3A.07 Post grade

In the late 1970s, communication-skills training also became part of general-practice vocational training [78-81]. At first, the main educational approach consisted of reflection on real patient encounters. Since the nineties, in several western countries, patient-physician communication issues have been addressed in primary care and general-practice vocational training by means of assessment of and feedback on videoed consultations with real patients [82-86]. Also starting in the nineties, communication workshops and courses were offered to medical-specialist residents and consultants especially in the field of oncology. These elective courses mainly concerned exploring patients' concerns and breaking bad news, using didactics, demonstrations, role-play with feedback, and reflection as teaching methods [87,88]. Some workshops for consultants even focused on the teaching of communication skills to students and residents [89-91]. Other workshops focused attention on the use of learned skills in clinical practice. However, assessment of performance in clinical practice was lacking [93]. In the Netherlands, elective courses and workshops for consultants were offered [94]. Several initiatives used videoed outpatient consultations for assessment and feedback [26,95]. In some western countries, elective communication courses were offered in residency training [96,97], and in the late nineties compulsory courses were incorporated in the training of Dutch residents in obstetrics and gynecology and in surgery [98,99]. These courses addressed challenging patient-education issues such as breaking bad news and dealing with conflict, non-adherence, and complaints. However, the effects of these courses on residents' communication behavior in clinical practice were not investigated.