Der Unterricht im Fach „Psychosomatische Medizin und Psychotherapie” an den Hochschulen der Bundesrepublik Deutschland nach Änderung der Approbationsordnung für Ärzte

[Teaching about chronic pain in psychosomatics courses - an overview of the situation in Germany and the Tübingen Model]

Teaching about chronic pain in psychosomatics courses - an overview of the situation in Germany and the Tübingen Model Objectives: When dealing with chronic pain patients it is crucial to take a bio-psycho-social approach. However, it is unclear how this approach is currently being taught to medical students, and how they judge its role and importance.

METHODS

We carried out a qualitative study (questionnaire) asking (1) German psychosomatic departments about pain-related teaching and (2) medical undergraduates about pain-relevant issues.

RESULTS

Bio-psycho-social facts are well represented within psychosomatics courses but only theoretically tested. There is still much room for improvement through cross-linking with other disciplines. In Tübingen, "psychosocial factors" and the "empathic doctor-patient relationship" play a significantly higher role when teaching psychosomatic courses than somatic ones. There were no significant differences regarding the role of an "integrative recording of medical history" or how the importance of any of the three topics was rated.

CONCLUSIONS

Chronic pain is well represented in psychosomatic courses in Germany, though exams could be more practical. The establishment of interdisciplinary approaches beyond the teaching of core psychosomatic content could be expanded and especially used more frequently when adapting curricula to competence-based standards.

[Learning objectives for psychosomatic medicine and psychotherapy in light of the National Competency-Based Catalogue of Learning Objectives for Medicine (NKLM)]

OBJECTIVE

The "National Competency-Based Catalogue of Learning Objectives for Medicine" ("Nationaler Kompetenzbasierter Lernzielkatalog Medizin,"NKLM) is a core curriculum developed for medical training. Here, the classic division by discipline and organ system has been abandoned, which requires each discipline to define its own core curriculum in specific catalogues of learning objectives. This article presents such a catalogue for Psychosomatic Medicine and Psychotherapy.

METHOD

A two-step DELPHI-method was used to survey faculty representatives for Psychosomatic Medicine and Psychotherapy. It reflected the discipline-specific university catalogues of learning objectives as well as the NKLM. A catalogue of learning objectives was then developed and approved.

RESULTS

The catalogue consists of two parts: (1) a 12-module core curriculum for Psychosomatic Medicine and Psychotherapy and (2) selected interdisciplinary learning objectives from the NKLM with relevant participation of the discipline in ten modules.

DISCUSSION

For the first time in Germany, this article presents a catalogue of learning objectives for Psychosomatic Medicine and Psychotherapy that is agreed upon by the relevant representatives. This enables the integration of psychosomatic and psychotherapeutic teaching contents from a department into the overall curriculum as required by the NKLM. In the future, methods should be established to allow regular updating and further development of this catalogue.

[Balint group work in Germany - results from a survey of Balint group leaders]

OBJECTIVES

Based on a postal survey of Balint group leaders from the year 2004, this study analyses the characteristics of Balint group work as described by Michael Balint (1896-1970)in modern Germany.

METHOD

A questionnaire was sent to 503 German Balint group leaders, 333 (66.2 %) of whom returned the questionnaire (40.5 % women, mean age 57.2 years).

RESULTS

Most Balint group leaders are specialists in psychosomatic medicine and psychotherapy (30.6 %), psychiatry and psychotherapy (17.1 %) or are general practitioners (12.3 %). Psychoanalysts rarely serve as Balint group leaders. Sessions are normally held every 2 weeks (26.7 %) or once a month (26.4 %). Despite the original intention of Michael Balint, the idea of holding weekly Balint groups is now seldom(3.9 %). 85 %of the Balint group leaders prefer sessions lasting 90 minutes. An average of 8.6 participants attend, with 2.1 persons missing. There is a great heterogeneity in the professions of Balint group leaders. 17.4 % of them are older 65 years.

CONCLUSIONS

This study shows that Balint group work in Germany is well integrated in both general practice and psychotherapy, and it is still of great interest to many specialists of other disciplines as well as a good way to realize further education. The ideas of Michael Balint are very much alive, but - because of the changed realities in the medical field - no longer as he originally foresaw, but in settings adapted to the new situations in medicine.

[Evaluation of the clinical course Psychosomatics and Psychotherapy employing standardized patients]

OBJECTIVE

Since the Winter Term 2008/2009 the Medical School of the University of Muenster, Germany, has used standardized patients in the clinical course Psychosomatic Medicine and Psychotherapy with fourth-year undergraduate students performing bio-psycho-social anamnesis on these standardized patients. We wanted to evaluate the influence of the course on the empathy of the students.

METHODS

A total of 107 students participated in the standardized patient program during the Winter Term 2009/2010, with 90 (84.1 %) completing the Jefferson Scale of Physician Empathy before and after the course. In addition, we conducted a standard evaluation of the medical faculty.

RESULTS

The pre-post comparison revealed a significant increase in empathy (d = 0.331, p = .001). The standard evaluation yielded a high satisfaction among the course participants, though several students did assess the course critically.

CONCLUSION

The implementation of a standardized patient program in psychosomatics and psychotherapy proved to be of value, since it increased empathy of the students and received a positive evaluation. To prevent the students from being humiliated, it is of particular importance to implement a gentle and tactful feedback.

Medical education in Germany

Following the changes made to the medical licensing regulations of 2002, medical education in Germany has been subject to radical modification, especially at undergraduate level. The implementation of the Bologna Process is still a matter of intense political debate, whilst positive movement has occurred in developing the professionalisation of teaching staff through a Masters Degree in Medical Education. In the area of postgraduate medical education, major restructuring of programmes is occurring, whilst the debate in continuing medical education is related to the amount of practical clinical education that is required.