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Makoul G, Noble L, Gulbrandsen P, van Dulmen S. Reinforcing the humanity in healthcare: The Glasgow Consensus Statement on effective communication in clinical encounters. PATIENT EDUCATION AND COUNSELING 2024; 122:108158. [PMID: 38330705 DOI: 10.1016/j.pec.2024.108158] [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: 12/06/2023] [Revised: 01/05/2024] [Accepted: 01/14/2024] [Indexed: 02/10/2024]
Abstract
Contemporary healthcare is characterized by multidisciplinary teamwork across a vast array of primary, secondary and tertiary services, augmented by progressively more technology and data. While these developments aim to improve care, they have also created obstacles and new challenges for both patients and health professionals. Indeed, the increasingly fragmented and transactional nature of clinical encounters can dehumanize the care experience across disciplines and specialties. Effective communication plays a pivotal role in reinforcing the humanity of healthcare through the delivery of person-centered care - compassionate, collaborative care that focuses on the needs of each patient as a whole person. After convening at the International Conference on Communication in Healthcare (Glasgow, 2022), an interdisciplinary group of researchers, educators and health professionals worked together to develop a framework for effective communication that both acknowledges critical challenges in contemporary health services and reinforces the humanity of healthcare. The Glasgow Consensus Statement is intended to function as a useful international touchstone for the training and practice of health professionals, fully recognizing and respecting that different countries are at different stages when it comes to teaching, assessment and policy. It also provides a vocabulary for monitoring the impact of system-level challenges. While effective communication may not change the structure of healthcare, it can improve the process if health professionals are supported in infusing the system with their own innate humanity and applying the framework offered within this consensus statement to reinforce the humanity in everyday practice.
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Affiliation(s)
- Gregory Makoul
- Department of Medicine, Yale School of Medicine, New Haven, USA; Human Understanding Institute, NRC Health, Lincoln, USA.
| | - Lorraine Noble
- UCL Medical School, University College London, London, UK; EACH: International Association for Communication in Healthcare, Salisbury, UK
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Akershus University Hospital, Nordbyhagen, Norway
| | - Sandra van Dulmen
- NIVEL - Netherlands Institute for Health Services Research, Utrecht, Netherlands; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Barnes RK, Woods CJ. Communication in Primary Healthcare: A State-of-the-Art Literature Review of Conversation-Analytic Research. RESEARCH ON LANGUAGE AND SOCIAL INTERACTION 2024; 57:7-37. [PMID: 38707494 PMCID: PMC11067862 DOI: 10.1080/08351813.2024.2305038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
We report the first state-of-the-art review of conversation-analytic (CA) research on communication in primary healthcare. We conducted a systematic search across multiple bibliographic databases and specialist sources and employed backward and forward citation tracking. We included 177 empirical studies spanning four decades of research and 16 different countries/health systems, with data in 17 languages. The majority of studies originated in United States and United Kingdom and focused on medical visits between physicians and adult patients. We generated three broad research themes in order to synthesize the study findings: managing agendas, managing participation, and managing authority. We characterize the state-of-the-art for each theme, illustrating the progression of the work and making comparisons across different languages and health systems, where possible. We consider practical applications of the findings, reflect on the state of current knowledge, and suggest some directions for future research. Data reported are in multiple languages.
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Affiliation(s)
- Rebecca K. Barnes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, U.K.
| | - Catherine J. Woods
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, U.K.
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Holderried F, Stegemann-Philipps C, Herschbach L, Moldt JA, Nevins A, Griewatz J, Holderried M, Herrmann-Werner A, Festl-Wietek T, Mahling M. A Generative Pretrained Transformer (GPT)-Powered Chatbot as a Simulated Patient to Practice History Taking: Prospective, Mixed Methods Study. JMIR MEDICAL EDUCATION 2024; 10:e53961. [PMID: 38227363 PMCID: PMC10828948 DOI: 10.2196/53961] [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: 10/25/2023] [Revised: 12/09/2023] [Accepted: 12/14/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Communication is a core competency of medical professionals and of utmost importance for patient safety. Although medical curricula emphasize communication training, traditional formats, such as real or simulated patient interactions, can present psychological stress and are limited in repetition. The recent emergence of large language models (LLMs), such as generative pretrained transformer (GPT), offers an opportunity to overcome these restrictions. OBJECTIVE The aim of this study was to explore the feasibility of a GPT-driven chatbot to practice history taking, one of the core competencies of communication. METHODS We developed an interactive chatbot interface using GPT-3.5 and a specific prompt including a chatbot-optimized illness script and a behavioral component. Following a mixed methods approach, we invited medical students to voluntarily practice history taking. To determine whether GPT provides suitable answers as a simulated patient, the conversations were recorded and analyzed using quantitative and qualitative approaches. We analyzed the extent to which the questions and answers aligned with the provided script, as well as the medical plausibility of the answers. Finally, the students filled out the Chatbot Usability Questionnaire (CUQ). RESULTS A total of 28 students practiced with our chatbot (mean age 23.4, SD 2.9 years). We recorded a total of 826 question-answer pairs (QAPs), with a median of 27.5 QAPs per conversation and 94.7% (n=782) pertaining to history taking. When questions were explicitly covered by the script (n=502, 60.3%), the GPT-provided answers were mostly based on explicit script information (n=471, 94.4%). For questions not covered by the script (n=195, 23.4%), the GPT answers used 56.4% (n=110) fictitious information. Regarding plausibility, 842 (97.9%) of 860 QAPs were rated as plausible. Of the 14 (2.1%) implausible answers, GPT provided answers rated as socially desirable, leaving role identity, ignoring script information, illogical reasoning, and calculation error. Despite these results, the CUQ revealed an overall positive user experience (77/100 points). CONCLUSIONS Our data showed that LLMs, such as GPT, can provide a simulated patient experience and yield a good user experience and a majority of plausible answers. Our analysis revealed that GPT-provided answers use either explicit script information or are based on available information, which can be understood as abductive reasoning. Although rare, the GPT-based chatbot provides implausible information in some instances, with the major tendency being socially desirable instead of medically plausible information.
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Affiliation(s)
- Friederike Holderried
- Tübingen Institute for Medical Education, Eberhard Karls University, Tübingen, Germany
| | | | - Lea Herschbach
- Tübingen Institute for Medical Education, Eberhard Karls University, Tübingen, Germany
| | - Julia-Astrid Moldt
- Tübingen Institute for Medical Education, Eberhard Karls University, Tübingen, Germany
| | - Andrew Nevins
- Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA, United States
| | - Jan Griewatz
- Tübingen Institute for Medical Education, Eberhard Karls University, Tübingen, Germany
| | - Martin Holderried
- Department of Medical Development, Process and Quality Management, University Hospital Tübingen, Tübingen, Germany
| | - Anne Herrmann-Werner
- Tübingen Institute for Medical Education, Eberhard Karls University, Tübingen, Germany
| | - Teresa Festl-Wietek
- Tübingen Institute for Medical Education, Eberhard Karls University, Tübingen, Germany
| | - Moritz Mahling
- Tübingen Institute for Medical Education, Eberhard Karls University, Tübingen, Germany
- Department of Diabetology, Endocrinology, Nephrology, Section of Nephrology and Hypertension, University Hospital Tübingen, Tübingen, Germany
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White SJ, Ho K, Maini K, Liang R. "Sorry for Holding You Up": Surgeons' Apologies for Lateness in Clinic Settings. HEALTH COMMUNICATION 2024:1-12. [PMID: 38177980 DOI: 10.1080/10410236.2023.2299888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Doctors running late may convey a lack of respect which can impair the therapeutic relationship. This study examines how surgeons address lateness in consultations with patients. We analyzed 52 consultation recordings from a range of surgical specialties in an Australian metropolitan setting. Conversation analysis was used to analyze interactional sequences where lateness was addressed. Six sequences were identified within four recordings. The two consultations with two apologies include a surgeon and registrar apologizing in a neurosurgical consultation and a surgeon apologizing twice within a colorectal consultation. Apologies were either accepted or responded to with an account for not accepting the apology. When these accounts were made, consultations could only progress when patients accepted an explanation for lateness or the degree of complainability about lateness was reduced. The infrequent occurrence of apologies for lateness, and the way in which these sequences unfolded when they did occur, suggest that there is greater acceptability of lateness for surgeons than in ordinary social situations.
