A communication skills course for preclinical students: evaluation of general practice based teaching using group methods

Clinical Clerkships in General Medicine Enable Students to Acquire Basic Medical Competencies and Experience in Community-Based Integrated Care: A Descriptive Questionnaire-Based Study

Background No previous research has targeted educators regarding educational practice and the achievements of students in terms of the learning objectives of clinical clerkships in university general medicine departments of Japan. We aimed to clarify the characteristics of clinical clerkships in Japanese general medicine departments using a questionnaire administered to chairpersons of university general medicine departments. Methods This was a descriptive questionnaire-based study using Google Forms (Google, Inc., Mountain View, CA, USA). We asked the chairpersons of general medicine departments in Japanese universities the following questions, with responses given on a 5-point Likert scale: Question 1: How well are primary symptoms in the national model core curriculum for undergraduate medical education taught in clinical clerkships in university general medicine departments? Question 2: How successfully can students achieve the learning objectives of the national model core curriculum for undergraduate medical education through clinical clerkships in general medicine departments of university hospitals? Question 3: How successfully can students achieve the learning objectives of the national model core curriculum for undergraduate medical education through clinical clerkships in other community clinics or hospitals? The results of the questionnaire responses are described as mean±standard deviation. Results Of the 71 Japanese universities with general medicine departments, 43 were included in the analysis. For Question 1, the symptoms and pathophysiologies with a mean score of 4 points or higher were fever, general malaise, anorexia, weight loss or gain, edema, abdominal pain, lymphadenopathy, and headache. All those symptoms require basic medical competencies. For Questions 2 and 3, the intramural clinical clerkship of general medicine departments had a higher mean score than the extramural clinical clerkship for diagnostic reasoning that emphasizes medical history and physical examination and a comprehensive approach to patients with multiple health problems. In contrast, the extramural clinical clerkship, in which medical students can build experience with community-integrated care, had a mean score of 3 points or higher for all items. Conclusions The clinical clerkship in general medicine departments of Japanese universities provides students with chances to acquire clinical competencies regarding primary symptoms and pathophysiologies. Additionally, the extramural clinical clerkship provides experience in community-based integrated care, including home medical care, collaboration, health and welfare, and long-term care.

From serendipity to technology: use of a web-based information and booking system to improve clinical attachments at a district general hospital

BACKGROUND

Clinical attachments form a vital part of the learning experience for medical students but may vary in educational value. This paper describes a project intended to improve the quality of attachments at a District General Hospital in Devon, UK after negative feedback was received from students.

AIMS

To improve educational quality by providing information and choice for students.

METHOD

The intervention was to set up a web-based system that allowed students to view before arrival all educational opportunities available, not only in the hospital but in the surrounding district. Students were contacted by email 2 weeks before their attachment and were then able to construct their own timetable from the menu of opportunities available.

RESULTS

The system was popular with students, recruited new providers of learning opportunities and also integrated learning across primary and secondary care.

CONCLUSIONS

The intervention encouraged a sense of ownership of the learning experience as well as maximising the use of available learning resources.

Closing the gap: collaborative learning as a strategy to embed evidence within occupational therapy practice

RATIONALE

The principles of clinical governance apply as guidelines for good practice to all practitioners. However, evidence-based practice (EBP) is proving a challenge for practitioners who lack the confidence to consume published research. For therapists not wishing to undertake formal study there is a risk of becoming disempowered within a culture of EBP. Opportunities to develop skills in consuming research have focused on the information dissemination model that has limited effect. Mutual reflective learning processes are recommended to empower practitioners to bridge the theory-practice gap.

AIM

An action research approach investigated practice based collaborative learning as a catalyst to increase therapist's competence and confidence in consuming research and to explore the transition toward EB practitioner.

