[Communication Test for Foreign Physicians in Germany: The Patient Communication Test]. / Kommunikationsprüfung ausländischer Ärzte in Deutschland: Patientenkommunikationstest.

INTRODUCTION: The number of foreign doctors in Germany has increased steadily in recent years. To obtain the German medical license, sufficient language competence is mandatory. Nevertheless, in practice, foreign doctors have considerable difficulties in their communication with patients, medical colleagues and other health professionals. This can lead to misunderstandings and thus impair patient safety. To overcome this problem, the "patient communication test" was developed and piloted as an additional requirement to be granted license to practice medicine in Germany. The aim of this study is to present our results in the development and piloting of this test. METHODS: 3 OSCE stations (Objective Structured Clinical Examination) were designed, which evaluate communication skills in 3 medical competences: history taking, case presentation and explaining to patients before obtaining informed consent. After extensive instruction of actors as patients and raters on the basis of the evaluation criteria, the communication test was subjected to pilot studies in 6 different cities (Freiburg, Jena, Mainz, Mannheim, Tübingen, and Ulm). RESULTS: In 2013, 639 foreign doctors participated in the test; 461 (72.14%) of these doctors passed the test on their first try, 51 (7.98%) on their second attempt and 6 (0.93%) on their third try. CONCLUSION: The patient communication test evaluates the communication skills of foreign doctors in OSCE-setting using standardized actor-patients. This improves the communication skills and enhances patient safety in the German health care system by smooth inter-professional and patient-centered communication.

[Equivalency examinations for foreign physicians in Baden-Wuerttemberg]. / Gleichwertigkeitsprüfung für ausländische Ärzte/Ärztinnen in Baden-Württemberg.

INTRODUCTION: Recent years have seen an increasing number of foreign doctors starting to practice medicine in German hospitals (or more rarely, in surgeries). In order to be granted the German license to practice medicine, doctors with a medical degree from outside the European Union have to undergo an equivalency examination. The supervisory authority for this is the examination office of the relevant federal state, which is why different procedures are being applied in the individual states. The aim of this paper is to point out the problems that frequently arise when conducting this specialist exam and to make suggestions as to how to improve the quality of the procedure. METHOD: 6 senior professors from the examination boards of the 4 medical schools in Baden-Wuerttemberg formed a focus group and discussed the difficulties associated with the exam, recorded problems in its actual implementation and then analysed the minutes of the meeting in a results-based manner in order to compile proposals for optimisation. RESULTS: In view of the deficits in subject knowledge, general communication skills and specific communication skills, the difficulties of the current recognition procedure and the existing equivalency exam fall into 3 categories: structure and content of the exam, examiners and exam candidates. CONCLUSIONS: In consultation with the State Examination Office Stuttgart, some processes for optimisation have been devised, e. g., to develop a special curriculum which could be used for guidance and to recruit more examiners. The recommendations of the focus group from Baden-Wuerttemberg are an important step towards more transparency and possibly towards a Germany-wide standardisation of this exam.

Three-month evaluation of vital tooth bleaching using light units-a randomized clinical study.

The aim of this study was to evaluate the color stability of vital bleaching using a halogen unit, laser, or only chemical activation up to three months after treatment. A total of 60 patients were divided into three groups, and their teeth were bleached with 38% hydrogen peroxide using three methods: acceleration of the bleaching process with halogen (eight minutes), laser (30 seconds), or chemical activation only. All teeth were bleached a maximum of four times (4 × 15 minutes) until a change of six shade tabs took place. The color was evaluated both visually and with a spectrophotometer before bleaching, immediately after bleaching, and one and three months after bleaching. Directly after bleaching, the use of halogen showed better results than laser (p≤0.05). One and three months after bleaching, no significant difference was found between the tested methods relative to the shade change, independent of the method of shade evaluation (p>0.05). As far as the color stability is concerned, bleaching with halogen resulted in stable color throughout the three months (p>0.05), whereas the other two methods resulted in whiter teeth after one and three months compared with the color directly after bleaching (p≤0.05). Bleaching with laser needed more time than halogen for the desired shade change (p≤0.05). Although directly after treatment bleaching with halogen resulted in better results, one and three months after bleaching the kind of acceleration used in the bleaching process did not have any effect on the esthetic results.