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Affiliation(s)
- Sarah J White
- Centre for Social Impact, University of New South Wales
| | - Ken Ho
- Faculty of Health Sciences & Medicine, Bond University
| | | | - Rhea Liang
- Faculty of Health Sciences & Medicine, Bond University
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White SJ, Condon B, Ditton-Phare P, Dodd N, Gilroy J, Hersh D, Kerr D, Lambert K, McPherson ZE, Mullan J, Saad S, Stubbe M, Warren-James M, Weir KR, Gilligan C. Enhancing effective healthcare communication in Australia and Aotearoa New Zealand: Considerations for research, teaching, policy, and practice. PEC INNOVATION 2023; 3:100221. [PMID: 37822775 PMCID: PMC10562187 DOI: 10.1016/j.pecinn.2023.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/08/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
Objective In this article we present a conceptual framework for enhancing effective healthcare communication in Australia and Aotearoa New Zealand. Methods Through an iterative, deliberative dialogue approach, we, as experts from a variety of health professions and academic disciplines, worked together to identify core values and considerations for healthcare communication across numerous health professions and disciplines and within research, teaching, policy, and practice contexts. Results The framework developed includes five core values at its centre: equitable, inclusive, evidence-based, collaborative, reflective. Around this are concentric circles showing key elements of collaborators, modality, context, and purpose. Each of these is explored. Conclusion This work may support benchmarking for healthcare providers, researchers, policymakers, and educators across a breadth of professions to help improve communication in clinical practice. The framework will also help to identify areas across disciplines that are shared and potentially idiosyncratic for various professions to promote interprofessional recognition, education, and collaboration. Innovation This framework is designed to start conversations, to form the foundation of a dialogue about the priorities and key considerations for developing teaching curricula, professional development, and research programs related to healthcare communication, providing a set of values specifically for the unique contexts of Australia and Aotearoa New Zealand. It can also be used to guide interdisciplinary healthcare professionals in advancing research, teaching, policy, and practice related to healthcare communication.
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Affiliation(s)
- Sarah J. White
- Centre for Social Impact, University of New South Wales, Sydney, Australia
| | - Brendan Condon
- Warrnambool Clinical School, Deakin University, Warrnambool, Australia
| | - Philippa Ditton-Phare
- School of Medicine & Public Health, The University of Newcastle, Newcastle, Australia
| | - Natalie Dodd
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, Australia
| | - John Gilroy
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Deborah Hersh
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Debra Kerr
- Institute for Healthcare Transformation, Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, Australia
| | | | - Judy Mullan
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Shannon Saad
- RPA Virtual Hospital, Sydney Local Health District, Sydney, Australia
| | - Maria Stubbe
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Matthew Warren-James
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, Australia
| | - Kristie R. Weir
- Sydney School of Public Health, University of Sydney, Sydney, Australia and Institute of Primary Health Care BIHAM, University of Bern, Bern, Switzerland
| | - Conor Gilligan
- School of Medicine & Public Health, The University of Newcastle, Newcastle, Australia
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White V, Chiswell M, Webber E, Martin P, Piper A. What Impact Does Participation in a Communication Skills Training Program Have on Health Professionals' Communication Behaviors: Findings from a Qualitative Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1600-1607. [PMID: 37157050 PMCID: PMC10166455 DOI: 10.1007/s13187-023-02305-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/10/2023]
Abstract
Communication skills training can enhance health professionals' knowledge and repertoire of effective communication practices. This paper describes the conceptual model underlying a 3-day retreat communication skills training program, methods used for training, and participant perception of outcomes from the training using qualitative interviews. Repeated qualitative telephone interviews (approximately 6 months apart) with participants of a 3-day Clinical Consultation Skills Retreat. Fourteen participants (70% response, 57% doctors) took part at Time 1, with 12 participating at Time 2. Semi-structured interviews were recorded and transcribed, and directional content analysis was conducted to assess themes in areas of key learnings, implementation of skills, and barriers. The training was received very positively with participants valuing the small group learning, role play, and facilitator skills. Key learnings were grouped into two themes: (i) tips and strategies to use in clinical practice and (ii) communication frameworks/methods, with the second theme reflecting an awareness of different communication styles. Most participants had tried to implement their new skills, with implementation reported as a more deliberate activity at T1 than at T2. Those implementing the new skills noted more open conversations with patients. Practical barriers of lack of time and expectations of others were mentioned more often at T2. A 3-day retreat-based communication training program was positively received and had a positive impact on the use of new communication skills. While further work is needed to determine whether effects of training are evidenced in objective clinical behaviors, the positive longer-term benefits found suggest this work would be worthwhile.
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Affiliation(s)
- V White
- Deakin University, 1 Gheringhap St, Geelong, Victoria, Australia.
| | - M Chiswell
- Deakin University, 1 Gheringhap St, Geelong, Victoria, Australia
| | - E Webber
- Cancer Council Victoria, 615 St Kilda Rd, Melbourne, Victoria, Australia
| | - P Martin
- Deakin University, 1 Gheringhap St, Geelong, Victoria, Australia
| | - A Piper
- Cancer Council Victoria, 615 St Kilda Rd, Melbourne, Victoria, Australia
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Borowczyk M, Stalmach-Przygoda A, Doroszewska A, Libura M, Chojnacka-Kuraś M, Małecki Ł, Kowalski Z, Jankowska AK. Developing an effective and comprehensive communication curriculum for undergraduate medical education in Poland - the review and recommendations. BMC MEDICAL EDUCATION 2023; 23:645. [PMID: 37679670 PMCID: PMC10486093 DOI: 10.1186/s12909-023-04533-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/24/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND The recognition of the importance of effective communication in the healthcare system has been growing. Given that communication courses must be adjusted to the specificity of a particular culture, language, and other contextual issues, many countries and communities sharing a common language have proposed their recommendations for a communication curriculum for undergraduate medical education. To date, no recommendations have been developed for either any Central and Eastern Europe countries or for regions where Slavic languages are spoken. Their specificity of post-communist transformation should be acknowledged. This study aims to review communication curriculums and offer recommendations for medical communication training for undergraduate medical students in Poland. METHODS The recommendations were developed through an iterative consultation process with lecturers, faculty members of medical schools, and education coordinators. PubMed and Google Scholar databases were searched to identify full text English and Polish language articles on communication curriculum for undergraduate medical education. Additionally, the new Regulation of the Polish Minister of Science and Higher Education, defining educational standards for undergraduate medical education was analysed in search of learning outcomes that could be applied in communication skills teaching. The authors extracted the most relevant communication skill competencies, as determined by the process participants, discussed current challenges, including those of the COVID-19 pandemic era, and indicated best practices. RESULTS A review was conducted, and a set of recommendations was developed pertaining to the scope and methodology of teaching communication skills. The study included: (1) definition, (2) education content, (3) learning outcomes, (4) the recommended teaching methods. The recommendations are in concord with the graduate profile, as well as the current structure of medical studies. The authors listed and discussed the basic communication competencies expected of medical graduates, as well as medical communication course content viewed from different perspectives, including clinical, psychological, sociological, legal, and linguistic. CONCLUSIONS Detailed recommendations aimed at integrating best practices into a comprehensive communication curriculum may promote successful teaching, learning, and assessment of medical communication.
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Affiliation(s)
- Martyna Borowczyk
- Department of Medical Simulation, Poznan University of Medical Sciences, Poznań, Poland
| | - Agata Stalmach-Przygoda
- Department of Medical Education, Center for Innovative Medical Education, Jagiellonian University Medical College Kraków, Kraków, Poland
| | - Antonina Doroszewska
- Department of Medical Communication, Medical University of Warsaw, Litewska 16 Street, Warszawa, 00-575, Poland.
| | - Maria Libura
- Department of Medical Education and Simulation of Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | | | - Łukasz Małecki
- Department of Medical Education, Center for Innovative Medical Education, Jagiellonian University Medical College Kraków, Kraków, Poland
| | | | - Aldona K Jankowska
- Laboratory for Social Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
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Pieterse AH, Gulbrandsen P, Ofstad EH, Menichetti J. What does shared decision making ask from doctors? Uncovering suppressed qualities that could improve person-centered care. PATIENT EDUCATION AND COUNSELING 2023; 114:107801. [PMID: 37230040 DOI: 10.1016/j.pec.2023.107801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Shared decision making (SDM) is infrequently seen in clinical practice despite four decades of efforts. We propose a need to explore what SDM asks from doctors in terms of enabling competencies and necessary, underlying qualities, and how these can be nurtured or suppressed in medical training. DISCUSSION Key SDM tasks call for doctors to understand communication and decision mechanisms to carry them out well, including reflecting on what they know and do not know, considering what to say and how, and listening unprejudiced to patients. Different doctor qualities can support accomplishing these tasks; humility, flexibility, honesty, fairness, self-regulation, curiosity, compassion, judgment, creativity, and courage, all relevant to deliberation and decision making. Patient deference to doctors, lack of supervised training opportunities with professional feedback, and high demands in the work environment may all inflate the risk of only superficially involving patients. CONCLUSIONS We have identified ten professional qualities and related competencies required for SDM, with each to be selected based on the specific situation. The competencies and qualities need to be preserved and nurtured during doctor identity building, to bridge the gap between knowledge, technical skills, and authentic efforts to achieve SDM.
