The value of training in communication skills for continuing medical education

Mental health and quality of life in patients with chronic liver disease: a single-center structural equation model

BACKGROUND

Chronic liver disease (CLD) is one of the leading disease burdens in Pakistan. Until now, there has only been limited focus in the country on providing health services through tertiary services in urban cities, whereas there is almost no research in Pakistan on the mental health and quality of life of CLD patients. This study aimed to understand which predictors influence the mental health and quality of life of CLD patients in order to advise better policy protection.

METHODS

Data was collected from CLD patients at the Pakistan Kidney and Liver Institute and Research Centre, Lahore, Pakistan. A total of 850 respondents were part of the final sample. The age of respondents ranged from 18 to 79 years and included the following diagnosis: (i) Chronic Viral Hepatitis (n = 271), (ii) Cirrhosis (n = 259), (iii) Hepatocellular Carcinoma (n = 193), and (iv) Non-viral Liver Disease (n = 127).

RESULTS

Mean results reveal that females as well as illiterate patients need more support for mental health and communication with their physician; whereas men need more support to develop coping strategies. Structural equation modelling results reveal that the severity of symptoms (β = 0.24, p < 0.001), coping strategies (β=-0.51, p < 0.001), and doctor communication (β=-0.35, p < 0.001) predict mental health. Quality of life is associated with the severity of symptoms (β=-0.36, p < 0.001), coping strategies (β = 0.26, p < 0.05), and doctor communication (β = 0.09, p < 0.05).

CONCLUSIONS

A 'bio-psycho-social-spiritual' model is recommended for Pakistan's CLD patients which includes the integration of social officers to provide support in four key areas to secure mental health and quality of life of patients.

Doctors' experiences of earlier mandatory postgraduate communication skills training: a qualitative study

OBJECTIVES

This study explored the question: what are doctors' perspectives on and experiences with their earlier mandatory postgraduate communication skills training?

METHODS

The study used a qualitative, exploratory design. We used purposeful sampling based on the principle of maximal variation to ensure different clinical perspectives. Thus, three focus groups were formed with 12 doctors who had attended mandatory postgraduate communication skills training within 1-9 years prior to the study. The doctors were from three specialties: internal medicine, oncology, and general practice. We used a semi-structured interview guide, and the focus groups were video-recorded. Thematic analysis was used to analyze the data material. Through an iterative process, we identified main and sub-themes.

RESULTS

The first-year residency mandatory postgraduate communication skills training provided all participants with skills that had helped them in their ongoing clinical work. In addition, five dominant themes were observed: modes of use, the timing of course, experience with experiential methods, sharing challenges with peers, and need for continuous feedback and follow-up.

CONCLUSIONS

Doctors value early mandatory postgraduate communication skills training even years after attending the course and request similar ongoing initiatives. Their experiences are positive, they found the timing relevant, and they used the learned skills in their ongoing clinical work, even years after the initial course. Our study indicates that more attention should be given to 'early career' postgraduate communication skills training that is tailored to specific clinical contexts, including hospital settings.

Impact of physician-patient relationship training on medical students' interpersonal skills during simulated medical consultations: a cross-sectional study

BACKGROUND

In medicine, the patient-centered approach is based on interpersonal skills, including communication, structuring the medical interview, and empathy, which have an impact on health professionals' interpersonal relationships and the quality of care. Training courses on this issue are therefore being developed in universities. We hypothesized that specific training courses in the physician-patient relationship could improve interpersonal skills among medical students during simulated consultations and the immediate satisfaction of standardized patients.

METHODS

This cross-sectional study enrolled fourth-year medical students who participated in a simulated medical consultation session with standardized patients. The evaluation of interpersonal skills was carried out using the Four Habits Coding Scheme, producing a synthetic score out of 115 points used as the primary endpoint. Some students benefited from the training courses offered by the university or by other organizations, mainly based on communication, active listening, or patient-centered approach. A comparison was made with students from the same graduating class who had not received any training.

