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BackgroundMost people affected by depression or anxiety disorders are treated solely by their primary care physician. Access to specialized mental health care is impeded by patients’ comorbidity and immobility in aging societies and long waiting times at the providers’ end. Video-based integrated care models may leverage limited resources more efficiently and provide timely specialized care in primary care settings. ObjectiveThe study aims to evaluate the feasibility of mental health specialist video consultations with primary care patients with depression or anxiety disorders. MethodsParticipants were recruited by their primary care physicians during regular practice visits. Patients who had experienced at least moderate symptoms of depression and/or anxiety disorders were considered eligible for the study. Patients were randomized into 2 groups receiving either treatment-as-usual as provided by their general practitioner or up to 5 video consultations conducted by a mental health specialist. Video consultations focused on systematic diagnosis and proactive monitoring using validated clinical rating scales, the establishment of an effective working alliance, and a stepped-care algorithm within integrated care adjusting treatments based on clinical outcomes. Feasibility outcomes were recruitment, rate of loss to follow-up, acceptability of treatment, and attendance at sessions. Effectiveness outcomes included depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), burden of specific somatic complaints (Somatic Symptom Disorder-B Criteria Scale-12), recovery (Recovery Assessment Scale-German [RAS-G]), and perception of chronic illness care (Patient Assessment of Chronic Illness Care), which were measured at baseline and 16 weeks postallocation by assessors blinded to the group allocation. ResultsA total of 50 patients with depression and/or anxiety disorders were randomized, 23 in the intervention group and 27 in the treatment-as-usual group. The recruitment yield (number randomized per number screened) and the consent rate (number randomized per number eligible) were 69% (50/73) and 86% (50/58), respectively. Regarding acceptability, 87% (20/23) of the participants in the intervention group completed the intervention. Of the 108 planned video consultations, 102 (94.4%) were delivered. Follow-up rates were 96% (22/23) and 85% (23/27) for the intervention and control groups, respectively. The change from baseline scores at postmeasurement for the No Domination by Symptoms domain of recovery (RAS-G) was somewhat higher in the intervention group than in the control group (Mann-Whitney U test: rank-biserial r=0.19; 95% CI −0.09 to 0.46; P=.18). We did not detect any notable differences between the intervention and control groups in terms of other effectiveness outcomes. We did not observe any serious adverse events related to the trial. ConclusionsThe intervention and study procedures were found to be feasible for patients, primary care practice staff, and mental health specialists. A sufficiently powered pragmatic trial on mental health specialist video consultations should be conducted to investigate their effectiveness in routine care. Trial RegistrationGerman Clinical Trials Register DRKS00015812; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015812.

Aim: The seminar program of the KWBW Verbundweiterbildungplus® is offered by the Competence Center for Postgraduate Medical Education in Baden-Württemberg (KWBW) for physicians specializing in general practice (GP trainees). Attendance is a voluntary one comprised of 48 curricular units of 45 minutes each per GP trainee. This seminar program is meant to be attended in parallel to the postgraduate medical education in clinic or practice. The intention behind this project was to develop objectives, topics and a feasible structure for a seminar curriculum while taking time and financial constraints into account.Method: The Kern cycle was applied in an open, modified nominal group consensus technique in the form of an iterative process. Participating were 17 experts from the departments of general practice at the universities in Freiburg, Heidelberg, Tuebingen and Ulm, plus a pediatrician.Results: The main objective was defined as empowering GP trainees to independently provide high-quality primary care, including in rural areas. A basic curriculum was defined based on relevant frameworks, such as the 2018 Model Regulation for Postgraduate Medical Training (Musterweiterbildungsordnung/MWBO) and the Competency-based Curriculum General Practice (KCA). Overall, the seminar curriculum has 62 basic modules with 2 curricular units each (e.g. Basic Principles of General Practice, Chest Pain, Billing) and another 58 two-unit modules on variable topics (e.g. digitalization, travel medicine) adding up to 240 (124+116) curricular units. A blueprint with a rotation schedule for all of the teaching sites in Baden-Württemberg allows regular attendance by n=400 GP trainees over a period of five years, with individual variability in terms of program length.Conclusion: The model entails a five-year, flexible program to accompany the postgraduate medical education in general practice which can also be implemented in multicenter programs and those with high enrollments. The model’s focus is on acquisition of core competencies for general practice. Despite the current shift to eLearning seminars due to SARS-CoV, the program’s implementation is being continued, constantly evaluated, and used to further develop the KWBW Verbundweiterbildung® program.

