[On call education for paediatricians may improve patient safety. Continuing professional development project in western Sweden evaluated]. / Bakjoursutbildning för barnläkare kan stärka patientsäkerheten - Fortbildningsprojekt utvärderas i Västra Götalandsregionen.

As part of a mandate to provide continuing professional development (CPD) for paediatricians in western Sweden and to support patient safety, we have addressed the professional demands which are imposed on today's consultant paediatricians on call, by designing and implementing a CPD programme for this group. Learning objectives for specific learning modules were developed from a pre-course needs assessment among consultants. The implemented programme included a variety of learning, assessment and evaluation methods. Each specific learning module began with a reading assignment exploring the key concept. This prepared the participants for the case discussion, in which they would analyse, reflect and achieve a deeper level of understanding. We believe that the educational methods used and the approach of the programme are applicable to specialist training as well as to CPD programmes in general, as part of a lifelong learning process.

Devising a competency-based continuing professional development programme to meet the needs of on-call consultant paediatricians.

AIM: To define the clinical competencies currently required by on-call consultant paediatricians in Sweden and to describe how these competencies can be acquired by using an outcome-based continuing professional development (CPD) programme. METHODS: The overall aims and objectives of the programme were formulated to meet the current responsibilities of an on-call consultant. It was delineated during a precourse needs assessment of 26 consultants, before being implemented with 16 participants, using a variety of learning, assessment and evaluation methods. RESULTS: The precourse needs assessment identified 217 clinical situations and 17 themes, and 139 subthemes were developed. During the programme evaluation, carried out using a reflective questionnaire, participants stated that they had improved their understanding of the role of, and demands on, the on-call consultant. They had also felt more confident on-call, had built a network of colleagues and updated their knowledge in relevant fields. CONCLUSION: We defined and implemented a competency-based CPD programme to meet the changing demands faced by on-call consultant paediatricians. The aims and objectives of the programme were formulated according to a needs assessment among consultant paediatricians active in on-call services. Evaluation of the programme indicates that participants moved in the direction of the overall objectives.

Is PHEEM a multi-dimensional instrument? An international perspective.

AIM: To look at the characteristics of Postgraduate Hospital Educational Environment Measure (PHEEM) using data from the UK, Brazil, Chile and the Netherlands, and to examine the reliability and characteristics of PHEEM, especially how the three PHEEM subscales fitted with factors derived statistically from the data sets. METHODS: Statistical analysis of PHEEM scores from 1563 sets of data, using reliability analysis, exploratory factor analysis and correlations of factors derived with the three defined PHEEM subscales. RESULTS: PHEEM was very reliable with an overall Cronbach's alpha of 0.928. Three factors were derived by exploratory factor analysis. Factor One correlated most strongly with the teaching subscale (R = 0.802), Factor Two correlated most strongly with the role autonomy subscale (R = 0.623) and Factor Three correlated most strongly with the social support subscale (R = 0.538). CONCLUSIONS: PHEEM is a multi-dimensional instrument. Overall, it is very reliable. There is a good fit of the three defined subscales, derived by qualitative methods, with the three principal factors derived from the data by exploratory factor analysis.

[Mini clinical evaluation exercise as evaluation tool of communicative and cooperative skills in the outpatient clinic]. / Mini-clinical evaluation exercise til evaluering af kommunikation og samarbejde i ambulatoriet.

INTRODUCTION: In the revised Danish medical specialist training increased focus has been placed on competences which are hard to evaluate such as communication skills. Mini-CEX seems promising as an evaluation tool. Our aim was to test: 1) whether mini-CEX was useable in the evaluation of communicative and cooperative skills and 2) whether mini-CEX would provide reproducible data. MATERIAL AND METHODS: Twenty-one residents were evaluated by mini-CEX by trained observers. Seventeen residents had at least two observations within a short period of time and these data were used to estimate the mini-CEX reproducibility. In addition to the residents, the nurses who assisted them in the outpatient clinic answered a questionnaire regarding the mini-CEX satisfaction. RESULTS: Observations had a median duration of 20 minutes (10-60 minutes) and the overall median duration of feedback was 15 minutes (5-60 minutes). Time used for feedback was halved from the first to the following feedback sessions. No significant clinical differences were observed between the scorings performed by the residents themselves and the observers, or the nurses of the outpatient clinic and the observers. In general, the residents were satisfied with the mini-CEX evaluations. CONCLUSION: The mini-CEX is a promising tool for the evaluation of communicative and cooperative skills.

[Learning "The Motivational Interview" in a simple way]. / Effekt af traening af erfarne sundhedsmedarbejdere i "den motiverende samtale".

INTRODUCTION: We wanted to explore if experienced doctors, nurses and dieticians could learn "The Motivational Interview" as developed by Botelho in a simple way. MATERIALS AND METHODS: 15 experienced doctors, nurses and dieticians took part. Our method was "learning by doing"--a 5-hour long workshop supported by IT-based learning material, followed by three months of work with own patients in diabetes care using the IT material for self study. RESULTS: Pre-tests and post-tests showed a statistically significant improvement of the use of the structure in this form of interview. CONCLUSION: It is concluded that this simple form of learning opportunity is effective for experienced health care personnel.

Radiotherapy and tamoxifen after mastectomy in postmenopausal women -- 20 year follow-up of the South Sweden Breast Cancer Group randomised trial SSBCG II:I.

