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Wollney EN, Vasquez TS, Stalvey C, Close J, Markham MJ, Meyer LE, Cooper LA, Bylund CL. Are evaluations in simulated medical encounters reliable among rater types? A comparison between standardized patient and outside observer ratings of OSCEs. PEC INNOVATION 2023; 2:100125. [PMID: 37214504 PMCID: PMC10194306 DOI: 10.1016/j.pecinn.2023.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 12/20/2022] [Accepted: 01/20/2023] [Indexed: 05/24/2023]
Abstract
Objective By analyzing Objective Structured Clinical Examination (OSCE) evaluations of first-year interns' communication with standardized patients (SP), our study aimed to examine the differences between ratings of SPs and a set of outside observers with training in healthcare communication. Methods Immediately following completion of OSCEs, SPs evaluated interns' communication skills using 30 items. Later, two observers independently coded video recordings using the same items. We conducted two-tailed t-tests to examine differences between SP and observers' ratings. Results Rater scores differed significantly on 21 items (p < .05), with 20 of the 21 differences due to higher SP in-person evaluation scores. Items most divergent between SPs and observers included items related to empathic communication and nonverbal communication. Conclusion Differences between SP and observer ratings should be further investigated to determine if additional rater training is needed or if a revised evaluation measure is needed. Educators may benefit from adjusting evaluation criteria to decrease the number of items raters must complete and may do so by encompassing more global questions regarding various criteria. Furthermore, evaluation measures may be strengthened by undergoing reliability and validity testing. Innovation This study highlights the strengths and limitations to rater types (observers or SPs), as well as evaluation methods (recorded or in-person).
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Affiliation(s)
- Easton N. Wollney
- Dept. of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Taylor S. Vasquez
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Carolyn Stalvey
- Dept. of Internal Medicine, College of Medicine, University of Florida, Gainesville, FL USA
| | - Julia Close
- Dept. of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Merry Jennifer Markham
- Dept. of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lynne E. Meyer
- Graduate Medical Education, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lou Ann Cooper
- Dept. of Medical Education, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Carma L. Bylund
- Dept. of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
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Bylund CL, Vasquez TS, Peterson EB, Ansell M, Bylund KC, Ditton-Phare P, Hines A, Manna R, Singh Ospina N, Wells R, Rosenbaum ME. Effect of Experiential Communication Skills Education on Graduate Medical Education Trainees' Communication Behaviors: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1854-1866. [PMID: 35857395 PMCID: PMC9712157 DOI: 10.1097/acm.0000000000004883] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE A better understanding of how communication skills education impacts trainees' communication skills is important for continual improvement in graduate medical education (GME). Guided by the Kirkpatrick Model, this review focused on studies that measured communication skills in either simulated or clinical settings. The aim of this systematic review was to examine the effect of experiential communication skills education on GME trainees' communication behaviors. METHOD Five databases were searched for studies published between 2001 and 2021 using terms representing the concepts of medical trainees, communication, training, and skills and/or behaviors. Included studies had an intervention design, focused only on GME trainees as learners, used experiential methods, and had an outcome measure of communication skills behavior that was assessed by a simulated or standardized patient (SP), patient, family member, or outside observer. Studies were examined for differences in outcomes based on study design; simulated versus clinical evaluation setting; outside observer versus SP, patient, or family member evaluator; and length of training. RESULTS Seventy-seven studies were ultimately included. Overall, 54 (70%) studies reported some positive findings (i.e., change in behavior). There were 44 (57%) single-group pre-post studies, 13 (17%) nonrandomized control studies, and 20 (26%) randomized control studies. Positive findings were frequent in single-group designs (80%) and were likely in nonrandomized (62%) and randomized (55%) control trials. Positive findings were likely in studies evaluating communication behavior in simulated (67%) and clinical (78%) settings as well as in studies with outside observer (63%) and SP, patient, and family member (64%) evaluators. CONCLUSIONS This review demonstrates strong support that experiential communication skills education can impact GME trainees' communication behaviors. Marked heterogeneity in communication trainings and evaluation measures, even among subgroups, did not allow for meta-analysis or comparative efficacy evaluation of different studies. Future studies would benefit from homogeneity in curricular and evaluation measures.
