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The competent physical examination of patients and the safe and professional implementation of clinical procedures constitute essential components of medical practice in nearly all areas of medicine. The central objective of the projects “Heidelberg standard examination” and “Heidelberg standard procedures”, which were initiated by students, was to establish uniform interdisciplinary standards for physical examination and clinical procedures, and to distribute them in coordination with all clinical disciplines at the Heidelberg University Hospital. The presented project report illuminates the background of the initiative and its methodological implementation. Moreover, it describes the multimedia documentation in the form of pocketbooks and a multimedia internet-based platform, as well as the integration into the curriculum. The project presentation aims to provide orientation and action guidelines to facilitate similar processes in other faculties.

Background: A competency-based education approach calls for frequent workplace-based assessments (WBA) of Entrustable Professional Activities (EPAs). While mobile applications increase the efficiency, it is not known how many assessments are required for reliable ratings and whether the concept can be implemented in all sizes of residency programs.Methods: Over 5 months, a mobile app was used to assess 10 different EPAs in daily clinical routine in Swiss anesthesia departments. The data from large residency programs was compared to those from smaller ones. We applied generalizability theory and decision studies to estimate the minimum number of assessments needed for reliable assessments.Results: From 28 residency programs, we included 3936 assessments by 306 supervisors for 295 residents. The median number of assessments per trainee was 8, with a median of 4 different EPAs assessed by 3 different supervisors. We found no statistically significant differences between large and small programs in the number of assessments per trainee, per supervisor, per EPA, the agreement between supervisors and trainees, and the number of feedback processes stimulated. The average “level of supervision” (LoS, scale from 1 to 5) recorded in larger programs was 3.2 (SD 0.5) compared to 2.7 (SD 0.4) (p0.7, at least a random set of 3 different EPAs needed to be assessed, with each EPA rated at least 4 times by 4 different supervisors, resulting in a total of 12 assessments.Conclusion: Frequent WBAs of EPAs were feasible in large and small residency programs. We found no significant differences in the number of assessments performed. The minimum number of assessments required for a g-coefficient >0.7 was attainable in large and small residency programs.

Introduction: Graduate medical education is being reformed in many countries, with a focus on the principles of competency-based medical education (CBME). A main novel aspect in this context is the implementation of entrustable professional activities (EPAs). The introduction of EPAs aims to better align training curricula with clinical practice, provide individualized supervision, and enhance the quality of feedback.Project description: This project report presents the development of a national strategy and the initial results of implementing entrustable professional activities in the Swiss context.Results: Affiliated with the Swiss Institute of Medical Education (SIME), an EPA-Commission was established with the mandate to develop a strategy and provide guidance to medical specialty societies. To date, 28 out of 45 specialty societies have sought advice from the EPA-Commission and have begun developing EPAs. Concurrently, the Commission has expanded the national faculty development courses, adapted the content, started offering multilingual courses, and has published a series of articles on CBME and EPAs. Selected pilot hospitals are now planning to implement EPA-based graduate medical education curricula. Additionally, the introduction of a nationwide electronic solution (app) for assessing EPAs is planned.Conclusion: The introduction of EPAs in graduate medical education is a multilayered project. In addition to medical education aspects, various social, organizational, and professional-political factors are crucial for the transformation processes. In the Swiss context, such a reform has been successfully initiated. Continuous evaluations of the ongoing projects will provide further insights for competency-based graduate medical education reforms.

