Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 23
Filtrar
Más filtros

Bases de datos
País/Región como asunto
Tipo del documento
País de afiliación
Intervalo de año de publicación
1.
Med Teach ; 40(9): 944-952, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-29347873

RESUMEN

BACKGROUND: There have been calls to enhance clinical education by strengthening supported active participation (SAP) of medical students in patient care. This study examines perceived quality of care when final-year medical students are integrated in hospital ward teams with an autonomous relationship toward their patients. METHODS: We established three clinical education wards (CEWs) where final-year medical students were acting as "physician under supervision". A questionnaire-based mixed-method study of discharged patients was completed in 2009-15 using the Picker Inpatient Questionnaire complemented by specific questions on the impact of SAP. Results were compared with matched pairs of the same clinical specialty from the same hospital (CG1) and from nationwide hospitals (CG2). Patients free-text feedback about their hospital stay was qualitatively evaluated. RESULTS: Of 1136 patients surveyed, 528 (46.2%) returned the questionnaire. The CEWs were highly recommended, with good overall quality of care and patient-physician/student-interaction, all being significantly (p < 0.001) higher for the CEW group while experienced medical treatment success was similar. Patient-centeredness of students was appreciated by patients as a support to a deeper understanding of their condition and treatment. CONCLUSION: Our study indicates that SAP of final-year medical students is appreciated by patients with high overall quality of care and patient-centeredness.


Asunto(s)
Prácticas Clínicas/organización & administración , Competencia Clínica , Pacientes Internos/psicología , Calidad de la Atención de Salud/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , Prácticas Clínicas/normas , Femenino , Hospitalización , Humanos , Masculino , Medicina/normas , Persona de Mediana Edad , Calidad de la Atención de Salud/normas
2.
BMC Med Educ ; 16(1): 301, 2016 Nov 24.
Artículo en Inglés | MEDLINE | ID: mdl-27881123

RESUMEN

BACKGROUND: Good communication is a major factor in delivering high quality in care. Research indicates that current communication skills training alone might not sufficiently enable students to find context-specific creative solutions to individual complex personal and interpersonal challenges in the clinical context. This study explores medical students' experiences with real communication dilemmas in a facilitated group setting. The aims were to gain a better understanding of whether and, if so, how reflective practice can enhance students' ability to find creative individual solutions in difficult communication situations and to identify factors within the reflective setting that foster their creative competency. METHODS: Thematic content analysis was used to perform a secondary analysis of semi-structured interview data from a qualitative evaluation of a group reflective practice training for final-year medical students. The categories that arose from the iterative deductive-inductive approach were analyzed in light of current scientific understandings of creativity. RESULTS: Reflection on real difficult clinical communication situations appears to increase medical students' ability to handle such situations creatively. Although group reflection on clinical dilemmas involving personal aspects can stir up emotions, participating students stated they had learned a cognitive process tool that enhanced their communicative competence in clinical practice. They also described changes in personal attitudes: they felt more able to persevere and to tolerate ambiguity, described themselves more open and self-efficient in such complex clinical communication situations and thus more motivated. Furthermore, they reported on factors that were essential in this process, such as reflection on current and real challenges, a group format with a trainer. CONCLUSIONS: Reflective practice providing a cognitive process tool and using real clinical challenges and trainer support in communication education may provide learners with the skills and attitudes to develop creativity in practice. Implementing reflection training in clinical communication education may increase students' overall communicative competency.


Asunto(s)
Competencia Clínica/normas , Comunicación , Creatividad , Educación de Pregrado en Medicina , Mejoramiento de la Calidad/normas , Estudiantes de Medicina/psicología , Actitud del Personal de Salud , Emociones , Humanos , Entrevistas como Asunto , Investigación Cualitativa
3.
BMC Med Educ ; 14: 122, 2014 Jun 22.
Artículo en Inglés | MEDLINE | ID: mdl-24952736

