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Braverman A. Improving Team Members' Attention During the OR Briefing or Time Out. AORN J 2024; 119:421-427. [PMID: 38804746 DOI: 10.1002/aorn.14144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/25/2023] [Accepted: 11/05/2023] [Indexed: 05/29/2024]
Abstract
Effective coordination among health care professionals is crucial to achieving optimal outcomes. In the OR, even minor errors can have catastrophic consequences. To mitigate the risk of error, health care professionals have adopted a briefing culture like that used in the aviation industry. Briefings are essential to ensure that everyone involved in a procedure knows the plan and potential risks and is prepared to perform their duties safely and effectively. The fundamental human sense involved in briefings is auditory perception; although important, hearing alone does not equate to focused attention. To enhance the efficacy of briefings, engaging the use of a second sense by adding a visual checklist may increase attentiveness and the chances of early error detection and prevention. Using a projection device may enhance all team members' engagement and participation during the briefing or time-out process and can be an effective tool for improving communication and reducing errors.
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Lian G, Xiao Y, Huang Y, Wang H, Huang L, Yang H, Zhu C, Mei W, Huang R. Attitudes toward communication skills with learner needs assessment within radiology residency programs in China: a cross-sectional survey. BMC Res Notes 2024; 17:114. [PMID: 38654288 PMCID: PMC11036608 DOI: 10.1186/s13104-024-06779-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Communication skills (CS) represent a core competency in radiology residency training. However, no structured curriculum exists to train radiology residents in CS in China. The aim of this study was to evaluate the status and prevalence of doctor-patient communication training among radiology residents in nine Chinese accredited radiology residency training programs and to determine whether there is a perceived need for a formalized curriculum in this field. METHODS We administered a cross-sectional online survey to radiology residents involved in CS training at nine standard residency training programs in China. The questionnaire developed for this study included CS training status, residents' demographics, attitudes toward CS training, communication needs, and barriers. Residents' attitudes toward CS training were measured with the Communication Skills Attitude Scale (CSAS) and its subscales, a positive attitude scale (PAS) and negative attitude scale (NAS). RESULTS A total of 133 (48.36%) residents participated in the survey. The mean total scores on the two dimensions of the CSAS were 47.61 ± 9.35 in the PAS and 36.34 ± 7.75 in the NAS. Factors found to be significantly associated with the PAS included receiving previous training in CS, medical ethics, or humanities and the doctor's attire. We found that first-year residents and poor personal CS were the most influential factors on the NAS. Only 58.65% of participants reported having previously received CS training during medical school, and 72.93% of respondents reported failure in at least one difficult communication during their residency rotation. Most of those surveyed agreed that CS can be learned through courses and were interested in CS training. Some of the most common barriers to implementing formal CS training were a lack of time, no standardized curriculum, and a lack of materials and faculty expertise. CONCLUSIONS Most residents had a very positive attitude toward CS training and would value further training, despite the limited formal CS training for radiology residents in China. Future efforts should be made to establish and promote a standard and targeted CS curriculum for Chinese radiology residents.
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Affiliation(s)
- GengPeng Lian
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Yubin Xiao
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Yingling Huang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Huanpeng Wang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Lipeng Huang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Hongwu Yang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Chunmin Zhu
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Wei Mei
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, 515041, Guangdong, China.
| | - Ruibin Huang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, 515041, Guangdong, China.
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Landry-Wegener BA, Kaniecki T, Gips J, Lebo R, Levine RB. Drama Training as a Tool to Teach Medical Trainees Communication Skills: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:851-860. [PMID: 36538658 DOI: 10.1097/acm.0000000000005121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Recognizing the similarities between the skills an actor needs and those required of a physician in clinical communication, medical educators have begun to create drama-based interventions to teach communication skills. The purpose of this scoping review was to summarize existing educational interventions that use drama training to teach medical trainees communication skills. METHOD The authors searched PubMed, CINAHL Plus, Embase, ERIC, and Web of Science Core Collection multiple times beginning in March 2020 through March 2022. Articles were included if they (1) described components of an educational intervention, (2) used an active intervention based on drama training, (3) stated a curricular goal of improving learners' communication skills, and (4) included medical trainee learners. Data extracted included the details of the targeted learners and educational interventions, assessment tools, and outcomes. The quality of each study was assessed. RESULTS Thirty articles met the inclusion criteria. Twenty-five (83%) articles included acting and improvisation exercises, 9 (30%) used some or all of the conventions of forum theater, and 3 (10%) used dramatic performance. The interventions included undergraduate, graduate, and continuing medical education learners. Most were elective and involved a member of the theatrical community. Although low overall study quality (average MERSQI score was 8.5) limited the strength of the evidence, of the 8 articles that evaluated learners' knowledge, skills, and/or behaviors, the majority showed an initial improvement in communication skills post-intervention. CONCLUSIONS This review is the first, to the authors' knowledge, to focus on the curricular goal of improving communication skills and to include a broader scope (beyond medical improv) of drama trainings. While the included articles represent a diverse group of interventions, generally they reported an outcome of improved communication skills in their learners. More high-quality studies are needed to determine best practices and the generalizability of drama-based initiatives.
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Affiliation(s)
- Bernard A Landry-Wegener
- B.A. Landry-Wegener is assistant professor, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy Kaniecki
- T. Kaniecki is a rheumatology fellow, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julia Gips
- J. Gips is a resident physician, Osler Medical Residency, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachael Lebo
- R. Lebo is clinical services librarian, Wegner Health Sciences Library, University of South Dakota, Sioux Falls, South Dakota
| | - Rachel B Levine
- R.B. Levine is professor and associate dean for faculty educational development, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Rivest J, Karazivan P, Desbeaumes Jodoin V, Flora L, Lambert C, Tranulis C, Daneault S. Listening to Cancer Patients' Narratives During Residency: A Pilot Study on a Communication Skills' Workshop Involving Patients-Partners. J Patient Exp 2023; 10:23743735231183674. [PMID: 37441277 PMCID: PMC10334025 DOI: 10.1177/23743735231183674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Abstract
The field of cancer care still lacks best practices in communication. Few postgraduate training programs offer formal training to develop such skills. The patient partnership has been used in medical education to increase the sensitivity of the subjective experiences of patients. In our Canadian center, residents and patient-partners participated in an educational workshop on communication focusing on patient's narrative. The aim of this pilot qualitative study was to explore the experiences of participants in the workshop. Using theoretical sampling, we recruited 6 residents and 6 patient-partners. Semi-structured interviews were conducted and transcribed. A thematic analysis was performed. From analysis, 4 themes emerged: (1) lack of communication skills training; (2) barriers to effective communication in cancer care; (3) the empathy of patient-partners towards the communication challenges faced by residents; and (4) the participants' reactions to the workshop. Based on our findings, our communication skills workshop centered on narrative medicine and involving patient-partners appears feasible. Future research could study its pedagogical value and the optimal learning environment required.
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Affiliation(s)
- Jacynthe Rivest
- Department of Psychiatry, Centre
Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
- Centre de Recherche du Centre
Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Philippe Karazivan
- Department of Family Medicine,
University of Montreal Faculty of Medicine, Montreal, Canada
- Center of Excellence for Partnership
with Patients and the Public, University of Montreal, Montreal, Quebec, Canada
| | - Véronique Desbeaumes Jodoin
- Department of Psychiatry, Centre
Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
- Centre de Recherche du Centre
Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Luigi Flora
- Center of Excellence for Partnership
with Patients and the Public, University of Montreal, Montreal, Quebec, Canada
- Innovation Center for partnership with
patients and the public, Côte d’Azur University, Clermont-Ferrand, France
| | - Carole Lambert
- Centre de Recherche du Centre
Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
- Department of Radiation Oncology,
University of Montreal Health Center, Montreal, Canada
| | - Constantin Tranulis
- Institut universitaire en santé mentale
de Montréal, Montreal, Quebec, Canada
| | - Serge Daneault
- Department of Family Medicine,
University of Montreal Faculty of Medicine, Montreal, Canada
- Centre de recherche de l’Institut
universitaire de gériatrie de Montréal, Montreal, Canada
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Verheijden M, Giroldi E, van den Eertwegh V, Luijkx M, van der Weijden T, de Bruin A, Timmerman A. Identifying characteristics of a skilled communicator in the clinical encounter. MEDICAL EDUCATION 2023; 57:418-429. [PMID: 36223270 DOI: 10.1111/medu.14953] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/21/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In medical communication research, there has been a shift from 'communication skills' towards 'skilled communication', the latter implying the development of flexibility and creativity to tailor communication to authentic clinical situations. However, a lack of consensus currently exists what skilled communication entails. This study therefore aims to identify characteristics of a skilled communicator, hereby contributing to theory building in communication research and informing medical training. METHOD In 2020, six nominal group technique (NGT) sessions were conducted in the context of the general practitioner (GP) training programme engaging 34 stakeholders (i.e. GPs, GP residents, faculty members and researchers) based on their experience and expertise in doctor-patient communication. Participants in each NGT session rank-ordered a 'Top 7' of characteristics of a skilled communicator. The output of the NGT sessions was analysed using mixed methods, including descriptive statistics and thematic content analysis during an iterative process. RESULTS Rankings of the six sessions consisted of 191 items in total, which were organised into 41 clusters. Thematic content analysis of the identified 41 clusters revealed nine themes describing characteristics of a skilled communicator: (A) being sensitive and adapting to the patient; (B) being proficient in applying interpersonal communication; (C) self-awareness, learning ability and reflective capacity; (D) being genuinely interested; (E) being proficient in applying patient-centred communication; (F) goal-oriented communication; (G) being authentic; (H) active listening; and (I) collaborating with the patient. CONCLUSIONS We conceptualise a skilled communication approach based on the identified characteristics in the present study to support learning in medical training. In a conceptual model, two parallel processes are key in developing adaptive expertise in communication: (1) being sensitive and adapting communication to the patient and (2) monitoring communication performance in terms of self-awareness and reflective capacity. The identified characteristics and the conceptual model provide a base to develop a learner-centred programme, facilitating repeated practice and reflection. Further research should investigate how learners can be optimally supported in becoming skilled communicators during workplace learning.
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Affiliation(s)
- Michelle Verheijden
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
| | - Esther Giroldi
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
| | - Valerie van den Eertwegh
- Skillslab, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Marscha Luijkx
- Department of Family Medicine, School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Anique de Bruin
- Department of Educational Development and Research, School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
| | - Angelique Timmerman
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Nassar AK, Weimer-Elder B, Yang R, Kline M, Dang BK, Spain DA, Knowlton LM, Valdez AB, Korndorffer JR, Johnson T. Developing an Inpatient Relationship Centered Communication Curriculum (I-RCCC) rounding framework for surgical teams. BMC MEDICAL EDUCATION 2023; 23:137. [PMID: 36859253 PMCID: PMC9979403 DOI: 10.1186/s12909-023-04105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Morning rounds by an acute care surgery (ACS) service at a level one trauma center are uniquely demanding, given the fast pace, high acuity, and increased patient volume. These demands notwithstanding, communication remains integral to the success of surgical teams. Yet there are limited published curricula that address trauma inpatient communication needs. Observations at our institution confirmed that the surgical team lacked a shared mental model for communication. We hypothesized that creating a relationship-centered rounding conceptual framework model would enhance the provider-patient experience. STUDY DESIGN A mixed-methods approach was used for this study. A multi-pronged needs assessment was conducted. Provider communion items for Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys were used to measure patients' expressed needs. Faculty with experience in relationship-centered communication observed morning rounds and documented demonstrated behaviors. A five-hour workshop was designed based on the identified needs. A pre-and post-course Assessment and course evaluation were conducted. Provider-related patient satisfaction items were measured six months before the course and six months after the workshop. RESULTS Needs assessment revealed a lack of a shared communication framework and a lack of leadership skills for senior trauma residents. Barriers included: time constraints, patient load, and interruptions during rounds. The curriculum was very well received. The self-reflected behaviors that demonstrated the most dramatic change between the pre and post-workshop surveys were: I listened without interrupting; I spoke clearly and at a moderate pace; I repeated key points; and I checked that the patient understood. All these changed from being performed by 50% of respondents "about half of the time" to 100% of them "always". Press Ganey top box likelihood to recommend (LTR) and provider-related top box items showed a trend towards improvement after implementing the training with a percentage difference of up to 20%. CONCLUSION The Inpatient Relationship Centered Communication Curriculum (I-RCCC) targeting senior residents and Nurse Practitioners (NP) was feasible, practical, and well-received by participants. There was a trend of an increase in LTRs and provider-specific patient satisfaction items. This curriculum will be refined based on the study results and potentially scalable to other surgical specialties.
