[Effects of a shared decision making model in psychiatric and neurologic practice]

Development and testing of a summative video-based e-examination in relation to an OSCE for measuring communication-related factual and procedural knowledge of medical students

Objective: In the context of educating medical students, testing of competence in medical communication is carried out primarily with the Objective Structured Clinical Examination [1]. This makes it possible to assess practical performance, but it is resource-intensive and has a negative impact on test quality. The project "Digital test tool for measuring communication skills in medical studies" (digiRole) was funded by the BMBF (Federal Ministry of Education and Research) and its objective was to develop digital formats as electronic versions of an OSCE in order to test the communication competency of medical students. Such digital forms of examination should be cost-effective, be relevant to clinical practice and have high psychometric quality. In terms of content, the examination questions should incorporate factual and procedural knowledge as components of communication competency, although we assumed that procedural knowledge is more relevant than facutal knowledge to OSCE performance. This article describes the development and testing of a video-based, communication-related e-examination that is relevant to passing the test, which is the first milestone of the overall project. Methodology: We produced videos and related exam questions in the form of a situational judgement test [2] related to medical psychology and medical sociology, based on the educational content of a preclinical course on doctor-patient communication at the Mainz University Medical Center. In the summer semester of 2018, 226 students sat for this video-based single-choice e-examination (VSE). In the winter semester of 2018/2019, a different cohort of 192 students participated in the VSE as well as a tried-and-tested communication OSCE with five stations [3]. Results: The internal consistencies for the VSE in the summer semester of 2018 were α=.55, in the winter semester 2018/19 with α=.62 and for the OSCE with α=.60. There was a positive correlation between the performance of the students with the VSE and that with the OSCE (r=.21, p≤.01). Principal Axis Analyses did not reveal any dimensioning in terms of factual and procedural knowledge. In the evaluation, the majority of the students stated that the VSE was quite relevant to the practise of medical communication and were in favour of retaining this form of examination. Conclusion: The correlation between the VSE and the OSCE is relatively low, so that the VSE in this form is not a satisfactory predictor of an OSCE result. In terms of internal consistency, the VSE and the OSCE produced an almost identical result. It can also be assumed that the VSE can achieve a high degree of objectivity with the use of standardised video-based examinations as well as greater resource efficiency than OSCEs.

[Core aspects of a needs-conform care of patients with multiple sclerosis : Utilization of outpatient services and shared decision making]

BACKGROUND

Due to the necessity for lifelong treatment, high costs for the healthcare system and changes in role expectations of patients towards physicians, multiple sclerosis (MS) is an important topic in healthcare research.

OBJECTIVE

The aim of this review is to provide an overview of the current study situation in Germany in 2020 on utilization of outpatient medical resources and shared decision making in patients with MS.

MATERIAL AND METHODS

For this review a literature search was carried out in PubMed and other extended sources in order to identify and present relevant publications.

RESULTS

There are only a few studies on the utilization of outpatient medical resources by patients with MS in Germany. The highest values for utilization were found for general practitioners, family physicians and neurologists whereas urologists were less frequently involved. The values for the utilization of services provided by physiotherapists greatly differed between the studies. Several studies using different approaches to shared decision making in Germany were identified and summarized. An important prerequisite for shared decision making is an adequate knowledge on the side of the patients.

CONCLUSION

Differences in the utilization of outpatient resources by MS patients in Germany can be explained by methodological differences and limitations of the individual studies. The use of shared decision making by MS patients is demanded by various parties but so far there is little evidence for a positive effect on the disease.

[Shared decision-making in acute psychiatric medicine : Contraindication or a challenge?]

BACKGROUND

The concept of shared decision-making (SDM) has existed since the 1990s in multiple fields of somatic medicine but has only been poorly applied in psychiatric clinical routine despite broad acceptance and promising outcomes in clinical studies on its positive effects.

MATERIALS AND METHODS

The concept itself and its practicability in mental health are carefully assessed and strategies for its future implementation in psychiatric medicine are presented in this article. Ongoing clinical studies probing some of those strategies are further outlined.