RESUMEN

BACKGROUND: Empathy is an outcome-relevant physician characteristic and thus a crucial component of high-quality communication in health care. However, the factors that promote and inhibit the development of empathy during medical education have not been extensively researched. Also, currently there is no explicit research on the perspective of practicing physicians on the subject. Therefore the aim of our study was to explore physicians' views of the positive and negative influences on the development of empathy during their medical education, as well as in their everyday work as physicians. METHOD: We administered a written Qualitative Short Survey to 63 physicians in seven specialties. They were able to respond anonymously. Our open-ended question was: "What educational content in the course of your studies and/or your specialist training had a positive or negative effect on your empathy?" We analyzed the data using thematic content analysis following Mayring's approach. RESULTS: Forty-two physicians took part in our survey. All together, they mentioned 68 specific factors (37 positive, 29 negative, 2 neutral) from which six themes emerged: 1. In general, medical education does not promote the development of empathy. 2. Recognizing the psycho-social dimensions of care fosters empathy. 3. Interactions with patients in medical practice promote empathy. 4. Physicians' active self-development through reflective practice helps the development of empathy. 5. Interactions with colleagues can both promote and inhibit empathy through their role modeling of empathic and non-empathic behavior. 6. Stress, time pressure, and adverse working conditions are detrimental to empathy development. CONCLUSIONS: Our results provide an overview of what might influence the development of clinical empathy, as well as hypothetical conclusions about how to promote it. Reflective practice seems to be lacking in current medical curricula and could be incorporated. Raising physicians' awareness of the psycho-social dimension of disease, and of the impact of peer influence and role modeling, seems promising in this regard, too. Stress and well-being seem to be closely related to physician empathy, and their modulation must take into account individual, social, and organizational factors. Further research should investigate whether or how these hypothetical conclusions can deepen our understanding of the determinants of physician empathy in order to help its promotion.


Asunto(s)
Educación Médica , Empatía , Médicos/psicología , Adulto , Anciano , Actitud del Personal de Salud , Recolección de Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa
4.
GMS J Med Educ ; 39(2): Doc16, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35692361

RESUMEN

Background: A large part of the population in Germany makes use of naturopathic, complementary and integrative medical treatments. There are now numerous scientific studies that provide evidence of efficacy for certain indications. At German medical faculties, selected procedures and their application are taught within the cross-sectoral unit called QB 12 and some elective courses, with a focus on specific aspects are offered. So far, however, there has been no structured curriculum that longitudinally anchors teaching across medical studies and enables all students to consider naturopathic and complementary medical options for patient care later on and to integrate them effectively into the diagnostic and treatment process. Objective: The aim of this position paper is to show the relevance of this topic for medical education, to clarify terminology and to present core competencies and possible implementation options for training. Method: The Integrative Medicine and Perspective Pluralism Committee of the German Association for Medical Education developed this position paper in a multi-stage consensual process, in cooperation with the Forum of University Work Groups on Naturopathic Treatment and Complementary Medicine. Results: First, different umbrella terms were discussed and an existing definition of integrative medicine and health was chosen for subsequent use. Building on this step, the status of education and its scientific foundation in Germany was considered in an international context. In the next step, a competency profile for medical training, consisting of seven areas of competency, was developed and described in detail with regard to naturopathic, complementary and integrative medicine. Implementation options were identified using possible starting points in the curriculum and using established examples of best practice. Conclusion: Despite different priorities at each faculty, it was possible to find an agreement on the development of competencies and anchoring them in medical education on the basis of a common definition of terms. Currently, the implementation in the mandatory and elective areas is very heterogeneous. As part of the current revision of the Medical Licensure Act, there are many possible starting points for the integration of naturopathic and complementary medical teaching content, especially in interprofessional and general practice courses. The implementation and accompanying research of targeted teaching settings should lay the foundations for a long-term and binding integration into medical education. Overall, it is clear that medical education in the field of naturopathy and complementary and integrative medicine has the potential to develop comprehensive core medical competencies.