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Affiliation(s)
- Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway; Health Services Research Unit (HØKH), Akershus University Hospital, 1478 Lørenskog, Norway
| | - Eirik H Ofstad
- The Medical Clinic, Nordland Hospital Trust, 8005 Bodø, Norway
| | - Julia Menichetti
- Health Services Research Unit (HØKH), Akershus University Hospital, 1478 Lørenskog, Norway
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Ayora A, Nogueras C, Jiménez-Panés S, Cortiñas-Rovira S. Teaching (remotely) to communicate (remotely) with relatives of patients during lockdown due to the COVID-19 pandemic. PEC INNOVATION 2023; 2:100151. [PMID: 37016635 PMCID: PMC10052879 DOI: 10.1016/j.pecinn.2023.100151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/06/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
Aim In 2020, due to the pandemic, the lack of specific knowledge on breaking bad news over the phone became apparent. This study aims at assessing the differences, or lack thereof, in satisfaction reported by participants in the different formats of a course in telephone communication for breaking bad news to families of patients, developed based on the previous experience of a team dedicated to this task during the peak of the pandemic. Methods Four courses were delivered, two in a fully streamed format and two in a blended format, part pre-recorded, part streamed. There were 41 attendants, mostly doctors, but also nurses, social workers, occupational therapists, and administrative staff who deal with families. Subsequently, a survey was conducted to assess the degree of satisfaction of the participants. Results Both formats scored very positively, with small advantages for the fully streamed format, mainly due to the difference in interaction activities. Conclusions The main conclusion is the need for these courses, which are demanded by the professionals themselves, without forgetting the benefit obtained from interprofessional education that enriches interaction and learning. Innovation The inclusion of administrative staff allows for a global vision of care for family members, which improves it.
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Affiliation(s)
- Ara Ayora
- Scientific Communication Research Group (GRECC), Department of Communication, Universitat Pompeu Fabra, Barcelona, Spain
| | - Carme Nogueras
- Geriatric Department at Hospital Universitari Germans Trias i Pujol in Barcelona, Spain
| | | | - Sergi Cortiñas-Rovira
- Scientific Communication Research Group (GRECC), Department of Communication, Universitat Pompeu Fabra and UPF-BSM Barcelona School of Management, Barcelona, Spain
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Lin CS, Yang CC. Evaluation of a digital game for teaching behavioral aspects of clinical communication in dentistry. BMC MEDICAL EDUCATION 2023; 23:78. [PMID: 36721149 PMCID: PMC9889244 DOI: 10.1186/s12909-023-04040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Traditionally, dental students learn the skills for dentist-patient interaction and communication via on-site contact with patients, when they start clinical training. However, preclinical students (who have not started clinical practice) have fewer chances to realize the context of dentist-patient interaction. It has remained unclear if a gamification approach via digital media, i.e., a computer role-playing game, can help to learn clinical communication skills. The intervention-based study investigates the effectiveness of the clinical dentist-patient communication (CDPC) game on students' motivation, beliefs, and self-efficacy to learn behavioral issues of clinical communication. METHODS Fifty-two dental students (Preclinical group) and 18 dental interns and dentists (Clinical group) played the CDPC game, which consists of 16 scenes of clinical context about dentist-patient communication (less than 40 min for playing), via web browsers. Pre-test and post-test questionnaires were used to assess their motivation, beliefs, and self-efficacy to learn behavioral issues of clinical communication. The effectiveness was examined by comparing pre-test and post-test scores within-subject and between-group difference was compared between Preclinical and Clinical groups, via non-parametric statistical tests. RESULTS (A) In the Preclinical group, participants showed a significant increase in motivation and self-efficacy in learning after playing the CDPC game (p < 0.05, adjusted of multiple comparison). (B) In contrast, the Clinical group did not show a significant difference before vs. after playing the game. (C) After playing the game, the Preclinical group showed a significant association between motivation and beliefs (p = 0.024) and between motivation and self-efficacy (p = 0.001); the Clinical group showed a significant association between motivation and beliefs (p = 0.033). CONCLUSIONS The current evidence suggests that gamification of learning helps preclinical students to understand the context of clinical dentist-patient interaction and increase their motivation and self-efficacy to learn behavioral issues of clinical communication.
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Affiliation(s)
- Chia-Shu Lin
- Department of Dentistry, College of Dentistry, National Yang Ming Chiao Tung University, 155, Sec. 2, Linong St., Taipei, 11221, Taiwan (ROC).
| | - Cheng-Chieh Yang
- Department of Dentistry, College of Dentistry, National Yang Ming Chiao Tung University, 155, Sec. 2, Linong St., Taipei, 11221, Taiwan (ROC)
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Dong K, Gagliardi AR. Person-centered care for diverse women: Narrative review of foundational research. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231192317. [PMID: 37596928 PMCID: PMC10440084 DOI: 10.1177/17455057231192317] [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: 12/14/2022] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 08/21/2023]
Abstract
Despite advocacy and recommendations to improve health care and health for persons who identify as women, women continue to face inequities in access to and quality of care. Person-centered care for women is one approach that could reduce gendered inequities. We conducted a series of studies to understand what constitutes person-centered care for women and how to achieve it. The overall aim of this article is to highlight the key findings of those studies that can inform policy, practice, and ongoing research. We conducted a narrative review of all studies related to person-centered care for women conducted in our group starting in 2018 over a 5-year period, which was general at the outset, and increasingly focused on racialized immigrant women who constitute a large proportion of the Canadian population. We organized study summaries by research phase: synthesis of person-centered care for women research, exploration of existing person-centered care for women guidance, consultation with key informants, consensus survey of key informants to prioritize strategies to achieve person-centered care for women, and consensus meeting with key informants to prioritize future research. We conducted the reported research in collaboration with an advisory group of diverse women and managers of community agencies. Our research revealed that little prior research had fully established what constitutes person-centered care for women, and in particular, how to achieve it. We also found little acknowledgment of person-centered care for women or strategies to support it in medical curriculum, clinical guidelines, or healthcare policies. We subsequently consulted women who differed by age, ethno-cultural group, health issue, education and geography, and clinicians of different specialties, who offered considerable insight on strategies to support person-centered care for women. Other diverse women, clinicians, healthcare managers, and researchers prioritized issues that warrant future research. We hope that by compiling a summary of our completed research, we draw attention to the need for person-centered care for women and motivate others to pursue it through policy, practice, and research.
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Affiliation(s)
- Kelly Dong
- Division of General Surgery and Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
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The Challenges of Visualisation During Delivery and Assessment of Clinical Teaching Under COVID-19: A Reflective Account of Problem Solving. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1397:199-213. [DOI: 10.1007/978-3-031-17135-2_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Grant M, Hockings H, Lapuente M, Adeniran P, Saud RA, Sivajothi A, Amin J, Crusz SM, Rashid S, Szabados B, Wells P, Boleti E, Powles TB. Learning from Crisis: a Multicentre Study of Oncology Telemedicine Clinics Introduced During COVID-19. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1861-1869. [PMID: 34213751 PMCID: PMC8249430 DOI: 10.1007/s13187-021-02053-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
The COVID-19 pandemic has necessitated adaptation of cancer patient care. Oncology patients who contract COVID-19 have poor outcomes. Telemedicine clinics (teleclinics) have been introduced for cancer patients to reduce the risk of horizontal transmission at St. Bartholomew's Hospital and The Royal Free Hospital in London. Teleclinics have become routine in many specialities; however, inclusion in oncology care was not standard prior to the pandemic. A mixed-methods survey was designed and delivered to cancer patients (n = 106) at St. Bartholomew's Hospital and The Royal Free Hospital who had transitioned to teleclinics in March 2020. The survey explored patients' perceptions of this format. In total, 96 (90.5%) patients consented to take part, across a range of tumour types. Overall, respondents reacted favourably to the format of the teleclinics, with 90.6% of respondents (87/96) stating they would utilise teleclinics beyond the pandemic. Additionally, a survey was distributed to clinicians delivering these teleclinics (n = 16) to explore previous training in, perceptions of, and lessons learned from the introduction of telemedicine. Results suggest patients are accepting of teleclinic use for most clinical purposes. Teleclinic implementation affords benefits to cancer patient care both during and after COVID-19, but there is an urgent need for telemedicine education in oncology specialty training.
