Skip to main content
SpringerLink
Log in

Zur Erlernbarkeit der Arzt-Patienten-Kommunikation in der Medizinischen Ausbildung

Physician–patient communication in medical education: can it be learned?

  • Leitthema
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

In der vorliegenden Übersichtsarbeit werden ausgewählte Arbeiten präsentiert, die belegen, dass viele Elemente einer professionellen Arzt-Patient-Kommunikation im Medizinstudium erlernbar sind; dabei sind das Ausmaß des Lernerfolges und die Möglichkeiten seiner Überprüfung abhängig von der Definition der Lernziele. Zu ihrer Begründung wird in den meisten Lehrplänen auf die Bedeutung eines eher partnerschaftlichen und nicht patriarchalischen Umgangs mit Patienten verwiesen. Dem wird hier eine Definition von Lehrzielen gegenübergestellt, die sich an den Bedürfnissen der klinischen Medizin orientiert: Studierende erheben belastbare anamnestische Angaben, sie können Gespräche explizit strukturieren und Informationen vermitteln, sie trauen sich zu, emotionale Äußerungen von Patienten aufzugreifen. Als Prüfungsformat in der professionellen Kommunikation wird das Objective Standardised Clinical Examination (OSCE) mit seinen Stärken und Schwächen diskutiert. In Zukunft wird der strukturierte Einsatz von Videoaufnahmen von Gesprächen dazu führen, dass Studierende das eigene Verhalten besser kritisch reflektieren können. Wünschenswert wäre der Einsatz von Verfahren zur unmittelbaren Rückmeldung an Studierende über arbeitsplatzbasierte Techniken wie Mini-Cex oder Workplace-based Assessment. Diese Lehr- und Prüfungsmethoden bedürfen allerdings einer nicht nur fachlich, sondern auch in der Kunst des Feedback-Gebens ausgebildeten Fakultät.

Abstract

Based on a review of recent key articles, this paper demonstrates that many elements of physician–patient communication can be learned successfully during medical education. Methods of assessment and definition of success depend largely on the definition of teaching goals, which are usually based on the principles of a more egalitarian and non-paternalistic physician–patient communication. In this article another approach is suggested. Teaching objectives in patient–physician communication can also be deduced from the needs of clinical medicine, resulting in the following goals: students are able to gather relevant data from patients’ history, they explicitly structure the consultation and the way they give information, they know how to respond to patients’ emotions. The Objective Standardised Clinical Examination (OSCE) is discussed with its strengths and weaknesses. The inclusion of video-based feedback is presented as a teaching tool to improve students’ self-reflection. Workplace-based assessment and Mini-CEX are promising educational tools that require a well-trained faculty, not only in the teaching and practice of communication but also in the art of giving constructive and yet honest feedback.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Hargie O, Boohan M, McCoy M, Murphy P (2010) Current trends in Communication Skills Training in UK schools of medicine. Med Teach 32:385–391

    Article  PubMed  Google Scholar 

  2. Swing SR (2007) The ACGME outcome project: retrospective and prospective. Med Teach 29:648–654

    Article  PubMed  Google Scholar 

  3. Kiessling C, Dieterich A, Fabry G, Hölzer H, Langewitz W, Mühlinghaus I, Pruskil S, Scheffer S, Schubert S (2010) Communication and social competencies in medical education in German-speaking countries: the Basel consensus statement. Results of a Delphi survey. Patient Education Couns 81:1259–1266

    Google Scholar 

  4. Rubin P, Franchi-Christopher D (2002) New edition of tomorrow’s doctors. Med Teach 24:368–369

    Article  PubMed  CAS  Google Scholar 

  5. Frank JR, Danoff D (2007) The CanMEDS initiative: implementing an outcomes-based framework of physician competencies. Med Teach 29: 642–647

    Article  PubMed  Google Scholar 

  6. Albanese MA, Mejicano G, Anderson WM, Gruppen L (2010) Building a competency-based curriculum: the agony and the ecstasy. Advances Health Sci Education: Theory Practice 15:439–454

