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.
Literatur
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
Swing SR (2007) The ACGME outcome project: retrospective and prospective. Med Teach 29:648–654
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
Rubin P, Franchi-Christopher D (2002) New edition of tomorrow’s doctors. Med Teach 24:368–369
Frank JR, Danoff D (2007) The CanMEDS initiative: implementing an outcomes-based framework of physician competencies. Med Teach 29: 642–647
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
de Haes H, Bensing J (2009) Endpoints in medical communication research, proposing a framework of functions and outcomes. Patient Education Couns 74:287–294
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
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
Salmon P, Young B (2005) Core assumptions and research opportunities in clinical communication. Patient Education Couns 58:225–234
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
Gorawara-Bhat R, Cook MA (2011) Eye contact in patient-centered communication. Patient Education Couns 82:442-447
Marcinowicz L, Konstantynowicz J, Godlewski C (2010) Patients‘ perceptions of GP non-verbal communication: a qualitative study. Br J Gen Pract 60:83–87
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
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
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
Butow PN, Brown RF, Cogar S, Tattersall MH, Dunn SM (2002) Oncologists‘ reactions to cancer patients‘ verbal cues. Psychooncology 11:47–58
Barth J, Lannen P (2010) Efficacy of communication skills training courses in oncology: a systematic review and meta-analysis. Annals Oncol 22:1030–1040
Bird J, Cohen-Cole SA (1990) The three-function model of the medical interview. An educational device. Adv Psychosom Med 20:65–88
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
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
Approbationsordnung für Ärzte, ausgegeben zu Bonn am 3. Juli 2002. Bundesgesetzblatt Jahrgang 2002 Teil I Nr. 44, 2405–2435
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
Cook DA (2010) Twelve tips for evaluating educational programs. Med Teach 32:296–301
Bowen JL (2006) Educational strategies to promote clinical diagnostic reasoning. New Engl J Med 355:2217–2225
Graber ML, Franklin N, Gordon R (2005) Diagnostic error in internal medicine. Arch Internal Med 165:1493–1499
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
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
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
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
Cegala DJ, Lenzmeier Broz S (2002) Physician communication skills training: a review of theoretical backgrounds, objectives and skills. Med Education 36:1004–1016
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
Rider EA, Hinrichs MM, Lown BA (2006) A model for communication skills assessment across the undergraduate curriculum. Med Teach 28:e127–134
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
Kurtz S, Silverman J, Draper J (1998) Teaching and learning communication skills in medicine. Radcliffe Medical Press Ltd., Abingdon Oxon, UK
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
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
Hodges B, McIlroy JH (2003) Analytic global OSCE ratings are sensitive to level of training. Medical Education 37:1012–1016
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
Newble D (2004) Techniques for measuring clinical competence: objective structured clinical examinations. Medical Education 38:199–203
Steele DJ, Hulsman RL (2008) Empathy, authenticity, assessment and simulation: a conundrum in search of a solution. Patient Education Couns 71:143–144
Wear D, Varley JD (2008) Rituals of verification: the role of simulation in developing and evaluating empathic communication. Patient Education Couns 71:153–156
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
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
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
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
Cook DA, Beckman TJ, Bordage G (2007) Quality of reporting of experimental studies in medical education: a systematic review. Medical Education 41:737–745
Thistlethwaite J, Hammick M (2010) The Best Evidence Medical Education (BEME) Collaboration: into the next decade. Med Teacher 32:880–882
Hammick M, Haig A (2007) The Best Evidence Medical Education Collaboration: processes, products and principles. Clin Teach 4:42–45
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
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
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
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
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
Norcini J, Burch V (2007) Workplace-based assessment as an educational tool: AMEE Guide No. 31. Med Teach 29:855–871
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
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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
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DOI: https://doi.org/10.1007/s00103-012-1533-0