Purpose: This report describes the essential steps in the development, implementation, evaluation and quality assurance of the written part of the Swiss Federal Licensing Examination for Human Medicine (FLE) and the insights gained since its introduction in 2011.Methods: Based on existing scientific evidence, international expertise, and experience gained from previous examinations, the FLE is developed by experts from all five medical faculties in Switzerland with the support of the Institute for Medical Education and is held simultaneously at five locations. The exam organisers document and review every examination held and continuously optimise the processes; they have summarised the results in this report.Results: The essential steps comprise the development, revision and translation of questions; construction of the exam and production of materials; candidate preparation; implementation and analysis. The quality assurance measures consist of guideline coherence in the development of the questions and implementation of the exam, revision processes, construction of the exam based on the national blueprint, multiphase review of the translations and exam material, and statistical analysis of the exam and the comments from candidates. The intensive collaboration, especially on the part of representatives from all the participating faculties and a central coordination unit, which provides methodological support throughout and oversees the analysis of the exam, has proven successful. Successfully completed examinations and reliable results in the eleven examinations so far implemented represent the outcomes of the quality assurance measures. Significant insights in recent years are the importance of appreciating the work of those involved and the central organisation of exam development, thus ensuring the long-term success of the process.Conclusion: Common guidelines and workshops, quality assurance measures accompanied by the continuous improvement of all processes, and appreciation of everyone involved, are essential to carrying out such an examination at a high-quality level in the long term.

Background: The Corona pandemic has made it difficult to conduct face-to-face events, which is why two workshops planned for the development of multiple choice (MC) questions were conducted online. Whether the online format is suitable for MC question development has not yet been described to our knowledge. Questions: The study aimed to answer the following questions from the perspective of the participants: How are the two online workshops evaluated in terms of their implementation? Are these online workshops suitable for developing MC questions? Is the online or face-to-face format preferred? As a measure of efficiency, it was examined whether the expected question output (standard of comparable face-to-face workshops) was achieved in the online workshops.Methods: In May and June 2020, two online workshops with a total of 24 participants were conducted for Swiss professional societies with SWITCHinteract. The participants’ feedback was collected via an anonymous online survey with 21 questions.Results: 88% of the participants took part in the voluntary online survey. The participants were satisfied with the implementation and found the online format suitable. The majority of the participants did not show a preference for a certain format (online vs. face-to-face), although in case of a format preference the online format was indicated more often. The expected question output was exceeded in both workshops. Technical aspects were most frequently cited as requiring improvement. Conclusion: Based on the results, online workshops for MC question development can be considered as a resource-saving and efficient alternative to face-to-face workshops. Increased use and optimization of online tools could further facilitate implementation and influence the format preference.

Recent studies have suggested that aneuploidy in malignant tumours could be a consequence of centrosome aberrations. Using immunofluorescence analysis with an antibody against gamma-tubulin and DNA image cytometry, we measured centrosome aberrations and DNA ploidy patterns in fine-needle aspiration biopsies (FNABs) of 58 breast lesions. Benign lesions did not show any centrosome aberrations. DNA diploid carcinomas showed a mean percentage of cells with centrosomal defects of 2.1%. The aneuploid invasive carcinomas could be divided into two subgroups by their significantly (P=0.0003) different percentage of cells with centrosome aberrations (2.0 and 10.3%, respectively) and their significantly (P=0.0003) different percentage of cells with nonmodal DNA content values determined by the Stemline Scatter Index (SSI), a measure of genomic instability. The percentage of cells with centrosome aberrations demonstrated a positive, linear correlation with the corresponding SSI (r=0.82, P<0.0001) and loss of tissue differentiation (r=0.78, P<0.0001). Our results indicate the percentage of cells with centrosome aberrations as being sufficient to divide the investigated tumours into three significantly different groups: benign lesions with no centrosomal aberrations, and two malignant tumour types with mean values of 2.1 and 9.6% of centrosomal defects, respectively. Together, these results demonstrate that centrosome aberrations correlate with genomic instability and loss of tissue differentiation. Furthermore, this study shows the feasibility of centrosomal analysis in FNAB of the breast and suggests centrosomal aberrations as possessing diagnostic and prognostic value. [ABSTRACT FROM AUTHOR]

