Nittritz Christine, Schaffer Susann, Kühlein Thomas, Roos Marco
Allgemeinmedizinisches Institut, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Deutschland.
Allgemeinmedizinisches Institut, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2016 Nov;117:57-64. doi: 10.1016/j.zefq.2016.09.007. Epub 2016 Oct 24.
The consultation is at the heart of general practice. It is the central setting through which primary care is delivered. The competency requirements are laid down internationally by competency-based curricula for undergraduate and postgraduate education. So far, there is no competency-based vocational training to develop consultation skills in general practice in Germany. The study describes experiences with consultation skills training as an element of general practice training as reported by trainees and trainers in Germany.
A qualitative and exploring approach was chosen because there is little experience with the German situation. We conducted structured focus group interviews with trainees and trainers, respectively. We recruited all participants by e-mail via the mail distributor "Junge Allgemeinmedizin Deutschland" (JADE, a trainee and junior GP organization) and the academic teachers of the Friedrich-Alexander University Erlangen-Nürnberg. Altogether, four focus group interviews with three to five participants were conducted, varying in length from 25 to 65minutes. All interviews were recorded digitally and transcribed verbatim. Then a qualitative content analysis was performed.
The statements of the ten trainees and five trainers mapped a system of four main categories: (a) association with the term consultation, (b) parts of a consultation, (c) competencies required for professional practice, (d) consultation skills training as an element of vocational training. Overall, all participants regarded the consultation as the most important element in general practice. Important content of consultations is to build a relationship with the patient, gather information, conduct physical examinations and achieve informed consent on further proceedings. All participants agreed that physicians need different sets of competencies: medical expertise, communication skills, examination skills and professionalism. Finally, there was a broad consensus that a competency-based general practice training to support the development of consultation skills is lacking in Germany. The majority acknowledged the need for change.
So far, the consultation skills development within the general practice training in Germany is regarded as deficient. Both trainees and trainers have stressed the importance of change in vocational training. With the new competency-based curriculum for general practice in Germany and the associated development of supporting tools important prerequisites have been provided.
会诊是全科医疗的核心。它是提供初级医疗服务的主要场景。本科和研究生教育基于能力的课程在国际上规定了能力要求。到目前为止，德国尚无基于能力的职业培训来培养全科医疗中的会诊技能。本研究描述了德国的学员和培训师报告的将会诊技能培训作为全科医疗培训一部分的经验。
由于对德国的情况了解甚少，因此选择了定性探索性方法。我们分别对学员和培训师进行了结构化焦点小组访谈。我们通过电子邮件通过邮件分发机构“德国青年全科医学”（JADE，一个学员和初级全科医生组织）以及埃尔朗根 - 纽伦堡弗里德里希 - 亚历山大大学的学术教师招募了所有参与者。总共进行了四次焦点小组访谈，每次有三到五名参与者，时长从25分钟到50分钟不等。所有访谈都进行了数字录音并逐字转录。然后进行了定性内容分析。
十名学员和五名培训师的陈述勾勒出一个包含四个主要类别的系统：（a）与会诊一词的关联，（b）会诊的组成部分，（c）专业实践所需的能力，（d）会诊技能培训作为职业培训的一部分。总体而言，所有参与者都认为会诊是全科医疗中最重要的要素。会诊的重要内容包括与患者建立关系、收集信息、进行体格检查以及就进一步的诊疗程序达成知情同意。所有参与者都同意医生需要不同的能力组合：医学专业知识、沟通技巧、检查技能和专业素养。最后，广泛达成的共识是德国缺乏支持会诊技能发展的基于能力的全科医疗培训。大多数人承认有变革的必要性。
到目前为止，德国全科医疗培训中的会诊技能发展被认为存在不足。学员和培训师都强调了职业培训变革的重要性。随着德国新的基于能力的全科医疗课程以及相关支持工具的开发，已经具备了重要的先决条件。
