Teaching and Assessing Communication Skills in Medical Undergraduate Training

The need to identify anatomy-related competencies in medical education

A profound grasp of anatomy is indispensable for shaping competent and safe medical practitioners. This knowledge acquisition is pivotal in the early stages of medical education and remains crucial throughout clinical training. However, the evolving landscape of medical education has ushered in changes to the anatomy curriculum, marked by a reduction in contact hours and a streamlined content structure to accommodate novel subjects and teaching methodologies. This transformation has precipitated a quandary in defining the essential scope and depth of anatomical knowledge to be imparted. Traditionally, surgeons assumed the role of anatomy instructors until Flexner's recommendations catalyzed the integration of trained anatomists. Nevertheless, the varied backgrounds of anatomists and the heterogeneity in anatomy curricula across institutions have introduced potential disparities in the quality of graduates. Addressing these challenges mandates the identification of key anatomy competencies tailored for undergraduate medical students. The imperative lies in ensuring that these competencies span cognitive, psychomotor, and affective domains, offering not only comprehensiveness but also direct applicability to clinical practice. Hence, this viewpoint highlights the necessity of adopting a systematic approach that includes gathering input from various stakeholders in developing and implementing a universal anatomy core competency framework, ensuring graduates are equipped for the multifaceted demands of clinical practice. Overall, the manuscript provides a comprehensive overview of the challenges and opportunities in anatomy education, with a clear call to action for a transformative approach to meet the evolving needs of medical practice.

Medical Students' Readiness for Prescription Communication Skills Training: A Needs Assessment Study

Background and objectives The quality of doctor-patient communication plays a crucial role in determining positive medical outcomes. Medical educators may be able to develop effective programs to orient the students toward learning communication skills with the aid of assessment of the attitude of medical students toward such learning. Recently, the National Medical Commission's updated syllabus strongly emphasized on the value of training in prescription communication skills (PCS), in pharmacology. Our study utilizes the Communication Skills Attitude Scale (CSAS) to explore medical students' attitudes toward learning PCS in a private medical college, aiming to address the dearth of data in the Indian context. Methodology This cross-sectional study assessed the attitudes of 131 second-year medical students at Adichunchanagiri Institute of Medical Sciences toward PCS training. Validated, 26-item CSAS was used to measure their attitudes which include 13 items of Positive Attitude Scale (PAS) and 13 items of Negative Attitude Scale (NAS), and data analysis was conducted using independent t-tests to explore potential associations based on socio-demographic factors. Results The study scale showed an acceptable internal consistency of 0.71 (Cronbach's alpha) with 0.92 and 0.76 for PAS and NAS, respectively. The overall mean PAS score and NAS score were 54.2±6.9 and 34.7±6.3, respectively, indicating that the majority of students recognized the significance of communication skills for their future medical practice. Male students had significantly lower PAS scores (52.1±7.4) compared to female students (55±6.6) (p=0.02). Students with a rural background had significantly higher PAS scores (56.2±6.1) (p=0.01) compared to those with an urban background (53.2±9.8). No significant association was seen with demographic parameters like schooling background, presence of doctors in the family, and mother tongue they spoke. Conclusion The study revealed that second-year medical students had a strong inclination toward learning PCS. Therefore, greater emphasis should be placed on providing adequate training in PCS to the students to ensure effective doctor-patient interactions.

Pattern of Answer Script Presentation Errors: Teacher and Student Perspectives

Background Answer script presentation is an effective means of conveying knowledge and understanding. It reflects clarity of thought and organization, which can positively influence scoring. Additionally, well-structured answers reduce the chances of misinterpretation, ensuring that your knowledge is accurately assessed. Despite its importance, there is limited research focusing on the specific errors students make in presenting their answers. Hence, this study explored common errors in answer script presentation from the perspectives of both teachers and students. Methods A cross-sectional study was conducted involving 240 students and 50 teachers in July 2024 at Mata Gujri Memorial Medical College, Bihar, India. A questionnaire was developed by a three-member panel of experts in education and assessment to ensure it was comprehensive and relevant to the study's objectives. The questionnaire comprised 12 items rated on a 5-point Likert scale where a higher score indicates higher perceptions of the error. Data were collected from teachers and students using the pre-tested self-administered printed questionnaire. The scores among the different perceived errors were compared by ANOVA and the scores between teachers and students were compared by unpaired t-test. Results Students perceived that their highest error was inconsistent handwriting (2.72±1.4), followed by incomplete diagrams (2.52±1.2) and disorganization (2.47±1.17). The error perceived to be least important was incorrect numbering (1.53±0.97), F=12.49, p-value<0.0001. Teachers perceived the error in illegible handwriting (4.36±0.48), followed by lack of emphasis (4.16±0.62) and disorganization (3.94±0.91) as the errors most likely to contribute to poor performance. The error perceived to be least important was inconsistent handwriting (2.4±1.01), F=18.22, p-value<0.0001. When the data were compared between teachers and students, except for inconsistent handwriting, the perceived error score by teachers was higher than the students perceived. Conclusion There was a significant disparity between students' and teachers' perceptions of common presentation errors, with teachers consistently rating the severity of errors higher than students. Both groups identified inconsistent handwriting as a prominent error. This underscores the need for better alignment and communication between students and educators regarding the importance of specific aspects of written presentation in assessments.