AIMS: To evaluate long-term effects of radiotherapy and tamoxifen after mastectomy on recurrence and survival in stage II breast cancer. METHODS: A randomised phase III study with three treatment alternatives. (1) Radiotherapy 50 Gy/25 fractions to chest wall and regional lymph nodes (RT). (2) Radiotherapy and tamoxifen 30 mg/day for one year (RT+tam) and 3. Tamoxifen (tam). RESULTS: 724 postmenopausal women were included between 1978 and 1985 and the trial was close to population based. Follow-up for survival was 23 years. Locoregional recurrences were reduced from 18.5% in the tam arm to 5.3% in the RT+tam arm. Overall mortality at 20 years was 71% in the RT arm, 68% in the RT+tam arm and 62% in the tam arm. The difference between RT+tam and tam was not significant except in the receptor positive subgroup in favour of non-irradiated patients (p=0.047). The cumulative incidence of systemic disease at 20 years was lower in the RT+Tam arm than in the RT arm, 40% versus 50% (p=0.047). CONCLUSION: Postmastectomy radiotherapy significantly reduced loco-regional recurrences, but overall survival was not improved. At 20 years, a lower mortality was recorded for non-irradiated patients treated with tam.

[Effect of 13 hours of medical interview training in undergraduate medical education]. / Effekt af 13 timer lang traening af det medicinske interview i den praegraduate laegeuddannelse.

The effect of a preparartory course in the medical interview ("taking history") followed by four months of practice was studied by comparison of a sample of trained students with a large group of untrained students, using the ACIRS rating scale. The course was 13 hours, spread out over one month. Training methods were 2 demonstrations and 3 videorecordings of interviews with simulated patients followed by feedback. Untrained students had severe gaps in important professional communication skills. About half of the trained students filled in these gaps as a result of the training. It is concluded that a short preparatory course followed by clinical experience is not enough to secure necessary interviewing skills in most medical students.

[Communication skills training for medical students: from the simple to the complex]. / Traening i informationssamtalen for medicinstuderende: fra det enkle til det komplekse.

Communication skills training at the Medical School of Copenhagen University aims to teach students basic skills in both interviewing and giving information. The article describes a method whereby the students follow a general communication skills model for giving information. The training is conducted with simulated patients (actors). It begins with providing information about simple diagnostic or operative procedures and routine tests. These skills are also practiced in clinical courses on real patients, under supervision. Later on, the students are trained in breaking bad news, but with simulated patients only.

Which basic communication skills in medicine are learnt spontaneously and which need to be taught and trained?

Students in the last semester of medical school and experienced junior doctors with no or little training in communication skills were observed while interviewing or informing simulated patients. There was a remarkable similarity in behaviour between the two categories. Communication skills characteristic of common social conversation were learnt spontaneously, while important professional basic communication skills were not learnt despite 10 or more years of clinical work. These discrepancies and subsequent gaps should be the focus of future training courses at both pre- and postgraduate level.

[The interactive lecture. A simple form of student-activating learning]. / Den interaktive forelaesning. En simpel form for studenteraktiverende undervisning.

INTRODUCTION: Activation of students in lectures to enhance learning by means of questions to be answered in buzz groups has been described in pedagogic handbooks and articles. We tried the concept in three lectures in biochemistry in order to evaluate use of time, training requirements of the lecturer, and method acceptance by students. MATERIAL AND METHODS: The experiment was carried out with a group of 87 medical students from a 4th semester course in biochemistry. Evaluation was made by direct observation and analysis of quantitative and qualitative data from a student questionnaire. RESULTS: Buzz groups and questions took less time than anticipated and not more than ten minutes of the lecture time. The lecturer needed supervision from a colleague to function well. Acceptance of the procedure was high among the students. Qualitative data indicate that students used more time for self-studies and moved towards deep learning. DISCUSSION: We conclude that interactive lecture could be implemented without major problems in lecture based educational programmes and that it is useful for the learning of the students.

[Learning clinical skills]. / Student på klinisk ophold.

INTRODUCTION: The purpose of this study was to analyse the learning environment of medical students in a medical ward and on the basis of this study to make specific suggestions as to how the students' clinical stay in a ward can be optimized. These suggestions were implemented and the effect evaluated. MATERIAL AND METHODS: This is a qualitative study. Through observations and interviews with students and staff in the ward the learning environment was analysed. After that an evaluation of the implemented project was carried out in a questionnaire to the ward and in interviews with the persons involved in the project. RESULTS: The result of the study concerning analysis and improvement of the students' stay can briefly be summarized as follows: The students' position in the unit can be characterized as that of an observer rather than as an active working participant in the ward. With this there is a risk that the medical student's trainee stay in a ward will turn into a "work-experience placement", the primary purpose of which will be for the medical student just to dip into the profession. This has consequences for the students' learning process in securing that the students acquire the necessary practical qualifications and acquire essential personal qualifications, such as self-dependence and abilities in decision-making and working under pressure. DISCUSSION: The study shows that doctors and students agree on the aim of the students' trainee stay: To involve the students in a working partnership in order to obtain the best learning experience. The study concludes that it is difficult to change well-established routines despite good intentions of all parties involved. Therefore, the study rises the question on how new routines are established in the educational culture of medicine.