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Affiliation(s)
- Carma L Bylund
- C.L. Bylund is professor, Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Taylor S Vasquez
- T.S. Vasquez is a doctoral student, Department of Public Relations, College of Journalism and Communications, University of Florida, Gainesville, Florida
| | - Emily B Peterson
- E.B. Peterson is senior research analyst, University of Southern California, Los Angeles, California
| | - Margaret Ansell
- M. Ansell is associate university librarian and associate chair, Health Science Center Libraries, University of Florida, Gainesville, Florida
| | - Kevin C Bylund
- K.C. Bylund is associate professor, Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Philippa Ditton-Phare
- P. Ditton-Phare is medical education support officer (psychiatry), Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - April Hines
- A. Hines is journalism and mass communications librarian, George A. Smathers Libraries, University of Florida, Gainesville, Florida
| | - Ruth Manna
- R. Manna is associate director, Patient Experience Partnerships, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Naykky Singh Ospina
- N. Singh Ospina is associate professor, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Robert Wells
- R. Wells is science writer, Office of Research, University of Central Florida, Orlando, Florida
| | - Marcy E Rosenbaum
- M.E. Rosenbaum is professor, Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Velásquez ST, Ferguson D, Lemke KC, Bland L, Ajtai R, Amezaga B, Cleveland J, Ford LA, Lopez E, Richardson W, Saenz D, Zorek JA. Interprofessional communication in medical simulation: findings from a scoping review and implications for academic medicine. BMC MEDICAL EDUCATION 2022; 22:204. [PMID: 35346159 PMCID: PMC8962252 DOI: 10.1186/s12909-022-03226-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Interprofessional communication is fundamental to the delivery of healthcare and can be taught in medical school and other health professional schools through interprofessional education (IPE) activities. Simulation centers have become a predominant location for simulation IPE activities with infrastructure able to support high fidelity activities in a controlled environment. In this secondary analysis of a scoping review conducted on simulation-based IPE, we describe the characteristics of previously reported simulation IPE activities involving undergraduate medical students in a simulation center focused on interprofessional communication. METHODS Electronic searches of PubMed, CINAHL, and ERIC databases in accordance with PRISMA-ScR guidelines were conducted to isolate relevant articles from 2016-2020. In total, 165 peer-reviewed articles met inclusion criteria and data extraction linked to four research questions was applied by one individual and the accuracy was confirmed by a second individual. A secondary analysis was performed to describe what existing approaches for simulation IPE in simulation center settings have been used to explicitly achieve interprofessional communication competencies in undergraduate medical education. A sub-dataset was developed from the original scoping review and identified 21 studies describing simulation IPE activities that took place in dedicated simulation centers, targeted the IPEC interprofessional communication domain, and involved undergraduate medical students. RESULTS Though diverse, the majority of simulation IPE activities described high-fidelity approaches involving standardized patients and utilized assessment tools with established validity evidence in IPE activities to measure learning outcomes. A minority of simulation IPE activities were described as hybrid and utilized more than one resource or equipment for the activity and only two were longitudinal in nature. Learning outcomes were focused predominantly on modification of attitudes/perceptions and few targeted higher levels of assessment. CONCLUSIONS Educators charged with developing simulation IPE activities for medical students focused on interprofessional communication should incorporate assessment tools that have validity evidence from similar activities, target higher level learning outcomes, and leverage hybrid models to develop longitudinal simulation IPE activities. Though an ideal environment to achieve higher level learning outcomes, simulation centers are not required for meaningful simulation IPE activities.
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Affiliation(s)
- Sadie Trammell Velásquez
- Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
- South Texas Veterans Health Care System, Medicine Service, San Antonio, TX, USA.
- Department of Medicine, Division of Hospital Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
| | - Diane Ferguson
- Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- H-E-B Clinical Skills Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kelly C Lemke
- School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Leticia Bland
- School of Health Professions, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Rebecca Ajtai
- Briscoe Library, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Braulio Amezaga
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - James Cleveland
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Center for Simulation Innovation, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Lark A Ford
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Emme Lopez
- Briscoe Library, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Wesley Richardson
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Daniel Saenz
- Graduate School of Biomedical Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Joseph A Zorek
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Linking Interprofessional Networks for Collaboration (LINC), Office of the Vice President for Academic, Faculty & Student Affairs, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Augustine J, Thurston MM, Gates AW, Manigault KR. Comparing perceptions of student abilities in diabetes self-management education and support among students, faculty and patients. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:409-416. [PMID: 33715804 DOI: 10.1016/j.cptl.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 10/16/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND PURPOSE Diabetes self-management education and support (DSMES) equips patients with diabetes with the knowledge needed for appropriate management. The purpose of this study was to compare perceptions of student confidence/aptitude held by students, pharmacy faculty preceptors, and patients regarding student teaching of a DSMES class. EDUCATIONAL ACTIVITY AND SETTING The study was a prospective assessment of fourth-year ambulatory care advanced pharmacy practice experience students. Students taught a single DSMES class and evaluated their confidence using a 14-item survey before and after the class. Patients who participated in the class and a pharmacy faculty observer completed the same instrument. Responses were compared using Friedman and Wilcoxon signed-rank tests, as appropriate. FINDINGS Twenty-six students completed the survey. Overall, students' self-perceived confidence scores significantly increased for all questions after teaching the DSMES class (P < .001 for all questions). Confidence scores among students and faculty preceptors were similar with no significant differences in perceived confidence. There were some significant differences found among student and patient scores, with patients assessing student's perceived self-confidence higher than the students on three items (P < .05). SUMMARY Student pharmacists' perceptions of their own confidence and abilities improved from before to after teaching a DSMES class. Student and faculty preceptor confidence scores were similar. There were few differences between student and patient confidence scores, with patients rating students highly on their perceived confidence in teaching a DSMES class. Patient feedback is important to consider when evaluating student confidence and abilities.
