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      Pilot implementation of the national longitudinal communication curriculum: experiences from four German faculties Translated title: Pilotimplementierung des Nationalen longitudinalen Mustercurriculums Kommunikation: Erfahrungen aus vier Fakultäten

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          Abstract

          Background: The German national longitudinal communication curriculum provides medical faculties with orientation for the content of their communication teaching. But its implementation also requires changes in the organization of teaching. However, due to a lack of reports and studies on experiences with the development and implementation of communication curricula, recommendations on the procedure and the use of suitable instruments cannot be provided. Consequently, as part of this exploratory study the implementation process of the communication curricula was observed at four faculties.

          Methods: A comparative case study was conducted against the background of a change management concept. The four participating faculties were selected in such a way that they differed significantly in their initial conditions, particularly the development stage of the communication curriculum. Group interviews were conducted with the project teams at each faculty concerning the conditions and experiences with the implementation process. The evaluation took the form of a qualitative content analysis with a focus on identifying supporting and inhibiting factors and useful activities.

          Results: Different faculty approaches, support structures, core skills, the scope of study and examination regulations, teaching organization and available resources can have a major impact on the implementation processes. It became clear that, depending on the status of the implementation process, other barriers and supporting conditions gain in importance. Strategically, it proved to be a particular success factor to implement the communication curriculum together with other innovations in the course of the conversion to a model study program. This enabled a particularly quick and efficient implementation. The implementation into an existing curriculum proved to be much more protracted. In addition, a change management concept was used to illustrate which measures were found to be effective for which task areas. This includes, for example, curricular mapping, the development of skills in communication teaching or the integration of communication into exams.

          Conclusions: Thus a concept with strategies and measures for the implementation of the National Longitudinal Communication Curriculum is available. It already contains numerous suggestions for planning one's own approach in line with the conditions and resources of other locations. However, it needs to be supplemented and further validated.

          Zusammenfassung

          Hintergrund: Das Nationale longitudinale Mustercurriculum Kommunikation gibt medizinischen Fakultäten Orientierung für die inhaltliche Gestaltung ihrer Kommunikationslehre. Zu seiner Umsetzung sind jedoch auch Veränderungen in der Organisation der Lehre erforderlich. Bisher fehlen allerdings Berichte und Untersuchungen zu den Erfahrungen mit der Entwicklung und Implementierung von Kommunikationscurricula, aus denen Empfehlungen zum Vorgehen abgeleitet werden können. Daher wurden im Rahmen dieser explorierenden Untersuchung vier Fakultäten bei der Implementierung ihrer Kommunikationscurricula begleitet.

          Methoden: Vor dem Hintergrund eines Change-Management-Konzepts wurde eine vergleichende Fallstudie durchgeführt. Die beteiligten vier Fakultäten wurden so ausgewählt, dass sie sich in ihren Ausgangsbedingungen, insbesondere im Entwicklungsstand des Kommunikationscurriculums, deutlich unterschieden. An jeder Fakultät wurden Gruppeninterviews mit den Projektteams zu den Voraussetzungen und den Erfahrungen mit dem Implementierungsprozess durchgeführt. Die Auswertung erfolgte in Form einer qualitativen Inhaltsanalyse zur Identifikation unterstützender und hemmender Einflussfaktoren und zielführender Aktivitäten.

          Ergebnisse: Einstellungen an der Fakultät, Unterstützung, Kompetenzen, der Spielraum der Studien- und Prüfungsordnungen, die Lehrorganisation und die verfügbaren Ressourcen können großen Einfluss auf Implementierungsprozesse nehmen. Deutlich wurde, dass je nach Stand im Implementierungsprozess andere Barrieren und unterstützende Bedingungen im Vordergrund stehen. Strategisch erwies es sich als ein besonderer Erfolgsfaktor, das Kommunikationscurriculum im Zuge der Umstellung auf einen Modellstudiengang gemeinsam mit anderen Innovationen umzusetzen. Dadurch war eine besonders rasche und effiziente Umsetzung möglich. Die Implementierung in ein bestehendes Curriculum erwies sich als deutlich langwieriger. Zusätzlich wurde anhand eines Change-Management-Konzepts abgebildet, für welche Aufgabenfelder welche Maßnahmen als zielführend befunden wurden. Dazu gehört etwa das Curricular Mapping, die Entwicklung von Kompetenzen zur Kommunikationslehre oder die Integration von Kommunikation in die Prüfungen.