Experience of focused workshop intervention in presentation skills - Importance of foundational skills for ophthalmologists in training

Background

The study was conducted to assess the impact of a workshop intervention designed to enhance presentation skills of ophthalmology fellows in training.

Methods

A 10-hour workshop on presentation skills was conducted for ophthalmology fellows in the 2022 cohort at a single institution. An email was sent to the 2022 cohort to recruit participants. A total of 29 fellows (19 females, 10 males) volunteered to participate in the study. Participants completed a self-rating questionnaire to assess improvement in their presentation skills at four different time points of the workshop. The self-rating questionnaire utilized a ten-point rating scale (1-10) and evaluated properties and content (PC) and soft skills (SS). Data were analysed using SPSS software. Friedman and post-hoc tests compared self-ratings at four time points. Statistical significance was set at p-value < 0.05.

Results

Both properties & content (PC) and soft skills (SS) showed significant difference (p < 0.001) post workshop compared to earlier stages. The higher self-rating (PC4 and SS4) highlights increased awareness towards the scope of improving the presentation after the workshop intervention.

Conclusions

Presentation skills empower medical professionals to better communicate with diverse audiences, demonstrating their currency in medical knowledge, lobbying for correct understanding, and bringing praxis to pedagogy. The findings support the integration of similar workshops into medical curricula to foster well-rounded medical professionals.

Effectiveness of Scenario-based Roleplay as a Method of Teaching Soft Skills for Undergraduate Medical Students

Background

Despite the widespread acknowledgment of the need and significance of soft skills (SKs) in health professions education, the subject is not emphasized enough in training students. These skills can be taught to undergraduates through roleplay. Communication skills and teamwork were taught by scenario-based roleplay and assessed in this study.

Objectives

The study aimed to implement scenario-based roleplay as a method of teaching communication skills and teamwork to undergraduate medical students and to assess their perceptions.

Methodology

A prospective study was conducted in the simulation/skills laboratory among 41 Phase I undergraduate medical students. The SKs taught during the sessions included communication skills, empathy, and teamwork.

Results

The mean of the responses obtained from Gap Kalamazoo Communication Skills Checklist score in the first encounter was 27.0, 38.12 in the second encounter, and 41.24 in the third encounter. The mean scores showed a statistically significant difference between E1 and E2, E1 and E3, and E2 and E3. Posttest scores of students to self-efficacy questionnaire showed significant improvement compared to pre-test scores. Students in the present study opined that they could learn the aspects that could not have been learned in didactic lectures about communication skills and teamwork.

Conclusion

Scenario-based roleplay can be used as an effective method for teaching SKs such as communication skills and teamwork for undergraduate medical students. Different scenarios which replicate the real-life situations can be incorporated to help students to learn and face the real-life encounters.

Validated checklist for assessing communication skills in undergraduate medical students: bridging the gap for effective doctor-patient interactions