RESULTS

The analysis of the primary endpoint showed a difference of 5 points between the group of students who had attended at least one training course and those who did not (p = 0.001). This difference was even more marked when the students had completed several training courses, up to 14 points higher with three training courses (p = 0.001), each with positive results in different areas of the care relationship.

CONCLUSIONS

Physician-patient relationship training currently provided in initial education appears to be effective in improving interpersonal skills. A repetition of this training is necessary to increase its impact.

The effects of team-based learning on nursing students’ learning performance with a focus on high-risk pregnancy: a quasi-experimental study

Purpose

The purpose of this study was to examine the effects of team-based learning (TBL) on nursing students’ communication ability, problem-solving ability, self-directed learning, and nursing knowledge related to high-risk pregnancy nursing.

Methods

This quasi-experimental study used a nonequivalent control group pretest-posttest design. The participants were 91 nursing students allocated to an experimental group (n=45) and a control group (n=46). The experimental group received TBL lectures three times over the course of 3 weeks (100 minutes weekly) and the control group received instructor-centered lectures three times over the course of 3 weeks (100 minutes weekly). Data were collected by questionnaires from September 10 to November 8, 2019. Data were analyzed using the chi-square test, paired t-test, and independent t-test.

Results

After the intervention, the mean scores of problem-solving ability (t=–2.59, p=.011), self-directed learning (t=4.30, p<.001), and nursing knowledge (t=3.18, p=.002) were significantly higher in the experimental group than in the control group. No significant difference in communication ability was found between the experimental and control group (t=1.38, p=.171)

Conclusion

The TBL program was effective for improving nursing students’ problem-solving ability, self-directed learning, and nursing knowledge. Thus, TBL can be considered an effective teaching and learning method that can improve the learning outcomes of high-risk pregnancy nursing in women’s health nursing classes. The findings suggest that TBL will be helpful for future nursing students to develop the nursing expertise necessary for providing nursing care to high-risk pregnant women.

Evaluating the Feasibility of Continuing Medical Education for Disseminating Emerging Science on the Breast Cancer and Environment Connection

Developing continuing medical education (CME) training programs is a strategy for communicating emerging science to health practitioners. This research tests the feasibility of using CME modules for translating and disseminating research findings from the Breast Cancer and Environment Research Program. Recent findings have identified certain windows of susceptibility, like during puberty, in which exposure to endocrine-disrupting chemicals can increase breast cancer risk later in life. In order to reach pediatric patients and their caregivers, using a Diffusion of Innovations framework, pediatric health-care providers were identified as opinion leaders. Two CME modules informed by theory and formative research were tested with a sample of pediatricians and pediatric nurse practitioners. Participants completed knowledge, attitude, intention, and behavior items immediately before and after exposure to a randomly assigned module, and then again 3 weeks later. Quantitative and qualitative results indicate knowledge gain and strong links between practitioners' intentions to enact and implemented behavior learned from training recommendations with parents and caregivers in their practices. Results indicate that CMEs can be an effective strategy for translational activities targeted to health providers in order to change behavior within practice.

Evaluation of a Patient Communication Skills Training Program for Medical Physicists

PURPOSE

To evaluate the efficacy of a training program designed to teach medical physicists how to communicate with patients effectively in the clinical environment.

METHODS AND MATERIALS

The training program was offered 3 times between 2016 and 2019. Participants were asked to rank their level of confidence in 5 categories relevant to patient communication on a 5-point Likert scale at 3 separate time points over the course of the training program. Participants were also asked to provide written responses to 5 common questions from patients at 2 separate time points, and these responses were numerically scored using the Constant Comparative Method. Competency in patient communication was assessed during simulated patient consults using a 9-element clinical competency assessment form. Changes in participants' stated level of confidence over the course of the training program and differences between faculty and residents were analyzed using the Student t test, and participants' scored responses to common questions were analyzed using analysis of variance.

