Videofragment Wim Brandsen - Tim Parks http://www.uitzendinggemist.net/aflevering/97860/boeken.html Fragment: minuut 2.56 4.23
Blended training helps medical specialists in communication with patients with Medically Unexplained Physical Symptoms Dr. Anne Weiland MUPS research & training Department Internal Medicine & Department General Practice Erasmus MC, University Medical Center Rotterdam
Prevalence new MUPS pt (n=550), Nimnuan, Wessely, 2001 Outpatient Clinic Prevalence (95% CI) Chest 41% (28-53) Rheumatology 45% (35-55) Cardiology 53% (43-63) Gastroenterology 58% (44-71) Neurology 62% (52-72) Gynaecology 66% (56-76)
Prevalence MUPS in Emergency Department Alsma J, Van de Wouw J, Jellema K, Coffeng S, Tobback E, Delesie L, Van den Brand C, Vogelaers D, Mariman A, De Paepe P, Van Saase J, Weiland A. Medically Unexplained Physical Symptoms in Patients Visiting the Emergency Department; An International Multicenter Retrospective Study. 2016. Submitted.
2004 by BMJ Publishing Group Ltd Neurologists find MUPS consultations difficult, Carson 2004
Explaining functional disorders, Carson et al. Pract Neurol 2016;16:56-61
MUPS - research & training in specialist care (2010-2014) Weiland A, Van de Kraats RE, et al. Encounters between medical specialists and MUPS patients; influences of communication on patient outcomes and use of healthcare: a literature review. Perspect Med Educ.2012;1:192-206 Review Pilot Training 14 hrs face to face In 4 sessions RCT 123 doctors 478 patients
Trained doctors explore more effectively Weiland A, Blankenstein AH, Van Saase JLCM, et al. Training medical specialists to communicate better with MUPS patients; a RCT. 2015. PLoS ONE 10(9):e0138342. doi:10.137/journal.pone.0138342.
Trained doctors inform more effectively Weiland A, Blankenstein AH, Van Saase JLCM, et al. Training medical specialists to communicate better with MUPS patients; a RCT. 2015. PLoS ONE 10(9):e0138342. doi:10.137/journal.pone.0138342
Advantages Blended Learning, Dankbaar et al. 2014 Higher level at start trainingsession Flexibility in learning Tailored learning Use of multimedia is motivating Standard content Online courses have no limits in numbers of participants Less productivity loss for doctors Less cotrainers needed -> cheaper
Structure Blended MUPS training From 14 hours in 4 sessions -> 8 hours in 2 sessions + 6 hours online
E-module on reassurance & discussing expectations
Test results Blended MUPS training (n=18)
Doctors evaluated both training models positively Content Length Feedback Useful! 2.8 Original training (n=92) 2.8 Blended training (n=44) 3-pnt scale (SE=0,18 ;1=min - 3=max) Weiland A, Blankenstein AH et al. Postgraduate education for medical specialists focused on patients with MUPS. Patient Educ Couns 92 (2013)355-360
I am glad I could help Thank you so much, it feels like I am finally making progress!
Transcultural communication and MUPS
Better exchange of information needed Weiland A, Blankenstein AH, Willems MHA, Van Saase JLCM, Van Daele PLA, Bootsma A, Vriens EM, Oberndorff-Klein Woolthuis A et al. Training medical specialists to write appropriate reply letters to GPs about patients with MUPS; a cluster randomized trial. Patient Educ Couns 98 (2015) 1229-1235. 285 reply letters specialist -> GP % Pre Contr. % Pre Interv. % Post Contr. % Post Interv. Referral question GP mentioned Answered GP s referral Q Questions of patient mentioned Answered patient s Q 33 30 41 32 33 37 33 33 32 33 37 33 44 41 61* 63* Somatic findings mentioned Additional investigations mentioned 81 71 86 82 84 77 91 75 Explanation MUPS mentioned Advice to patient and GP mentioned 30 62 27 54 31 69 41 66
Take home messages Blended learning in training MUPS communication skills works! Online courses serve the face-to-face training when doctors are absent. Transcultural MUPS communication needs our attention! Cooperation between primary and specialist MUPS care is vital.
Thanks for your attention Thanks to teamwork: Prof. Dr. Jan van Saase, Department of Internal Medicine Erasmus MC, Rotterdam, NL Prof. Dr. Sandra van Dulmen, NIVEL and Department of Primary and Community Care Radboud University Medical Center, Nijmegen, NL Prof. Dr. Lidia Arends, Department of Psychology, Education & Child studies, Faculty of Social Sciences, Erasmus University Rotterdam, NL Dr. Mary Dankbaar, programme manager e-learning Erasmus MC, Rotterdam, NL Dr. Els Vriens, Department of Neurology Diakonessenhuis, Utrecht, NL www.erasmusmc.nl/onverklaarde-klachten a.weiland@erasmusmc.nl