Communication skills are fundamental in healthcare, but assessing them among medical students presents challenges. In the Indian context, the lack of a specific assessment tool further compounds the issue. Thus this study aimed to develop and validate an observation-based communication skills checklist tailored to Phase I Bachelor of Medicine and Bachelor of Surgery (MBBS) students. The checklist was developed using both inductive and deductive approaches and underwent rigorous testing to ensure its reliability and validity. After piloting, the finalized version was administered to 84 Phase I MBBS students. Results indicated a critical content validity ratio of 0.78, face validity of 0.80, and an impressive Cronbach's alpha of 0.91, indicating good internal consistency and reliability of the checklist. The students scored over 80% in all checklist domains, except for empathy (73%) and support (74%), highlighting areas for potential improvement. Nonetheless, about 75% of students expressed satisfaction with the checklist's communication skills assessment. The feedback from faculty members was positive, as they found the checklist was easy to use, quick, and effective for evaluating communication skills. Consequently, the checklist's introduction has been well received by both students and faculty. In conclusion, the developed checklist proves to be an effective and valid instrument for assessing communication skills in Phase I MBBS students. By integrating this tool into observed station clinical examinations, medical educators can comprehensively evaluate students' communication behaviors. Moreover, the checklist serves as a valuable resource for bridging the gap between theoretical knowledge and practical application, enabling future physicians to excel in doctor-patient interactions, a crucial aspect of patient-centered care.NEW & NOTEWORTHY This article presents a highly unique and novel approach by introducing a structured checklist for communication skill assessment in medical students. Its rigorous validation process ensures reliability and effectiveness, while its adaptation to sociocultural norms highlights its relevance and applicability. The user-friendly design with a single-page layout and dichotomous scale further enhances its practicality in objective structured clinical examinations. The developed checklist equips educators with a valuable resource to assess and improve students' communication abilities.

Developing an effective and comprehensive communication curriculum for undergraduate medical education in Poland - the review and recommendations

BACKGROUND

The recognition of the importance of effective communication in the healthcare system has been growing. Given that communication courses must be adjusted to the specificity of a particular culture, language, and other contextual issues, many countries and communities sharing a common language have proposed their recommendations for a communication curriculum for undergraduate medical education. To date, no recommendations have been developed for either any Central and Eastern Europe countries or for regions where Slavic languages are spoken. Their specificity of post-communist transformation should be acknowledged. This study aims to review communication curriculums and offer recommendations for medical communication training for undergraduate medical students in Poland.

METHODS

The recommendations were developed through an iterative consultation process with lecturers, faculty members of medical schools, and education coordinators. PubMed and Google Scholar databases were searched to identify full text English and Polish language articles on communication curriculum for undergraduate medical education. Additionally, the new Regulation of the Polish Minister of Science and Higher Education, defining educational standards for undergraduate medical education was analysed in search of learning outcomes that could be applied in communication skills teaching. The authors extracted the most relevant communication skill competencies, as determined by the process participants, discussed current challenges, including those of the COVID-19 pandemic era, and indicated best practices.

RESULTS

A review was conducted, and a set of recommendations was developed pertaining to the scope and methodology of teaching communication skills. The study included: (1) definition, (2) education content, (3) learning outcomes, (4) the recommended teaching methods. The recommendations are in concord with the graduate profile, as well as the current structure of medical studies. The authors listed and discussed the basic communication competencies expected of medical graduates, as well as medical communication course content viewed from different perspectives, including clinical, psychological, sociological, legal, and linguistic.

CONCLUSIONS

Detailed recommendations aimed at integrating best practices into a comprehensive communication curriculum may promote successful teaching, learning, and assessment of medical communication.

Assessment of Communication Skills in MBBS Interns with Objective Structured Video Examination (OSVE)

Background

Medical graduates enter work force with substantial knowledge but are they prepared for practice in diverse settings? To train medical interns in communication skills using Demonstration Observation Assistance and Performance (DOAP) and to assess communication skills in medical interns using objective structured video examination (OSVE).

Methods and Materials

DOAP sessions of all 27 interns posted in Community Medicine and Pediatrics departments during the duration of the study were conducted in six clinical scenarios followed by two OSVEs.

Methods and Material

Interns performed selected activity independently twice for assessments. Videos submitted by interns were assessed by Gap Kalamazoo assessment forms (OSVE). Data analysis was done by appropriate methods. Percentages and proportions and calculation of median scores with interquartile ranges.

Results

Seventy one point four percent of faculty and 96.3% of interns were satisfied with module implementation. More than = 57.8% marks were scored by 94.45% interns in self-assessment and faculty assessment and by 100% interns in patient assessment. Median scores of all second assessments were higher.

Conclusions

DOAP method is good for training of interns in communication skills. OSVE may be an appropriate assessment tool as it leads to progression in learning.