RESULTS

Fifteen medical physicists participated in the training program: 6 resident physicists (4 first year and 2 second year) and 9 faculty physicists. Mean participant-stated level of confidence increased significantly across all categories (P < .05) between the first and second training intervention and between the second and third training intervention. There was no significant difference in mean participant-stated level of confidence between faculty and resident medical physicists. We observed statistically significant improvements in scored responses to common patient questions between the 2 assessment time points (P < .05). Of the 15 participants, 14 met competency assessment goals during simulated patient consults.

CONCLUSIONS

The patient communication skills training program increases medical physicists' level of confidence across 5 patient communication categories and improves their responses to common questions from patients. In addition, the program can discern differences in communication competency between physicists.

Continuing Medical Education as a Translational Science Opportunity for Health Communication Researchers: The BCERP Model

Health communication researchers often work across health issues to engage in research that bridges distance between bench scientists and practitioners. This translational activity is essential to increase the likelihood that emerging science from the laboratory makes it into the hands of health professionals who can integrate it into their everyday practice with patients. An underutilized translational approach by communication researchers is the development of continuing medical education (CME) opportunities that incorporate a communication science approach to the uptake of recommended practices based on emerging science. This manuscript explains the nature of translational science, highlights the role of CME as an integral strategy for engaging in it, and then provides the exemplar of a training and evaluation project funded by the National Institute for Environmental Health Sciences for the Breast Cancer and the Environment Research Program (BCERP). Lessons learned are discussed as they relate to developing a translational opportunity for the BCERP.

Effectiveness of a modified doctor-patient communication training Programme designed for surgical residents in China: a prospective, large-volume study at a single Centre

BACKGROUND

Effective doctor-patient communication (DPC) is important to improve the quality of care and treatment outcomes. This study aimed to evaluate the effectiveness of a modified DPC training programme designed for surgical residents in China.

METHODS

A total of 210 surgical residents from 7 specialties were recruited to participate in a communication skills training programme. The extended SEGUE scale was administered to supervisors, and a visual analogue scale (VAS) was administered to standardized patients (SPs) and trainees. Evaluations were conducted by comparing the pre-post scale scores (before, immediately after and 1 month after the programme). Training effects were assessed using the Friedman test and the intraclass correlation coefficient (ICC).

RESULTS

Compared to the extended SEGUE scale total scores before the programme, the scores both immediately after and 1 month after the program increased significantly (15.88 ± 1.93 vs. 26.40 ± 1.47 and 26.15 ± 1.36, respectively, p < 0.001). The scores of five of the six dimensions in the extended SEGUE scale significantly increased (p < 0.001), except for the patient's perspective dimension score, which had no change (p = 0.162). With respect to this dimension, a subgroup analysis by gender indicated an increase among females (p < 0.001) and a decrease among males (p < 0.001). The VAS scores, which were evaluated for the SPs and trainees, increased significantly compared to the scores before the program, both immediately after and 1 month after the programme (4.31 ± 1.35 vs. 7.36 ± 1.62 and 7.34 ± 1.24, p < 0.001; 7.31 ± 1.25 vs. 8.39 ± 1.32 and 8.30 ± 1.24, p < 0.001, respectively). The consistency of the VAS between the SPs and surgical residents was 0.26 (p < 0.001), 0.70 (p < 0.001), and 0.70 (p < 0.001) before, immediately after and 1 month after the programme, respectively.

CONCLUSION

This training programme improved the DPC competency of surgical residents, effectively increased the levels of satisfaction of both SPs and surgical residents, and improved the consistency of evaluation between SPs and surgical residents during doctor-patient encounters. The registration UIN is ChiCTR1800019790 from November 28, 2018.

Training programs in communication skills to improve self-efficacy for health personnel: Protocol for a systematic review and meta-analysis

BACKGROUND

Patient-centered care should be the focus of health services, where improvements in the communication skills of health professionals promote excellent health and quality care. Thus, this study is a protocol for a systematic review and meta-analysis to evaluate the effectiveness of training programs in communication skills to promote self-efficacy in the communication of health personnel.

