Institut für medizinische und pharmazeutische Prüfungsfragen (IMPP), Mainz, Germany.
Universitätsklinikum Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Germany.
GMS J Med Educ. 2021 Mar 15;38(3):Doc71. doi: 10.3205/zma001467. eCollection 2021.
As doctors often fail to explain diagnoses and therapies to patients in an understandable and appropriate way, the improvement of doctor-patient communication is essential. The current medical training and examinations are focused on verbal rather than on written communication. Following the premise of "assessment drives learning", the final medical licensing examination in Germany has been further developed by the German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy (IMPP). As part of the discharge management the candidates have to prepare a report for the patient that is understandable and provides them with all important information about their stay in hospital. A standardized evaluation form for formative and summative feedback has been developed and tested with regard to applicability and the assurance of test quality criteria, especially the reliability to assess the written communication skills of the students. In an expert consensus procedure, a draft for a standardized evaluation form was developed. This form was revised after an initial trial run on patient-directed reports written by students in their last year of medical studies. Afterwards twenty-one patient-directed reports were evaluated by fourteen different examiners. The reliability was tested by calculating the generalizability-coefficient and by analysing the inter-rater reliability. The first test on the evaluation of the patient-directed reports indicated the practicability of the application and the usefulness of the evaluation form as an instrument for assessing the written communication skills of students. The analyses of the inter-rater reliability showed that the degree of agreement in the evaluations was partly different between two groups of examiners. The calculated G-coefficient indicates a high reliability. The content validity of the evaluation form was given through the comprehensive medical expertise in the development process. Assessing written patient-directed communication is a benefit of the newly developed last part of the medical licensing examination in Germany. Continuous formative assessment and feedback based on the evaluation form is intended to improve the written communication skills of future doctors. Furthermore, a better understanding of their diagnosis and treatment as well as a trusting relationship with their doctor may empower patients in the medical decision process and lead to fewer dismissal errors in the future. For consistent use of the evaluation form a standardized training of examiners should be implemented.
由于医生常常无法以可理解和适当的方式向患者解释诊断和治疗方案，因此改善医患沟通至关重要。目前的医学培训和考试侧重于口头沟通而非书面沟通。基于“评估驱动学习”的前提，德国国家医学、药学和心理治疗考试研究所（IMPP）进一步发展了德国的最终医学执照考试。作为出院管理的一部分，考生必须为患者准备一份易懂的报告，其中提供有关其住院期间的所有重要信息。已经制定了一个标准化的评估表，用于形成性和总结性反馈，并根据适用性和测试质量标准的保证，特别是可靠性，对学生的书面沟通技巧进行了测试。在专家共识程序中，制定了标准化评估表的草案。在对医学生最后一年撰写的面向患者的报告进行初步试用后，对该表格进行了修订。之后，由 14 名不同的考官对 21 份面向患者的报告进行了评估。通过计算通用性系数和分析评分者间的可靠性来测试可靠性。对评估面向患者的报告的首次测试表明，该应用程序具有实用性，并且评估表作为评估学生书面沟通技巧的工具具有实用性。评分者间可靠性的分析表明，两组考官的评估结果在某种程度上存在差异。计算得出的 G 系数表明可靠性较高。在开发过程中，通过全面的医学专业知识为评估表提供了内容有效性。评估书面的面向患者的沟通是德国新开发的医学执照考试最后一部分的优势。基于评估表的持续形成性评估和反馈旨在提高未来医生的书面沟通技巧。此外，更好地了解他们的诊断和治疗以及与他们的医生建立信任关系，可以增强患者在医疗决策过程中的能力，并减少未来的解雇错误。为了一致使用评估表，应实施对考官的标准化培训。