Disclosing information about randomised controlled trials in oncology: training concept and evaluation of an individualised communication skills training for physicians COM-ON-rct.

When physicians disclose information about randomised controlled trials, they have to balance the requirements of conducting high standard research and the respect for patients' rights. Physicians need training in this difficult matter. An individualised communication skills training (CST) about randomised controlled trials for oncologists has been developed. The aim of this publication is to describe the concept of our CST and present data of evaluation by the participants: First, a theoretical introduction about a communication model and important ethical and legal issues was presented. Individual learning goals of participants were then derived through video assessment with actor-patients. The learning goals were the basis for practicing in role play. Individual coaching helped physicians to transfer the made experience into their daily work. Forty physicians have been trained. The acceptance of the training concept was assessed by a questionnaire consisting of 14 items and using a 6-point scale from 1 (very best) to 6 (very bad): the individualised CST was highly accepted (mean = 1.33). Practicing with actor-patients (mean = 1.4), providing constructive feedback (mean = 1.3) and assessing individual learning goals (mean = 1.85) were seen as helpful. Our CST trains physicians to realise best research standards and incorporate patients' rights.

[Need for and use of a university clinic mental health liaison service]. / Psychosomatischer Liaisondienst am Universitätsklinikum. Bedarf und Inanspruchnahme.

BACKGROUND: Little is known about the complex decision-making process involving recognition of psychosocial stress, its diagnosis, and psychotherapeutic intervention within the framework of a psychosomatic consulting and liaison service. PATIENTS AND METHODS: Psychosocial stress was recorded using a psychometric questionnaire for 392 patients on admission to hospital, the estimated need of psychotherapeutic treatment, and the application of a psychosomatic liaison service. RESULTS: Of the examined patients, 44% presented with at least one mental disorder requiring treatment according to ICD-10 criteria. According to the expert opinions, a need for psychotherapeutic treatment was present in 41%, while 54% were themselves motivated for at least one of the psychotherapeutic treatments offered. Psychotherapy was actually received by 35% of the patients. While mental disorders and emotional distress were significant predictors of the need for treatment as rated by experts, they played no genuine role in determining indication or whether a patient accepts the use of psychotherapy CONCLUSION: Psychotherapeutic interventions in the liaison service are not always effective or related to the indication.

Need and use of psychotherapeutic interventions within a psychosomatic liaison service in neurology.

OBJECTIVES: The study addresses the evaluation of psychosocial distress, the need for care as determined by a psychotherapist and patients, and the realization of psychotherapeutic interventions within a routine psychosomatic liaison service. MATERIAL AND METHODS: A total of 84 patients from one unit at the Department of Neurology of the University of Freiburg, Germany, underwent a structured psychodiagnostic interview and filled out self-rating instruments to evaluate mental disorders, psychosocial distress, ways of coping strategies and quality of life. The need for treatment and the motivation of patients were estimated by both patients and a liaison psychotherapist. RESULTS: Using ICD-10-F criteria, mental and behavioral disorders were diagnosed in 35% of cases. Professional assessment indicated a need for psychotherapeutic treatment in 37% of patients; actual intervention occurred in 27%. Only slight agreement was found between the estimated need for treatment and the interventions actually performed. CONCLUSIONS: The realization of psychotherapeutic interventions is subject to a complex interaction between the needs of a patient, the "objective" psychosocial distress of the patient, and institutional factors. About 10% of the hospitalized patients considered in the study need continuous psychotherapeutic treatment.

The efficacy and safety of a coumarin-/troxerutin-combination (SB-LOT) in patients with chronic venous insufficiency: a double blind placebo-controlled randomised study.

