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      The longitudinal curriculum "social and communicative competencies" within Bologna-reformed undergraduate medical education in Basel

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          Abstract

          Background: Within the Bologna reform, a longitudinal curriculum of “social and communicative competencies” (SOKO) was implemented into the new Bachelor-Master structure of undergraduate medical education in Basel (Switzerland).

          Project description: The aim of the SOKO curriculum is to enable students to use techniques of patient-centred communication to elicit and provide information to patients in order to involve them as informed partners in decision making processes. The SOKO curriculum consists of 57 lessons for the individual student from the first bachelor year to the first master year. Teaching encompasses lectures and small group learning. Didactic methods include role play, video feedback, and consultations with simulated and real patients. Summative assessment takes place in objective structured clinical examinations (OSCE).

          Conclusion: In Basel, a longitudinal SOKO curriculum based on students’ cumulative learning was successfully implemented. Goals and contents were coordinated with the remaining curriculum and are regularly assessed in OSCEs. At present, most of the workload rests on the shoulders of the department of psychosomatic medicine at the university hospital. For the curriculum to be successful in the long-term, sustainable structures need to be instituted at the medical faculty and the university hospital to guarantee high quality teaching and assessment.

          Translated abstract

          Hintergrund: Mit der Umstellung auf die Bachelor-/Masterstruktur wurde in Basel (Schweiz) ein longitudinales Curriculum „soziale und Kommunikative Kompetenzen“ (SOKO) in das Medizinstudium implementiert.

          Projektbeschreibung: Ziel ist es, den Studierenden grundlegende Techniken einer patientenzentrierten Kommunikation in dem Sinne zu vermitteln, dass die Studierenden in der Lage sind, Informationen zu erheben und Informationen an Patientinnen und Patienten weiterzugeben, um sie als gut informierte Partner am Entscheidungsprozess zu beteiligen. Das SOKO Curriculum umfasst aus Sicht der Studierenden 57 Unterrichtsstunden. In Vorlesungen und kleinen Gruppen kommen vom 1. bis 3. Bachelor- und im 1. Masterstudienjahr Rollenspiele, Videofeedback, Simulationspatienten und der Kontakt mit realen Patienten als didaktische Methoden zum Einsatz. Die Lernziele werden in den summativen klinisch-praktischen OSCE-Prüfungen abgeprüft.

          Schlussfolgerungen: In Basel konnte mit der Umstellung auf die Bologna-Struktur ein longitudinales SOKO-Curriculum implementiert werden, das kumulatives Lernen erlaubt, auf die Inhalte des sonstigen Studiums Bezug nimmt und regelmäßig in den OSCEs abgeprüft wird. Zurzeit wird ein Großteil der Lehre durch die Psychosomatik des Unispital Basels geleistet. Für die Zukunft wird entscheidend sein, nachhaltige Strukturen in der gesamten Fakultät und im gesamten Unispital zu verankern, um dauerhaft eine hohe Qualität des Unterrichts und der Prüfungen sicherzustellen.

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          Essential elements of communication in medical encounters: the Kalamazoo consensus statement.

          G Makoul (2001)
          In May 1999, 21 leaders and representatives from major medical education and professional organizations attended an invitational conference jointly sponsored by the Bayer Institute for Health Care Communication and the Fetzer INSTITUTE: The participants focused on delineating a coherent set of essential elements in physician-patient communication to: (1) facilitate the development, implementation, and evaluation of communication-oriented curricula in medical education and (2) inform the development of specific standards in this domain. Since the group included architects and representatives of five currently used models of doctor-patient communication, participants agreed that the goals might best be achieved through review and synthesis of the models. Presentations about the five models encompassed their research base, overarching views of the medical encounter, and current applications. All attendees participated in discussion of the models and common elements. Written proceedings generated during the conference were posted on an electronic listserv for review and comment by the entire group. A three-person writing committee synthesized suggestions, resolved questions, and posted a succession of drafts on a listserv. The current document was circulated to the entire group for final approval before it was submitted for publication. The group identified seven essential sets of communication tasks: (1) build the doctor-patient relationship; (2) open the discussion; (3) gather information; (4) understand the patient's perspective; (5) share information; (6) reach agreement on problems and plans; and (7) provide closure. These broadly supported elements provide a useful framework for communication-oriented curricula and standards.
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            Interventions for improving the adoption of shared decision making by healthcare professionals.