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Affiliation(s)
| | | | - Rachel Yang
- Department of Surgery, Stanford University, Stanford, CA, USA
| | - Merisa Kline
- Stanford Medicine Patient Experience, Physician Partnership Team, Stanford, CA, USA
| | - Bryan K Dang
- Stanford Medicine Patient Experience, Physician Partnership Team, Stanford, CA, USA
| | - David A Spain
- Department of Surgery, Stanford University, Stanford, CA, USA
| | - Lisa M Knowlton
- Department of Surgery, Stanford University, Stanford, CA, USA
| | - Andre B Valdez
- Stanford Medicine Patient Experience, Physician Partnership Team, Stanford, CA, USA
| | | | - Tyler Johnson
- Department of Surgery, Stanford University, Stanford, CA, USA
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Adam P, Mauksch LB, Brandenburg DL, Danner C, Ross VR. Optimal training in communication model (OPTiCOM): A programmatic roadmap. PATIENT EDUCATION AND COUNSELING 2023; 107:107573. [PMID: 36410312 DOI: 10.1016/j.pec.2022.107573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Teaching primary care residents patient communication skills is essential, complex, and impeded by barriers. We find no models guiding faculty how to train residents in the workplace that integrate necessary system components, the science of physician-patient communication training and competency-based medical education. The aim of this project is to create such a model. METHODS We created OPTiCOM using four steps: (1) communication educator interviews, analysis and theme development; (2) initial model construction; (3) model refinement using expert feedback; (4) structured literature review to validate, refine and finalize the model. RESULTS Our model contains ten interdependent building blocks organized into four developmental tiers. The Foundational value tier has one building block Naming relationship as a core value. The Expertize and resources tier includes four building blocks addressing: Curricular expertize, Curricular content, Leadership, and Time. The four building blocks in the Application and development tier are Observation form, Faculty development, Technology, and Formative assessment. The Language and culture tier identifies the final building block, Culture promoting continuous improvement in teaching communication. CONCLUSIONS OPTiCOM organizes ten interdependent systems building blocks to maximize and sustain resident learning of communication skills. Practice Implications Residency faculty can use OPTiCOM for self-assessment, program creation and revision.
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Affiliation(s)
- Patricia Adam
- Department of Family Medicine and Community Health, University of Minnesota, Smiley's Clinic, 2020 East 28th Street, Minneapolis, MN 55407, USA.
| | - Larry B Mauksch
- Emeritus - Department of Family Medicine, University of Washington, Home, 6026 30th Ave NE, Seattle, WA 98115, USA.
| | - Dana L Brandenburg
- Department of Family Medicine and Community Health, University of Minnesota, Smiley's Clinic, 2020 East 28th Street, Minneapolis, MN 55407, USA.
| | - Christine Danner
- Department of Family Medicine and Community Health, University of Minnesota, Bethesda Clinic, 580 Rice St, St Paul, MN 55103, USA.
| | - Valerie R Ross
- University of Washington Department of Family Medicine, Family Medicine Residency Program, Box 356390, 331 N.E. Thornton Place, Seattle, WA 98125, USA.
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Baghus A, Giroldi E, Timmerman A, Schmitz E, Erkan F, Röhlinger D, Pieterse A, Dielissen P, Kramer A, Rietmeijer C, Muris J, van der Weijden T. Identifying residents' educational needs to optimising postgraduate medical education about shared decision-making. PATIENT EDUCATION AND COUNSELING 2022; 105:3086-3095. [PMID: 35810045 DOI: 10.1016/j.pec.2022.06.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To investigate how to optimise resident engagement during workplace learning of shared decision-making (SDM) by understanding their educational needs. METHODS A qualitative multicentre study was conducted using video-stimulated interviews with 17 residents in General Practice. Video recordings of residents' recent clinical encounters were used to facilitate reflection on their educational needs. RESULTS Data analysis resulted in five themes regarding residents' educational needs for learning SDM: acquiring knowledge and skills needed to perform SDM; practising SDM; reflection and feedback; longitudinal and integrated training; and awareness and motivation for performing SDM. CONCLUSION Residents expressed a need for continuous attention to be paid to SDM during postgraduate medical education. That would help them engage in two parallel learning processes: acquiring the knowledge and skills necessary to perform SDM, and practising SDM in the clinical workplace. Alignment between the educational curriculum, workplace learning and resident learning activities is essential to operationalise SDM attitude, knowledge and skills into clinical performance. PRACTICE IMPLICATIONS The identified educational needs provide ingredients for fostering the development of SDM proficiency. The findings suggest that residents and clinical supervisors need parallel training to bridge the gap between education and clinical practice when learning SDM.
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Affiliation(s)
- Anouk Baghus
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands.
| | - Esther Giroldi
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands; Department of Educational Development and Research, Maastricht University, Maastricht, the Netherlands
| | - Angelique Timmerman
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
| | - Emmeline Schmitz
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
| | - Fatma Erkan
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
| | - Darwin Röhlinger
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
| | - Arwen Pieterse
- Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Patrick Dielissen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anneke Kramer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Chris Rietmeijer
- Department of General Practice and Elderly Care Medicine, Amsterdam University Medical Centers, Location VUmc, Amsterdam, the Netherlands
| | - Jean Muris
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
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Driever EM, Tolhuizen IM, Duvivier RJ, Stiggelbout AM, Brand PLP. Why do medical residents prefer paternalistic decision making? An interview study. BMC MEDICAL EDUCATION 2022; 22:155. [PMID: 35260146 PMCID: PMC8903731 DOI: 10.1186/s12909-022-03203-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 01/19/2022] [Indexed: 05/19/2023]
Abstract
BACKGROUND Although shared decision making is championed as the preferred model for patient care by patient organizations, researchers and medical professionals, its application in daily practice remains limited. We previously showed that residents more often prefer paternalistic decision making than their supervisors. Because both the views of residents on the decision-making process in medical consultations and the reasons for their 'paternalism preference' are unknown, this study explored residents' views on the decision-making process in medical encounters and the factors affecting it. METHODS We interviewed 12 residents from various specialties at a large Dutch teaching hospital in 2019-2020, exploring how they involved patients in decisions. All participating residents provided written informed consent. Data analysis occurred concurrently with data collection in an iterative process informing adaptations to the interview topic guide when deemed necessary. Constant comparative analysis was used to develop themes. We ceased data collection when information sufficiency was achieved. RESULTS Participants described how active engagement of patients in discussing options and decision making was influenced by contextual factors (patient characteristics, logistical factors such as available time, and supervisors' recommendations) and by limitations in their medical and shared decision-making knowledge. The residents' decision-making behavior appeared strongly affected by their conviction that they are responsible for arriving at the correct diagnosis and providing the best evidence-based treatment. They described shared decision making as the process of patients consenting with physician-recommended treatment or patients choosing their preferred option when no best evidence-based option was available. CONCLUSIONS Residents' decision making appears to be affected by contextual factors, their medical knowledge, their knowledge about SDM, and by their beliefs and convictions about their professional responsibilities as a doctor, ensuring that patients receive the best possible evidence-based treatment. They confuse SDM with acquiring informed consent with the physician's treatment recommendations and with letting patients decide which treatment they prefer in case no evidence based guideline recommendation is available. Teaching SDM to residents should not only include skills training, but also target residents' perceptions and convictions regarding their role in the decision-making process in consultations.
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Affiliation(s)
- Ellen M Driever
- Department of Innovation and Research, Isala Hospital, Dokter van Heesweg 2, 8025, AB, Zwolle, the Netherlands.
- Lifelong Learning Education and Assessment Research Network (LEARN), University Medical Centre Groningen, Groningen, the Netherlands.
| | - Ivo M Tolhuizen
- Faculty of Medical Science, University Medical Centre of Groningen, Groningen, the Netherlands
| | - Robbert J Duvivier
- Centre for Education Development and Research in Health Professions (CEDAR), University Medical Centre Groningen, Groningen, the Netherlands
- Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - Anne M Stiggelbout
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Paul L P Brand
- Lifelong Learning Education and Assessment Research Network (LEARN), University Medical Centre Groningen, Groningen, the Netherlands
- Department of Medical Education and Faculty Development, Isala Hospital, Zwolle, the Netherlands
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Møller JE, Henriksen J, Søjnæs C, Brøgger MN. Doctors' experiences of earlier mandatory postgraduate communication skills training: a qualitative study. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2022; 13:47-55. [PMID: 35247250 PMCID: PMC9017507 DOI: 10.5116/ijme.6213.7ee7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Jane Ege Møller
- Department of Clinical Medicine, HEALTH, Aarhus University, Denmark
| | - Jakob Henriksen
- Department of Clinical Pharmacology, Aarhus University Hospital, Denmark
| | - Charlotte Søjnæs
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, The Capital Region of Denmark, Denmark
| | - Matilde Nisbeth Brøgger
- Center for Health Communication, School of Communication and Culture, ARTS, Aarhus University, Denmark
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Nabeel M, Prasad RM, Kemnic T, Wang L, Khan NNS. Structured, Timely, and Individualized Patient Feedback to Residents and its Effect on HCAHPS Scores. J Patient Exp 2022; 9:23743735221112583. [PMID: 35836777 PMCID: PMC9274411 DOI: 10.1177/23743735221112583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Physician communication is integral for improving patients’ experience and
clinical outcomes. Hospital Consumer Assessment of Healthcare Providers and
Systems (HCAHPS) scores are used by the Centers for Medicare & Medicaid
Services to assess the quality of care provided to the patients. We conducted a
prospective pre–post-intervention study from March 2018 to March 2020 and
included patients and residents of the community-based university-affiliated
Internal Medicine Residency Program. Residents’ communication was evaluated
through resident surveys and results were shared with them and attending
physicians within 48 h. To correlate with the effect over a 4-year period, 839
HCAHPS surveys were obtained for attending physicians as an outcome measure. The
mean overall HCAHPS score and doctor's communication scores increased by 8.52
and 6.06 points post-intervention. The doctor's performance score for respect
increased by 6.18 points, listening increased by 3.12 points, and explanation
increased by 8.23 points. This study demonstrates that timely, structured, and
individualized resident feedback in an academic medicine service can result in a
sustainable increase in the attendings’ overall HCAHPS and doctor's
communication scores.
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Affiliation(s)
| | | | - Tyler Kemnic
- Michigan State University, East Lansing, MI, USA
| | - Ling Wang
- Michigan State University, East Lansing, MI, USA
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van Veenendaal H, Voogdt-Pruis HR, Ubbink DT, van Weele E, Koco L, Schuurman M, Oskam J, Visserman E, Hilders CGJM. Evaluation of a multilevel implementation program for timeout and shared decision making in breast cancer care: a mixed methods study among 11 hospital teams. PATIENT EDUCATION AND COUNSELING 2022; 105:114-127. [PMID: 34016497 DOI: 10.1016/j.pec.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Evaluation of a multilevel implementation program on shared decision making (SDM) for breast cancer clinicians. METHODS The program was based on the 'Measurement Instrument for Determinants of Innovations-model' (MIDI). Key factors for effective implementation were included. Eleven breast cancer teams selected from two geographical areas participated; first six surgery teams and second five systemic therapy teams. A mixed method evaluation was carried out at the end of each period: Descriptive statistics were used for surveys and thematic content analysis for semi-structured interviews. RESULTS Twenty-eight clinicians returned the questionnaire (42%). Clinicians (96%) endorse that SDM is relevant to breast cancer care. The program supported adoption of SDM in their practice. Limited financial means, time constraints and concurrent activities were frequently reported barriers. Interviews (n = 21) showed that using a 4-step SDM model - when reinforced by practical examples, handy cards, feedback and training - helped to internalize SDM theory. Clinicians experienced positive results for their patients and themselves. Task re-assignment and flexible outpatient planning reinforce sustainable change. Patient involvement was valued. CONCLUSION Our program supported breast cancer clinicians to adopt SDM. PRACTICE IMPLICATIONS To implement SDM, multilevel approaches are needed that reinforce intrinsic motivation by demonstrating benefits for patients and clinicians.
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Affiliation(s)
- Haske van Veenendaal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands; Dutch Association of Oncology Patient Organizations, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands.
| | - Helene R Voogdt-Pruis
- Dutch Association of Oncology Patient Organizations, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands; UMCU Julius Global Health, PO box 85500, 3508 GA Utrecht, Netherlands.
| | - Dirk T Ubbink
- Amsterdam University Medical Centers, location Academic Medical Center, Department of Surgery, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Esther van Weele
- Dutch Association of Oncology Patient Organizations, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands; Vestalia, Acaciapark 136, 1213 LD Hilversum, The Netherlands.
| | - Lejla Koco
- Radboud University Medical Center, Department of Radiology and Nuclear Medicine, Geert Grooteplein Zuid 22, 6525 GA Nijmegen, The Netherlands.
| | - Maaike Schuurman
- Dutch Association of Breast Cancer Patients, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands.
| | - Jannie Oskam
- Dutch Association of Breast Cancer Patients, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands.
| | - Ella Visserman
- Dutch Association of Oncology Patient Organizations, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands.
| | - Carina G J M Hilders
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands; Reinier de Graaf Hospital, Board of Directors, Reinier de Graafweg 5, 2625 AD Delft, The Netherlands.