Asunto(s)
Educación Médica , Medicina Integrativa , Naturopatía , Diversidad Cultural , Curriculum , Docentes Médicos , Alemania , Humanos
5.
Support Care Cancer ; 19(8): 1197-209, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-20593203

RESUMEN

PURPOSE: Understanding how the information needs of cancer patients (CaPts) vary is important because met information needs affect health outcomes and CaPts' satisfaction. The goals of the study were to identify subgroups of CaPts based on self-reported cancer- and treatment-related information needs and to determine whether subgroups could be predicted on the basis of selected sociodemographic, clinical and clinician-patient relationship variables. METHODS: Three hundred twenty-three CaPts participated in a survey using the "Cancer Patients Information Needs" scale, which is a new tool for measuring cancer-related information needs. The number of information need subgroups and need profiles within each subgroup was identified using latent class analysis (LCA). Multinomial logistic regression was applied to predict class membership. RESULTS: LCA identified a model of five subgroups exhibiting differences in type and extent of CaPts' unmet information needs: a subgroup with "no unmet needs" (31.4% of the sample), two subgroups with "high level of psychosocial unmet information needs" (27.0% and 12.0%), a subgroup with "high level of purely medical unmet information needs" (16.0%) and a subgroup with "high level of medical and psychosocial unmet information needs" (13.6%). An assessment of sociodemographic and clinical characteristics revealed that younger CaPts and CaPts' requiring psychological support seem to belong to subgroups with a higher level of unmet information needs. However, the most significant predictor for the subgroups with unmet information needs is a good clinician-patient relationship, i.e. subjective perception of high level of trust in and caring attention from nurses together with high degree of physician empathy seems to be predictive for inclusion in the subgroup with no unmet information needs. CONCLUSIONS: The results of our study can be used by oncology nurses and physicians to increase their awareness of the complexity and heterogeneity of information needs among CaPts and of clinically significant subgroups of CaPts. Moreover, regression analyses indicate the following association: Nurses and physicians seem to be able to reduce CaPts' unmet information needs by establishing a relationship with the patient, which is trusting, caring and empathic.


Asunto(s)
Necesidades y Demandas de Servicios de Salud , Evaluación de Necesidades , Neoplasias , Educación del Paciente como Asunto/métodos , Adulto , Anciano , Algoritmos , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Encuestas Epidemiológicas , Humanos , Difusión de la Información , Funciones de Verosimilitud , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Satisfacción del Paciente , Relaciones Médico-Paciente , Estudios Retrospectivos , Estadística como Asunto , Factores de Tiempo , Adulto Joven
6.
Front Psychiatry ; 12: 768341, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-35058817

RESUMEN

Introduction: During the first lockdown of the COVID-19 pandemic, several medical students volunteered as assistants in hospitals, public health departments, and other healthcare services to support and substitute permanent staff. The underlying motivations to help are unclear. Therefore, we aimed to assess medical students' motivations and influencing variables such as perceived stress and burden, compassion, and indicators of spirituality. Materials and Methods: Cross-sectional survey (convenience sample) from May to June 2020, directly after the first lockdown, among medical students with standardized instruments. One of them is the 12-item Motivations to Help Scale (MtHS) which was designed to fit to the population of medical students. Results: Among the 731 completers, 52% were working as volunteers during the pandemic in different medical areas, most in hospitals and only a few in other areas (9% in public health departments, 6% in outpatient services), 37% would have liked to work but did not get an appropriate employment, and 21% did not intend to voluntarily support the hospital staff. Their mental burden during work was rather low, while they were somewhat affected by the personal fate of the patients. With respect to their motivations to volunteer as measured with the MtHS, Altruistic Intentions/Helping (Cronbach's alpha = 0.898) scored highest, followed by Practical Application/Learning (Cronbach's alpha = 0.808), while Role Testing/Recognition (Cronbach's alpha = 0.702) scored lowest. Those who volunteered had significantly higher scores for Altruistic Intentions/Helping and Practical Application/Learning, while the different phases of medical study (preclinical phase, clinical phase, and higher semester) had no influence on the extent of the students' motivation. The motivations to help were not at all or only marginally (inversely) related to indicators of stress and burden, while Altruistic Intentions/Helping was weakly related to affections by patients' fate. Conclusions: Medical students' intention to support healthcare professionals as supplementary assistants were both prosocial and proself motivated. With this opportunity to practically apply their current knowledge and to improve their skills and competences, volunteering students might be more motivated for their further studies and their future career as compassionate medical doctors.