BACKGROUND: The objective was to evaluate the oedema-protective effect of a vasoactive drug (coumarin/troxerutin [SB-LOT]) plus compression stockings in patients suffering from chronic venous insufficiency after decongestion of the legs as recommended by the new guidelines. PATIENTS AND METHODS: 231 patients were randomly assigned medical compression stockings plus SB-LOT (90 mg coumarin and 540 mg troxerutin per day) or medical compression stockings plus placebo for the first 4 weeks and SB-LOT or placebo for the second 12 weeks of the study. The primary efficacy endpoint was the lower leg volume measured by well-established water plethysmometry. RESULTS: 226 patients were evaluated. After ceasing compression stockings, an edema protective effect was detected in the SB-LOT-group but not in the controls. Recurrence of leg volume increase was by 6.5 +/- 12.1 ml and by 36.7 +/- 12.1 ml in the SB-LOT and placebo group, respectively (p = 0.0402). The local complaint score and general aspects of quality of life were also superior for the SB-LOT-group (p = 0.0041). Significant differences were also observed with regard to clinical global impression and therapeutic effect. No serious adverse drug reaction or clinically relevant impairment of laboratory parameters occur. CONCLUSION: This study confirms the oedema-protective effect of SB-LOT in chronic venous insufficiency and provides a treatment option for patients who discontinue compression after a short time.

The need for psychosocial support in parents with cochlear implanted children.

OBJECTIVE: The aim of the study was to assess the need of parents with Cochlear implanted children for psychosocial support, based on psychic symptoms reported by these parents and their motivation to make use of psychosocial interventions. METHODS: Fifty seven mothers and 46 fathers of 57 Cochlear implanted children were evaluated separately, employing validated questionnaires (Symptom Checklist-90-R and Questionnaire on Psychosocial Support). RESULTS: 26% of the mothers and 25% of the fathers showed severe psychic symptoms as reflected in the Symptom Checklist-90-R. Fifty nine percent of the mothers and 60% of the fathers were highly motivated to participate in psychosocial interventions--especially in the form of further information on their children's ailment and in parents' groups. CONCLUSIONS: The data presented suggest that there is a need for psychosocial support in 18% of the parents; 8% of the parents show high psychic stress, but low motivation. The rest of the parents are not in need of support; nevertheless, 42% of the parents are highly motivated in favor of psychosocial interventions.

[Psychotherapeutic and psychosocial therapy in general practice. Results of demonstration project on quality management in psychosocial primary care]. / Psychotherapeutische und psychosoziale Behandlungsmassnahmen in der Hausarztpraxis. Ergebnisse im Rahmen eines Demonstrationsprojektes zur Qualitätssicherung in der psychosomatischen Grundversorgung.

Since 1987, psychosocial primary care (PPC) provided by General Practitioners, are reimbursed by German health insurances. The aim of the psychosocial primary care is to improve recognition and treatment of mental disorders in the primary care sector. As a part of a eight-center national demonstration program on quality management in the outpatient services, General Practitioners (n = 191) from 5 regions participated in the study. 1341 treatment episodes of patients with predominately psychosocial strain were documented. Differences between psychosocial strain, treatment and outcome were determined by analyses of variance. Men and patients beyond the age of 65 were underrepresented. Psychosocial treatments were offered more often to those patients, who had the highest level of anxiety and depression. Patients with physical illness, with pain and without psychological attribution to the illness belief were offered less psychosocial interventions and reached a worse outcome. The study outcome helps to improve training programs as to recognition and treatment of psychosocial problems in primary care. Male and generally elderly patients with somatic symptoms and lack of psychological attribution need a special psychosocial intervention to improve the outcome.

[Somatisizing patients. Concrete recommendations for a stepwise therapy in general practice]. / Somatisierende Patienten. Konkrete Vorschläge für eine Stufentherapie in der Hausarztpraxis.