    Google Scholar 

  7. de Haes H, Bensing J (2009) Endpoints in medical communication research, proposing a framework of functions and outcomes. Patient Education Couns 74:287–294

    Article  Google Scholar 

  8. Lazare A, Putnam SM, Lipkin M (1995) Three functions of the medical interview. In: Lazare A, Putnam SM, Lipkin M (Hrsg) The medical interview. Clinical care, education and research. Springer, New York Heidelberg

  9. Epstein RM, Street RL (2007) Patient-centered communication in cancer care: promoting healing and reducing suffering. In: NIH Publication No. 07-6225. National Cancer Institute, Bethesda, MD

  10. Salmon P, Young B (2005) Core assumptions and research opportunities in clinical communication. Patient Education Couns 58:225–234

    Article  Google Scholar 

  11. Langewitz W, Keller A, Denz M, Wossmer-Buntschu B, Kiss A (1995) Patientenzufriedenheits-Fragebogen (PZF): Ein taugliches Mittel zur Qualitätskontrolle der Arzt-Patient-Beziehung? Psychother Psychosom Med Psychol 45:351-357

    PubMed  CAS  Google Scholar 

  12. Gorawara-Bhat R, Cook MA (2011) Eye contact in patient-centered communication. Patient Education Couns 82:442-447

    Article  Google Scholar 

  13. Marcinowicz L, Konstantynowicz J, Godlewski C (2010) Patients‘ perceptions of GP non-verbal communication: a qualitative study. Br J Gen Pract 60:83–87

    Article  PubMed  Google Scholar 

  14. Robinson J, Walley T, Pearson M, Taylor D, Barton S (2002) Measuring consultation skills in primary care in England: evaluation and development of content of the MAAS scale. Br J Gen Pract 52:889–893

    PubMed  CAS  Google Scholar 

  15. Del Piccolo L, de Haes H, Heaven C, et al (2011) Development of the Verona Coding Definitions of Emotional Sequences to code health providers‘ responses (VR-CoDES-P) to patient cues and concerns. Patient Education Couns 82:149–155

    Article  Google Scholar 

  16. Zimmermann C, Del Piccolo L, Bensing J et al (2011) Coding patient emotional cues and concerns in medical consultations: The Verona Coding Definitions of Emotional Sequences (VR-CoDES). Patient Education Couns 82:141–148

    Article  Google Scholar 

  17. Butow PN, Brown RF, Cogar S, Tattersall MH, Dunn SM (2002) Oncologists‘ reactions to cancer patients‘ verbal cues. Psychooncology 11:47–58

    Article  PubMed  CAS  Google Scholar 

  18. Barth J, Lannen P (2010) Efficacy of communication skills training courses in oncology: a systematic review and meta-analysis. Annals Oncol 22:1030–1040

    Article  Google Scholar 

  19. Bird J, Cohen-Cole SA (1990) The three-function model of the medical interview. An educational device. Adv Psychosom Med 20:65–88

    PubMed  CAS  Google Scholar 

  20. Young B, Ward J, Forsey M, Gravenhorst K, Salmon P (2011) Examining the validity of the unitary theory of clinical relationships: comparison of observed and experienced parent-doctor interaction. Patient Education Couns 85:60–67

    Article  Google Scholar 

  21. O’Keefe M, Roberton D, Sawyer M, Baghurst P (2003) Medical student interviewing: a randomized trial of patient-centredness and clinical competence. Family Practice 20:213–219

    Article  Google Scholar 

  22. Approbationsordnung für Ärzte, ausgegeben zu Bonn am 3. Juli 2002. Bundesgesetzblatt Jahrgang 2002 Teil I Nr. 44, 2405–2435

  23. Peets AD, Cooke L, Wright B, Coderre S, McLaughlin K (2010) A prospective randomized trial of content expertise versus process expertise in small group teaching. BMC Med Educ 10:70

