Talking about dying and death: Essentials of communicating about approaching death from the perspective of major stakeholders.

OBJECTIVES: Although caring for dying patients and their family caregivers (FC) is integral to patient care, training in communication about approaching death is almost inexistent in medical and nursing curricula. Consequently, many health professionals have insufficient knowledge about conducting these conversations. In order to gain a broader insight into essential aspects of this communication from different perspectives, we conducted focus groups with key stakeholders. METHODS: Medical specialists, nurses, medical students, bereaved FC and patient representatives participated in five focus groups (n = 30). Following a focus group schedule, we elicited relevant aspects of communication about approaching death, associated emotions, and appropriate communication frameworks. We analyzed data thematically. RESULTS: Four main themes were central to conversations about approaching death: (1) embracing care within medical expertise, (2) preparing the conversation while remaining open to the unexpected, (3) recognizing and reflecting on own emotions and reactions, and (4) establishing a meaningful connection with others. SIGNIFICANCE OF RESULTS: Communicating about approaching death with dying patients and their FC can be complex and challenging at a professional and personal level. With the recognition of the dying phase, a process is initiated for which health professionals need solid clinical knowledge about but also effective communication skills, constant self-reflection and self-care strategies. Comprehensive training and supervision while dealing with the challenges of communicating approaching death to dying patients and their FC are key, particularly for trainees, less experienced physicians and nurses. The essential components identified in this study can help health professionals to master these conversations.

Damage tolerant design of additively manufactured metallic components subjected to cyclic loading: State of the art and challenges.

Undoubtedly, a better understanding and the further development of approaches for damage tolerant component design of AM parts are among the most significant challenges currently facing the use of these new technologies. This article presents a thorough overview of the workshop discussions. It aims to provide a review of the parameters affecting the damage tolerance of parts produced by additive manufacturing (shortly, AM parts) with special emphasis on the process parameters intrinsic to the AM technologies, the resulting defects and the residual stresses. Based on these aspects, basic concepts are reviewed and critically discussed specifically for AM materials: Criteria for damage tolerant component design;Criteria for the determination of fatigue and fracture properties;Strategies for the determination of the fatigue life in dependence of different manufacturing conditions;Methods for the quantitative characterization of microstructure and defects;Methods for the determination of residual stresses;Effect of the defects and the residual stresses on the fatigue life and behaviour. We see that many of the classic concepts need to be expanded in order to fit with the particular microstructure (grain size and shape, crystal texture) and defect distribution (spatial arrangement, size, shape, amount) present in AM (in particular laser powder bed fusion). For instance, 3D characterization of defects becomes essential, since the defect shapes in AM are diverse and impact the fatigue life in a different way than in the case of conventionally produced components. Such new concepts have immediate consequence on the way one should tackle the determination of the fatigue life of AM parts; for instance, since a classification of defects and a quantification of the tolerable shapes and sizes is still missing, a new strategy must be defined, whereby theoretical calculations (e.g. FEM) allow determining the maximum tolerable defect size, and non-destructive testing (NDT) techniques are required to detect whether such defects are indeed present in the component. Such examples show how component design, damage and failure criteria, and characterization (and/or NDT) become for AM parts fully interlinked. We conclude that the homogenization of these fields represents the current challenge for the engineer and the materials scientist.

Elementary school children as standardized patients in a summative OSCE - A mixed-method study according to the Ottawa criteria for good assessment.

BACKGROUND: The goal of the present study was to evaluate whether children as standardized patients (SPs) for a summative OSCE station fulfills the Ottawa criteria for good assessment. METHODS: Data for participating students (n = 124), raters (n = 11), and children (n = 127) were collected using questionnaires (students, raters), focus groups (raters), and interviews (children, raters). The psychometrics (including reproducibility) of this OSCE station were also analyzed according to quality indices. RESULTS: Validity, reproducibility, feasibility, educational effect, and acceptability were attained for this OSCE station. Students and raters accepted the new approach and evaluated it as fair and acceptable, with realism and validity. This OSCE station had a perceived positive educational effect for ∼30% of the students, who expected child SPs. Raters stated it as feasible to involve children. The children enjoyed their participation, which was acceptable and feasible. Statistical measures were in the recommended ranges and showed reproducibility. CONCLUSION: Children as SPs for a summative OSCE station was perceived as fair, acceptable, realistic, and feasible by all stakeholders, and with perceived positive educational impact. This pediatric OSCE station fulfilled five of the seven Ottawa criteria for good assessment. Further studies are needed to investigate different pediatric stations.

