Learning on treatment occasions
A key feature of the Düsseldorf Curriculum of Medicine is an innovative teaching and learning format that is unique in Germany: Learning on Patient's Complaints. Our faculty has defined treatment occasions that can occur both in the outpatient area of primary care and in any other level of care, and coordinated these with the clinics of the UKD. This resulted in the Düsseldorf List of Complaint Items with 123 occasions for medical consultation. Based on the respective treatment occasion, the students work independently on at least 65 real patient cases on wards and outpatient clinics in this format by the end of the fifth year of study in addition to Bedside Teaching. The focus is on interdisciplinary history taking and physical examination of unknown patients. The student-centered format thus promotes independent learning and prepares students for everyday professional life.
The LaB process can be divided into five phases. You can find a detailed description of the respective process in the manuals for practical lessons.
Selection of patients
Firstly, the teachers explain to the students which patients with which treatment issues have agreed to take part in the lessons. The students compare which treatment cases they have already dealt with and decide together who will "take on" which patients. Six patients are available per group of six students.
Patient admission
In contrast to teaching patients, in this learning format, students take a complete medical history independently without medical supervision and carry out a systematic, comprehensive physical examination appropriate to the reason for treatment. The aim is to use the medical history and physical examination to generate suspected diagnoses and to be able to plan the next steps in diagnosis and treatment.
Examination findings
After the patient has been admitted, the students can ask the teacher for the results of further diagnostics and - if necessary, supported by the teacher - make their own findings.
Research and preparation of the case presentation
Using textbooks, scientific publications and qualified online resources, students then work through their individual patient case theoretically and record their findings on a documentation sheet. In this way, they gradually learn about the underlying clinical picture as well as the diagnostic, differential diagnostic and therapeutic procedures.
In this way, students work on two to three patient cases per week. If necessary, a treatment occasion can also be dealt with several times, as it can lead to different diagnoses and therapies in different patients. By approaching unknown patients and systematically dealing with patient cases, they develop clinical expertise and interdisciplinary thinking for their future careers. Learning from treatment cases thus leads to a steady increase in expertise.
Case presentation, feedback, consolidation
The LaB concludes with an event in which all students in the respective group of 6 present the patient cases they have examined. There are several different options for this presentation, as described below, all of which become relevant in medical practice.
The supervising doctors evaluate the patient presentation using a feedback form according to predefined criteria. Finally, the students receive the completed feedback form and additional constructive, personal feedback on their case presentation and an in-depth case discussion develops with the other students in the group and the teacher. This ultimately ensures the further development and individual competence growth of the students.
Intraprofessional handover - senior physician:senior physician
The students hand over the patient to the teacher, who assumes the role of the responsible senior physician. The patient is unknown to the senior physician. The aim is to provide all the information necessary to jointly discuss the further diagnostic and therapeutic procedure.
Intraprofessional handover - night service
The students hand over the patient to the teacher in the role of night duty. The aim is to provide all the information that is relevant for the night shift in a compact manner in order to safely care for the patient, who is previously unknown to them.
Interprofessional handover (e.g. to nursing, physiotherapy)
The students hand over the patient to the teacher in the role of the nurse responsible for the respective ward. They do not yet know the patient. Particularly in the case of patients with complex, long-standing medical histories, the selection of information that is relevant for carers is the most important preliminary consideration that contributes to an efficient handover.
Evidence-based patient report
The students write an evidence-based patient report. The report is based on the results of the medical history, physical examination (if applicable), discussion of findings, research and management considerations.
Patient-friendly report
In addition, the students write a report for the patient. This report should contain all important information for the patient and be comprehensible.
The aim is for students to be able to deal with patient-understandable formulations at their leisure. This will ultimately also help in spontaneous verbal communication with patients and their relatives when it comes to explaining complex issues in an understandable way.
Case conference
In the case conference, students present their patient cases in the role of experts in an interactive case discussion. They also train their presentation, moderation and teaching skills.
The aim is to look at patient cases from different perspectives - including perspectives for which there is little time for reflection in everyday clinical practice. To this end, an in-depth impulse is used by the presenting student to initiate a well-founded discussion. For example, economic, social, ethical or therapeutic aspects can be taken into consideration. The format offers space for in-depth discussions and complex questions that go beyond the mere discussion of the patient case and help the group to further develop competences in one of the eight areas of expertise.
Introduction Video for Students
In this video, we explain an example of a possible process for learning on treatment occasions. Please note that this is just one example from many possible formats.
Introduction Video for Teachers
In this video, we explain an example of a possible process for learning on treatment occasions. Please note that this is just one example from many possible formats.