Maria Lammerding-Koeppel

Impact of Scientific Versus Emotional Wording of Patient Questions on Doctor-Patient Communication in an Internet Forum: A Randomized Controlled Experiment with Medical Students.

Background Medical expert forums on the Internet play an increasing role in patient counseling. Therefore, it is important to understand how doctor-patient communication is influenced in such forums both by features of the patients or advice seekers, as expressed in their forum queries, and by characteristics of the medical experts involved. Objective In this experimental study, we aimed to examine in what way (1) the particular wording of patient queries and (2) medical experts’ therapeutic health concepts (for example, beliefs around adhering to a distinctly scientific understanding of diagnosis and treatment and a clear focus on evidence-based medicine) impact communication behavior of the medical experts in an Internet forum. Methods Advanced medical students (in their ninth semester of medical training) were recruited as participants. Participation in the online forum was part of a communication training embedded in a gynecology course. We first measured their biomedical therapeutic health concept (hereinafter called “biomedical concept”). Then they participated in an online forum where they answered fictitious patient queries about mammography screening that either included scientific or emotional wording in a between-group design. We analyzed participants’ replies with regard to the following dimensions: their use of scientific or emotional wording, the amount of communicated information, and their attempt to build a positive doctor-patient relationship. Results This study was carried out with 117 medical students (73 women, 41 men, 3 did not indicate their sex). We found evidence that both the wording of patient queries and the participants’ biomedical concept influenced participants’ response behavior. They answered emotional patient queries in a more emotional way (mean 0.92, SD 1.02) than scientific patient queries (mean 0.26, SD 0.55; t 74=3.48, P<.001, d=0.81). We also found a significant interaction effect between participants’ use of scientific or emotional wording and type of patient query (F 2,74=10.29, P<.01, partial η2=0.12) indicating that participants used scientific wording independently of the type of patient query, whereas they used emotional wording particularly when replying to emotional patient queries. In addition, the more pronounced the medical experts’ biomedical concept was, the more scientifically (adjusted β=.20; F 1,75=2.95, P=.045) and the less emotionally (adjusted β=–.22; F 1,74=3.66, P=.03) they replied to patient queries. Finally, we found that participants’ biomedical concept predicted their engagement in relationship building (adjusted β=–.26): The more pronounced their biomedical concept was, the less they attempted to build a positive doctor-patient relationship (F 1,74=5.39, P=.02). Conclusions Communication training for medical experts could aim to address this issue of recognizing patients’ communication styles and needs in certain situations in order to teach medical experts how to take those aspects adequately into account. In addition, communication training should also make medical experts aware of their individual therapeutic health concepts and the consequential implications in communication situations.

Twelve tips for successfully implementing logbooks in clinical training

Abstract Background: Logbooks are widely used to set learning outcomes and to structure and standardize teaching in clinical settings. Experience shows that logbooks are not always optimally employed in clinical training. In this article, we have summarized our own experiences as well as results of studies into twelve tips on how to successfully implement logbooks into clinical settings. Methods: We conducted both a workshop concerning the importance of logbook training to exchange experiences in teaching practice, organization, didactic knowledge and a literature research to compare our own experiences and add additional aspects. Results: Tips include the process of developing the logbook itself, the change-management process, conditions of training and the integration of logbooks into the curriculum. Conclusions: Logbooks can be a valuable tool for training in clinical settings, especially when multiple sites are involved, when you take our tips into consideration.

Development of a seminar on medical professionalism accompanying the dissection course

INTRODUCTION Medical professionalism is an increasingly important issue in medical education. The dissection course represents a profound experience for undergraduate medical students, which may be suitable to address competencies such as self-reflection and professional behavior. MATERIAL AND METHODS Based on a needs assessment, a seminar on medical professionalism was developed to parallel the dissection course. The conceptual framework for the teaching intervention is experiential learning. Specific learning goals and an interview guideline were formulated. After a pilot run, peer-teaching was introduced. RESULTS Over three terms (winter 2012/13, 2013/14, 2014/15), an average of 129 students voluntarily participated in the seminar, corresponding to 40% of the student cohort. The evaluation (n=38) shows a majority of students agreeing that the seminar offers support with this extraordinary situation in general and also that the seminar helps them to become first impressions on how to cope with death and dying in their later professional life as a doctor, and, that it also provides them the means to reflect upon their own coping mechanisms. CONCLUSION Although not yet implemented as an obligatory course, the seminar is appreciated and positively evaluated. Medical professionalism is an implicit aspect of the dissection course. To emphasize its importance, a teaching intervention to explicitly discuss this topic is advisable.

Medical teachers' perception of professional roles in the framework of the German National Competence-Based Learning Objectives for Undergraduate Medical Education (NKLM)-A multicenter study.

Abstract Background: Based on CanMEDS and others, the German National Competence-Based Learning Objectives for Undergraduate Medical Education (NKLM) were recently consented. International studies recommend integrating national and cultural context when transferring a professional roles framework in different countries. Teachers’ misconceptions may establish barriers in role understanding and implementation. Objectives: The aim is to analyze medical teachers’ rating and perception of NKLM roles in order to reveal differences to official definitions. Methods: A two-step sequential mixed methods design was used including a survey and focus groups with N = 80 medical teachers from four German universities. Results: Most of the teachers highly valued the importance of the role “Medical Expert” and understood comprehensively. The Communicator and the Collaborator were rated fairly and perceived to a large extent. Other intrinsic roles like Health Advocate and Scholar showed more deficits in perception and less importance by the participants. This was seen generally problematic and should be considered carefully. Manager and professional showed one-sided weaknesses either in importance or perception. Conclusion: Medical teachers considered NKLM roles relevant for medical practice, although their role perception differed considerably. The value and risk matrix visualizes the specific role profile and offers strategic implications for NKLM communication and handling, thus supporting change management.