Development, production and evaluation of 2-dimensional transfer tattoos to simulate skin conditions in health professions education.

BACKGROUND: Moulages can greatly extend the possibilities of simulation in teaching and assessment. Since moulages that fit an educator's exact needs are often unavailable commercially, this paper explains how 2-dimensional transfer tattoos can be independently developed, produced, and evaluated. METHODS: From representative photographs of the specific skin condition an analogue copy of the pathological finding is drawn. Once validated by the medical expert, it can be digitized by scanning and processed using graphics software. The final digital image file is printed onto transfer paper. Once applied and fixed onto the intended wearer, usually a simulated patient, its authenticity can be confirmed, and further transfer tattoos can be produced. RESULTS: Using this moulage technique we produced 10 different 2-dimensional transfer tattoos to date, including hematoma, Janeway lesions and splinter nails. These moulages are used in clinical skills training, formative and high-stakes summative assessment in undergraduate medical and nursing programs. CONCLUSIONS: By sharing our development process for 2-dimensional transfer tattoos, health profession educators can produce their own that best fit their local educational needs. Due to their high authenticity and standardization, 2-dimensional transfer tattoos are ideal for use in high-stakes assessment.

Simulated patient-based teaching of medical students improves pre-anaesthetic assessment: A rater-blinded randomised controlled trial.

BACKGROUND: Pre-anaesthetic assessment of patients is a complex competency that needs to be taught during anaesthesia clerkships. OBJECTIVES: We aimed to improve student teaching and investigated the effectiveness of trained 'simulated patients' (lay persons or actors trained to portray specific roles or symptoms) in the teaching of medical students to perform routine pre-anaesthetic assessments. We hypothesised that the intervention of one 30-min teaching sequence with a simulated patient will improve the performance of year 4 medical students in pre-anaesthesia assessment of elective surgical patients, compared with the control of standard apprentice-based teaching. DESIGN: Randomised controlled trial. SETTING/PARTICIPANTS: One hundred and forty-four year 4 medical students at the University of Bern. INTERVENTION: These students were randomised to either the standard clinician-supervised learning in the operating theatre (n=71; control group) or a single teaching session with a simulated patient (nonhealthcare provider, as a trained layperson) (n=73; intervention group). Both groups of students then performed pre-anaesthetic patient visits. The student performances during these visits were assessed according to the mini-Clinical Evaluation Exercise tool by trained anaesthesiologists blinded to randomisation. The 71 students in the standard clinical supervision group also underwent the simulated patient teaching session on the day following the assessments. RESULTS: The students in the intervention group of simulated patient teaching scored significantly higher in both their mini-Clinical Evaluation Exercise overall impression scores (8.8 ±â€Š0.8 vs. 8.3 ±â€Š0.9; P = 0.004) and mean domain scores (8.7 ±â€Š0.8 vs. 8.3 ±â€Š0.9; P = 0.01), compared with those of the control group with the standard clinical supervision. CONCLUSION: The current single teaching encounter with a trained layperson acting as a simulated patient improved medical student performances in their pre-anaesthetic clinical assessment of surgical patients. This might be a suitable alternative to reduce the teaching burden for busy and costly clinicians.

The impact of an audience response system on a summative assessment, a controlled field study.

