The internet keeps gaining importance in health care [1,2]. Searching for answers to medical questions, patients and laypeople increasingly use the internet to communicate and to get access to health-related information before and after (or instead) consulting a doctor [3,4]. At the same time more and more players offer information and advice online.

Since medical knowledge is often complicated and difficult to assess, medical professionals are in demand to adapt to the changing social and technological situation - especially for preventive reasons. On the one hand, doctors are supposed to communicate with highly as well as inadequately informed laypeople in a professional manner to increase patients' adherence. On the other hand, they should be able to provide reasonable orientation and guidance in online settings and use the possibilities of the internet effectively [5, 6].

Skilled online communication can provide a useful complement to traditional doctor-patient communication, if it meets equal standards. But as especially text-based online communication differs strongly from real-life doctor-patient interaction (e.g. anonymity, lack of audio-visual cues), its reliability is often doubted. Studies showed that medical doctors are aware of the demand, but unsure about online patient communication (e.g., professional reasons, data protection, payment). They frequently stated to require better preparation for online consultation.

Therefore, the quantity and quality of accessible information, specific characteristics of computer-mediated communication, as well as legal concerns and risks create new challenges for doctors’ communication skills [7, 8] that need to be met. Besides a change in conditions and attitude concerning this topic, adequate training options are essential to develop skills for information exchange and doctor-patient relationship building in online settings.

Our study focuses on the question, how medical students can be prepared effectively for the described challenges of professional web-based communication and the task of online counselling.

► Does an online forum provide an effective training tool/environment for online counselling?

► Which didactical approach is suitable to frame the individual training with the online forum?

Therefore, we developed a simulation training program, involving a realistic, purpose-built online forum and virtual patients as vital components.

We integrated the training in the gynaecology clerkship (9^th semester) as an add-on. The individual counselling activities within the online forum were embedded in a four-day blended learning course concept (Figure 1). N=78 students attended the course in groups of n=9-10 students each, focussing either a self-directed approach (G1; n=39) or a teacher-directed approach (G2; n=39) with more information and time for group discussion in preliminary seminars.

Figure 1: Study design and course concept (blended learning)

We used freeware (phpBB) to build the forum with individual sub-forums for each participant in the training, thus facilitating a protected environment. We installed fictitious patient vignettes with different profiles (e.g., age, patient history) and pre-defined enquiries of varying complexity (e.g., given information) in all sub-forums to be answered by the respective course participant (Figure 2). All patient cases dealt with mammography screening.

Figure 2: Simulated patient enquiry

In this prospective randomized parallel group trial we evaluated course concept, online forum and effects on students’ communication skills qualitatively and quantitatively by questionnaires and pre-/post-tests (OSCE with checklist, independent raters; self-assessment).

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