Introduction: Specialist medical assessments fulfil the task of ensuring that physicians have the clinical competence to independently represent their field and provide the best possible care to patients, taking into account the current state of knowledge. To date, there are no comprehensive reports on the status of specialist assessments in the German-speaking countries (DACH). For that reason, the assessment methods used in the DACH region are compiled and critically evaluated in this article, and recommendations for further development are described.Methods: The websites of the following institutions were searched for information regarding testing methods used and the organisation of specialist examinations: Further links were considered and the results were presented in tabular form. The assessment methods used in the specialist assessments are critically examined with regard to established quality criteria and recommendations for the further development of the specialist assessments are derived from these.Results: The following assessment methods are already used in Switzerland and Austria: written examinations with multiple choice and short answer questions, structured oral examinations, the Script Concordance Test (SCT) and the Objective Structured Clinical Examination (OSCE). In some cases, these assessment methods are combined (triangulation). In Germany, on the other hand, the oral examination has so far been conducted in an unstructured manner in the form of a ‘collegial content discussion’. In order to test knowledge, practical and communicative competences equally, it is recommended to implement a triangulation of methods and follow the further recommendations described in this article.Conclusion: While there are already accepted approaches for quality-assured and competence-based specialist assessments in Switzerland and Austria at present, there is still a long way to go in Germany. Following the recommendations presented in this article, a contribution could be made to improving the specialist assessments in the DACH region according to the specialist assessments objectives.

Introduction: Virtual Patients (VP) are electronic interactive patient cases. The aim of this PhD project was to explore how to improve the design and implementation of VPs to foster learning of clinical reasoning. Methods: This PhD report is based on five consecutive studies. Using focus groups among clerkship students, we explored design features of VP. A modified Delphi study among VP experts was used to establish a VP design typology. Validity evidence was established for a questionnaire to evaluate VP design from the student perspective. In student focus groups, we explored features on how to implement VP into a clerkship. Further, we explored students’ perception of different exam formats, in an assessment of a clerkship which includes learning with VP, by focus groups, and examined whether their psychometric properties differ. Results: Aspects to improve VP design: Aspects to improve VP implementation: Conclusion: Our results are in line with insights outside of VP research. Our studies demonstrate how VP can be designed, systematically further improved, and implemented to foster learning of clinical reasoning.

Aim: Virtual patients (VPs) are a one-of-a-kind e-learning resource, fostering clinical reasoning skills through clinical case examples. The combination with face-to-face teaching is important for their successful integration, which is referred to as “blended learning”. So far little is known about the use of VPs in the field of continuing medical education and residency training. The pilot study presented here inquired the application of VPs in the framework of a pediatric residency revision course. Methods: Around 200 participants of a pediatric nephology lecture (‘nephrotic and nephritic syndrome in children’) were offered two VPs as a wrap-up session at the revision course of the German Society for Pediatrics and Adolescent Medicine (DGKJ) 2009 in Heidelberg, Germany. Using a web-based survey form, different aspects were evaluated concerning the learning experiences with VPs, the combination with the lecture, and the use of VPs for residency training in general.Results: N=40 evaluable survey forms were returned (approximately 21%). The return rate was impaired by a technical problem with the local Wi-Fi firewall. The participants perceived the work-up of the VPs as a worthwhile learning experience, with proper preparation for diagnosing and treating real patients with similar complaints. Case presentations, interactivity, and locally and timely independent repetitive practices were, in particular, pointed out. On being asked about the use of VPs in general for residency training, there was a distinct demand for more such offers. Conclusion: VPs may reasonably complement existing learning activities in residency training.

