Abstract
Purpose
Poor medication communication of physicians to patients is detrimental, e.g. for medication adherence. Reasons for physicians’ deficits in medication communication may be unfavourable conditions in daily practice or already insufficient training during their (undergraduate) medical studies. We explored medical students’ communication on new medications in simulated physician-patient conversations to identify actual deficits indicating apparent educational needs.
Methods
Fifth year medical students attending a mandatory course at the University of Cologne had simulated physician-patient consultations aiming at drug prescription. In 2015, 21 consultations were recorded, transcribed and subjected to qualitative content analysis based on the method of inductive coding.
Results
Even essential information on drug therapy was often lacking (e.g. adverse effects, drug administration). Some aspects were addressed more frequently than others. This seemed to differ depending on the diagnosis underlying the particular treatment (acute event vs. chronic disease). The extent of information on drug treatments given in simulated physician-patient consultations varied significantly between students.
Conclusions
Fifth year medical students showed appreciable deficits in communicating drug prescriptions to patients though there were remarkable inter-individual differences. Our findings suggest that communication on drug therapy to patients is no self-evolving skill. Thus, there is obviously a need for emphasizing medication communication in the training of medical students. Communication aids specifically aiming at medication communication might facilitate learning of adequate medication communication skills.
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Notes
Chronic obstructive pulmonary disease
References
Dusing R (2006) Adherence to medical treatment. Dtsch Med Wochenschr 131(46 Spec):H28–H30. doi:10.1055/s-2006-955059
Osterberg L, Blaschke T (2005) Adherence to medication. N Engl J Med 353(5):487–497. doi:10.1056/NEJMra050100
Chowdhury R, Khan H, Heydon E, Shroufi A, Fahimi S, Moore C, Stricker B, Mendis S, Hofman A, Mant J (2013) Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. Eur Heart J 34(38):2940–2948. doi:10.1093/eurheartj/eht295
Simpson SH, Eurich DT, Majumdar SR, Padwal RS, Tsuyuki RT, Varney J, Johnson JA (2006) A meta-analysis of the association between adherence to drug therapy and mortality. BMJ 333(7557):15. doi:10.1136/bmj.38875.675486.55
Makoul G, Arntson P, Schofield T (1995) Health promotion in primary care: physician-patient communication and decision making about prescription medications. Soc Sci Med 41(9):1241–1254. doi:10.1016/0277-9536(95)00061-B
Tarn DM, Heritage J, Paterniti DA, Hays RD, Kravitz RL, Wenger NS (2006) Physician communication when prescribing new medications. Arch Intern Med 166(17):1855–1862. doi:10.1001/archinte.166.17.1855
Barry CA, Bradley CP, Britten N, Stevenson FA, Barber N (2000) Patients’ unvoiced agendas in general practice consultations: qualitative study. BMJ 320(7244):1246–1250. doi:10.1136/bmj.320.7244.1246
Ziegler DK, Mosier MC, Buenaver M, Okuyemi K (2001) How much information about adverse effects of medication do patients want from physicians? Arch Intern Med 161(5):706–713. doi:10.1001/archinte.161.5.706
Barat I, Andreasen F, Damsgaard EMS (2001) Drug therapy in the elderly: what doctors believe and patients actually do. Br J Clin Pharmacol 51(6):615–622. doi:10.1046/j.0306-5251.2001.01401.x
Tarn DM, Flocke SA (2011) New prescriptions: how well do patients remember important information? Fam Med 43(4):254
Stevenson FA, Barry CA, Britten N, Barber N, Bradley CP (2000) Doctor–patient communication about drugs: the evidence for shared decision making. Soc Sci Med 50(6):829–840. doi:10.1046/j.0306-5251.2001.01401.x
Richard C, Lussier M-T (2006) Nature and frequency of exchanges on medications during primary care encounters. Patient Educ Couns 64(1):207–216. doi:10.1016/j.pec.2006.02.003
Cegala DJ, Lenzmeier Broz S (2002) Physician communication skills training: a review of theoretical backgrounds, objectives and skills. Med Educ 36(11):1004–1016. doi:10.1046/j.1365-2923.2002.01331.x
Koerfer A, Köhle K, Obliers R, Sonntag B, Thomas W, Albus C (2008) Training und Prüfung kommunikativer Kompetenz. Aus-und Fortbildungskonzepte zur ärztlichen Gesprächsführung Gesprächsforschung - Online-Zeitschrift zur verbalen Interaktion 9:34–78
Bechmann S (2014) Kann man kommunizieren lernen? - Medizinische Kommunikation in der ärztlichen Ausbildung. In: Francke A (ed) Medizinische Kommunikation: Grundlagen der ärztlichen Gesprächsführung vol 4132. UTB, Tübingen
