Attitudes and Knowledge of Dental Students in Bosnia and Herzegovina Towards Child Abuse and Neglect

INTRODUCTION

Child abuse and neglect (CAN) are social and public health problems. Access to oral health care for abused and neglected children is a challenge. The aim of this study was to assess the attitudes and knowledge of dental students from Bosnia and Herzegovina towards CAN.

MATERIALS AND METHODS

A cross-sectional survey was conducted among 263 dental students from two public universities in Bosnia and Herzegovina. The students answered 31 questions about the topic of CAN. The study population was categorised by year of study into six groups. Pearson's chi-squared test was used to analyse differences among participants regarding the year of study. The level of significance was set at p < 0.05.

RESULTS

The results show that 10.26% of total participants had experienced some knowledge about the topic of CAN during their studies, 17.87% had read about it in professional dental literature and 8.74% had some form of education and training on the topic. Over 50% of participants answered all of the questions about social indicators of CAN correctly. The knowledge of the study participants was found to be deficient concerning some physical signs of CAN found in the orofacial region. For a significant number of questions 'I don't know' was a frequent answer.

CONCLUSION

The level of knowledge of dental students from Bosnia and Herzegovina regarding the challenge of CAN is insufficient. An important strategy this to improve this is to increase the education and training of child abuse and neglect in dental curriculums.

Theories, Models, Frameworks, Guidelines, and Recommendations for Trauma-Informed Oral Healthcare Services: A Scoping Review

BACKGROUND

Traumatic life experiences (TLE) are common and can affect a person's physical being and health-related behaviors, including those related to oral health. This scoping review aimed to identify evidence exploring the implementation and provision of trauma-informed care (TIC) in oral health services delivery.

METHODS

Arksey and O'Malley's framework with enhancements proposed by Levac et al. and Peters et al. was used. Studies were selected based on a preset inclusion and exclusion criteria and the population/concept/context framework. Primary charting of descriptive data was conducted, followed by thematic analysis to identify ideas common within the included literature. Searches were conducted in Medline (via Ovid), APA PsycINFO (via Ovid), Embase (Elsevier), Scopus, CINAHL (via EBSCO), and Cochrane databases. Google Scholar and ProQuest were used to identify grey literature.

RESULTS

The search identified 251 records, with fifteen records meeting the inclusion criteria. Limited models, frameworks, and recommendations for trauma-informed practices in oral health services were identified. Recommendations for TIC practices were identified, and clinical practice adjustments for dental practitioners were described to improve service delivery for patients who may have experienced trauma. Avenues for future research were identified.

CONCLUSIONS

Limited evidence exists to guide trauma-informed practice in oral health service delivery. This scoping review highlights the need for further research into approaches and practices of TIC for oral health services delivery to assess their efficacy and the need to develop evidence-based TIC frameworks to meet the unique needs of oral health service providers and populations.

Implementation of a communication curriculum in undergraduate dental education-students' opinions during a 5-year development phase

INTRODUCTION

Communication training has become an essential part of the dental curriculum. The aim of this study was to evaluate the communication curriculum developed and introduced 2016-2021 at the University of Bern, School of Dental Medicine (SDM), Switzerland.

MATERIALS AND METHODS

The curriculum was implemented cumulatively in three phases: (1) lectures and accompanying role plays, (2) forum theatre and trainer-based communication training and (3) self-assessment. Students were surveyed 2016-2021 at the end of each semester using anonymous online questionnaires with five-point Likert scales (0-4).

RESULTS

A total of 191 fourth- and fifth-year students were surveyed, and 165 (86.4%) questionnaires were analysed. The mean age of the participants was 24.2 ± 1.4 and 45.5% were female. While students' opinions about the need to communicate increased during weekly lectures in phase 1, their opinions about their ability to communicate simultaneously decreased. During phase 2, fourth-year students' opinions on the need to communicate with dental patients increased from 3.22 ± 0.61 to 3.73 ± 0.45 (p = .001), anticipated benefits for dentists increased from 2.78 ± 0.71 to 3.43 ± 0.57 (p = .001) and for patients from 3.00 ± 0.76 to 3.47 ± 0.63 (p = .022). Only in phase 3, opinions on the ability to communicate statistically significantly increased for both fourth- (2.34 ± 0.71 to 2.72 ± 0.60, p = .033) and fifth-year (2.20 ± 0.63 to 2.86 ± 0.59, p = .001) students. Preferred teaching and assessment methods were trainer-based communication trainings (73.1%), lectures (67.3%) and self-assessments in the student clinic (59.6%).