METHODS

This systematic review protocol is conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) statement guidelines and the Cochrane Handbook of Systematic Reviews of Interventions. The review should include studies carried out with health professionals who have undergone training in communication skills aimed at promoting their self-efficacy. Clinical trials (randomized, non-randomized), community trials, and quasi-experimental studies should be included. Therefore, the comprehensive search strategy will be conducted in the following databases: PubMed/Medline, Scopus, Web of Science, EMBASE, Science Direct, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL). Two independent reviewers will conduct all study selection procedures, data extraction, and methodological evaluation, and disagreements will be referred to a third reviewer. RevMan 5.3 software will be used to gather data and perform the meta-analysis if possible.

RESULTS

This systematic review will provide evidence on more effective programs for communication skills training and will consider information such as duration, educational strategies, assessment measures, and outcomes that promote health worker self-efficacy.

DISCUSSION

This systematic review should provide evidence for effective communication skills training for health professionals in order to guide new strategies for quality care.

DISSEMINATION AND ETHICS

The findings of this scoping review will be disseminated in print, at conferences, or via peer-reviewed journals. Ethical approval is not necessary as this paper does not involve patient data.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019129384.

Workplace-based communication skills training in clinical departments: Examining the role of collegial relations through positioning theory

INTRODUCTION

Studies suggest that the workplace is a key to understanding how clinical communication skills learning takes place and that medical communication skills need to be reinforced over time in order not to deteriorate. This study explored the perceptions of doctors in four hospital departments who participated in a workplace-based communication training project. Its specific focus was the relationship between collegial relations and learning communication skills.

METHODS

The study applied a qualitative design using an ethnographic methodology, i.e. interviews and observations. Positioning theory was used as the theoretical framework.

RESULTS

Training communication skills with colleagues in the actual workplace setting was valued by the participants who experienced more sharing of communication challenges, previously understood as something private one would not share with colleagues. However, collegial relations were also barriers for providing critical feedback, especially from junior doctors to their seniors.

CONCLUSION

The position as "colleague" both reinforced the communication skills training and hindered it. The communication skills educational model had a flat, non-hierarchical structure which disturbed the hierarchical structure of the workplace, and its related positions.

How do Swiss medical schools prepare their students to become good communicators in their future professional careers: a questionnaire and interview study involving medical graduates, teachers and curriculum coordinators

BACKGROUND

Since 2011, the Swiss Catalogue of Learning Objectives (SCLO) has provided the framework for assessing communication skills in the Swiss Medical Federal Licensing Examination (FLE). This study evaluates how far the communication curricula of five Swiss medical schools match the SCLO and international recommendations. It also explores their strengths, weaknesses, opportunities and threats (SWOT).

METHODS

A mixed method approach was used. In a first step, curriculum coordinators/key communication skills teachers and medical graduates were asked to fill out a questionnaire based on communication related objectives from the SCLO and a review of European consensus statements on communication training. Second, information was collected from all Swiss medical schools to identify which communication skills were taught in which formats and at what time points within the 6-year curricula. Finally, 3-4 curriculum coordinators/key communication skills teachers from each medical school were interviewed about their communication curriculum, using SWOT analysis.

RESULTS

Sixteen teachers/coordinators (response rate 100%) and 389 medical graduates (response rate 43%) filled out the questionnaire. Both the teachers/coordinators and the graduates considered that two thirds of the communication items listed in the questionnaire were covered in their curricula. Between sixty and two hundred structured hours were dedicated to communication, predominantly in small group and experiential formats. Assessment relied on both MCQs and OSCEs. Most of the training occurred during the first three years of medical school. Teachers felt that the need for communication skills training was now well-recognized by their institution and was taught with appropriate teaching methods. However, recruitment and training of teachers, continuity of communication skills training during clinical years, and the adoption of a common frame of reference among the five medical schools, remained a challenge.

CONCLUSION

Although the Swiss medical schools all offered a partly longitudinal communication skills training, with appropriate teaching methods, this study indicates that the communication skills actually taught do not fully match the SCLO or international recommendations. There was less training for complex communication skills training during the clinical years, and ensuring quality and coherence in the teaching remained a challenge.