Elwyn G, Edwards A, Kinnersley P (1999) Shared decision-making in primary care: the neglected second half of the consultation. Br J Gen Pract 49(443):477–482
Härtl A, Bachmann C, Blum K, Höfer S, Peters T, Preusche I, Raski B, Rüttermann S, Wagner-Menghin M, Wünsch A (2015) Desire and reality—teaching and assessing communicative competencies in undergraduate medical education in German-speaking Europe—a survey. GMS Z Med Ausbild 32 (5)
Dearden E, Mellanby E, Cameron H, Harden J (2015) Which non-technical skills do junior doctors require to prescribe safely? A systematic review. Br J Clin Pharmacol 80(6):1303–1314. doi:10.1111/bcp.12735
Illing J, Morrow G, Kergon C, Burford B, Spencer J, Peile E, Davies C, Baldauf B, Allen M, Johnson N (2008) How prepared are medical graduates to begin practice? A comparison of three diverse UK medical schools. Final summary and conclusions for the GMC Education Committee. http://www.gmc-uk.org/about/research/25059.asp. Accessed cited 2016 Sep 29
Schiessl C, Hallal H, Johannsen W, Kliche O, Neumann E, Thrien C, Stosch C (2010) Gut vorbereitet ins Praktische Jahr mit dem Kölner PJ-STArT-Block. Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA) 23 (25.09)
Mayring P (2015) Qualitative Inhaltsanalyse. Grundlagen und Techniken. 12., überarbeitete Auflage. Beltz, Weinheim
Elo S, Kyngäs H (2008) The qualitative content analysis process. J Adv Nurs 62(1):107–115. doi:10.1111/j.1365-2648.2007.04569.x
Yi ZM, Zhi XJ, Yang L, Sun SS, Zhang Z, Sun ZM, Zhai SD (2015) Identify practice gaps in medication education through surveys to patients and physicians. Patient Prefer Adherence 9:1423–1430. doi:10.2147/ppa.s93219
De Vries T, Henning RH, Hogerzeil H, Fresle D (1994) Guide to good prescribing. World Health Organization Action Programme on Essential Drugs. http://apps.who.int/iris/bitstream/10665/59001/1/WHO_DAP_94.11.pdf. Accessed cited 2016 Sep 30
Zetterqvist A, Aronsson P, Hagg S, Kjellgren K, Reis M, Tobin G, Booth S (2015) On the pedagogy of pharmacological communication: a study of final semester health science students. BMC Med Educ 15:186. doi:10.1186/s12909-015-0467-2
Aronsson P, Booth S, Hägg S, Kjellgren K, Zetterqvist A, Tobin G, Reis M (2015) The understanding of core pharmacological concepts among health care students in their final semester. BMC Med Educ 15(1):1. doi:10.1186/s12909-015-0522-z
Matthes J, Johannsen W, Herzig S Change of medical students’ self-appraisal of pharmacological knowledge and skills over time. In: Naunyn-schmiedebergs archives of pharmacology, 2013. Springer 233 Spring St, New York, NY 10013 USA, pp S52-S53
Tobaiqy M, McLay J, Ross S (2007) Foundation year 1 doctors and clinical pharmacology and therapeutics teaching. A retrospective view in light of experience. Br J Clin Pharmacol 64(3):363–372. doi:10.1111/j.1365-2125.2007.02925.x
Brinkman D, Tichelaar J, Schutte T, Benemei S, Böttiger Y, Chamontin B, Christiaens T, Likic R, Maˇiulaitis R, Marandi T (2016) Essential competencies in prescribing: a first European cross-sectional study among 895 final-year medical students. Clin Pharmacol Ther. doi:10.1002/cpt.521
Sabaté E (2003) Adherence to long-term therapies: evidence for action. World Health Organization, Geneva
Krass I, Schieback P, Dhippayom T (2015) Adherence to diabetes medication: a systematic review. Diabet Med 32(6):725–737. doi:10.1111/dme.12651
Yeaw J, Benner JS, Walt JG, Sian S, Smith DB (2009) Comparing adherence and persistence across 6 chronic medication classes. J Manag Care Pharm 15(9):728–740. doi:10.18553/jmcp.2009.15.9.728
Zolnierek KBH, DiMatteo MR (2009) Physician communication and patient adherence to treatment: a meta-analysis. Med Care 47(8):826. doi:10.1097/mlr.0b013e31819a5acc
Ross S, Maxwell S (2012) Prescribing and the core curriculum for tomorrow’s doctors: BPS curriculum in clinical pharmacology and prescribing for medical students. Br J Clin Pharmacol 74(4):644–661. doi:10.1111/j.1365-2125.2012.04186.x
Hogerzeil HV, Barnes KI, Henning R, Kocabasoglu YE, Möller H, Smith AJ, Summers RS (2001) De Vries T. Teacher’s guide to good prescribing World Health Organization, Geneva
Fischer M, Bauer D, Mohn K (2015) Endlich fertig! Nationale Kompetenzbasierte Lernzielkataloge Medizin (NKLM) und Zahnmedizin (NKLZ) gehen in die Erprobung. GMS Z Med Ausbild 32(3):Doc35
Jünger J, Köllner V, von Lengerke T, Neuderth S, Schultz J-H, Fischbeck S, Karger A, Kruse J, Weidner K, Henningsen P (2016) Kompetenzbasierter Lernzielkatalog Ärztliche Gesprächsführung Competence-based catalogue of learning objectives for conducting medical consultations. Z Psychosom Med Psyc 62(1):5–19. doi:10.13109/zptm.2016.62.1.5