Objective: Since 2011, the new national final examination in human medicine has been implemented in Switzerland, with a structured clinical-practical part in the OSCE format. From the perspective of the national Working Group, the current article describes the essential steps in the development, implementation and evaluation of the Federal Licensing Examination Clinical Skills (FLE CS) as well as the applied quality assurance measures. Finally, central insights gained from the last years are presented. Methods: Based on the principles of action research, the FLE CS is in a constant state of further development. On the foundation of systematically documented experiences from previous years, in the Working Group, unresolved questions are discussed and resulting solution approaches are substantiated (planning), implemented in the examination (implementation) and subsequently evaluated (reflection). The presented results are the product of this iterative procedure.Results: The FLE CS is created by experts from all faculties and subject areas in a multistage process. The examination is administered in German and French on a decentralised basis and consists of twelve interdisciplinary stations per candidate. As important quality assurance measures, the national Review Board (content validation) and the meetings of the standardised patient trainers (standardisation) have proven worthwhile. The statistical analyses show good measurement reliability and support the construct validity of the examination. Among the central insights of the past years, it has been established that the consistent implementation of the principles of action research contributes to the successful further development of the examination.Conclusion: The centrally coordinated, collaborative-iterative process, incorporating experts from all faculties, makes a fundamental contribution to the quality of the FLE CS. The processes and insights presented here can be useful for others planning a similar undertaking.

BackgroundE-learning and blended learning approaches gain more and more popularity in emergency medicine curricula. So far, little data is available on the impact of such approaches on procedural learning and skill acquisition and their comparison with traditional approaches. ObjectiveThis study investigated the impact of a blended learning approach, including Web-based virtual patients (VPs) and standard pediatric basic life support (PBLS) training, on procedural knowledge, objective performance, and self-assessment. MethodsA total of 57 medical students were randomly assigned to an intervention group (n=30) and a control group (n=27). Both groups received paper handouts in preparation of simulation-based PBLS training. The intervention group additionally completed two Web-based VPs with embedded video clips. Measurements were taken at randomization (t0), after the preparation period (t1), and after hands-on training (t2). Clinical decision-making skills and procedural knowledge were assessed at t0 and t1. PBLS performance was scored regarding adherence to the correct algorithm, conformance to temporal demands, and the quality of procedural steps at t1 and t2. Participants’ self-assessments were recorded in all three measurements. ResultsProcedural knowledge of the intervention group was significantly superior to that of the control group at t1. At t2, the intervention group showed significantly better adherence to the algorithm and temporal demands, and better procedural quality of PBLS in objective measures than did the control group. These aspects differed between the groups even at t1 (after VPs, prior to practical training). Self-assessments differed significantly only at t1 in favor of the intervention group. ConclusionsTraining with VPs combined with hands-on training improves PBLS performance as judged by objective measures.

Background: Malawi faces a severe lack of health workers. Despite initiatives to address this problem, a critical shortage of health care staff remains. This lack challenges the education and training of junior medical staff, especially medical interns in their final and crucial training year before they independently work as medical doctors.Project description: We have introduced an e-learning platform in the medical department of the Kamuzu Central Hospital (KCH) in Malawi. With the support of computer-assisted instruction, we aimed to improve the quality of medical training and education, as well as access to current medical materials, in particular for interns.Method: From March to April 2012, we conducted a qualitative evaluation to assess relevance and appropriateness of the e-learning platform. Data was collected via face-to-face interviews, a guided group discussion and a checklist based observation log. Evaluation data was recorded and coded using content analysis, interviewees were chosen via purposive sampling.Results: E-learning proved to be technically feasible in this setting. Users considered the e-learning platform to be relevant and appropriate. Concerns were raised about sustainability, accessibility and technical infrastructure, as well as limited involvement and responsibilities of Malawian partners. Interest in e-learning was high, yet, awareness of and knowledge about the e-learning platform among potential users was low. Evaluation results indicated that further adaptions to local needs are necessary to increase usage and accessibility.Conclusions: Interview results and our project experiences showed that, in the given setting, e-learning requires commitment from local stakeholders, adequate technical infrastructure, identification and assignation of responsibilities, as well as specific adaption to local needs.