Communication Skill Training Levels among Critical Care Doctors in India

Medical training programs outline the necessity of communication skills but there is likely a dearth of teaching at the bedside in part due to prioritization of other skills over communication or due to lack of opportunity. In India, the majority of critical care units are open in nature, and communication lead is likely to be taken by the primary specialty rather than the critical care doctors themselves. In the majority of the cases, the root cause analysis shows a lack of clear communication as a barrier. The sicker the patient, the higher the chance for anxiety and miscommunication among healthcare professionals as well as the family. The current project aims to find the training levels in Indian critical care settings and draw conclusions to see if there are avenues to improve the process. This study was based on a web-based questionnaire that was sent out to 1,000 critical care doctors across India. Educational experience and learning of communication techniques/concepts were assessed using a modified educational experience and attitudes questionnaire. Baseline demographic data were obtained and results were tabulated across 193 complete responses, which consistently showed a disparity in perceived levels of competence across different mandatory aspects of communication. Further, we find that though communication is a trainable skill, the mode of training has been largely reactive and has remained so for the last 20 years hinting at poor training in communication. Our survey suggests an urgent need for improvement of the training processes to reduce the burden of ethical, clinical, and legal dilemmas in critical care.

How to cite this article

Gopaldas JA, Narayanaswamy N, Chandregowda NP. Communication Skill Training Levels among Critical Care Doctors in India. Indian J Crit Care Med 2023;27(8):567-571.

Construction of a nurses' interpersonal communication knowledge system: A Delphi study

BACKGROUND

Effective communication is essential for nursing students to provide safe patient care. Many communication consensuses focus on physician-associated communication rather than nurses' interpersonal communication. However, studies on developing a systematic and comprehensive communication knowledge system for nursing students are scarce.

OBJECTIVES

To explore the teaching content and teaching framework of nurses' interpersonal communication, construct a systematic and scientific knowledge system for interpersonal communication among nursing students and provide a theoretical basis for the training of nurses on interpersonal communication.

METHODS

Based on the literature review and comparative research, this study explored the theoretical basis and basic principles of constructing an interpersonal communication knowledge system for nurses. Moreover, a correspondence questionnaire on nurses' interpersonal communication knowledge systems was initially constructed to clarify the related teaching content and structure. Finally, the Delphi method was used to establish the index of the nurses' interpersonal communication knowledge system according to the principle of expert selection and inclusion criteria.

RESULTS

The Delphi method included 26 experts from nursing education, clinical nursing, nursing management and other fields for consultation. The effective response rate of the letter inquiry was 96.3 % in the first round and 100 % in the second round. The judgment basis, familiarity and authority coefficient of expert consultation were 0.907, 0.862 and 0.884, respectively. In the two rounds of inquiry, the coordination coefficients of the total questionnaire were 0.228 and 0.302, which was statistically significant (P < 0.001). Thereafter, a wheeled model of nurses' interpersonal communication knowledge system with 3 primary indicators, 13 secondary indicators and 58 tertiary indicators was constructed, which included professional ethics and attitude, communication knowledge and communication skills.

CONCLUSION

Literature and comparative research methods along with Delphi expert consultation were used to construct a scientific and systematic knowledge system of nurses' interpersonal communication. The research methods were feasible, and the results were scientific and reliable, thereby providing a basis for the education of nurses' interpersonal communication among nurses and the compilation of related teaching materials in China and globally. Furthermore, special attention should be paid to the comprehensive cultivation of nursing students' professional ethics and attitude, communication knowledge and communication skills.

Vaccine Champions Training Program: Empowering Community Leaders to Advocate for COVID-19 Vaccines

Strong community engagement has been critical to support COVID-19 vaccine uptake in Australia and elsewhere. Community engagement builds trust, enables tailored information dissemination and shapes social norms. Engagement is particularly important in communities with greater vaccine hesitancy, lower health literacy and mistrust in authorities. Early in 2021, as a team of vaccine social scientists and clinicians, we developed a program to train and empower community, faith, industry and healthcare leaders to advocate for COVID-19 vaccines as “vaccine champions”. We partnered with the Victorian Department of Health to deliver 91 online Vaccine Champions sessions from March 2021 to June 2022. Over 80 people who received this training were supported by the Department of Health to become formal vaccine champions, independently delivering over 100 locally tailored information sessions. Our survey evaluation of 20 sessions delivered in 2022 found most participants (94%, 118/125) felt more confident to discuss safety and effectiveness of COVID-19 vaccines and find relevant information after attending a session. We also recorded >90% participant satisfaction with training content, format and presentation. Qualitative feedback from two group interviews highlighted the value of vaccine communication role plays and opportunities for discussion. In this brief report, we present an overview of the Vaccine Champions program, evaluation and next steps.

Communication skills preparedness for practice: Is there a key ingredient in undergraduate curricula design?

OBJECTIVE

To characterize medical interns' experience regarding communication skills education and to explore potential associations with preparedness for practice.