Langewitz W (2012) Zur Erlernbarkeit der Arzt-Patienten-Kommunikation in der medizinischen Ausbildung. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 55(9):1176–1182. doi:10.1007/s00103-012-1533-0
Wouda JC, van de Wiel HB (2013) Education in patient–physician communication: how to improve effectiveness? Patient Educ Couns 90(1):46–53. doi:10.1016/j.pec.2012.09.005
Loh A, Simon D, Kriston L, Härter M (2007) Patientenbeteiligung bei medizinischen Entscheidungen. Dtsch Arztebl 104(21):A1483–A1488
Charles C, Gafni A, Whelan T (1997) Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med 44(5):681–692. doi:10.1016/s0277-9536(96)00221-3
Charles C, Gafni A, Whelan T (1999) Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med 49(5):651–661. doi:10.1016/s0277-9536(99)00145-8
Dickinson D, Raynor DT, Kennedy JG, Bonaccorso S, Sturchio JL (2003) What information do patients need about medicines? BMJ 2:3. doi:10.1136/bmj.327.7419.861
Berry DC, Knapp PR, Raynor T (2002) Is 15 per cent very common? Informing people about the risks of medication side effects. Int J Pharm Pract 10(3):145–151. doi:10.1111/j.2042-7174.2002.tb00602.x
Gigerenzer G, Gaissmaier W, Kurz-Milcke E, Schwartz LM, Woloshin S (2007) Helping doctors and patients make sense of health statistics. Psychol Sci Public Interest 8(2):53–96. doi:10.1093/acprof:oso/9780199390076.003.0005
Bosworth HB, Granger BB, Mendys P, Brindis R, Burkholder R, Czajkowski SM, Daniel JG, Ekman I, Ho M, Johnson M (2011) Medication adherence: a call for action. Am Heart J 162(3):412–424. doi:10.1016/j.ahj.2011.06.007
Matthes J, Albus C (2014) Improving adherence with medication: a selective literature review based on the example of hypertension treatment. Dtsch Arztebl Int 111(4):41–47. doi:10.3238/arztebl.2014.0041
Hauser K, Niehaus M, Albus C, Herzig S, Matthes J It always takes two-teaching how to communicate drug prescriptions to patients. In: naunyn-schmiedebergs archives of pharmacology, 2015. Springer 233 Spring St, New York, NY 10013 USA, pp S60-S60
Cullati S, Courvoisier DS, Charvet-Bérard AI, Perneger TV (2011) Desire for autonomy in health care decisions: a general population survey. Patient Educ Couns 83(1):134–138. doi:10.1016/j.pec.2010.04.025
Guadagnoli E, Ward P (1998) Patient participation in decision-making. Soc Sci Med 47(3):329–339. doi:10.1016/s0277-9536(98)00059-8
Laidsaar-Powell RC, Bu S, McCaffery KJ (2013) Partnering with and involving patients. The Oxford Handbook of Health Communication, Behavior Change, and Treatment Adherence:84–85. doi:10.1093/oxfordhb/9780199795833.013.011
Acknowledgements
We thank Jessica Köth and Wiebke Seemann for technical help with recording simulated conversations. The help of Monika Endres with transcription is appreciated. Thanks to Jana Bauer for helpful discussions. This work was in part supported by the rectorate of the University of Cologne [Inno-2013-3-3].
Authors’ contribution
KH and JM designed the study, analysed the data and wrote the manuscript.
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Every student whose role play was to be filmed and analysed gave his or her written consent. After transcription of the conversations, only anonymised transcripts were used for further analysis. A formal approval by our local ethics committee was thus considered not necessary.
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The authors declare that they have no conflict of interest.
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Table S1
Detailed description of identified codes and underlying contents. The column in the middle gives the definitions of each code. The column on the right gives issues derived from the conversation transcripts that are underlying the respective code. (DOCX 19 kb)
Figure S1
Manual for physician-patient communication on medication as used in medical education in Cologne. Based upon the essential steps of shared decision-making as compiled by Loh et al. [40] we propose certain steps to be addressed by a (simulated) physician when talking to a (simulated) patient about a new medication. (GIF 318 kb)
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Hauser, K., Matthes, J. Medical students’ medication communication skills regarding drug prescription—a qualitative analysis of simulated physician-patient consultations. Eur J Clin Pharmacol 73, 429–435 (2017). https://doi.org/10.1007/s00228-016-2192-0
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DOI: https://doi.org/10.1007/s00228-016-2192-0