gms | German Medical Science

Communicative competence as a key competence of professional medical interaction is insufficiently embedded in the training curricula of many faculties [1]. The development of the corresponding courses is a complex and multi-layered process. The primary aim of the project “Communicative Competences of Physicians” (BMG) was the pilot implementation of the longitudinal model communication curriculum [2]. The core task for Mainz, as one of four locations, was to integrate communication training into the clinical subjects and implement it longitudinally throughout the degree program.

It was known before the project began that there would be resistance and negative attitudes towards teaching communication at the location. Statements like: “That’s unnecessary” or “Students can do all of that already” reflected this. Ignoring resistance or countering it with social pressure results in obstruction and counter-pressure. Resistance overcome, on the other hand, can provide new resources [3]. For this reason, the following steps were taken.

At the outset of the project, the SWOT analysis [4], [5] was used to assess site-specific strengths and weaknesses for the continued development of the communication curriculum. The prevalence of a more positive or negative attitude [6], [7], [8] according to the concept of institutional readiness was observed. In particular, the strategic implementation stages according to the change management concepts of Lewin [9] and Kotter [10], [11] made it possible to consider this aspect. Lewin’s concept of “thawing” [9] emphasises that the affected individuals and the setting must be prepared for upcoming change processes. The aim is to achieve a broad-based conviction that change is needed, as well as emotional investment (enthusiasm).

To allow for a realistic assessment of the situation, the project was presented to the faculty’s teaching committee. In this context, it was possible to reliably identify teachers and students with favourable and unfavourable attitudes, analyse the arguments that were presented, and evaluate them for further action. Based on the results, concrete courses of action were planned:

An invitation to a group discussion was issued with the intention of finding support in this circle and allowing for reflection and coordination regarding the planned course of action.

For this group of people, a climate of trust had to be created as an important prerequisite for a successful change process, so that resistance could then be addressed openly in one-on-one conversations.

The “four-room model” [12] describes how people typically experience change processes. Pressure to change is initially ignored, followed by a phase of confusion and only then acceptance and a willingness to actively participate. With this knowledge, reactions can be identified and people can be accompanied through change processes in a targeted manner. The recommendations of Kuster et al. [3] are also helpful. According to this, individuals are willing to change if, among other things:

• their past performance is recognised,
• they are well informed,
• the necessary support can be provided.

Prior to the one-on-one meetings, supportive measures were listed that the neutral central learning platform Rudolf Frey Lernklinik can provide for communication training. These include:

• rooms for teaching communication in small groups, with associated observation booths,
• video technology for recording and analysing meetings,
• simulated patients,
• advice on the creation of teaching concepts.

In the SWOT analysis, positive and negative attitudes in terms of motivation levels were mentioned (see table 1 [Tab. 1]). Some particularly committed lecturers were named as an important resource, but scepticism and resistance were expected for the most part. The presentation to the faculty’s teaching committee made it possible to identify those in favour and those opposed.

Contact with supporters strengthened our position and yielded constructive advice on how to proceed, such as the opportunity for communication between lecturers on the evolution of teaching communication.

As a way of acknowledging past performance, individuals with negative attitudes were asked which learning objectives of the sample communication curriculum [2] were already mapped in their respective subjects. This was deliberately done in one-on-one conversations. In this way, information deficits could be identified and eliminated quickly. In this confidential environment, there was a greater willingness to address problems and deficits as well as the need for support. With the resulting action plan, it was possible to make offers that aligned with needs. In the spirit of participatory design [13], lecturers were successfully motivated to further develop communication instruction. Thus, ideas for the implementation of communication lessons arose spontaneously from the clinical subjects, e.g. to include informed-consent interviews in the practical course for surgery or prepare for parent interviews in paediatrics using peer interviews between students. In addition to this, the provided rooms with observation booths for small groups were well received, as were the simulated patients.

In the end, participation in communication instruction was secured for each clinical subject, and the model curriculum was expanded longitudinally.

The causes of resistance and negative attitudes are initially obscured. Often, these behaviours do not represent a rejection of the subject matter, but rather express that teachers believe they do not have enough expertise. With this knowledge, it was possible to provide the individuals in question with targeted information and needs-based support, thus persuading them to actively participate.

This field report was developed as part of the project “Communicative competences of physicians – pilot implementation, accompanying evaluation and development of implementation strategies for a longitudinal model curriculum on communication in medicine” with funding from the German Federal Ministry of Health (BMG). Grant number: ZMV I1 2516FSB200.

Name of location: University Medical Center of the Johannes Gutenberg University Mainz

Field of study/profession: Medicine

Number of students per year or semester: ca. 140-220 students per semester

Has a longitudinal communication curriculum been implemented? Yes

In which semesters are communicative and social competences taught? Semesters 1, 2, 4, 5, 6, 7, 8, 9, 10

What teaching formats are used? Seminar, class, practical course, lecture, e-learning

In which semesters are communicative and social competences tested (formative assessment or relevant for passing, and/or graded)? Semesters 1, 2, 4, 5, 7, 8, 9, 10

Which examination formats are used? Essay, key feature problem examination, poster production, oral-practical, OSCE, patient care report, open-book exam, multiple-choice exam

Who (e.g. clinic, institution) is responsible for development and implementation? Decentralised: each institution individually

Dr. rer. physiol. Anke Hollinderbäumer, MME

• graduate psychologist
• research assistant at the Rudolf Frey Lernklink central learning platform, responsible for the communication curriculum and OSCE examinations

Dr. phil. Barbara Hinding

• graduate psychologist
• research assistant at the Institute for Medical and Pharmaceutical Examination Questions (IMPP)

Dr. med. Holger Buggenhagen, MME

• head of the Rudolf Frey Klinik central learning platform
• senior anaesthesiologist

Prof. Dr. med. Jana Jünger, MME (Bern)

• Director of the Institute for Medical and Pharmaceutical Examination Questions (IMPP)
• development of the postgraduate program Master of Medical Education (MME) in Germany
• member of the MME course management and lecturer for the modules Examinations, Educational Research, and Evaluation
• management of various projects for the implementation of communication curricula in medical education as well as the development of new examination formats for the assessment of communicative competences

The authors declare that they have no competing interests.