    Article  PubMed  Google Scholar 

  24. Cook DA (2010) Twelve tips for evaluating educational programs. Med Teach 32:296–301

    Article  PubMed  Google Scholar 

  25. Bowen JL (2006) Educational strategies to promote clinical diagnostic reasoning. New Engl J Med 355:2217–2225

    Article  PubMed  CAS  Google Scholar 

  26. Graber ML, Franklin N, Gordon R (2005) Diagnostic error in internal medicine. Arch Internal Med 165:1493–1499

    Article  Google Scholar 

  27. Langewitz W (2011) Patientenzentrierte Kommunikation. In: Adler RH, Herzog W, Joraschky P et al (Hrsg) Uexküll. Psychosomatische Medizin. Theoretische Modelle und klinische Praxis. Elsevier, Urban & Fischer, München, S 338–347

  28. Langewitz WA, Loeb Y, Nubling M, Hunziker S (2009) From patient talk to physician notes – comparing the content of medical interviews with medical records in a sample of outpatients in Internal Medicine. Patient Education Couns 76:336–340

    Article  Google Scholar 

  29. Back AL, Arnold RM, Baile WF et al (2007) Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Arch Internal Med 167:453–460

    Article  Google Scholar 

  30. Bachmann C, Hölzer H, Dieterich A et al (2009) Longitudinales, bologna-kompatibles Modell-Curriculum „Kommunikative und Soziale Kompetenzen“: Ergebnisse eines interdisziplinären Workshops deutschsprachiger medizinischer Fakultäten. GMS Z Med Ausbild 26:Doc38

    Google Scholar 

  31. Cegala DJ, Lenzmeier Broz S (2002) Physician communication skills training: a review of theoretical backgrounds, objectives and skills. Med Education 36:1004–1016

    Article  Google Scholar 

  32. Duffy FD, Gordon GH, Whelan G et al (2004) Assessing competence in communication and interpersonal skills: the Kalamazoo II report. Academic Medicine: J Assoc Am Medical Colleges 79:495–507

  33. Rider EA, Hinrichs MM, Lown BA (2006) A model for communication skills assessment across the undergraduate curriculum. Med Teach 28:e127–134

    Article  PubMed  Google Scholar 

  34. Solomon DJ, Szauter K, Rosebraugh CJ, Callaway MR (2000) Global ratings of student performance in a standardized patient examination: Is the whole more than the sum of the parts? Advances Health Sci Education: Theory Practice 5:131–140

    Google Scholar 

  35. Kurtz S, Silverman J, Draper J (1998) Teaching and learning communication skills in medicine. Radcliffe Medical Press Ltd., Abingdon Oxon, UK

  36. Humphris GM, Kaney S (2001) The Liverpool brief assessment system for communication skills in the making of doctors. Advances Health Sci Education: Theory Practice 6:69–80

    Google Scholar 

  37. Hodges B, Hanson M, McNaughton N, Regehr G (2002) Creating, monitoring, and improving a psychiatry OSCE: a guide for faculty. Acad Psychiatry 26:134–161

    Article  PubMed  Google Scholar 

  38. Hodges B, McIlroy JH (2003) Analytic global OSCE ratings are sensitive to level of training. Medical Education 37:1012–1016

    Article  PubMed  Google Scholar 

  39. Scheffer S, Muehlinghaus I, Froehmel A, Ortwein H (2008) Assessing students‘ communication skills: validation of a global rating. Advances Health Sci Education: Theory Practice 13:583–592

    Google Scholar 

  40. Newble D (2004) Techniques for measuring clinical competence: objective structured clinical examinations. Medical Education 38:199–203

    Article  PubMed  Google Scholar 

  41. Steele DJ, Hulsman RL (2008) Empathy, authenticity, assessment and simulation: a conundrum in search of a solution. Patient Education Couns 71:143–144

    Article  CAS  Google Scholar 

  42. Wear D, Varley JD (2008) Rituals of verification: the role of simulation in developing and evaluating empathic communication. Patient Education Couns 71:153–156