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Affiliation(s)
- Michael Grant
- Barts Cancer Institute, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Barbican, London, EC1M 6BE UK
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
- Specialist Kidney Cancer Unit, Royal Free Hospital, Royal Free NHS Foundation Trust, London, UK
| | - Helen Hockings
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Maria Lapuente
- Barts Cancer Institute, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Barbican, London, EC1M 6BE UK
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Philip Adeniran
- Barts Cancer Institute, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Barbican, London, EC1M 6BE UK
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Rabiah Abbas Saud
- Barts Cancer Institute, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Barbican, London, EC1M 6BE UK
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Anjali Sivajothi
- Barts Cancer Institute, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Barbican, London, EC1M 6BE UK
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Jubel Amin
- Barts Cancer Institute, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Barbican, London, EC1M 6BE UK
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Shanthini M. Crusz
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Sukaina Rashid
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Bernadette Szabados
- Barts Cancer Institute, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Barbican, London, EC1M 6BE UK
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Paula Wells
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Ekaterini Boleti
- Specialist Kidney Cancer Unit, Royal Free Hospital, Royal Free NHS Foundation Trust, London, UK
| | - Thomas B. Powles
- Barts Cancer Institute, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Barbican, London, EC1M 6BE UK
- Department of Oncology, St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
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Engel KG, Pedersen K, Johansen MD, Schoennemann KR, Kjaer LB, Nayahangan LJ. Consensus on communication curriculum content in Danish undergraduate medical education: A Delphi study. MEDICAL TEACHER 2022; 44:1221-1227. [PMID: 35649701 DOI: 10.1080/0142159x.2022.2072280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The acquisition of skills in patient-centered communication is a critical aspect of medical education which demands both resource-intensive instruction and longitudinal opportunities for learning. Significant variation currently exists in the content and timing of communication education. The aim of this study was to establish consensus regarding communication curriculum content for undergraduate medical education (UME) within the country of Denmark. METHODS This study employed a Delphi process which is a widely accepted method for establishing consensus among experts and can be utilized to guide planning and decision-making in education. For this study, consensus was based on greater than 60% agreement between participants. Diverse stakeholders, representing all four universities with medical schools in Denmark, participated in an iterative three-round Delphi process which involved: (1) identifying key curricular elements for medical student education, (2) rating the importance of each item, and (3) prioritizing items relative to one another and rating each item based on the level of mastery that was expected for each skill (i.e. knowledge, performance with supervision, or performance independently). RESULTS A national sample of 149 stakeholders participated with a 70% response rate for round 1, 81% for round 2, and 86% for round 3. The completed Delphi process yielded 56 content items which were prioritized in rank order lists within five categories: (1) establishing rapport, engaging patient perspectives and responding to needs; (2) basic communication skills and techniques; (3) phases and structure of the encounter; (4) personal characteristics and skills of the student; (5) specific challenging patient groups and context-dependent situations. DISCUSSION Using a Delphi process, it was possible to achieve consensus regarding communication curriculum content for UME. These findings provide an important foundation for ensuring greater uniformity in UME, as well as supporting the important longitudinal goals of communication skill development across medical training.
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Affiliation(s)
- Kirsten Greineder Engel
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR and Education and the University of Copenhagen, Copenhagen, Denmark
- Massachusetts General Hospital, Boston, MA, USA
| | - Kamilla Pedersen
- Centre for Educational Development, Aarhus University, Aarhus, Denmark
| | - Mette Dencker Johansen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Katrine Rahbek Schoennemann
- Department of Oncology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Louise Binow Kjaer
- Centre for Educational Development, Aarhus University, Aarhus, Denmark
- Health, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR and Education and the University of Copenhagen, Copenhagen, Denmark
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Chao YP, Kang CJ, Chuang HH, Hsieh MJ, Chang YC, Kuo TBJ, Yang CCH, Huang CG, Fang TJ, Li HY, Lee LA. Comparison of the effect of 360° versus two-dimensional virtual reality video on history taking and physical examination skills learning among undergraduate medical students: a randomized controlled trial. VIRTUAL REALITY 2022; 27:637-650. [PMID: 35992202 PMCID: PMC9379871 DOI: 10.1007/s10055-022-00664-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 05/25/2022] [Indexed: 05/07/2023]
Abstract
Before caring for patients, video instruction is commonly used for undergraduate medical students, and 360° virtual reality (VR) videos have gained increasing interest in clinical medical education. Therefore, the effect of immersive 360° VR video learning compared with two-dimensional (2D) VR video learning in clinical skills acquisition should be evaluated. This randomized, intervention-controlled clinical trial was aimed to assess whether immersive 360° VR video improves undergraduate medical students' learning effectiveness and reduces the cognitive load in history taking and physical examination (H&P) training. From May 1 2018 to October 30 2018, 64 senior undergraduate medical students in a tertiary academic hospital were randomized to receive a 10-min immersive 360° (360° VR video group; n = 32) or 2D VR instructional video (2D VR video group; n = 32), including essential knowledge and competency of H&P. The demographic characteristics of the two groups were comparable for age, sex, and cognitive style. The total procedure skill score, physical examination score, learner's satisfaction score, and total cognitive load in the 360° VR video group were significantly higher than those in the 2D VR video group (effect sizes [95% confidence interval]: 0.72 [0.21-1.22], 0.63 [0.12-1.13], 0.56 [0.06-1.06], and 0.53 [0.03-1.03], respectively). This study suggested that a10-minute 360° VR video instruction helped undergraduate medical students perform fundamental H&P skills as effectively as 2D VR video. Furthermore, the 360° VR video might result in significantly better procedural metrics of physical examinations with higher learner satisfaction despite the higher cognitive load. Supplementary Information The online version contains supplementary material available at 10.1007/s10055-022-00664-0.
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Affiliation(s)
- Yi-Ping Chao
- Department of Computer Science and Information Engineering, Graduate Institute of Medical Mechatronics, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Main Branch, 33305 Taoyuan, Taiwan
| | - Chung-Jan Kang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Linkou Main Branch, 33305 Taoyuan, Taiwan, Republic of China
| | - Hai-Hua Chuang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, 33305 Taiwan
- School of Medicine, College of Life Science, National Tsing Hua University, Hsinchu, 300044 Taiwan
- Department of Industrial Engineering and Management, National Taipei University of Technology, 10608 Taipei, Taiwan
| | - Ming-Ju Hsieh
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, 33305 Taiwan
| | - Yu-Che Chang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, 33305 Taiwan
| | - Terry B. J. Kuo
- Institute of Brain Science, National Yang Ming Chiao Tung University, 11221 Taipei, Taiwan
| | - Cheryl C. H. Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, 11221 Taipei, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, 33305 Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang Gung University, 33302 Taoyuan, Taiwan
| | - Tuan-Jen Fang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Linkou Main Branch, 33305 Taoyuan, Taiwan, Republic of China
| | - Hsueh-Yu Li
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Linkou Main Branch, 33305 Taoyuan, Taiwan, Republic of China
| | - Li-Ang Lee
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Linkou Main Branch, 33305 Taoyuan, Taiwan, Republic of China
- School of Medicine, College of Life Science, National Tsing Hua University, Hsinchu, 300044 Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, 11221 Taipei, Taiwan
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Taylor DJ, Goodwin D. Organisational failure: rethinking whistleblowing for tomorrow's doctors. JOURNAL OF MEDICAL ETHICS 2022; 48:medethics-2022-108328. [PMID: 35803713 DOI: 10.1136/jme-2022-108328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
The duty to protect patient welfare underpins undergraduate medical ethics and patient safety teaching. The current syllabus for patient safety emphasises the significance of organisational contribution to healthcare failures. However, the ongoing over-reliance on whistleblowing disproportionately emphasises individual contributions, alongside promoting a culture of blame and defensiveness among practitioners. Diane Vaughan's 'Normalisation of Deviance' (NoD) provides a counterpoise to such individualism, describing how signals of potential danger are collectively misinterpreted and incorporated into the accepted margins of safe operation. NoD is an insidious process that often goes unnoticed, thus minimising the efficacy of whistleblowing as a defence against inevitable disaster. In this paper, we illustrate what can be learnt by greater attention to the collective, organisational contributions to healthcare failings by applying NoD to The Morecambe Bay Investigation. By focusing on a cluster of five 'serious untoward incidents' occurring in 2008, we describe a cycle of NoD affecting trust handling of events that allowed poor standards of care to persist for several years, before concluding with a poignant example of the limitations of whistleblowing, whereby the raising of concerns by a senior consultant failed to generate a response at trust board level. We suggest that greater space in medical education is needed to develop a thorough understanding of the cultural and organisational processes that underpin healthcare failures, and that medical education would benefit from integrating the teaching of medical ethics and patient safety to resolve the tension between systems approaches to safety and the individualism of whistleblowing.