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Affiliation(s)
- Jill Augustine
- Mercer University College of Pharmacy Department of Pharmacy Practice, 3001 Mercer University Drive, Atlanta, GA 30341, United States.
| | - Maria Miller Thurston
- Mercer University College of Pharmacy Department of Pharmacy Practice, 3001 Mercer University Drive, Atlanta, GA 30341, United States.
| | - Adam W Gates
- Atlanta Cancer Care, NE Float, 3400-C Old Milton Parkway, Suite 400, Alpharetta, GA 30005, United States
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Roshal JA, Chefitz D, Terregino CA, Petrova A. Comparison of self and simulated patient assessments of first-year medical students' Interpersonal and Communication Skills (ICS) during Objective Structured Clinical Examinations (OSCE). BMC MEDICAL EDUCATION 2021; 21:107. [PMID: 33596892 PMCID: PMC7887830 DOI: 10.1186/s12909-021-02540-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/04/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Interpersonal and communication skills (ICS) are important core competencies in medical education and certification. In this study, we identified self- and simulated patient (SP)-reported ratings of US first-year medical students' ICS and the influence of age and gender on performance appraisal during the Objective-Structured Clinical Examination (OSCE). METHODS OSCE participants, including 172 first-year medical students and 15 SPs were asked to evaluate the students' ICS using the American Board of Internal Medicine-Patient-Satisfaction Questionnaire (ABIM-PSQ), electronically and via paper, respectively. Self- and SP-reported ratings of students' ICS were presented as the median on a 5-point Likert-scale and as three categories defined as "good," "very good," and "inadequate." RESULTS SPs assessed all 172 students in the OSCE, while 43.6% of students assessed their own performance. The majority of students and SPs evaluated the students' ICS as very good. 23.3% of SPs and 5.3% of students rated the medical students' ability to encourage patient question-asking and answer questions as inadequate (P < 0.002). Neither age nor gender influenced the medical students' self-assessment of ICS. Female SPs assigned lower scores to students in regard to respecting patients and encouraging patient question-asking and answering. Older SPs was more likely to assign lower scores on all survey questions. CONCLUSIONS In the present study, self- and SP-reported ratings of first-year medical students' ICS were mainly "very good" with no influence of students' age or gender. Older age and female gender among the SPs were associated with a reduction in SP-reported ratings of students' ICS.
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Affiliation(s)
- Joshua A Roshal
- Rutgers Robert Wood Johnson Medical School, Medical Education Building, MEB 202, 125 Paterson Street, New Brunswick, NJ, 08901, USA
| | - Dalya Chefitz
- Rutgers Robert Wood Johnson Medical School, Medical Education Building, MEB 202, 125 Paterson Street, New Brunswick, NJ, 08901, USA
| | - Carol A Terregino
- Rutgers Robert Wood Johnson Medical School, Medical Education Building, MEB 202, 125 Paterson Street, New Brunswick, NJ, 08901, USA
| | - Anna Petrova
- Rutgers Robert Wood Johnson Medical School, Medical Education Building, MEB 202, 125 Paterson Street, New Brunswick, NJ, 08901, USA.
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Andersen BR, Hinrich JL, Rasmussen MB, Lehmann S, Ringsted C, Løkkegaard E, Tolsgaard MG. Social ties between team members affect patient satisfaction: a data-driven approach to handling complex network analyses. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:581-606. [PMID: 31691181 DOI: 10.1007/s10459-019-09941-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/28/2019] [Indexed: 06/10/2023]
Abstract
Research from outside the medical field suggests that social ties between team-members influence knowledge sharing, improve coordination, and facilitate task completion. However, the relative importance of social ties among team-members for patient satisfaction remains unknown. In this study, we explored the association between social ties within emergency teams performing simulated caesarean sections (CS) and patient-actor satisfaction. Two hundred seventy-two participants were allocated to 33 teams performing two emergency CSs in a simulated setting. We collected data on social ties between team-members, measured as affective, personal and professional ties. Ties were rated on 5-point Likert scales. In addition, participants' clinical experience, demographic data and their knowledge about team members' roles were surveyed. Perceived patient satisfaction was measured on a 5-point Likert scale. Data was analysed with a linear regression model using elastic net regularization. In total, 109 predictor variables were analysed including 84 related to social ties and 25 related to clinical experience, demographics and knowledge test scores. Of the 84 variables reflecting social ties, 34 (41%) had significant association with patient satisfaction, p < 0.01. By contrast, a significant association with patient satisfaction was found for only one (4%) of the 25 variables reflecting clinical experience, demographics and knowledge of team roles. Affective ties and personal ties were found to be far more important predictors in the statistical model than professional ties and predictors relating to clinical experience. Social ties between emergency team members may be important predictors of patient satisfaction. The results from this study help to enhance our conceptual understanding of social ties and their implications for team-dynamics. Our study challenges existing views of team-performance by placing emphasis on achieving collective competence through affective and personal social ties, rather than focusing on traditional measures of expertise.
