Robert L. Hulsman

Effectiveness of selection in medical school admissions: evaluation of the outcomes among freshmen

Context  In 2000 our medical school introduced a selection procedure (SP) for 10% of the otherwise randomly selected (RS) applicants. Students with excellent high school grade point averages (GPAs) were allowed direct access (DA) to our medical school. The selection procedure focused on medical comprehension, social and ethical understanding of health care, and communication and interpersonal skills.

The psychophysiology of medical communication. Linking two worlds of research

OBJECTIVE Medical communication is goal oriented behavior. As such, it can be modeled as a chain of decisions, resulting from cognitive and emotional processes each potentially associated with psychophysiological reactions. Psychophysiological may be helpful to detect small changes in affect or arousal in the course of a consultation that would be difficult to detect by other evaluations of the process, like self-reports. The question is how psychophysiological communication research should be modeled for unraveling in more detail the cognitive, emotional and interpersonal processes which underlie physician and patient behavior. METHODS In the world of medical communication research the six-function model of medical communication reveals a number of fundamental perceptual, cognitive and emotional processes which may evoke psychophysiological responses. The world of psychophysiological research encompasses domains of perception, mental imagery, anticipation and action which all have close connections with fundamental tasks in communication. CONCLUSION This paper discusses ten methodological issues in linking continuous psychophysiological data to verbal and nonverbal events in a medical consultation observed with the Verona coding system. PRACTICE IMPLICATIONS When linking the two worlds of research, the methodological challenges discussed need to be solved to obtain a valid and reliable application of psychophysiological measures in medical communication research.

Empathy, authenticity, assessment and simulation: A conundrum in search of a solution

In this issue of Patient Education and Counseling, Wear and experiences be? The answer for Wear and Varley, citing a Varley [1] present medical educators and clinical communication skills researchers a conundrum. They argue that trainees’ empathic abilities cannot be validly assessed through simulated encounters employing standardized patients. These encounters are too artificial. Simulated patients do not have the conditions or emotional concerns they are asked to portray and trainees are not ‘‘really’’ responsible for their care. Without this responsibility, and the relationship associated with this responsibility, genuine feelings of empathy will not emerge. Consequently, in the context of an assessment, such as in an OSCE, examinees are placed in the position of having to pretend empathy by play acting socially desirable behaviors that will get them passing scores on a check list. However, successful acting says nothing about the emotional experience of truly caring about and connecting with another human being. Thus, assessment promotes inauthenticity on the part of the trainee. To make matters worse, according to Wear and Varley, the behavioral checklists devised to measure empathic behaviors trivialize the very qualities we wish to assess by reducing them to mere surface behaviors that an examinee can turn on and off in order to score points with the assessor. Finally, Wear and Varley argue that because teaching and assessment are inextricably linked, teaching efforts are likely to be skewed to emphasize the surface level behaviors enshrined on the assessment checklist. This deprives learners of opportunities to acquire the habits of mind and sensitivity needed for ‘‘earnest attempts to understand and relate to patients’ stories’’ ([1], p. 154). But, and here is where the conundrum truly rears its ugly head, what we assess sends a clear message about what we value. If we do not assess manifestations of empathy in some meaningful way, we run the risk that our students will devalue its importance. As medical educators know all too well, students tend to focus their time and effort on those areas in which they are rewarded by ‘‘making the grade.’’ The solution Wear and Varley offer is to ‘‘move beyond the checklist’’ and provide students learning experiences that encourage them ‘‘towards deeper, richer considerations of what their patients are experiencing and what trainees themselves are experiencing in that relationship’’ ([1], p. 155). And what might these