A Simulation-Based Workshop to Improve Dermatologists' Communication Skills: A Pilot for Continuing Medical Education

INTRODUCTION

Communication skills influence the quality of health care and patient experience; both may affect provider reimbursement. There are few opportunities available for practicing physicians to receive direct feedback on communication in patient encounters. The purpose of this simulation-based patient encounter workshop was for dermatologists to practice and obtain feedback on their communication skills.

METHODS

In March 2016, dermatologists participated in a workshop with four simulated patient encounters. Cases were developed based on a prior needs assessment. Standardized patient educators evaluated participants' communication using the Master Interview Rating Scale and provided verbal feedback. Physicians rated the usefulness of the simulation and the feedback received through a survey upon workshop completion.

RESULTS

Of the 170 physicians who registered, 103 participated in the simulation. The workshop was highly rated in meeting its three learning objectives (score of 4.5-4.6 out of a maximum score of 5). The lowest-rated communication skills were as follows: allowing the patient to share their narrative thread (3.1), summarizing the patient's history from the provider (3.8), and assessing patient understanding (3.8).

CONCLUSIONS

Participants reported that this communication workshop effectively satisfied its learning objectives. Opportunities to practice and improve communication skills as part of continuing medical education will benefit the clinical experience of patients and physicians alike, and the workshop may be formatted to serve physicians of other specialties. The lowest-scoring communication areas identified in this study present an opportunity to develop a tailored curriculum for physician-patient communication in the future.

Communication skills training: Adapting to the trends and moving forward

Communication ability is one of the core requirements of doctors' competency. Teaching communication to medical students and junior doctors has attracted much attention. With the challenge of escalating demands, the status of training communication skills has been promoted in the past several decades. The training content was integrated with other courses and various pedagogic approaches have been applied and proved to be effective. Practical strategies and mixed types were highly recommended. However, there are still many problems, including the fragmentation of the training, insufficient practice, inadequate qualified teachers, case adaptation, course localization and impediment from the environment. This paper proposes some suggestions to solve the problems.

Patients' attitudes towards the participation of medical students in clinical examination and care in Western Saudi Arabia

Background and Objectives:

Patients are essential for the acquisition and development of medical students clinical skills for their tasks. The study aimed to identify factors that influence patients’ attitudes towards the involvement of medical students in clinical examination and care in Western Saudi Arabia.

Methods:

A cross-sectional study using self-administered questionnaire was conducted among Saudi and non-Saudi patients at two university hospitals in Jeddah, Western Saudi Arabia. Information sought included demographic characteristics (age, gender, educational level, job, income, and marital status); patients’ attitude and comfort level towards different types of students’ involvement; factors influencing patients’ cooperation with medical students (students’ level of training, manner, skills, and attire. All these were assessed on a five-point Likert scale. Data was entered and analyzed using SPSS v 19.

Results:

Four hundred and seventeen adult patients participated. Fifty-one percent indicated a positive attitude towards involving medical students in clinical examination and care. Female and young patients (<45 years old) were more likely to be negative in their attitude and be less comfortable towards involving medical students in their care. The highest overall mean comfort score was with medical students taking history followed by observations and less invasive examination. Patients’ mean confidence scores regarding students’ attire were the highest for female traditional attire and for scrub suit for males.

Conclusion:

Of the influential factors that could affect patients’ willingness to cooperate with medical students, clinical skills followed by manner and level of training ranked first. Ensuring that students mastered specific procedures before coming into direct contact with patients using patient simulators, for example, would improve patients’ acceptance of student participation.

How do medical specialists value their own intercultural communication behaviour? A reflective practice study

BACKGROUND

Intercultural communication behaviour of doctors with patients requires specific intercultural communication skills, which do not seem structurally implemented in medical education. It is unclear what motivates doctors to apply intercultural communication skills. We investigated how purposefully medical specialists think they practise intercultural communication and how they reflect on their own communication behaviour.

