Use of a hydrophilic coating wire reduces significantly the rate of central vein punctures and the incidence of pneumothorax in totally implantable access port (TIAP) surgery

Background: Insertion of a Totally Implantable Access Port (TIAP) can be performed either via Central Vein Puncture (CVP) or Brachiocephalic Vein Cut-down (venous section-VS). The primary success rate of TIAP implantation using VS rarely ever achieves 100%. The objective of this study was to describe a modified VS approach using a hydrophilic coated wire (TVS). Methods: From 01.01.2015 to 31.12.2015, all patients receiving TIAP implantations were screened. During this time, all patients in whom the primary VS procedure was found to be unsuccessful were analysed. Results: In 2015, 1152 patients had TIAP implantations performed by 24 different surgeons. Of these, 277 patients needed a second line rescue strategy either by CVP (n= 69) or TVS (n= 208). There were no statistically significant differences regarding demographics or indication for TIAP implantation between CVP and TVS. The operation time and the qualification of the operating surgeon between CVP and TVS did not differ significantly. After the introduction of the guidewire with a hydrophilic coated wire, the need for CVP decreased significantly from 12.7% to 8.8% (p< 0.0001). In patients receiving CVP as a second line rescue strategy, the incidence of pneumothorax (n= 3 patients (4.3%)) was significantly higher compared to patients with TVS as a second line rescue strategy (n= 1 patient (0.48%),p=0.02). Conclusion: The use of a hydrophilic coated wire significantly decreased the number of CVP and the incidence of pneumothorax. TVS is a safe and successful second-line rescue strategy

Specific feedback makes medical students better communicators

Background: Feedback is regarded a key element in teaching communication skills. However, specific aspects of feedback have not been systematically investigated in this context. Therefore, the aim of this study was to investigate the effectiveness of communication skills training (CST) integrating specific, structured and behavioral feedback. Methods: We condensed best practice recommendations for feedback in a CST for undergraduate medical students and compared the effect of specific, structured and behavior-orientated feedback (intervention group CST-behav) to general, experience-orientated feedback (CST- exp. as our control group) in a randomized controlled trial (RCT). We investigated changes on communication skills evaluated by independent raters, and evaluated by standardized patients (SP). To do that, every student was video-recorded in a pre and post assessment. Results: Sixty-six undergraduate medical students participated voluntarily in our study. Randomization did not result in equally skilled groups at baseline, so valid inter-group comparisons were not possible. Therefore, we analyzed the results of 34 students of our intervention group (CST-behav). Five out of seven domains in communication skills as evaluated by independent raters improved significantly, and there was a significant change in the global evaluation by SP. Conclusions: Although we were unable to make between-group comparisons, the results of the within group pre-post evaluation suggest that specific feedback helps improve communication skills

Integrating 360° behavior-orientated feedback in communication skills training for medical undergraduates: concept, acceptance and students’ self-ratings of communication competence

BACKGROUND: Feedback is considered a key didactic element in medical education, especially for teaching of communication skills. This study investigates the impact of a best evidence-based practice feedback concept within the context of communication skills training (CST). We evaluate this concept for acceptance and changes in students self-ratings of communication competence. METHODS: Our CST integrating feedback process comprises a short theoretical introduction presenting standards for good communication and a constructive 360° feedback from three perspectives: feedback from peers, from standardized patients (SPs), and from a trainer. Feed-forward process was facilitated for documenting suggestions for improvements based on observable behaviors to maximize learning benefits. Our CST was applied to four groups of eight or nine students. We assessed the data on students’ acceptance using a 6-point scale ranging from very good (1) to poor (6), applied a forced choice question to rank didactic items, and assessed changes in student’ self-ratings of their communication competence on a 10-cm visual analogue scale (VAS). RESULTS: Thirty-four medical undergraduates (82 % female, 18 % male) in their first clinical year, with an average age of 21.4 years (SD = 1.0), participated in the new training. The concept achieved high acceptance from good to very good: overall impression (M = 1.56), sufficient interaction for discussion (M = 1.15), and constructive learning atmosphere (M = 1.18). Specific elements, such as practical training with SPs (M = 1.18) and feedback by SPs (M = 1.12), showed highest acceptance. The forced choice ranking placed all feedback elements at the top of the list (feedback (FB) by SPs, rank 2; FB by trainer, rank 3; FB by colleagues, rank 4), whereas theoretical elements were at the bottom (theoretical introduction, rank 7; memory card, rank 9). Overall, student self-ratings of communication competence significantly improved in nine of the ten communication items assessed by VAS and showed a pre-post effect size of ES = 0.74 on a global rating. CONCLUSIONS: This study demonstrates that the training concept based on 360° behavioral feedback was well accepted and generated significant changes in student self-ratings of their communication competence. Further research is needed to determine the effects on objective communication performance. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12909-016-0792-0) contains supplementary material, which is available to authorized users

Integrating 360° behavior-orientated feedback in communication skills training for medical undergraduates: concept, acceptance and students’ self-ratings of communication competence