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13
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van Veenendaal H, Peters LJ, Ubbink DT, Stubenrouch FE, Stiggelbout AM, Brand PL, Vreugdenhil G, Hilders CG. Effectiveness of individual feedback and coaching on shared decision-making consultations in oncology care: Study protocol for a randomized clinical trial (Preprint). JMIR Res Protoc 2021; 11:e35543. [PMID: 35383572 PMCID: PMC9021945 DOI: 10.2196/35543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background Shared decision-making (SDM) is particularly important in oncology as many treatments involve serious side effects, and treatment decisions involve a trade-off between benefits and risks. However, the implementation of SDM in oncology care is challenging, and clinicians state that it is difficult to apply SDM in their actual workplace. Training clinicians is known to be an effective means of improving SDM but is considered time consuming. Objective This study aims to address the effectiveness of an individual SDM training program using the concept of deliberate practice. Methods This multicenter, single-blinded randomized clinical trial will be performed at 12 Dutch hospitals. Clinicians involved in decisions with oncology patients will be invited to participate in the study and allocated to the control or intervention group. All clinicians will record 3 decision-making processes with 3 different oncology patients. Clinicians in the intervention group will receive the following SDM intervention: completing e-learning, reflecting on feedback reports, performing a self-assessment and defining 1 to 3 personal learning questions, and participating in face-to-face coaching. Clinicians in the control group will not receive the SDM intervention until the end of the study. The primary outcome will be the extent to which clinicians involve their patients in the decision-making process, as scored using the Observing Patient Involvement–5 instrument. As secondary outcomes, patients will rate their perceived involvement in decision-making, and the duration of the consultations will be registered. All participating clinicians and their patients will receive information about the study and complete an informed consent form beforehand. Results This trial was retrospectively registered on August 03, 2021. Approval for the study was obtained from the ethical review board (medical research ethics committee Delft and Leiden, the Netherlands [N20.170]). Recruitment and data collection procedures are ongoing and are expected to be completed by July 2022; we plan to complete data analyses by December 2022. As of February 2022, a total of 12 hospitals have been recruited to participate in the study, and 30 clinicians have started the SDM training program. Conclusions This theory-based and blended approach will increase our knowledge of effective and feasible training methods for clinicians in the field of SDM. The intervention will be tailored to the context of individual clinicians and will target the knowledge, attitude, and skills of clinicians. The patients will also be involved in the design and implementation of the study. Trial Registration Netherlands Trial Registry NL9647; https://www.trialregister.nl/trial/9647 International Registered Report Identifier (IRRID) DERR1-10.2196/35543
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Affiliation(s)
- Haske van Veenendaal
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
- Dutch Association of Oncology Patient Organizations, Utrecht, Netherlands
| | - Loes J Peters
- Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Dirk T Ubbink
- Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | | | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, Netherlands
| | - Paul Lp Brand
- Department of Innovation and Research, Isala Hospital, Zwolle, Netherlands
| | | | - Carina Gjm Hilders
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
- Board of Directors, Reinier de Graaf Hospital, Delft, Netherlands
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14
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Vipler B, Knehans A, Rausa D, Haidet P, McCall-Hosenfeld J. Transformative Learning in Graduate Medical Education: A Scoping Review. J Grad Med Educ 2021; 13:801-814. [PMID: 35070093 PMCID: PMC8672835 DOI: 10.4300/jgme-d-21-00065.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 06/29/2021] [Accepted: 08/16/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Transformative learning (TL) is an educational theory focused on deep fundamental shifts in an individual's worldview. Such shifts are well known to occur within graduate medical education (GME). However, TL in GME has yet to be formally explored. OBJECTIVE We performed a scoping review of the literature on TL within GME to identify areas where trainees currently experience or have potential to experience TL, and to explore areas where fostering TL has been used as a pedagogical tool. METHODS In January 2020, we searched 7 databases to identify literature on TL in GME. Additional articles were identified by hand-searching the Journal of Graduate Medical Education. RESULTS A total of 956 articles were identified through database search with 3 unique articles found via hand-searching. Abstracts and manuscripts were screened by 2 authors and disagreements arbitrated by a third, yielding 28 articles for our analysis. The main components of TL (disorienting dilemma, reflection, discourse, action) took various forms. TL was closely linked with professionalism training and professional identity formation. Training programs in primary care fields were most frequently referenced. Often, trainees were experiencing TL without recognition of the theory by their educators. Gaps in the graduate medical education literature exist pertaining to TL in venues such as diversity, equity, and inclusion. CONCLUSIONS Our scoping review uncovered the following themes: TL and professionalism, TL and primary care, and TL by other names. TL is likely occurring but going unrecognized in some settings.
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Affiliation(s)
- Benjamin Vipler
- Benjamin Vipler, MD, MEd, is a Hospitalist, Division of Hospital Medicine, University of Colorado Hospital, and Assistant Professor, University of Colorado School of Medicine
| | - Amy Knehans
- Amy Knehans, MLIS, is Associate Librarian, George T. Harrell Health Sciences Library, Penn State Health Milton S. Hershey Medical Center
| | - Daniel Rausa
- Daniel Rausa, DO, is General Internist, Directorate for Primary Care, Captain James A. Lovell Federal Health Care Center, and Clinical Instructor, Department of Medicine, Rosalind Franklin University of Medicine and Science
| | - Paul Haidet
- Paul Haidet, MD, MPH, is General Internist, Division of General Internal Medicine, Penn State Health Milton S. Hershey Medical Center, and Distinguished Professor of Medicine, Public Health Sciences, and Humanities, Penn State College of Medicine
| | - Jennifer McCall-Hosenfeld
- Jennifer McCall-Hosenfeld, MD, MSc, is General Internist, Division of General Internal Medicine, Penn State Health Milton S. Hershey Medical Center, and Associate Dean for Faculty and Professional Development, Associate Professor of Medicine and Public Health Sciences, Penn State University College of Medicine
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15
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Derksen FAWM, Olde Hartman TC, Lagro-Janssen ALM, Kramer AWM. Clinical empathy in GP-training: Experiences and needs among Dutch GP-trainees. "Empathy as an element of personal growth". PATIENT EDUCATION AND COUNSELING 2021; 104:3016-3022. [PMID: 33863583 DOI: 10.1016/j.pec.2021.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Clinical empathy has been described as a key component of effective person-centeredness in patient-physician communication. Yet little is known about general practitioner (GP) trainees' experiences and opinions regarding clinical empathy, empathy-education and the development of empathic skills. This study aimed to explore trainees' experiences with clinical empathy during GP training. METHODS This study used focus group interviews. GP trainees at two Dutch universities were approached by e-mail. Focus groups were conducted between April and November 2018. Six focus groups were conducted: two with starting trainees, two with trainees at the end of their first year and two with trainees at the end of their 3 years' training. Two experienced qualitative researchers analyzed the focus groups. During the thematic analysis the differences and similarities between the various stages of education were taken into account and a framework for the identified themes and subthemes was developed. RESULTS Thirty-five GP trainees took part. Four main themes could be identified. Starting trainees experienced frictions regarding the influence of personal affective reactions on their medical competencies. Trainees at the end of their first year indicated that they reached a balance between empathic involvement and their responsibility to carry out relevant medical tasks, such as following GP guidelines. Trainees at the end of their three years' training recognized the mutual relationship between the development of the behavioral part of clinical empathy and personal growth. All trainees stated that their needs concerning education changed during their GP training and proposed changes to the curriculum. CONCLUSIONS GP trainees face various obstacles in developing empathic skills and behavior. Particularly they mention handling personal affective reactions. Trainees express a clear wish for clinical empathy, in its theoretical as well as its skill and emotional aspects, to play a central role in the curriculum. PRACTICE IMPLICATIONS More explicit attention to be paid to empathy by embedding theoretical education, explicit attention to skill training and assessment of empathic behavior by patients and supervisors.
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Affiliation(s)
- F A W M Derksen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - T C Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A L M Lagro-Janssen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A W M Kramer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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16
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Kappy B, Herrmann LE, Schumacher DJ, Statile AM. Building a doctor, one skill at a time: Rethinking clinical training through a new skills-based feedback modality. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:304-311. [PMID: 34037967 PMCID: PMC8505598 DOI: 10.1007/s40037-021-00666-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/30/2021] [Accepted: 04/21/2021] [Indexed: 05/12/2023]
Abstract
The Accreditation Council for Graduate Medical Education milestones and entrustable professional activities (EPAs) are important assessment approaches but may lack specificity for learners seeking improvement through daily feedback. As in other professions, clinicians grow best when they engage in deliberate practice of well-defined skills in familiar contexts. This growth is augmented by specific, actionable coaching from supervisors. This article proposes a new feedback modality called microskills, which are derived from the psychology, negotiation, and business literature, and are unique in their ability to elicit targeted feedback for trainee development. These microskills are grounded in both clinical and situational contexts, thereby mirroring learners' cognitive schemas and allowing for more natural skill selection and adoption. When taken as a whole, microskills are granular actions that map to larger milestones, competencies, and EPAs. This article outlines the theoretical justification for this new skills-based feedback modality, the methodology behind the creation of clinical microskills, and provides a worked example of microskills for a pediatric resident on a hospital medicine rotation. Ultimately, microskills have the potential to complement milestones and EPAs and inform feedback that is specific, actionable, and relevant to medical learners.
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Affiliation(s)
- Brandon Kappy
- Department of Pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Lisa E Herrmann
- Department of Pediatrics, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Daniel J Schumacher
- Department of Pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Angela M Statile
- Department of Pediatrics, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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17
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Stalmeijer RE, Varpio L. The wolf you feed: Challenging intraprofessional workplace-based education norms. MEDICAL EDUCATION 2021; 55:894-902. [PMID: 33651450 PMCID: PMC8359828 DOI: 10.1111/medu.14520] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/29/2021] [Accepted: 02/26/2021] [Indexed: 05/26/2023]
Abstract
CONTEXT The trajectory towards becoming a medical professional is strongly situated within the clinical workplace. Through participatory engagement, medical trainees learn to address complex health care issues through collaboration with the interprofessional health care team. To help explain learning and teaching dynamics within the clinical workplace, many scholars have relied on socio-cultural learning theories. In the field of medical education, this research has largely adopted a limited interpretation of a crucial dimension within socio-cultural learning theory: the expert who guides the trainee into the community is almost exclusively from the same profession. We contend that this narrow interpretation is not necessary. This limited focus is one we choose to maintain-be that choice intentional or implicit. In this cross-cutting edge paper, we argue that choosing an interprofessional orientation towards workplace learning and guidance may better prepare medical trainees for their future role in health care practice. METHODS By applying Communities of Practice and Landscapes of Practice , and supported by empirical examples, we demonstrate how medical trainees are not solely on a trajectory towards the Community of Physician Practice (CoPP) but also on a trajectory towards various Landscapes of Healthcare Practice (LoHCP). We discuss some of the barriers present within health care organisations and professions that have likely inhibited adoption of the broader LoHCP perspective. We suggest three perspectives that might help to deliberately and meaningfully incorporate the interprofessional learning and teaching dynamic within the medical education continuum. CONCLUSION Systematically incorporating Landscapes of Competence, Assessment, and Guidance in workplace-based education-in addition to our current intraprofessional approach-can better prepare medical trainees for their roles within the LoHCP. By advocating and researching this interprofessional perspective, we can embark on a journey towards fully harnessing and empowering the health care team within workplace-based education.
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Affiliation(s)
- Renée E. Stalmeijer
- School of Health Professions EducationFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Lara Varpio
- Center for Health Professions EducationDepartment of MedicineUniformed Services University of the Health SciencesBethesdaMDUSA
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18
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Wisener KM, Driessen EW, Cuncic C, Hesse CL, Eva KW. Incentives for clinical teachers: On why their complex influences should lead us to proceed with caution. MEDICAL EDUCATION 2021; 55:614-624. [PMID: 33222291 DOI: 10.1111/medu.14422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION When medical education programs have difficulties recruiting or retaining clinical teachers, they often introduce incentives to help improve motivation. Previous research, however, has shown incentives can unfortunately have unintended consequences. When and why that is the case in the context of incentivizing clinical teachers remains unclear. The purposes of this study, therefore, were to understand what values and motivations influence teaching decisions; and to delve deeper into how teaching incentives have been perceived. METHODS An interpretive description methodology was used to improve understanding of the development and delivery of teaching incentives. A purposeful sampling strategy identified a heterogenous sample of clinical faculty teaching in undergraduate and postgraduate contexts. Sixteen semi-structured interviews were conducted and transcripts were analyzed using an iterative process to develop a thematic structure that accounts for general trends and individual variations. RESULTS Clinicians articulated interrelated and dynamic personal and environmental factors that had linear, dual-edged and inverted U-shaped impacts on their motivations towards teaching. Barriers were frequently rationalized away, but cumulative barriers often led to teaching attrition. Clinical teachers were motivated when they felt valued and connected to their learners, peers, leadership, and/or the medical education community. While incentives aimed at producing these connections could be perceived as supportive, they could also negatively impact motivation if they were impersonal, inequitable, inefficient, or poorly framed. DISCUSSION/CONCLUSION These findings reinforce the literature suggesting that it is necessary to proceed with caution when labeling any particular factor as a motivator or barrier to teaching. They take us deeper, however, towards understanding how and why clinical teachers' perceptions are unique, dynamic and fluid. Incentive schemes can be beneficial for teacher recruitment and retention, but must be designed with nuance that takes into account what makes clinicians feel valued if the strategy is to do more good than harm.