METHODS

Two hundred sixty-six medical interns answered an original questionnaire specifically developed to explore how well they feel their undergraduate training had prepared them in key aspects of medical communication. Instrument's psychometric properties were tested. Medical schools' curricula were considered and associations explored using non-parametric tests.

RESULTS

The questionnaire reliability was high, with Cronbach's alphas ranging from 0.89 to 0.94 on all the factors. Core communication skills were highly rated. Perceived preparedness was lower in aspects concerning dealing with emotion, breaking bad news and communicating with speech impaired patients. Better preparedness was associated with a longitudinal integration of communication skills throughout the curriculum, simulation with standardized patients and real patient interviewing with feedback on communication skills.

CONCLUSIONS

Integrated programs, standing on a strong experimental component, particularly combining patient-simulation strategies with continuous supervision and learner centred feedback, were associated with higher preparedness. These results support the expansion of an educational model based on simulation strategies and structured longitudinally throughout the undergraduate medical curriculum.

PRACTICE IMPLICATIONS

This study intends to inform educational background and to support further development of communication skills curricula.

Effectiveness of Roleplay Video Method in Teaching Communication Skills for Undergraduate Medical Students in Pharmacology in Indian Medical School

Background Communication is an important skill to be honed and applied by Indian medical graduate, as per revised regulations on Graduate Medical Education 2019. The objective of the present study was to evaluate the effectiveness of roleplay video demonstration in teaching communication skills to students using standard pharmacology drug prescription scenarios.

Materials and Methods In this study, 136 students were divided into three batches, and in each batch, they were paired as a group of one doctor and patient and were asked to perform a roleplay of doctor-patient communication to a standard drug prescription case scenario. Communication skills of the simulated doctor were assessed before and after the administration of standard roleplay video, using modified Kalamazoo consensus statement by both the patient (peer evaluation) and the doctor (self-assessment). The effectiveness of roleplay was evaluated by comparing the total score before and after the roleplay demonstration using the Wilcoxon signed rank test. The difference between the scores of self-evaluation and peer evaluation was tested using Mann–Whitney U test.

Results The communication skills score of after intervention-before intervention (p = 0.001) showed 59 positive ranks and 36.64 mean rank among patient group and 61 positive ranks and 36.74 mean rank among doctors' group, indicating there was a significant improvement in communication.

Conclusion Roleplay video demonstration improved the communication skills of students in the pharmacology practical class session. It helped in the active participation of the students and was appreciated by the majority of the students.

Simulated Patients for Competency-Based Undergraduate Medical Education Post COVID-19: A New Normal in India

The conventional medical curriculum in India needed more focus on explicit teaching and assessment of interpersonal and communication skills, professionalism, team-work and reflection for prevention and better management of increasing incidences of violence against doctors by building good doctor-patient relationships. Increasing number of seats in Indian medical colleges, decreasing hospital stay of patients, and decrease in faculty requirements will hamper adequate supervised authentic clinical experiences of undergraduates for developing clinical skills. The recent COVID-19 pandemic has led to a significant decrease in student-patient encounters. Simulated patients are being used in many countries to address many of these issues. To make the Indian medical graduates competent to function as primary physician of first contact, competency-based medical education along with guidelines for use of skill-lab and simulation has been introduced from 2019. The current review is focused on the need and use of simulated patients; their advantages, limitations and role in students’ teaching and assessment. It also gives a brief outline of their training process. Simulated patients should be used to supplement day-to-day learning, help in transition to attending real patients and also save enormous faculty time in the post-COVID-19 new normal. However, simulated patients are unlikely to completely replace real patients’ experiences.

The Current State of Doctors' Communication Skills in Mainland China from the Perspective of Doctors' Self-evaluation and Patients' Evaluation: A Cross-Sectional Study

OBJECTIVE

To assess doctors' communication skills in mainland China using the SEGUE Framework.

METHODS

A survey on doctors' communication skills with doctors (n = 1361) and patients (n = 1757) from 14 provinces in eastern, central and western China was conducted.

RESULTS

The doctors' self-evaluation scores were higher than patients' evaluations (p < .001). The scores of female doctors were higher than males (p = .022). Both doctors' self-evaluations and patients' evaluations indicated that the scores of doctors in tertiary hospitals were higher than those in primary hospitals.

CONCLUSION

Doctors' communication skills don't match patients' needs. Female doctors are more empathetic and patient than male doctors and consequently have better communication skills. Doctors in tertiary hospitals have better communication skills because tertiary hospitals provide more training opportunities in communication skills and have better medical services and management.