Background: The task of the Competence Centers for vocational training (KW) is to increase the attractiveness and quality of vocational (=post-graduate) training in general practice. For this purpose, they offer, among other things, a structured seminar program for post-graduate trainees in general practice (GP-trainees). During the Covid-19 pandemic the seminar program of the KWBW-Verbundweiterbildung in Baden-Württemberg was converted to digital formats. The goal of the paper is to evaluate the acceptance by the GP-trainees and lecturers, to describe experiences with the conversion to e-learning and to derive recommendations with regard to the future orientation of seminar programs in post-graduate as well as continuing medical education. The implementation was based on a modified Kern-cycle and aimed at offering eight teaching units of 45 minutes each to a large number of GP-trainees. It tried to maintain the high quality of content and education as well as the interactive character of the previous seminars. For this purpose, the events were designed as synchronous webinars (six units) with asynchronous preparation and post-processing (two units) according to the flipped classroom method. The evaluation by the participating GP-trainees and lecturers was performed online using a multi-center developed and pre-piloted questionnaire.Results and discussion: N=101 GP-trainees participated in the evaluation of five individual seminar days in the second quarter of 2020 (response rate 97%). 58% (N=59) of the trainees were satisfied or very satisfied with the implementation. 82% (n=83) rated pre-tasks as helpful. 99% (n=100) would participate in an online seminar again. For 52% (n=53) of the trainees, the attitude towards e-learning had changed positively. The main advantages mentioned were no travel, save in time and costs as well as increased flexibility. The main disadvantages mentioned were less personal interaction and technical obstacles. The high acceptance of the new digital format showed the fundamental potential of e-learning in continuing medical education. The experiences can be a source of inspiration for other departments and KW. However, it also shows that important goals of KW, such as the personal interaction of the peer group, could not be achieved. In the future, it is important to develop a suitable mix of presence and digital formats with the aim to improve the attractiveness as well as sustainability of continuing medical education.

BackgroundMany patients with mental disorders remain untreated. Video-based mental health care demonstrates comparable effectiveness to face-to-face treatments and is a promising mode for delivering specialized care within primary care. Nevertheless, professionals struggle with implementing video consultations in their daily practice. Specifically, little is known about mental health specialists’ acceptance of mental health video consultations in routine practice. The PROVIDE (ImPROving cross-sectoral collaboration between primary and psychosocial care: An implementation study on VIDEo consultations) project aims to improve cross-sectoral collaboration between primary and psychosocial care through implementing video consultations in primary care. To increase the uptake of video consultations, it is crucial to account for necessary prerequisites and to tailor interventions to the needs of the target group prior to implementation. ObjectiveThe aim of this study was to explore the acceptance of video consultations embedded in primary care from the perspectives of mental health specialists in Germany. MethodsWe conducted a qualitative, exploratory, preimplementation study in urban and rural counties. We conducted three semistructured focus groups with 11 mental health specialists. We used qualitative content analysis combining an inductive-deductive approach, applying the Tailored Implementation in Chronic Diseases (TICD) framework to the text material, which comprises individual health professional factors; patient factors; professional interactions; incentives and resources; capacity for organizational change; social, political, and legal factors; and guideline factors. ResultsAgainst the background of long waiting times and a shortage of mental health specialists, especially in rural areas, participants valued video consultations as a potential means to improve access to mental health care. With respect to the TICD framework domains, the participants most often discussed individual health professional factors, followed by patient factors. All participants highlighted the importance of a trusting relationship between the patient and the therapist and doubted whether such a relationship could be established through video consultations (11/11, 100%). However, participants considered mental health specialist video consultations to be particularly suited for patients in rural areas, those with impaired mobility, and those who may otherwise remain untreated (6/11, 55%). Most participants expected video consultations to help the aforementioned patient groups avoid tedious searching for an available therapist and save on travel time and, therefore, improve access to specialized care for patients (7/11, 64%). Moreover, the participants expected video consultations to improve collaboration with the family physician (6/11, 55%). Finally, participants identified organizational aspects, such as reliable scheduling, the duration of the individual consultation (9/11, 82%), and reimbursement conditions (7/11, 67%), as key drivers for the acceptance and adoption of the model. ConclusionsWhile mental health specialists expect video consultations to improve access to specialized care for some patients, they consistently wonder whether such consultations can establish a trusting patient-therapist relationship. When implementing video consultations, these concerns should be addressed by training providers in managing technology-based treatment settings, with extra consideration for fostering the patients’ and therapists’ engagement. Trial RegistrationGerman Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one

BackgroundThe implementation of a personal electronic health record (PHR) is a central objective of digitalization policies in the German health care system. Corresponding legislation was passed with the 2015 Act for Secure Digital Communication and Applications in the Health Sector (eHealth Act). However, compared with other European countries, Germany still lags behind concerning the implementation of a PHR. ObjectiveIn order to explore potential barriers and facilitators for the adoption of a PHR in routine health care in Germany, this paper aims to identify policies, structures, and practices of the German health care system that influence the uptake and use of a PHR. MethodsA total of 33 semistructured interviews were conducted with a purposive sample of experts: 23 interviews with different health care professionals and 10 interviews with key actors of the German health care system who were telematics, eHealth, and information technology experts (eHealth experts). The interviews were transcribed verbatim and subjected to a content analysis. ResultsFrom the expert perspective, a PHR was basically considered desirable and unavoidable. At the same time, a number of challenges for implementation in Germany have been outlined. Three crucial themes emerged: (1) documentation standards: prevailing processes of the analog bureaucratic paper world, (2) interoperability: the plurality of actors and electronic systems, and (3) political structure: the lack of clear political regulations and political incentive structures. ConclusionsWith regard to the implementation of a PHR, an important precondition of a successful digitalization will be the precedent reform of the system to be digitized. Whether the recently passed Act for Faster Appointments and Better Care will be a step in the right direction remains to be seen.