METHOD AND RESULTS

A diagnostic survey reaffirmed therapist's lack of confidence in EBP. Formative interviews (n = 5) found an over reliance on professional craft and personal knowledge. Research knowledge was not included in participants' construct of a good practitioner and engagement in higher order critical reflection was limited. Collaborative learning groups (n = 6) embedded in practice integrated research, theory, practice and critical reflection. Supported by the collegial learning environment, a learning package developed participants' confidence and competence in consuming published research. Summative interviews (n = 5) evaluated the group and found that therapists were empowered to incorporate propositional knowledge into their clinical reasoning, engage in critical reflection and challenge their practice. They felt confident to incorporate EBP into their continuing professional development plans. Sustainability of these changes requires commitment from the therapists and the workplace.

How can experience in clinical and community settings contribute to early medical education? A BEME systematic review

REVIEW DATE

Review period January 1992-December 2001. Final analysis July 2004-January 2005. BACKGROUND AND REVIEW CONTEXT: There has been no rigorous systematic review of the outcomes of early exposure to clinical and community settings in medical education. OBJECTIVES OF REVIEW: Identify published empirical evidence of the effects of early experience in medical education, analyse it, and synthesize conclusions from it. Identify the strengths and limitations of the research effort to date, and identify objectives for future research.

SEARCH STRATEGY

Ovid search of: BEI, ERIC, Medline, CINAHL and EMBASE Additional electronic searches of: Psychinfo, Timelit, EBM reviews, SIGLE, and the Cochrane databases. Hand-searches of:Medical Education, Medical Teacher, Academic Medicine, Teaching and Learning in Medicine, Advances in Health Sciences Education, Journal of Educational Psychology.

CRITERIA

DEFINITIONS

EXPERIENCE

Authentic (real as opposed to simulated) human contact in a social or clinical context that enhances learning of health, illness and/or disease, and the role of the health professional. Early: What would traditionally have been regarded as the preclinical phase, usually the first 2 years. Inclusions: All empirical studies (verifiable, observational data) of early experience in the basic education of health professionals, whatever their design or methodology, including papers not in English. Evidence from other health care professions that could be applied to medicine was included.

EXCLUSIONS

Not empirical; not early; post-basic; simulated rather than 'authentic' experience.

DATA COLLECTION

Careful validation of selection processes. Coding by two reviewers onto an extensively modified version of the standard BEME coding sheet. Accumulation into an Access database. Secondary coding and synthesis of an interpretation.

HEADLINE RESULTS

A total of 73 studies met the selection criteria and yielded 277 educational outcomes; 116 of those outcomes (from 38 studies) were rated strong and important enough to include in a narrative synthesis of results; 76% of those outcomes were from descriptive studies and 24% from comparative studies. Early experience motivated and satisfied students of the health professions and helped them acclimatize to clinical environments, develop professionally, interact with patients with more confidence and less stress, develop self-reflection and appraisal skill, and develop a professional identity. It strengthened their learning and made it more real and relevant to clinical practice. It helped students learn about the structure and function of the healthcare system, and about preventive care and the role of health professionals. It supported the learning of both biomedical and behavioural/social sciences and helped students acquire communication and basic clinical skills. There were outcomes for beneficiaries other than students, including teachers, patients, populations, organizations and specialties. Early experience increased recruitment to primary care/rural medical practice, though mainly in US studies which introduced it for that specific purpose as part of a complex intervention.

CONCLUSIONS

Early experience helps medical students socialize to their chosen profession. It helps them acquire a range of subject matter and makes their learning more real and relevant. It has potential benefits for other stakeholders, notably teachers and patients. It can influence career choices.

Comparing self-reported communication skills of medical students in traditional and integrated curricula: a nationwide study

OBJECTIVES

To investigate medical students' self-assessments of their communication skills through medical school related to background factors, curriculum design and perceived medical school stress.

METHODS

Medical students at all year levels attending Norwegian universities in the spring of 2003 were mailed the Oslo Inventory of Self-reported Communication Skills (OSISCS) developed by the authors. Of the total number of students (N=3055), 60% responded. One school had a traditional curriculum, the other three ran integrated models.