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Affiliation(s)
- Daniel James Taylor
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Dawn Goodwin
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Bachmann C, Pettit J, Rosenbaum M. Developing communication curricula in healthcare education: An evidence-based guide. PATIENT EDUCATION AND COUNSELING 2022; 105:2320-2327. [PMID: 34887158 DOI: 10.1016/j.pec.2021.11.016] [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: 08/02/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To present a guide for communication curriculum development in healthcare professions for educators and curriculum planners. METHODS We collated a selection of theories, frameworks and approaches to communication curriculum development to provide a roadmap of the main factors to consider when developing or enhancing communication skills curricula. RESULTS We present an evidence-based guide for developing and enhancing communication curriculum that can be applied to undergraduate and postgraduate healthcare education. Recommended steps to consider during the communication curricula development process include thoughtful examination of current communication education, needs assessment, focused learning goals and objectives, incorporation of experiential educational strategies allowing for skills practice and feedback and use of formative and summative assessment methods. A longitudinal, developmental and helical implementation approach contributes to reinforcement and sustainment of learners' knowledge and skills. CONCLUSION AND PRACTICE IMPLICATIONS Drawing on best practices in developing communication curricula can be helpful in ensuring successful approaches to communication skills training for any level of learner or healthcare profession. This position paper provides a guide and identifies resources for new and established communication curriculum developers to reflect on strengths and opportunities in their own approaches to addressing the communication education needs of their learners.
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Affiliation(s)
- Cadja Bachmann
- Office of the Dean of Education, Medical Faculty, University of Rostock, Germany.
| | - Jeffrey Pettit
- Department of Family Medicine, Office of Consultation and Research in Medical Education, University of Iowa Carver College of Medicine, USA
| | - Marcy Rosenbaum
- Department of Family Medicine, Office of Consultation and Research in Medical Education, University of Iowa Carver College of Medicine, USA
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18
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Kerr D, Martin P, Furber L, Winterburn S, Milnes S, Nielsen A, Strachan P. Communication skills training for nurses: Is it time for a standardised nursing model? PATIENT EDUCATION AND COUNSELING 2022; 105:1970-1975. [PMID: 35301988 DOI: 10.1016/j.pec.2022.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/10/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Debra Kerr
- Centre for Quality and Patient Safety, Institute for Health Transformation, Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia.
| | - Peter Martin
- Centre for Organisational Change in Person-Centred Healthcare, Deakin University, School of Medicine, Faculty of Health, Geelong, VIC, Australia; University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Lynn Furber
- Healthcare Communication Matters, London, UK
| | - Sandra Winterburn
- Norwich Medical School, University of East Anglia, Faculty of Medicine and Health Sciences, UK
| | - Sharyn Milnes
- University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Annegrethe Nielsen
- Department of Nursing, University College Copenhagen, Copenhagen, Denmark
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Kelly S, Smyth E, Murphy P, Pawlikowska T. A scoping review: virtual patients for communication skills in medical undergraduates. BMC MEDICAL EDUCATION 2022; 22:429. [PMID: 35659213 PMCID: PMC9166208 DOI: 10.1186/s12909-022-03474-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/09/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Communication is an essential competence for medical students. Virtual patients (VP), computerized educational tools where users take the role of doctor, are increasingly used. Despite the wide range of VP utilization, evidence-based practical guidance on supporting development of communication skills for medical students remains unclear. We focused this scoping review on VP affordance for student learning especially important in the current environment of constrained patient access. METHODS This scoping review followed Arksey & O'Malley's methodology. We tested and used a search strategy involving six databases, resulting in 5,262 citations. Two reviewers independently screened titles, full texts (n= 158) and finally performed data extraction on fifty-five included articles. To support consideration of educational affordance the authors employed a pragmatic framework (derived from activity theory) to map included studies on VP structure, curricular alignment, mediation of VP activity, and socio-cultural context. RESULTS Findings suggest that not only the VP itself, but also its contextualization and associated curricular activities influence outcomes. The VP was trialled in the highest proportion of papers as a one-off intervention (19 studies), for an average duration of 44.9 minutes (range 10-120min), mainly in senior medical students (n=23), notably the largest group of studies did not have VP activities with explicit curricular integration (47%). There was relatively little repeated practice, low levels of feedback, self-reflection, and assessment. Students viewed VPs overall, citing authenticity and ease of use as important features. Resource implications are often omitted, and costings would facilitate a more complete understanding of implications of VP use. CONCLUSION Students should be provided with maximal opportunity to draw out the VPs' full potential through repeated practice, without time-constraint and with curricular alignment. Feedback delivery enabling reflection and mastery is also key. The authors recommend educators to explicitly balance computerized authenticity with instructional design integrated within the curriculum.
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Affiliation(s)
- Síle Kelly
- Department of Medicine, RCSI University of Medicine and Health Science, Smurfit Building, ERC, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
| | - Erica Smyth
- Health Professions Education Centre, RCSI University of Medicine and Health Science, Dublin, Ireland
| | - Paul Murphy
- Library, RCSI University of Medicine and Health Science, Dublin, Ireland
| | - Teresa Pawlikowska
- Health Professions Education Centre, RCSI University of Medicine and Health Science, Dublin, Ireland
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20
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Angouri J, Mesinioti P, Siassakos D. Let’s talk about it: reframing communication in medical teams. Best Pract Res Clin Obstet Gynaecol 2022; 80:75-91. [DOI: 10.1016/j.bpobgyn.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 11/30/2022]
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Anderson NN, Gagliardi AR. Unclear if future physicians are learning about patient-centred care: Content analysis of curriculum at 16 medical schools. MEDICAL TEACHER 2021; 43:1085-1091. [PMID: 33915064 DOI: 10.1080/0142159x.2021.1918332] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Given barriers of patient-centred care (PCC) among physicians and trainees, this study assessed how medical schools addressed PCC in curriculum. METHOD The authors used content analysis to describe PCC in publicly-available curriculum documents of Canadian medical schools guided by McCormack's PCC Framework, and reported results using summary statistics and text examples. RESULTS The authors retrieved 1459 documents from 16 medical schools (median 49.5, range 16-301). Few mentioned PCC (301, 21.2%), and even fewer thoroughly or accurately described PCC. Significantly more clerkship versus pre-clerkship (24.0% vs 12.6%, p < 0.00001), and elective compared with core course descriptions (24.7% vs 14.9%, p < 0.00001) mentioned PCC. The domain of foster a healing relationship was common (79.0%) compared with other domains: address concerns (16.5%), exchange information (14.9%), enable self-care (10.4%), share decisions (4.5%), and manage uncertainty (1.3%). CONCLUSIONS Overall, few documents mentioned or described PCC or related concepts. This varied by school, and was more frequent in clerkship and elective courses, suggesting that student exposure may be brief and variable. Thus, it remains unclear if medical students are fully exposed to what PCC means and how to implement it. Future research is needed to confirm if PCC content in medical curriculum is lacking.
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Affiliation(s)
- Natalie N Anderson
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
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22
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Thompson T, Grove L, Brown J, Buchan J, Kerry AL, Burge S. COGConnect: A new visual resource for teaching and learning effective consulting. PATIENT EDUCATION AND COUNSELING 2021; 104:2126-2132. [PMID: 33422369 DOI: 10.1016/j.pec.2020.12.016] [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: 01/09/2020] [Revised: 11/22/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Consultation skills are essential to clinical practice and, when effective, can facilitate diagnoses and improve patient satisfaction. Various models exist to facilitate consultation teaching. These can be prescriptive, a challenge to apply in clinical settings and are often designed for primary care. In redesigning our entire curriculum, we sought to create a new visual, digital, resource for consultation teaching, aligned with statements from the UK Council for Clinical Communication (UKCCC), and suitable for the evolving expectations of patients, clinicians and the UK NHS, in 21st century medicine. METHODS We conducted a literature review encompassing teaching methods, NHS Priorities, patients' priorities, lifestyle interventions and practitioner resilience. COGConnect was designed iteratively through consultation with a graphic designer, health psychologists, a range of clinicians, and a consultation expert, and has evolved through extensive use in our new "effective consulting" course in primary and secondary care. RESULTS COGConnect is deliberately visual, iterative, bi-directional and multi-phasic. The central image of COGConnect is two persons in connection; the floating cogs suggesting an encounter of different agents who must adapt their cog-connection in terms of speed, direction and dimension. Around this image we place five core values. The consultation phases are represented by ten colourful cogs, with important additions including 'formulating', 'activating' and 'integrating'. CONCLUSION COGConnect builds on the strengths of existing frameworks and provides a strong visual resource suitable for digital learning. It offers greater emphasis on explicit clinical reasoning, activation of patient self-care and learning from the interaction. Having become the de facto resource for consultation skills training across primary and secondary care in our institution, the next phase is to develop the COGConnect.info website and a programme of formal evaluation.
