In these consultations the physician confronts the patient or relative with a serious illness Erastin purchase or the death of a loved one, and should then pay ample attention to the emotions evoked. Discussion of options should take place in the second half of the consultation or in a follow-up consultation. The NEG and DTR consultations are also quite similar in goals,

structure, and required skills. In these consultations the handling of emotions is also important, but negotiating takes a more prominent place than in the BBN and PMD consultations. The topics are dealt with in small group sessions with discussions of clinical experiences, short instructions, role-play with trained actors, feedback, and reflection. The simulated consultations are based on scenarios that encompass the communication problems of the topic. The scenarios relate to the residents’ clinical experiences and are constructed with the help of experienced consultants. Before the role-play exercise, the residents discuss the medical information

and their own clinical experience with the scenario. This procedure is intended to eliminate as much as possible the influence of case difficulty, and knowledge about and familiarity with the cases, on communication performance. In the simulated consultations, trained actors play the role of the patient or relative. The actors’ appearance is based on suitability for the scenario and availability. However, the residents do not meet the same actor twice, which means that the patient or relative is never familiar to them. The simulated consultations take place in a separate room that is fitted out CB-839 solubility dmso as an ADP ribosylation factor authentic consulting room. Thus, contextual variables are the same for all consultations. All consultations are videotaped for feedback purposes. From our collection of 248 videotaped consultations, performed on the first day of training, we selected a random sample of 50 consultations, consisting

of 29 BBN consultations and 21 NEG consultations. The 50 residents (35 male, 15 female) who performed these consultations, also subsequently performed a PMD or DTR consultation on the second day of training. Thus, we used 100 consultations in this study. Which type of consultation each resident performed on the second day, was determined by chance. Twenty-two (6 male, 16 female) actors appeared as simulated patients or relatives in the 100 consultations selected. Some actors portrayed several scenarios several times, while other actors appeared only once. Table 1 gives an overview of the consultations. The number of actors used in each of the four consultation types, is presented in brackets. The principal investigator (J.C.W.) and two psychology students assessed the communication competency of the residents using the CELI instrument [39]. This instrument is based on a validated model of patient education and assesses the quality of a physician’s communication competency by assigning scores to the performance of separate communication skills.