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Affiliation(s)
- Katherine M Wisener
- Office of Faculty Development, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Erik W Driessen
- Department of Educational Development and Research, Faculty of Medicine, University of Maastricht, Maastricht, The Netherlands
| | - Cary Cuncic
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Cassandra L Hesse
- Department of Educational and Counseling Psychology, and Special Education, Faculty of Education, Vancouver, BC, Canada
| | - Kevin W Eva
- Department of Medicine, Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC, Canada
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19
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Draaisma E, Maggio LA, Bekhof J, Jaarsma ADC, Brand PLP. Impact of deliberate practice on evidence-based medicine attitudes and behaviours of health care professionals. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:118-124. [PMID: 33242154 PMCID: PMC7952477 DOI: 10.1007/s40037-020-00634-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 09/24/2020] [Accepted: 11/05/2020] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Although evidence-based medicine (EBM) teaching activities may improve short-term EBM knowledge and skills, they have little long-term impact on learners' EBM attitudes and behaviour. This study examined the effects of learning EBM through stand-alone workshops or various forms of deliberate EBM practice. METHODS We assessed EBM attitudes and behaviour with the evidence based practice inventory questionnaire, in paediatric health care professionals who had only participated in a stand-alone EBM workshop (controls), participants with a completed PhD in clinical research (PhDs), those who had completed part of their paediatric residency at a department (Isala Hospital) which systematically implemented EBM in its clinical and teaching activities (former Isala residents), and a reference group of paediatric professionals currently employed at Isala's paediatric department (current Isala participants). RESULTS Compared to controls (n = 16), current Isala participants (n = 13) reported more positive EBM attitudes (p < 0.01), gave more priority to using EBM in decision making (p = 0.001) and reported more EBM behaviour (p = 0.007). PhDs (n = 20) gave more priority to using EBM in medical decision making (p < 0.001) and reported more EBM behaviour than controls (p = 0.016). DISCUSSION Health care professionals exposed to deliberate practice of EBM, either in the daily routines of their department or by completing a PhD in clinical research, view EBM as more useful and are more likely to use it in decision making than their peers who only followed a standard EBM workshop. These findings support the use of deliberate practice as the basis for postgraduate EBM educational activities.
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Affiliation(s)
- Eelco Draaisma
- Lifelong Learning, Education & Assessment Research Network (LEARN), University Medical Centre Groningen, Groningen, The Netherlands.
- Women and Children's Centre, Isala Hospital, Zwolle, The Netherlands.
| | - Lauren A Maggio
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Jolita Bekhof
- Women and Children's Centre, Isala Hospital, Zwolle, The Netherlands
| | - A Debbie C Jaarsma
- Lifelong Learning, Education & Assessment Research Network (LEARN), University Medical Centre Groningen, Groningen, The Netherlands
| | - Paul L P Brand
- Lifelong Learning, Education & Assessment Research Network (LEARN), University Medical Centre Groningen, Groningen, The Netherlands
- Women and Children's Centre, Isala Hospital, Zwolle, The Netherlands
- Isala Academy, Department of Medical Education and Faculty Development, Isala Hospital, Zwolle, The Netherlands
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20
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Chang SL, Kuo MJ, Lin YJ, Chen SA, Yang YY, Cheng HM, Yang LY, Kao SY, Lee FY. Virtual reality informative aids increase residents' atrial fibrillation ablation procedures-related knowledge and patients' satisfaction. J Chin Med Assoc 2021; 84:25-32. [PMID: 33230060 DOI: 10.1097/jcma.0000000000000464] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia, and increasing numbers of patients receive AF ablation nowadays. Therefore, in the cardiology division, residents need to be familiar with the AF ablation procedure-related knowledge for primary care. This study evaluated the baseline residents and patients' self-efficacy to the AF ablation procedure-related knowledge, developed the specific virtual reality (VR) informative aids, and evaluated the effects of VR training and resident-led VR aids-based patient education on their self-efficacy, in the aspects of familiarity, confidence and anxiety, and satisfaction. METHODS From 2019, April to 2020, April, this 1-year prospective prestudy and poststudy was undergone in the cardiology division. Between 2019, April and 2019, December, the experienced physicians were invited to develop VR informative aids for AF ablation procedure-related knowledge. Between January 2020 and April 2020, newly developed VR informative aids were implemented in the educational program of training rotated residents for giving patient education. RESULT A total of 20 residents and 32 patients were enrolled. The baseline self-reported self-efficacy and knowledge scores were relatively low among rotated residents and their patients. In addition to the high level of satisfaction, self-efficacy and knowledge scores of residents and their patients were increased after VR aids-based training and resident-led patient education. Higher degree of improvement in self-efficacy was noted among patients with depression/anxiety history than those without history. The follow-up assessments among residents showed that the positive effects of VR aids were sustained until 2 weeks later. CONCLUSION Overall, residents and patients reported that the VR aids increase the effectiveness of patient education, achieve the purpose of a paperless environment, and motivate them to recommend it to others. The implementation of resident-to-patient education has a positive impact on trainees and patients understanding about AF ablation procedures-related knowledge.
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Affiliation(s)
- Shih-Lin Chang
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ming-Jen Kuo
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yenn-Jiang Lin
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shih-Ann Chen
- Vice Superintendent, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ying-Ying Yang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Clinical Skills Training, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hao-Min Cheng
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ling-Yu Yang
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shou-Yen Kao
- Vice Superintendent, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Vice Superintendent, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Baugh AD, Vanderbilt AA, Baugh RF. Communication training is inadequate: the role of deception, non-verbal communication, and cultural proficiency. MEDICAL EDUCATION ONLINE 2020; 25:1820228. [PMID: 32938330 PMCID: PMC7534221 DOI: 10.1080/10872981.2020.1820228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 05/29/2023]
Abstract
In this commentary, we argue that the limited experiential exposure of medical students to different cultures makes the instruction devoted to communication skills inadequate. The relationship of these dynamics to honesty in clinical encounters is explored. Absent significant experiential exposure to differing group cultures to counter the natural tendency to favor one's own, discrimination prevails. Knowledge or awareness of cultural differences does not necessarily equate to communication proficiency. Critically, interactions based on lived experience offer a deeper knowledge and understanding of culturally meaningful nuances than that imparted through other formats. Medical students' lack of experiential exposure to different cultures results in communication miscues. When the stakes are high, people detect those miscues diminishing trust in the doctor-patient relationship. Greater experiential cultural exposure will enhance the facility and use of culturally specific communication cues. At its core, the requisite transformation will require medical students to adapt to other cultures and greater representation by marginalized and stigmatized populations not only among the studentry but staff and faculty. The time is now to ensure that the physicians we produce can care for all Americans. What cannot be taught must be identified by the selection process. Competence with half the population is a failure for American medicine.
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Affiliation(s)
- Aaron D. Baugh
- Pulmonary, Critical Care, Allergy, Sleep Medicine, Department of Internal Medicine, University of California San Francisco Medical School, San Francisco, CA, USA
| | | | - Reginald F. Baugh
- Department of Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
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A qualitative exploration of clinicians' strategies to communicate risks to patients in the complex reality of clinical practice. PLoS One 2020; 15:e0236751. [PMID: 32790675 PMCID: PMC7425874 DOI: 10.1371/journal.pone.0236751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Risk communication, situated in the model of shared decision making (SDM), is an essential element in daily clinical practice. The scientific literature makes a number of generic recommendations. Yet the application of risk communication remains a challenge in patient-clinician encounters. How clinicians actually communicate risk during consultations is not well understood. We aimed to explore the risk communication strategies used by clinicians and extract narratives and visualizations of those strategies to help inform medical education. METHODS In this qualitative descriptive study, we interviewed fifteen purposely sampled clinicians from several medical disciplines, who were familiar with the concept of SDM. Deductive and inductive content analysis was used during an iterative data collection and analyses process. RESULTS Our study identified various strategies reported to be used by clinicians to address the complexities of risk communication such as dealing with uncertainty. These included verbal, numerical and visual risk communication and framing. Clinicians were familiar with recommended risk formats such as natural frequencies and population pictograms. However, it became clear that clinicians' expertise and communication goals also play an important role in the risk talk. Clinicians try to lay a foundation for balanced decision-making and to incorporate patient preferences while faced with several challenges such as the dilemma of raising awareness but triggering anxiety or fan fear in patients. Consequently, they also use communication goals such as influencing mindset and reassuring patients. Additionally, clinicians frequently have to account for the illusion of certainty in the risk talk. CONCLUSION Risk communication is a multi-faceted construct that cannot be dealt with in isolation from the clinical context. For future research we recommend considering a more practical framework within the clinical setting and to take a goal-directed approach into account when investigating and teaching the topic. The patient perspective should also be addressed in further research.
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Glod SA, Kang A, Wojnar M. Family Meeting Training Curriculum: A Multimedia Approach With Real-Time Experiential Learning for Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10883. [PMID: 32175474 PMCID: PMC7062545 DOI: 10.15766/mep_2374-8265.10883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Effective communication skills are widely recognized as an important aspect of medical practice. Several tools and curricula for communications training in medicine have been proposed, with increasing attention to the need for an evidence-based curriculum for communication with families of patients in the intensive care unit (ICU). METHODS We developed a curriculum for internal medicine residents rotating through the medical ICU that consisted of a didactic session introducing basic and advanced communication skills, computer-based scenarios exposing participants to commonly encountered dilemmas in simulated family meetings, and experiential learning through the opportunity to identify potential communication challenges prior to facilitating actual family meetings, followed by structured peer debriefing. Seventeen residents participated in the study. RESULTS We administered the Communication Skills Attitude Scale to participants before and after participation in the curriculum, as well as a global self-efficacy survey, with some items based on the Common Ground rating instrument, at the end of the academic year. There were no significant changes in either positive or negative attitudes toward learning communication skills. Resident self-perceived efficacy in several content domains improved but did not reach statistical significance. DISCUSSION Our curriculum provided interactive preparatory training and an authentic experience for learners to develop skills in family meeting facilitation. Learners responded favorably to the curriculum. Use of the Family Meeting Behavioral Skills (FMBS) tool helped residents and educators identify and focus on specific skills related to the family meeting. Next steps include gathering and analyzing data from the FMBS tool.
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Affiliation(s)
- Susan A. Glod
- Associate Professor, Department of Medicine, Penn State College of Medicine
- Medicine Clerkship Director, Penn State College of Medicine
| | - Ashley Kang
- Resident, Internal Medicine Residency Program, Montefiore Medical Center
| | - Margaret Wojnar
- Professor, Department of Medicine, Penn State College of Medicine
- Pulmonary/Critical Care Fellowship Director, Penn State College of Medicine
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Ruiz Moral R, García de Leonardo C, Cerro Pérez A, Caballero Martínez F, Monge Martín D. Barriers to teaching communication skills in Spanish medical schools: a qualitative study with academic leaders. BMC MEDICAL EDUCATION 2020; 20:41. [PMID: 32041592 PMCID: PMC7011270 DOI: 10.1186/s12909-020-1944-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/23/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND In recent years, Spanish medical schools (MSs) have incorporated training in communication skills (CS), but how this training is being carried out has not yet been evaluated. OBJECTIVE To identify the barriers to the introduction and development of CS teaching in Spanish MSs. METHODS In a previous study, 34 MSs (83% of all MSs in Spain) were invited to participate in a study that explored the factual aspects of teaching CS in these schools. The person responsible for teaching CS at each school was contacted again for this study and asked to respond to a single open-ended question. Two researchers independently conducted a thematic analysis of the responses. RESULTS We received responses from 30 MSs (85.7% of those contacted and 73% of all MSs in Spain). Five main thematic areas were identified, each with different sub-areas: negative attitudes of teachers and academic leaders; organisation, structure and presence of CS training in the curriculum; negative attitudes of students; a lack of trained teachers; and problems linked to teaching methods and necessary educational logistics. CONCLUSIONS The identified barriers and problems indicate that there are areas for improvement in teaching CS in most Spanish MSs. There seems to be a vicious circle based on the dynamic relationship and interdependence of all these problems that should be faced with different strategies and that requires a significant cultural shift as well as decisive institutional support at the local and national levels. The incorporation of CS training into MS curricula represents a major challenge that must be addressed for students to learn CS more effectively and avoid negative attitudes towards learning CS.