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Affiliation(s)
- Trevor Thompson
- Centre for Academic Primary Care, School of Population Health Sciences, University of Bristol, Bristol, BS8 2PS, UK.
| | - Lizzie Grove
- Centre for Academic Primary Care, School of Population Health Sciences, University of Bristol, Bristol, BS8 2PS, UK
| | - Juliet Brown
- Centre for Academic Primary Care, School of Population Health Sciences, University of Bristol, Bristol, BS8 2PS, UK
| | - Jess Buchan
- Centre for Academic Primary Care, School of Population Health Sciences, University of Bristol, Bristol, BS8 2PS, UK
| | - Anthony L Kerry
- Department of Respiratory Medicine, Western Hospital NHS Foundation Trust, Swindon, SN3 6BB, UK
| | - Sarah Burge
- Bristol Medical School, University of Bristol, 69 St Michael's Hill, Bristol, BS2 8DZ, UK
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Manalastas G, Noble LM, Viney R, Griffin AE. What does the structure of a medical consultation look like? A new method for visualising doctor-patient communication. PATIENT EDUCATION AND COUNSELING 2021; 104:1387-1397. [PMID: 33272747 DOI: 10.1016/j.pec.2020.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/15/2020] [Accepted: 11/20/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This project developed an innovative methodology for visualising consultation structure by categorising doctor-patient talk into the phases proposed by an established educational model of clinical communication. METHOD Consultation phases were identified from verbatim transcripts using the tasks and process skills of the Calgary-Cambridge Guide to the Medical Interview. Seventy-eight simulated consultations from a 'History-taking' station of a postgraduate examination for physicians were analysed by two independent raters. Transcripts were converted into diagrams comprising up to six phases: Initiating, Gathering information, Summary, Explanation, Planning and Closing. RESULTS The dominant phases were Gathering information, Planning and Explanation (66 %, 10 % and 12 % of talk respectively). While consultations broadly followed the expected chronological sequence, less than a third (23/78) contained all six phases, with Closing and Summary most frequently absent. Half of consultations (40/78) did not include phases in the predicted order, with intertwined phases commonly observed. CONCLUSIONS In this standardised setting, doctors created variable consultation structures, typically omitting phases involving consolidation and agreement of plans going forward. PRACTICE IMPLICATIONS The method enables visualisation and comparison of consultation structure. The findings pose questions about the alignment of practice with educational guidance and the opportunities afforded to patients to actively engage in consultations.
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Affiliation(s)
| | | | - Rowena Viney
- UCL Medical School, University College London, London, UK.
| | - Ann E Griffin
- UCL Medical School, University College London, London, UK.
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Cooper N, Bartlett M, Gay S, Hammond A, Lillicrap M, Matthan J, Singh M. Consensus statement on the content of clinical reasoning curricula in undergraduate medical education. MEDICAL TEACHER 2021; 43:152-159. [PMID: 33205693 DOI: 10.1080/0142159x.2020.1842343] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Effective clinical reasoning is required for safe patient care. Students and postgraduate trainees largely learn the knowledge, skills and behaviours required for effective clinical reasoning implicitly, through experience and apprenticeship. There is a growing consensus that medical schools should teach clinical reasoning in a way that is explicitly integrated into courses throughout each year, adopting a systematic approach consistent with current evidence. However, the clinical reasoning literature is 'fragmented' and can be difficult for medical educators to access. The purpose of this paper is to provide practical recommendations that will be of use to all medical schools. METHODS Members of the UK Clinical Reasoning in Medical Education group (CReME) met to discuss what clinical reasoning-specific teaching should be delivered by medical schools (what to teach). A literature review was conducted to identify what teaching strategies are successful in improving clinical reasoning ability among medical students (how to teach). A consensus statement was then produced based on the agreed ideas and the literature review, discussed by members of the consensus statement group, then edited and agreed by the authors. RESULTS The group identified 30 consensus ideas that were grouped into five domains: (1) clinical reasoning concepts, (2) history and physical examination, (3) choosing and interpreting diagnostic tests, (4) problem identification and management, and (5) shared decision making. The literature review demonstrated a lack of effectiveness for teaching the general thinking processes involved in clinical reasoning, whereas specific teaching strategies aimed at building knowledge and understanding led to improvements. These strategies are synthesised and described. CONCLUSION What is taught, how it is taught, and when it is taught can facilitate clinical reasoning development more effectively through purposeful curriculum design and medical schools should consider implementing a formal clinical reasoning curriculum that is horizontally and vertically integrated throughout the programme.
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Affiliation(s)
- Nicola Cooper
- Medical Education Centre, University of Nottingham, Nottingham, UK
| | | | - Simon Gay
- School of Medicine, University of Leicester, Leicester, UK
| | | | - Mark Lillicrap
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Joanna Matthan
- School of Dental Sciences, Newcastle University, Newcastle, UK
| | - Mini Singh
- Division of Medical Education, University of Manchester, Manchester, UK
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Stovel RG, Gabarin N, Cavalcanti RB, Abrams H. Curricular needs for training telemedicine physicians: A scoping review. MEDICAL TEACHER 2020; 42:1234-1242. [PMID: 32757675 DOI: 10.1080/0142159x.2020.1799959] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
PURPOSE The use of telemedicine, a part of 'Virtual Care', is rapidly entering mainstream clinical practice. The ideal curriculum for educating physicians to practice in this emerging field has not been established. We examined the literature to evaluate published curricula for quality and comprehensiveness through the lens of Competency-Based Medical Education (CBME). METHODS We performed a scoping review using CanMEDS as a framework. Peer-reviewed articles describing telemedicine training curricula were identified. Trainee population, curricular points, stage of implementation, evaluation depth, country, and citations (a marker of quality) were examined. RESULTS Forty-three curricula from 11 countries were identified, addressing all training levels and covering multiple specialties. Instructional methods included lectures (60.5%), hands-on experiences (76%), directed reading (24%), online modules (21%), reflection (13%), simulation (34%), and group discussions (16%). Hands-on curricula covered all CanMEDS roles more often. Twenty-nine of the implemented curricula were evaluated; 83% were rated positively. CONCLUSIONS Our scoping review helps inform more comprehensive and efficacious curricula for teaching telemedicine. We suggest centering curricula on a competency-based, outcomes-oriented framework such as CanMEDS with multiple teaching modalities complementing hands-on experiences. This will facilitate rigorous telemedicine training to deliver on the promise of high-quality patient care.
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Affiliation(s)
- Rebecca G Stovel
- Department of Medicine, University of Toronto, Toronto, Canada
- HoPingKong Centre for Excellence in Education and Practice (CEEP), Toronto, Canada
- Department of Medicine, Women's College Hospital, Toronto, Canada
| | - Nadia Gabarin
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Rodrigo B Cavalcanti
- Department of Medicine, University of Toronto, Toronto, Canada
- HoPingKong Centre for Excellence in Education and Practice (CEEP), Toronto, Canada
- Department of Medicine, University Health Network, Toronto, Canada
| | - Howard Abrams
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, University Health Network, Toronto, Canada
- OpenLab, University Health Network, Toronto, Canada
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Manalastas G, Noble LM, Viney R, Griffin AE. Patient autonomy in the consultation: How signalling structure can facilitate patient-centred care. PATIENT EDUCATION AND COUNSELING 2020; 103:2269-2279. [PMID: 32507588 DOI: 10.1016/j.pec.2020.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To identify types and functions of doctors' verbal signalling behaviours used to share consultation structure with patients. METHOD Doctors' verbal utterances signalling what would happen in the consultation were identified by two independent raters from transcripts of 78 simulated consultations from a postgraduate examination for physicians. In total, 974 behaviours were categorised as informing, inviting or instructing. Principles adopted from Speech Act Theory and Conversation Analysis were used to examine their function from their literal meaning and use in context. RESULTS Signalling behaviours to inform were most frequent, particularly 'signposts', with less informative signalling behaviours also found ('posts without signs' and 'signs without posts'). Behaviours to invite involvement offered limited choice. Doctors also instructed the patient in what to do (behaviour) or not to do (emotion). Behaviours signalled more 'micro-level' changes than broader consultation aims. Signalling behaviours carried roles beyond their literal meaning ('hyperfunctions') and were combined ('stacked'), often seen deflecting the conversation away from patient concerns. CONCLUSION Doctors use a variety of verbal signalling behaviours with multiple functions. As well as sharing information, these behaviours regulate patient agency in the consultation. PRACTICE IMPLICATIONS Doctors' signalling behaviours may play an important role in facilitating or inhibiting patient autonomy.
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Affiliation(s)
| | | | - Rowena Viney
- UCL Medical School, University College London, London, UK.
| | - Ann E Griffin
- UCL Medical School, University College London, London, UK.
