Writing letters to patients as an educational tool for medical students

BACKGROUND: Despite rapid growth and development of medical technology, personal relationship between the patient and physician remains the basis of high quality treatment. The aim of our study was to develop, implement and evaluate patient therapeutic letters written by students as a tool in teaching family medicine. METHODS: The study included all 6(th) year students attending their rounds in family medicine, structured into two 10-day cycles, one in urban offices and one in offices on the Adriatic islands (rural). After receiving detailed instructions, students wrote letters to two patients after a consultation in the office. The letters were audited by patients and 3 family medicine experts who used a grading instrument (scale 0 – poor, 1 – medium, 2 – good) for 1) adequacy and clarity of description of patients’ disease/state, 2) knowledge, 3) adequacy of recommendations, 4) courtesy and respect and 5) language and style. Patients and experts were also asked to underline phrases they thought would be difficult to understand; the underlined text was subjected to content analysis. RESULTS: Both the patients and the experts gave high scores for the value and quality of the letters in terms of the description of the problem, adequacy of recommendations given, and courtesy and respect (mean (±standard deviation) 5.65 ± 0.79 for patients vs. 4.87 ± 0.79 for experts out of maximum score of 6). Family medicine experts were stricter than patients in their evaluation of the content of the letters (adequacy and clarity of disease description (P < 0.001) and adequacy of recommendations (P < 0.001). Both the patients and the experts seemed to like longer letters as the length of the letter showed significant positive correlation with the quality summary score (correlation r = 0.492 vs. r = 0.338, respectively, P < 0.010). Overlapping of the text underlined as difficult to understand by patients and experts was found in 10 (11.6%) out of 86 letters. The highest overlap (20 terms) was found for the category “Technical terms unclear to a lay reader”. CONCLUSIONS: Writing of a letter to their first patients may be a useful tool for students to personally experience the practice of medicine and establish better partnership with patients in health care

Do we need the "adolescent crisis" diagnosis?

The aim of the study was to examine patients in adolescent crisis at the beginning of treatment and after a period of 12 months in order to evaluate the relative diagnostic and therapeutic validity. The study included 153 Split University students in adolescent crisis; 90 of them were treated by counseling and 63 served as controls. For diagnosis, Hampstead index and Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) multiaxial evaluation were used, allowing a wider insight into personal functioning. The study sample was split in 7 significantly different diagnostic subgroups. The counseling-treated examinees had better personality functioning after 12 months, but did not differ significantly from the control group. Some of their single functions were more severely disturbed at the very beginning. Counseling is a valuable therapeutic and diagnostic tool for adolescent crisis. The assessment must evaluate the entire person, because looking at only one aspect, due to different development and its place, a wrong conclusion may be reached. The "adolescents crisis" entity is clinically relevant