Beyond communication training: The MaRIS model for developing medical students' human capabilities and personal resilience

Beyond words: analyzing non-verbal communication techniques in a medical communication skills course via synchronous online platform

Background

Effective doctor-patient relationships hinge on robust communication skills, with non-verbal communication techniques (NVC) often overlooked, particularly in online synchronous interactions. This study delves into the exploration of NVC types during online feedback sessions for communication skill activities in a medical education module.

Methods

A cohort of 100 first-year medical students and 10 lecturers at the Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), engaged in communication skills activities via Microsoft Teams. Sessions were recorded, and lecturer NVC, encompassing body position, facial expressions, voice intonation, body movements, eye contact, and paralinguistics, were meticulously observed. Following these sessions, students provided reflective writings highlighting their perceptions of the feedback, specifically focusing on observed NVC.

Results

The study identified consistent non-verbal communication patterns during feedback sessions. Lecturers predominantly leaned forward and toward the camera, maintained direct eye contact, and exhibited dynamic voice intonation. They frequently engaged in tactile gestures and paused to formulate thoughts, often accompanied by filler sounds like "um" and "okay." This consistency suggests proficient use of NVC in providing synchronous online feedback. Less observed NVC included body touching and certain paralinguistic cues like long sighs. Initial student apprehension, rooted in feelings of poor performance during activities, transformed positively upon observing the lecturer's facial expressions and cheerful intonation. This transformation fostered an open reception of feedback, motivating students to address communication skill deficiencies. Additionally, students expressed a preference for comfortable learning environments to alleviate uncertainties during feedback reception. Potential contrivances in non-verbal communication (NVC) due to lecturer awareness of being recorded, a small sample size of 10 lecturers limiting generalizability, a focus solely on preclinical lecturers, and the need for future research to address these constraints and explore diverse educational contexts.

Conclusion

Medical schools globally should prioritize integrating NVC training into their curricula to equip students with essential communication skills for diverse healthcare settings. The study's findings serve as a valuable reference for lecturers, emphasizing the importance of employing effective NVC during online feedback sessions. This is crucial as NVC, though occurring online synchronously, remains pivotal in conveying nuanced information. Additionally, educators require ongoing professional development to enhance proficiency in utilizing NVC techniques in virtual learning environments. Potential research directions stemming from the study's findings include longitudinal investigations into the evolution of NVC patterns, comparative analyses across disciplines, cross-cultural examinations, interventions to improve NVC skills, exploration of technology's role in NVC enhancement, qualitative studies on student perceptions, and interdisciplinary collaborations to deepen understanding of NVC in virtual learning environments.

The effects of diverse fidelity scenarios on stress in medical students when taking patients' medical histories: A longitudinal study

Taking patients' medical history correctly is the basis of diagnosis and therapy. Medical students as a vulnerable group may perceive patient-physician interactions as stressful. This study examines stress among medical students in different degrees of fidelity when taking a patient's medical history. In this longitudinal study, students' stress levels were assessed during scenarios with different degrees of fidelity (role-play, simulated patient encounters and real patient encounters) using standardised questionnaires (State-Trait Anxiety Inventory and a distress scale) and the physiological measurement of heart rate variability. The stress level of participating medical students (N = 128) was expected to significantly increase during scenarios of increasing fidelity (M_roleplay  = 2.08 ± 0.92; SPEs: M_{simulatedpatient}  = 2.68 ± 1.08; RPEs: M_realpatient  = 3.35 ± 1.08; p < 0.001). Whereas physiological stress was significantly higher with real patients (N = 106), psychological stress was not affected by the fidelity of the scenarios (N = 85). Medical students experienced stress when taking patients' medical history. Medical students might be unaware of their perceived stress based on the results. Thus, they should know how to cope with stress in such situations.

Twelve tips for medical students experiencing an interruption in their academic progress

For every commencing cohort of medical students, a small but significant number will experience an interruption to their academic progression because of academic difficulties, health concerns or external influences outside of the students' control. During the process of researching the factors surrounding difficulties with academic progression, students told us many ways that they have learned from that experience, which then allowed most of them to graduate. This paper combines the shared experiences of students who have had an interruption, and those of the authors as medical educators.