METHODS

Using reflective practice, 17 medical specialists independently watched two fragments of videotapes of their own outpatient consultations: one with a native patient and one with a non-native patient. They were asked to reflect on their own communication and on challenges they experience in intercultural communication. The interviews were open coded and analysed using thematic network analysis.

RESULTS

The participants experienced only little differences in their communication with native and non-native patients. They mainly mentioned generic communication skills, such as listening and checking if the patient understood. Many participants experienced their communication with non-native patients positively. The participants mentioned critical incidences of intercultural communication: language barriers, cultural differences, the presence of an interpreter, the role of the family and the atmosphere.

CONCLUSION

Despite extensive experience in intercultural communication, the participants of this study noticed hardly any differences between their own communication behaviour with native and non-native patients. This could mean that they are unaware that consultations with non-native patients might cause them to communicate differently than with native patients. The reason for this could be that medical specialists lack the skills to reflect on the process of the communication. The participants focused on their generic communication skills rather than on specific intercultural communication skills, which could either indicate their lack of awareness, or demonstrate that practicing generic communication is more important than applying specific intercultural communication. They mentioned well-known critical incidences of ICC: language barriers, cultural differences, the presence of an interpreter, the role of the family and the atmosphere. Nevertheless, they showed a remarkably enthusiastic attitude overall was noteworthy. A strategy to make doctors more aware of their intercultural communication behaviour could be a combination of experiential learning and ICC training, for example a module with reflective practice.

Exploring residents' communication learning process in the workplace: a five-phase model

Context

Competency-based education is a resurgent paradigm in professional medical education. However, more specific knowledge is needed about the learning process of such competencies, since they consist of complex skills. We chose to focus on the competency of skilled communication and want to further explore its learning process, since it is regarded as a main competency in medical education.

Objective

This study aims to explore in more detail the learning process that residents in general practice go through during workplace-based learning in order to become skilled communicators.

Methods

A qualitative study was conducted in which twelve GP residents were observed during their regular consultations, and were interviewed in-depth afterwards.

Results

Analysis of the data resulted in the construction of five phases and two overall conditions to describe the development towards becoming a skilled communicator: Confrontation with (un)desired behaviour or clinical outcomes was the first phase. Becoming conscious of one’s own behaviour and changing the underlying frame of reference formed the second phase. The third phase consisted of the search for alternative behaviour. In the fourth phase, personalization of the alternative behaviour had to occur, this was perceived as difficult and required much time. Finally, the fifth phase concerned full internalization of the new behaviour, which by then had become an integrated part of the residents’ clinical repertoire. Safety and cognitive & emotional space were labelled as overall conditions influencing this learning process.

Conclusions

Knowledge and awareness of these five phases can be used to adjust medical working and learning environments in such a way that development of skilled medical communication can come to full fruition and its benefits are more fully reaped.

Using decision trees to characterize verbal communication during change and stuck episodes in the therapeutic process

Methods are needed for creating models to characterize verbal communication between therapists and their patients that are suitable for teaching purposes without losing analytical potential. A technique meeting these twin requirements is proposed that uses decision trees to identify both change and stuck episodes in therapist-patient communication. Three decision tree algorithms (C4.5, NBTree, and REPTree) are applied to the problem of characterizing verbal responses into change and stuck episodes in the therapeutic process. The data for the problem is derived from a corpus of 8 successful individual therapy sessions with 1760 speaking turns in a psychodynamic context. The decision tree model that performed best was generated by the C4.5 algorithm. It delivered 15 rules characterizing the verbal communication in the two types of episodes. Decision trees are a promising technique for analyzing verbal communication during significant therapy events and have much potential for use in teaching practice on changes in therapeutic communication. The development of pedagogical methods using decision trees can support the transmission of academic knowledge to therapeutic practice.

Doctor-patient communication skills training in mainland China: a systematic review of the literature

OBJECTIVES

To conduct a systematic review of studies on doctor-patient communication skills training (CST) for medical students and physicians in mainland China.

