Rainer Obliers

Improving informed consent of surgical patients using a multimedia-based program?: results of a prospective randomized multicenter study of patients before cholecystectomy.

Objective:The term “informed consent” explains the process by which a patient, before treatment, is provided comprehensive and impartial information regarding a planned operative procedure so that he/she understands the implications of the procedure before consenting. The goal of the current study was to investigate whether standard methods of consenting can be improved using a multimedia-based information program (MM-IP). Patients and Methods:In a prospective multicenter study, 80 patients undergoing laparoscopic cholecystectomy went through the standard informed consent process. One group of patients was also given access to a MM-IP. Questionnaires were completed before surgery. These evaluated how patients perceived their own understanding of important aspects of their illness (ie, disease, therapeutic alternatives, operation, risks) and satisfaction with the consenting process. Patients’ anxiety levels were also assessed. These questionnaires were used to evaluate the effectiveness of the MM-IP for improving the consent process. Results:Seventy-six patients (47 women, 29 men, median age 54 years) were included. There was no significant age or gender variation between the groups (standard n = 41 and MM-IP n = 35). Eighty-two percent of all respondents were satisfied with the standard informed consent process. However, perceived understanding of the material was significantly improved in the MM-IP group (P < 0.001). Patients with less formal education profited particularly from the MM-IP. Preoperative anxiety did not vary between the groups. Conclusion:Use of the multimedia-based program was positively evaluated by patients, and significantly improved patients’ perceived understanding of their disease and its treatment. It is, therefore, valuable in the informed consent process.

A Multimedia Tool for the Informed Consent of Patients prior to Gastric Banding

Objective: Severe obesity is a clear indication for appropriate, effective weight loss therapy. One option is operative intervention, e.g., gastric banding. Risks of the operation and therapeutic alternatives need to be comprehensibly presented to the patient. The literature has shown that better informed consent is obtained using information presented in a multimedia/video‐based format. The current study developed and evaluated a multimedia program aimed at obtaining informed consent from obese patients before gastric banding.

The effect of undergraduate education in communication skills: a randomised controlled clinical trial

PURPOSE To determine whether students improve their communication skills as a result of supervised patient care and whether a newly implemented communication course could further improve these skills. METHOD We conducted a randomised, controlled trial including all participants of the first clinical treatment course (n = 26) between October 2006 and February 2007. Randomisation was balanced by gender and basic communication skills. The test group practised dentist-patient communication skills in small groups with role-plays and videotaped real patient interviews, whereas the control group learned in problem-based workshops both on a weekly basis. Before and after the interventions (two group pre- and post-design) all students conducted two interviews with simulated patients. The encounters were rated using a 10-item checklist derived from the Calgary-Cambridge Observation Guide I. RESULTS Repeated measures ANOVA (alpha = 0.05) showed a significant difference of the sum scores of the ratings between test and control group (P = 0.004). The participants educated in communication skills improved significantly (Delta = +14.9; P = 0.004), whereas in the control group no accretion of practical communication competence was observed (Delta = -3.9; P = 0.23). CONCLUSION It could be demonstrated that solely interacting with patients during a clinical treatment course did not inevitably improve professional communication skills. In contrast, implementation of a course in communication skills improved the practical competence in dentist-patient interaction.

Student Evaluation Scale for Medical Courses with Simulations of the Doctor-Patient Interaction (SES-Sim).

Objective: Simulations of doctor-patient interactions have become a popular method for the training of medical skills, primarily communication skills. A new questionnaire for the measurement of students’ satisfaction with medical courses using this technique is presented, the Student Evaluation Scale for Medical Courses with Simulations of the Doctor-Patient Interaction (SES-Sim). Method: A set of items focusing on the course quality and the core elements of simulations was created and presented to 220 medical students who had been trained with this method. Results: Based on factor-analyses 18 items were selected for the final version of the scale, which represent five dimensions: learning success, actors, premises, tutors and students. The five dimensions are all significantly correlated with a 1-item-measure of the general satisfaction with the course. Conclusion: The SES-Sim enables tutors to assess in an economic way whether the course has met the students’ needs and what can be done better.

Zur Evaluation von Arzt-Patienten-Kommunikation — Perspektiven einer angewandten Diskursethik in der Medizin

Die Medizin vollzieht gegenwartig ihre “kommunikative Wende”. Von dieser Entwicklung wird die Medizin sowohl als Wissenschaft erfast, deren semiotische Fundierung gerade in Vorbereitung ist2, wie auch als Handlungs- und Versorgungssystem, dessen uberfallige Reform sich nicht mehr allein mit dem technisch-naturwissenschaftlichen Fortschritt begrunden last. Vielmehr hat eine ungebremste biotechnisch orientierte Fortschrittsglaubigkeit die gegenwartige Sinnkrise der Medizin eher noch verstarkt, die inzwischen auf das medizinische Ausbildungssystem ubergreift. In dem Mase, wie mit dem Paradigmenwechsel von der biomechanischen zur biopsychosozialen Medizin die Bedeutung des arztlichen Gesprachs fur Anamnese, Diagnose und Therapie erkannt wurde, offenbarten sich die Defizite in der medizinischen Ausbildung, die alsbald vor dem Problem stand, wie denn die kommunikative Kompetenz des Arztes als Teil seiner psychosozialen Kompetenz zu fordern sei.