Patients with physical symptoms but no detectable organic substrate often present a challenge for the family doctor. The therapeutic approach discussed herein focuses on the development of a psychosomatic model of the problem. In this step-by-step approach, the patient's subjective understanding of, and attitude towards, his illness and its treatment are established, alternative psychosomatic models of disease based on a consideration of psychophysiological interactions are worked out jointly with the patient, and, finally, thought is given to the current complaints within the context of the patient's personality and life situation. The basis for successful treatment is an empathic and sound doctor-patient relationship based on trust that gives the patient the feeling that he and his problem are being taken seriously. The prerequisite for the use of such a program is appropriate training in basic psychosomatic care.

[Primary psychosomatic management in general practice. Results of a German nationwide demonstration project of quality assurance]. / Psychosomatische Grundversorgung in der Hausarztpraxis. Ergebnisse eines bundesweiten Demonstrationsprojektes zur Qualitätssicherung.

In the frame of a national demonstration program, psychosocial care of patients with psychological and psychosomatic problems were assessed. General practitioners (n = 191) from six regions participated in the study. 1341 treatment episodes of patients with predominately psychosocial symptoms were documented. Anxiety (62%), depression (51%) and marital/family conflicts (44%) were the most frequent symptoms. Somatic treatment and psychosocial intervention were offered equally. Patients with psychosocial treatment achieved better results. Partners and family members were rarely integrated into therapy. The procedures employed to improve outcome were quality circles, family-orientated case conferences, consultation services and collaborative groups.

Alexithymia and attachment representation in idiopathic spasmodic torticollis.

We investigated alexithymia and the mental representation of attachment in idiopathic spasmodic torticollis (IST). It was hypothesized a) that alexithymia in IST is more prevalent than in a nonclinical control group and b) that significant correlations emerge between alexithymia and a dismissing attachment representation. Twenty patients with IST and 20 healthy controls matched for age and sex were administered the Toronto Alexithymia Scale (TAS-20) and the Adult Attachment Interview (AAI). Attachment was classified using the Attachment Interview Q-sort. IST patients scored significantly higher on the measure of alexithymia than subjects in the comparison group. In IST a dismissing attachment representation was significantly more frequent than in the control group. Across the total sample, externally oriented thinking correlated positively with dismissing attachment, and both externally oriented thinking and difficulty communicating feelings (two of the three subscales of the TAS-20) correlated inversely with secure attachment. Alexithymia is more prevalent in IST than in normals. As was hypothesized, alexithymia in adults is significantly interrelated with the mental representation of attachment.

Psychosocial care by general practitioners--where are the problems? Results of a demonstration project on quality management in psychosocial primary care.

OBJECTIVE: Since 1987, psychosocial services have been a part of the primary care setting in Germany. In the framework of an eight-center national demonstration program, problems in the diagnosis and therapy of psychosocial problems and psychosomatic disorders were assessed. Methods to improve quality were also implemented. METHOD: General practitioners (n = 191) from six regions participated in the study. One thousand three hundred and forty-one treatment episodes of patients with predominantly psychosocial symptoms were documented. Differences between psychosocial strain, treatment, and outcome were determined by analyses of variance. RESULTS: Anxiety (62%), depression (51%), and marital/family conflicts (44%) were the most frequent symptoms. Psychosocial treatment was offered more often to those patients who had the highest level of anxiety and depression. Patients with pain and without a psychological attribution to their illnesses were offered less psychosocial treatment and suffered worse results. Partners and family members were rarely integrated into therapy. The procedures employed to improve outcome were quality circles, family-oriented case conferences, consultation services, and collaborative groups. CONCLUSIONS: These initial results are promising. A process of internal quality management has been initiated. Some of the physicians still resist documenting the data. Patients with somatic symptoms without psychological attribution may need special psychosocial interventions to improve their outcomes.