METHODS

We retrieved articles from six electronic databases, and searched additional eligible papers by checking reference lists. Chinese or English-language studies focused on CST and implemented in mainland China were applied to the pre-determined criteria. Articles included were further reviewed under the following categories: participant; training strategy; assessment; and outcome.

RESULTS

20 studies met the inclusion criteria. 90% of the CST improved trainees' communication skills using a strategy which included a didactic component combined with practical rehearsal and feedback. The duration of training varied substantially. A lack of enhancement in empathy, and the use of open-ended questions were reported. 83% of the assessment instruments were self-designed and most lacked reliability and validity testing. Only two of the included studies evaluated patient satisfaction.

CONCLUSIONS

The majority of included studies attained statistically significant improvements. Chinese doctors and medical students' communication skills can be enhanced through CST.

PRACTICE IMPLICATIONS

Future studies in China should place stronger emphasis on the development of training strategies, validation of the assessment instruments, and evaluation of patient satisfaction affected by CST.

Residents' perceived barriers to communication skills learning: comparing two medical working contexts in postgraduate training

OBJECTIVE

Contextual factors are known to influence the acquisition and application of communication skills in clinical settings. Little is known about residents' perceptions of these factors. This article aims to explore residents' perceptions of contextual factors affecting the acquisition and application of communication skills in the medical workplace.

METHOD

We conducted an exploratory study comprising seven focus groups with residents in two different specialities: general practice (n=23) and surgery (n=18).

RESULTS

Residents perceive the use of summative assessment checklists that reduce communication skills to behavioural components as impeding the learning of their communication skills. Residents perceive encouragement to deliberately practise in an environment in which the value of communication skills is recognised and support is institutionalised with appropriate feedback from role models as the most important enhancing factors in communication skills learning.

CONCLUSION

To gradually realise a clinical working environment in which the above results are incorporated, we propose to use transformative learning theory to guide further studies.

PRACTICAL IMPLICATIONS

Provided it is used continuously, an approach that combines self-directed learning with observation and discussion of resident-patient consultations seems an effective method for transformative learning of communication skills.

How to attain expertise in clinical communication?

Several factors complicate the attainment of expertise in clinical communication. Medical curricula and postgraduate training insufficiently provide the required learning conditions of deliberate practice to overcome these obstacles. In this paper we provide recommendations for learning objectives and teaching methods for the attainment of professional expertise in patient education. Firstly, we propose to use functional learning objectives derived from the goals and strategies of clinical communication. Secondly, we recommend using teaching and assessment methods which: (1) contain stimulating learning tasks with opportunities for immediate feedback, reflection and corrections, and (2) give ample opportunity for repetition, gradual refinements and practice in challenging situations. Video-on-the-job fits these requirements and can be used to improve the competency in patient education of residents and medical staff in clinical practice. However, video-on-the-job can only be successful if the working environment supports the teaching and learning of communication and if medical staff which supervises the residents, is motivated to improve their own communication and didactic skills.

Learning in context: identifying gaps in research on the transfer of medical communication skills to the clinical workplace

OBJECTIVE

In order to reduce the inconsistencies of findings and the apparent low transfer of communication skills from training to medical practice, this narrative review identifies some main gaps in research on medical communication skills training and presents insights from theories on learning and transfer to broaden the view for future research.

METHODS

Relevant literature was identified using Pubmed, GoogleScholar, Cochrane database, and Web of Science; and analyzed using an iterative procedure.

RESULTS

Research findings on the effectiveness of medical communication training still show inconsistencies and variability. Contemporary theories on learning based on a constructivist paradigm offer the following insights: acquisition of knowledge and skills should be viewed as an ongoing process of exchange between the learner and his environment, so called lifelong learning. This process can neither be atomized nor separated from the context in which it occurs. Four contemporary approaches are presented as examples.

CONCLUSION

The following shift in focus for future research is proposed: beyond isolated single factor effectiveness studies toward constructivist, non-reductionistic studies integrating the context.

PRACTICE IMPLICATIONS

Future research should investigate how constructivist approaches can be used in the medical context to increase effective learning and transition of communication skills.

