Search

[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.

Abstract Background The care of patients with a life-threatening, progressive and far advanced illness in a home-care setting requires appropriate individual care and requires the active support of family caregivers. General practice teams are usually the primary care givers and first contact and are best placed to offer support to family caregivers and to recognise and respond to the burden of care giving on family members. The aim of this project is to develop a best practice model for engaging with and supporting family caregivers. Findings The project is framed as an exploratory trial for a subsequent implementation study, covering phases 0, I and II of the MRC (Medical Research Council) framework for development, design and evaluation of complex interventions. The project is a multi-method procedure and has two phases. In the first phase, which has already been completed, we used a reflective practice procedure where general practice teams were asked about how they currently deal with family caregivers. In the second phase, a participatory action research approach aims to improve identification and response to when support is necessary for family caregivers. Ten participating general practice teams each enrol 40 eligible patients and their family caregiver, to identify structures and tools feasible for use in their practice. Standardised self-reported questionnaires (Burden Scale for Family Caregivers and Quality of Life Questionnaire Core 15 Palliative) are being applied at study inclusion (prior to or during the implementation period) and after 6 and 12 months to explore implementation effects. Qualitative assessment of general practice teams’ experiences will be triangulated with the quantitative evaluation of the implementation. Discussion This two-step approach, which is appropriate to primary palliative care in the German health care context, will enable general practice teams to develop feasible, acceptable and successful strategies for the implementation of best practice to successfully support family caregivers of patients at the end of life.

Abstract Background In Germany, there is a shortage of young physicians in several specialties, the situation of general practitioners (GP) being especially precarious. The factors influencing the career choice of German medical students are poorly understood. This study aims to identify factors influencing medical students' specialty choice laying a special focus on general practice. Methods The study was designed as a cross-sectional survey. In 2010, students at the five medical schools in the federal state of Baden-Wuerttemberg (Germany) filled out an online-questionnaire. On 27 items with 5-point Likert scales, the students rated the importance of specified individual and occupational aspects. Furthermore, students were asked to assign their intended medical specialty. Results 1,299 students participated in the survey. Thereof, 1,114 students stated a current choice for a specialty, with 708 students choosing a career in one of the following 6 specialties: internal medicine, surgery, gynaecology and obstetrics, paediatrics, anaesthetics and general practice. Overall, individual aspects ('Personal ambition', 'Future perspective', 'Work-life balance') were rated as more important than occupational aspects (i.e. 'Variety in job', 'Job-related ambition') for career choice. For students favouring a career as a GP individual aspects and the factor 'Patient orientation' among the occupational aspects were significantly more important and 'Job-related ambition' less important compared to students with other specialty choices. Conclusions This study confirms that future GPs differ from students intending to choose other specialties particularly in terms of patient-orientation and individual aspects such as personal ambition, future perspective and work-life balance. Improving job-conditions in terms of family compatibility and work-life balance could help to increase the attractiveness of general practice. Due to the shortage of GPs those factors should be made explicit at an early stage at medical school to increase the number of aspirants for general practice.

Abstract Background The care of palliative patients challenges the health care system in both quantity and quality. Especially the role of primary care givers needs to be strengthened to provide them with the knowledge and the confidence of applying an appropriate end-of-life care to palliative patients. To improve health care services for palliative patients in primary care, interested physicians in and around Heidelberg, Germany, are enabled to participate in the community-based program 'Palliative Medical Initiative North Baden (PAMINO)' to improve their knowledge in dealing with palliative patients. The impact of this program on patients' health and quality of life remains to be evaluated. Methods/Design The evaluation of PAMINO is a non-randomized, controlled study. Out of the group of primary care physicians who took part in the PAMINO program, a sample of 45 physicians and their palliative patients will be compared to a sample of palliative patients of 45 physicians who did not take part in the program. Every four weeks for 6 months or until death, patients, physicians, and the patients' family caregivers in both groups answer questions to therapy strategies, quality of life (QLQ-C15-PAL, POS), pain (VAS), and burden for family caregivers (BSFC). The inclusion of physicians and patients in the study starts in March 2007. Discussion Although participating physicians value the increase in knowledge they receive from PAMINO, the effects on patients remain unclear. If the evaluation reveals a clear benefit for patients' quality of life, a larger-scale implementation of the program is considered. Trial registration: The study was registered at ‘current controlled trials (CCT)’, registration number: ISRCTN78021852.