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Rocha SR, Romão GS, Setúbal MSV, Lajos GJ, Luz AG, Collares CF, Amaral E. Cross-Cultural Adaptation of the Communication Assessment Tool for Use in a Simulated Clinical Setting. TEACHING AND LEARNING IN MEDICINE 2020; 32:308-318. [PMID: 32090632 DOI: 10.1080/10401334.2020.1717958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Construct: The Communication Assessment Tool (CAT) is a 14-item instrument developed in English to assess medical trainees' interpersonal communication skills from the patient's perspective in clinical settings. Background: Using validated instruments and simulated patients constitutes good practice in assessing doctor-patient communication. The CAT was designed for use in real practice, but has not yet been applied to assessing OB-GYN residents' delivery of bad news in Objective Structured Clinical Examination (OSCE) stations. This study aims to provide validity evidence for using the CAT to assess residents' interpersonal communication skills under difficult circumstances in a simulated clinical setting in Brazil. Approach: Cross-cultural adaptation comprised translation into Portuguese, synthesis of translations, and back-translation. Next, a committee of 10 external and independent experts rated the items for linguistic equivalence and relevance to the overall scale. Researchers used the expert ratings to produce a preliminary Brazilian-Portuguese version. This version was applied by four simulated patients to assess 28 OB-GYN residents completing two, 10-minute OSCE stations focused on delivering bad news. Item and scale content validity indices and internal-consistency reliability were calculated. Simulated patients were interviewed to clarify any doubt regarding the content and usability of the tool and their response process. Findings: Thirteen of the 14 items in the Brazilian-Portuguese version were considered "equivalent" by at least 70% of the experts. All items were considered relevant by 100% of the experts. The Item Content Validity Index ranged from .9 to 1, and the Scale Content Validity Index was .99. The instrument showed good reliability for both scenarios (Cronbach's alpha > .90). Simulated patients considered the CAT easy to understand and complete. Conclusions: This study provides validity evidence for using the Brazilian-Portuguese CAT in a simulated clinical environment to assess OB-GYN residents' delivery of bad news. Based on this study's findings, the OB-GYN Department organized an annual formative assessment for residents to improve their interpersonal communication skills. This version of the CAT may also be applicable to other specialties.
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Affiliation(s)
| | | | | | - Giuliane Jesus Lajos
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Adriana Gomes Luz
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Carlos Fernando Collares
- Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands
| | - Eliana Amaral
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
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Wenceslau LD, Fonseca VKTD, Dutra LDA, Caldeira LG. Um roteiro de entrevista clínica centrada na pessoa para a graduação médica. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2020. [DOI: 10.5712/rbmfc15(42)2154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
O ensino de habilidades de comunicação clínica na graduação médica encontra nos princípios e componentes do Método Clínico Centrado na Pessoa (MCCP) uma referência importante para a definição de suas competências. No entanto, mesmo tendo contato com o MCCP em sua formação, é frequente que estudantes de medicina recorram à utilização da anamnese tradicional centrada na agenda médica como um roteiro mais seguro para realização de suas entrevistas. Propomos, como uma hipótese para essa dificuldade dos estudantes, a falta de uma tradução do MCCP em um roteiro padronizado de entrevista médica, especialmente para ensino na graduação. Neste relato, a partir de modelos de entrevista clínica centrada na pessoa (ECCP) selecionados da literatura internacional, apresentamos a primeira etapa de um roteiro de ECCP original, adaptado ao cenário brasileiro. O objetivo deste relato é oferecer uma referência de fácil utilização em língua portuguesa e que possa ser aprimorada pelos profissionais envolvidos com o ensino de comunicação clínica na educação superior no Brasil. Estudos empíricos ainda são necessários para endossar uma utilização mais ampla da proposta aqui apresentada.
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Lawless MT, Archibald MM, Ambagtsheer RC, Kitson AL. Factors influencing communication about frailty in primary care: A scoping review. PATIENT EDUCATION AND COUNSELING 2020; 103:436-450. [PMID: 31551158 DOI: 10.1016/j.pec.2019.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/14/2019] [Accepted: 09/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To summarise the available evidence on the factors influencing communication about frailty in the primary care setting. METHODS We conducted a scoping review, searching five electronic databases (PubMed, Scopus, CINAHL, PsycINFO, and ProQuest) for studies addressing communication about frailty in primary care practice. Reference list and grey literature searching was conducted to identify additional articles. A narrative descriptive method was used to synthesise the findings. RESULTS The search identified 3185 articles and 37 were included in the review. We identified five categories of factors influencing communication about frailty at the consumer, healthcare provider, and system levels: (1) consumer perceptions, information needs, and communication preferences; (2) healthcare providers' knowledge, capacities, and attitudes; (3) clinical communication skills and training; (4) availability of information and communication technologies; and (5) care coordination, collaboration, and case management. CONCLUSION Findings offer considerations for the design and delivery of initiatives to improve communication about frailty in primary care both at the local clinical level and at the broader level of healthcare service delivery. PRACTICE IMPLICATIONS Healthcare providers and systems require practical, evidence-informed guidance regarding the development of a systematic approach to the quality and timing of communication about frailty in healthcare encounters.
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Affiliation(s)
- Michael T Lawless
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; National Health and Medical Research Council Centre of Research Excellence in Transdisciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, Australia.
| | - Mandy M Archibald
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; National Health and Medical Research Council Centre of Research Excellence in Transdisciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, Australia
| | | | - Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; National Health and Medical Research Council Centre of Research Excellence in Transdisciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, Australia
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Links MJ, Watterson L, Martin P, O'Regan S, Molloy E. Finding common ground: meta-synthesis of communication frameworks found in patient communication, supervision and simulation literature. BMC MEDICAL EDUCATION 2020; 20:45. [PMID: 32046704 PMCID: PMC7014645 DOI: 10.1186/s12909-019-1922-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Effective communication between patients-clinicians, supervisors-learners and facilitators-participants within a simulation is a key priority in health profession education. There is a plethora of frameworks and recommendations to guide communication in each of these contexts, and they represent separate discourses with separate communities of practice and literature. Finding common ground within these frameworks has the potential to minimise cognitive load and maximise efficiency, which presents an opportunity to consolidate messages, strategies and skills throughout a communication curriculum and the possibility of expanding the research agenda regarding communication, feedback and debriefing in productive ways. METHODS A meta-synthesis of the feedback, debriefing and clinical communication literature was conducted to achieve these objectives. RESULTS Our analysis revealed that the concepts underlying the framework can be usefully categorised as stages, goals, strategies, micro-skills and meta-skills. Guidelines for conversations typically shared a common structure, and strategies aligned with a stage. Core transferrable communication skills (i.e., micro-skills) were identified across various types of conversation, and the major differences between frameworks were related to the way that power was distributed in the conversation and the evolution of conversations along the along the path of redistributing power. As part of the synthesis, an overarching framework "prepare-EMPOWER enact" was developed to capture these shared principles across discourses. CONCLUSIONS Adopting frameworks for work-based communication that promote dialogue and empower individuals to contribute may represent an important step towards learner-centred education and person-centred care for patients.
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Affiliation(s)
- Matthew Jon Links
- Gold Coast University Hospital and Health Service, Southport, Australia.
- Griffith University Institute of Educational Research and School of Medicine, Brisbane, Australia.
- Medical Oncology, 1 Hospital Boulevarde, Southport, QLD, 4215, Australia.
| | - Leonie Watterson
- Sydney Clinical Skills and Simulation Centre, Royal North Shore Hospital Sydney, Sydney, New South Wales, Australia
| | - Peter Martin
- Deakin University Faculty of Health, School of Medicine, Geelong, Australia
| | - Stephanie O'Regan
- Sydney Clinical Skills and Simulation Centre, Royal North Shore Hospital Sydney, Sydney, New South Wales, Australia
| | - Elizabeth Molloy
- Department of Medical Education, University of Melbourne, Melbourne, Australia
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Swordy A, Noble LM, Bourne T, Van Lessen L, Lokugamage AU. Footprints of Birth: An Innovative Educational Intervention Foregrounding Women's Voices to Improve Empathy and Reflective Practice in Maternity Care. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:192-198. [PMID: 32898117 DOI: 10.1097/ceh.0000000000000302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION A global movement on respectful maternity care has arisen because of widespread accounts of dehumanized maternity care. This article considers the use of a transformative learning approach to highlight patient agency and personhood in health care. An educational intervention using patient narratives was introduced in a maternity unit to foster a culture of listening and responsiveness to women's voices. This article reports the impact on staff and student learning, empathy, and reflective practice. METHODS A total of 245 interprofessional providers participated in 14 workshops over a 16-month period. Participants represented a range of health professions including medicine, midwifery, nursing, and allied professions. Senior management, administrators, and peer support volunteers also attended. Session sizes ranged from 5 to 60 attendees. The format included documentary-style videos of patient feedback followed by audience discussion. Discussion points were collected and qualitatively analyzed for participants' critical reflection, emotional engagement, cognitive dissonance, and perspective transformation. RESULTS Learners reflected on the client-caregiver relationship and care provision. Staff and students showed empathy for the women sharing their stories. Learners were disturbed by failings in care and wished to improve services. All provider groups highlighted the importance of communication, compassion, and patient autonomy as key elements of maternity care. DISCUSSION Multiprofessional learners engaged emotionally with women's narratives and reflected critically on their roles in maternity care. Learners' responses showed evidence of transformative learning. Staff and students recognized the value of providing respectful, empathic care. Educational interventions highlighting patients' voices may promote patient autonomy by reducing dehumanization in health care.
