Laura Kranenburg Van Koppen

The main question of this thesis is how we can support postgraduate training of communication skills for future medical specialists. Two main aspects are considered. The first aspect is the postgraduate training of communication skills in daily practice in chronic diseases. Secondly, specific attention is needed for communication skills concerning rare diseases for several reasons. Due to small numbers there is scarce experience with the treatment of these patients in general training centers. This requires another approach in training.

Extensive research has been performed regarding training of communication skills. Doctor-patient communication skills can be taught in courses, are learnt, but are easily forgotten if not maintained by practice. The most important enhancing factor in post-graduate communication training is encouragement to deliberately practice in an environment in which the value of communication skills is recognized and support is institutionalized with appropriate feedback from role models. Communication is a competency that should be longitudinally learned across the whole training continuum in an authentic setting with a lot of practice in many different contexts with regular meaningful feedback.

Question arises to what extent these elements are implemented in the daily practice of postgraduate training in chronic diseases. The field of rheumatology is highly suitable to look into this question. Besides general communication skills specific attention goes out to Shared Decision Making (SDM), supporting patients and healthcare professionals to jointly make a decision based on the best available evidence for treatment options while respecting patient’s values and preferences.

There are several challenges in training doctor-patient communication in rare diseases. Online learning is evenly effective as classroom teaching and might offer a solution in rare diseases. In order to gain insight in training of doctor-patient communication skills in rare diseases by use of online learning we look into the field of disorders of sex development (DSD), which is a subspecialty of the paediatric endocrinologist. Care for individuals with DSD is characterized by varying short- and long-term challenges that may emerge throughout one’s lifespan. This requires adequate doctor-patient communication skills.

In this chapter we studied which methods are used to train doctor-patient communication skills amongst residents rheumatology in the Netherlands, how these are perceived by residents and educators and how these relate to evidence regarding postgraduate training of communication skills. We send out an online questionnaire, performed semi-structured interviews among rheumatologists in training and educators and performed a scoping