[english] The aim of this paper, written by the committee of educational research methodology of the “Society for Medical Education” of the German-speaking countries, will give recommendations for the review process of scientific papers in medical education. The recommendations are based on the results of a workshop in 2007 and on a survey among reviewers of the journal GMS Z Med Ausbild. It reflects on international standards and research in medical education in Germany. The paper describes reviewer’s function concerning the journal of GMS Z Med Ausbild and specifies criteria for the review process with regard to the editors and reviewers; it also gives proposals for a feedback to the author. The catalogue of criteria for the reviewers is pictured in a checklist. The present recommendations shall help to increase the quality of the review process and to improve the national and international acceptance of the journal GMS Z Med Ausbild. Additionally, transparency of the review processes will support authors to submit a scientific article of high quality. [german] Ziel des vorliegenden Artikels des „Ausschusses für Methodik der Ausbildungsforschung“ der Gesellschaft für Medizinische Ausbildung ist, Empfehlungen für die Begutachtung von Manuskripten in der medizinischen Ausbildungsforschung vorzustellen. Die Empfehlungen basieren auf den Ergebnissen eines Workshops 2007 und einer Befragung von Gutachtern. Sie berücksichtigen darüber hinaus sowohl internationale Standards als auch die Situation der medizinischen Ausbildungsforschung in Deutschland. Es werden die Aufgaben eines Gutachters der GMS Z Med Ausbild dargelegt und Kriterien für den Begutachtungsprozess sowohl für die Herausgeber als auch für die Gutachter beschrieben. Sie enthalten außerdem Vorschläge für ein Autoren-Feedback. Der Kriterienkatalog für die Gutachter wird darüberhinaus in einer Checkliste abgebildet. Die vorliegenden Empfehlungen sollen dazu beitragen, die Qualität des Begutachtungsprozesses zu steigern und das nationale und internationale Ansehen der Fachzeitschrift GMS Z Med Ausbild zu verbessern. Die Transparenz des Begutachtungsprozesses dient den Autoren, einen qualitativ hochwertigen und anspruchsvollen Beitrag einzureichen.

Einleitung: Aufgrund der immer kürzer werdenden Liegezeiten von Patienten in den Universitätskliniken stehen immer weniger „echte“ Patienten für den Einsatz in der Lehre zur Verfügung. Virtuelle Patienten können in diesem Kontext als sinnvolle Ergänzung des Ausbildungsprogramms gesehen werden. Gleichwohl ist die Erstellung von virtuellen Patienten (VP) sehr aufwändig und deshalb kommt in letzter Zeit verstärkt der Wunsch auf, einmal erstellte virtuelle Patienten hochschulübergreifend, idealerweise auch systemübergreifend, in verschiedenen Lernumgebungen nutzen zu können. Eine Möglichkeit hierzu bietet das derzeit laufende eViP-Projekt [1]. Der Artikel versucht, die Schwierigkeiten bei der Entwicklung des beim eViP verwendeten MedBiquitous Virtual Patient Standard [2] zum Austausch virtueller Patienten, aber auch dessen Umsetzung im fallbasierten Trainingssystem CAMPUS [3], näher zu beleuchten. Methoden: Der MedBiquitous Virtual Patient Standard soll den Austausch zwischen unterschiedlichen VP-Systemen sicherstellen. Um den Austausch von virtuellen Patienten zwischen verschiedenen Systemen zu ermöglichen, müssen in einem ersten Schritt eigene virtuelle Patienten in den MedBiquitous Virtual Patient Standard exportiert und wieder importiert werden können. In einem zweiten Schritt ist der Im- und Export von virtuellen Patienten fremder Systeme vorgesehen. Ergebnisse: Alle beteiligten Partner beschäftigen sich derzeit noch mit dem Im- und Export eigener virtueller Patienten. Hierbei durchläuft der sich noch in der Entwicklung befindende Standard aktuell mehrere Iterationsschritte. Diskussion: Ein Standard zum Austausch von virtuellen Patienten ist nur sinnvoll, wenn mehrere Partnersysteme einen akzeptablen Im- und Export von virtuellen Patienten in diesen Standard anbieten. Aufgrund der didaktisch unterschiedlichen Ansätze und Konzepte der einzelnen Systeme wird ein Austauch von virtuellen Patienten jedoch nur mit Informationsverlusten möglich sein.