            Shared decision making (SDM) is a process by which a healthcare choice is made jointly by the practitioner and the patient and is said to be the crux of patient-centred care. Policy makers perceive SDM as desirable because of its potential to a) reduce overuse of options not clearly associated with benefits for all (e.g., prostate cancer screening); b) enhance the use of options clearly associated with benefits for the vast majority (e.g., cardiovascular risk factor management); c) reduce unwarranted healthcare practice variations; d) foster the sustainability of the healthcare system; and e) promote the right of patients to be involved in decisions concerning their health. Despite this potential, SDM has not yet been widely adopted in clinical practice. To determine the effectiveness of interventions to improve healthcare professionals' adoption of SDM. We searched the following electronic databases up to 18 March 2009: Cochrane Library (1970-), MEDLINE (1966-), EMBASE (1976-), CINAHL (1982-) and PsycINFO (1965-). We found additional studies by reviewing a) the bibliographies of studies and reviews found in the electronic databases; b) the clinicaltrials.gov registry; and c) proceedings of the International Shared Decision Making Conference and the conferences of the Society for Medical Decision Making. We included all languages of publication. We included randomised controlled trials (RCTs) or well-designed quasi-experimental studies (controlled clinical trials, controlled before and after studies, and interrupted time series analyses) that evaluated any type of intervention that aimed to improve healthcare professionals' adoption of shared decision making. We defined adoption as the extent to which healthcare professionals intended to or actually engaged in SDM in clinical practice or/and used interventions known to facilitate SDM. We deemed studies eligible if the primary outcomes were evaluated with an objective measure of the adoption of SDM by healthcare professionals (e.g., a third-observer instrument). At least two reviewers independently screened each abstract for inclusion and abstracted data independently using a modified version of the EPOC data collection checklist. We resolved disagreements by discussion. Statistical analysis considered categorical and continuous primary outcomes. We computed the standard effect size for each outcome separately with a 95% confidence interval. We evaluated global effects by calculating the median effect size and the range of effect sizes across studies. The reviewers identified 6764 potentially relevant documents, of which we excluded 6582 by reviewing titles and abstracts. Of the remainder, we retrieved 182 full publications for more detailed screening. From these, we excluded 176 publications based on our inclusion criteria. This left in five studies, all RCTs. All five were conducted in ambulatory care: three in primary clinical care and two in specialised care. Four of the studies targeted physicians only and one targeted nurses only. In only two of the five RCTs was a statistically significant effect size associated with the intervention to have healthcare professionals adopt SDM. The first of these two studies compared a single intervention (a patient-mediated intervention: the Statin Choice decision aid) to another single intervention (also patient-mediated: a standard Mayo patient education pamphlet). In this study, the Statin Choice decision aid group performed better than the standard Mayo patient education pamphlet group (standard effect size = 1.06; 95% CI = 0.62 to 1.50). The other study compared a multifaceted intervention (distribution of educational material, educational meeting and audit and feedback) to usual care (control group) (standard effect size = 2.11; 95% CI = 1.30 to 2.90). This study was the only one to report an assessment of barriers prior to the elaboration of its multifaceted intervention. The results of this Cochrane review do not allow us to draw firm conclusions about the most effective types of intervention for increasing healthcare professionals' adoption of SDM. Healthcare professional training may be important, as may the implementation of patient-mediated interventions such as decision aids. Given the paucity of evidence, however, those motivated by the ethical impetus to increase SDM in clinical practice will need to weigh the costs and potential benefits of interventions. Subsequent research should involve well-designed studies with adequate power and procedures to minimise bias so that they may improve estimates of the effects of interventions on healthcare professionals' adoption of SDM. From a measurement perspective, consensus on how to assess professionals' adoption of SDM is desirable to facilitate cross-study comparisons.
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              A conceptual framework for the use of illness narratives in medical education.

              The use of narratives, including physicians' and patients' stories, literature, and film, is increasingly popular in medical education. There is, however, a need for an overarching conceptual framework to guide these efforts, which are often dismissed as "soft" and placed at the margins of medical school curricula. The purpose of this article is to describe the conceptual basis for an approach to patient-centered medical education and narrative medicine initiated at the University of Michigan Medical School in the fall of 2003. This approach, the Family Centered Experience, involves home visits and conversations between beginning medical students and patient volunteers and their families and is aimed at fostering humanism in medicine. The program incorporates developmental and learning theory, longitudinal interactions with individuals with chronic illness, reflective learning, and small-group discussions to explore the experience of illness and its care. The author describes a grounding of this approach in theories of empathy and moral development and clarifies the educational value that narratives bring to medical education. Specific pedagogical considerations, including use of activities to create "cognitive disequilibrium" and the concept of transformative learning, are also discussed and may be applied to narrative medicine, professionalism, multicultural education, medical ethics, and other subject areas in medical education that address individuals and their health care needs in society.
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                Author and article information

                Journal
                GMS Z Med Ausbild
                GMS Z Med Ausbild
                GMS Z Med Ausbild
                GMS Zeitschrift für Medizinische Ausbildung
                German Medical Science GMS Publishing House
                1860-7446
                1860-3572
                15 August 2013
                2013
                : 30
                : 3
                : Doc31
                Affiliations
                [1 ]Klinikum der LMU München, Lehrstuhl für Didaktik und Ausbildungsforschung in der Medizin, München, Deutschland
                [2 ]Universitätsspital Basel, Innere Medizin, Psychosomatik, Basel, Schweiz
                Author notes
                *To whom correspondence should be addressed: Claudia Kiessling, Klinikum der LMU München, Lehrstuhl für Didaktik und Ausbildungsforschung in der Medizin, Ziemssenstraße 1, 80336 München, Deutschland, Tel.: +49 (0)89/5160-7203, Fax: +49 (0)89/5160-7202, E-mail: claudia.kiessling@ 123456med.uni-muenchen.de
                Article
                zma000874 Doc31 urn:nbn:de:0183-zma0008742
                10.3205/zma000874
                3778532
                24062811
                8d6a714b-198b-4d70-80ac-50c0aab1dce8
                Copyright © 2013 Kiessling et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by-nc-nd/3.0/). You are free to copy, distribute and transmit the work, provided the original author and source are credited.

                History
                : 14 February 2013
                : 02 May 2013
                : 29 April 2013
                Categories
                Article

                Medicine
                communication skills,longitudinal curriculum,undergraduate medical education,bologna process

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