Table 3 Quotes extracted from the semi-structured interviews conducted with key communication skills teachers and curriculum coordinators (MS = Medical school)
Strengths | Institutional support | Quote 1: Yes, exactly. But also, I have the feeling, at least since I started taking over, that deanery and faculty are very open to improvements, and this proposal of mine, which costs money, to use patient actors systematically, was accepted immediately. That was even heartily supported by (X and Y?) and by the Vice Dean for Education. MS1 |
Curriculum structure | Quote 2: Somehow, we also have a structure, I think, a pedagogical structure which makes sense. We … first students are asked to observe and put words on what they observe. Then they do some role playing themselves. And then they meet patients, real patients, standardized (simulated) patients, always in run-of-the-mill situations, not necessarily too complex ones. And then, when preparing their Master’s degree, they have … they tackle more specific, more complex questions such as the announcement of a severe diagnosis or the motivation interview … this kind of things and so somewhere it … luckily, but like this it is gradual. Therefore, I believe it is rather well thought out (done).MS5 | |
Framework | Quotes 3: So, as I was telling you, we really have something that has been identified for this now. I think it is supported by a sufficiently widely recognized model to believe it is valid (Calgary-Cambridge Guide) and I know it is used in X, in Y. I am also in a position of responsibility here, therefore I know that it is also the model. MS4 Well, in short, all this to say that it is not too esoteric; it is something that is known. And then, finally, when other models are mentioned to us we can very often draw a parallel with this one. MS5 | |
Weaknesses | Lack of continuity | Quotes 4: Or to bridge this gap, somewhere we have the feeling, there is a gap somewhere during clinical years. Before they were trained and then they are completely focused on managing their mostly technical daily duties, to get it all correct and right, and so, and/ (…) MS3 The other weakness is that there are plenty of subjects which are not taught, or else taught too early, because they are rarely taken up again later on. MS4 |
Insufficient coherence | Quote 5: I think, it is very heterogeneous, depending on who the teacher is. We have very good documents and a solid database, but it’s just/ it’s impossible to standardize, because it varies a lot depending on which teacher is in charge, I think. MS2 | |
Insufficient feedback by experienced supervisors | Quote 6: On the one hand, of course, I see the present lack of sufficient infrastructure as a weakness, but also and above all the lack of financial and especially personnel resources. We often had to restrict ourselves to communication feedback from the perspective of the actor (standardized patient?), and would have frequently rather liked to hear experts who, being on their home ground, already, yes, bring some experience. The patient’s perspective is one thing, but I consider professional supervision, also in such communication scenarios which also have technical aspects, I think it is very/or not only me, but we think it is very, very important and we would like to intensify that. MS3 | |
Opportunities | Entrustable Professional Activities | Quote 7: I would say that the chance … another opportunity is that we are currently switching from the learning objectives to the entrustable professional activities, do you know what it is? And this, I think, is clearly an opportunity, because I believe that in EPA it is actually integrated. Therefore each time, if you say ‘he must know how to explain the preoperative assessment’ there is some communication. So I think that it is in fact a great opportunity, if one introduces the EPA, to introduce communication and professionalism, and ethics and values in the whole curriculum. So this, I think is a great opportunity.MS4 |
Threats | New potentially basic science oriented medical schools | Quote 8: And of course then I am wondering, if there is now a Bachelor in medicine offered by the ETH, which doesn’t have an actual medical faculty and no patient contact, they do not have a hospital really and the ETH is an outstanding University for basic sciences and technology and they offer a tremendous amount of qualities, but physician-patient-communication (laughing) probably isn’t part of these qualities. MS3 |
Academic promotion | Quote 9: Another (…) weakness I see, is that/But that’s, I think, a problem with teaching in general, that the real top-top-level of the faculty/I can’t say they’re not interested, that would be wrong. There are some, who are really involved, but have other priorities. So, priorities are technical development and research, but I suppose, that’s not only the case here in (...). MS3 | |
Development of a reductionist vision of communication | Quote 10: As far as weaknesses are concerned, I think that one of them is that we are still staying a little too much on the level of the recipe. It means getting technique and communication mixed up. I think that to focus our training in communication on standardized patients and the OSCE makes us feel that we are in something which is perceived as artificial… we have to start weakening (opening up) the checklist syndrome and develop more the job perspective in the wider meaning of the word. The job of a physician is the relationship, which then takes up a variety of forms. (comes in handy in lots of situations). MS5 |