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Affiliation(s)
- Betina Ristorp Andersen
- Department of Gynaecology and Obstetrics, North Zealand Hospital, University of Copenhagen, 3400, Hillerød, Denmark.
- Copenhagen Academy of Medical Education and Simulation, Capital Region of Denmark, 2100 Copenhagen, Denmark.
| | - Jesper Løve Hinrich
- Cognitive Systems, Department of Applied Mathematics and Computer Science, Technical University of Denmark, 2800, Lyngby, Denmark
| | - Maria Birkvad Rasmussen
- Department of Gynaecology and Obstetrics, Hvidovre Hospital, University of Copenhagen, 2650 Hvidovre, Denmark
| | - Sune Lehmann
- Cognitive Systems, Department of Applied Mathematics and Computer Science, Technical University of Denmark, 2800, Lyngby, Denmark
| | - Charlotte Ringsted
- Center for Health Science Education, Faculty of Health, Aarhus University, Vennelyst Boulevard 4, 8000, Aarhus, Denmark
| | - Ellen Løkkegaard
- Department of Gynaecology and Obstetrics, North Zealand Hospital, University of Copenhagen, 3400, Hillerød, Denmark
| | - Martin G Tolsgaard
- Copenhagen Academy of Medical Education and Simulation, Capital Region of Denmark, 2100 Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Rigshospitalet, University of Copenhagen, 2100, Copenhagen, Denmark
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Patel SA, Halpin RM, Keosayian DL, Streckfus CF, Barros JA, Franklin DR, Quock RL, Jeter CB, Franklin A. Impact of simulated patients on students' self-assessment of competency in practice of geriatric dentistry. J Dent Educ 2020; 84:908-916. [PMID: 32394449 DOI: 10.1002/jdd.12176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/15/2020] [Accepted: 04/25/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE The evaluation of the effectiveness of simulation training in dentistry has previously been focused primarily on psychomotor hand skills. This study explored the impact of simulated patient (SP) encounters in simulation on students' self-assessment of competency in their clinical and communication abilities with geriatric patients. METHODS Students from 2 cohorts were recruited for this study. Cohort 1 (n = 30) participated in the standard curriculum with no simulation training and served as the control group. Cohort 2 (n = 34) participated in a SP experience, simulating the initial stages of a care visit for 2 nursing home patients. Students' perceptions of competency to perform these clinical and communication tasks were assessed. A group debriefing session was held 5 weeks post-simulation where Cohort 2 completed a student feedback form. RESULTS A statistically significant change (P < 0.00001) was noted for both cohorts in their self-reported competence to perform clinical tasks following exposure to an independent clinical experience. In addition to this gain, individuals in Cohort 2 demonstrated improvements following simulation and expressed different responses of impact to questions related to treatment, pharmacology, and managing a complex medical history. CONCLUSIONS This study suggests that simulation of patient interactions using SPs can strengthen students' self-assessment of competency in their abilities, leading to more genuine interactions with actual patients. These findings will help inform the design of future SP encounters as a component of an evolving humanistic curriculum.
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Affiliation(s)
- Shalizeh A Patel
- Department of Restorative Dentistry & Prosthodontics, The University of Texas Health Science Center at Houston (UTHealth) School of Dentistry, Houston, Texas, USA
| | - Richard M Halpin
- Educational Technology, Office of Technology Services and Informatics, UTHealth School of Dentistry, Houston, Texas, USA
| | - Diana L Keosayian
- Institutional Effectiveness, UTHealth Office of Academic Affairs, Houston, Texas, USA
| | - Charles F Streckfus
- Department of Diagnostic and Biomedical Sciences, UTHealth School of Dentistry, Houston, Texas, USA
| | - Juliana A Barros
- Department of Restorative Dentistry & Prosthodontics, The University of Texas Health Science Center at Houston (UTHealth) School of Dentistry, Houston, Texas, USA
| | - Deborah R Franklin
- Department of General Practice and Dental Public Health, UTHealth School of Dentistry, Houston, Texas, USA
| | - Ryan L Quock
- Department of Restorative Dentistry & Prosthodontics, The University of Texas Health Science Center at Houston (UTHealth) School of Dentistry, Houston, Texas, USA
| | - Cameron B Jeter
- Department of Diagnostic and Biomedical Sciences, UTHealth School of Dentistry, Houston, Texas, USA
| | - Amy Franklin
- UTHealth School of Biomedical Informatics, Houston, Texas, USA
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Gude T, Tyssen R, Anvik T, Grimstad H, Holen A, Baerheim A, Vaglum P, Løvseth L. Have medical students' attitudes towards clinical communication skills changed over a 12- year period? A comparative long-term study. BMC MEDICAL EDUCATION 2020; 20:11. [PMID: 31924191 PMCID: PMC6954512 DOI: 10.1186/s12909-019-1915-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 12/19/2019] [Indexed: 05/02/2023]
