BackgroundBy 2013 Palliative Care will become a mandatory examination subject in the medical curriculum in Germany. There is a pressing need for effective and well-designed curricula and assessment methods. Debates are on going as how Undergraduate Palliative Care Education (UPCE) should be taught and how knowledge and skills should be assessed. It is evident by this time that the development process of early curricula in the US and UK has led to a plethora of diverse curricula which seem to be partly ineffective in improving the care for the seriously ill and dying offered by newly qualified doctors, as is demonstrated in controlled evaluations. The goals of this study were to demonstrate an evidence-based approach towards developing UPCE curricula and investigate the change in medical students’ self-perceived readiness to deal with palliative care patients and their families.MethodsTo evaluate the effects of the UPCE curriculum we chose a prospective, controlled, quasi-experimental, pre, retrospective-pre, post study design. A total of n = 37 3rd and 4th –year medical students were assigned to the intervention group (n = 15; 4th -year) and to the control group (n = 22; 3rd-year). Resting on the self-efficacy concept of Bandura the measurement was conducted by a refined test-battery based on two independent measurements (the revised Collet-Lester-Fear-of-Death-Scale and the instrument of the “Program in Palliative Care Education and Practice” at Harvard Medical School) including 68 items altogether in a five-point Likert-scale. These items were designed to test elementary skills in caring for the dying and their relatives as perceived by medical undergraduates. Datasets from both groups were analysed by paired and independent two-sample t-test. The TREND statement for reporting non-randomized evaluations was applied for reporting on this quasi-experimental study.ResultsThree constructs showed statistically significant differences comparing the intervention group before and after. Willingness to accompany a dying patient increased from 21.40 to 37.30 (p < .001). Self-estimation of competence in communication with dying patients and their relatives increased from 12.00 to 23.60 (p = .001). Finally, self-estimation of knowledge and skills in Palliative Care increased from 8.30 to 13.20 (p = .001).ConclusionsThis study is a small but systematic step towards rigorous curricular development in palliative care. Our manualised curriculum is available for scrutiny and scientific feedback to support an open and constructive process of best-practice comparison in palliative care.
Psychodynamic inpatient psychotherapy, as practiced under naturalistic conditions, is an effective treatment of depression. Predictors of therapeutic effects within different therapeutic settings, however, remain unclear. The sustainability of the therapeutic effects found and their impact on psychodynamic relevant constructs have still to be proven.
Depression is one of the most common illnesses. The effectiveness of psychodynamic psychotherapy on depressive symptom load has been demonstrated. However, for patients suffering from comorbid personality disorder (PD) a decreased benefit has been reported, as well as fewer rates of remission and extended duration of remission. However, findings are inconsistent. The objective of this study was to determine potential differences in therapy-outcome comparing female patients with and without comorbid PD. Including female inpatients aged between 25-45 years (N=377) in a psychodynamic treatment, the dissenting outcome on depressive symptom load (among others BDI; HAMD) as well as psychodynamic variables (IPO) by patients with and without comorbid PD were analysed within a naturalistic multicenter intervention study (STOP-D). Data were collected in 15 psychodynamically oriented psychosomatic hospital units in Germany, based on self- and external-assessment instruments. Under comparable therapy-doses, female patients with and without comorbid PD benefit significantly from psychodynamic inpatient treatment. By equivalent baseline severity of clinical symptoms patients without comorbid PD show larger effect sizes in all inventories than patients with comorbid PD. Although the benefit is lower for depressed patients with comorbid personality disorder, the positive effect of inpatient psychodynamic psychotherapy is statistically and clinically significant in both groups. Influences of further comorbid symptoms and confounding symptoms between depression and PD, which were difficult to control, are possible. Further studies are necessary. Although patients with comorbid PD benefit significantly from the inpatient treatment, a special therapeutic design seems to be indicated for these patients.
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