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Affiliation(s)
- Roger Ruiz Moral
- Department of Medical Education, School of Medicine, Faculty of Health Sciences, Universidad Francisco de Vitoria (UFV), Edificio E. Ctra M-515 Pozuelo-Majadahonda, 3028 Madrid, Spain
| | | | | | | | - Diana Monge Martín
- Family and Preventive Medicine, Epidemiology and Statistics, School of Health Sciences (UFV), Madrid, Spain
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van der Vleuten C, van den Eertwegh V, Giroldi E. Assessment of communication skills. PATIENT EDUCATION AND COUNSELING 2019; 102:2110-2113. [PMID: 31351785 DOI: 10.1016/j.pec.2019.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/06/2019] [Indexed: 05/26/2023]
Abstract
OBJECTIVE This paper addresses how communication skills can best be assessed. Since assessment and learning are strongly connected, the way communication skills are best learned is also described. RESULTS Communication skills are best learned in a longitudinal fashion with ample practice in an authentic setting. Confrontation of behavior initiates the learning process and should be supported by meaningful feedback through direct observation. When done appropriately a set of (learned) communication skills become integrated skilled communication, being versatilely used in purposeful goal-oriented clinical communication. The assessment of communication skills should follow a modern approach to assessment where the learning function of assessment is considered a priority. Individual assessments are feedback-oriented to promote further learning and development. The resulting rich information may be used to make progression decisions, usually in a group or committee decision. CONCLUSION This modern programmatic approach to assessment fits the learning of skilled communication well. PRACTICE IMPLICATIONS Implementation of a programmatic assessment approach to communication will entail a major innovation to education.
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Affiliation(s)
- Cees van der Vleuten
- Maastricht University, Department of Educational Development and Research, School of Health Professions Education(SHE), Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands.
| | - Valerie van den Eertwegh
- Maastricht University, Skillslab, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands
| | - Esther Giroldi
- Maastricht University, Department of Educational Development and Research, School of Health Professions Education(SHE), Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands; Maastricht University, Department of Family Medicine, Care and Public, Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands
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Lombardo L, Ehlers J, Lutz G. Is your mind set? - how are intra- and interpersonal competences dealt with in medical education? A multi-professional qualitative study. BMC MEDICAL EDUCATION 2019; 19:317. [PMID: 31438949 PMCID: PMC6704522 DOI: 10.1186/s12909-019-1748-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 08/12/2019] [Indexed: 05/16/2023]
Abstract
BACKGROUND Professional intrapersonal and interpersonal competences (IICs) form an important part of medical expertise but are given little attention during clinical training. In other professional fields such as psychotherapy, education and aviation, training in IICs is an integral part of education and practice. In medicine, IICs tend to actually decline during studies. To date it is unclear why IICs are given less attention in medicine, despite evidence for their importance in the treatment process. In view of this, the study examined the role of IICs in the treatment process, the current situation of IIC training in medicine and, most importantly, the reasons for the comparatively low focus on IICs in the clinical training of medical students. METHODS Semi-structured interviews were carried out with 21 experts from a variety of medical specialties and non-medical professions that provide a training with a stronger focus on IIC development. The interviews were evaluated using grounded theory. RESULTS The experts confirmed the idea that IICs are an equally important component in the treatment process, along with medical knowledge and technical skills. They also described large differences between the IICs possessed by physicians but noted a general developmental need. The key shortcoming was perceived to be a deep-seated defensiveness towards learning from mistakes and deficits e.g. through reflection and feedback. The interaction of different factors that seem to be reasons for this defensiveness and perpetuate it were identified: lack of support in dealing with insecurities in the face of responsibility; the notion of medicine as a science with the categories of right and wrong answers; and a range of pressures arising from the setting, such as hierarchical, economic and competition pressures. CONCLUSION Our study showed, that the defensive attitude towards learning from mistakes and deficits especially in the field of IICs appears to be a subtle but powerful obstacle for implementing IICs in medical training, in contrast to other professional fields. This obstacle is sustained by various underlying barrier factors. We therefore propose that changes should be made within a cultural transformation targeting this defensive mindset and culture and its presumed reasons.
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Affiliation(s)
- Lisa Lombardo
- Institute for Didactics and Educational Research in Health Care, Department of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455 Witten, Germany
- Integrated Curriculum for Anthroposophic Medicine (ICURAM), Medical Theory, Integrative and Anthroposophic Medicine, Department of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455 Witten, Germany
| | - Jan Ehlers
- Chair for Didactics and Educational Research in Health Care, Department of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455 Witten, Germany
| | - Gabriele Lutz
- Integrated Curriculum for Anthroposophic Medicine (ICURAM), Chair for Medical Theory, Integrative and Anthroposophic Medicine, Department of Medicine, Faculty of Health, Witten / Herdecke University, Gerhard Kienle Weg 4, 58313 Herdecke, Germany
- Department of Psychosomatic Medicine, Gemeinschaftskrankenhaus Herdecke, Gerhard Kienle Weg 4, 58313 Herdecke, Germany
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Skelly K, Rosenbaum M, Barlow P, Priebe G. Comparing resident-patient encounters and case presentations in a family medicine clinic. MEDICAL EDUCATION 2019; 53:677-686. [PMID: 30761598 PMCID: PMC6570533 DOI: 10.1111/medu.13806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/11/2018] [Accepted: 12/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Oral case presentations following resident-patient interactions provide the primary mechanism by which faculty supervisors assess resident competence. However, the extent to which these presentations capture the content and quality of resident-patient communication during the encounter remains unknown. We aimed to determine whether: (i) the resident-patient encounter content matched information conveyed in the case presentation; (ii) the quality of resident-patient communication was accurately conveyed, and (iii) supervisors addressed effective and ineffective communication processes. METHODS A total of 22 pairs of resident-patient encounters and family medicine resident case presentations were video- or audiorecorded, transcribed and compared for content. Resident-patient communication was assessed using adapted versions of the Calgary-Cambridge Guide to the Medical Interview and Explanation and Planning Scale. RESULTS Interviews and presentations contained largely congruent content, but social history and the patient's perspective were consistently excluded from case presentations. Although six of 19 specific communication skills were used in over 80% of resident encounters, the effective use of communication skills was widely variable. In most presentations, the quality of resident-patient communication was not explicitly conveyed to the supervisor. Although resident presentations provided 'cues' about communication issues, supervisors rarely responded. CONCLUSIONS This study lends support to direct observation in workplace-based learning of communication skills. When content areas such as the patient's perspective and education are excluded, supervisors cannot address them. In addition, presentations provided minimal insight about the quality of resident-patient encounters and limited the ability to address communication skills. These skills could be enhanced by attending to communication cues during case presentations, making increased use of direct observation and feedback, and promoting faculty development to address these missed teaching opportunities.
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Affiliation(s)
- Kelly Skelly
- Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Marcy Rosenbaum
- Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Patrick Barlow
- Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Garrick Priebe
- Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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Rubinelli S, Silverman J, Aelbrecht K, Deveugele M, Finset A, Humphris G, Martin P, Rosenbaum M, van Dulmen S, van Weel-Baumgarten E. Developing the International Association for Communication in Healthcare (EACH) to address current challenges of health communication. PATIENT EDUCATION AND COUNSELING 2019; 102:1217-1221. [PMID: 30661729 DOI: 10.1016/j.pec.2019.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 12/30/2018] [Accepted: 01/05/2019] [Indexed: 06/09/2023]
Abstract
In 2017, EACH celebrated its change of name from European Association for Communication in Healthcare to EACH: International Association for Communication in Healthcare. This paper aims to present the developments and achievements of EACH over the past five years with a focus on its mission in promoting and advancing the field of communication in healthcare. Specifically, the paper focuses on how EACH, first, promotes research in the field of health communication, second, provides support, resources and sharing for healthcare communication teachers and, third, aims at influencing policy through dissemination of evidence. This paper also explores future challenges and directions for EACH to further strengthen its impact by designing activities in knowledge transfer and knowledge dissemination, engaging with patients and truly benefitting from their expertise, fostering active participation and networking among its members, targeting interventions to the needs of different countries around the world and refining knowledge-sharing and cooperation both within the membership of EACH and outside the association to as wide an audience as possible. Scholars, educators and practitioners active in the field of healthcare communication are invited to comment on this paper and to actively contribute towards the goals of EACH.
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Affiliation(s)
- Sara Rubinelli
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Frohburgstrasse 3, P.O. Box 4466, 6002 Lucerne, Switzerland; Swiss Paraplegic Research, Guido Zäch Institute, Guido Zäch Strasse 4a, 6207 Nottwil, Switzerland.
| | - Jonathan Silverman
- School of Medicine, Deakin University, Australia; School of Clinical Medicine, University of Cambridge, UK.
| | - Karolien Aelbrecht
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, De Pintelaan 185, B-9000 Ghent, Belgium.
| | - Myriam Deveugele
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, De Pintelaan 185, B-9000 Ghent, Belgium.
| | - Arnstein Finset
- University of Oslo, Institute of Basic Medical Sciences, Department of Behavioural Sciences in Medicine, 1111, Blindern, N-0317 Oslo, Norway.
| | - Gerry Humphris
- University of St Andrews, Medical School, North Haugh, St Andrews, Fife, KY16 9TF, UK.
| | - Peter Martin
- Faculty of Health, Deakin University, Burwood, Victoria, Australia.
| | - Marcy Rosenbaum
- University of Iowa Carver College of Medicine, Iowa City, IA, US.
| | - Sandra van Dulmen
- Rodboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; NIVEL (Netherlands Institute for health services research), Utrecht, the Netherlands; Faculty of Health Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Evelyn van Weel-Baumgarten
- Rodboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands.
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Ruiz-Moral R, Gracia de Leonardo C, Caballero Martínez F, Monge Martín D. Medical students' perceptions towards learning communication skills: a qualitative study following the 2-year training programme. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2019; 10:90-97. [PMID: 31055522 PMCID: PMC6766390 DOI: 10.5116/ijme.5cbd.7e96] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/22/2019] [Indexed: 05/11/2023]
Abstract
OBJECTIVES This study aimed to gain an understanding of the perceptions of 4th-year medical students about a training course in communication skills with 'experiential learning' characteristics, completed over the past two years. METHODS Twenty 4th-year medical students were invited to participate in a qualitative study with focus groups. These students were selected randomly, stratifying by gender, from all 4th-year medical students (106) at the Francisco de Vitoria University (Madrid). The students had just completed their communication skills training taught in small groups, with simulated patient interviews and feedback. The focus-group facilitator used an open-ended discussion guide to explore the students' perceptions. Thematic analysis was used to identify salient themes from these discussions. RESULTS Sixteen students participated in two focus groups. The discussions revealed two contrasting perceptions: while this learning is considered useful, it nevertheless brings about a great deal of stress, especially regarding student exposure to peers in small-group sessions when interviewing standardised patients, and summative assessment. This generates a range of negative feelings in students that could affect perspective and attitude towards the importance of doctor-patient relationships. CONCLUSIONS Experiential learning is effective in improving students' communication skills. However, these results suggest that use of such strategies requires a strong focus on "student-centred" teaching approaches, in order to minimise some sensitive topics that may arise during the learning. Further research is needed to refine these strategies depending on the teaching situation and to identify different ways of implementing these experiential methods.
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Affiliation(s)
- Roger Ruiz-Moral
- Department of Medical Education, School of Medicine, Francisco de Vitoria University, Spain
| | | | | | - Diana Monge Martín
- Department of Statistic and Research, School of Medicine, Francisco de Vitoria University, Spain
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Noordman J, Post B, van Dartel AAM, Slits JMA, olde Hartman TC. Training residents in patient-centred communication and empathy: evaluation from patients, observers and residents. BMC MEDICAL EDUCATION 2019; 19:128. [PMID: 31046756 PMCID: PMC6498499 DOI: 10.1186/s12909-019-1555-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 04/15/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND Patient-centred communication and empathy are key enablers for patient-centred care. However, several studies suggest a downward trend regarding the empathic communication skills of physicians during medical residency. It is known that communication training can have a positive effect on patient-centred communication, empathy and relational skills. Training residents in patient-centred communication and empathy can be an opportunity to improve the patient-centred care. To evaluate the training a tri-focal perspective will be used. METHODS A 3-day training was developed to improve residents' patient-centred communication and empathy skills at an academic medical health centre, in the Netherlands. The training included: (1) the basics of patient-centred communication and empathy (through presentations, scientific literature), (2) practicing with actors, and (3) reflecting on residents' video recorded consultations (by themselves and communication experts). A pilot study with a pre-post design was conducted to evaluate the training from patient and observer perspectives. Semi-structured interviews were used to get insight into residents' perspective. Nine residents from different specialities followed the training and enrolled in the pilot study. During two random days consultations between residents and patients were video recorded. Patients were asked to fill in two questionnaires, indicating their perspective on residents' empathy and communication skills before as well as after the consultation. All video recorded consultations were coded to rate residents' communication skills, empathy, computer use and agenda-setting. Statistical analysis were performed using multilevel analysis. RESULTS A total of 137 eligible patients took part in the pilot study. Trained residents showed significant improvement in patient-rated empathy scores. According to observers, residents' computer use improved significantly after the training. The communication skills of trained residents did not improve significantly. Agenda setting by residents showed a downward trend. Almost all residents were satisfied with the training, especially with the video-feedback. CONCLUSIONS A brief training significantly increased residents' empathy scores according to patients and significantly decreased residents' computer use according to observers. These findings indicate that the quality of patient-centred care can be improved by integrating patient-centred communication into residency programs, at an academic medical health centre. The ultimate goal is to structurally embed the training in residents' education program.