RESULTS AND DISCUSSION

On top of the ubiquitous shortage of time in clinical routine, psychiatrists report their concern about patients' limited abilities in sharing decisions and their own fear of potentially harmful decisions resulting from a shared process. Misinterpretation of shared decision-making restricting the health care professional to rather an informed choice scenario and their own adhesion to the traditional paternalistic decision-making approach further add to SDM's underutilization. Those hurdles could be overcome by communication skill workshops for all mental health care professionals, including nursing personnels, psychologists, social workers and physicians, as well as the use of decision aids and training courses for patients to motivate and empower them in sharing decisions with the medical staff. By this, the patient-centered treatment approach demanded by guidelines, carers and users could be further facilitated in psychiatric clinical routine.

[Medical rehabilitation from a lifespan perspective]

Lifespan research investigates the development of individuals over the course of life. As medical rehabilitation deals with primary and secondary prophylaxis, treatment, and compensation of chronic illnesses, a lifespan perspective is needed for the classification and diagnosis of chronic disorders, the assessment of course modifying factors, the identification of vulnerable life periods and critical incidents, the implementation of preventive measures, the development of methods for the evaluation of prior treatments, the selection and prioritization of interventions, including specialized inpatient rehabilitation, the coordination of therapies and therapists, and for evaluations in social and forensic medicine. Due to the variety of individual risk constellations, illness courses and treatment situations across the lifespan, personalized medicine is especially important in the context of medical rehabilitation, which takes into consideration hindering and fostering factors alike.

[Adherence to psychopharmacological treatment: Psychotherapeutic strategies to enhance adherence]

Effective psychopharmacological medication with good tolerability represents the cornerstone of treatment for severe mental illness; however, the 1-year adherence rates are only approximately 50%. The term adherence emphasizes the collaborative responsibility of the clinician and the patient for a positive treatment outcome. Reasons for non-adherence are manifold and include patient-specific factors, such as self-stigmatization, lack of social and familial support, cognitive impairment and substance use besides insufficient effectiveness and the occurrence of side effects of the psychotropic drugs. To enhance adherence, both clinician and patient have to fully understand all the reasons for and against adherence to medication before a collaborative decision is made on future long-term treatment. A positive attitude towards medication critically depends on whether patients feel that the medication supports the attainment of the individual goals.

[Documentation in psychiatry and psychotherapy: prerequisites and clinical practice]

BACKGROUND

As a result of changes to the legal and economic framework over the past years, medical documentation has changed substantially.

METHODS

Based on a literature search of important medicolegal studies and appeal decisions, an overview is given of legal principles and their practical consequences, especially for the fields of psychiatry and psychotherapy.

RESULTS

Documentation is a contractual and crime-related duty arising from the professional code for doctors and the legal obligation to provide documentation. In addition to being a memory aide for the doctor, its purposes are to safeguard and justify the treatment and to provide legal evidence. The documentation should be provided in a format that is sufficiently clear for specialist staff, using keywords, possibly handwritten, and use contemporary terminology. All important diagnostic and therapeutic measures must be documented. This is particularly important when the treatment deviates from standard treatment and in medical procedures aiming to protect the patient.

CONCLUSIONS

The legal requirements for documentation are becoming more stringent. The time spent on such activities has so far not been reimbursed by the financing bodies.

[Timely diagnosis and efficient early-rehabilitation for schizophrenic disorders in the community -- perspectives of a new standard]

Schizophrenia and schizophrenia spectrum disorders are severe mental illnesses with diverse courses of illness and often severe long-term disabilities. The sooner therapeutic and rehabilitative measures are taken the better the prognostic outlook is. Wrong but persistent stereotypes of incurability and dangerousness associated with schizophrenia pose severe obstacles to timely diagnosis and interventions and must be overcome. Today various efficient methods in therapy and rehabilitation are available. Evidence-based interventions are best delivered by multi-professional teams in the community. A person-centred approach combines biological, psychological, and social treatments in an integrated model including the social network and the individual goals of patients and their families. Concepts and results of international research efforts regarding state-of-the-art management of schizophrenia are presented and discussed.