Integration of simulation into medical school basic sciences
mation. Health related knowledge is often complex and difficult to evaluate. Consequently, professional medical expertise is urgently required on the internet: medical doctors are supposed to communicate with highly or inadequately informed laypeople in a professional manner and have to provide reasonable online orientation and guidance. Thus, computermediated communication, the extent and quality of available information, as well as legal concerns and risks, create new challenges for doctors' communication skills. Even though text based communication differs strongly from face to face situations (e.g. anonymity, reduced audio visual cues) online counselling should meet standards equal to those of reallife doctor patient consultations. Medical doctors frequently state that they require better skills, confidence and security in providing expert online counselling. Therefore, training is the key to practising and monitoring skilled information exchange and building up relationships in online settings. What was tried? We considered a purpose built online forum to be a suitable training environment to meet the described challenge, because healthrelated online forums are widely used to discuss medical topics; they are able to provide additional information about particular users (e.g. personal profiles) and to record forum activities (e.g. access to certain posts) We constructed a realistic online forum using freeware (phpBB; MySQL) with individual sub forums for each participant, facilitating a protected environment for self directed training. We applied fictitious patient vignettes with different profiles (e.g. age, profession and patient history) including various predefined enquiries of varying complexity in all individual sub forums to be answered by advanced medical students in the role of medical doctors. We integrated the training as an add on in the gynaecology clerkship (ninth semester) The simulated forum was embedded in a 4 day blended learning course concept: pre test (answering an enquiry) introduction to forum and topic, 3 days voluntary online patient counselling activity, posttest, and feedback in live meeting. All cases dealt with mammography screening. Seventy eight students attended the course in groups of 9 10 students each. The course concept, online forum and their effects on students' competence in communication were evaluated qualitatively and quantitatively by questionnaires and preand post tests (self assessment; online counselling objective structured clinical examination (OSCE) two independent raters) What lessons were learned? Students were satisfied with the course concept (87% and the application of the forum (79% Besides preand post test enquiries, which were responded to by all students, 54% of the students responded to n 2 additional fictitious patient enquiries. The results showed a significant increase in competence in counselling revealed by both self assessment (Z 2.33; p 0.05) and OSCE (Z 2.99; p 0.01) The self directed educational strategy to put theory into practice by training in relevant skills using an online counselling scenario was highly appreciated; the relevance of online communication became clear. However, more elaborate implementation (e.g. not just add on, more time on task) as well as the supply of more diversified topics were requested. The forum offers a feasible, realistic and flexible setting for simulating counselling in different scenarios (e.g. cost effectiveness, easy preparation and usage) This approach is a promising first step towards establishing an effective programme to meet the challenges of online counselling. It may be applicable to other medical disciplines and training levels as well.
Medical education