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Affiliation(s)
- J. Noordman
- Department of Primary and Community care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Nivel, Netherlands institute for health services research, Utrecht, The Netherlands
| | - B. Post
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A. A. M. van Dartel
- Department of Primary and Community care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J. M. A. Slits
- Department of Primary and Community care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - T. C. olde Hartman
- Department of Primary and Community care, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Brown J, Bearman M, Kirby C, Molloy E, Colville D, Nestel D. Theory, a lost character? As presented in general practice education research papers. MEDICAL EDUCATION 2019; 53:443-457. [PMID: 30723929 DOI: 10.1111/medu.13793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 10/17/2018] [Accepted: 11/19/2018] [Indexed: 05/17/2023]
Abstract
OBJECTIVES The use of theory in research is reflected in its presence in research writing. Theory is often an ineffective presence in medical education research papers. To progress the effective use of theory in medical education, we need to understand how theory is presented in research papers. This study aims to elicit how theory is being written into general practice (GP) vocational education research papers in order to elucidate how theory might be more effectively used. This has relevance for the field of GP and for medical education more broadly. METHODS This is a scoping review of the presentation of theory in GP vocational education research published between 2013 and 2017. An interpretive approach is taken. We frame research papers as a form of narrative and draw on the theories of Aristotle's poetics and Campbell's monomyth. We seek parallels between the roles of theory in a research story and theories of characterisation. RESULTS A total of 23 papers were selected. Theories of 'reflective learning', 'communities of practice' and 'adult learning' were most used. Six tasks were assigned to theory: to align with a position; to identify a research problem; to serve as a vehicle for an idea; to provide a methodological tool; to interpret findings, and to represent an object of examination. The prominence of theory in the papers ranged from cameo to major roles. Depending on the way theory was used and the audience, theory had different impacts. There were parallels between the tasks assigned to theory and the roles of four of Campbell's archetypal characters. Campbell's typology offers guidance on how theory can be used in research paper 'stories'. CONCLUSIONS Theory can be meaningfully present in the story of a research paper if it is assigned a role in a deliberate way and this is articulated. Attention to the character development of theory and its positioning in the research story is important.
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Affiliation(s)
- James Brown
- Monash Institute for Health and Clinical Education, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
- Eastern Victoria GP Training, Churchill, Victoria, Australia
| | - Margaret Bearman
- Centre for Research in Assessment and Digital Learning, Office of the Deputy Vice Chancellor (Education), Deakin University, Geelong, Victoria, Australia
| | - Catherine Kirby
- Eastern Victoria GP Training, Churchill, Victoria, Australia
- School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Churchill, Victoria, Australia
| | - Elizabeth Molloy
- Department of Medical Education, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Colville
- University Department of Medicine, Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Debra Nestel
- Monash Institute for Health and Clinical Education, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Denniston C, Molloy EK, Ting CY, Lin QF, Rees CE. Healthcare professionals' perceptions of learning communication in the healthcare workplace: an Australian interview study. BMJ Open 2019; 9:e025445. [PMID: 30782935 PMCID: PMC6377557 DOI: 10.1136/bmjopen-2018-025445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/19/2018] [Accepted: 12/12/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES The literature focuses on teaching communication skills in the 'classroom', with less focus on how such skills are informally learnt in the healthcare workplace. We grouped healthcare work based on the cure:care continuum to explore communication approaches based on work activities. This study asks: 1) How do healthcare professionals believe they learn communication in the workplace? 2) What are the differences (if any) across the 'type of work' as represented by the cure:care continuum? DESIGN This qualitative study used semi-structured individual interviews. SETTING Community care and acute hospitals in Australia (Victoria and New South Wales). PARTICIPANTS Twenty qualified healthcare professionals (medicine n=4, nursing n=3, allied health n=13) from various clinical specialties (eg, acute, rehabilitation, surgery, palliative care) participated. METHODS Data were analysed using framework analysis, which involved the development of a thematic coding framework. Findings were mapped to participants' descriptions of work using the cure:care continuum. RESULTS Three themes were identified that varied across the cure:care continuum: professional discourse-tying communication approaches to work activities; personal identities-the influence of personal identities on healthcare communication and role modelling-the influence of others in the socially bound context of healthcare work. CONCLUSIONS This study highlights the influence of professional, personal and social factors on the learning of healthcare communication in the workplace. Our study illuminates differences in communication practice related to work activities, as conceptualised by the cure:care continuum. The results call for further examination of the 'nature' of work activities and the concomitant influence on developing healthcare communication.
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Affiliation(s)
- Charlotte Denniston
- Monash Centre for Scholarship in Health Education (MCSHE), Monash University, Clayton, Victoria, Australia
- Department of Medical Education, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth K Molloy
- Department of Medical Education, The University of Melbourne, Melbourne, Victoria, Australia
| | - Chee Yan Ting
- Department of Physiotherapy, Monash University, Clayton, Victoria, Australia
| | - Qi Fei Lin
- Department of Physiotherapy, Monash University, Clayton, Victoria, Australia
| | - Charlotte E Rees
- Monash Centre for Scholarship in Health Education (MCSHE), Monash University, Clayton, Victoria, Australia
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Govaerts MJB, van der Vleuten CPM, Holmboe ES. Managing tensions in assessment: moving beyond either-or thinking. MEDICAL EDUCATION 2019; 53:64-75. [PMID: 30289171 PMCID: PMC6586064 DOI: 10.1111/medu.13656] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/16/2018] [Accepted: 06/08/2018] [Indexed: 05/09/2023]
Abstract
CONTEXT In health professions education, assessment systems are bound to be rife with tensions as they must fulfil formative and summative assessment purposes, be efficient and effective, and meet the needs of learners and education institutes, as well as those of patients and health care organisations. The way we respond to these tensions determines the fate of assessment practices and reform. In this study, we argue that traditional 'fix-the-problem' approaches (i.e. either-or solutions) are generally inadequate and that we need alternative strategies to help us further understand, accept and actually engage with the multiple recurring tensions in assessment programmes. METHODS Drawing from research in organisation science and health care, we outline how the Polarity Thinking™ model and its 'both-and' approach offer ways to systematically leverage assessment tensions as opportunities to drive improvement, rather than as intractable problems. In reviewing the assessment literature, we highlight and discuss exemplars of specific assessment polarities and tensions in educational settings. Using key concepts and principles of the Polarity Thinking™ model, and two examples of common tensions in assessment design, we describe how the model can be applied in a stepwise approach to the management of key polarities in assessment. DISCUSSION Assessment polarities and tensions are likely to surface with the continued rise of complexity and change in education and health care organisations. With increasing pressures of accountability in times of stretched resources, assessment tensions and dilemmas will become more pronounced. We propose to add to our repertoire of strategies for managing key dilemmas in education and assessment design through the adoption of the polarity framework. Its 'both-and' approach may advance our efforts to transform assessment systems to meet complex 21st century education, health and health care needs.
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Affiliation(s)
- Marjan J B Govaerts
- Department of Educational Development and ResearchFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
| | - Cees P M van der Vleuten
- Department of Educational Development and ResearchFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
| | - Eric S Holmboe
- Accreditation Council for Graduate Medical EducationChicagoIllinoisUSA
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Patel V, Buchanan H, Hui M, Patel P, Gupta P, Kinder A, Thomas H. How do specialist trainee doctors acquire skills to practice patient-centred care? A qualitative exploration. BMJ Open 2018; 8:e022054. [PMID: 30327402 PMCID: PMC6194471 DOI: 10.1136/bmjopen-2018-022054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/31/2018] [Accepted: 09/11/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES The importance of patient-centred care (PCC) has been increasingly recognised. However, there is limited work exploring what doctors actually understand by PCC, and how they perceive they acquire PCC skills in the workplace. The objectives of our study were to explore (1) what UK doctors, in specialist training, perceive to be the essential components of PCC, (2) if/how they acquire these skills, (3) any facilitators/barriers for engaging in PCC and (4) views on their PCC training. DESIGN Qualitative study using in-depth individual semi-structured interviews with UK specialist trainees. Interview transcripts were thematically analysed. SETTING AND PARTICIPANTS Thirty-one specialist trainee doctors, with at least 4 years postgraduate experience, were interviewed. Participants worked in various medical specialities within the Medical Directorate of an acute hospital in the East Midlands of England. RESULTS Interview data were transcribed verbatim and categorised into three main themes. The first theme was 'Understanding PCC' where the doctors gave varied perspectives on what they understood by PCC. Although many were able to highlight key components of PCC, there were also some accounts which demonstrated a lack of understanding. The second theme was 'Learning PCC skills: A work in progress'. Learning to be patient-centred was perceived to be an ongoing process. Within this, trainee doctors reported 'on-the-job' learning as the main means of acquiring PCC skills, but they also saw a place for formal training (eg, educational sessions focussing on PCC, role play). 'Delivering PCC: Beyond the physician' referred to the many influences the doctors reported in learning and delivering PCC including patients, the organisation and colleagues. Observing consultants taking a patient-centred approach was cited as an important learning tool. CONCLUSIONS Our findings may assist clinical educators in understanding how trainee doctors perceive PCC, and the factors that influence their learning, thereby helping them shape PCC skills training.
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Affiliation(s)
- Veena Patel
- Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
| | - Heather Buchanan
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Michelle Hui
- Department of Rheumatology, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Prashanth Patel
- Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, leicester, UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Pankaj Gupta
- Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, leicester, UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Alison Kinder
- Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
| | - Hywel Thomas
- School of Education, University of Birmingham, Birmingham, UK
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Gaunt A, Markham DH, Pawlikowska TRB. Exploring the Role of Self-Motives in Postgraduate Trainees' Feedback-Seeking Behavior in the Clinical Workplace: A Multicenter Study of Workplace-Based Assessments From the United Kingdom. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1576-1583. [PMID: 29979211 DOI: 10.1097/acm.0000000000002348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To explore trainees' feedback-seeking behavior in the postgraduate surgical workplace using a self-motives framework. Self-motives include self-assessment "to obtain accurate information about the self," self-improvement "to improve one's traits, abilities, and skills," self-enhancement "to enhance the favorability of self views," and self-verification "to maintain consistency between one's central self-view and new self-relevant information." METHOD This project constituted a further framework analysis of previously obtained qualitative focus group data that originally explored trainees' perceptions and use of workplace-based assessment (WBA). Data were collected from multiple centers in the United Kingdom from 2012 to 2013. Content was analyzed to identify references in the data that reflected the above self-motives and in relation to contextual themes identified from within the data. RESULTS Trainees' motivations for seeking feedback broadly fit within a self-motives framework. Trainees' feedback seeking using WBA related to self-enhancement and self-verification, whereas outside WBA trainees reported self-improvement and self-assessment motives. Where trainees perceived WBA represented an opportunity to learn, they described a self-improvement motive toward seeking feedback, whereas when WBA represented an assessment of learning, trainees described tensions between self-enhancement and self-improvement motives. CONCLUSIONS Surgical trainees' motivations for seeking feedback can be explained using a conceptual self-motives framework. Trainees need to be motivated to seek accurate informational feedback so they can improve their performance within the clinical workplace. To achieve this, trainees need training; current assessment systems must change to allow trainees to seek such feedback without fear and concern about this information being used as an assessment of learning.
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Affiliation(s)
- Anne Gaunt
- A. Gaunt was a PhD student, Warwick Medical School, University of Warwick, Coventry, United Kingdom, and registrar in general surgery, University Hospital North Midlands, Stoke on Trent, United Kingdom, at the time of this work. She is currently a registrar in general surgery, New Cross Hospital, Wolverhampton, United Kingdom. D.H. Markham is consultant general surgeon, South Warwickshire Foundation Trust, Warwick, United Kingdom. T. Pawlikowska is general practitioner, medical educationalist, and director, Health Professions Education Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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Stigt JA, Koele JH, Brand PLP, Jaarsma DAC, Slootweg IA. Workplace mentoring of residents in generic competencies by an independent coach. PERSPECTIVES ON MEDICAL EDUCATION 2018; 7:337-341. [PMID: 30187390 PMCID: PMC6191395 DOI: 10.1007/s40037-018-0452-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION During postgraduate education in pulmonology, supervisors are responsible for training residents in generic competencies such as communication, professionalism and collaboration, but their focus commonly lies more on medical-technical competencies. As an alternative approach to supporting residents to develop generic skills, we developed a personal mentoring program with a non-medical professional as mentor. In this study, the residents' experiences with the mentoring program were evaluated. METHODS After an introductory session in which individual learning goals were established, pulmonology residents received at least six, 60-90-minute, individual, mentoring sessions largely consisting of feedback after being observed during daily clinical activities, over a period of 9 months. The residents' experiences with mentoring were explored through in-depth interviews followed by a qualitative content analysis. RESULTS From March to November 2016, ten residents in pulmonology completed the program. Despite initial scepticism, mentoring encouraged residents to reflect deeply on their professional interactions. This caused an increased awareness of the effects of their communication and behaviour on patients. Experimenting with communication and different behaviours in subsequent interactions felt rewarding and contributed to further development, resulting in increased self-confidence and job satisfaction. DISCUSSION Mentoring residents by non-medical coaching was associated with improved residents' proficiency in generic competencies.