Feedback is considered a key didactic element in medical education, especially for teaching of communication skills. This study investigates the impact of a best evidence-based practice feedback concept within the context of communication skills training (CST). We evaluate this concept for acceptance and changes in students self-ratings of communication competence.Our CST integrating feedback process comprises a short theoretical introduction presenting standards for good communication and a constructive 360° feedback from three perspectives: feedback from peers, from standardized patients (SPs), and from a trainer. Feed-forward process was facilitated for documenting suggestions for improvements based on observable behaviors to maximize learning benefits. Our CST was applied to four groups of eight or nine students. We assessed the data on students' acceptance using a 6-point scale ranging from very good (1) to poor (6), applied a forced choice question to rank didactic items, and assessed changes in student' self-ratings of their communication competence on a 10-cm visual analogue scale (VAS).Thirty-four medical undergraduates (82 % female, 18 % male) in their first clinical year, with an average age of 21.4 years (SD = 1.0), participated in the new training. The concept achieved high acceptance from good to very good: overall impression (M = 1.56), sufficient interaction for discussion (M = 1.15), and constructive learning atmosphere (M = 1.18). Specific elements, such as practical training with SPs (M = 1.18) and feedback by SPs (M = 1.12), showed highest acceptance. The forced choice ranking placed all feedback elements at the top of the list (feedback (FB) by SPs, rank 2; FB by trainer, rank 3; FB by colleagues, rank 4), whereas theoretical elements were at the bottom (theoretical introduction, rank 7; memory card, rank 9). Overall, student self-ratings of communication competence significantly improved in nine of the ten communication items assessed by VAS and showed a pre-post effect size of ES = 0.74 on a global rating.This study demonstrates that the training concept based on 360° behavioral feedback was well accepted and generated significant changes in student self-ratings of their communication competence. Further research is needed to determine the effects on objective communication performance

Does optimized feedback improve communication skills in medical students attending communication skills training part 1?

Feedback ist didaktisches Schlüsselelement in der medizinischen Ausbildung, insbesondere für das Unterrichten kommunikativer Fertigkeiten. Jedoch fehlte es bisher an systematischen Untersuchungen bezüglich spezifischer Aspekte des Feedbackprozesses im Kontext von Kommunikationstrainings für Medizinstudierende. Ziel der Studie war es durch ein videogestütztes Prä-Post-Assessment den Effekt eines neuen, auf verhaltensorientiertem Feedback basierenden Kurskonzepts mit einem auf erfahrungsorientiertem Feedback fußenden zu vergleichen. Es wurden Daten zur Akzeptanz, Selbst- sowie Fremdeinschätzung durch unabhängige Experten und Schauspielpatienten erhoben.Feedback is considered a key didactic element in medical education, especially for teaching communication skills. However, specific aspects of the feedback process have not been systematically investigated in the context of communication skills training for medical students. The aim of the study was to compare the effect of a new training concept based on behavior-oriented feedback with one based on experience-oriented feedback using a video-based pre-post assessment. Data on acceptance, students´ self-ratings and ratings of blinded experts and standardized patients were collected

How to assess communication skills? : development of the rating scale ComOn Check

Background:Good communication is a core competency for all physicians. Thus, medical students require adequate preparation in communication skills. For research purposes, as well as for evaluation in teaching, there is a clear need for reliable assessment tools. We analyzed the shortcomings of existing instruments and saw a need for a new rating scale. The aim of this publication is to describe the development process for, and evaluation of, a new rating scale.Methods: First, we developed the rating scale in 10 steps. Then, two raters evaluated the newly developed rating scale by rating 135 videotaped consultations of medical students with standardized patients. Additionally, standardized patients evaluated students’ performance, which was used as an outside criterion to validate ratings.Results:Our rating scale comprises six domains with 13 specific items evaluated on a fivepoint Likert scale: initiating conversation, patient’s perception, structure of conversation, patient’s emotions, end of conversation, and general communication skills. Item-total correlation coefficients between the checklist items ranged from 0.15 to 0.78. Subscale consistency was calculated for domains comprised of more than one item and Cronbach’s α ≥ 0.77, indicating acceptable consistency. Standardized patients’ global evaluation correlated moderately with overall expert ratings (Spearman’s ρ = .40, p Conclusion:Our rating scale is a reliable and applicable assessment tool. The rating scale focuses on the evaluation of general communication skills and can be applied in research as well as in evaluations, such as objective structured clinical examinations (OSCE).Abbreviations: CST: Communication skills training; ICC: Intra-class correlation coefficient; OSCE: Objective structured clinical examination; SP: Standardized patients; SD: Standard deviation; M: Mea

Additional file 1: of Integrating 360° behavior-orientated feedback in communication skills training for medical undergraduates: concept, acceptance and students’ self-ratings of communication competence

Memory Card: Key points of good communication. (DOCX 38 kb

Additional file 4: of Integrating 360° behavior-orientated feedback in communication skills training for medical undergraduates: concept, acceptance and students’ self-ratings of communication competence

Communication Skills Training Post-Assessment: Self-Rating of communication Competence after attending the training (3 × 1.5 h). (DOCX 565 kb