermore, experts in data safety, data security, data availability and interface experts for selected and secure transfer of personal medical information between common IT systems, as well as clinical quality and risk managers, health service researchers and health economic experts must be integrated in the development and implementation processes of eHealth applications in ORL. Successful eHealth projects in ORL essentially require clearly defined professional objectives with measurable and predefined outcome parameters regarding patient safety, treatment quality, treatment outcome and health-care costs. In addition to a high usability for ORL patients and physicians to support their engagement, eHealth applications must also meet the highest standards of data security, data safety and data availability for personal medical information and provide standardized interfaces to common IT systems used by otorhinolaryngologists. Though eHealth applications may also contribute to the reduction of health-care costs (e.g., by reduced travel costs or online transfer of discharge summaries), multiple reward and especially adequate reimbursement systems, research funding and a closer focus on eHealth topics by the ORL societies are needed to support the development of the disruptive innovation to benefit patients and health-care providers in the field of ORL.