National train-the-trainer certificate programme for improving healthcare communication in Austria.

OBJECTIVES: In Austria a national train-the-trainer programme (TTT) has been developed, implemented and evaluated with the aim of training and certifying participants for developing, implementing and delivering communication skills training (CST) for health professionals. METHODS: The programme included 5 in-person courses, application homework with feedback, peer work, and regular trainer network meetings. Global satisfaction with training and changes in self-efficacy among TTT-participants and their learners in the CST delivered as practice projects were evaluated. RESULTS: 18 participants have graduated from the TTT-pilot. 98 people took part in the 9 CST delivered by TTT-participants. Participants' satisfaction has been rated very positively both for TTT and CST. At post-programme/post-training, statistically significant improvement was observed in self-efficacy for the TTT-participants and for the CST-participants. Additionally, valuable suggestions for programme/training improvement were identified. CONCLUSIONS: This programme is an important step to sustainably improving CST in Austria. To guarantee high quality and consistency, a set of standards for certification have been developed for TTT and CST. PRACTICE IMPLICATIONS: Implementation of best practices in training trainers and communication skills teaching can be guided by a structured approach. Those wanting to implement similar programmes can benefit from strengths and suggestions for improvement identified in this national project.

Upscaling communication skills training - lessons learned from international initiatives.

OBJECTIVE: To collect experiences and to identify the main facilitators and barriers for the implementation process of large scale communication training programs. METHODS: Using a multiple case study design, data was collected from leaders of the individual programs in Australia, Ireland, Austria and Denmark. The RE-AIM framework was used to evaluate the components: Reach, Effectiveness, Adoption, Implementation, and Maintenance of the programs. RESULTS: The programs, all based on the Calgary-Cambridge Guide, succeeded in reaching the intended target groups corresponding to between 446 and 3000 healthcare workers. New courses are planned and so far the outcome of the intervention has been investigated in two countries. The fact that implementation, including educating trainers, relies on a few individuals was identified as the main challenge. CONCLUSION: Large scale communication training programs based on the Calgary-Cambridge Guide can be implemented and adopted in multiple different healthcare settings across a national health system culture. The importance of standardized trainer education and adaption of the programs to clinical practice was highlighted. PRACTICE IMPLICATIONS: In order to address the sustainability of the programs and to allow the intervention to scale up, it is important to prioritise and allocate resources at the political and organizational level.

[From stand-alone solution to longitudinal communication curriculum--development and implementation at the Faculty of Medicine in Heidelberg]. / Von der Insellösung zum Longitudinalen Kommunikationscurriculum--Entwicklung und Implementierung am Beispiel der Medizinischen Fakultät Heidelberg.

At the Faculty of Medicine in Heidelberg, implementation of an interdisciplinary longitudinal curriculum was started in 2001 with the goal of achieving sustained promotion of communicative and clinical competences. The aim of this paper is to describe the development and implementation of Heidelberg's longitudinal communication curriculum. Furthermore, innovative aspects and strategies are discussed. The methodological approaches for development and implementation were Kern's "Six-step Approach" and a SWOT analysis. The process resulted in an innovative communication curriculum that starts with an integrated curriculum for developing clinical and communicative competence in the pre-clinical phase and continues in the clinical phase with medical communication and interactive training. Satisfaction with the communication curriculum and its effectiveness were rated highly by students. Residents who had graduated from Faculty of Medicine in Heidelberg rated the extent to which they had communicative competencies at the time of their graduation at their disposal significantly higher than residents who had graduated from the other 4 medical faculties in Baden-Württemberg. The experiences gained in Heidelberg can be applied by other faculties.

Introducing a curricular program culminating in a certificate for training peer tutors in medical education.

AIM: Student tutorials are now firmly anchored in medical education. However, to date there have only been isolated efforts to establish structured teacher training for peer tutors in medicine. To close this gap, a centralized tutor training program for students, culminating in an academic certificate, was implemented at Heidelberg University Medical School. The program also counts within the scope of the post-graduate Baden-Württemberg Certificate in Academic Teaching (Baden-Württemberg Zertifikat für Hochschuldidaktik). METHOD: Based on a needs assessment, a modular program comprised of four modules and a total of 200 curricular units was developed in cooperation with the Department for Key Competencies and Higher Education at Heidelberg University and implemented during the 2010 summer semester. This program covers not only topic-specific training sessions, but also independent teaching and an integrated evaluation of the learning process that is communicated to the graduates in the form of structured feedback. In addition, to evaluate the overall concept, semi-structured interviews (N=18) were conducted with the program graduates. RESULTS: To date, 495 tutors have been trained in the basic module on teaching medicine, which is rated with a mean overall grade of 1.7 (SW: 0.6) and has served as Module I of the program since 2010. A total of 17% (N=83) of these tutors have gone on to enroll in the subsequent training modules of the program; 27 of them (m=12, f=15) have already successfully completed them. Based on qualitative analyses, it is evident that the training program certificate and its applicability toward the advanced teacher training for university instructors pose a major incentive for the graduates. For successful program realization, central coordination, extensive coordination within the medical school, and the evaluation of the attained skills have proven to be of particular importance. CONCLUSION: The training program contributes sustainably to both quality assurance and professionalism, as well as to solving the issue of resources in medical education. The introduction and continued development of similar programs is desirable.

[Doctor-patient-communication in an oncological outpatient department. A linguistic study of communication problems]. / "Seitdem mir der Arzt gesagt hat 'Tumor' - Das war's." : Arzt-Patient-Kommunikation an der onkologischen Ambulanz. Eine sprachwissenschaftliche Pilotstudie zu Problemen der Verständigung.

Recognising and attending to patients' most relevant issues and main concerns are the basis for patient-oriented work. This qualitative study investigates the ways in which doctors communicate with their patients. The method of study is conversation and discourse analysis. The source of data are audio recordings of 20 introductory medical consultations in an oncological outpatient department in Austria. In a macro-analytical approach the duration of verbal contribution as well as the topics mentioned are analyzed. Results show that 34% of the consultation time is used for activities other than the actual doctor-patient-communication. Furthermore, the share of patients' verbal contribution was found to be half that of the doctor. Much room is given to information about chemotherapy, less is dedicated to topics like the stages of the illness and the hope for recovery. The micro-analytical approach shows that patients keep trying to allude to topics which are especially relevant to them. This happens very subtly and implicitly by means of interactional markings of relevance. These are communicative and interactive methods such as a change in volume or in speech patterns, the use of strong metaphors or hesitation phenomena. Doctors, however, often give insufficient attention to such initiatives from patients and follow their own, often institutionally-related, pre-requisites. Drawing on two examples, this article shows how insufficient attention to patient-relevant issues results in a lower quality of doctor-patient-communication, and lower satisfaction of patients and doctors. Two positive examples show that adequate attention to patient-relevant issues is possible and increases quality of doctor-patient-communication, as well as participants' satisfaction. It is argued that insufficient attention to patient-relevant issues also reduces time efficiency.