Background: In face of the looming shortage of general practitioners, primary healthcare providers and post-graduate training in general practice are increasingly becoming part of the political agenda in Germany. In 2009 the program “Verbundweiterbildung Baden-Württemberg” (VWB BW) was developed by the Competence Center for General Practice in Baden-Wuerttemberg to ensure primary healthcare in the future by enhancing the attractiveness of general medicine. This paper describes the experiences that have been gathered in developing a post-graduate training-program for physicians undergoing specialist training in general practice.Project description: The Competence Center for General Practice in Baden-Wuerttemberg supports the organization of regional networks dedicated to post-graduate medical education. First core element of the VWB BW program is a special seminar series for physicians pursuing post-graduate training. This seminar program is aligned with the German competency-based curriculum in general medicine and is meant to promote medical expertise and other related competencies, such as business and medical practice management and communication skills. Mentoring and advising the physicians regarding professional and personal planning form the second core element. The third core element is seen in the train-the-trainer seminars that address the competencies of the trainers. In order to focus the program’s content closely on the needs of the target groups, scientifically based evaluations and research are carried out.Results: Since starting in 2009, 685 physicians have entered the program and 141 have passed the examination to become medical specialists (as of December 2016). In total, 31 networks, 60 hospitals and 211 general practices have participated. The seminar sessions have been rated on average with 1.43 on a six-point Likert scale by the physician trainees (1=extremely satisfied, 6=extremely dissatisfied). Alongside the medical training, these physicians viewed the exchange of information and experiences with other physicians as very positive and important. In 185 seminars lasting 90 minutes each, the seminar program has presently covered 250 out of 320 units in the competency-based curriculum for general medicine. A total of 281 trainers have been trained in 13 train-the-trainer courses and have rated this course on average with 1.36 on a six-point Likert scale. Above all, the trainers emphasized the exchange of information and experiences with other trainers as very positive. In 2013 the DEGAM concept for its Verbundweiterbildung program was developed based on that of the VWB BW. Since 2008 over 40 articles on the topic of post-graduate medical education have been published.Conclusion: The steadily increasing number of participants over the years demonstrates that the VWB BW is relevant for recent medical graduates and contributes to the attractiveness of general practice. The consistently excellent evaluations of the training program and the train-the-trainer course affirm the focus on the needs of the target groups. The post-graduate VWB BW program advances structured, competency-based and quality-oriented specialist training and fosters professional sharing between physicians – something that could also be relevant for other fields. The increasing numbers of participating physicians and specialists in general practice in Baden-Württemberg lead to the conclusion that the VWB BW program positively influences the number of general practitioners.