PRACTICE IMPLICATIONS

This study confirms the applicability of the SEGUE Framework to doctors and patients in mainland China. The effectiveness of cultivating doctors' communication skills should be evaluated through feedback from the perspective of both doctors and patients. Medical institutes need to prioritize patients' needs and provide training in doctors' communication skills to address the discrepancy in the perceptions of doctors and patients.

Enhancing communication skills among residents in India: An interprofessional education approach

BACKGROUND

Interprofessional education (IPE) provides opportunities to postgraduates to develop communication skills which are vital for interactions with patients, their relatives, colleagues, paramedical and nursing staff. There is a need to develop an innovative IPE based module on communication skills for postgraduates stressing upon the existing lacunae and requirements detected by a validated assessment tool. We assessed the residents' appraisal of communication skills by a validated questionnaire to identify key areas to improve their communication skills and to determine perceptions of all the stakeholders i.e. faculty, nursing staff and paramedical staff.

METHODS

A descriptive correlational design using an online self-administered questionnaire on a sample of a total of 200 participants comprising residents, paramedical staff, nursing staff and faculty of tertiary care hospital. Study was approved by the Institutional Ethical Committee. Data was analysed by SPSS Version 22.0 used. (p value < 0.05 significant).

RESULTS

The participants included 113 residents, 17 paramedical staff, 33 Nursing staff and 37 faculty members. The present study found a significant difference of scores of means between the residents, faculty, paramedical staff and nursing staff p value < 0.05 except for alter centrism, interaction management and environmental control. The mean scores were also significantly different between the first, second and third year residents.

CONCLUSION

This study validates the need to enhance the communication skills of residents. The scores obtained will help us design and refine IPE module for the benefit of the residents.

Simulated Patients for Competency-Based Undergraduate Medical Education Post COVID-19: A New Normal in India

The conventional medical curriculum in India needed more focus on explicit teaching and assessment of interpersonal and communication skills, professionalism, team-work and reflection for prevention and better management of increasing incidences of violence against doctors by building good doctor-patient relationships. Increasing number of seats in Indian medical colleges, decreasing hospital stay of patients, and decrease in faculty requirements will hamper adequate supervised authentic clinical experiences of undergraduates for developing clinical skills. The recent COVID-19 pandemic has led to a significant decrease in student-patient encounters. Simulated patients are being used in many countries to address many of these issues. To make the Indian medical graduates competent to function as primary physician of first contact, competency-based medical education along with guidelines for use of skill-lab and simulation has been introduced from 2019. The current review is focused on the need and use of simulated patients; their advantages, limitations and role in students' teaching and assessment. It also gives a brief outline of their training process. Simulated patients should be used to supplement day-to-day learning, help in transition to attending real patients and also save enormous faculty time in the post-COVID-19 new normal. However, simulated patients are unlikely to completely replace real patients' experiences.

Clinical Communication Skills Training in Dental Medical Education: The COVID-19 Pandemic Challenge

It is very important for healthcare professionals to have good clinical communication skills, especially dentists. Patient-centred care results in patient satisfaction, better outcomes, and less complaints from dental patients. Due to the onset of the COVID-19 pandemic, the clinical communications skills programme of the pre-graduate course in dental medicine at the University of Porto had to be transformed to an online format. Based on their role as faculty, the authors aimed to recount their initial reflections and concerns within this perspective, and to share how they adapted to the new reality of teaching clinical communication skills online, as well as the conclusions of our experience, in the hope that this will help others who may have to go through a similar process. The authors acknowledged that the students achieved the pre-established goals of the clinical communications skills programme through the new online format.

Inter-personal versus content: assessment of communication skills in Iraqi physicians

OBJECTIVES

The current study sought to evaluate the communication skills of Iraqi physicians from a patient perspective, differentiating between "interpersonal" and "content" components of communication. In the past century, the doctor-patient relationship has changed considerably, shifting from a paternalistic, physician-dominated approach to a more dynamic and patient-centered. In such a context, effective communication skills have become even more crucial for good medical practice and most accreditation organizations urge medical schools to teach and evaluate communication skills.

METHODS

A cross-sectional study was conducted at Baghdad Teaching Hospital's three major departments (Surgery, Medicine, Obs/ Gyne). The final sample included 270 participants. A factor analysis was performed and generated two dimensions ("interpersonal" and "content"). Statistical differences between the groups and between the two dimensions of the questionnaire were analysed through t-tests and ANOVA. In addition, a multiple linear regression model was used to study the effect of some variables on the dependent variable "communication".