    Article  Google Scholar 

  43. Cherry MG, Fletcher I, O’Sullivan H, Shaw N (2012) What impact do structured educational sessions to increase emotional intelligence have on medical students? BEME Guide No. 17. Med Teach 34:11–19

    Article  PubMed  Google Scholar 

  44. Berkhof M, van Rijssen HJ, Schellart AJ, Anema JR, van der Beek AJ (2011) Effective training strategies for teaching communication skills to physicians: an overview of systematic reviews. Patient Education Couns 84:152–162

    Article  Google Scholar 

  45. Schildmann J, Kupfer S, Burchardi N, Vollmann J (2012) Teaching and evaluating breaking bad news: a pre-post evaluation study of a teaching intervention for medical students and a comparative analysis of different measurement instruments and raters. Patient Education Couns 86:210–219

    Article  Google Scholar 

  46. Dauphinee WD, Wood-Dauphinee S (2004) The need for evidence in medical education: the development of best evidence medical education as an opportunity to inform, guide, and sustain medical education research. Academic Medicine: J Association Am Medical Colleges 79:925–930

  47. Cook DA, Beckman TJ, Bordage G (2007) Quality of reporting of experimental studies in medical education: a systematic review. Medical Education 41:737–745

    Article  PubMed  Google Scholar 

  48. Thistlethwaite J, Hammick M (2010) The Best Evidence Medical Education (BEME) Collaboration: into the next decade. Med Teacher 32:880–882

    Article  Google Scholar 

  49. Hammick M, Haig A (2007) The Best Evidence Medical Education Collaboration: processes, products and principles. Clin Teach 4:42–45

    Article  Google Scholar 

  50. Tamblyn R, Abrahamowicz M, Dauphinee D et al (2007) Physician scores on a national clinical skills examination as predictors of complaints to medical regulatory authorities. JAMA 298:993–1001

    Article  PubMed  CAS  Google Scholar 

  51. O’Neill PA, Jones A, Willis SC, McArdle PJ (2003) Does a new undergraduate curriculum based on Tomorrow’s Doctors prepare house officers better for their first post? A qualitative study of the views of pre-registration house officers using critical incidents. Medical Education 37:1100–1108

    Article  Google Scholar 

  52. Zick A, Granieri M, Makoul G (2007) First-year medical students‘ assessment of their own communication skills: a video-based, open-ended approach. Patient Education Couns 68:161–166

    Article  Google Scholar 

  53. Hulsman RL, Harmsen AB, Fabriek M (2009) Reflective teaching of medical communication skills with DiViDU: assessing the level of student reflection on recorded consultations with simulated patients. Patient Education Couns 74:142–149

    Article  CAS  Google Scholar 

  54. Lee CA, Chang A, Chou CL, Boscardin C, Hauer KE (2011) Standardized patient-narrated web-based learning modules improve students‘ communication skills on a high-stakes clinical skills examination. J Gen Internal Med 26:1374–1377

    Article  Google Scholar 

  55. Norcini J, Burch V (2007) Workplace-based assessment as an educational tool: AMEE Guide No. 31. Med Teach 29:855–871

    Article  PubMed  Google Scholar 

  56. Pelgrim EA, Kramer AW, Mokkink HG, van den Elsen L, Grol RP, van der Vleuten CP (2011) In-training assessment using direct observation of single-patient encounters: a literature review. Advances Health Sci Education: Theory Practice 16:131–142

    Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Psychosomatik - Innere Medizin, Universitätsspital Basel, Hebelstr. 2, 4031, Basel, Schweiz

    W. Langewitz

Authors
  1. W. Langewitz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W. Langewitz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Langewitz, W. Zur Erlernbarkeit der Arzt-Patienten-Kommunikation in der Medizinischen Ausbildung. Bundesgesundheitsbl. 55, 1176–1182 (2012). https://doi.org/10.1007/s00103-012-1533-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00103-012-1533-0

Schlüsselwörter

Keywords

Search

Navigation