Abstract
BACKGROUND Attitudes towards learning clinical communication skills at the end of medical school are likely to reflect the students' training and motivation for the continued development of their skills as doctors. Students from two Norwegian medical schools, one with a traditional, and the other with an integrated curriculum, were approached in 2003 and 2015; with regard to changes in students' attitudes towards acquiring communication skills in two diverse learning environments. This comparison might reveal the effects of the training programs from a long-term perspective, as neither of the medical schools made any major curriculum changes within the study period. METHODS The samples comprised final-year medical students. Two separate cross-sectional surveys performed 12 years apart (2003 and 2015) used items from the Communication Skills Attitude Scale in addition to age and gender. The traditional curriculum included only theoretical teaching and no contact with patients was made during the first 2 to 2.5 years of medical school. However, the integrated curriculum combined training in theoretical and clinical communication skills with early patient contact from the beginning. RESULTS Attitudes improved from the first to the second survey at both schools, however, students from the integrated school reported more positive attitudes than those from the traditional school. Female students from the integrated school contributed the most to the difference in attitudes in both surveys. CONCLUSIONS Students in both traditional and integrated curricula improved their attitudes from the first to the second assessment. However, compared with the traditional curriculum, the integrated one fostered even higher levels of positive attitudes towards acquiring communication skills, and a pronounced influence was observed on female students. These findings suggest that an educational program with greater emphasis on improving attitudes among male students may be required.
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Affiliation(s)
- Tore Gude
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, POB 1111 – Blindern, N-0317 Oslo, Norway
| | - Reidar Tyssen
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, POB 1111 – Blindern, N-0317 Oslo, Norway
| | - Tor Anvik
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Hilde Grimstad
- Department of Public Health and General Practice, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Are Holen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anders Baerheim
- Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Per Vaglum
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, POB 1111 – Blindern, N-0317 Oslo, Norway
| | - Lise Løvseth
- Dept. Research and Development, Division of Psychiatry, St Olavs’ University hospital, Box 3250 Torgarden, 7006 Trondheim, Norway
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Lor M, Vang X, Rabago D, Brown RL, Backonja M. “It Hurts as If…”: Pain-Associated Language, Visual Characterization, and Storytelling in Hmong Adults. PAIN MEDICINE 2019; 21:1690-1702. [DOI: 10.1093/pm/pnz268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AbstractObjectivePain is challenging to diagnose and manage in primary care, especially when patients have limited English proficiency (LEP). Little is known about whether LEP patients can provide pain information that is consistent with the process and the content that providers expect in a clinical interaction. We explore how LEP Hmong patients communicate their pain to providers in primary care settings.MethodsA qualitative study with 67 Hmong participants (63% female and x̄ age = 53.7 years) were recruited from a Midwestern state. Semistructured interviews on pain communication were conducted, audio-recorded, transcribed, and analyzed using directed content analysis.ResultsThe Hmong participants described pain using stories that generally had the same dimensions of information that providers require for pain assessment. These included references to time, causality, associated symptoms or related experiences, intensity, and consequences of pain. However, the participants expressed some pain dimensions in language that was not shared by providers: visual metaphors that were generally in reference to pain quality and fewer words for pain location, intensity, and some qualities. Participants used two strategies to decide whether they should tell their pain story: assessing the provider and determining whether their story was appreciated. The perception that providers underappreciated their stories resulted in dissatisfaction and undertreatment of pain. Ultimately, this resulted in having less frequent contact with providers or changing providers.ConclusionsFindings demonstrate a discordance in the expected process and content of the clinical interaction between LEP Hmong patients and providers, suggesting the need for culturally appropriate pain assessments in this population.
