Development and piloting of a Situational Judgement Test for emotion-handling skills using the Verona Coding Definitions of Emotional Sequences (VR-CoDES)

Objective: Emotion-handling skills are key components for interpersonal communication by medical professionals. The Verona Coding Definitions of Emotional Sequences (VR-CoDES) appears useful to develop a Situational Judgment Test (SJT) for assessing emotion-handling skills. Methods: In phase 1 we used a multi-stage process with expert panels (npanel1 = 16; npanel2 = 8; npanel3 = 20) to develop 12 case vignettes. Each vignette includes (1) video representing a critical incident containing concern(s) and/or cue(s), (2) standardized lead-in-question, (3) five response alternatives. In phase 2 we piloted the SJT to assess validity via an experimental study with medical students (n = 88). Results: Experts and students rated most of the ‘Reduce space’ responses as inappropriate and preferred ‘Explicit’ responses. Women scored higher than men and there was no decline of empathy according to students’ year of study. There were medium correlations with self-assessment instruments. The students’ acceptance of the SJT was high. Conclusion: The use of VR-CoDES, authentic vignettes, videos and expert panels contributed to the development and validity of the SJT. Practice implications: Development costs were high but could be made up over time. The agreement on a proper score and the implementation of an adequate feedback structure seem to be useful

Entwicklung und Validierung eines Situational Judgement Tests zum Umgang mit Emotionen für Medizinstudierende

Die vorliegende Doktorarbeit widmet sich den übergeordneten Fragestellungen, wie ein Situational Judgement Test zur Prüfung des professionellen Umgangs mit Emotionen von Medizinstudierenden entwickelt und validiert werden kann und inwieweit dieses Prüfungsformat empathisches Verhalten voraussagen kann. In drei aufeinanderfolgenden Studien wurde ein computer-basierter Situational Judgement Test theoriegeleitet entwickelt (Studie 1), mit Medizinstudierenden der LMU München im Rahmen einer experimentellen Studie getestet (Studie 2), in Relation zu anderen Prüfungsformaten validiert und Empfehlungen für den curricularen Einsatz des Situational Judgement Test ausgesprochen (Studie 3). Die Ergebnisse der Studien 1 und 2 (Paper I) zeigen, dass VR-CoDES ein praktikables Rahmenmodell zur Entwicklung eines SJTs zur Messung der Empathiefähigkeit von Medizinstudierenden ist. Um Medizinstudierenden dabei zu helfen, professionelles empathisches Verhalten zu entwickeln, muss die Prüfungssituation realistische Kontexte nachbilden, welches wir mit einer vorgeschalteten qualitativen Interviewstudie erreichten. Wie sich des Weiteren herausstellte waren die Verwendung von authentischen Szenarien als Grundlage für die Fallvignetten, der Einsatz von Videos in einer online-basierten Lernplattform und das Heranziehen von Expertenpanels zur Entwicklung und Validierung des Tests sowie eines entsprechenden Scores, wichtige Komponenten zur erfolgreichen Entwicklung und Implementierung eines SJTs. Durch Studie 3 (Paper II) konnten wir uns einem Verständnis von ärztlicher Empathiefähigkeit und ihrer Messung annähern, indem wir verschiedene Instrumente, die die einzelnen Komponenten von Empathie abdecken, kombinierten. Wir stützten unsere Studie auf Definitionen und auf Instrumente, die im Bereich der medizinischen Ausbildung gut etabliert und validiert sind. Wir konnten zeigen, dass die Komponenten des multidimensionalen Empathie-Modells interkorreliert sind und nicht getrennt voneinander auftreten und, dass sich der von uns entwickelte SJT gut dazu eignet, die prozeduralen Wissensanteile von Empathie bei Medizinstudierenden zu messen. Die zwei von uns eingesetzten Scores (Experten-basiert und theoriebasiert) des SJTs sagten empathisches Verhalten im OSCE voraus. Durch unsere Empfehlungen für den Einsatz von verschiedenen Prüfungsinstrumenten zur Messung medizinischer Empathiefähigkeit konnten wir einen sinnvollen Beitrag zur zukünftigen Gestaltung von longitudinalen Medizincurricula leisten. Hier findet auch der von uns entwickelte SJT einen berechtigten Platz und kann einen wichtigen Anteil des multidimensionalen Konstrukts der ärztlichen Empathiefähigkeit valide abbilden

