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Communication(training) in medical curricula

Communication(training) in medical curricula. MM 2003 Pärnu. Tina Schweickert. I will talk about. Why is communication important? What are the problems caused by bad communication? Benefits of communication training Some examples for a training Some problems with the training.

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Communication(training) in medical curricula

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  1. Communication(training) in medical curricula MM 2003 Pärnu Tina Schweickert

  2. I will talk about... • Why is communication important? • What are the problems caused by bad communication? • Benefits of communication training • Some examples for a training • Some problems with the training

  3. What´s the point of communication?! (I) • History taking contributes 60-80% of the data for diagnosis.1-4 1. Hampton JR et al, Relative contributions of history taking, physical examination and laboratory investigation to diagnosis and management of medical out-patients. BMJ 1975;2:486-9 2. Sander G. The importance of the history in the medical clinic and the cost of unnecessary tests. American heart Journal 1980;100:928-31 3.Kassirer JP. Teaching clinical medicine by iterative hypothesis testin. New England Journal of Medicine 1983;309:921-3. 4. Peterson MC et al. Contribution of the history, physical examination and laboratory investigation in making diagnoses. The Western Journal of Medicine 1992;156:163-

  4. What´s the point of communication?! (II) • Providing information to the patient: -> but not the number of items told is important, but their significance to the patient Tuckett D, Williams A. , Social Science and Medicine 1984;18:571-80 -> more than 50% of the patients deviate from the doctors advice or do not follow it at all! 1. Sackett DL, Snow DC. The John;s Hopkins University Press 1979 2. DiMatteo MR, DiNicola DD. New York: Pergamon Press; 1982 3. Haynes B et al. The John;s Hopkins University Press 1979

  5. What about the quality of communication? • Dissatisfaction is expressed in studies: -> Doctors interrupt their patient´s opening statements after 18 seconds ->Patients don´t understand what the doctors explains -> advice is not always an answer to the patient´s question -> advice is too difficult to follow Beckmann HB, Frankell RM. Annals of Internal Medicine1984;101:692-6

  6. So what is good communication? • effective if both attribute the same meaning or significance to the words • doctor tries actively to understand the patient´s perspective: • situation • believes • point of view • worries • attributions • fears • doctor is able to share this understanding!!

  7. Results of improved communication: • increased satisfaction of patient1,2 • increased cooperation of patient3 • no increase of time spend with patients4 • decreased duration of treatment3, 5-7 • decrease duration of hospital stay8 • fewer request for painkillers9 • fewer malpractice suits10

  8. References 1.Eisenthal S, Lazare A, Udin H. Archives of General Psychiatry 1979;36:393-8 2. Eisenthal S, Lazare A. Journal of Mental Disease 1976;162:169-76 3. Steward MA. Social Sciences and Medicine 1984;19:167-75 4.Roter DL et al. Social Sciences and Medicine 1984;19:167-75 5. Steward MA. Canadian Medical Association Journal 1995;152:1423-33 6. Spiegel D, Bloom KR, Kraemer HC, Gottheil E. Lancet 1989;339:888-91 7. Little P, Williamson I, Warner G, Gould C, Gantle M, Kinmonth AL. BMJ 1997;314:722-7 8. Mumford E, Schlesinger HJ, Glass GV. American Journal of Psychological Health 1982;72:141-51 9. Egbert LD, Batitt GE, Welch CE. New England Journal of Medicine 1964;270:825-7 10. Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Journal of the American Medical Association 1997;277:553-9

  9. Studying- a risk for communication skills? Communication skills deteriorate during medical school!!1-4 • Helfer RE. Pediatrics 1970;45:623-7 • Poole AD, Sanson-Fisher RW. Social Science and Medicine 1979;13A:37-43 • Bishop JM, Fleetwood-Walker P, Wishard E, Swire H, Wright AD, Green ID. Medical Education 1998;32:283-8 • Pfeiffer C, Madray H, Ardolino A, Willms J. Medical Education 1998;32:283-8

  10. Studying- a risk for communication skills • students enter medical school as empathetic, unbiased listeners gaining knowledge difficult to integrate natural compassion and the task of discovering relevant facts

  11. therefore… • health care organisations have recommended communication skills training should be an integral part of any medical curriculum 1. GMC, Educational Committee. Tomorrow´s doctors. London: General medical council, 1993 2. AAMC. Report III. Contemprorary issues in medicine: Communication in medicine. Medical schools objectives project. Washington: Association of American Medical Colleges; 1999.

  12. Elementary findings about communication training: • any training is better than no training1,2 • training with practising is better than traditional methods alone3 • longitudinal training is better than concentrated training4 • there is no systematic difference in teaching by teachers of different disciplines5-9

  13. References • Maguire P, Fairbairn S, Fletcher C. BMJ 1986;292:1573-8 • Sanson-Fisher R, Fairbairn S, Maguire P, Medical Education 1981; 15:33-7 • Rutter DR, Maguire P. Lancet 1976; 225:558-60. • Flaherty JA. in : Rezler AG, Flaherthy A. editors. The Interpersonal dimension in Medical Education, Springer Verlag, New York 1985 • Quirck M, Letendre A. Journal of Medical Education 1986;61:603-5 • Lynch DJ, Tamburino MB, Nagel R. Medical Teacher 1992;14:59-64. • Levine JH.Teaching and Learning in Medicine 1995;5:77-8. • van Dahlen J, van Hout JCHM, Wolfhagen HAP, Scherpbier AJJA, van der Vleuten CPM. Medical Teacher 1999;21:308-10.

  14. The Maastricht Model • The program starts in the first year • groups of 10 students meet once every two weeks • simulated patient contact, recorded on video • fellow students and tutor give feedback • assessment : OSCE

  15. Problems • the model is impracticable and too time consuming in real -> rather a problem of organisation of healthcare! • limitation of simulated patients • not everything can be simulated • multiprofessional collaboration • cultural diversed society • changing health care with ageing population

  16. Development of the Training: • The teaching material was produced • An assessment tool was developed • Evaluation instrument was developed • Professionalisation of teacher training

  17. The Bergen Modell • 1 week intensive training during the 3rd year • group of 4-8 students • four patients a day

  18. longitudinal or concentrated? longitudinal trainings are more effective!

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