Entwicklung und Evaluation des Selbstsicherheitstrainings für Studierende der Medizin. Eine randomisierte kontrollierte Interventionsstudie.

This dissertation evaluates self-assertiveness training (“SST”) program for medical students at the Philipps University in Marburg (“UMR”). Recent studies, shown that self-confidence and training empathy using video feedback and role-playing promote social intelligence and an increased awareness of others. The effects of the program, which included theoretical seminar followed by SST, was examined at 3 different points, before, after the theoretical seminar, and after SST. SST is small group (12-18) training of the use of goal-oriented behaviors - cooperative, inhibited, inhibited-aggressive, aggressive - to dealing with patients in a sensitive and empathic manner In the study, standardized video based behavioral observations were made during 8-minute patient simulations (part of the UMR curricular teaching from 2012-2014) using a coding guide with verbal, non-verbal, target-oriented, non-target-oriented, and empathetic and sociopathic criteria. Although 343 students received SST, only 225 students took part in after theoretical seminar questionnaire. Based upon standardized questionnaires the group was broken up into 4 clusters (empathic, anxious, emotionally immature, students with psychopathic behaviors), although all of the participants received the same training. Data analysis showed that cooperative behavior, especially among empathic students, increased significantly. Anxious and emotionally immature students increased their use of goal-oriented (specially after Combination of SST und TS) verbal and non-verbal behavior in the patient discussion as well as self-protective behaviors. In contrast to the group of empathic students, students with psychopathic abnormalities used non-goal-oriented criteria more often in conversation (P <0.02) as well as psychopathic strategies and often stood out in the video analysis. SST helped to promote empathy and overcome inhibitions while studying human medicine. Two recommendations are suggested by the study. First, in order to maintain empathy throughout the course of studies (many international studies show a decrease in empathy during medical school), SST should be conducted regularly, across all of the semesters in medical school. Secondly, currently the selection of medical students is based upon prior performance and knowledge, yet doctoring is fundamentally a caregiving role. However, SST showed the least effectiveness in student with psychopathic tendencies. We show that empathic behavior in patient communication can be measured through structured, semi-standardized behavioral observation. This should be used as a criterion for medical school admission. SST, based upon this study of filmed patient interviews, was deemed effective to train doctors with the level emotional competence required to survive in difficult interpersonal situations and high-performance demands to be able to obtain the resilience needed in everyday medical practice. In conclusion, a high level of emotional competence leads to higher patient satisfaction and compliance. Also it leads to doctor personal satisfaction, and clinical efficiency which improves medical care and lowers health costs. Empathy can be trained. A side benefit is that the skills taught through SST can be used to analyze and optimize interpersonal interactions. Even though method is time consuming and requires small group training, it is necessary to train doctors with a high degree of empathy and the self-protective tools to minimize burn-out. UMR’s SST methods and curriculum should be supplemented by further studies on a voice frequency and facial emotional analysis as well as further training optimization.