"It's Not that Easy"--Medical Students' Fears and Barriers in End-of-Life Communication.

This study aims to assess and improve communication education for medical students in palliative care (PC) with the use of simulated patients (SP) in Germany. More specifically, to explore how students evaluate the use of SP for end-of-life communication training and which fears and barriers arise. A pilot course was implemented. Qualitative content analysis was used to analyse transcribed recordings of the course. Pre- and post-course questionnaires containing open-ended questions ascertained students' motivation for participating, their preparation within their degree programme and whether they felt they had learned something important within the course. Seventeen medical students in their third to fourth year of education (age 22-31) participated in the five-session course and answered the questionnaires (pre n = 17, post n = 12). Students felt insufficiently prepared and insecure. Discussing end-of-life issues was experienced as challenging and emotionally moving. Within the conversations, although students sometimes showed blocking behaviour in reaction to emotional impact, they valued the consideration of emotional aspects as very important. The course was overall highly appreciated and valued as being helpful. The communication situation with the SP was perceived as authentic. Ten out of 12 students confirmed to have learned something important (post course). Our results indicate an urgent need for better communication training for medical students. Due to the fact that bedside teaching in PC is not feasible for all students, training with standardized SP can be a way to generate an authentic learning situation. Techniques to address fears and blocking behaviour should, however, also be considered.

[Multimedia learning program for medical consultation]. / Multimediales Lernprogramm zur ärztlichen Gesprächsführung.

To improve communicative competence during physicians' consultations, we developed a computer-assisted multimedia learning programme. This programme can be used in medical education as well as in continuing education for physicians. Dependent on individual skills and needs, the system, based on hypertext links, can be tailored to expand and improve communicative competence in a series of steps. The programme is based on a manual of medical interviewing and breaking bad news. The user gains information about theory and techniques of verbal intervention. He is trained to be able to reflectively observe and interactively intervene in video-taped and transcribed physician-patient dialogues. In a contrast-typological approach to model learning, in which negative and positive cases can be compared in a problem-based concept, alternative types of interventions can be recognised and evaluated. Finally, the learning goals in verbal intervention techniques should be subject of self-evaluation which can be objectified by further evaluations.

[Can problem-based learning help medical students to assimilate knowledge? Evaluation of a first semester course in medical psychology]. / Welche Fähigkeiten fördert problemorientiertes Lernen bei Studierenden der Medizin? Evaluation eines Erstsemester-Tutoriums "medizinische Psychologie".

Before the introduction of problem-based teaching and learning schemas, careful consideration must be given to the system devised for the evaluation of results. In the framework of a problem-based first-semester tutorial in medical psychology, certain interdisciplinary skills of prime importance to a doctor were tested to establish whether they were learnt more effectively by this approach than by traditional training methods. The experimental group was found to rank higher than controls in the following behavioural capacities: precise casework; differentiated approach to further treatment of patients; the ability to form hypotheses and to test them critically.

[Problem-based teaching and learning. An opportunity for medical psychology, psychosomatic medicine and psychotherapy?]. / Problemorientiertes Lehren und Lernen. Eine Chance auch für die Fächer Medizinische Psychologie, Psychosomatik und Psychotherapie?

All proposals for a reform of the study of medicine recommend problem-based teaching and learning methods. The rapid increase in the number of medical faculties abroad offering experimental courses along these lines is an indicator of their usefulness. The results of empirical research also suggest that departments of medical psychology, psychosomatic medicine and psychotherapy should participate more closely in the introduction and exploration of the advantages of this didactic approach.