7.
Med Teach ; 32(7): 552-7, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20653376

RESUMEN

BACKGROUND: Active participation of medical students in patient care has been shown to be important for professional development of learners. Not much is known about the impact of active student participation (ASP) to the quality of patient care. AIMS: We established a Clinical Education Ward (CEW) for the final year medical students caring for patients under structured clinical supervision. This study investigates the views of both patients and clinical staff on the impact of ASP on patient care. METHODS: The Picker Inpatient Questionnaire (PIQ) was used to survey all the patients admitted to the CEW during the pilot phase. Results concerning the general quality of health care and the patient-physician relationship (PPR) were compared to two matched pair control groups: patients of the same department (CG1) and of internal wards in Germany (CG2). In addition, quantitative and qualitative data were collected from patients and clinical staff members to specify the impact of students on patient care. RESULTS: Out of 111 patients, 64 responded. The PIQ results revealed very minor problems in the assessment of the overall general quality of care and in PPR at the CEW, while significant improvements existed when compared to CG2. Furthermore, 79% of the patients and 95% of the staff members recorded a positive impact of ASP. Qualitative data illustrated and complemented these results. Chances and challenges in programs with high participation of students in clinical care are discussed. CONCLUSION: ASP may not only be useful for learners but also offers chances and benefits for patient care.


Asunto(s)
Actitud del Personal de Salud , Prácticas Clínicas/métodos , Atención al Paciente/métodos , Satisfacción del Paciente , Estudiantes de Medicina , Anciano , Prácticas Clínicas/normas , Femenino , Alemania , Humanos , Medicina Interna/educación , Medicina Interna/métodos , Masculino , Atención al Paciente/psicología , Atención al Paciente/normas , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/normas , Relaciones Médico-Paciente , Proyectos Piloto
8.
Patient Educ Couns ; 103(11): 2320-2327, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32389386

RESUMEN

OBJECTIVE: This study examines whether students in the clinical phase show reduced well-being and lower empathy scores compared to preclinical students. Furthermore, it explores students' most stressful experiences. METHODS: A cross-sectional mixed-methods study was conducted among medical students of the revised patient- and student-centred curriculum at Witten/Herdecke University (Germany). An online survey included questions regarding empathy (JSPE-S), well-being (WHO-5), distressing factors in the learning and clinical environments, mistreatment and thoughts of dropping out. RESULTS: 176 (34 %) of 517 medical students completed the questionnaire, 73 being preclinical and 103 clinical students. Despite lower well-being, clinical student did not demonstrate lower empathy levels. Main stressors during the clinical phase were negative physician role models and financially focussed care rather than challenging patient encounters. Compared to preclinical students, clinical students showed more mistreatment experiences and higher ratings towards thoughts of dropping out. CONCLUSION: Our results illustrate contemporary challenges to establishing a learner-centred clinical environment that nurtures well-being and empathy of medical students. The sustainment of empathy despite more stressful experiences and lower well-being may be due to protective factors. PRACTICE IMPLICATIONS: The paper suggests activities to support clinical students to find ways to adapt the clinical learning environment to students' needs.


Asunto(s)
Educación de Pregrado en Medicina/métodos , Empatía , Estrés Laboral/psicología , Atención al Paciente , Relaciones Médico-Paciente , Estudiantes de Medicina/estadística & datos numéricos , Adulto , Comunicación , Estudios Transversales , Femenino , Alemania , Humanos , Masculino , Distrés Psicológico , Encuestas y Cuestionarios
9.
Artículo en Inglés | MEDLINE | ID: mdl-26955394

RESUMEN

Introduction. Goitre with euthyroid function or with subclinical or mild hyperthyroidism due to thyroid autonomy is common. In anthroposophic medicine various thyroid disorders are treated with Colchicum autumnale (CAU). We examined the effects of CAU in patients with goitre of both functional states. Patients and methods. In an observational study, 24 patients with goitre having suppressed thyroid stimulating hormone (TSH) levels with normal or slightly elevated free thyroxine (fT4) and free triiodothyronine (fT3) (group 1, n = 12) or normal TSH, fT3, and fT4 (group 2, n = 12) were included. After 3 months and after 6 to 12 months of CAU treatment, we investigated clinical pathology using the Hyperthyroid Symptom Scale (HSS), hormone status (TSH, fT4, and fT3), and thyroidal volume (tV). Results. After treatment with CAU, in group 1 the median HSS decreased from 4.5 (2.3-11.8) to 2 (1.3-3) (p < 0.01) and fT3 decreased from 3.85 (3.5-4.78) to 3.45 (3.3-3.78) pg/mL (p < 0.05). In group 2 tV (13.9% (18.5%-6.1%)) and TSH (p < 0.01) were reduced. Linear regression for TSH and fT3 in both groups indicated a regulative therapeutic effect of CAU. Conclusions. CAU positively changed the clinical pathology of subclinical hyperthyroidism and thyroidal volume in patients with euthyroid goitre by normalization of the regulation of thyroidal hormones.