Introduction: This project report describes the development, “piloting” and evaluation of an interprofessional seminar on team communication bringing together medical students and Interprofessional Health Care B.Sc. students at the Medical Faculty of Heidelberg University, Germany.Project Description: A five-member interprofessional team collaborated together on this project. Kolb’s concept formed the theoretical foundation for the seminar, which explored three interprofessional competency areas: team work, communication and values/ethics. Evaluation for the purposes of quality assurance and future curricula development was conducted using two quantitative measures: Results: The key finding from the standardized course evaluation was that the interprofessional seminars were rated more positively [M=2.11 (1 most positive and 5 most negative), SD=1, n=27] than the monoprofessional seminars [M=2.55, SD=0.98, n=90]. The key finding from the UWE-IP-D survey, comparing pre and post scores of the interprofessional (IP) (n=40) and monoprofessional (MP) groups (n=34), was that significant positive changes in mean scores for both groups towards communication, teamwork and interprofessional learning occurred. Conclusions: Lessons learnt included: a) recognising the benefit of being pragmatic when introducing interprofessional education initiatives, which enabled various logistical and attitudinal barriers to be overcome; b) quantitative evaluation of learning outcomes alone could not explain positive responses or potential influences of interprofessional aspects, which highlighted the need for a mixed methods approach, including qualitative methods, to enrich judgment formation on interprofessional educational outcomes.

BackgroundThe integration of new information and communication technologies (ICTs) is becoming increasingly important in reorganizing health care. Adapting ICTs as supportive tools to users' needs and daily practices is vital for adoption and use. ObjectiveIn order to develop a Web-based personal electronic health record (PEPA), we explored user requirements and needs with regard to desired information and functions. MethodsA qualitative study across health care sectors and health professions was conducted in a regional health care setting in Germany. Overall, 10 semistructured focus groups were performed, collecting views of 3 prospective user groups: patients with colorectal cancer (n=12) and representatives from patient support groups (n=2), physicians (n=17), and non-medical HCPs (n=16). Data were audio- and videotaped, transcribed verbatim, and thematically analyzed using qualitative content analysis. ResultsFor both patients and HCPs, it was central to have a tool representing the chronology of illness and its care processes, for example, patients wanted to track their long-term laboratory findings (eg, tumor markers). Designing health information in a patient accessible way was highlighted as important. Users wanted to have general and tumor-specific health information available in a PEPA. Functions such as filtering information and adding information by patients (eg, on their well-being or electronic communication with HCPs via email) were discussed. ConclusionsIn order to develop a patient/user centered tool that is tailored to user needs, it is essential to address their perspectives. A challenge for implementation will be how to design PEPA’s health data in a patient accessible way. Adequate patient support and technical advice for users have to be addressed.

[english] Introduction: The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibility to spend one quarter of the internship, in the last year of their academic studies, in a practice of family medicine. The demonstrated teaching method aims at giving feedback to the student based on video recordings of patient consultations (student-patient) with the help of a checklist. Video-feedback is already successful used in medical teaching in Germany and abroad. This feasibility study aims at assessing the practicability of video-assisted feedback as a teaching method during internship in general practice. Teaching method: First of all, the general practice chooses a guideline as the learning objective. Secondly, a subsequent patient – student – consultation is recorded on video. Afterwards, a video-assisted formative feedback is given by the physician. A checklist with learning objectives (communication, medical examination, a structured case report according to the guideline) is used to structure the feedback content. Feasibility: The feasibility was assessed by a semi structured interview in order to gain insight into barriers and challenges for future implementation. The teaching method was performed in one general practice. Afterwards the teaching physician and the trainee intern were interviewed. The following four main categories were identified: feasibility, performance, implementation in daily routine, challenges of the teaching concept.The results of the feasibility study show general practicability of this approach. Installing a video camera in one examination room may solve technical problems. The trainee intern mentioned theoretical and practical benefits using the guideline. The teaching physician noted the challenge to reflect on his daily routines in the light of evidence-based guidelines. Conclusion: This teaching method supports quality control and standardizing of learning objectives during the internship in general practice by using general practice guidelines. The use of a checklist enhances this method in general practice. We consider the presented teaching method in the context of the planned modification of the Medical Licenses Act is part of quality control and standardisation of medical teaching during general practice internships. In order to validate these presumptions, further, evaluation of this method concerning the learning objectives using the guidelines of general practice need to be carried out.