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Affiliation(s)
- Jos A Stigt
- Department of Pulmonology, Isala Hospital, Zwolle, The Netherlands.
| | - Janine H Koele
- Department of Pulmonology, Isala Hospital, Zwolle, The Netherlands
| | - Paul L P Brand
- Isala Women's and Children's Hospital, Zwolle, The Netherlands
- UMCG Postgraduate School of Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Debbie A C Jaarsma
- Center for Education Development and Research in Health Professions, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Irene A Slootweg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Dijkhuizen K, Bustraan J, de Beaufort AJ, Velthuis SI, Driessen EW, van Lith JMM. Encouraging residents' professional development and career planning: the role of a development-oriented performance assessment. BMC MEDICAL EDUCATION 2018; 18:207. [PMID: 30185174 PMCID: PMC6125996 DOI: 10.1186/s12909-018-1317-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 08/28/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Current postgraduate medical training programmes fall short regarding residents' development of generic competencies (communication, collaboration, leadership, professionalism) and reflective and deliberate practice. Paying attention to these non-technical skills in a structural manner during postgraduate training could result in a workforce better prepared for practice. A development-oriented performance assessment (PA), which assists residents with assessment of performance and deliberately planned learning activities, could potentially contribute to filling this gap. This study aims to explore residents experiences with the PA. METHODS We conducted a qualitative interview study with 16 residents from four different medical specialties who participated in the PA, scheduled halfway postgraduate training. The PA was conducted by an external facilitator, a psychologist, and focused specifically on professional development and career planning. Residents were interviewed 6 months after the PA. Data were analysed using the framework method for qualitative analysis. RESULTS Residents found the PA to be of additional value for their training. The overarching merit was the opportunity to evaluate competencies not usually addressed in workplace-based assessments and progress conversations. In addition, the PA proved a valuable tool for assisting residents with reflecting upon their work and formulating their learning objectives and activities. Residents reported increased awareness of capacity, self-confidence and enhanced feelings of career-ownership. An important factor contributing to these outcomes was the relationship of trust with the facilitator and programme director. CONCLUSION The PA is a promising tool in fostering the development of generic competencies and reflective and deliberate practice. The participating residents, facilitator and programme directors were able to contribute to a safe learning environment away from the busy workplace. The facilitator plays an important role by providing credible and informative feedback. Commitment of the programme director is important for the implementation of developmental plans and learning activities.
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Affiliation(s)
- Kirsten Dijkhuizen
- Centre for Innovation in Medical Education, Leiden University Medical Centre, PO Box 9600, Zone V7-P, 2300 RC Leiden, the Netherlands
- Department of Obstetrics, Leiden University Medical Centre, PO Box 9600, Zone K6-P, 2300 RC Leiden, the Netherlands
| | - Jacqueline Bustraan
- Centre for Innovation in Medical Education, Leiden University Medical Centre, PO Box 9600, Zone V7-P, 2300 RC Leiden, the Netherlands
| | - Arnout J. de Beaufort
- Centre for Innovation in Medical Education, Leiden University Medical Centre, PO Box 9600, Zone V7-P, 2300 RC Leiden, the Netherlands
| | - Sophie I. Velthuis
- Centre for Innovation in Medical Education, Leiden University Medical Centre, PO Box 9600, Zone V7-P, 2300 RC Leiden, the Netherlands
| | - Erik W. Driessen
- Department of Educational Development & Research Maastricht University, Universiteitssingel 60, 6229 Maastricht, the Netherlands
| | - Jan M. M. van Lith
- Department of Obstetrics, Leiden University Medical Centre, PO Box 9600, Zone K6-P, 2300 RC Leiden, the Netherlands
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Stiefel F, de Vries M, Bourquin C. Core components of Communication Skills Training in oncology: A synthesis of the literature contrasted with consensual recommendations. Eur J Cancer Care (Engl) 2018; 27:e12859. [PMID: 29873149 DOI: 10.1111/ecc.12859] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 03/27/2018] [Accepted: 04/13/2018] [Indexed: 11/27/2022]
Abstract
This systematic review synthesises the literature on Communication Skills Training (CST) programmes for oncology professionals to identify their core components and compare them with the recommendations formulated in a position paper based on a European expert consensus meeting. A systematic literature search was conducted using MEDLINE (OVID and PUBMED), CINAHL, EMBASE, PSYCHINFO, Web of Science and the Cochrane Library. The analytic approach relied on an a priori framework based on the position paper's recommendations, generating several themes. Forty-nine articles were included. The CST programmes reported between 2010 and 2016 were heterogeneous. Some recommendations, especially those regarding content and pedagogic tools, were followed by most providers, while others, such as setting, objectives and participants, were not. This synthesis raises questions on how CST programmes are conceived and how they could or should be conceived in future. While medicine, especially clinical communication, is socially and culturally embedded, some recommendations regarding CST programmes seem to be universally valuable, contributing to ensure quality and enhanced credibility, and thus endorsement and sustained implementation, of CST programmes in the oncology setting.
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Affiliation(s)
- Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Mirjam de Vries
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
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Giroldi E, Veldhuijzen W, Geelen K, Muris J, Bareman F, Bueving H, van der Weijden T, van der Vleuten C. Developing skilled doctor-patient communication in the workplace: a qualitative study of the experiences of trainees and clinical supervisors. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:1263-1278. [PMID: 28220333 PMCID: PMC5663797 DOI: 10.1007/s10459-017-9765-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 02/14/2017] [Indexed: 05/16/2023]
Abstract
To inform the development of recommendations to facilitate learning of skilled doctor-patient communication in the workplace, this qualitative study explores experiences of trainees and supervisors regarding how trainees learn communication and how supervisors support trainees' learning in the workplace. We conducted a qualitative study in a general practice training setting, triangulating various sources of data to obtain a rich understanding of trainees and supervisors' experiences: three focus group discussions, five discussions during training sessions and five individual interviews. Thematic network analysis was performed during an iterative process of data collection and analysis. We identified a communication learning cycle consisting of six phases: impactful experience, change in frame of reference, identification of communication strategies, experimentation with strategies, evaluation of strategies and incorporation into personal repertoire. Supervisors supported trainees throughout this process by creating challenges, confronting trainees with their behaviour and helping them reflect on its underlying mechanisms, exploring and demonstrating communication strategies, giving concrete practice assignments, creating safety, exploring the effect of strategies and facilitating repeated practice and reflection. Based on the experiences of trainees and supervisors, we conclude that skilled communication involves the development of a personal communication repertoire from which learners are able to apply strategies that fit the context and their personal style. After further validation of our findings, it may be recommended to give learners concrete examples, opportunities for repeated practise and reflection on personal frames of reference and the effect of strategies, as well as space for authenticity and flexibility. In the workplace, the clinical supervisor is able to facilitate all these essential conditions to support his/her trainee in becoming a skilled communicator.
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Affiliation(s)
- Esther Giroldi
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - Wemke Veldhuijzen
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Kristel Geelen
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jean Muris
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Frits Bareman
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Herman Bueving
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Cees van der Vleuten
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
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Gaunt A, Patel A, Rusius V, Royle TJ, Markham DH, Pawlikowska T. 'Playing the game': How do surgical trainees seek feedback using workplace-based assessment? MEDICAL EDUCATION 2017; 51:953-962. [PMID: 28833426 DOI: 10.1111/medu.13380] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/24/2016] [Accepted: 05/18/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Although trainees and trainers find feedback interactions beneficial, difficulties in giving and receiving feedback are reported. Few studies have explored what drives trainees to seek feedback. This study explores how workplace-based assessments (WBAs) influence the ways surgical trainees seek feedback and feedback interactions. METHODS Utilising a template analysis approach, we conducted 10 focus groups with 42 surgical trainees from four regions across the UK. Data were independently coded by three researchers, incorporating three a priori themes identified from a previous quantitative study. Further themes emerged from exploration of these data. The final template, agreed by the three researchers, was applied to all focus group transcripts. The themes were linked in a diagrammatical form to allow critical exploration of the data. RESULTS Trainees' perceptions of the purpose of WBA for learning or an assessment of learning, and their relationship with their trainer impacted upon how trainees chose to use WBA. Perceiving WBA as a test led trainees to 'play the game': seek positive and avoid negative feedback through WBA. Perceiving WBA as a chance to learn led trainees to seek negative feedback. Some trainees sought negative feedback outside WBA. Negative feedback was more important for changing practice compared with positive feedback, which enabled trainees to 'look good' but had less of an effect on changing clinical practice. The timing of feedback relative to WBA was also important, with immediate feedback being more beneficial for learning; however, delayed feedback was still sought using WBA. DISCUSSION Trainees' perceptions of the purpose of WBA and their relationship with their trainer informed when they chose to seek feedback. Trainees who perceived WBA as a test were led to 'play the game' by seeking positive and avoiding negative feedback. Outside of WBA, trainees sought negative feedback, which was most important for change in practice.
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Affiliation(s)
- Anne Gaunt
- Education Development, Warwick Medical School, University of Warwick, Coventry, UK
- Department of General Surgery, University Hospital North Midlands, Stoke on Trent, UK
| | - Abhilasha Patel
- Department of General Surgery, University Hospital North Midlands, Stoke on Trent, UK
| | - Victoria Rusius
- Department of General Surgery, Royal Blackburn Hospital, Blackburn, UK
| | - T James Royle
- Department of Colorectal Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Deborah H Markham
- Department of General Surgery, South Warwickshire Foundation Trust, Warwick, UK
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Pascual-Ramos V, Flores-Alvarado DE, Portela-Hernández M, Maldonado-Velázquez MDR, Amezcua-Guerra LM, López-Zepeda J, Álvarez E, Rubio N, Lastra OV, Saavedra MÁ, Arce-Salinas CA. Communication skills in candidates for accreditation in rheumatology are correlated with candidate's performance in the objective structured clinical examination. ACTA ACUST UNITED AC 2017; 15:97-101. [PMID: 28755908 DOI: 10.1016/j.reuma.2017.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/22/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Mexican Accreditation Council for Rheumatology annually certifies trainees in Rheumatology using a multiple-choice test and an objective structured clinical examination (OSCE). Since 2015, candidate's communication skills (CS) have been rated by both patients and by physician examiners and correlated with results on the OSCE. This study compared the CS from candidates to annual accreditation in Rheumatology as rated by patients and by physician examiners, and assessed whether these correlated with candidate's performance in the OSCE. MATERIAL AND METHODS From 2015 to 2017, 8areas of CS were evaluated using a Likert scale, in each OSCE station that involved a patient. Both patient and physician evaluators were trained annually and their evaluations were performed blindly. The associations were calculated using the Pearson correlation coefficient. RESULTS In general, candidates were given high CS scores; the scores from patients of the candidate's CS were better than those of physician examiners; within the majority of the stations, both scores were found to correlate moderately. In addition, the scoring of CS correlated with trainee performance at the corresponding OSCE station. Interestingly, better correlations were found when the skills were rated by the patients compared to physician scores. The average CS score was correlated with the overall OSCE performance for each trainee, but not with the multiple-choice test, except in the 2017 accreditation process, when a weak correlation was found. CONCLUSIONS CS assessed during a national accreditation process correlated with the candidate's performance at the station level and with the overall OSCE.