A Mixed Methods Assessment of the Management Role of Physicians

Introduction: Physicians are increasingly confronted with new requirements in their daily job, which go beyond the mere treatment of patients. The aim of this Mixed-Method-Study is to better understand management as it relates to physicians' daily work, to clarify the physicians' perception of their management role and to examine physician's self-assessed competence in these functions. Methods: We used three different instruments: Semi-structured interviews, a self-assessment survey and direct observations to evaluate managerial activities performed by residents. Both latter were based on instruments established for management research. Results: Interviewed residents were familiar with the term Management but had difficulties in defining it. Concerning managerial functions in context of their daily work, we identified three main categories: Self-management, Patient-management and Management of the ward. In this context, physicians named numerous examples of management tasks and for which they felt ill prepared. Eightyeight residents participated in the self-assessment survey and rated the majority of the management tasks as necessary for the residents' work. Although physicians estimated the proportion of managerial work to comprise only 40.6%, a much higher number of mere management tasks could be identified through direct observations (n = 12). Activities related to management were more often observed than genuine physician tasks.Discussion: This study illustrates the prominent role of management activities in context of the residents' work, while at the same time showing that residents do not feel sufficiently educated, prepared nor competent in management tasks

The role of the emotive, moral, and cognitive components for the prediction of medical students’ empathic behavior in an Objective Structured Clinical Examination (OSCE)

Objectives: Investigate whether medical students’ emotive abilities, attitudes, and cognitive empathic professional abilities predict empathic behavior in an Objective Structured Clinical Examination (OSCE). Methods: Linear and multiple regressions were used to test concurrent validity between Interpersonal Reactivity Index (IRI), Jefferson Scale of Physician Empathy (JSPE-S), Situational Judgement Test (SJT-expert-based score (SJT-ES), SJT-theory-based score (SJT-TS)) and empathic behavior in an OSCE measured by Berlin Global Rating (BGR) and Verona Coding Definitions for Emotion Sequences (VR-CoDES). Results: Highest amounts of explained variance of empathic behavior measured by VR-CoDES were found for the SJT-ES (R2 = 0.125) and SJT-TS (R2 = 0.131). JSPE-S (R2 = 0.11) and SJT-ES (R2 = 0.10) explained the highest amount of variance in empathic behavior as measured by BGR. Stepwise multiple regression improved the model for BGR by including SJT-ES and JSPE-S, explaining 16.2% of variance. Conclusions: The instrument measuring the emotive component (IRI) did not significantly predict empathic behavior, whereas instruments measuring moral (JSPE-S) and cognitive components (SJT) significantly predicted empathic behavior. However, the explained variance was small. Practice implications: The instrument measuring the emotive component (IRI) did not significantly predict empathic behavior, whereas instruments measuring moral (JSPE-S) and cognitive components (SJT) significantly predicted empathic behavior. However, the explained variance was small. In a longitudinal assessment program, triangulation of different instruments assessing empathy offers a rich perspective of learner's empathic abilities. Empathy training should include the acquisition of knowledge, attitudes, and behavior to support learner's empathic behaviors

Feedback in medical education - a workshop report with practical examples and recommendations

Background: As a teaching method, feedback is an integral part of medical education. However, there is a lack of a uniform theoretical basis or generally recognized guidelines for its specific design. Against this background, the aim of this article is to discuss conceptual considerations and empirical findings regarding feedback using various practical examples. Procedure and conceptual considerations: Building on the results of a workshop of the Committee for Communicative and Social Competences of the Society for Medical Education (GMA), this article first explains central conceptual considerations and empirical results on the topic of feedback. A particular focus is on various variables that influence the effect of feedback. This includes the feedback source, the frequency of feedback, starting points of feedback, the connection between feedback and reflection as well as the motivation and meta-cognitive skills of the feedback recipient. Practical examples: The implementation of feedback in practice is illustrated using eight examples from the field of medical and dental education. They stem from various settings and the focus is on formative oral feedback. It will become evident that the focus is more on the givers of feedback than the recipients of feedback. Instructions for recipients of feedback on how to reflect on it is still the exception. Discussion: Many of the relevant aspects for the effect of feedback described in the literature are already taken into account in the practical examples discussed. In conclusion, seven recommendations are made for implementing feedback in practice