Education in patient-physician communication: how to improve effectiveness?

OBJECTIVE

Despite educational efforts expertise in communication as required by the CanMEDS competency framework is not achieved by medical students and residents. Several factors complicate the learning of professional communication.

METHODS

We adapted the reflective-impulsive model of social behaviour to explain the complexities of learning professional communication behaviour. We formulated recommendations for the learning objectives and teaching methods of communication education. Our recommendations are based on the reflective-impulsive model and on the model of deliberate practice which complements the reflective-impulsive model. Our recommendations are substantiated by those we found in the literature.

RESULTS

The reflective-impulsive model explains why the results of communication education fall below expectations and how expertise in communication can be attained by deliberate practice. The model of deliberate practice specifies learning conditions which are insufficiently fulfilled in current communication programmes.

CONCLUSION

The implementation of our recommendations would require a great deal of effort. Therefore we doubt whether expertise in professional communication can be fully attained during medical training.

PRACTICE IMPLICATIONS

We propose that the CanMEDS communication competencies not be regarded as endpoints in medical education but as guidelines to improve communication competency through deliberate practice throughout a professional career.

Perspective: clinical communication education in the United Kingdom: some fresh insights

Clinical communication education is now part of the core curriculum of every medical school in the United Kingdom and the United States. It has emerged over 30 years because of various societal, political, and policy drivers and is supported by an impressive evidence base.For a variety of reasons, however, clinical communication has become separated from other parts of medical education and tends to be positioned in the early years of the curriculum, when students have limited experience of being in the clinical workplace and working with patients. The teachers of clinical communication, whether medical-school-based or clinically based, may not share learning goals for the subject and this may, therefore, provide a disintegrated learning experience for students.Clinical communication teachers need to inject fresh thinking into the teaching and learning of the subject to unite it with clinical practice in the authentic clinical workplace. Engaging with theories of workplace learning, which aim to overcome the theory/practice gap in vocational education, may be the way forward. The author suggests various ways that this might be achieved-for example, by situating clinical communication education throughout the whole undergraduate curriculum, by integrating the topic of clinical communication with other areas of medical education, by developing coteaching and curriculum design partnerships between medical school and clinical workplace, and by developing a greater range of postgraduate education that offers opportunities for professional development in clinical communication for qualified doctors that is complementary with what is taught in undergraduate education.

[Case-based interactive PACS learning: introduction of a new concept for radiological education of students]

PURPOSE

Medical curricula are currently being reformed in order to establish superordinated learning objectives, including, e.g., diagnostic, therapeutic and preventive competences. This requires a shifting from traditional teaching methods towards interactive and case-based teaching concepts. Conceptions, initial experiences and student evaluations of a novel radiological course Co-operative Learning In Clinical Radiology (CLICR) are presented in this article.

MATERIALS AND METHODS

A novel radiological teaching course (CLICR course), which combines different innovative teaching elements, was established and integrated into the medical curriculum. Radiological case vignettes were created for three clinical teaching modules. By using a PC with PACS (Picture Archiving and Communication System) access, web-based databases and the CASUS platform, a problem-oriented, case-based and independent way of learning was supported as an adjunct to the well established radiological courses and lectures. Student evaluations of the novel CLICR course and the radiological block course were compared.

RESULTS

Student evaluations of the novel CLICR course were significantly better compared to the conventional radiological block course. Of the participating students 52% gave the highest rating for the novel CLICR course concerning the endpoint overall satisfaction as compared to 3% of students for the conventional block course. The innovative interactive concept of the course and the opportunity to use a web-based database were favorably accepted by the students. Of the students 95% rated the novel course concept as a substantial gain for the medical curriculum and 95% also commented that interactive working with the PACS and a web-based database (82%) promoted learning and understanding.

CONCLUSION

Interactive, case-based teaching concepts such as the presented CLICR course are considered by both students and teachers as useful extensions to the radiological course program. These concepts fit well into competence-oriented curricula.