Table 1 Description of the training formats of the integrated consultation course

1. Supervised training with simulated patients (year4 - 6)

Students practice full consultations with simulated patients in groups of three. Each student is responsible for one part of the consultation (opening/history taking – physical examination – diagnosis, treatment and planning) whereby the student can rely on the supervising physician and peers for help. Afterwards students start with a self-reflection activity, followed by feedback from two peers and supervisor.

2. Online training (year 5)

An interactive web environment positions students individually in “virtual” consultations. Students are responsible for judging the consultation process and content on accuracy. The observation of small film fragments is guided by open-ended questions that prompt students about the various dimensions of consultations. Students type their answers in an input box and immediate, standardized feedback follows.

3. Unsupervised training with simulated patients (year 5)

Students train in pairs without supervision. Each of them conducts a full consultation with a simulated patient, while their peer observes. Feedback starts with a self-reflection activity followed by feedback of the simulated patient and peer. After the two consultations, a debriefing session take place with a physician (8–12 students) to discuss students’ questions.

4. Clerkship training with real patients (year 6–7)

Especially during emergency, GP training, Pediatrics and Internal Medicine clerkships students practice partial or full consultations with real patients, often in a separate room. Afterwards students debrief their clinical supervisor and observe the end of the consultation.