10.
Med Klin (Munich) ; 99(10): 578-84, 2004 Oct 15.
Artículo en Alemán | MEDLINE | ID: mdl-15490073

RESUMEN

PURPOSE: Cross-sectional study to evaluate the psychological distress of patients with Graves' disease 5 years after diagnosis. PATIENTS AND METHODS: 45 female patients being treated for Graves' disease in a specialized endocrinological practice in Wuppertal, Germany, were asked to fill in the Symptom Checklist-90-R (SCL-90-R) and the Hospital Anxiety and Depression Scale (HADS). All patients were in a euthyroid state for at least 6 months. RESULTS: Patients were found to have significantly elevated mean values in the SCL-90-R compared with normal values for healthy test candidates. According to the Global Severity Index (GSI) more than one third (35.6%) of patients were suffering from psychological distress. These patients also showed elevated scores in the anxiety subscale of HADS. Almost all patients (95.6%) had elevated scores in the depression subscale of HADS. Patients with high levels of psychological distress (GSI > 60) were more likely to suffer a relapse than those with normal levels (p < 0.05). Patients in latent hyperthyroid state did not show higher levels of psychological distress than those with normal thyrotropin (TSH). CONCLUSION: Many patients with a history of Graves' disease suffer from chronic psychological distress which cannot be explained by the metabolic state of the thyroid gland. Whether this finding results from damage to the CNS or reflects a generally increased stress vulnerability is unclear. Psychological treatment appears to be indicated in many cases of Graves' disease.


Asunto(s)
Depresión/etiología , Enfermedad de Graves/complicaciones , Estrés Psicológico/etiología , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad , Estudios Transversales , Depresión/diagnóstico , Femenino , Enfermedad de Graves/psicología , Humanos , Masculino , Persona de Mediana Edad , Estrés Psicológico/diagnóstico , Encuestas y Cuestionarios
11.
GMS Z Med Ausbild ; 31(4): Doc46, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25489346

RESUMEN

STUDY AIM: Physician empathy constitutes an outcome-relevant aim of medical education. Yet, the factors promoting and inhibiting physician empathy have not yet been extensively researched, especially in Germany. In this study, we explored German medical students' views of the factors promoting and inhibiting their empathy and how their experiences were related to their curricula. METHODS: A qualitative short survey was conducted at three medical schools: Bochum University, the University of Cologne and Witten/Herdecke University. Students were invited to complete an anonymous written questionnaire comprised of open-ended questions inquiring about the educational content of and situations during their medical education that positively or negatively impacted their empathy. Data were analyzed through qualitative content analysis according to the methods of Green and Thorogood. RESULTS: A total of 115 students participated in the survey. Respondents reported that practice-based education involving patient contact and teaching with reference to clinical practice and the patient's perspective improved their empathy, while a lack of these inhibited it. Students' internal reactions to patients, such as liking or disliking a patient, prejudice and other attitudes, were also considered to influence their empathy. Although each of the three schools takes a different approach to teaching interpersonal skills, no relevant differences were found in their students' responses concerning the possible determinants of empathy. CONCLUSION: Providing more training in practice and more contact with patients may be effective ways of promoting student empathy. Students need support in establishing therapeutic relationships with patients and in dealing with their own feelings and attitudes. Such support could be provided in the form of reflective practice training in order to promote self-awareness. More research is needed to evaluate these hypothetical conclusions.