[german] Einleitung: Am Ende des Medizinstudiums in Deutschland findet ein klinischer Studienabschnitt, das Praktische Jahr (PJ), statt. Dieser teilt sich in drei Abschnitte von jeweils 16 Wochen. Verpflichtend sind die Fächer Innere Medizin und Chirurgie, zusätzlich wird ein Wahltertial absolviert. Neben anderen Fächern kann das Wahltertial auch in der Allgemeinmedizin absolviert werden. Die hier dargestellte Unterrichtsmethode zielt darauf ab, Videoaufnahmen von Konsultationen (PJ-Student – Patient) als Grundlage für ein strukturiertes Feedback des Lehrarztes an den Studenten zu nutzen.Die Fragestellung der vorgestellten Machbarkeitsuntersuchung ist es, die Umsetzbarkeit des Unterrichtskonzeptes im Praktischen Jahr in der Allgemeinmedizin zu evaluieren. Unterrichtsmethode: Zuerst wird als fachliche Grundlage eine allgemeinmedizinische Leitlinie ausgewählt. Anschließend wird ein PJ-Studierender-Patienten-Kontakt auf Video aufgezeichnet. Danach gibt der Lehrarzt anhand des Videos ein formatives Feedback. Der Lehrarzt wird durch eine Checkliste mit den wesentlichen Lernzielen (Kommunikation, körperliche Untersuchung, strukturierte Fallvorstellung in Bezug zur Leitlinie) unterstützt. Machbarkeit: Die Machbarkeit wurde mit einem semistrukturierten Interview bezüglich Barrieren und Chancen für den Implementierungsprozess evaluiert. In einer Praxis wurde die Unterrichtsmethode durchgeführt. Anschließend wurde mit dem Lehrarzt und der PJ-Studentin ein Interview geführt.Aus den Interviews mit dem Lehrarzt und der PJ-Studentin wurden diese vier Hauptkategorien gebildet: Machbarkeit, Durchführung, Implementierung in die Routine, Herausforderungen des Lehrkonzepts.Die Machbarkeitsuntersuchung zeigt eine generelle Umsetzbarkeit des Unterrichtskonzeptes. Die technischen Probleme können durch fest installierte Videosysteme in einem Praxisraum gelöst werden. Die PJ-Studentin erlebte die Beschäftigung mit der Leitlinie theoretisch und in der praktischen Umsetzung als einen fachlichen Gewinn. Die Lehrärzte können die Chance und Herausforderung nutzen, ihren Umgang mit den Leitlinien zu reflektieren. Schlussfolgerung: Die Videoaufzeichnung und das auf Checklisten basierte Feedback ermöglichen eine standardisierte Umsetzung ohne durch zu detaillierte Vorgaben einzuengen. Die Checklisten ermöglichen es, die Unterrichtsmethode breit umzusetzen. Die technischen Voraussetzungen können geschaffen werden. Die Realitätsnähe ermöglicht ein „Hereinwachsen“ in das Berufsfeld. Weitere Evaluationen, die sich mit den Lernzielen der symptomorientierten Leitlinien der Allgemeinmedizin beschäftigen, müssen noch folgen. Für die zukünftige Implementierung des Lehrkonzepts bedarf es einer weiteren konkreten Ausarbeitung der Checklisten für die einzelnen Leitlinien.

[english] Background: Since 2008 the Verbundweiterbildung programme of the Competence Centre General Practice Baden-Wuerttemberg offers continual improvement with regards to content and structure of general practice training. The programme uses the didactical concept of the CanMEDs competencies, which were developed in Canada, as a postgraduate medical training framework. Train the trainer (TTT)-programmes are an additional important element of these contentual optimisations of postgraduate training. Within this article we describe the conception and evaluation of the first TTT-workshop within the programme Verbundweiterbildung. Methods: The conception of the first TTT-workshop was influenced by results of a survey of general practitioner (GP) trainers and by experiences with teaching GP trainers involved in medical undergraduate teaching. A questionnaire was designed to get a self-assessment about organisational and didactic aspects oriented on the CanMEDs competencies of postgraduate medical training. In addition, the workshop was evaluated by the participants.Results: The workshop lasted 12 teaching units and included the following elements: introduction into the CanMEDs competencies, feedback training, fault management, legal and organisational aspects of post graduate training. From the 29 participating trainers 76% were male and on average 57 years old. The evaluation showed a good to very good acceptance of the workshop. Initial self-rating showed the need of improving in the fields of determining learning objectives, providing formative feedback and incorporation of a trainee. Most trainers rated themselves as very good in procure CanMEDs competencies with the exclusion of the competencies “Manager“ and “Scholar“. Conclusion: A TTT-programme is an important method to improve GP training which has not been used in Germany so far. Such a GP TTT-programme should highlight especially training in providing feedback and teaching in management aspects. Results of this article add information that can be used for developing TTT-programmes also in other specialties.