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Affiliation(s)
- Maichou Lor
- Columbia University School of Nursing, University of Wisconsin-Madison, School of Nursing, Madison, Wisconsin
| | - Xia Vang
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - David Rabago
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Roger L Brown
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin
| | - Miroslav Backonja
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Pilnick A, Trusson D, Beeke S, O’Brien R, Goldberg S, Harwood RH. Using conversation analysis to inform role play and simulated interaction in communications skills training for healthcare professionals: identifying avenues for further development through a scoping review. BMC MEDICAL EDUCATION 2018; 18:267. [PMID: 30453956 PMCID: PMC6245918 DOI: 10.1186/s12909-018-1381-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/05/2018] [Indexed: 05/09/2023]
Abstract
BACKGROUND This paper responds to previously published debate in this journal around the use of sociolinguistic methods in communication skills training (CST), which has raised the significant question of how far consultations with simulated patients reflect real clinical encounters. This debate concluded with a suggestion that sociolinguistic methods offer an alternative analytic lens for evaluating CST. We demonstrate here that the utility of sociolinguistic methods in CST is not limited to critique, but also presents an important tool for development and delivery. METHODS Following a scoping review of the use of role play and simulated interaction in CST for healthcare professionals, we consider the use of the specific sociolinguistic approach of conversation analysis (CA), which has been applied to the study of health communication in a wide range of settings, as well as to the development of training. DISCUSSION Role play and simulated interaction have been criticised by both clinicians and sociolinguists for a lack of authenticity as compared to real life interactions. However they contain a number of aspects which healthcare professionals report finding particularly useful: the need to think on one's feet in real time, as in actual interaction with patients; the ability to receive feedback on the simulation; and the ability to watch and reflect on how others approach the same simulation task in real time. Since sociolinguistic approaches can help to identify inauthenticity in role play and simulation, they can also be used to improve authenticity. Analysis of real-life interactions using sociolinguistic methods, and CA in particular, can identify actual interactional practices that are used by particular patient groups. These practices can then be used to inform the training of actors simulating patients. In addition, the emphasis of CA on talk as joint activity means that proper account can be taken of the way in which simulated interaction is co-constructed between simulator and trainee. We suggest that as well as identifying potential weaknesses in current role play and simulation practice, conversation analysis offers the potential to enhance and develop the authenticity of these training methods.
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Affiliation(s)
- Alison Pilnick
- School of Sociology and Social Policy, University of Nottingham, Nottingham, NG7 2RD UK
| | - Diane Trusson
- Institute for Mental Health, University of Nottingham, Nottingham, UK
| | - Suzanne Beeke
- Language and Cognition Research Department, University College London, London, UK
| | - Rebecca O’Brien
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah Goldberg
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Rowan H. Harwood
- School of Health Sciences, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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11
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Schreckenbach T, Ochsendorf F, Sterz J, Rüsseler M, Bechstein WO, Bender B, Bechtoldt MN. Emotion recognition and extraversion of medical students interact to predict their empathic communication perceived by simulated patients. BMC MEDICAL EDUCATION 2018; 18:237. [PMID: 30314497 PMCID: PMC6186136 DOI: 10.1186/s12909-018-1342-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/27/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND This study assessed the impact of medical students' emotion recognition ability and extraversion on their empathic communication, as perceived by simulated patients in a training context. METHODS This study used a crossed-effect data structure and examined 245 students in their fourth year of medical school. The students' personality traits were assessed based on a self-assessment questionnaire of the short form of the Big Five Inventory; their emotion recognition ability was measured using a performance test (Diagnostic Analysis of Nonverbal Accuracy-2, Adult Facial Expressions). Simulated patients evaluated the medical students' empathic communication. RESULTS Students with a combination of high emotion recognition ability and extraversion received more positive ratings from simulated patients than their fellow students with a combination of emotion recognition ability and low extraversion. The main effects of emotion recognition or extraversion were not sufficient to yield similar effects. There were no other effects related to the remaining Big Five variables. CONCLUSIONS The results support the hypothesis that to build rapport with patients, medical staff need to combine emotional capabilities with a dispositional interest in interpersonal encounters.
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Affiliation(s)
- Teresa Schreckenbach
- Department of General and Visceral Surgery, Frankfurt University Hospital, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Falk Ochsendorf
- Department of Dermatology, Frankfurt University Hospital, Frankfurt/Main, Germany
| | - Jasmina Sterz
- Department of Trauma Surgery, Frankfurt University Hospital, Frankfurt/Main, Germany
| | - Miriam Rüsseler
- Department of Trauma Surgery, Frankfurt University Hospital, Frankfurt/Main, Germany
| | - Wolf Otto Bechstein
- Department of General and Visceral Surgery, Frankfurt University Hospital, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Bernd Bender
- Department of Trauma Surgery, Frankfurt University Hospital, Frankfurt/Main, Germany
| | - Myriam N. Bechtoldt
- Department of Management & Economics, EBS University of Business and Law, Oestrich-Winkel, Germany
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Englar RE. Tracking Veterinary Students' Acquisition of Communication Skills and Clinical Communication Confidence by Comparing Student Performance in the First and Twenty-Seventh Standardized Client Encounters. JOURNAL OF VETERINARY MEDICAL EDUCATION 2018; 46:235-257. [PMID: 30285598 DOI: 10.3138/jvme.0917-117r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The American Veterinary Medical Association's Council on Education mandates that veterinary students graduate with competence in clinical communication. Communication competence facilitates the successful transition of students into clinical practice by improving veterinary client satisfaction and reducing the risk of litigation. Curricular experimentation with communications training has led to innovative approaches to this content area, including the adoption of standardized patients from human health care education. Although the use of standardized clients (SCs) is time and resource intensive, their use by veterinary educators has allowed students to work through authentic cases in a safe learning environment in which learner goals drive training. Despite the increasing popularity of SC-based communications curricula, outcomes assessment studies that track the resultant student growth are lacking. Ninety students in the inaugural class of 2018 at Midwestern University College of Veterinary Medicine participated in 27 SC encounters over eight consecutive quarters. Students' use of Calgary-Cambridge Guide communication skills was compared in the first and twenty-seventh encounters. On the basis of SC evaluations of student performance, students increased their use of all communication skills in the final encounter compared with baseline. Students were also more likely to take a comprehensive patient history, build rapport, and retain the client. Mean scores for pre- and post-encounter communication confidence, as self-reported by students, also increased. These findings support that a SC-rich curriculum facilitates student acquisition of communication skills and promotes confidence when students approach entry-level clinical tasks such as history taking.