Einleitung: Elektronische virtuelle Patienten kommen in der medizinischen Ausbildung zunehmend zum Einsatz. Evaluationen zur umfassenden curricularen Einbindung dieser innovativen E-Learning-Programme liegen bisher nicht vor. Methoden: Virtuelle Patienten wurden entsprechend wichtiger didaktischer Prinzipien gestaltet und seit Jahren sowohl zum Lernen als auch Prüfen im Rahmen des regulären Unterrichts von Medizinstudierenden in der Kinderheilkunde eingesetzt. Dieses Projekt wurde anhand eines Fragebogens des Kompetenzzentrums E-Learning Baden-Württemberg (Ulm) evaluiert. Die Stichprobe bestand aus Studierenden des Pädiatrie-Moduls 4 (n=28), die dieses Modul an der Universität Heidelberg vom 25.6.–19.7.07 absolvierten. Ergebnisse: Der Rücklauf betrug 93%. Die Ergebnisse zeigten eine sehr hohe Akzeptanz, Relevanz und Anwenderfreundlichkeit, einen sehr hohen Grad der Integration in das Gesamtcurriculum und einen sehr guten Lernerfolg. Das Projekt erhielt aufgrund der Bewerbungsunterlagen und der Evaluationsergebnisse den 1. Platz des E-Learning-Preises Baden-Württemberg 2007. Diskussion: Die Stichprobe ist klein. Sie bestätigt jedoch die Ergebnisse vorangegangener systematischer Evaluationen mit großen Studierendenzahlen. Fazit: Die umfassende curriculare Einbindung virtueller Patienten wird von Studierenden als sinnvoll und das praxisnahe Lernen unterstützend angesehen.

[english] Introduction: Communicative competence is essential for daily medical routine. The usefulness of communication-trainings for physicians is described in various publications. However, specific trainings in paediatrics are rarely found. A characteristic for paediatric work is that the primary communication is not only with the patient – the child – but also with the parents. Beside self-assessment external assessment by parents can be used for evaluation of paediatrician’s communicative skills.Methods: 28 paediatric residents (intervention group n = 14; control group n = 14) of the University Children’s Hospital of Heidelberg took part in a communication training using standardised parents and -patients (SP), video recording and feedback by peers, SPs and supervisors. Data of self-evaluated communicative competence in contact with parents was collected from all participants before and after the training of the intervention group. In addition there was an assessment of parents’ satisfaction with the paediatricians-parents communication concerning their children’s treatment nine weeks before and nine weeks after the training (n = 248). A follow-up survey to record the transfer into clinical practice was conducted with the participants after six months.Results: After the training participants of the intervention group showed an increased feeling of communicative competence in reference to communicative situations that were explicitly practiced in the training. The external assessment by parents generally showed a positive evaluation of paediatricians’ communication skills. However, a group effect was not found. In