[german] Zielsetzung: Das Programm Verbundweiterbildung des Kompetenzzentrums Allgemeinmedizin Baden Württemberg bietet seit 2008 strukturelle und inhaltliche Optimierungen für die Weiterbildung Allgemeinmedizin an. Das Programm orientiert sich am didaktischen Konzept der in Kanada entwickelten Kompetenzfelder der CanMEDs. Schulungen für Weiterbildungsbefugte, sogenannte „Train the Trainer (TTT) -Programme“, sind ein ergänzendes wesentliches Element einer inhaltlichen Optimierung der Weiterbildung. Der vorliegende Artikel beschreibt die Konzeption und Evaluation des ersten TTT-Workshops im Rahmen der Verbundweiterbildung. Methodik: Für die Konzeption des TTT-Workshops wurden Ergebnisse einer Umfrage bei Weiterbildungsbefugten sowie Erfahrungen aus Schulungen allgemeinmedizinischer Lehrpraxen herangezogen. Ferner wurde ein Fragebogen konzipiert, mit dem die Vorgehensweisen der Weiterbilder sowie deren Selbsteinschätzung, bestimmte Kompetenzen (orientiert am CanMEDs Modell) vermitteln zu können, abgefragt wurden. Ergänzend wurde die Veranstaltung evaluiert.Ergebnisse: Der Workshop war mit 12 Unterrichtseinheiten konzipiert und enthielt folgende Elemente: Einführung in die Kompetenzfelder der CanMEDs, Feedbacktraining, Fehlermanagement, rechtliche und organisatorische Aspekte der Weiterbildung. Es nahmen 29 Weiterbildungsbefugte (im Mittel 57 Jahre, 76% männlich) teil. Die Evaluationsergebnisse zeigen eine gute bis sehr gute Akzeptanz der Veranstaltung. Die eingangs durchgeführte Fragebogenerhebung zu den aktuellen Vorgehensweisen der Weiterbilder zeigt Optimierungsbedarf bei der Vereinbarung von Lernzielen, Feedbackgabe und der strukturierten Einarbeitung eines Arztes in Weiterbildung. Der überwiegende Teil der Weiterbildungsbefugten schätzt sich insgesamt als sehr gut in der Vermittlung von CanMEDs Kompetenzen ein, lediglich bei den Kompetenzfeldern „Praxismanagement“ und „Lehren und Lernen“ ist die Selbsteinschätzung etwas schwächer. Schlussfolgerungen: Für die Allgemeinmedizin können TTT-Programme eine wichtige, bisher in Deutschland ungenutzte Maßnahme darstellen, um die Weiterbildung zu optimieren. Ein TTT-Programm für Allgemeinmedizin sollte schwerpunktmäßig aus Feedbacktraining sowie Schulung in Aspekten des „Praxismanagements“ und „Lehren und Lernen“ bestehen. Die vorliegenden Ergebnisse können auch für die Entwicklung von TTT-Programmen für andere Gebiete genutzt werden.

[english] Objectives: A clinical practice guideline (CPG) contains specifically developed recommendations that can serve physicians as a decision aid in evidence-based practice. The implementation of heart failure (HF) CPGs represents a challenge in general practice. As part of the development of a tailored curriculum, aim of this study was to identify barriers of guideline adherence and needs for medical education (CME) in HF care.Methods: We conducted a modified focus group with elements of a workshop of three hours duration. Thirteen GPs collected and discussed together and parallel in smaller groups barriers of guideline implementation. Afterwards they performed a needs assessment for a tailored CME curriculum for chronic HF. The content of the discussions was analysed qualitatively according to Mayring and categorised thematically.Results: Barriers of guideline adherence were found in the following areas: doctor: procedural knowledge (knowledge gaps), communicative and organisational skills (e.g. time management) and attitude (dissatisfaction with time-money-relation). Patients: individual case-related problems (multimorbidity, psychiatric comorbidity, expectations and beliefs). Doctor and patient: Adherence and barriers of communication. Main measures for improvement of care concerned the areas of the identified barriers of guideline adherence with the focus on application-oriented training of the abovementioned procedural knowledge and skills, but also the supply of tools (like patient information leaflets) and patient education. Conclusion: For a CME-curriculum for HF tailored to the needs of GPs, a comprehensive educational approach seems necessary. It should be broad-based and include elements of knowledge and skills to be addressed and trained case-related. Additional elements should include support in the implementation of organisational processes in the practice and patient education.