CONCLUSION

Communication curricula in dental education using methods such as lectures and trainer-based communication trainings may additionally need to include self-assessments to be effective from the students' perspective.

Dentistry responding in domestic violence and abuse (DRiDVA) feasibility study: a qualitative evaluation of the implementation experiences of dental professionals

BACKGROUND

Domestic Violence and Abuse (DVA) is a persistent public health problem in the UK. Healthcare settings offer an opportunity to ask patients about DVA, either opportunistically or in response to the presence of injuries. However, it has been suggested that dental practices and dental teams have not been actively involved supporting adult patients when presenting with injuries that might have resulted from DVA. This qualitative study was conducted to satisfy the evaluative component of the Dentistry Responding in Domestic Violence and Abuse (DRiDVA) feasibility study.

METHODS

In total, 30 participants took part in the study; nine associate dentists and practice principals/owners took part in one-to-one interviews and 21 auxiliary staff took part across two focus group discussion sessions. Data were analysed using the seven step Framework Analysis process.

RESULT

Three key themes were identified from the data, focusing on barriers to enquiring about domestic violence and abuse, Facilitators of identification and referral of DVA in dental settings, and recommendations for further adaptation of intervention to dental settings.

CONCLUSION

DVA training coupled with robust referral pathways to a named specialist DVA advocate increases knowledge and awareness of the signs of DVA and confidence in making onward referrals. Further research is needed to understand how to increase dental professional willingness to ask patients about DVA.

A Scoping Review on the Use of Experiential Learning in Professional Education on Intimate Partner Violence

Purpose

Intimate partner violence (IPV) involves any form of emotional, physical, and sexual abuse including controlling behaviors by an intimate partner. Front line service workers such as social workers, nurses, lawyers, and physicians are often the first professionals to come into contact with individuals experiencing IPV but are often inadequately prepared to respond appropriately as IPV education is highly variable. Experiential learning (EL), also known as learning by doing, has gained much attention from educators; however, the extent and type of EL strategies used to teach IPV competencies has not yet been explored. Our aim was to extract what is known from the literature about the use of EL strategies to teach IPV competencies to front line service providers.

Methods

We conducted a search from May 2021 through November 2021. Reviewers independently screened citations in duplicate using pre-determined eligibility criteria. Data collected included study demographics (publication year, country, etc.), study participants, and information about the IPV EL.

Results

Of 5216 identified studies, 61 were included. Medicine and nursing represented the majority of learners in the included literature. Graduate students were the targeted learners in 48% of articles. Low fidelity EL was used most frequently in 48% of the articles; and role play was the EL mode most frequently utilized (39%) overall.

Conclusions

This scoping review provides a comprehensive overview of the limited literature on how EL is used to teach IPV competencies and identifies significant gaps related to the lack of intersectional analysis within educational interventions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10896-023-00552-4.

The association between adverse childhood experiences and oral health: A systematic review

OBJECTIVE

It is well established that adverse childhood experiences (ACEs) negatively affect health and are associated with health-risk behaviors. This study aimed to provide a systematic review of the studies that examine the relationship between ACE exposure and oral health among adults aged 18 years and older.

METHODS

The following electronic databases were searched in January 2022: MEDLINE, Cochrane, Web of Science, CINAHL via EBSCOhost, ProQuest, ScienceDirect, and Google Scholar. Data were extracted independently by two reviewers. The quality of the studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

Among the 292 articles identified, four met the eligibility criteria. All included studies were cross-sectional and of satisfactory quality. The dental outcomes included: last dental visit, last dental cleaning, number of filled teeth, number of extracted teeth, and number of remaining teeth. The studies showed that exposure to ACE was negatively associated with oral health. The relationship between ACE score and oral health outcome measures was found to be directly proportional.

CONCLUSION

There is an association between ACE and poor oral health. Moreover, the association was proven to have a dose-response relationship. Given that the studies in the literature were cross-sectional, causality cannot be determined with certainty, therefore interpretation of the results should be cautious. Longitudinal follow-up studies are needed to understand how ACEs contribute to oral diseases later in life.