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Álvarez I, Selva L, Medina JL, Sáez S. Using root metaphors to analyze communication between nurses and patients: a qualitative study. BMC MEDICAL EDUCATION 2017; 17:216. [PMID: 29145833 PMCID: PMC5689157 DOI: 10.1186/s12909-017-1059-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 11/03/2017] [Indexed: 05/17/2023]
Abstract
BACKGROUND Metaphors in communication can serve to convey individuals' backgrounds, contexts, experiences, and worldviews. Metaphors used in a health care setting can help achieve consensual communication in professional-patient relationships. Patients use metaphors to describe symptoms, or how disease affects them. Health professionals draw on shared understanding of such metaphors to better comprehend and meet patient needs, and to communicate information that patients can more easily integrate into their lives. This study incorporated a theoretical framework based on four worldviews, each with an underlying foundational metaphor (root metaphor). The use of these root metaphors (formism, mechanism, contextualism, and organicism) can have an explanatory function and serve to impart new meanings, as each type of metaphor can lead to a particular interpretation. The study aimed to extract and discuss the root metaphors, with a view to analyzing the communication between health professionals and patients. METHODS In a case study in Spain over a six-month period, we analyzed the content of recorded, transcribed interviews conducted by one nurse with 32 patients who had chronic illnesses. We inductively extracted five categories that emerged from the interviews: blood sugar, cholesterol, exercise, blood pressure, and diet. We then examined these categories from the standpoint of each of the four root metaphors using two approaches: A series (deductive) and an emergent (inductive) approach. RESULTS The results show that the nurse tended to primarily use two worldviews: mechanism and formism. In contrast, patients tended to favor mechanism when discussing cholesterol, blood pressure, and blood sugar levels, whereas contextualism was predominant when the category was diet or exercise. CONCLUSIONS This study adds to the existing literature on health professionals and patients' communication. It shows how the use of Pepper's root metaphors help to analyze the communication between the nurse and patients. Furthermore, it shows they are both using different root metaphors when they are talking about illness and treatments especially regarding blood sugar, cholesterol, exercise, blood pressure, and diet. Further qualitative and quantitative studies are needed to solidly these findings.
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Affiliation(s)
- Isabel Álvarez
- Philosophy and Science of Education, Autonomous University of Barcelona, Barcelona, Spain
- Department of Systematic and Social Pedagogy, Autonomous University of Barcelona, 08193 Bellatera, Cerdanyola del Vallès, Barcelona, Spain
| | - Laia Selva
- Biotechnology. Health Education, University of Lleida, Lleida, Spain
| | - José Luis Medina
- Philosophy and Science of Education, University of Barcelona, Barcelona, Spain
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Thomson FC, MacKenzie RK, Anderson M, Denison AR, Currie GP. Incorporating patient partner scores into high stakes assessment: an observational study into opinions and attitudes. BMC MEDICAL EDUCATION 2017; 17:214. [PMID: 29141624 PMCID: PMC5688703 DOI: 10.1186/s12909-017-1063-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 11/07/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Volunteer patients (also known as patient partners (PPs)) play a vital role in undergraduate healthcare curricula. They frequently take part in objective structured clinical examinations (OSCE) and rate aspects of students' performance. However, the inclusion and weighting of PP marks varies, while attitudes and opinions regarding how (and if) they should contribute towards the pass/fail outcome are uncertain. METHODS A prospective observational study was conducted to explore beliefs of PPs regarding inclusion of their scores in a high stakes undergraduate OSCE in a single UK medical school. All PPs delivering components of the local MBChB curriculum were asked to participate in the questionnaire study. Quantitative and qualitative data were analysed using descriptive statistics and framework analysis respectively. RESULTS Fifty out of 160 (31% response rate) PPs completed the questionnaire; 70% had participated in a final year OSCE. Thirty (60%) felt their marks should be incorporated into a student's overall score, while 28% were uncertain. The main reasons for inclusion were recognition of the patient perspective (31%) and their ability to assess attitudes and professionalism (27%), while reasons against inclusion included lack of PP qualification/training (18%) and concerns relating to consistency (14%). The majority of PPs were uncertain what proportion of the total mark they should contribute, although many felt that 5-10% of the total score was reasonable. Most respondents (70%) felt that globally low PP scores should not result in an automatic fail and many (62%) acknowledged that prior to mark inclusion, further training was required. CONCLUSION These data show that most respondents considered it reasonable to "formalise their expertise" by contributing marks in the overall assessment of students in a high stakes OSCE, although what proportion they believe this should represent was variable. Some expressed concerns that using marks towards progress decisions may alter PP response patterns. It would therefore seem reasonable to compare outcomes (i.e. pass/fail status) using historical data both incorporating and not incorporating PP marks to evaluate the effects of doing so. Further attention to existing PP training programmes is also required in order to provide clear instruction on how to globally rate students to ensure validity and consistency.
