Communication is a key skill in healthcare and central to a good relationship between healthcare professionals and patients, and contributes to optimal patient care. DocCom.Deutsch (DCD) is an established online learning platform that facilitates the acquisition of communication skills. The DCD project was initiated 10 years ago – a good time point to look back and to the furture.

The first German-language DCD version was inspired by the US production “DocCom” and was developed in 2012 with the support of the “Novartis Foundation for Man and the Environment”, multiple experts as well as the Drexel University. It became apparent that a literal translation was not useful as the cultural differences in lifestyle, conversation and care practices were too great. The first 12 modules were therefore fully adapted and all patient examples were redesigned.

At the start of the DCD development, physician-patient communication was particularly emphasised. Today we are deliberately designing new modules in an interprofessional way. The importance of communication skills across the various health care professions is recognised through the increasingly widespread communication courses in nursing and medicine, in practical assessments as well as the new Master’s course in Pharmacy in Bern, where communication training is a solid aspect of the dispensing curriculum. The modules are also uutilised in various Certificates of Advanced Studies (CAS) at the Universities of Bern and Zurich, and are a component of those modules with a communication focus (e.g. CAS Palliative Care).

For optimal communication in healthcare, the stakeholders can orientate themselves on high-level, evidence-based principles, which are didactically prepared in specific modules in the DCD. The following modules facilitate a good relationship between the healthcare professional and patient:

• CENTERING: Integration of patient-centred and physician-centred conversations
• RELATIONSHIP: Building the physician-patient relationship
• HISTORY: Obtaining information
• PERSPECTIVE: The patient's perspective
• INFORMATION: Information sharing

In addition, DCD offers modules on specific topics of conversation and particular circumstances, e.g .:

• EMOTION: dealing with intense emotions: anger, fear, sadness
• MOTIVATION: Changes in health behaviour: advice, assistance, support
• BADNEWS: Delivering bad news
• MISTAKES: Talking about incidents
• Further modules can be selected in DCD

The main idea behind DCD is that good communication can be learned and that the evidence-based concepts can be easily implemented through practice. DCD is designed as an online component for “blended learning”. Following individual online learning, the new knowledge is ideally applied in practical exercises in safe conditions with "simulation staff". Through feedback and peer feedback, we have documented improvements in both knowledge, behaviour and attitudes. With this foundation, it is possible to be better prepared for an in-depth experience with patients in everyday clinical practice with minimal hesitation.

The online learning opportunities from DCD thus form a bridge between theory and practice: Numerous videos show how good communication can be practically applied in different situations. So that learners can memorise the model-based communication steps shown in the video, the videos are annotated and also concise incorrect examples are provided to ensure such errors can be knowlingly avoided. Important steps in the conversation are commented on and, if appropriate, further explained via talking heads. In this way, the learners obtain an insight into what experts and patients reflect on during a conversation.

During the pandemic, DCD has proven to be a helpful bridge to communication lessons at numerous medical faculties in German-speaking countries. In Bern over the lockdown, via prepartion using DCD, aspects of the communication training were moved completely online. Our exprience with online communication training using DCD is described briefly here.

It is a fundamental principle that DCD modules are informed by research. Many basic principles of the above modules are already broadly underpinned by research. As a result of social change, new needs in patient communication are also being recognised. To this end, accompanied by research, we are developing additional communication models, e.g .:

• SPIRITUALITY: incorporating spiritual aspects. As part of an NRP 74 project. Link to general information and module (online since January 2021; registration required)
• DEATH: Conversations about impending death. As part of the following project Link. Module is online since November 2021 (registration required)
• In the coming year we will be launching a new and equally important module covering “participatory decision-making”.

Research on the learning effectiveness of the DCD modules is important to us. Examples of our own publications include:

• Schmitz, F.M., Schnabel, K. P., Bauer, D., Woermann, U., Guttormsen, S. (2020). Learning how to break bad news from worked examples: Does the presentation format matter when hints are embedded? Results from randomised and blinded field trials. Patient Educ Couns, 103(9): 1850-1855.  
• Schmitz, F. M., Schnabel, K. P., Bauer, D., Bachmann, C., Woermann, U., Guttormsen, S. (2018). The learning effects of different presentations of worked examples on medical students’ breaking-bad-news skills: A randomized and blinded field trial. Patient Educ Couns, 101(8):1439-1451. 
• Schmitz, F. M., Schnabel, K., Stricker, D., Fischer, M. R., & Guttormsen, S. (2017). Learning communication from erroneous video-based examples: A double blind randomised controlled trial. Pat Educ Couns, 100(6):1203-1212.

The learning effectiveness of US version is also well documented.