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Affiliation(s)
| | | | | | | | | | | | - Everardo Álvarez
- Consejo Mexicano de Reumatología, Coyoacán, Ciudad de México, México
| | - Nadina Rubio
- Consejo Mexicano de Reumatología, Coyoacán, Ciudad de México, México
| | - Olga Vera Lastra
- Consejo Mexicano de Reumatología, Coyoacán, Ciudad de México, México
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- Consejo Mexicano de Reumatología, Coyoacán, Ciudad de México, México
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Ditton-Phare P, Loughland C, Duvivier R, Kelly B. Communication skills in the training of psychiatrists: A systematic review of current approaches. Aust N Z J Psychiatry 2017; 51:675-692. [PMID: 28462636 DOI: 10.1177/0004867417707820] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES A range of communication skills training programmes have been developed targeting trainees in various medical specialties, predominantly in oncology but to a lesser extent in psychiatry. Effective communication is fundamental to the assessment and treatment of psychiatric conditions, but there has been less attention to this in clinical practice for psychiatrists in training. This review examines the outcomes of communication skills training interventions in psychiatric specialty training. METHODS The published English-language literature was examined using multiple online databases, grey literature and hand searches. The review was conducted and reported using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies examining the efficacy of communication skills training were included. Randomised controlled trials, pseudo-randomised studies and quasi-experimental studies, as well as observational analytical studies and qualitative studies that met criteria, were selected and critically appraised. No limits were applied for date of publication up until 16 July 2016. RESULTS Total search results yielded 2574 records. Of these, 12 studies were identified and reviewed. Two were randomised controlled trials and the remaining 10 were one-group pretest/posttest designs or posttest-only designs, including self-report evaluations of communication skills training and objective evaluations of trainee skills. There were no studies with outcomes related to behaviour change or patient outcomes. Two randomised controlled trials reported an improvement in clinician empathy and psychotherapeutic interviewing skills due to specific training protocols focused on those areas. Non-randomised studies showed varying levels of skills gains and self-reported trainee satisfaction ratings with programmes, with the intervention being some form of communication skills training. CONCLUSION The heterogeneity of communication skills training is a barrier to evaluating the efficacy of different communication skills training programmes. Further validation studies examining specific models and frameworks would support a stronger evidence base for communication skills training in psychiatry. It remains a challenge to develop research to investigate behaviour change over time in clinical practice or to measure patient outcomes due to the effects of communication skills training.
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Affiliation(s)
- Philippa Ditton-Phare
- 1 Hunter New England Mental Health, Newcastle, NSW, Australia.,2 School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,3 Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, NSW, Australia
| | - Carmel Loughland
- 1 Hunter New England Mental Health, Newcastle, NSW, Australia.,2 School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,3 Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, NSW, Australia
| | - Robbert Duvivier
- 2 School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Brian Kelly
- 1 Hunter New England Mental Health, Newcastle, NSW, Australia.,2 School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,3 Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, NSW, Australia
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Oikonomidou D, Anagnostopoulos F, Dimitrakaki C, Ploumpidis D, Stylianidis S, Tountas Y. Doctors' Perceptions and Practices of Breaking Bad News: A Qualitative Study From Greece. HEALTH COMMUNICATION 2017; 32:657-666. [PMID: 27367603 DOI: 10.1080/10410236.2016.1167991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
There is limited information about doctors' communication behaviors and their salient beliefs with regard to bad news disclosure in Greece. In this qualitative study we investigated the self-reported practices of doctors on breaking bad news, their perceptions about the factors affecting the delivery of such news, and their beliefs about the most appropriate disclosure manner. A focus group discussion and individual interviews were conducted. Twenty-five resident and specialist doctors from primary health care and hospital settings participated. We analyzed the collected data with content analysis techniques. Participants were found to acknowledge the importance of appropriate and effective delivery of bad news; however, none of them reported the implementation of empirically informed communication practices. They described communication patterns mainly formed by their work experience and often guided by the patient's family requests. Doctor, patient, and family characteristics and organizational features and resources were reported to affect the delivery of bad news. Participants perceived the most appropriate disclosure manner as an individualized approach to each patient's unique needs. They suggested an interdisciplinary, collaborative management of the delivery process and the establishment of formal supportive services. These findings may provide useful information for the development of tailored, empirically informed curriculum interventions and educational programs in order to address several barriers to communication. Sociocultural characteristics that influence the disclosure practice, as well as physicians' perceptions that are consistent with the optimal information delivery, should be taken into account. System-level strategies that focus on the development of patient-centered communication also need to be prioritized.
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Affiliation(s)
- Despoina Oikonomidou
- a Department of Hygiene, Epidemiology and Medical Statistics , University of Athens Medical School
| | | | - Christine Dimitrakaki
- a Department of Hygiene, Epidemiology and Medical Statistics , University of Athens Medical School
| | - Dimitrios Ploumpidis
- c First Department of Psychiatry, Eginition Hospital , University of Athens Medical School
| | | | - Yannis Tountas
- a Department of Hygiene, Epidemiology and Medical Statistics , University of Athens Medical School
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Liu Y, Huang Y, Gao H, Cheng X. Communication skills training: Adapting to the trends and moving forward. Biosci Trends 2017; 11:142-147. [PMID: 28458335 DOI: 10.5582/bst.2017.01095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Ye Liu
- School of Basic Medical Sciences, Fudan University
| | | | - Hong Gao
- Zhongshan Hospital, Fudan University
| | - Xunjia Cheng
- School of Basic Medical Sciences, Fudan University
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Oerlemans M, Dielissen P, Timmerman A, Ram P, Maiburg B, Muris J, van der Vleuten C. Should we assess clinical performance in single patient encounters or consistent behaviors of clinical performance over a series of encounters? A qualitative exploration of narrative trainee profiles. MEDICAL TEACHER 2017; 39:300-307. [PMID: 28049379 DOI: 10.1080/0142159x.2017.1270427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND A variety of tools have been developed to assess performance which typically use a single clinical encounter as a source for making competency inferences. This strategy may miss consistent behaviors. We therefore explored experienced clinical supervisors' perceptions of behavioral patterns that potentially exist in postgraduate general practice trainees expressed as narrative profiles to aid the grading of clinical performance. METHODS We conducted semistructured interviews with clinical supervisors who had frequently observed clinical performance in trainees. Supervisors were asked to describe which behavioral patterns they had discerned in excellent and underperforming trainees, during different stages of training, in their careers as clinical supervisor. We analyzed the interviews using a grounded theory approach. RESULTS The analysis resulted in a conceptual framework that distinguishes between desirable and undesirable narrative profiles. The framework consists of two dimensions: doctor-patient interaction and medical expertise. Personal values appear to be a moderating factor. CONCLUSIONS According to experienced clinical supervisors, consistent behaviors do exist in GP trainees when observing clinical performance over time. The conceptual framework has to be validated by further observational studies to assess its potential for making robust and fair assessments of clinical performance and monitor the development of consultation performance over time.
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Affiliation(s)
- Marjolein Oerlemans
- a Department of Family Medicine , Maastricht University , Maastricht , the Netherlands
| | - Patrick Dielissen
- b Department of Primary and Community Care , Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Angelique Timmerman
- a Department of Family Medicine , Maastricht University , Maastricht , the Netherlands
| | - Paul Ram
- a Department of Family Medicine , Maastricht University , Maastricht , the Netherlands
| | - Bas Maiburg
- a Department of Family Medicine , Maastricht University , Maastricht , the Netherlands
| | - Jean Muris
- a Department of Family Medicine , Maastricht University , Maastricht , the Netherlands
| | - Cees van der Vleuten
- c School of Health Professions Education , Maastricht University , the Netherlands
- d School of Medicine, Flinders University , Adelaide , Australia
- e University of the Witwatersrand , Johannesburg , South Africa
- f Curtin University , Perth , Australia
- g Northumbria University , Newcastle upon Tyne , UK
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van Loon KA, Teunissen PW, Driessen EW, Scheele F. The Role of Generic Competencies in the Entrustment of Professional Activities: A Nationwide Competency-Based Curriculum Assessed. J Grad Med Educ 2016; 8:546-552. [PMID: 27777665 PMCID: PMC5058587 DOI: 10.4300/jgme-d-15-00321.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Entrustable professional activities (EPAs) seek to translate essential physician competencies into clinical practice. Until now, it is not known whether EPA-based curricula offer enhanced assessment and feedback to trainees. OBJECTIVE This study examined program directors' and senior residents' justifications for entrustment decisions and what role generic, cross-specialty competencies (such as communication skills, collaboration, and understanding health care systems) play in these decisions. METHODS Entrustment decisions for all Dutch obstetrics and gynecology residents between January 2010 and April 2014 were retrieved from their electronic portfolios. Justifications for entrustment were divided into 4 categories: the resident's experience, his or her technical performance, the presence of a generic competency, and training. Template analysis was used to analyze in depth the types of justifications, which play a role in entrustment decisions. RESULTS A total of 5139 entrustment decisions for 375 unique residents were extracted and analyzed. In 59% of all entrustment decisions, entrusting a professional task to a resident was justified by the experience of the resident. Generic competencies were mentioned in 0.5% of all entrustment decisions. Template analysis revealed that the amount of exposure and technical skills are leading factors, while the quality of the performance was not reported to be of any influence. CONCLUSIONS Entrustment decisions only rarely are based on generic competencies, despite the introduction of competency frameworks and EPAs. For program directors, a leading factor in entrustment decisions is a resident's exposure to an activity, and the quality of a resident's performance appears to play only a minor role.
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Affiliation(s)
- Karsten A. van Loon
- Corresponding author: Karsten A. van Loon, MSc, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands,
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Improving Resident Communication in the Intensive Care Unit. The Proceduralization of Physician Communication with Patients and Their Surrogates. Ann Am Thorac Soc 2016; 13:1624-8. [DOI: 10.1513/annalsats.201601-029ps] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Roze des Ordons AL, Lockyer J, Hartwick M, Sarti A, Ajjawi R. An exploration of contextual dimensions impacting goals of care conversations in postgraduate medical education. BMC Palliat Care 2016; 15:34. [PMID: 27001665 PMCID: PMC4802849 DOI: 10.1186/s12904-016-0107-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 03/15/2016] [Indexed: 11/10/2022] Open
Abstract
Background Postgraduate medical trainees are not well prepared difficult conversations about goals of care with patients and families in the acute care clinical setting. While contextual nuances within the workplace can impact communication, research to date has largely focused on individual communication skills. Our objective was to explore contextual factors that influence conversations between trainees and patients/families about goals of care in the acute care setting. Methods We conducted an exploratory qualitative study involving five focus groups with Internal Medicine trainees (n = 20) and a series of interviews with clinical faculty (n = 11) within a single Canadian centre. Thematic framework analysis was applied to categorize the data and identify themes and subthemes. Results Challenges and factors enabling goals of care conversations emerged within individual, interpersonal and system dimensions. Challenges included inadequate preparation for these conversations, disconnection between trainees, faculty and patients, policies around documentation, the structure of postgraduate medical education, and resource limitations; these challenges led to missed opportunities, uncertainty and emotional distress. Enabling factors were awareness of the importance of goals of care conversations, support in these discussions, collaboration with colleagues, and educational initiatives enabling skill development; these factors have resulted in learning, appreciation, and an established foundation for future educational initiatives. Conclusions Contextual factors impact how postgraduate medical trainees communicate with patients/families about goals of care. Attention to individual, interpersonal and system-related factors will be important in designing educational programs that help trainees develop the capacities needed for challenging conversations. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0107-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amanda L Roze des Ordons
- Department of Critical Care Medicine and Division of Palliative Medicine, South Health Campus Intensive Care Unit, University of Calgary, 4448 Front St SE, Calgary, AB, T3M 1M4, Canada.
| | - Jocelyn Lockyer
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael Hartwick
- Divisions of Critical Care and Palliative Care, University of Ottawa, Ottawa, ON, Canada
| | - Aimee Sarti
- Divisions of Critical Care and Palliative Care, University of Calgary, Ottawa, ON, Canada
| | - Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, VIC, Australia
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van der Vleuten CPM. Competency-based education is beneficial for professional development. PERSPECTIVES ON MEDICAL EDUCATION 2015; 4:323-325. [PMID: 26553242 PMCID: PMC4673061 DOI: 10.1007/s40037-015-0232-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Cees P M van der Vleuten
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
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Wouda JC, van de Wiel HBM. Supervisors' and residents' patient-education competency in challenging outpatient consultations. PATIENT EDUCATION AND COUNSELING 2015; 98:1084-1091. [PMID: 26074498 DOI: 10.1016/j.pec.2015.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/07/2015] [Accepted: 05/11/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES We compared supervisors' and residents' patient-education competency in challenging consultations in order to establish whether supervisors demonstrate sufficient patient-education competency to act credibly as role models and coaches for residents. METHODS All consultations conducted at one, two, or three of the outpatient clinics of each of the participating physicians were videoed. Each participant selected two challenging consultations from each clinic for assessment. We assessed their patient-education competency using the CELI instrument, we calculated net consultation length for all videoed consultations and we measured patient opinion about the patient education received using a questionnaire. RESULTS Forty-four residents and fourteen supervisors participated in the study. They selected 230 consultations for assessment. On average, supervisors and residents demonstrated similar patient-education competency. Net consultation length was longer for supervisors. Patient opinion did not differ between supervisors and residents. CONCLUSIONS Supervising consultants generally do not possess sufficient patient-education competency to fulfill their teaching roles in workplace-based learning that is aimed at improving residents' patient-education competency. PRACTICE IMPLICATIONS Not only residents but also supervising consultants should improve their patient-education competency. Workplace-based learning consisting of self-assessment of and feedback on videoed consultations could be useful in attaining this goal.
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Affiliation(s)
- Jan C Wouda
- University of Groningen, University Medical Center Groningen, The Netherlands.
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