Students learn to apply their theoretical knowledge in practice at the School of Medicine's Clinical Training Centre (KTZ). The KTZ moved into its new premises in the spring and has now been officially opened.
"Mrs Müller, please," can be heard in the corridor. Shortly afterwards, a young woman enters the room. An equally young man shakes her hand, sits down behind the desk in the centre of the room and she takes a seat in front of it. Next to the door is a dark red couch with a paper cover, and on the bookshelf behind the desk is a model of a human torso. "My name is Gareth Edwards, I'm a seventh-year medical student. What brings you to me today?"
Mrs Müller explains that she has been experiencing shortness of breath and chest tightness for several weeks. Edwards listens, nods and asks the patient about her symptoms, medical history and personal situation. A fellow student and a lecturer observe the anamnesis interview from the side, listen and take notes. Between them, a camera records the conversation.
In their fourth year, the students conduct a complete patient interview for the first time - from start to finish. They are not sitting opposite real patients, but actors. Personalities, complaints and behaviour are taken from a script. The film recordings allow the students to analyse themselves afterwards: What questions did I ask? What was my body language like? Did I respond appropriately to my patient's concerns?
Introducing students to the practice at an early stage
At this stage, the topic of communication, the dialogue with patients, plays a particularly important role: the prospective doctors have four clinical internships ahead of them. They spend five weeks at the KTZ in the run-up to each internship to prepare for the tasks, treatments and patient contact they will encounter there. The first skills labs of this kind were founded in the 1970s in Illinois (USA) and Maastricht (Netherlands). Today, they are also standard at medical Schools in Germany.
"It has been found that when students enter the medical profession, they very often complain that they do not feel well prepared for everyday life. The KTZ offers a protected environment in which students can try out methods and skills before applying them to patients," explains Kirsten Gehlhar, Head of the Dean of Studies at the School. The first courses were held two years ago, back then in building V04, and since then the School has been steadily expanding the centre's facilities and services. This spring, the KTZ moved into its new premises in V02.
The training sessions have been an integral part of the medical degree programme in Oldenburg from the very beginning. "It is part of our concept to introduce students to practice at an early stage so that they can see what they are learning theory for," continues Gehlhar. The students try out a lot of things on themselves and their fellow students. They should lose their inhibitions about touching patients and get a feeling for what it means to be a patient themselves and to be touched by others, supposed strangers.
At the end of the first year of study, the junior doctors sit opposite their first drama patients. Together with them, they learn to interpret symptoms, use examination methods and ask the right questions to make a diagnosis. Later on, they also learn how to deal with difficult cases and diagnose more complex clinical pictures. Video recordings are also used for this.
Ulf Goerges is in charge of the simulation patient programme. He coordinates the actors, practises the cases with them, offers training and supports the lecturers in developing the scripts on request. Goerges explains that the actors make it much easier for the students to take a case seriously than if a fellow student were to slip into the role of the patient. "It's different when you have someone sitting in front of you who is 60 or 70 years old. You forget that they're an actor and have a different level of respect."
Goerges can draw on a large group of acting patients of all ages. Many of them are amateur actors and came to the programme through his contacts - Goerges is an actor himself - or calls within the university. The role of the patient is particularly challenging from an acting point of view, as every consultation is different. The actors have to internalise their role and react flexibly to their counterparts. At the same time, they have to reflect on their own situation: Is the doctor looking at me? Do I understand what he is doing? Is he responding to my concerns? The subsequent feedback is particularly valuable for the students.
Working with drama patients enables students to approach more complex cases. "You can do things that you can't do with patients. Things you can only practise with drama patients; delivering bad news or dealing with psychiatric cases, for example," explains Gehlhar. The effort involved in the simulation patient programme pays off: By the end of the fourth year of the programme, students can be seen to have made significant progress in dealing with patients. And the feedback from the clinics is also positive.
In the body of an 80-year-old
However, there are also treatments that the students are not able to try out on the patients: Drawing blood, inserting a catheter or delivering a baby. Models and materials are available for each department to practise these skills: From stethoscopes, hammers and ear mirrors to ECG and ultrasound equipment, intubation trainers, a resuscitation manikin and models for preparing for labour. With the help of a so-called "Ageman suit", students can even put themselves in the shoes of an 80-year-old.
"In the courses, the skill is demonstrated once, then the students go together in small groups and practise with the tutors. There are regular practical exams that test what they have learnt. There are also practice courses for this," explains Stephanie Voigt. She coordinates the courses for years four to six at the KTZ. In future, the KTZ would like to offer even more practice courses outside of the curriculum, in which students can deepen certain skills - for example ultrasound examinations. The aim is to prepare future doctors even better for clinical reality.
