Development and implementation of a tool for measuring the training effectiveness of the patient-centered consultation model.

Background: The patient-centered consultation model comprises four elements: exploring health, illness and disease experiences, understanding the whole person, finding common ground, and enhancing the patient-doctor relationship. This method is taught at the course in general practice at Copenhagen University. The aim of the study was to develop a simple tool consisting of a questionnaire about the patient-centered elements and a test video consultation. The outcome is the change in the students' ability to identify these elements. Used as a pre-course and post-course test it can inform the teachers which elements of the patient-centered consultation need intensifying in the teaching. Methods: The students from a course in general practice volunteered to participate in all steps of the development. They took part in individual interviews to select items from an already existing questionnaire (DanSCORE). The preliminary questionnaire was tested for face and content validity, pilot-tested and tested for test-retest reliability. All video consultations were transcribed and assessed for patient-centered elements through a conversation analysis. The videos showed medical students seeing real patients. Results: The preliminary version of the questionnaire (called DanOBS) had 23 items. In the subsequent interviews, items were reduced to 17, each with three response options. After a pilot test, the questionnaire was further reduced to 13 items, all strictly relevant to the model and with two response options. The final questionnaire had acceptable test-retest reliability. The number of test consultation videos underwent a reduction from six videos to one. Conclusions: The DanOBS combined with a test video consultation, used as a pre-and post-course test demonstrates for teachers which elements in the patient-centered consultation need to be intensified in the teaching.

Evaluating Simulated Consultation Videos in Teaching Patient-Centered General Practice.

This article was migrated. The article was marked as recommended. Introduction In the general practice course at Copenhagen University, students are taught patient-centered consultations. The aim of this study is to evaluate the feasibility of a new method for measuring the effect of this teaching, and of adding access to simulated consultation videos to usual teaching. Methods The university assigned 293 final-semester students to three groups: a 'Control Group' with usual curriculum, an 'Access Group' that watched simulated consultation video clips online and a 'Teaching Group' where the video clips were discussed in teaching sessions. The outcome was the change in students' ability to identify patient-centered elements in a test video consultation, measured with a questionnaire before and after the course. Results An overall teaching effect was observed, which was most apparent in communication items such as "making a contract about the topic for the consultation" and "summarizing". Changes in clinical items and general issues were small. Conclusion A tool for measuring the effect of teaching general practice consultation skills combining a test video and a questionnaire is presented. Topics needing to be highlighted in teaching could be identified using the tool.

Postoperative education and pain in patients with inguinal hernia.

AIM: This paper reports a study to investigate whether education can reduce postoperative pain in patients operated on for inguinal hernia. BACKGROUND: Operation for inguinal hernia is a frequent, elective procedure. Studies indicate that 20% of patients operated on for this condition still have moderate to severe pain on the sixth postoperative day. They also show a connection between postoperative pain and time to return to work, inconvenience relating to recreation and work and development of chronic pain. METHOD: The design was a randomized, clinically controlled, single-blinded study, carried out in 2002-2003. The intervention group received education on discharge from hospital, followed by a telephone interview on the second postoperative day. The control group was given the usual routine information. In a questionnaire, patients ranked their pain on a 100-mm Visual Analogue Scale on the first, third and seventh postoperative days. RESULTS: The study included 234 consecutive patients. The baseline characteristics for the intervention and the control group were identical. Pain was analysed as the difference in Visual Analogue Scale scores immediately preoperatively and on the chosen days postoperatively. No difference was found for pain while resting, pain when moving on the first and third postoperative day and time to return to work. Statistically, there was a significant difference (P = 0.028) between the groups for pain when moving on the seventh postoperative day. The estimated mean difference was 7 mm (95% confidence interval 0.7-13.1 mm). CONCLUSIONS: In patients operated on for inguinal hernia, postoperative education and a telephone interview have no effect on postoperative pain while resting and time to return to work. The effect on pain while moving was slight. There is no reason to change standard practice.

Analysis of two large functionally uncharacterized regions in the Methanopyrus kandleri AV19 genome.

BACKGROUND: For most sequenced prokaryotic genomes, about a third of the protein coding genes annotated are "orphan proteins", that is, they lack homology to known proteins. These hypothetical genes are typically short and randomly scattered throughout the genome. This trend is seen for most of the bacterial and archaeal genomes published to date. RESULTS: In contrast we have found that a large fraction of the genes coding for such orphan proteins in the Methanopyrus kandleri AV19 genome occur within two large regions. These genes have no known homologs except from other M. kandleri genes. However, analysis of their lengths, codon usage, and Ribosomal Binding Site (RBS) sequences shows that they are most likely true protein coding genes and not random open reading frames. CONCLUSIONS: Although these regions can be considered as candidates for massive lateral gene transfer, our bioinformatics analysis suggests that this is not the case. We predict many of the organism specific proteins to be transmembrane and belong to protein families that are non-randomly distributed between the regions. Consistent with this, we suggest that the two regions are most likely unrelated, and that they may be integrated plasmids.