Trauma-Informed Care Curricula for the Health Professions: A Scoping Review of Best Practices for Design, Implementation, and Evaluation

PURPOSE

Trauma-exposed persons often experience difficulties accessing medical care, remaining engaged in treatment plans, and feeling psychologically safe when receiving care. Trauma-informed care (TIC) is an established framework for health care professionals, but best practices for TIC education remain unclear. To remedy this, the authors conducted a multidisciplinary scoping literature review to discern best practices for the design, implementation, and evaluation of TIC curricula for health care professionals.

METHOD

The research team searched Ovid MEDLINE, Cochrane Library, Elsevier's Scopus, Elsevier's Embase, Web of Science, and the PTSDpubs database from the database inception date until May 14, 2021. Worldwide English language studies on previously implemented TIC curricula for trainees or professionals in health care were included in this review.

RESULTS

Fifty-five studies met the inclusion criteria, with medicine being the most common discipline represented. The most prevalent learning objectives were cultivating skills in screening for trauma and responding to subsequent disclosures (41 studies [74.5%]), defining trauma (34 studies [61.8%]), and understanding trauma's impact on health (33 studies [60.0%]). Fifty-one of the studies included curricular evaluations, with the most common survey items being confidence in TIC skills (38 studies [74.5%]), training content knowledge assessment (25 studies [49.0%]), participant demographic characteristics (21 studies [41.2%]), and attitudes regarding the importance of TIC (19 studies [37.3%]).

CONCLUSIONS

Future curricula should be rooted in cultural humility and an understanding of the impacts of marginalization and oppression on individual and collective experiences of trauma. Moreover, curricula are needed for clinicians in more diverse specialties and across different cadres of care teams. Additional considerations include mandated reporting, medical record documentation, and vicarious trauma experienced by health care professionals.

Establishing and validating a survey for trauma-informed, culturally responsive change across multiple systems

Aim

The purpose of the present study was to establish and validate the Survey for Trauma-Informed Systems Change (STISC), a measure of culturally responsive trauma-informed care (TIC) and services that can be administered to professionals in any field or industry.

Subject/methods

The current study with 262 respondents from judicial, healthcare, political, non-profit, and for-profit settings examined the internal consistency reliability and factor structure of the STISC.

Results

A total of 262 respondents from various industries accessed the pre-training survey. Seven of the 59 items were reassigned to alternate subscales and three subscales were merged following correlation analysis. Internal consistency reliability for subscales based on the final item assignments was good or excellent (lower 95% confidence limits for hierarchical omega ≥ 0.85). The root mean square error of approximation estimate for the confirmatory factor analysis based on final item assignments was acceptable (0.073; 90% CI 0.71, 0.76). Neither the comparative fit index value of 0.76 nor the Tucker–Lewis fit index value of 0.75 approached conventional thresholds for acceptable fit.

Conclusion

Given the absence of a validated alternative, this study supports use of the STISC tool to measure the degree of an individual’s trauma-informed knowledge and positive attitudes toward trauma-informed systems change, as well as trauma-informed practices in the workplace. Further study and refinement will aim to determine whether the STISC survey is sensitive to change, which will provide stronger support for the survey’s potential usefulness as a cost-effective method of standardizing trauma-informed systems change programs across multiple fields and industries.

An approach to trauma-informed education in prelicensure nursing curricula introduction

BACKGROUND

Trauma-informed care (TIC) is an evolving concept that acknowledges the prevalence and impacts of trauma on health; however, knowledge related to implementation for nursing students remains limited.

PURPOSE

The purpose of this study is to understand the learning perspectives of nursing students and develop an innovative conceptual model to guide educators in implementing teaching and learning strategies related to TIC, consistent with the trauma and resiliency competencies for nurses.

METHODS

Qualitative analysis of student responses after an online module to educate students on adverse childhood experiences (ACEs), trauma, and their impact on health through the lifespan.

RESULTS

Three persistent themes emerged from the data: Growing in Self-Awareness, Filling Learning Needs, and Envisioning Future Roles. From these themes, we developed a framework for TIC content for nursing and other healthcare curricula.

CONCLUSIONS

Our findings demonstrate a model to embed ACE education, TIC competencies, secondary traumatic stress awareness, and methods of self-care, including resiliency skills, into undergraduate nursing education.