          Schlussfolgerungen: Somit liegt ein Konzept mit Strategien und Maßnahmen zur Implementierung des Nationalen longitudinalen Kommunikationscurriculums vor. Es enthält bereits jetzt zahlreiche Anregungen zur Planung des eigenen Vorgehens passend zu den Gegebenheiten und Ressourcen anderer Standorte. Allerdings bedarf es der Ergänzung und weiteren Validierung.

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          How does communication heal? Pathways linking clinician-patient communication to health outcomes.

          Although prior research indicates that features of clinician-patient communication can predict health outcomes weeks and months after the consultation, the mechanisms accounting for these findings are poorly understood. While talk itself can be therapeutic (e.g., lessening the patient's anxiety, providing comfort), more often clinician-patient communication influences health outcomes via a more indirect route. Proximal outcomes of the interaction include patient understanding, trust, and clinician-patient agreement. These affect intermediate outcomes (e.g., increased adherence, better self-care skills) which, in turn, affect health and well-being. Seven pathways through which communication can lead to better health include increased access to care, greater patient knowledge and shared understanding, higher quality medical decisions, enhanced therapeutic alliances, increased social support, patient agency and empowerment, and better management of emotions. Future research should hypothesize pathways connecting communication to health outcomes and select measures specific to that pathway. Clinicians and patients should maximize the therapeutic effects of communication by explicitly orienting communication to achieve intermediate outcomes (e.g., trust, mutual understanding, adherence, social support, self-efficacy) associated with improved health.
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            Design-Based Research: Putting a Stake in the Ground

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              Effective physician-patient communication and health outcomes: a review.

              To ascertain whether the quality of physician-patient communication makes a significant difference to patient health outcomes. The MEDLINE database was searched for articles published from 1983 to 1993 using "physician-patient relations" as the primary medical subject heading. Several bibliographies and conference proceedings were also reviewed. Randomized controlled trials (RCTs) and analytic studies of physician-patient communication in which patient health was an outcome variable. The following information was recorded about each study: sample size, patient characteristics, clinical setting, elements of communication assessed, patient outcomes measured, and direction and significance of any association found between aspects of communication and patient outcomes. Of the 21 studies that met the final criteria for review, 16 reported positive results, 4 reported negative (i.e., nonsignificant) results, and 1 was inconclusive. The quality of communication both in the history-taking segment of the visit and during discussion of the management plan was found to influence patient health outcomes. The outcomes affected were, in descending order of frequency, emotional health, symptom resolution, function, physiologic measures (i.e., blood pressure and blood sugar level) and pain control. Most of the studies reviewed demonstrated a correlation between effective physician-patient communication and improved patient health outcomes. The components of effective communication identified by these studies can be used as the basis both for curriculum development in medical education and for patient education programs. Future research should focus on evaluating such educational programs.
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                Author and article information

                Journal
                GMS J Med Educ
                GMS J Med Educ
                GMS J Med Educ
                GMS Journal for Medical Education
                German Medical Science GMS Publishing House
                2366-5017
                15 March 2021
                2021
                : 38
                : 3 , Communicative and Social Competencies/Kommunikative und soziale Kompetenzen
                : Doc52
                Affiliations
                [1 ]Institut für Medizinische und Pharmazeutische Prüfungsfragen (IMPP), Mainz, Germany
                [2 ]Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Psychosomatische Medizin und Psychotherapie, Hamburg, Germany
                [3 ]Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Urologie, Hamburg, Germany
                [4 ]Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Rudolf Frey Lernklinik – Zentrale Lehrplattform, Mainz, Germany
                [5 ]Universitätsklinik Heidelberg, Klinik für Allgemeine Innere Medizin und Psychosomatik, Heidelberg, Germany
                [6 ]Otto-von-Guericke-Universität Magdeburg, Klinik für Nieren- und Hochdruckkrankheiten, Diabetologie und Endokrinologie, Magdeburg, Germany
                Author notes
                *To whom correspondence should be addressed: Barbara Hinding, Institut für Medizinische und Pharmazeutische Prüfungsfragen (IMPP), Rheinstr. 4, D-55116 Mainz, Germany, E-mail: BHinding@ 123456impp.de
                Article
                zma001448 Doc52 urn:nbn:de:0183-zma0014481
                10.3205/zma001448
                7994880
                33824888
                688d25df-fa10-458d-8f1c-f3a4d431ee48
                Copyright © 2021 Hinding et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

                History
                : 31 March 2020
                : 30 September 2020
                : 17 August 2020
                Categories
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                education,curriculum,implementation science,communication,patient-centered care

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