gms | German Medical Science

Koch et al.'s article [1] is remarkable in that it provides a ranked comparative numerical evaluation of the offered courses on communication and social competence at several German-language faculties. Drawing one's attention to this subject is definitely welcome. However, taking a closer look, one is confronted with a number of questions concerning the conception, method, results, contradictions and opposing statements, as well as (unused) sources and evidence. The significance of this subject calls for a contribution by way of a critical discussion.

The article first refers to a number of standards concerning communication between doctor and patient and underlines the importance of the Basel Consensus Statement [2] for German-speaking countries. This describes five major fields of competence, which are divided into 19 topics and 131 learning goals. Despite the detailed reference to this Statement the structure, however, is given no further importance in the present work. The survey instrument merely contains the dichotomous question as to whether goals of learning are defined or not (free comments on it are not published). In view of the fact that the Basel Consensus as well as this work are oriented toward "competences", one must raise the basic question as to the significance of describing the characteristics of the offered courses when one is unable to, and does not, establish any association with competences.

Information concerning the development of the questionnaire is not given. Therefore, the considerations that led to the selection of the mentioned didactic methods and their numerical evaluation remain unclear. The reason why the evaluation includes the absolute number of courses offered in a curriculum is also not clear. Are ten short lectures at the beginning of the curriculum more valuable than six extensive courses that are carefully positioned through years 1 - 6? Even with regard to other features used for numerical evaluation of the applied didactic methods, the rationale for their weighting is not clear. Is the use of real patients in a (or every) course - with no further didactic explanation - really four times as valuable as the use of educational films? It is also not clear whether the recipients of the questionnaire were informed about the proposed publication of a ranking.

Data collected at the level of nominal scales are used to calculate means - a fact that, in association with the unpublished rationale for the development of the survey instrument, merely gives the impression of providing a quantitatively justifiable argument for disclosing the "methodology" of the courses and for the creation of a ranking list.

In addition to the results which must be viewed critically in terms of concept and method, it is remarkable that the datum which is probably most simple to determine quantitatively (the total length of the specific compulsory class in terms of time) could not be included in the scoring system because "comparable data about the length of the courses in minutes were not available at all sites" (the question of the "length of the course in minutes" is not included in the survey instrument; here the questions refer to the number of "semester hours", which is interpreted diversely, as we know from experience). On comparison, the reliability and actual significance of the data pertaining to decision-related questions such as "Training of teaching staff - yes/no?" or "Examination - yes/no?" are also questionable.

Contradictions between the data provided in the summary and those in the text are also worthy of mention. In the summary, according to the authors, a "learning-goal-oriented and literature-based approach was rarely used" in the planning phase, whereas in the text the authors say that learning goals were specifically defined for 98% of the courses (questions concerning reference to published literature, however, are entirely absent in the survey instrument). Presumably for various reasons, the longitudinal structure mentioned in the summary as the subject of the survey and the length in terms of time are not mentioned in the text.

Discrepancies as regards the survey instrument are also found in other aspects. In the questionnaire and in Table 2 the authors mention "educational films", whereas in the text they refer to "video analyses" as teaching aids. They possibly mean the analysis of educational films, but one may also (and probably should) interpret it as the analysis of video films of the attendees who were doing the exercises.

A number of detailed questions cannot be addressed here. However, it would be interesting to know why schools highly committed to teaching of communication, such as Heidelberg, are not mentioned (refer to "Communication and Interaction Training in Medicine MediKIT", last mentioned in [3]). The explanation for the absence of some faculties is not satisfactory. In the Methods section the authors mention 34 faculties in Germany, which also appears to be incorrect.

In the Introduction section the authors mention important standards concerning the subject. However, they provide no evidence for the design of the survey instrument. Finally, the interested reader is disappointed when he/she desires further information about the Berlin Reform Course which has been rated very high and is mentioned at the end of the paper, and then finds, as a reference, a 15-year-old (!) summary of the implementation of OSCE's. (The paper itself does not address the test methods used at the various sites).

The subject of communication, which has been neglected for a long time in the training of medical doctors, deserves more attention and encouragement. It is a crucial medical competence and will continue to gain importance in the future. Detailed suggestions for the design of curricula are available for German-speaking countries as well [4]. One may well agree with the authors in that the investigated subject is currently very heterogeneous in nature and, in view of current developments, it should be possible to collect data about yet undetermined or indeterminable aspects in the future. In doing so it should be clarified whether the creation of a ranking is an adequate access to the subject – we refer to concerns about, and criteria for, "rankings" [5]. One should also find out how one derives robust data, regardless of the goal one then intends to pursue. A comprehensible rendition of developments and the achieved level of excellence was published recently for Great Britain [6] and would be very desirable for German-speaking countries as well.

The author declare that he has no competing interests.