Knut Aspegren

In the revised Danish medical specialist training increased focus has been placed on competences which are hard to evaluate such as communication skills. Mini-CEX seems promising as an evaluation tool. Our aim was to test: 1) whether mini-CEX was useable in the evaluation of communicative and cooperative skills and 2) whether mini-CEX would provide reproducible data. Twenty-one residents were evaluated by mini-CEX by trained observers. Seventeen residents had at least two observations within a short period of time and these data were used to estimate the mini-CEX reproducibility. In addition to the residents, the nurses who assisted them in the outpatient clinic answered a questionnaire regarding the mini-CEX satisfaction. Observations had a median duration of 20 minutes (10-60 minutes) and the overall median duration of feedback was 15 minutes (5-60 minutes). Time used for feedback was halved from the first to the following feedback sessions. No significant clinical differences were observed between the scorings performed by the residents themselves and the observers, or the nurses of the outpatient clinic and the observers. In general, the residents were satisfied with the mini-CEX evaluations. The mini-CEX is a promising tool for the evaluation of communicative and cooperative skills.

We wanted to explore if experienced doctors, nurses and dieticians could learn "The Motivational Interview" as developed by Botelho in a simple way. 15 experienced doctors, nurses and dieticians took part. Our method was "learning by doing"--a 5-hour long workshop supported by IT-based learning material, followed by three months of work with own patients in diabetes care using the IT material for self study. Pre-tests and post-tests showed a statistically significant improvement of the use of the structure in this form of interview. It is concluded that this simple form of learning opportunity is effective for experienced health care personnel.

Background: The aim of the study was to explore the feasibility of 360 degree assessment in early specialist training in a Danish setting. Present Danish postgraduate training requires assessment of specific learning objectives. Residency in Internal Medicine was chosen for the study. It has 65 learning objectives to be assessed. We considered 22 of these suitable for assessment by 360-degrees assessment. Methods: Medical departments of six hospitals contributed 42 interns to the study. Each resident was assessed by ten persons of whom one was a secretary, four were nurses and five senior doctors. The assessors spent 14,5 minutes (median) to fill in the forms. Results: Of the 22 chosen objectives, 15 could reliably be assessed by doctors, 7 by nurses and none by secretaries. Conclusions: The method was practical in busy clinical departments and was well accepted by the assessors. Reliability of the method was acceptable. It discrimintated satisfactorily between the good and not so good performers.

The Postgraduate Hospital Educational Environment Measure (PHEEM) has been translated into Danish and then validated with good internal consistency by 342 Danish junior and senior hospital doctors. Four of the 40 items are culturally dependent in the Danish hospital setting. Factor analysis demonstrated that seven items are interconnected. This information can be used to shorten the instrument by perhaps another three items.

The effect of a preparartory course in the medical interview ("taking history") followed by four months of practice was studied by comparison of a sample of trained students with a large group of untrained students, using the ACIRS rating scale. The course was 13 hours, spread out over one month. Training methods were 2 demonstrations and 3 videorecordings of interviews with simulated patients followed by feedback. Untrained students had severe gaps in important professional communication skills. About half of the trained students filled in these gaps as a result of the training. It is concluded that a short preparatory course followed by clinical experience is not enough to secure necessary interviewing skills in most medical students.

Students in the last semester of medical school and experienced junior doctors with no or little training in communication skills were observed while interviewing or informing simulated patients. There was a remarkable similarity in behaviour between the two categories. Communication skills characteristic of common social conversation were learnt spontaneously, while important professional basic communication skills were not learnt despite 10 or more years of clinical work. These discrepancies and subsequent gaps should be the focus of future training courses at both pre- and postgraduate level.