the follow-up survey participants reported an improved self-perception and specific elements of the training that facilitated the daily clinical practice with parents and their children. Discussion: The training of specific relevant clinical situations lead to an increase in perceived communicative competence and competence in handling difficult encounters with parents. Communication trainings should be integrated not only into the medical student education but also into post-graduate education curricula. [german] Einführung: Kommunikative Kompetenzen sind wesentlich für den ärztlichen Alltag. In der Literatur wird vielfach der Nutzen von Kommunikationsschulungen für Ärzte beschrieben, über gezielte Schulungen für den Fachbereich Pädiatrie finden sich nur vereinzelt Berichte. Die Besonderheit der pädiatrischen Versorgung besteht dabei im Wesentlichen darin, dass nicht nur die Kommunikation zum Patienten – dem Kind –, sondern auch zu dessen Eltern oder Bezugspersonen eine entscheidende Rolle spielt. Zur Überprüfung kommunikativer Fähigkeiten von Pädiatern können neben Selbsteinschätzungen auch Fremdeinschätzungen durch Eltern dienen.Methode: 28 Assistenzärzte (Interventionsgruppe n = 14; Kontrollgruppe n = 14) der Universitätsklinik für Kinder- und Jugendmedizin in Heidelberg nahmen an einer Kommunikationsschulung teil. Diese beinhaltete Übungsgespräche mit standardisierten Eltern und -Patienten (SP), Videoaufzeichnungen sowie Feedback von SPs, Peers und Supervisoren. Daten zur Selbsteinschätzung der eigenen kommunikativen Kompetenz wurden vor und nach der Schulung der Interventionsgruppe von allen Teilnehmern erhoben. Weiterhin wurde neun Wochen vor und neun Wochen nach Abschluss der Schulung eine Elternbefragung bei n = 248 Eltern durchgeführt, in der die Zufriedenheit mit dem Arztkontakt hinsichtlich der Arzt-Eltern Kommunikation erfasst wurde. Nach 6 Monaten schloss sich eine Nachbefragung bei den Teilnehmern zum Transfer in den Klinikalltag an.Ergebnis: Bei den Teilnehmern der Interventionsgruppe zeigte sich im Gegensatz zur Kontrollgruppe nach Abschluss der Schulung eine signifikante Steigerung der subjektiven Kompetenzeinschätzung in Bezug auf die kommunikativen Situationen, die speziell in der Schulung trainiert wurden. Die Fremdeinschätzung durch die Eltern ergab eine generell sehr positive Bewertung der Ärzte, es ließ sich jedoch kein Gruppeneffekt nachweisen. Im Langezeitverlauf berichteten die Teilnehmer von einer verbesserten Selbstwahrnehmung und benannten konkrete Elemente der Schulung, die ihnen die tägliche klinische Arbeit im Kontakt mit Eltern erkrankter Kinder erleichterten.Diskussion: Das Training von spezifischen, für den klinischen Alltag typischen Situationen führt zu einer Verbesserung der Selbsteinschätzung kommunikativer Kompetenzen bezüglich des Umgangs mit schwierigen Situationen im Elternkontakt. Eine Integration von Kommunikationsschulungen nicht nur in das Medizinstudium, sondern auch in postgraduierte Ausbildungs-Curricula erscheint daher sinnvoll.

