Curriculum factors influencing knowledge of communication skills among medical students

Background Communication training builds on the assumption that understanding of the concepts related to professional communication facilitates the training. We know little about whether students' knowledge of clinical communication skills is affected by their attendance of communication training courses, or to what degree other elements of the clinical training or curriculum design also play a role. The aim of this study was to determine which elements of the curriculum influence acquisition of knowledge regarding clinical communication skills by medical students. Methods The study design was a cross-sectional survey performed in the four Norwegian medical schools with different curricula, spring 2003. A self-administered questionnaire regarding knowledge of communication skills (an abridged version of van Dalen's paper-and-pencil test) was sent to all students attending the four medical schools. A total of 1801 (59%) students responded with complete questionnaires. Results At the end of the 1st year of study, the score on the knowledge test was higher in students at the two schools running communication courses and providing early patient contact (mean 81%) than in the other two medical schools (mean 69–75%, P ≤ 0.001), with students studying a traditional curriculum scoring the lowest. Their scores increased sharply towards the end of the 3rd year, during which they had been subjected to extensive patient contact and had participated in an intensive communication course (77% vs. 72% the previous year, P ≤ 0.01). All students scored generally lower in academic years in which there was no communication training. However, at the end of the final year the difference between the schools was only 5% (81% vs. 86%, P ≤ 0.001). Conclusion The acquisition of knowledge regarding communication skills by medical students may be optimised when the training is given together with extensive supervised patient contact, especially if this teaching takes place in the initial years of the curriculum

Integration of oncology and palliative care : a Lancet Oncology Commission

Full integration of oncology and palliative care relies on the specific knowledge and skills of two modes of care: the tumour-directed approach, the main focus of which is on treating the disease; and the host-directed approach, which focuses on the patient with the disease. This Commission addresses how to combine these two paradigms to achieve the best outcome of patient care. Randomised clinical trials on integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Early delivery of patient-directed care by specialist palliative care teams alongside tumour-directed treatment promotes patient-centred care. Systematic assessment and use of patient-reported outcomes and active patient involvement in the decisions about cancer care result in better symptom control, improved physical and mental health, and better use of health-care resources. The absence of international agreements on the content and standards of the organisation, education, and research of palliative care in oncology are major barriers to successful integration. Other barriers include the common misconception that palliative care is end-of-life care only, stigmatisation of death and dying, and insufficient infrastructure and funding. The absence of established priorities might also hinder integration more widely. This Commission proposes the use of standardised care pathways and multidisciplinary teams to promote integration of oncology and palliative care, and calls for changes at the system level to coordinate the activities of professionals, and for the development and implementation of new and improved education programmes, with the overall goal of improving patient care. Integration raises new research questions, all of which contribute to improved clinical care. When and how should palliative care be delivered? What is the optimal model for integrated care? What is the biological and clinical effect of living with advanced cancer for years after diagnosis? Successful integration must challenge the dualistic perspective of either the tumour or the host, and instead focus on a merged approach that places the patient's perspective at the centre. To succeed, integration must be anchored by management and policy makers at all levels of health care, followed by adequate resource allocation, a willingness to prioritise goals and needs, and sustained enthusiasm to help generate support for better integration. This integrated model must be reflected in international and national cancer plans, and be followed by developments of new care models, education and research programmes, all of which should be adapted to the specific cultural contexts within which they are situated. Patient-centred care should be an integrated part of oncology care independent of patient prognosis and treatment intention. To achieve this goal it must be based on changes in professional cultures and priorities in health care

Att finna sin plats i flödessamhället : En studie om identitet i regionaliseringens Europa

Syftet med uppsatsen har varit att med utgångspunkt i den regionaliseringsprocess som idag äger rum i Europa, undersöka samt analysera hur regionaliseringens förändrade drivkrafter påverkar människors möjlighet att identifiera sig med denna regionalisering. För att illustrera detta har en empirisk studie av Region Skåne ur ett aktörsperspektiv genomförts, där fokus har legat på att framhäva mänskliga aspekter som identitet i motsats till de ekonomiska beträffande EU:s utveckling och mål om sammanhållning. För att undersöka detta har intervjuer och litteraturstudier genomförts, där företrädare för Region Skåne samt Sydsvenska Industri- och Handelskammaren utgjort respondenter för intervjuerna. Undersökningens resultat har sedan i uppsatsens avslutande diskussion relaterats till teorier om flödessamhället, regionalisering och identitet. En för uppsatsen central konklusion är att bristen på medborgerlig förankring i regionaliseringsprocessen riskerar att skapa en polarisering mellan platsrum och flödesrum. Riskerna med denna polarisering ligger i att vi människor inte kan relatera till flödesrummet eftersom det är något som sker utanför den mänskliga identitetssfären

Turning Point on Climate Change?

Emergent Municipal Response in Sweden: Pilot Study. The pilot study indicates that the number of Swedish municipalities responding to the issue of climate change appears to be increasing. It also tells us, however, that only some of them are engaged in concrete action. Learning that, an important question arises, "Why are only some Swedish municipalities responding concretely, while the majority is not?" A companion question is, "Who, and what, have made the difference in that smaller group of municipalities?" The pilot study reported on here is a step in addressing those questions

Planning for Climate Change: The Adaptation Challenge

A Nordic Perspective. Conference Report. On September 11, 2007, a group of 70 practitioners, policymakers, researchers and other actors met in Helsinki to discuss one the most challenging and important issues on the current global agenda – climate change, and particularly adaptation to the effects of a changing climate. This conference, entitled, Planning for Climate Change: The Adaptation Challenge – A Nordic Perspective, organised by the Nordic Council of Ministers and Nordregio, Nordic Centre for Spatial Development, examined the challenges and opportunities inherent in climate change adaptation in the Nordic Countries and how planning and political processes can deal with these imperatives

Clinical evaluation of a photon-counting tomosynthesis

mammography syste