BACKGROUND: Audience response systems allow to activate the audience and to receive a direct feedback of participants during lectures. Modern systems do not require any proprietary hardware anymore. Students can directly respond on their smartphone. Several studies reported about a high level of satisfaction of students when audience response systems are used, however their impact on learning success is still unclear. METHODS: In order to evaluate the impact of an audience response system on the learning success we implemented the audience response system eduVote into a seminar series and performed a controlled crossover study on its impact on assessments. One hundred fifty-four students in nine groups were taught the same content. In four groups, eduVote was integrated for the first topic while five groups were taught this topic without the audience response systems. For a second topic, the groups were switched: Those groups who were taught before using eduVote were now taught without the audience response system and vice versa. We then analysed the impact of the audience response system on the students' performance in a summative assessment and specifically focused on questions dealing with the topic, for which the audience response system was used during teaching. We further assessed the students' perception on the use of eduVote using questionnaires. RESULTS: In our controlled crossover study we could not confirm an impact of the audience response system eduVote on long-term persistence i.e. the students' performance in the summative assessment. Our evaluation revealed that students assessed the use of eduVote very positively, felt stronger engaged and better motivated to deal with the respective topics and would prefer their integration into additional courses as well. In particular we identified that students who feel uncomfortable with answering questions in front of others profit from the use of an audience response system during teaching. CONCLUSIONS: Audience response systems motivate and activate students and increase their engagement during classes. However, their impact on long-term persistence and summative assessments may be limited. Audience response systems, however, specifically allow activating students which cannot be reached by the traditional way of asking questions without such an anonymous tool.

Improving the assessment of communication competencies in a national licensing OSCE: lessons learned from an experts' symposium.

BACKGROUND: As the communication competencies of physicians are crucial for providing optimal patient care, their assessment in the context of the high-stakes Objective Structured Clinical Examination (OSCE) is of paramount importance. Despite abundant literature on the topic, evidence-based recommendations for the assessment of communication competencies in high stakes OSCEs are scarce. As part of a national project to improve communication-competencies assessments in the Swiss licensing exam, we held a symposium with national and international experts to derive corresponding guidelines. METHODS: Experts were invited on account of their recognized expertise either in teaching or assessing communication competencies, or in conducting national high-stakes OSCEs. They were asked to propose concrete solutions related to four potential areas for improvement: the station design, the rating tool, the raters' training, and the role of standardized patients. Data gene.rated in the symposium was available for analysis and consisted of video recordings of plenary sessions, of the written summaries of group work, and the cards with participants' personal take-home messages. Data were analyzed using a thematic analysis approach. RESULTS: Nine major suggestions for improving communication-competencies assessments emerged from the analysis and were classified into four categories, namely, the roles of the OSCE scenarios, rating tool, raters' training, and simulated patients. CONCLUSION: In the absence of established evidence-based guidelines, an experts' symposium facilitated the identification of nine practical suggestions for improving the assessment of communication competencies in the context of high-stakes OSCEs. Further research is needed to test effectiveness of the suggestions and how they contribute to improvements in the quality of high-stakes communication-competencies assessment.

Development and evaluation of three-dimensional transfers to depict skin conditions in simulation-based education.

Modern medical moulages are becoming increasingly important in simulation-based health professions education. Their lifelikeness is important so that simulation engagement is not disrupted while their standardization is crucial in high-stakes exams. This report describes in detail how three-dimensional transfers are developed and produced so that educators will be able to develop their own. In addition, evaluation findings and lessons learnt from deploying transfers in summative assessments are shared. Step-by-step instructions are given for the creation and application of transfers, including materials and photographic visualizations. We also examined feedback on 10 exam stations (out of a total of 81) with self-developed three-dimensional transfers and complement this with additional lessons learnt. By the time of submission, the authors successfully developed and deployed over 40 different three-dimensional transfers representing different clinical findings in high-stakes exams using the techniques explained in this article or variations thereof. Feedback from students and examiners after completing the OSCE is predominantly positive, with lifelikeness being the quality most often commented upon. Caveats derived from feedback and own experiences are included. The step-by-step approach reported can be adapted and replicated by healthcare educators to build their own three-dimensional transfers. This should widen the scope and the lifelikeness of their simulations. At the same time we propose that this level of lifelikeness should be expected by learners as not to disrupt simulation engagement. Our evaluation of their use in high-stakes assessments suggests they are both useful and accepted.