Dentists' Competence and Knowledge on Domestic Violence and How to Improve It-A Review

Domestic violence (DV) is an important public health topic with a high prevalence in society. Dentists are also frontline responders to DV, as they not only treat victims of DV with dental injuries, but they can also screen for the presence of DV because they see patients for regular check-ups. Using the WHO definition, which describes domestic violence as intimate partner violence, 17 papers could be included in our analyses. The results of this review clearly indicated that although dentists, as members of the health care sector, are important frontline responders to DV, they are neither trained adequately at medical school nor do most feel competent enough to ask victims about DV or support them as needed. DV is often not taught at dentistry schools at all. The aims of this review were to provide an overview of existing literature on dentists' knowledge and beliefs regarding DV, whether and how DV is taught in medical education and to give recommendations on how to improve the education of dentists on this topic. Based on our findings, we recommend that DV education should be mandatory at dentistry schools and in further training for dentists with a focus on communication with victims, how DV can be identified and how to support victims well.

A video- and feedback-based approach to teaching communication skills in undergraduate clinical dental education: The student perspective

OBJECTIVE

Student evaluation of a communication-education programme that combined patient consultation videos with peer- or expert-based feedback.

METHODS

A self-perception questionnaire was given to undergraduate dental students who had undertaken a curricular communication training and feedback programme, in which each participant was videoed three times during a patient interview or consultation, subsequently receiving either peer (PG) or expert feedback (EG). The questionnaire used feedback programme content to evaluate student perspectives, ascertaining whether the students experienced a gain in knowledge and professional conversational skills, whether videos or feedback helped them improve more and general questions about the structure and content of the curriculum. Differences between feedback groups were analysed (Mann-Whitney U test).

RESULTS

45 participants (peer group: n = 23, expert group: n = 22) took part in the study. The peer group experienced watching their video (38%) and receiving feedback (33%) as their major beneficial aspect to improve communication skills (watching fellow student´s video: 17%, providing feedback: 12%). The expert group experienced the major effect in receiving expert feedback (73%, video watching: 27%). The students said that communication skills should be a core competency in dental education learning outcomes (PG: 4.48 ± 0.67, EG: 4.41 ± 0.67; P > 0.05) and that communication curricula should include video-based feedback (PG: 3.91 ± 0.73, EG: 4.00 ± 0.93; P > 0.05).

CONCLUSION

Watching videos and both receiving and providing peer group feedback were experienced as helpful in improving students' communication skills. These findings suggest that a longitudinal communication curriculum, which includes both video-based peer feedback and correlated self-reflection, is a promising learning approach for dental education.

The Effectiveness of Educational Intervention in Improving Primary Health-Care Service Providers' Knowledge, Identification, and Management of Elder Abuse and Neglect: A Systematic Review

Elder abuse and neglect (EAN) occurrence is expected to increase in many countries due to rapidly aging populations, yet it is still unrecognized and underreported. Gaps were identified in the knowledge and skills to intervene EAN among health-care service providers. It is still unclear whether educating health-care service providers on EAN improve the identification and management of EAN cases. A systematic review was conducted on the effectiveness of educational intervention designed to improve primary health-care service providers' (PHSPs) knowledge, attitude, and practice in managing EAN cases. We performed a comprehensive and systematic search for original studies in the following major electronic databases (ScienceDirect, PubMed, EMBASE, and CINAHL) and specialist registers (Cochrane Central Controlled Trials Register) with a set of search terms. Studies included were randomized controlled trials (RCTs) and observational studies on EAN education intervention that aimed to improve knowledge, attitude, and management skills of the PHSPs. There were no publication period restrictions until June 2018 and written in English. Overall, three RCTs and 10 observational studies were selected. These studies were grouped based on the type of the study, methodological quality (six moderate risk of bias and seven serious risk of bias), and the type of educational intervention (seven face-to-face educational intervention, two educational videos, two simulation-based training, and two online educational training). The education programs in the selected studies range from brief didactic to experiential learning. EAN educational intervention among primary care service providers potentially result in increasing awareness and knowledge on EAN. However, there is a lack of evidence on the changes of attitude and practice.