[german] Zielsetzung: Leitlinien zur Herzinsuffizienz (HI) enthalten systematisch entwickelte Empfehlungen, deren Umsetzung speziell in der hausärztlichen Praxis eine bekannte Herausforderung darstellt. Ziel der vorliegenden Studie war es, Barrieren bei der Umsetzung der Leitlinienempfehlungen zu identifizieren, Vorschläge zu Verbesserungsmaßnahmen der hausärztlichen Versorgung und für die Entwicklung einer bedarfsgerechten Fortbildung zu gewinnen.Methodik: Es wurde eine modifizierte Fokusgruppe mit Workshopcharakter durchgeführt. In drei parallelen Kleingruppen erarbeiteten 13 Hausärzte Barrieren bei der Leitlinienumsetzung zur HI. Darauf aufbauend wurde eine Bedarfsanalyse bzgl. der Lernziele und der spezifischen Verbesserungsmaßnahmen für eine hausärztliche Fortbildung zur HI durchgeführt. Die protokollierten Aussagen der Ärzte wurden mittels Inhaltsanalyse nach Mayring ausgewertet und anschließend thematisch kategorisiert.Ergebnisse: Als Barrieren der Umsetzung vorhandener Leitlinien nannten die teilnehmenden Ärzte arztseitige Defizite und Unterstützungsbedarf in den Dimensionen Wissen, kommunikativen und organisatorischen Fähigkeiten (z. B. Zeitmangel/-management) und der Haltung gegenüber Leitlinien (z.B. Faulheit). Den Patienten wurden individuelle, patientenbezogene Probleme (z.B. Komplexität des Einzelfalles bei Multimorbidität, psychische Komorbidität) sowie ablehnende Einstellungen (z.B. gegenüber „Schulmedizin“) zugeschrieben. Im Bereich der Arzt-Patient-Interaktion wurden u.a. mangelnde medikamentöse Adhärenz und Kommunikationsprobleme als Barrieren genannt. Vorschläge zu Verbesserungs- bzw. Schulungsmaßnahmen umfassten breit angelegte Schulungskonzepte (z.B. in interdisziplinären Qualitätszirkeln mit Fall-Audit), die neben der Vermittlung von Wissensaspekten aus einer (idealerweise einheitlichen) Leitlinie auch praktische Fertigkeiten hinsichtlich Arzt-Patienten-Kommunikation und Praxis-Organisation einschlossen. Die Bereitstellung praktikabler Arbeitsmaterialien und Patientenschulungen sollten aus Sicht der Teilnehmer die Arztschulungen ergänzen.Schlussfolgerung: Ein Fortbildungs-Curriculum für Hausärzte zur HI scheint einer umfassenden Leitlinienschulung zu bedürfen, in welchen insbesondere Handlungskompetenz und kommunikative Fertigkeiten anwendungsorientiert geübt werden sollten. Weitere Bestandteile sollten Hilfestellungen zur Implementierung von Organisationsabläufen und Patientenschulungen sein.

[english] Background: Ever since the last amendment to the German Medical Licensing Act took effect in 2002, medical students may complete four months of the Practical Year (PY) in general practices. Formative feedback between the teaching general practitioner (GP) and the PY student is a key element in creating a learning environment. GPs involved in teaching therefore need further education in giving feedback.Methods: A 4-hour feedback training session for GPs involved in teaching which used standardized patients and students was developed and tested in a pilot study. In role plays, GPs experienced feedback situations. Using an evaluation questionnaire, changes in self-perceived feedback skills were assessed (familiarity of feedback rules, preparation for giving feedback to PY students, possibilities to improve communication skills in doctor–patient situations).Results: Sixteen GPs who were involved or interested in PY teaching participated in the feedback training program. Afterwards, participants said they felt more comfortable in giving formative feedback and more assured in their communication skills. The confidence in their own feedback improved, especially by taking the student’s part in the role plays. An exercise between a standardized patient and a standardized stubborn student was a challenge, but proved to be extremely useful.Conclusion: The opinions of the participating GPs to the feedback training underscore its importance. Therefore, we recommend integrating such a feedback training program into the education of GPs involved in teaching.[german] Hintergrund: Seit der letzten Novelle der Approbationsordnung 2002 besteht die Möglichkeit, ein Tertial des Praktischen Jahres (PJ) in Hausarztpraxen zu absolvieren. Konstruktives Feedback zwischen Arzt und PJ-Studenten ist dabei ein zentrales Element in der Gestaltung des Lernumfeldes in der Arztpraxis. Es bedarf dahingehend einer Ausbildung der in die Lehre involvierten niedergelassenen Lehrärzte.Methoden: Es wurde ein vierstündiges Feedbacktrainingsprogramm mit standardisierten Rollenspielen für Lehrärzte in der Allgemeinmedizin entwickelt und in einem Pilotversuch umgesetzt. Mittels eines Evaluationsbogens wurde eine Selbsteinschätzung der Teilnehmer im Feedback durch einen Vorher-Nachher-Vergleich erfasst (Bekanntheit von Feedbackregeln, Vorbereitung auf Gesprächssituationen mit PJ-Studierenden, Verbesserungsmöglichkeiten der kommunikativen Fähigkeiten im Arzt-Patienten-Gespräch).Ergebnisse: 16 allgemeinmedizinisch tätige Ärztinnen und Ärzte, in PJ involviert bzw. daran interessiert, nahmen an dem Feedbacktraining teil. Die Teilnehmer waren ihrer eigenen Einschätzung folgend nach dem Training vertrauter mit formativem Feedback, ebenso im Umgang mit den eigenen kommunikativen Fertigkeiten. Das Selbstvertrauen in das eigene Feedback verbesserte sich vor allem durch die Selbsterfahrung in der studentischen Rolle. Die Kommunikationsübung zwischen einem Standardisierten Patienten und einem uneinsichtigen Standardisierten Studenten wurde als besondere Herausforderung, aber auch als sehr nützlich im Rahmen des Trainings angesehen.Schlussfolgerung: Die Rückmeldungen der allgemeinmedizinisch tätigen Teilnehmer zum Feedbacktraining bestätigen unseren Ansatz. Wir empfehlen daher die Integration eines solchen Feedbacktrainings in die Ausbildung von Lehrärzten im Fach Allgemeinmedizin.