How to talk about dying? The development of an evidence-based model for communication with patients in their last days of life and their family caregivers.

Objective: To help healthcare professionals (HCP) act with more confidence when communicating about approaching death, we sought to develop a communication model for HCP to facilitate conversations with dying patients and family caregivers (FC) in nonemergency situations. Methods: We used a four-phase integrative approach: (1) creation of a preliminary model based on a systematic literature review and expert knowledge, (2) review of the model draft by international palliative care experts, (3) review by key stakeholders, and (4) final appraisal by communication experts. Results: After the clinical recognition of dying, the communication model provides a structure and practical communication aids for navigating the conversation based on three phases. It describes the content and relational level as core dimensions of effective conversations about approaching death and highlights the importance of HCP self-awareness and self-care when caring for the dying. Conclusion: Based on systematic involvement of key stakeholders, the model supports clinicians navigating challenging conversations about approaching death with dying patients and their FC successfully and with more confidence. Innovation: This study expands the theoretical basis for communication about approaching death and offers a pragmatic model for educational interventions and clinical use.

Using self and peer video annotations of simulated patient encounters in communication training to facilitate the reflection of communication skills: an implementation study.

Background: The mandatory communication skills course for fourth-year medical students at the University of Bern Medical School aims to prepare students for challenging communication situations. Students role-play four different scenarios with simulated patients (SPs) and receive feedback from the patient's perspective. The scenarios are video-recorded and uploaded onto the University's virtual learning environment. Students can watch and annotate their own videos and give others access to view them. Project description: Although the course is well liked by students, we identified three areas for improvement: lack of faculty feedback; little active use of the video-recordings;lack of opportunity for students to discuss their experiences with each other. We aimed to address these shortcomings by introducing an additional learning task: students are asked to annotate a section of the video in which they had performed well, and one in which they thought they could have done better, in both their own and a colleague's videos. These video clips and annotations served as the basis of a subsequent two-hour small-group seminar with a physician tutor. The course was evaluated by a mandatory online questionnaire. Results: All 247 students completed the questionnaire. The annotation tool and task were deemed to be comprehensible. Students believed they had learnt more from annotating a peers' video than from their own and most thought being assessed by peers was acceptable. The physician tutors' comments were largely deemed as helpful. The mean mark for the course given by students was 4.6 (median 5) (1=very poor, 6=very good). Conclusion: A communication skills course expanded by video-annotations and group discussions with a physician tutor was shown to be feasible and was well received by students and faculty.

"Telephone consultation for medical emergencies" - development, implementation and evaluation of a course in identifying and handling medical emergencies via telephone for 5th year medical students.

Objectives: Advising patients seeking medical guidance while communicating with them via telephone is a highly relevant skill in clinical daily life. However, telephone consultations differ from face-to-face interactions: clinical examination is nearly impossible and visual signals cannot be observed. Thus, telephone consultations require specific skills training. This article describes the development, implementation and evaluation of a course, "Telephone Consultation for Medical Emergencies", for 5th year medical students at the University of Bern, Switzerland. Methods: Following the evidence in the literature for telephone consultations, we developed guidelines for effective communication via telephone. After self-study of preparatory material, learners engaged in telephone consultations with simulated patients (SP) at the simulation center. They received multi-dimensional feedback regarding the encounter. Results: The course was successfully implemented in 2012. Evaluations showed the course to be well-received by students. In a survey, students agreed that they had learned many new skills and that they considered this learning as being important in their future employment. They felt that the SP feedback was helpful and that being observed by peer-students during the encounter or filling in a checklist while observing peer-students in other encounters added to their learning. During the debriefing of the simulation with a clinical expert, students judged the scenarios as realistic and relevant, praised the SP performances and identified that the most instructive aspect of the training was the opportunity to practice and to get feedback. Conclusion: Telephone consultations require specific skills that should be trained. The current Covid-19 pandemic and the recommendations of government institutions for patients to contact healthcare professionals primarily via telephone stress the importance of adequately training these skills. In this publication we describe a feasible and viable format for implementing this process.