Dental care of patients exposed to sexual abuse: Need for alliance between staff and patients

The aim was to explore the experiences of sexually abused individuals as dental patients. Purposively selected were 13 informants (11 women) aged 19-56. All had experienced sexual abuse as children or adults and memories of this abuse had been triggered and expressed during a dental appointment. They were encouraged to relate in their own words their experiences of the dental appointment. The interviews were recorded digitally, transcribed verbatim, and analysed according to Qualitative Content Analysis. The overall theme illustrating the latent content was The dental appointment - a volatile base requiring predictability and a secure working alliance. The first category covering the manifest content was The dental care provider "assumes responsibility," with two subcategories: (i) contradictory disclosure, and (ii) alliance formation - a levelling of power. The second category was The patient is "in focus," with two subcategories: (i) alertness to signs of discomfort, and (ii) attention to obvious but subtle expressions of needs. On an understanding that the patient has been sexually abused, an individually tailored, patient-centered approach to treatment is suggested. Dental care providers may also need to be aware of and reflect on their position of power, in relation to the patient and its possible chairside implications.

Adaptation measures in dental care for children with history of Adverse Childhood Experiences: A practical proposal

Adverse Childhood Experiences (ACEs) such as maltreatment, abuse, or neglect can disrupt childhood development and increase the risk of health issues, including dental health. Such a vulnerable population frequently may deny dental treatment due to fear of intimate contact in the oral cavity, resulting in a vicious cycle that further leads to detrimental oral health. It is important for dentists, particularly pediatric dentists, to not only understand how to identify potential cases of abuse or maltreatment but also how to treat these patients so that the dental treatment does not become a negative experience. The purpose of this paper is to understand the psychological and physical implications of pediatric patients who have had ACEs and to identify the best methods to manage these patients during the dental treatment.

Systematic Review of Evaluations of Trauma-Informed Organizational Interventions That Include Staff Trainings

Enthusiasm for trauma-informed practice has increased dramatically. Organizational interventions that train staff about trauma-informed practice are frequently used to promote trauma-informed systems change, but evidence about these interventions' effects has not been integrated. A systematic review was conducted of studies that evaluated the effects of organizational interventions that included a "trauma-informed" staff training component. A search was conducted in July 2017 and studies were identified in PubMed, PsycINFO, and the Published International Literature on Traumatic Stress database, limited to articles published in English after 2000. Six hundred and thirty-two articles were screened and 23 met inclusion criteria. Seventeen studies used a single group pretest/posttest design, five used a randomized controlled design, and one used a quasi-experimental design with a nonrandomized control group. The duration of trauma-informed trainings ranged from 1 hr to multiple days. Staff knowledge, attitudes, and behaviors related to trauma-informed practice improved significantly pre-/posttraining in 12 studies and 7 studies found that these improvements were retained at ≥1month follow-up. Eight studies assessed the effects of a trauma-informed organizational intervention on client outcomes, five of which found statistically significantly improvements. The strength of evidence about trauma-informed organization intervention effects is limited by an abundance of single group, pretest/posttest designs with short follow-up periods, unsophisticated analytic approaches, and inconsistent use of assessment instruments. In addition to addressing these methodological limitations, priorities for future research include understanding intervention effects on clients' perceptions of care and the mechanisms through which changes in staff knowledge and attitudes about trauma-informed practice influence client outcomes.

Discussing elder abuse and neglect in undergraduate dental education: a commentary

The intra- and extra-oral signs of physical abuse and neglect can appear visible to a dental professional during routine care. Yet, little is known about the existing pedagogies employed to discuss elder abuse and neglect in undergraduate dental education and the level of knowledge undergraduate dental students have about elder abuse and neglect. The purpose of this commentary is to present a literature review exploring how the subject of elder abuse and neglect is taught in dental schools and to discuss the results of a brief knowledge-based questionnaire focused on elder abuse and neglect applied to Canadian undergraduate dental students.

Dental students' perceived and actual knowledge of elder abuse: An online training curriculum

AIMS

Elder abuse, defined as emotional, physical, or sexual abuse, financial exploitation, or neglect, is a growing problem. Dental professionals have the unique opportunity to identify elder abuse. However, elder abuse awareness training, targeting dental students, is insufficient and research is limited. This knowledge gap prompted the research team at the University of Tennessee Health Science Center (UTHSC) to develop, implement, and evaluate an online Elder Abuse Awareness Professional Education Training (EAAPET) program, designed to educate dental and other health professionals to recognize, respond to, and report elder abuse.