Asunto(s)
Concienciación , Educación de Pregrado en Medicina , Empatía , Relaciones Médico-Paciente , Autoevaluación (Psicología) , Adulto , Actitud del Personal de Salud , Comunicación , Femenino , Alemania , Humanos , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Investigación Cualitativa , Facultades de Medicina , Encuestas y Cuestionarios , Adulto Joven
12.
Patient Educ Couns ; 92(3): 337-45, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23642894

RESUMEN

OBJECTIVE: Professional capabilities, such as empathy and patient-centeredness, decline during medical education. Reflective practice is advocated for teaching these capabilities. The Clinical Reflection Training (CRT) is a reflective practice intervention using the professional dilemmas faced by medical students during clinical practice. The aim of this study was to evaluate students' perceptions of the helpfulness of the CRT and its effects on their medical education. METHODS: Eighteen semi-structured interviews were conducted with medical students who had participated in the CRT. Content analysis was used to analyze the interview data. RESULTS: Medical students did not feel adequately prepared to manage the difficult personal and interpersonal problems frequently encountered in clinical practice. They reported that the CRT reduces stress, improves patient care and serves as a tool for professional development. CONCLUSION: The CRT may be a useful tool for developing professionalism during medical education, reducing stress and enhancing the quality of patient care. PRACTICE IMPLICATIONS: Providing students with reflective practice training that draws on their current personal clinical problems in order to improve their clinical work may be a productive investment in personal professional development, physician health, and quality improvement.


Asunto(s)
Competencia Clínica/normas , Educación Médica/organización & administración , Aprendizaje , Atención al Paciente/normas , Estudiantes de Medicina/psicología , Adulto , Actitud del Personal de Salud , Humanos , Entrevistas como Asunto , Investigación Cualitativa , Mejoramiento de la Calidad
13.
Artículo en Inglés | MEDLINE | ID: mdl-23573149

RESUMEN

Objectives. To examine the impact of active student participation on quality of care in an integrative inpatient setting. Methods. Over a two-year period, we surveyed all patients treated on the Clinical Education Ward for Integrative Medicine (CEWIM), where final-year medical students are integrated into an internal medicine ward complementing conventional medicine with anthroposophic medicine. Patients treated on the regular wards of the same internal medicine department served as the control group (CG). General quality of care was studied with the Picker Inpatient Questionnaire, physician empathy with the Consultation and Relational Empathy measure, and patient enablement with the Patient Enablement Index. ANCOVA was used to control for covariates while examining significant differences between both patient groups. Results. Comparison of the CG wards and the CEWIM revealed no significant differences in medical treatment success. The CEWIM, however, achieved better results for physician-patient interaction, physician empathy, and patient enablement. Eighty Percent of the CEWIM patients rated student participation as positively impacting quality of care. Conclusion. Our results indicate that incorporating students in an integrative healthcare setting may result in greater patient centeredness. Further studies are needed to determine whether this is due to organizational advantages, students' empathic activity, the impact of teaching, or learner-teacher interaction.

14.
Patient Educ Couns ; 89(3): 455-60, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22306457

RESUMEN

OBJECTIVE: To develop the hypothesis that reductionism in medical anthropology, professional education and health care influences empathy development, communication and patient satisfaction. METHOD: We identified relevant literature and reviewed the material in a structured essay. We reflected our hypothesis by applying it to Anthroposophic Medicine (AM), an example of holistic theory and practice. RESULTS: Reductionism in medical anthropology such as in conventional medicine seems to lead to a less empathetic and less communicative health care culture than holism such as in CAM disciplines. However, reductionism can be transformed into a systemic, multi-perspective holistic view, when the emergent properties of the physical, living, psychic, spiritual and social levels of human existence and the causal relations between them are more carefully accounted for in epistemology, medical anthropology and professional education. This is shown by the example of AM and its possible benefits for communication with and satisfaction of patients. CONCLUSION: A non-reductionistic understanding of the human being may improve communication with patients and enhance patient benefit and satisfaction. PRACTICE IMPLICATIONS: Interdisciplinary qualitative and quantitative studies are warranted to test this hypothesis and to understand the complex relations between epistemology, medical anthropology, education, health care delivery and benefit for patients.


