Physicians' roles in competency-based teaching: Do students recognize them?

Introduction: Imparting the concept of physician's roles with the help of new teaching formats is becoming increasingly important in medical education. The "ambulatory care simulation" was developed at the Medical Faculty Mannheim as a format to teach the roles of "medical expert," "communicator", "health advocate", "manager", "team member" and "professional" in the practical year. During the "ambulatory care simulation", students work through case scenarios with simulated patients focusing on the physician's roles and subsequently discussing and reflecting on their experiences. Several measures are designated to ensure that each role is covered by the new teaching format. The present study investigates whether the physician's roles are actually addressed during the "ambulatory care simulation" and whether the competency-based learning objectives are recognized by the students. Methods: All participants in 12 of the 38 obligatory "ambulatory care simulations" signed informed consents to be filmed during the "ambulatory care simulation". These videos were categorized using previously defined observation criteria. A total of 211 out of 224 students completed and handed in a one-minute paper at the end of the "ambulatory care simulation". The answers to the question, "What have you learned?" have been assigned to competency-based learning objectives. Results: Although instructors and students adhered to the guidelines in the recorded "ambulatory care simulations", the most frequently addressed roles were "medical expert" and "communicator." Two-thirds of the participants indicate learning outcomes that do not correspond to the previously defined learning objectives of the "ambulatory care simulation". Discussion: To ensure a thorough understanding and long-lasting appreciation of the physician's roles, longitudinal integration of teaching interventions into the curriculum is to be favored over single teaching units. Instructors need intensive preparation for the unfamiliar construct of physician's roles. The learning objectives must also be made more transparent. Conclusion: Especially complex teaching formats need to be evaluated for success if they are to achieve their aims. Formative evaluations enable verification of whether the learning objectives are addressed, recognized and, finally, achieved.