Pathways towards designing effective medical communication curricula

Already in 1957 in his book ‘‘The doctor, his patient and the illness’’ Michael Balint stressed the importance of good patient– physician communication [1]. He recognized that the interpersonal behaviour of the physician could have a healing impact on the patient, regardless of the treatment, and he asked for recognition of the emotional as well as the physical aspects of a patient’s complaint. He was probably the first to advocate the skills of attentive listening to patients. Since then, the teaching of communication skills became more and more implemented in medical schools and communication teachers tried to establish which communication skills are essential for practising physicians and should be taught to medical students. In 1991 the first (Toronto) consensus statement about the content of a medical communication curriculum appeared [2] followed by many other consensus statements [3–9]. The first consensus statements were mainly based on the opinions of experts in the field, but gradually empirical research of favourable outcomes of skill performance also determined the content of statements. However, consensus statements were mainly formulated for medical curricula. Consensus statements for non-medical professions were much less developed and consensus statements for inter-professional communication education did not exist. Thus, a group of EACH members developed a more comprehensive consensus statement which contains learning objectives for patient–provider communication as well as for inter-professional communication and for communication in health care teams. In this issue of PEC Bachmann et al. [10] present this consensus statement which includes 61 learning objectives for a Health Professions Core Communication Curriculum (HPCCC) for all undergraduate education in health care in Europe. The consensus statement is built on the opinions of 121 communication experts from 15 professional fields and 16 European countries. Although a consensus statement can be a useful tool for the structuring of learning objectives that are to be dealt with in a communication curriculum, a mere list of learning objectives can also be a drawback since it does not take into account the context in which the skills have to be performed and assessed. Therefore, Street and de Haes [11] propose in this issue of PEC a functional model of medical communication which specifies seven key communication goals and desired outcomes that need to be accomplished in order to have quality health care. These seven key functions represent the communication tasks and identify the corresponding skills students are expected to learn in order to accomplish desired outcomes. The functional approach offers an advantage for the teaching and assessment of health care communication over a consensus approach, since it stresses that

Developing a digital communication training tool on information-provision in oncology: uncovering learning needs and training preferences

BackgroundAdequate information-provision forms a crucial component of optimal cancer care. However, information-provision is particularly challenging in an oncology setting. It is therefore imperative to help oncological health care practitioners (HCP) optimise their information-giving skills. New forms of online education, i.e. e-learning, enable safe and time and location independent ways of learning, enhancing access to continuous learning for HCP.As part of a user-centred approach to developing an e-learning to improve information-giving skills, this study aims to: 1) uncover the learning needs of oncological healthcare providers related to information- provision, and 2) explore their training preferences in the context of clinical practice.MethodsFocus groups and interviews were organised with oncological HCP (medical specialists and clinical nurse specialists) addressing participants’ learning needs concerning information- provision and their training preferences with respect to a new digital training tool on this issue. All sessions were audiorecorded and transcribed verbatim. Using an inductive approach, transcripts were independently coded by three researchers and discussed to reach consensus. Main themes were summarised and discussed.ResultsFour focus group sessions (total n = 13) and three interviews were conducted. The first theme concerned the patient outcomes HCP try to achieve with their information. We found HCP to mainly strive to promote patients’ understanding of information. The second theme concerned HCP reported strategies and challenges when trying to inform their patients. These entailed tailoring of information to patient characteristics, structuring of information, and dealing with patients’ emotions. Regarding HCP training preferences, an e-learning should be neatly connected to clinical practice. Moreover, participants desired a digital training to allow for feedback on their own (videotaped) information-giving skills from peers, communication experts, and/or patients; to monitor their progress and to tailored the training to individual learning needs.ConclusionsAn e-learning for improvement of information-giving skills of oncological HCP should be aimed at the transfer of skills to clinical practice, rather than at enhancing knowledge. Moreover, an e-learning is probably most effective when the facilitates individual learning needs, supports feedback on competence level and improvement, and allows input from significant others (experts, peers, or patients).

In zulke waters vangt men zulke visschen. Een evaluatie van de decentrale selectie van geneeskundestudenten in het AMC-UvA

Inleiding: Sinds 2001 wordt 10% van de studenten via decentrale selectie toegelaten tot de geneeskundeopleiding van het AMC-UvA. Onderzocht is of de decentraal geselecteerde studenten verschillen van de ingelote studenten en de via de 8+ regeling toegelaten studenten.