Learning how to break bad news from worked examples: Does the presentation format matter when hints are embedded? Results from randomised and blinded field trials.

OBJECTIVES: Video-based worked examples enable medical students to successfully prepare for breaking-bad-news (BBN) encounters with simulated patients (SPs). This is especially true when examples include hints that signal important content. This paper investigates whether the beneficial effect of hints only applies to video-based worked examples or also text-based examples. METHODS: One-hundred-and-forty-seven fourth-year medical students attending a BBN training participated in either of two equally scaffolded, randomised field trials. Prior to encountering SPs, the students worked through an e-learning module introducing the SPIKES protocol for delivering bad news; it contained the same worked example presented to either of four groups as text or video, with or without additional hints denoting the SPIKES steps being implemented. RESULTS: Only a main effect of 'hints' was revealed, implying that students in the hints groups delivered the news to an SP significantly more appropriately than those in the without-hints groups. CONCLUSIONS: Independent of their presentation format, worked examples with hints best foster students' BBN skills learning. PRACTICE IMPLICATIONS: In addition to video, text-based worked examples can effectively prepare students for BBN simulations if hints are included. This offers an affordable alternative to video examples, as text examples can be generated with less effort.

Delivering a geriatric OSCE station in times of Covid-19 using makeup artistry.

In the wake of the Covid-19 pandemic, people over 65 or suffering from certain conditions were deemed at high risk and asked to isolate themselves. This led to the simulated patient (SP) program at the University of Bern being depleted of middle-aged and elderly SP. Meanwhile, an OSCE had to be delivered using adapted cases that minimized physical contact between candidates and SP. Short of suitable cases at such short notice, the case of an elderly patient with postural instability had to be added to the exam blueprint. With elderly SP off the roster, it was decided to use makeup effects to achieve visual authenticity. A combination of wigs (grey hair, hairdo), 3D Probondo transfers (forehead wrinkles), old age stipple (crow's feet), and colouring (age spots) were used to achieve the old-age effects, while SPs wore scarves to cover their neckline. The lower face was covered with protective face masks in accordance with the exam's Covid-19 hygiene protocol. Case-related feedback from candidates and examiners was analysed for any direct or indirect remark attributable to the ageing effects. As no comment touched upon the subject of the appearance of age, this was interpreted as success, as any distracting effect from the SPs' appearance in this regard would surely have prompted remarks or even complaints. The SPs' feedback revealed how applying the ageing effects helped them adopt the octogenarian's role. This report explains how SP in their fifties were made fit for an octogenarian's case in an OSCE using makeup effects. The effort required for the ageing simulation was considerable, but it is hoped that in future, with more planning time, the amount of effort required can be reduced. The feedback obtained from the candidates suggest the appearance of SPs was not experienced as a distraction, which was the primary objective of this exercise. Adapting our approach to their own contexts allows educators to include cases with elderly patients in their OSCE that cannot be re-written for younger SP, so long as Covid-19 prevents elderly SP from participating.

Use of simulation patients in the third section of the medical examination.

In order to protect patients and students during the Covid 19 pandemic, the third section of the medical examination (M3) in Halle (Saale) was conducted in a modified form in accordance with the "Verordnung zur Abweichung von der Approbationsordnung für Ärzte bei einer epidemischen Lage von nationaler Tragweite" [1]. The one-day examination took place at the Dorothea Erxleben Learning Center (DELH) of the Martin Luther University Halle-Wittenberg on standardized simulation subjects. In contrast to previous years, all examiners were examined individually in internal medicine, surgery and their elective subject of the practical year. In the evaluations carried out, the standardized cases were assessed as consistent and fair by examiners and exam takers. Approximately 90% of the examiners could imagine to test a state examination with simulated patients again. After successful pilot testing, a study will be conducted in the coming exam to determine whether the substitution of real patients with simulated patients in the M3 exam can contribute to better standardization and objectivity while maintaining the same high level of acceptance in the exam. Whether the high acceptance will remain constant can only be checked in the course of the study.