[english] Introduction: “Standardised patients” are finding increased application within medical training and have become an indispensable component of communication training for medical students. In the Anglo-American world, “standardised patients” are also employed in the postgraduate curriculum for resident physicians. In the German-speaking realm, however, there are currently no publications indicating the use of “standardised parents” in the specialist field of paediatrics. The basic recurring question concerning the extent to which training with “standardised parents” can be considered adequately realistic - a question which has already been raised in connection with the use of “standardised patients” - is of particular relevance in the case of highly experienced clinical staff. The degree to which feedback from “standardised parents” proves helpful in everyday clinical life also remains to be ascertained. Methods: In the current project, a communication training course involving “standardised patients”, who simulated the parents and caregivers of ill children, was carried out with residents of Heidelberg University Clinic for Paediatric and Adolescent Medicine. 28 Accident and Emergency were trained in dealing with problems and difficult situations arising in communication with parents. Following the physician-parent dialogue, the respective physician received feedback from the actors, fellow medical peers and supervisors. The authenticity of the cases and their relevance in the context of a realistic training course for communication skills was assessed by means of a questionnaire for participants. Additionally, participants evaluated the quality of the feedback received following the physician-parent dialogue. Results: Physicians considered the training cases to be extremely authentic and of relevance regarding both the improvement of communication skills and confidence in dealing with the parents of ill children. Feedback from actors (Likert scale: M = 1.08; SD = 0.28), from supervisors (M = 1.25; SD = 0.68) and medical peers (M =1.29; SD = 0.55) received very high ratings. Discussion: In the project presented here, the application of “standardised parents” represents a valuable tool which can be considered a suitable and obligatory component within a structured communication training course for paediatric residents. Furthermore, the employment of “standardised parents” could prove of interest in the context of graduate medical education. [german] Einführung: "Standardisierte Patienten“ (SP) sind simulierte Patienten, die sorgfältig und gewissenhaft trainiert wurden, um ihre erlernte Erkrankung in einer standardisierten und gleich bleibenden Art und Weise für didaktische Lehrzwecke zu präsentieren. SP werden in der Medizinischen Ausbildung zunehmend eingesetzt und sind inzwischen ein unverzichtbarer Bestandteil eines Kommunikationstrainings von Medizinstudenten. Auch für die Ausbildungscurricula von Assistenzärzten auf dem Weg zum Facharzt werden im angloamerikanischen Raum inzwischen SP eingesetzt. In der Pädiatrie wird die Verwendung von Schauspielern zu Schulungszwecken bisher nur vereinzelt beschrieben. Die wiederkehrende Frage nach einer ausreichenden Realitätsnähe und nach dem Nutzen ihres Feedbacks, wie sie bereits hinsichtlich des Einsatzes von SP aufgeworfen wurde, bleibt auch bei Schulungen mit "standardisierten Eltern“, bei denen der Patient - das Kind - gar nicht oder nur teilweise anwesend ist, bestehen. Methode: In dem vorliegenden Projekt wurde für 28 Ärzte der Universitätsklinik für Kinder- und Jugendmedizin Heidelberg mit einer mittleren Berufserfahrung von 4,2 Jahren ein Kommunikationstraining mit "standardisierten Eltern“ durchgeführt. Dazu wurden 13 Schauspieler anhand ausführlicher Rollenskripte für den Einsatz als „standardisierte Eltern“ trainiert. Die Auswahl der Schauspieler erfolgte aus einem umfangreichen Pool an erfahrenen Schauspieler, die bereits Vorerfahrung im Einsatz als "standardisierte Patienten“ hatten. Berufserfahrene pädiatrische Dienstärzte wurden anhand neun klinischer Szenarien im Umgang mit Problemen und schwierigen Gesprächssituationen im Kontakt mit Eltern erkrankter Kinder geschult. Im Anschluss an das Arzt-Eltern-Gespräch erhielten die trainierten Ärzte ein Feedback von den Schauspielern selbst, den teilnehmenden ärztlichen Kollegen ("peers“) sowie den Supervisoren der Unterrichtsveranstaltungen. Mittels einer schriftlichen Evaluation der Teilnehmer wurde die Authentizität der "standardisierten Eltern“ sowie die Relevanz der Fälle für eine praxisnahe Schulung hinsichtlich kommunikativer Fähigkeiten erfasst. Darüber hinaus wurde eine Einschätzung der Teilnehmer hinsichtlich der Qualität der nach dem Arzt-Eltern-Gespräch erhaltenen Feedbacks eingeholt. Ergebnis: Die Fälle der Schulungen wurden von den Ärzten als äußerst authentisch und relevant hinsichtlich der Verbesserung der eigenen kommunikativen Fertigkeiten und der Sicherheit im Umgang mit Eltern erkrankter Kinder gewertet. Die Teilnehmer bewerteten (sechsstufige Likert Skala:1 = und 6 = ) das Feedback der Schauspieler (Mittelwert (M) = 1,08; Standardabweichung (SD) = 0,28), der Supervisoren (M = 1,25; SD = 0,68) und der „peers“ (M =1,29; SD = 0,55) als etwa gleich relevant und nützlich. Diskussion: "Standardisierte Eltern“ werden von angehenden Fachärzten der Pädiatrie als sehr authentisch eingeschätzt. Das Feedback der "standardisierten Eltern“ wird als sehr hochwertig angesehen. Die Grundlage für diese Einschätzungen bildet eine fundierte Vorbereitung und Konzeption der Schulungsfälle sowie ein umfassendes Training der "standardisierten Eltern“ hinsichtlich der Feedbackgabe. Ein weitreichender Einsatz von "standardisierten Eltern“ wäre auch für die Ausbildung von angehenden Ärzten im Fachbereich Pädiatrie wünschenswert.