The prescription talk - an approach to teach patient-physician conversation about drug prescription to medical students.

Background: Medication communication from physicians to patients often is poor, by this among others enhancing the risk of non-adherence. In this context, a neglect regarding the prescription talk has been complained. Aim of the project: In a newly developed elective medical students work on physician-patient conversations dealing with drug prescription. Essential aspects related to an effective and safe drug treatment are combined with steps of shared decision-making. Together with a tutor, students develop a (model) conversation guide that might be tailored according to individual needs and views. Description/Methods: In a one-week course 3rd-5th year medical students treat a paper case according to problem-based learning. This is accompanied by a one-hour lecture and literature provided on an online learning platform (ILIAS). During a workshop, aspects of drug treatment and patient participation are integrated into a guide for a prescription talk. At the end of the week the students are invited to apply the (if need be individualized) guide in a simulated physician-patient communication with an actor. The conversation is evaluated using a checklist based upon the (model) conversation guide. Results: Informal and formalized feedback indicate high acceptance and satisfaction of participants with this elective. The checklist turned out to be of acceptable to good reliability with mostly selective items. Portfolio entries and written evaluation suggest that participants' positions and attitudes are influenced.

Outcome-Relevant Effects of Shared Decision Making.

BACKGROUND: Shared decision making (SDM) is considered a gold standard for the cooperation of doctor and patient. SDM improves patients' overall satisfaction and their confidence in decisions that have been taken. The extent to which it might also positively affect patient-relevant, disease-related endpoints is a matter of debate. METHODS: We systematically searched the PubMed database and the Cochrane Library for publications on controlled intervention studies of SDM. The quality of the intervention and the risk of bias in each publication were assessed on the basis of pre-defined inclusion and exclusion criteria. The effects of SDM on patient-relevant, disease-related endpoints were compared, and effect sizes were calculated. RESULTS: We identified 22 trials that differed widely regarding the patient populations studied, the types of intervention performed, and the mode of implementation of SDM. In ten articles, 57% of the endpoints that were considered relevant were significantly improved by the SDM intervention compared to the control group. The median effect size (Cohen's d) was 0.53 (0.14-1.49). In 12 trials, outcomes did not differ between the two groups. In all 22 studies identified, 39% of the relevant outcomes were significantly improved compared with the control groups. CONCLUSION: The trials performed to date to addressing the effect of SDM on patient-relevant, disease-related endpoints are insufficient in both quantity and quality. Although just under half of the trials reviewed here indicated a positive effect, no final conclusion can be drawn. A consensus-based standardization of both SDM-promoting measures and appropriate clinical studies are needed.

The effect of undergraduate education in communication skills: a randomised controlled clinical trial.

PURPOSE: To determine whether students improve their communication skills as a result of supervised patient care and whether a newly implemented communication course could further improve these skills. METHOD: We conducted a randomised, controlled trial including all participants of the first clinical treatment course (n = 26) between October 2006 and February 2007. Randomisation was balanced by gender and basic communication skills. The test group practised dentist-patient communication skills in small groups with role-plays and videotaped real patient interviews, whereas the control group learned in problem-based workshops both on a weekly basis. Before and after the interventions (two group pre- and post-design) all students conducted two interviews with simulated patients. The encounters were rated using a 10-item checklist derived from the Calgary-Cambridge Observation Guide I. RESULTS: Repeated measures ANOVA (alpha = 0.05) showed a significant difference of the sum scores of the ratings between test and control group (P = 0.004). The participants educated in communication skills improved significantly (Delta = +14.9; P = 0.004), whereas in the control group no accretion of practical communication competence was observed (Delta = -3.9; P = 0.23). CONCLUSION: It could be demonstrated that solely interacting with patients during a clinical treatment course did not inevitably improve professional communication skills. In contrast, implementation of a course in communication skills improved the practical competence in dentist-patient interaction.

Improving informed consent of surgical patients using a multimedia-based program? Results of a prospective randomized multicenter study of patients before cholecystectomy.

OBJECTIVE: The term "informed consent" explains the process by which a patient, before treatment, is provided comprehensive and impartial information regarding a planned operative procedure so that he/she understands the implications of the procedure before consenting. The goal of the current study was to investigate whether standard methods of consenting can be improved using a multimedia-based information program (MM-IP). PATIENTS AND METHODS: In a prospective multicenter study, 80 patients undergoing laparoscopic cholecystectomy went through the standard informed consent process. One group of patients was also given access to a MM-IP. Questionnaires were completed before surgery. These evaluated how patients perceived their own understanding of important aspects of their illness (ie, disease, therapeutic alternatives, operation, risks) and satisfaction with the consenting process. Patients' anxiety levels were also assessed. These questionnaires were used to evaluate the effectiveness of the MM-IP for improving the consent process. RESULTS: Seventy-six patients (47 women, 29 men, median age 54 years) were included. There was no significant age or gender variation between the groups (standard n = 41 and MM-IP n = 35). Eighty-two percent of all respondents were satisfied with the standard informed consent process. However, perceived understanding of the material was significantly improved in the MM-IP group (P < 0.001). Patients with less formal education profited particularly from the MM-IP. Preoperative anxiety did not vary between the groups. CONCLUSION: Use of the multimedia-based program was positively evaluated by patients, and significantly improved patients' perceived understanding of their disease and its treatment. It is, therefore, valuable in the informed consent process.

A multimedia tool for the informed consent of patients prior to gastric banding.

OBJECTIVE: Severe obesity is a clear indication for appropriate, effective weight loss therapy. One option is operative intervention, e.g., gastric banding. Risks of the operation and therapeutic alternatives need to be comprehensibly presented to the patient. The literature has shown that better informed consent is obtained using information presented in a multimedia/video-based format. The current study developed and evaluated a multimedia program aimed at obtaining informed consent from obese patients before gastric banding. RESEARCH METHODS AND PROCEDURE: An interactive multimedia program was developed with information about preoperative examinations, the operation itself, hospital stay, operative risks, alternative therapies, and the pathophysiology and health risks of obesity. Two groups (Group 1, n = 20, mean age 38 years, informed consent attained with conventional document information; Group 2, n = 20, mean age 37 years, informed consent attained with additional multimedia information) were interviewed regarding comprehensibility of the information presented, personal satisfaction, and anxiety levels during the informed consent process. RESULTS: Group 2 showed significantly better (p < 0.05) understanding of the presented information and higher levels of satisfaction with the informed consent process. Anxiety levels did not significantly differ between the two groups. DISCUSSION: Because patient satisfaction with the informed consent process and understanding of the presented information significantly improved, the multimedia program clearly benefits both surgeons and patients. Personal contact from the surgeon remains essential. High volumes of information presented in multimedia format do not alleviate patient anxiety, and personal contact may be beneficial.

[Integrative psychosomatics: contributions to a reform of medical training]. / Integrierte Psychosomatik: Beiträge zu einer Reform des Medizinstudiums.

Medical training has so far mainly emphasised teaching of knowledge and neglected fostering of theoretical and practical competence in doctors' occupation. The consequences of these deficits are often experienced as "practice shock" when young doctors start working. New concepts of teaching moduls in psychosocial subjects may enhance medical competence. We present some of the contents and didactic concepts which we have implemented in the medical curriculum of Cologne University.