Palastina gehört zu den Gebieten mit der größten Dichte an internationalen (Hilfs-)Organisationen. Seit Anfang der 1990er-Jahre haben sich Einrichtungen der Entwicklungszusammenarbeit, Bildungstrager, Institutionen der Friedens- und Konfliktbearbeitung, konfessionelle Organisationen und auch politische Stiftungen vor Ort niedergelassen. Auch wenn sich die Mandate unterscheiden, sie eint der Wille, einen Beitrag zur Entwicklung der Palästinensischen Gebiete mit Blick auf einen unabhängigen Staat innerhalb einer Zweistaatenlösung zu leisten. Aber die bisherigen Ergebnisse sind mager, ein Umdenken scheint notwendig. [ABSTRACT FROM AUTHOR]

The aim of the study was to identify factors that predict impairment in daily life for patients of working age with knee complaints 6 months after receiving physiotherapy. A prospective, multicentre observational study was conducted in private physiotherapy practices. Patients ( n = 237) aged 18-65 years with a physiotherapy referral because of knee complaints were studied. Treatment was documented on a standardized form by the physiotherapists and was not influenced by the investigators. The 16-item version of the Musculoskeletal Function Assessment Questionnaire was used as primary outcome measure. Baseline scores for impairment in daily life, symptom characteristics, socio-demographic and psychosocial factors, physical activity, nicotine consumption and comorbidities were investigated as possible predictors of recovery. Predictors identified by multiple linear regression were: self-prognosis on work ability, mental resources, obesity, diagnostic subgroup anterior knee pain and the comorbidities rheumatoid arthritis and diabetes. An active primary therapy approach enhanced recovery. Variables explained 38% of variance (adjusted R2). The knowledge of the identified factors supports the setting of therapy goals together with the patient. Therefore, only a short questionnaire is necessary. Moreover, the results underpin the importance of an active therapy plan. [ABSTRACT FROM AUTHOR]

Background: Regular intake of medicines prevents hospitalization and improves treatment outcomes in patients with chronic diseases; however, requires good patient-physician communication. Yet, this communication is often insufficient and characterized by misunderstandings. This paper aimed to explore whether a training session on medication counseling for general practitioners (GPs) can improve patient satisfaction about information on medicines. Methods: Within a seamless care project (HeiCare®), a questionnaire to assess patient satisfaction with information on medicines and other questions related to medication issues was distributed among 370 patients. Results were returned to physicians in a feedback report, discussed in a training session, and a subsequent second questionnaire was sent to patients. Results: Patients showed a significant increase in satisfaction with overall information on medicines and with information on potential problems when experiencing medication counseling after their GP received a feedback report and/or training session. Conclusion: Individual feedback and training sessions can improve medication counseling and GPs' awareness of patients' attitudes toward medicines and thus increase patients' satisfaction with medicines information received. Regular feedback to the GP on patients' satisfaction with information and patients' beliefs in medicines can be obtained by patient surveys or by addressing these issues in regular medication counseling encounters. Physicians need to be trained to listen to patients' views and concerns on medication. [ABSTRACT FROM AUTHOR]

Background: Chronic (systolic) heart failure (CHF) represents a clinical syndrome with high individual and societal burden of disease. Multifaceted interventions like case management are seen as promising ways of improving patient outcomes, but lack a robust evidence base, especially for primary care. The aim of the study was to explore the effectiveness of a new model of CHF case management conducted by doctors' assistants (DAs, equivalent to a nursing role) and supported by general practitioners (GPs). Methods: This patient-randomised controlled trial (phase II) included 31 DAs and employing GPs from 29 small office-based practices in Germany. Patients with CHF received either case management (n = 99) consisting of telephone monitoring and home visits or usual care (n = 100) for 12 months. We obtained clinical data, health care utilisation data, and patient-reported data on generic and disease-specific quality of life (QoL, SF-36 and KCCQ), CHF self-care (EHFScBS) and on quality of care (PACIC-5A). To compare between groups at follow-up, we performed analyses of covariance and logistic regression models. Results: Baseline measurement showed high guideline adherence to evidence-based pharmacotherapy and good patient self-care: Patients received angiotensin converting enzyme inhibitors (or angiotensin-2 receptor antagonists) in 93.8% and 95%, and betablockers in 72.2% and 84%, and received both in combination in 68% and 80% of cases respectively. EHFScBS scores (SD) were 25.4 (8.4) and 25.0 (7.1). KCCQ overall summary scores (SD) were 65.4 (22.6) and 64.7 (22.7). We found low hospital admission and mortality rates. EHFScBS scores (-3.6 [-5.7;-1.6]) and PACIC and 5A scores (both 0.5, [0.3;0.7/0.8]) improved in favour of CM but QoL scores showed no significant group differences (Physical/Mental SF-36 summary scores/KCCQ-os [95%CI]: -0.3 [-3.0;2.5]/-0.1 [-3.4;3.1]/1.7 [-3.0;6.4]). Conclusions: In this sample, with little room for improvement regarding evidence-based pharmacotherapy and CHF self-care, case management showed no improved health outcomes or health care utilisation. However, case management significantly improved performance and key intermediate outcomes. Our study provides evidence for the feasibility of the case management model. Trial registration number: ISRCTN30822978 [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "The Career Expectations of Medical Students: Findings of a Nationwide Survey in Germany," by Bernhard Gibis et al. in the 2012 issue.