RESULTS

The study showed a significant difference between "interpersonal" and "content" communication, with patients reporting higher satisfaction for the former. Reported satisfaction rates varied amongst the three departments with the Surgery specialty scoring significantly lower than the Medicine and the Obs/Gyne department. The duration of care under the current physician, a higher rank of specialty and the settings (inpatients versus outpatients) were positively and significantly associated with a higher quality of communication skills.

CONCLUSIONS

These findings have significant implications for training institutions.

Entraînement aux compétences communicationnelles : évaluation d’un débriefing et analyse de son lien avec le sentiment d’efficacité personnelle et les attitudes d’étudiants en médecine

Contexte :  Il a été montré que bien que la simulation soit un moyen efficace d’entraîner les compétences communicationnelles (CC), le débriefing peut avoir des effets délétères sur le sentiment d’efficacité personnelle (SEP) et les attitudes de certains étudiants.Buts :Nous avons implanté un entraînement aux CC auprès de nos étudiants en médecine. Nos objectifs sont : 1) faire évaluer la qualité du climat instauré par le formateur lors du débriefing de la séance de simulation ; 2) connaître le SEP et les attitudes des étudiants envers les CC après le débriefing et ; 3) voir s’il existe des corrélations entre ces variables et l’évaluation qui est faite du climat de débriefing.Méthodes :167 étudiants en troisième année de médecine ont répondu à un questionnaire en ligne clôturant la fin d’un entraînement aux CC. Ce questionnaire quantitatif investiguait leur perception quant à la qualité du climat du débriefing, leur SEP rétrospectivement rapporté avant et après l’entraînement et leurs attitudes.Résultats :Les résultats indiquent une augmentation du SEP à l’égard des CC après l’entraînement. En outre, des corrélations positives significatives ont été identifiées entre une évaluation favorable du climat de débriefing et des scores élevés d’amélioration de SEP et d’attitudes positives envers l’entraînement aux CC.Conclusion :Une évaluation favorable du climat de débriefing semble liée à des scores élevés de SEP et d’attitudes positives rapportés après l’entraînement. Cette étude exploratoire invite à s’intéresser davantage à ces variables (évaluation du débriefing, SEP, attitudes) et leur lien avec le transfert des CC entraînées vers la pratique.

Standardized Patients or Conventional Lecture for Teaching Communication Skills to Undergraduate Medical Students: A Randomized Controlled Study

OBJECTIVE

The conduct of a medical interview is a challenging skill, even for the most qualified physicians. Since a training is needed to acquire the necessary skills to conduct an interview with a patient, we compared role-play with standardized patients (SP) training and a conventional lecture for the acquisition of communications skills in undergraduate medical students.

METHODS

An entire promotion of third year undergraduate medical students, who never received any lessons about communications skills, were randomized into 4 arms: 1) SP 2 months before the testing of medical communications skills (SP); 2) conventional lecture 2 months before the testing (CL); 3) two control groups (CG) without any intervention, tested either at the beginning of the study or two months later. Students were blindly assessed by trained physicians with a modified 17-items Calgary-Cambridge scale.

RESULTS

388 students (98.7%) participated. SP performed better than CL, with significant statistical differences regarding 5 skills: the use of open and closed questions, encouraging patient responses, inviting the patient to clarify the missing items, encouraging of the patient's emotions, and managing the time and the conduct of the interview. The SP group specifically improved communications skills between the SP training and testing sessions regarding 2 skills: the use of open and closed questions and encouraging patient responses. No improvements in communications skills were observed in CG between the two time points, ruling out a possible time effect.

CONCLUSION

Role-play with standardized patients appears more efficient than conventional lecture to acquire communication skills in undergraduate medical students.

Evaluation of a course to prepare international students for the United States Medical Licensing Examination step 2 clinical skills exam

PURPOSE

United States (US) and Canadian citizens attending medical school abroad often desire to return to the US for residency, and therefore must pass US licensing exams. We describe a 2-day United States Medical Licensing Examination (USMLE) step 2 clinical skills (CS) preparation course for students in the Technion American Medical School program (Haifa, Israel) between 2012 and 2016.

METHODS

Students completed pre- and post-course questionnaires. The paired t-test was used to measure students' perceptions of knowledge, preparation, confidence, and competence in CS pre- and post-course. To test for differences by gender or country of birth, analysis of variance was used. We compared USMLE step 2 CS pass rates between the 5 years prior to the course and the 5 years during which the course was offered.