Using simulated forums for training of online patient counselling.

What problems were addressed? A central challenge of medical education, across all disciplines, is keeping up with rapidly evolving – and expanding – foundational knowledge. It may be particularly difficult for programmes and departments with relatively small numbers of core teaching faculty staff to design andmaintain their own comprehensive curricula. One approach to assist programmes with this challenge has been to create and disseminate shared curriculum resources. This approach, however, still requires significant faculty effort that may exceed what any individual or small group may be able to provide. What was tried? The National Neuroscience Curriculum Initiative (NNCI; www.nncionline.org) represents one approach for sharing resources. The NNCI is designed around a series of ‘modules’ that represent specific teaching methods built on principles of adult learning. Within each module are individual sessions that focus on neuroscience content. Initial feedback on the NNCI has been extremely positive with regard to the teaching approaches: for example, in the 1.5 years since its inception, at least 40 residency programmes have implemented NNCI materials. The primary request from end users has been for the development of more specific content. To facilitate expansion of content, the NNCI pioneered ‘crowdsourcing’ events at two separate conferences with a combined attendance of over 200. Each was a specialised event for educators who were interested in improving the teaching of neuroscience at their host programmes. At each event, an expert faculty member demonstrated a sample class from the Neuroscience in the Media (NITM) module. In a second session, participants were divided into small groups and asked to write their own sample sessions with new content following the NITM format. Moderators were available to assist anyone with questions. Responses were submitted online and recorded directly into a database. What lessons were learned? In total, these events generated 100 new submissions across a range of neuroscience topics (and according to participants’ areas of interest). By leveraging the strengths of our audience, we were able to exponentially increase productivity. Feedback from the experience was generally positive: 75% of participants rated the session as effective. Many individuals reported initially feeling scared or intimidated by the prospect of teaching this module and then empowered by having written their own material. For example, one participant wrote: ‘This was my favourite session of the day. It was so great to know that I could actually do what you are teaching.’ Another described the session as a ‘revolutionary experience’. The biggest limitation has been the need to edit the large amount of content generated. The majority of submissions were in relatively rough form, necessitating both copyediting and review for scientific accuracy. As one response to this, we are posting some of the more promising submissions as ‘rough cuts’ with the caveat to readers that they have not undergone expert review. To the best of our knowledge, this is the first time that crowdsourcing has been used in graduate medical education. We believe this is a creative and effective approach to collaboratively develop shared curriculum resources.

Benchmarking for research-related competencies – a curricular mapping approach at medical faculties in Germany

Abstract Objectives: Internationally, scientific and research-related competencies need to be sufficiently targeted as core outcomes in many undergraduate medical curricula. Since 2015, standards have been recommended for Germany in the National Competency-based Learning Objective Catalogue in Medicine (NKLM). The aim of this study is to develop a multi-center mapping approach for curricular benchmarking against national standards and against other medical faculties. Method: A total of 277 faculty members from four German medical faculties have mapped the local curriculum against the scientific and research-related NKLM objectives, using consented procedures, metrics, and tools. The amount of mapping citations of each objective is used as indicator for its weighting in the local curriculum. Achieved competency levels after five-year education are compared. Results: All four programs fulfill the NKLM standards, with each emphasizing different sub-competencies explicitly in writing (Scholar: 17–41% of all courses; Medical Scientific Skills: 14–37% of all courses). Faculties show major or full agreement in objective weighting: Scholar 44%, scientific skills 79%. The given NKLM competency level is met or even outperformed in 78–100% of the courses. Conclusions: The multi-center mapping approach provides an informative dataset allowing curricular diagnosis by external benchmarking and guidance for optimization of local curricula.

German MedicalTeachingNetwork (MDN) implementing national standards for teacher training.

Abstract Background: An increasing demand for proof of professionalism in higher education strives for quality assurance (QA) and improvement in medical education. A wide range of teacher trainings is available to medical staff in Germany. Cross-institutional approval of individual certificates is usually a difficult and time consuming task for institutions. In case of non-acceptance it may hinder medical teachers in their professional mobility. Aim: The faculties of medicine aimed to develop a comprehensive national framework, to promote standards for formal faculty development programmes across institutions and to foster professionalization of medical teaching. Methods and results: Addressing the above challenges in a joint approach, the faculties set up the national MedicalTeacherNetwork (MDN). Great importance is attributed to work out nationally concerted standards for faculty development and an agreed-upon quality control process across Germany. Medical teachers benefit from these advantages due to portability of faculty development credentials from one faculty of medicine to another within the MDN system. Conclusion: The report outlines the process of setting up the MDN and the national faculty development programme in Germany. Success factors, strengths and limitations are discussed from an institutional, individual and general perspective. Faculties engaged in similar developments might be encouraged to transfer the MDN concept to their countries.