Asunto(s)
Antropología Médica , Medicina Antroposófica , Educación Médica/métodos , Empatía , Relaciones Médico-Paciente , Comunicación , Atención a la Salud/métodos , Salud Holística , Humanos , Satisfacción del Paciente
15.
GMS Z Med Ausbild ; 29(1): Doc11, 2012.
Artículo en Inglés, Alemán | MEDLINE | ID: mdl-22403596

RESUMEN

OBJECTIVE: The present study gives a brief introduction into 1. the definition of physician empathy (PE) and 2. its influence on patients' health outcomes. Furthermore 3. we present assessment instruments to measure PE from the perspective of the patient and medical student. The latter topic will be explored in detail as we conducted a pilot study on the German versions of two self-assessment instruments of empathy, which are mostly used in medical education research, namely the "Jefferson Scale of Physician Empathy, Student Version" (JSPE-S) and the "Interpersonal Reactivity Index" (IRI). METHODS: We first present an overview of the current empirical and theoretical literature on the definition and outcome-relevance of PE. Additionally, we conducted basic psychometric analyses of the German versions of the JSPE-S and the IRI. Data for this analyses is based on a cross-sectional pilot-survey in N=44 medical students and N=63 students of other disciplines from the University of Cologne. RESULTS: PE includes the understanding of the patient as well as verbal and non-verbal communication, which should result in a helpful therapeutic action of the physician. Patients' health outcomes in different healthcare settings can be improved considerably from a high quality empathic encounter with their clinician. Basic psychometric results of the German JSPE-S and IRI measures show first promising results. CONCLUSION: PE as an essential and outcome-relevant element in the patient-physician relationship requires more consideration in the education of medical students and, thus, in medical education research. The German versions of the JSPE-S and IRI measures seem to be promising means to evaluate these education aims and to conduct medical education research on empathy.


Asunto(s)
Educación Médica , Empatía , Relaciones Médico-Paciente , Resultado del Tratamiento , Comunicación , Curriculum , Femenino , Alemania , Humanos , Masculino , Satisfacción del Paciente , Estudiantes de Medicina/psicología , Adulto Joven
16.
Patient Educ Couns ; 89(3): 447-54, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22738823

RESUMEN

OBJECTIVES: the development and preliminary evaluation of a new medical program aimed at educating students in patient-centered integrative care and developing appropriate educational strategies. METHODS: The Integrated Curriculum for Anthroposophic Medicine (ICURAM) was developed with modules on anthroposophic medicine integrated into the full 6 years of the regular medical curriculum. The educational strategy is the ESPRI(2)T approach, combining Exploratory learning, Supported participation, Patient-based learning, Reflective practice, Integrated learning, an Integrative approach and Team-based learning. The student participation, assessed based on the number of credit points earned per year (ctp/year) through the ICURAM (1 ctp=30 h workload), served as a preliminary indicator of student interest. RESULTS: Of the 412 55%medical students participated in the program: 16% full participation (≥ 4 ctp/year), 18% partial participation (1-3.99 ctp/year) and 22% occasional participation (0.25-0.99 ctp/year). The amount of additional workload taken on by students was between 7.8h/year for occasional participants, 33 h/year for partial participants and 84 h/year for full participants. CONCLUSION: More than half of medical students were willing to invest a significant amount of additional time in the optional program. PRACTICE IMPLICATIONS: An integrative medical curriculum with a student-centered educational strategy seems to be of interest to most medical students.


Asunto(s)
Medicina Antroposófica , Curriculum , Educación de Pregrado en Medicina/métodos , Medicina Integrativa/educación , Atención Dirigida al Paciente/métodos , Adulto , Femenino , Alemania , Humanos , Aprendizaje , Práctica Psicológica , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Estudiantes de Medicina/psicología
18.
Patient Educ Couns ; 84(2): 208-16, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-20708897