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Affiliation(s)
- Alice Swordy
- Dr. Swordy: Foundation Year Doctor, UCL Medical School, University College London, London, United Kingdom;Dr. Noble: Associate Professor in Clinical Communication, UCL Medical School, University College London, London, United Kingdom; Mrs. Bourne: Associate Professor of Midwifery, Whittington Health NHS Trust, London, United Kingdom, and Department of Adult, Child and Midwifery, Middlesex University, London, United Kingdom; Mrs. Van Lessen: Consultant Midwife, Whittington Health NHS Trust, London, United Kingdom, and Department of Adult, Child and Midwifery, Middlesex University, London, United Kingdom; Dr. Lokugamage: Consultant Obstetrician & Gynaecologist, Honorary Associate Professor, UCL Medical School, University College London, London, United Kingdom, and Whittington Health NHS Trust, London, United Kingdom
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Ernstmann N, Herden J, Weissbach L, Karger A, Hower K, Ansmann L. Prostate-specific health-related quality of life and patient-physician communication - A 3.5-year follow-up. PATIENT EDUCATION AND COUNSELING 2019; 102:2114-2121. [PMID: 31399225 DOI: 10.1016/j.pec.2019.07.030] [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: 02/22/2019] [Revised: 07/15/2019] [Accepted: 07/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of this study is to examine associations between prostate-specific health-related quality of life (HRQOL) and aspects of patient-physician communication in localized prostate cancer treatment. METHODS Data of patients with localized prostate cancer were collected at 6-month intervals over a 3.5-year period within a prospective, observational study (HAROW). Data collection comprised D'Amico risk categories, the Charlson Comorbidity Index, patient-physician communication (information, shared decision making, support, devotion), and prostate-specific HRQOL (incontinence aid, urinary symptoms, bowel symptoms, hormonal treatment-related symptoms, sexual functioning, sexual activity). Data of N = 1722 patients undergoing radical prostatectomy were analyzed by longitudinal multilevel analysis. RESULTS The mean patient age was 65 years; 31% had a low risk and 38% an intermediate risk of cancer growth and spread; 73% had a Charlson Comorbidity Index of 0. Significant associations were found between prostate-specific HRQOL and shared decision making, support and devotion. Patient information was not significantly associated with aspects of prostate-specific HRQOL. CONCLUSION Patient reported long term outcomes are associated with aspects of patient-physician communication in prostate cancer patients. Patients feeling involved by their urologists experience less side effects of (surgical) treatment. PRACTICE IMPLICATIONS Special communication training programmes should be developed and implemented for urologists.
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Affiliation(s)
- Nicole Ernstmann
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany; Center for Integrated Oncology Bonn (CIO), Bonn, Germany.
| | - Jan Herden
- Department of Urology, University Hospital Cologne, Cologne, Germany.
| | | | - André Karger
- Clinical Institute of Psychosomatic Medicine and Psychotherapy, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
| | - Kira Hower
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany.
| | - Lena Ansmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
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Witheridge A, Ferns G, Scott-Smith W. Revisiting Miller's pyramid in medical education: the gap between traditional assessment and diagnostic reasoning. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2019; 10:191-192. [PMID: 31655795 PMCID: PMC7246123 DOI: 10.5116/ijme.5d9b.0c37] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 10/07/2019] [Indexed: 05/30/2023]
Affiliation(s)
- Annamaria Witheridge
- Division of Medical Education, Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - Gordon Ferns
- Division of Medical Education, Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - Wesley Scott-Smith
- Division of Medical Education, Brighton and Sussex Medical School, Falmer, Brighton, UK
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Abstract
OBJECTIVE The General Medical Council (GMC) recommends medical schools to develop and implement curricula enabling students to achieve the required learning outcomes. UK medical schools follow the GMC's Outcomes for graduates, which are generic. GMC plans to introduce a national Medical Licensing Assessment (MLA) for the medical graduates wanting to practise medicine in the UK in 2022. With no standardised or unified undergraduate (UG) curriculum in UK, various specialties have expressed concerns about not being represented in medical schools and developed specialty-specific core curricula. The aim of this review was to identify learned bodies who have developed a core curriculum for UK medical schools and highlight the drivers, gaps and future approaches to curricular development and implementation. METHODS A literature search was conducted using online databases (EMBASE, MEDLINE, ERIC, HMIC, PubMed and CDSR), search engines and related websites (Google and Google Scholar, Department of Health, GMC and BMA) for relevant articles from 1996 to 5 March 2019 (~20 years). A methodological framework to map the key concepts of UG medical curriculum was followed. Any relevant body with a core curriculum for UK medical UGs was included. RESULTS A total of 1283 articles were analysed with 31 articles included in the qualitative synthesis, comprising 26 specialties (clinical n=18, foundation subjects n=4 and professionalism related n=4). WHO, European and national (eg, Royal Colleges of UK) specialty bodies provided specific core learning outcomes for the medical graduates. Patient safety, disease burden, needs of society and inadequate preparedness of medical graduates were drivers for the development of these curricula. CONCLUSIONS This is the first comprehensive review of literature on UG core curricula recommending minimum standards on knowledge and skills, in alignment with GMC's Outcomes for graduates for all the UK medical students. Adopting and assessing unified standards would help reduce variability across UK medical schools for both generic and specialty-specific competencies.
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Affiliation(s)
- Maulina Sharma
- Medical Education Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Dermatology, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | - Ruth Murphy
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Gillian A Doody
- Medical Education Centre, School of Medicine, University of Nottingham, Nottingham, UK
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Jalal Z, Akhtar S, Finlay K, King K, Goel N, Ward J. Perceptions of UK Community Pharmacists on Current Consultation Skills and Motivational Interviewing as a Consultation Approach: A Qualitative Study. PHARMACY 2019; 7:E52. [PMID: 31159294 PMCID: PMC6630739 DOI: 10.3390/pharmacy7020052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Community pharmacists' roles in the UK are evolving; pharmacists currently deliver a wider range of clinical services with more patient-focused care. The objectives of this study were (i) to investigate UK community pharmacists' views on their current communication skills in pharmacist-patient facing consultations, and (ii) to explore the perceptions of UK community pharmacists towards the application of motivational interviewing (MI) in a pharmacy consultation. In-depth qualitative face-to-face, semi-structured interviews with ten practicing community pharmacists were carried out, ranging from 30-60 minutes in length. The interviews were audio recorded, transcribed verbatim and thematic analysis was employed. Four themes emerged from the data: (1) the fight for time; (2) wrestling with consultation styles; (3) a personal communication evolution; and (4) unfamiliar but engaging motivational interviewing. These themes demonstrated the juxtaposition between the desire for patient-centred care and the pressures of managing broader dispensing work. Participants were critical of academic and continuous professional learning (CPD) training in communication skills and there was a strong recognition of the potential role of MI in promoting patient autonomy and outcomes. Participants recognized a few elements of MI techniques in their current consultations, but welcomed further training on behavioral change for effective consultations, expressing a desire for practical MI-specific training. Face-to-face CPD of consultation skills is needed to avoid the feeling of isolation among UK practicing pharmacists and rigidity in consultation delivery. Support for community pharmacists from other pharmacy staff could relieve current pressures and allow pharmacists time to develop and acquire effective skills for patient facing roles. Behavioural change consultation skills training for pharmacists could be an effective strategy to address these current challenges.
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Affiliation(s)
- Zahraa Jalal
- School of Pharmacy, University of Birmingham, Birmingham B15 2TT, UK.
| | - Sania Akhtar
- School of Pharmacy, University of Birmingham, Birmingham B15 2TT, UK.
| | - Katherine Finlay
- School of Psychology and Wellbeing, The University of Buckingham, Buckingham, Bucks MK18 1EG, UK.
| | - Kathryn King
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London SE1 8WA, UK.
| | - Neera Goel
- School of Pharmacy, University of Birmingham, Birmingham B15 2TT, UK.
| | - Jonathan Ward
- Interactive Studies Unit, University of Birmingham, Birmingham B15 2TT, UK.
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