METHODS AND RESULTS

Ninety-six dental students, attending the UTHSC College of Dentistry during the fall semester of 2018, were enrolled. Pre- and post-assessments, designed to assess changes in students' perceived and actual knowledge, were conducted. Paired sample t-test results indicate that the EAAPET program significantly improved students' perception of their abilities to identify, respond to, and report elder abuse. Improvement was also demonstrated within students' actual knowledge of how to appropriately interact with suspected elder abuse victims. Qualitative assessment suggested the training was well received by the students.

CONCLUSIONS

Based on these findings, the authors recommend that dental schools integrate elder abuse awareness education into their curriculums.

Exposure to Adverse Childhood Experiences and Oral Health Measures in Adulthood: Findings from the 2010 Behavioral Risk Factor Surveillance System

INTRODUCTION

Adverse childhood experiences (ACEs) are negative life events occurring before the age of 18 y. ACEs are risk factors for heart disease and diabetes in adult life. Furthermore, individuals who experience ACEs are more likely to smoke and become obese-factors associated with poor oral health.

OBJECTIVE

This study investigated likely associations between ACEs and the oral health measures of the 2010 Behavioral Risk Factor Surveillance System (BRFSS).

METHODS

Data from 16,354 participants of the 2010 BRFSS were analyzed with SAS 9.4. ACE scores were calculated in 2 domains: abuse (emotional, physical, or sexual) and household challenges (parental separation or divorce, intimate partner violence, household substance abuse, household mental illness, and incarceration). ACE scores, ranging from 0 to 8, were categorized into 0, 1, 2, 3, and ≥4. The 2010 BRFSS oral health measures included >1 y since last dental visit, ≥6 teeth extracted, and ≥2 y since last dental cleaning. Survey logistic regression estimated prevalence odds ratios and 95% CIs, adjusted for age, sex, race/ethnicity, and educational attainment.

RESULTS

The weighted mean ACE score was 1.74 (95% CI = 1.68 to 1.81), and the weighted and age-standardized percentages of study participants with ACE scores of 0, 1, 2, 3, and ≥4 were 33.1%, 24.3%, 14.9%, 9.69%, and 18.1%, respectively. There appeared to be a dose-response association between categories of ACE scores and the oral health measures. Specifically, when compared with participants with an ACE score of 0, participants with ACE scores of 1, 2, 3, and ≥4 had adjusted prevalence odds ratios (95% CIs) of 1.10 (0.82 to 1.47), 1.20 (0.90 to 1.60), 1.35 (0.98 to 1.85), and 1.72 (1.31 to 2.26), respectively, for reporting ≥2 y since last dental cleaning.

CONCLUSIONS

Findings suggest that ACEs may be associated with poor oral health measures in adulthood, even after adjusting for important oral diseases risk factors. Longitudinal follow-up studies are needed to delineate pathways by which this relationship occurs.

KNOWLEDGE TRANSFER STATEMENT

Our findings indicate that exposure to childhood trauma may have negative impacts on oral health in adulthood. Oral health practitioners need to be aware of the potential impacts of childhood trauma on health behaviors that ultimately affect oral health outcomes.

Determining Recommendations for Improvement of Communication Skills Training in Dental Education: A Scoping Review

Professional communication skills have a significant impact on dental patient satisfaction and health outcomes. Communication skills training has been shown to improve the communication skills of dental students. Therefore, strengthening communication skills training in dental education shows promise for improving dental patient satisfaction and outcomes. The aim of this study was to facilitate the development of dental communication skills training through a scoping review with compilation of a list of considerations, design of an example curriculum, and consideration of barriers and facilitators to adoption of such training. A search to identify studies of communication skills training interventions and programs was conducted. Search queries were run in three databases using both text strings and controlled terms (MeSH), yielding 1,833 unique articles. Of these, 35 were full-text reviewed, and 17 were included in the final synthesis. Considerations presented in the articles were compiled into 15 considerations. These considerations were grouped into four themes: the value of communication skills training, the role of instructors, the importance of accounting for diversity, and the structure of communication skills training. An example curriculum reflective of these considerations is presented, and consideration of potential barriers and facilitators to implementation are discussed. Application and evaluation of these considerations are recommended in order to support and inform future communication skills training development.