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Affiliation(s)
- Fiona C. Thomson
- The School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Rhoda K. MacKenzie
- The School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Marie Anderson
- The School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Alan R. Denison
- The School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Graeme P. Currie
- The School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD UK
- Clinic C, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN UK
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15
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Graf J, Smolka R, Simoes E, Zipfel S, Junne F, Holderried F, Wosnik A, Doherty AM, Menzel K, Herrmann-Werner A. Communication skills of medical students during the OSCE: Gender-specific differences in a longitudinal trend study. BMC MEDICAL EDUCATION 2017; 17:75. [PMID: 28464857 PMCID: PMC5414383 DOI: 10.1186/s12909-017-0913-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/22/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND Communication skills are essential in a patient-centred health service and therefore in medical teaching. Although significant differences in communication behaviour of male and female students are known, gender differences in the performance of students are still under-reported. The aim of this study was to analyse gender differences in communication skills of medical students in the context of an OSCE exam (OSCE = Objective Structured Clinical Examination). METHODS In a longitudinal trend study based on seven semester-cohorts, it was analysed if there are gender differences in medical students' communication skills. The students (self-perception) and standardized patients (SP) (external perception) were asked to rate the communication skills using uniform questionnaires. Statistical analysis was performed by using frequency analyses and t-tests in SPSS 21. RESULTS Across all ratings in the self- and the external perception, there was a significant gender difference in favour of female students performing better in the dimensions of empathy, structure, verbal expression and non-verbal expression. The results of male students deteriorated across all dimensions in the external perception between 2011 and 2014. DISCUSSION & CONCLUSION It is important to consider if gender-specific teaching should be developed, considering the reported differences between female and male students.
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Affiliation(s)
- Joachim Graf
- Medical Faculty Tuebingen, Dean’s Office for Students’ Affairs, Geissweg 5/1, D-72076 Tuebingen, Germany
- Department of Women’s Health, Research Institute for Women’s Health, University Hospital Tuebingen, Calwerstrasse 7, D-72076 Tuebingen, Germany
- Department of Women’s Health, University Hospital Tuebingen, Calwerstrasse 7, D-72076 Tuebingen, Germany
| | - Robert Smolka
- DRK Clinic Center Berlin, Hospital for Psychosomatic Medicine and Psychotherapy, Spandauer Damm 130, D-14050 Berlin, Germany
| | - Elisabeth Simoes
- Department of Women’s Health, Research Institute for Women’s Health, University Hospital Tuebingen, Calwerstrasse 7, D-72076 Tuebingen, Germany
- Department of Women’s Health, University Hospital Tuebingen, Calwerstrasse 7, D-72076 Tuebingen, Germany
- Staff Section Social Medicine, University Hospital Tuebingen, Hoppe-Seyler-Strasse 6, D-72076 Tuebingen, Germany
| | - Stephan Zipfel
- Medical Faculty Tuebingen, Dean’s Office for Students’ Affairs, Geissweg 5/1, D-72076 Tuebingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Internal Medicine, Osianderstrasse 5, D-72076 Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Internal Medicine, Osianderstrasse 5, D-72076 Tuebingen, Germany
| | - Friederike Holderried
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Tuebingen, Internal Medicine, Otfried-Müller-Strasse 10, D-72076 Tübingen, Germany
- Interdisciplinary Training Centre DocLab, Medical Faculty Tuebingen, Elfriede-Aulhorn-Strasse 10, D-72076 Tuebingen, Germany
| | - Annette Wosnik
- Medical Faculty Tuebingen, Dean’s Office for Students’ Affairs, Geissweg 5/1, D-72076 Tuebingen, Germany
| | - Anne M. Doherty
- Department of Psychiatry, University Hospital Galway, Galway, Ireland
| | - Karina Menzel
- Section of Public Health, University Hospital Duesseldorf, Moorenstrasse 5, D-40225 Duesseldorf, Germany
| | - Anne Herrmann-Werner
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Internal Medicine, Osianderstrasse 5, D-72076 Tuebingen, Germany
- Interdisciplinary Training Centre DocLab, Medical Faculty Tuebingen, Elfriede-Aulhorn-Strasse 10, D-72076 Tuebingen, Germany
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Vaglum P, Gude T. Re: Mot en nasjonal delprøve i medisinstudiet. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:783-4. [DOI: 10.4045/tidsskr.16.0383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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