Effect of psychotherapy on the course of Crohn's disease. Results of the German prospective multicenter psychotherapy treatment study on Crohn's disease. German Study Group on Psychosocial Intervention in Crohn's Disease.

BACKGROUND: Our aim was to study the influence of psychotherapy in addition to a standardized corticosteroid treatment on the somatic and psychosocial course of Crohn's disease. METHODS: In a prospective, randomized multicenter study 108 of 488 patients received either drug treatment or, in the intervention group, additionally psychotherapy in the first half of the 2-year follow-up period. RESULTS: Eighty-four patients (77.8%) completed the somatic and 81 (75%) the psychosocial follow-up. Twenty-three per cent of the control group and 30% of the psychotherapy group showed episode-free courses; 29% and 17%, respectively, underwent surgery due to failure of drug treatment. The main analysis, which was based on subranking by number, duration, and severity of relapses, failed to show significant differences between the two groups (P = 0.125). The same result was obtained for the psychosocial status after 1 year in the main target criteria depression, anxiety, psychosocio-communicative status, and quality of life. CONCLUSIONS: The confirmatory analysis did not prove significantly better courses after additional psychotherapy. There was a tendency towards fewer operations.

[Contents of a "basic psychosomatic management" curriculum. Results of a 4-year concomitant evaluation]. / Anforderungen an ein Curriculum "Psychosomatische Grundversorgung". Ergebnisse einer vierjährigen Begleitevaluation.

The results of evaluations proceeding the educational seminar "Psychosomatic Primary Care" in South Baden are presented and analyzed. From 1991 to 1995, approximately 450 physicians took part in these courses. From critical feedback and suggestions for improvement obtained from participants following each course, recommendations for future seminars pertaining to content, structure, process, didactic and evaluation are presented.

[Evaluation of the educational curriculum in psychosocial fields and general medicine in human medicine subjects--results of a total Germany pilot study in the 1995 summer semester]. / Evaluation von Lehrveranstaltungen in den psychosozialen Fächern und der Allgemeinmedizin im Studiengang Humanmedizin--Ergebnisse einer bundesweiten Pilotuntersuchung im Sommersemester 1995.

With the discussion of the quality of medical education in Germany the importance of evaluating the curriculum has grown. A working group of representatives of the German scientific societies for general medicine and the so-called "psychosocial" disciplines in medical education had adapted a questionnaire from Harvard Medical School and tested this version for the first time in summer 1995. 56 teachers and 1250 students took part in this pilot study. The instrument proved to be sufficiently valid to evaluate the quality of different types of teaching lessons. The disciplines (Medical Sociology, Medical Psychology, Social Medicine, General Medicine, Psychotherapy/Psychosomatics) were valued equally with concern to their relevance for medical education. They got significantly better values for quality of teaching and teaching engagement of the professors. It is recommended to notice these results in the actual debate on the reform of the medical curriculum and to include other disciplines in further evaluative investigations.

[Coping with illness by young diabetic patients: a comparison from the viewpoint of patients, their parents and personal physicians]. / Krankheitsanpassung jugendlicher Diabetiker: ein Vergleich der Sicht der Patienten, ihrer Eltern und der behandelnden Arzte.

108 adolescents with type 1 diabetes as well as their parents and physicians in charge were studied in a prospective longitudinal design. Most of the juvenile patients were of good metabolic control. The results from different questionnaires of coping are presented. The opinions of the patients, their parents and the physicians in charge differ in some important aspects. Furthermore there are significant differences between the patients of best versus worst metabolic control as far as the extent of self reported psychosocial problems related with the disease is concerned.

[Psychosomatic aspects of inflammatory bowel diseases]. / Psychosomatik entzündlicher Darmerkrankungen.

The article reviews the most important psychosomatic aspects of inflammatory bowel diseases. It discusses aspects of etiology, coping with the disease and problems of psychotherapeutic treatment. At last the authors' special family therapy oriented consultation/liaison cooperation model with the gastroenterologists is described.