RESULTS

Ninety students took the course between 2012 and 2016. Course evaluations began in 2013. Seventy-three students agreed to participate in the evaluation, and 64 completed the pre- and post-course surveys. Of the 64 students, 58% were US-born and 53% were male. Students reported statistically significant improvements in confidence and competence in all areas. No differences were found by gender or country of origin. The average pass rate for the 5 years prior to the course was 82%, and the average pass rate for the 5 years of the course was 89%.

CONCLUSION

A CS course delivered at an international medical school may help to close the gap between the pass rates of US and international medical graduates on a high-stakes licensing exam. More experience is needed to determine if this model is replicable.

Twelve tips for just in time teaching of communication skills for difficult conversations in the clinical setting

The ability to communicate well with patients and other members of the healthcare team is a vital skill for physicians to have, but one that is often not emphasized in medical education. Learners of all levels can obtain and develop good communication skills regardless of their natural ability in this area, and the clinical setting represents an underutilized resource to accomplish this task. With this in mind, we have reviewed the growing body of literature on the subject and organized our findings into twelve tips to help educators capitalize on these missed opportunities. While our emphasis is helping learners with difficult discussions, these tips can be easily adapted to any other clinical encounter requiring clear communication. Teaching effective communication skills in the clinical setting requires some extra time, but the steps outlined should not take more than a few minutes to complete. Taking the time to develop these skills in our learners will make a significant difference not only their lives but also their patients and their families.

Breaking Bad News - Perceptions of Pediatric Residents

The present study evaluated the perceptions and practice of 92 final year pediatric residents with regard to breaking bad news. Only 16% of residents had received any training in communication skills. Majority (65%) of the residents were not comfortable while breaking bad news.

Perception and Attitude of Medical Students towards Communication Skills Lab and Teaching Module

INTRODUCTION

The knowledge of proper communication skills with the patients plays a pivotal role in success of medical professionals. A practical approach would be to initiate its training at an early stage of education period of undergraduate medical students.

AIM

To assess perception and attitude of medical students towards Communication Skills Lab (CSL) and teaching module in Central India.

MATERIALS AND METHODS

This cross-sectional study was conducted in Department of General Surgery at Index Medical College, Indore, India. Undergraduate medical students were trained as per a systematic teaching module in a well equipped 'CSL'. Feedback was obtained via Likert scale and analysed after completion of the training course of eight days.

RESULTS

A majority of the students (96.43%) opined that the training had improved their communication with the patients. They also felt that such training should be integrated in regular teaching curriculum of our country.

CONCLUSION

The training of basic communication skills can be introduced at an early stage of undergraduate medical curriculum in form of an effective, interesting and acceptable teaching module.

Using Role-plays as an Empathy Education Tool for Ophthalmology Postgraduate

Purpose:

To assess the role of an “empathy sensitizing module” (ESM) in ophthalmology postgraduates in promoting effective empathetic communication.

Methodology:

Thirty-nine ophthalmology postgraduates were taught effective empathetic communication using specially designed module, comprising of five illustrative role-plays. We evaluated the impact of the training by (a) self-assessment of empathy quotient by residents using Jefferson Scale of Empathy (JSE scale) before and 6 weeks after ESM training and (b) nonparticipant observation (NPO) by trained faculty in real-life settings over the next 4 months. A peer-validated, self-designed checklist was used for NPO. The change in score was analyzed using Student's paired t-test. The faculty observed the use of empathy in real-life patient encounters of the trainees over the next 6 months. In addition, secondary qualitative data were collected and analyzed to assess the impact of the module on other stakeholders such as the role-playing undergraduate students and core faculty.

Results:

Pretraining assessment revealed that concept of empathy during patient communication was understood by only 10% students. PostESM training, the self-rated mean empathy score, on JSE, significantly increased from 95.9 to 106.7 (of a maximum of 140). This was also confirmed by a significant improvement in externally rated empathy and soft skills scores (from 29.3 to 39.1; of a maximum of 55) using the NPO tool. Focus group discussion was done on the continued display of empathy by the trainees in real-life situation over 6 months of observation by the faculty. The group agreed that there was a gradual attrition of initial gain in empathy behavior over the observation period of 6 months. The spillover benefits of the training process were observed among the role-playing undergraduates as well. A thematic analysis of their reflections on the process revealed a substantial change with an improved understanding of effective communication.

Conclusions:

There is a definite scope for introducing empathetic communication in medical training. Empathetic communication can be improved by effective training in a contextual manner with a need for regular reinforcement. Sensitization at all levels including the faculty is required to implement effective communication skills in medical profession.