Feedback in medical education - a workshop report with practical examples and recommendations.

Background: As a teaching method, feedback is an integral part of medical education. However, there is a lack of a uniform theoretical basis or generally recognized guidelines for its specific design. Against this background, the aim of this article is to discuss conceptual considerations and empirical findings regarding feedback using various practical examples. Procedure and conceptual considerations: Building on the results of a workshop of the Committee for Communicative and Social Competences of the Society for Medical Education (GMA), this article first explains central conceptual considerations and empirical results on the topic of feedback. A particular focus is on various variables that influence the effect of feedback. This includes the feedback source, the frequency of feedback, starting points of feedback, the connection between feedback and reflection as well as the motivation and meta-cognitive skills of the feedback recipient. Practical examples: The implementation of feedback in practice is illustrated using eight examples from the field of medical and dental education. They stem from various settings and the focus is on formative oral feedback. It will become evident that the focus is more on the givers of feedback than the recipients of feedback. Instructions for recipients of feedback on how to reflect on it is still the exception. Discussion: Many of the relevant aspects for the effect of feedback described in the literature are already taken into account in the practical examples discussed. In conclusion, seven recommendations are made for implementing feedback in practice.

Assessment of spatial anatomical knowledge with a 'three-dimensional multiple choice test' (3D-MC).

BACKGROUND: Text only multiple choice questions (MCQs) are often inadequate to assess anatomical and histological knowledge and may encourage students to memorize abstract textbook knowledge. An alternative are the "spotters" or "tag tests" well-known in North American and British anatomy. However, the psychometric properties of this assessment have only been reported in one study for a format using short answer questions. AIMS: To describe the implementation and feasibility of a multiple choice "tag test" (3D-MC) using prosected specimens, histological slides, models and radiographs; to report the psychometric properties and students' acceptance of the 3D-MC; to compare it with a traditional multiple choice format. RESULTS: The administration of the 3D-MC did not pose any major problems. The 3D-MC was significantly easier (mean scores 75% vs. 64%) than traditional MCQs. The estimated correlation (corrected for attenuation) between the two MCQ formats was r = 0.814. Reliability for the 3D-MC was. 665 for 30 items. Student acceptance was very high. CONCLUSIONS: The 3D-MC is a feasible, reliable and well-accepted test of anatomical knowledge. Further research should investigate if the higher cost as compared to MCQs using photographs is justified by the assessment of different knowledge and abilities as compared to MCQs using photographs.

Looking back: twenty years of reforming undergraduate medical training and curriculum frameworks in Switzerland.

Introduction: To date, hardly any reports exist that outline the reforms in medical studies in Switzerland from the first partial reforms in the 1970s until today. Methods: This article outlines the recent history of medical curricula, their reforms in the early 1970s and, based on these, the key reasons for the major curricular reforms of the 2000s from the perspective of the authors. Results: The various projects, initiatives and legislative elements at the national level include the introduction of new quality control instruments - federal examination and programme accreditation, the introduction of a national catalogue of learning objectives and its two follow-up editions, as well as the implementation of the Bologna reform in undergraduate medical curricula. Examples of the key new elements found in all medical training in Switzerland include: the interdisciplinary orientation of learning content in organ and functional system-oriented subject areas or modules, the enhanced valorisation of practical clinical training, as well as the introduction of problem-oriented formats and the integration of partly formative, partly summative exams according to the format of the objective structured practical examination (OSCE). Characteristics unique to the four medical faculties and their medical training programme are also highlighted. Discussion: The described projects, initiatives and legislative elements have led to a dynamic, continuous development of medical curricula in Switzerland. The close cooperation between the faculties and the Federal Office of Public Health (FOPH) has also resulted in a redefinition of the roles and responsibilities of universities and the Federal Government according to the new Law on Medical Professions. This guarantees the medical faculties a great deal of autonomy, without neglecting quality assurance.

