Enhancing medical students' communication skills: development and evaluation of an undergraduate training program

<p>Abstract</p> <p>Background</p> <p>There is a relative lack of current research on the effects of specific communication training offered at the beginning of the medical degree program. The newly developed communication training "Basics and Practice in Communication Skills" was pilot tested in 2008 and expanded in the following year at the University Medical Centre Hamburg-Eppendorf in Germany. The goal was to promote and improve the communicative skills of participants and show the usefulness of an early offered intervention on patient-physician communication within the medical curriculum.</p> <p>Methods</p> <p>The students participating in the project and a comparison group of students from the standard degree program were surveyed at the beginning and end of the courses. The survey consisted of a self-assessment of their skills as well as a standardised expert rating and an evaluation of the modules by means of a questionnaire.</p> <p>Results</p> <p>Students who attended the communication skills course exhibited a considerable increase of communication skills in this newly developed training. It was also observed that students in the intervention group had a greater degree of self-assessed competence following training than the medical students in the comparison group. This finding is also reflected in the results from a standardised objective measure.</p> <p>Conclusions</p> <p>The empirical results of the study showed that the training enabled students to acquire specialised competence in communication through the course of a newly developed training program. These findings will be used to establish new communication training at the University Medical Centre Hamburg-Eppendorf.</p

Class Evolution Tree: a graphical tool to support decisions on the number of classes in exploratory categorical latent variable modeling for rehabilitation research

The aim of our study was to develop a graphical tool that can be used in addition to standard statistical criteria to support decisions on the number of classes in explorative categorical latent variable modeling for rehabilitation research. Data from two rehabilitation research projects were used. In the first study, a latent profile analysis was carried out in patients with cancer receiving an inpatient rehabilitation program to identify prototypical combinations of treatment elements. In the second study, growth mixture modeling was used to identify latent trajectory classes based on weekly symptom severity measurements during inpatient treatment of patients with mental disorders. A graphical tool, the Class Evolution Tree, was developed, and its central components were described. The Class Evolution Tree can be used in addition to statistical criteria to systematically address the issue of number of classes in explorative categorical latent variable modeling

Prädiktoren der stationären Behandlungsdauer von Patienten mit psychischen Störungen

Zusammenfassung Fragestellung: In einer systematischen Literaturanalyse werden patientenseitige Prädiktoren der stationären Behandlungsdauer psychischer Erkrankungen untersucht. Methode: Die Datenbanken Medline, Embase, Psyndex, PsycINFO und EBMR wurden systematisch nach Studien (1990-2009) zur stationären Behandlungsdauer bei Patienten mit den ICD-10 Diagnosen F3 - F6 durchsucht. Die Studien wurden hinsichtlich ihrer methodischen Qualität bewertet. Ergebnisse: Es wurden 21 Studien mit 28 untersuchten soziodemographischen und klinischen Prädiktoren in die Analyse einbezogen. Längere Behandlungszeiten finden sich bei allein lebenden Patienten sowie bei höheren Ausprägungen der Variablen Ausgangsbelastung, Krankheitsdauer, Anzahl der Vorbehandlungen, Arbeitsunfähigkeit und psychische Komorbidität. Zwangs-, Ess- und Persönlichkeitsstörungen werden länger behandelt als depressive, Angst-, somatoforme und Anpassungsstörungen. Uneinheitlich sind die Ergebnisse zu Alter, Geschlecht, Bildung und Beruf. Diskussion: Eine Zusammenfassung der Befunde wird durch die Heterogenität hinsichtlich Auswertungsverfahren, Art der Behandlung und untersuchten Patientengruppen erschwert. Bei zufriedenstellender methodischer Qualität der meisten Studien stellen die Ergebnisse erste Tendenzen dar, insgesamt wird ein hoher Forschungsbedarf deutlich. Abstract OBJECTIVES In a systematic literature review we examined patient-related predictors of inpatient treatment duration for mental disorders. METHODS The databases Medline, Embase, Psyndex, PsycINFO and EBMR were systematically reviewed for studies in the years 1990-2009 regarding treatment duration of inpatients with ICD-10 diagnoses F3-F6. Also, their methodological quality was evaluated. RESULTS Twenty-one studies examining 28 predictors (sociodemographic, clinical) were included. Longer treatment durations were found for patients living alone and with higher levels of initial symptom severity, duration of mental disorder, number of previous treatments, work absenteeism, and comorbidity. Obsessive-compulsive, eating and personality disorders were treated longer than depressive, anxiety, somatoform, and adjustment disorders. Results for age, gender, education, and profession were inconsistent. CONCLUSIONS The studies included heterogeneous analyses, treatments, and patients. Despite their sufficient methodical quality, these results are only tentative

Symptom change trajectories during inpatient psychotherapy in routine care and their associations with long-term outcomes

This study examined symptom change trajectories during inpatient psychotherapy and the association of these changes with long-term outcomes. In an observational multicenter study, weekly measurements of symptom severity were performed during inpatient treatment and 6 months after discharge. The symptom severity was measured using the 18-item scale of the Hamburg Modules for the Assessment of Psychosocial Health. The sample included 576 inpatients (mean age: 43.9 years; 77.6% female; main diagnoses: depressive (57.2%), adjustment (15.8%), anxiety (7.4%), and eating disorders (7.2%); mean treatment duration: 42.0 days). With empirically and clinically informed growth mixture models four subgroups of symptom change were revealed: gradual response (71%), early response (9%), delayed response (5%), and nonresponse (11%). Particularly low educational level, non-employment and chronic disorders were associated with unfavorable symptom courses (non- and delayed response). Long-term outcomes differed systematically across subgroups (p<0.001; η(2)=0.165). The patients who responded early presented the highest rates of clinically significant improvement (43.9%) from admission to follow-up. Nearly all of these patients (92.7%) showed reliable improvement. Due to the high association of symptom change trajectories with long-term outcomes, results may contribute to interventions that are tailored to the needs of patients and may foster longer lasting therapeutic effectiveness