Termination of pregnancy for fetal anomaly: a systematic review of the healthcare experiences and needs of parents

BACKGROUND

Improved technology and advances in clinical testing have resulted in increased detection rates of congenital anomalies during pregnancy, resulting in more parents being confronted with the possibility of terminating a pregnancy for this reason. There is a large body of research on the psychological experience and impact of terminating a pregnancy for fetal anomaly. However, there remains a lack of evidence on the holistic healthcare experience of parents in this situation. To develop a comprehensive understanding of the healthcare experiences and needs of parents, this systematic review sought to summarise and appraise the literature on parents' experiences following a termination of pregnancy for fetal anomaly.

REVIEW QUESTION

What are the healthcare experiences and needs of parents who undergo a termination of pregnancy following an antenatal diagnosis of a fetal anomaly?

METHODS

A systematic review was undertaken with searches completed across six multi-disciplinary electronic databases (Medline, Embase, PsycINFO, CINAHL, Web of Science, and Cochrane). Eligible articles were qualitative, quantitative or mixed methods studies, published between January 2010 and August 2021, reporting the results of primary data on the healthcare experiences or healthcare needs in relation to termination of pregnancy for fetal anomaly for either, or both parents. Findings were synthesised using Thematic Analysis.

RESULTS

A total of 30 articles were selected for inclusion in this review of which 24 were qualitative, five quantitative and one mixed-methods. Five overarching themes emerged from the synthesis of findings: (1) Contextual impact on access to and perception of care, (2) Organisation of care, (3) Information to inform decision making, (4) Compassionate care, and (5) Partner experience.

CONCLUSION

Compassionate healthcare professionals who provide non-judgemental and sensitive care can impact positively on parents' satisfaction with the care they receive. A well organised and co-ordinated healthcare system is needed to provide an effective and high-quality service.

TRIAL REGISTRATION

PROSPERO registration number: CRD42020175970 .

Deepening the teaching and learning of clinical communication

Aims: clinical communication (CC) relates to health professionals’ interaction with patients/families. CC is fundamental for the physicians’ role. This paper aims to contribute to the discussion about reflection and feedback for meaningful teaching and learning of CC.Methods: the authors provided a short review and conceptual discussion of the history and nature of CC teaching, followed by exploring the role of reflection and feedback in teaching CC.Results: communicating well can be challenging as it requires medical students and professionals to adapt their communication to each patient/family while obtaining all the needed information, conveying trustworthiness, care, and compassion. The teaching of CC to medical students involves deepening the doctor-patient relationship’s technical, relational, and emotional elements. CC requires teaching that is flexible and tailored to the participants’ needs. Therefore, teaching CC must go beyond asking the appropriate question or applying specific checklist-based behaviours. In teaching CC, it is crucial to give medical students support to discuss personal and institutional barriers and attitudes and explore how to transfer their learning to clinical practice. To that end, reflection should be encouraged to allow students to express difficulties and feelings and enhance their understanding of themselves and others. Within this process, feedback is essential to moving beyond skill-based teaching to reflection-based learning.Conclusion: the move from skills-based learning requires using reflective processes and feedback to allow students to learn about their communication tendencies and needs to become more flexible and attuned to different patient’s needs in clinical encounters.

Foster Well-being Throughout the Career Trajectory: A Developmental Model of Physician Resilience Training

Physician burnout is common across specialties and largely driven by demands of the current health care industry. However, the obvious need for systems change does not address the unavoidable impact of providing care to those who suffer. An intentional, developmental, longitudinal approach to resiliency training would not distract from fixing a broken system or blame physicians for their distress. Existing models and approaches to resilience training are promising but limited in duration, scope, and depth. We call for and describe a career-long model, introduced early in undergraduate medical training, extending into graduate medical education, and integrated throughout professional training and continuing medical education, in intrapersonal and interpersonal skills that help physicians cope with the emotional, social, and physical impact of care provision.