The learning effects of different presentations of worked examples on medical students' breaking-bad-news skills: A randomized and blinded field trial.

OBJECTIVES: Effective instructional approaches are needed to enable undergraduates to optimally prepare for the limited training time they receive with simulated patients (SPs). This study examines the learning effects of different presentation formats of a worked example on student SP communication. METHODS: Sixty-seven fourth-year medical students attending a mandatory communication course participated in this randomized field trial. Prior to the course, they worked through an e-learning module that introduced the SPIKES protocol for delivering bad news to patients. In this module, a single worked example was presented to one group of students in a text version, to a second group in a video version, and to a third group in a video version enriched with text hints denoting the SPIKES steps. RESULTS: The video-with-hints group broke bad news to SPs significantly more appropriately than either of the other groups. Although no further condition-related effects were revealed, students who learned from the text version most frequently (although non-significantly) ignored unpleasant emotions (standardised emotional cues and concerns) expressed by the SPs. CONCLUSIONS: The learning effect was strongest when the video-based worked example was accompanied by hints. PRACTICE IMPLICATIONS: Video-related learning approaches that embed attention-guiding hints can effectively prepare undergraduates for SP encounters.

10 years of didactic training for novices in medical education at Charité.

Introduction: Many medical faculties are introducing faculty development programmes to train their teaching staff with the aim of improving student learning performance. Frequently changing parameters within faculties pose a challenge for the sustainable establishment of such programmes. In this paper, we aim to describe facilitating and hindering parameters using the example of the basic teacher training (BTT) course at the Charité - Universtitätsmedizin Berlin (Charité). Project description: After sporadic pilot attempts for university education training, basic teacher training was finally established at the Charité in 2006 for all new teaching staff. An interdisciplinary taskforce at the office for student affairs designed the programme according to the Kern cycle of curriculum development, while the Charité advanced training academy provided the necessary resources. Within ten years more than 900 faculty members have completed the BTT (9% of current active teaching staff at the Charité). The BTT programme underwent several phases (piloting, evaluation, review, personnel and financial boosting), all of which were marked by changes in the staff and organizational framework. Evaluations by participants were very positive, sustainable effects on teaching could be proven to a limited extent. Discussion: Success factors for the establishment of the programme were the institutional framework set by the faculty directors, the commitment of those involved, the support of research grants and the thoroughly positive evaluation by participants. More challenging were frequent changes in parameters and the allocation of incentive resources for other, format-specific training courses (e.g. PBL) as part of the introduction of the new modular curriculum of the Charité. Conclusion: The sustainment of the programme was enabled through strategic institutional steps taken by the faculty heads. Thanks to the commitment and input by those at a working level as well as management level, the basic teacher training course is today an established part of the faculty development programme at the Charité.

Learning communication from erroneous video-based examples: A double-blind randomised controlled trial.

OBJECTIVE: Appropriate training strategies are required to equip undergraduate healthcare students to benefit from communication training with simulated patients. This study examines the learning effects of different formats of video-based worked examples on initial communication skills. METHODS: First-year nursing students (N=36) were randomly assigned to one of two experimental groups (correct v. erroneous examples) or to the control group (no examples). All the groups were provided an identical introduction to learning materials on breaking bad news; the experimental groups also received a set of video-based worked examples. Each example was accompanied by a self-explanation prompt (considering the example's correctness) and elaborated feedback (the true explanation). RESULTS: Participants presented with erroneous examples broke bad news to a simulated patient significantly more appropriately than students in the control group. Additionally, they tended to outperform participants who had correct examples, while participants presented with correct examples tended to outperform the control group. CONCLUSION: The worked example effect was successfully adapted for learning in the provider-patient communication domain. PRACTICE IMPLICATIONS: Implementing video-based worked examples with self-explanation prompts and feedback can be an effective strategy to prepare students for their training with simulated patients, especially when examples are erroneous.