RESUMEN

OBJECTIVE: We hypothesized that patients' ratings of physician empathy (PE) would be higher among those with private health insurance (PHI, referring to financial incentive) than among patients with statutory health insurance (SHI). METHODS: A postal survey was administered to 710 cancer patients. PE was assessed using the Consultation-and-Relational-Empathy measure. T-tests were conducted to analyse whether PHI and SHI-patients differ in their ratings of PE and variables relating to contact time with the physician. Structural-equation-modelling (SEM) verified mediating effects. RESULTS: PHI-patients rated physician empathy higher. SEM revealed that PHI-status has a strong significant effect on frequency of talking with the physician, which has a strong significant effect (1) on PE and (2) has a moderate effect on patients' perception of medical staff stress, thereby also affecting patients' ratings of PE. CONCLUSIONS: Our findings suggest that PHI-status is one necessary precondition for physicians spending more time with the patient. Spending more time with the PHI-patient has two major effects: it results in a more positive perception of PE and positively impacts PHI-patients' perception of medical staff stress, which in turn, again influences PE. PRACTICAL IMPLICATIONS: Health policy should discuss these findings in terms of equality in receiving high-quality care.


Asunto(s)
Empatía , Planes de Aranceles por Servicios , Cobertura del Seguro , Seguro de Salud , Motivación , Relaciones Médico-Paciente , Anciano , Anciano de 80 o más Años , Capitación , Comunicación , Análisis Factorial , Femenino , Financiación Personal , Política de Salud , Humanos , Masculino , Neoplasias/terapia , Satisfacción del Paciente , Médicos/psicología , Sector Privado , Encuestas y Cuestionarios
19.
Acad Med ; 86(8): 996-1009, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-21670661

RESUMEN

PURPOSE: Empathy is a key element of patient-physician communication; it is relevant to and positively influences patients' health. The authors systematically reviewed the literature to investigate changes in trainee empathy and reasons for those changes during medical school and residency. METHOD: The authors conducted a systematic search of studies concerning trainee empathy published from January 1990 to January 2010, using manual methods and the PubMed, EMBASE, and PsycINFO databases. They independently reviewed and selected quantitative and qualitative studies for inclusion. Intervention studies, those that evaluated psychometric properties of self-assessment tools, and those with a sample size <30 were excluded. RESULTS: Eighteen studies met the inclusion criteria: 11 on medical students and 7 on residents. Three longitudinal and six cross-sectional studies of medical students demonstrated a significant decrease in empathy during medical school; one cross-sectional study found a tendency toward a decrease, and another suggested stable scores. The five longitudinal and two cross-sectional studies of residents showed a decrease in empathy during residency. The studies pointed to the clinical practice phase of training and the distress produced by aspects of the "hidden," "formal," and "informal" curricula as main reasons for empathy decline. CONCLUSIONS: The results of the reviewed studies, especially those with longitudinal data, suggest that empathy decline during medical school and residency compromises striving toward professionalism and may threaten health care quality. Theory-based investigations of the factors that contribute to empathy decline among trainees and improvement of the validity of self-assessment methods are necessary for further research.


Asunto(s)
Empatía , Internado y Residencia , Estudiantes de Medicina/psicología , Competencia Clínica , Curriculum , Humanos
20.
Patient Educ Couns ; 82(3): 361-9, 2011 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-21315537

RESUMEN

OBJECTIVE: The aims of this study are twofold: (1) the theory-based development of a patient self-report measure of physician warmth and (2) the application of cognitive interview methodology to understand patients' perception and interpretation of this new measure. METHODS: A draft measure was developed based on an in-depth literature review of the concept of human warmth by a multidisciplinary expert group. Sixteen cognitive probing interviews were conducted to examine how patients perceive and interpret this new measure and to identify potential problems. A content analysis of the interviews was used to evaluate findings. RESULTS: Findings indicate that the WARMOMETER is a short patient self-report assessment of physician warmth, which seems easy and intuitive to understand. In addition, most respondents were found to share a common concept of physician warmth. CONCLUSIONS: Verification of our study hypotheses and confirmation of the theoretical assumptions of human warmth give basic indications that the WARMOMETER seems to be a valid and sensitive patient self-report instrument for assessing the socio-emotional quality of physicians. PRACTICE IMPLICATIONS: These first promising results of our cognitive interviews suggest that the WARMOMETER may also be used and further validated in future health communication studies, also with other healthcare professionals.


Asunto(s)
Cognición , Comunicación , Relaciones Interpersonales , Relaciones Médico-Paciente , Percepción Social , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Emociones , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Autoinforme , Conducta Social , Factores Socioeconómicos , Encuestas y Cuestionarios
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA