Geke A. Blok

What is a clinical skill? Searching for order in chaos through a modified Delphi process

Background: Everybody seems to know what a clinical skill (CS) is but closer consideration shows that the concept of a CS is not as clear as might be assumed. Some seem to use “CSs” when just referring to physical examination skills, whereas others use the term to also include diagnostic, communication and practical skills. CSs are more than a simple performance, but clinicians are often not consciously aware of the complex interplay of different components of a CS that they are practicing and accordingly do not teach all these aspects to students. Methods: A modified Delphi research was designed to explore concepts around the definition of a CS and its components for learning and teaching. The panel consisted of a group of British doctors, all involved in teaching CSs. Results: One hundred and twenty-two items were identified and ranked through two rounds of a Delphi process, coded into thirty-seven codes and clustered into six principle themes: professional roles; components of CSs; performance; psychomotor aspects; educational environment; and teacher versus student centeredness. Conclusions: A CS may contain one or several different domains such as: physical examination skills, practical procedure, communication skills, and management. Acquiring CSs includes three components: learning how to perform certain movements (procedural knowledge), why one should do so (underlying basic science knowledge), and what the findings might mean (clinical reasoning). If we are to teach CSs for clinical practice, we must take these three different components into account in our instructional design.

Staff training to deal with bereaved relatives in intensive care – conclusion of 11 years and 874 workshops of the European Donor Hospital Education Programme in Germany

The Dutch European Donor Hospital Education Programme (EDHEP) was developed to train doctors and nurses to communicate with bereaved relatives and to make the donation request. Main issues and aims were the psychology of loss and grief, reflection of professional experience with the bereaved, improvement of the ability to pass on the news of the death and improvement of the ways in which the donation request can be made.[1,2] The workshop uses different working methods, mainly mini-lectures, small group work and discussions, videopresentations of case vignettes and role-plays and exercises to improve communication with relatives. For the use in Germany the one-day workshop was adapted to the German language, law and clinical practice. Between 1994 and 2004, 874 one-day workshops of the German version of the EDHEP were conducted in Germany, showing a peak in 1995 (142 workshops). More than 9000 participants from different types of clinics [mainly intensive care unit (ICU) staff] attended the workshops, among them 24% doctors and 76% nurses (Table 1). The programme’s broad acceptance is also reflected by the great number of clinics involved (some sending staff to more than one workshop). The workshops were regularly evaluated by means of questionnaires for participants and moderators. The evaluation data of 75 workshops and experiences of 760 participants (return rate almost 90%) are reported below. The average age of the participants was 34 years (range 21–59 years), 51% were women and 47% men (2% not reported). On average, the participants had 10 years of professional experience. Thirty-four per cent were doctors, 56% nurses and 4% psychologists. The participants had been working for 6.2 years on average in their present working field (e.g. surgery, internal medicine and ICU). The task of requesting organ donation was perceived as difficult by most of the participants, 70% described it as ‘difficult’ or ‘very difficult’. The framework of the workshop, the methods used and issues dealt with in the workshop were clearly appreciated by more than 90% of the participants (group size, organization and benefit of the group training). The EDHEP was altogether well accepted in Germany. More than 90% of the participants reported to be ‘satisfied’ with the workshop. This result is in line with positive programme evaluations in the Netherlands and the UK [1,2]. The main goals of the EDHEP workshop with regard to the participants were achieved. Most participants believe that after the workshop they will be better able to deal with the relatives, to better communicate with them and to make a request regarding organ donation (Table 2). More than three quarters of the participants (78%) indicated that their skills in dealing with bereaved relatives had greatly improved as a direct result of the EDHEP workshop. More specifically, two-thirds of all participants (66%) rated improvement in their ability to decide, when to ask for donation and how to communicate with the relatives. They expected that because of the workshop they will be better able to cope with these situations. Fourty-seven per cent expressed the expectation that it will be much easier to make the request for organ donation and 44% expected that the workshop had improved their ability to help the relatives to cope with their loss. The results underline the fact that the relatives’ immense pain and strain create a distinct need among doctors and caring staff for this programme. They also reflect the programme’s high standard of quality and the qualified work of the trainers (clinical psychologists or medical psychotherapists), who were carefully selected and who had received a 2-day training in preparation for the workshop performance. The framework conditions proved to be equally important (whole-day organisation outside of the clinic, small groups) and were appreciated by the participants. The individual elements of the workshop were well accepted, although the method of working with role-plays in the medical field required some adjustment of the participants. However, role-plays are the core element of the workshop in order to provide intense training. The participants also attested to the favourable effect the workshop had on the co-operation between the doctors and nurses. Interdisciplinary training groups are

“Het moet wel een simulatie blijven.” Een onderzoek naar echte klachten bij simulatiepatiënten

Inleiding: In het Skillslab van de Faculteit der Geneeskunde van de Universiteit Maastricht wordt veel gebruik gemaakt van het leermiddel simulatiepatienten. Dit gebeurt met veel plezier voor de student en de simulatiepatient. In contacten met medewerkers van het Skillslab geven simulatiepatienten echter ook wel aan negatieve ervaringen te hebben met het optreden als simulatiepatient. Ook in de literatuur is beschreven dat simulatiepatienten last kunnen hebben van klachten na het spelen van een patientenrol. We hebben daarom onderzocht in hoeverre ook onze simulatiepatienten door het spelen van een rol last of hinder ondervinden van bepaalde klachten.