Background: Many patients diagnosed with cancer use complementary and integrative healthcare (CIH) approaches to manage their cancer- and treatment-related symptoms and improve their well-being. Evidence suggests that counseling on CIH can improve health outcomes and decrease healthcare costs by increasing patient activation. This qualitative study explores the experiences of cancer patients who underwent interprofessional counseling on CIH to gain insights into how these patients were able to integrate recommended CIH measures into their daily lives while undergoing conventional cancer treatment. Methods: Forty semi-structured interviews were conducted with cancer patients participating in the CCC-Integrativ study and its process evaluation. The interviews were audio-recorded, transcribed verbatim, and analyzed using content analysis following Kuckartz and Rädiker. A purposeful sampling strategy was used to achieve a balanced sample regarding gender, age, cancer diagnosis, and treatment approach. Results: Most patients with cancer reported largely implementing the CIH recommendations. Participants acknowledged the efficacy of CIH recommendations in managing their symptoms. They felt strengthened and empowered to actively take part in their healthcare decisions. However, the patients encountered obstacles in incorporating the recommended CIH applications into their daily routines. These challenges encompassed the effort required for treatment application (e.g., baths, compresses), limitations imposed by the cancer disease (e.g., fatigue, pain), difficulties acquiring necessary materials, associated costs, and lack of infrastructure for CIH. Facilitators of CIH implementation included the availability of easily manageable CIH measures (e.g., herbal teas), informative materials on their application, distribution of samples, family support, and a high level of self-efficacy. The patient-centered approach and strong patient-provider partnership within the counseling context were perceived as empowering. Participants expressed a desire for a consistent point of contact to address their CIH concerns. Conclusions: The findings underscore the benefits of CIH counseling for cancer patients’ symptom management and overall well-being. Healthcare professionals providing CIH counseling to patients with cancer may recognize the barriers identified to better support their patients in the regular use of CIH.

Medical guidelines recommend actively addressing patients' information needs regarding complementary and integrative healthcare (CIH). Within the CCC-Integrativ study, an interprofessional counseling program on CIH was developed and implemented at four comprehensive cancer centers (CCCs) in Germany. As part of the process evaluation, this study examines cancer patients' experiences with interprofessional CIH counseling sessions conducted by a physician and a nurse. Forty problem-centered interviews were conducted using a semi-structured interview guide. All interviews were audio-recorded, transcribed verbatim, and analyzed using deductive–inductive content analysis based on Kuckartz and Rädiker's approach. Findings revealed that most participants had prior experience with CIH approaches and were burdened by physiological and psychological symptoms. Counseling sessions focused on cancer- and treatment-related symptoms and appropriate CIH recommendations (e.g., herbal poultice against anxieties and acupressure against nausea). Participants appreciated the mutual exchange and integration of perspectives from different healthcare professions within the interprofessional approach. They noted that the counseling team comprehensively addressed their healthcare and CIH information needs. Suggestions for improvement included the specificity of the CIH recommendations. As the participants only received counseling and no CIH treatments, information about reputable CIH providers was particularly important to many seeking advice. Patients with cancer receiving tailored CIH counseling from two healthcare professionals experienced benefits in CIH counseling for symptom management. The interprofessional teams offered a comprehensive perspective on patients' needs, proposing personalized recommendations for symptom control. These insights may foster collaboration between healthcare professionals interested in CIH counseling, enabling them to expand and consolidate their counseling services. [ABSTRACT FROM AUTHOR]