RESULTS

Students assessed their instrumental communication skills to increase linearly year by year, while the relational skills showed a curve-linear trajectory reaching the optimum level half-way into the curriculum. Students attending the traditional school reported lower levels of instrumental skills compared to the students from the integrated schools. In relational skills, a similar difference was maintained half-way into the curriculum, but disappeared towards the end. Perceived medical school stress correlated to the self-reported end point levels of the two types of communication skills.

DISCUSSION

The trajectories of self-reported instrumental and relational skills indicate significant variations in facilitating mechanisms between curricula, cognitive processing and perceived medical school stress.

CONCLUSIONS

Self-reported instrumental and relational communication skills develop differently in medical students over the years according to the type of curriculum.

PRACTICE IMPLICATIONS

Curricula should be evaluated for improvement implementations.

Medical students taking the role of the mother in paediatric interview evaluation

BACKGROUND

Medical students develop the skills required to interview parents and children through practice and by receiving feedback. Parental perceptions of medical student skills in child health interviews can be used to enhance student learning.

OBJECTIVES

To integrate maternal perspectives of medical student interviews into student learning, and to compare student and maternal evaluations of simulated medical student interviews.

METHODS

A sample of 45 medical students viewed 2 standardised videotapes in which a 'medical student' interviewed the mother of a sick child. The videotapes demonstrated contrasting levels of 'student' clinical competence and patient-centeredness. After each interview students were asked to rate their satisfaction and recall of information as if they were the mother in the interview. Student satisfaction was measured using the Interpersonal Skills Rating Scale (IPS). Recall of interview information was assessed by questionnaire, with student answers coded independently before analysis. Following both videotapes, students reviewed transcripts of the interviews and discussed their evaluations. Student responses were compared with maternal satisfaction and recall responses after viewing of the same videotapes.

RESULTS

Student IPS ratings were higher following the high clinical competence, high patient-centred interview (P < 0.0001). Student recall of specific information was greater for some items following the high clinical competence, high patient-centred interview, but was lower for others. Maternal and student satisfaction and recall were similar following the 2 interviews.

CONCLUSION

Students and mothers agreed on the qualities of a successful interview. Experiencing an interview through the 'eyes' of a mother provided students with valuable insights regarding interview skills.

Self-assessment of communication skills preparedness: adult versus pediatric skills

PURPOSE

To characterize and compare incoming residents' self-reported 1) amount and sufficiency of medical school training in clinical communication for patients of different ages, and 2) training experience and anticipated comfort level when breaking news of serious diagnoses with patients of different ages.

METHOD

A self-assessment tool was voluntarily completed by residents entering Brown- and Dartmouth-affiliated residencies. Descriptive statistics were generated and 2-tailed t tests were used to compare mean responses for patient age categories within each area of questioning.

RESULTS

A total of 143 (78%) of 184 residents completed self-assessments. Estimates of training time with adult patients were greater than any other patient age category and were rated most sufficient. Twelve percent and 11% of respondents reported no formal training in pediatric and adolescent skills, respectively, and more than half reported that they had never observed a pediatric or adolescent "bad news" interaction. Half of the respondents had personally informed a patient or family of a serious diagnosis, most often concerning middle-aged or elderly patients. Respondents anticipated greatest discomfort discussing serious illness in younger patients and least discomfort discussing serious illness in adult and elderly patients.

CONCLUSIONS

Residents feel less prepared for and receive less training in general communication skills, particularly skills required for delivering bad news, in pediatric clinical interactions as compared with interactions with adult patients. Additional formalized training in communication skills and strategies for breaking bad news to pediatric and adolescent patients may be warranted.

A patient-centred approach to defining and assessing interviewing competency

The inclusion of communication skills as a core competency in health care curricula, has led to the need to define adequacy in this area. Developments in the field of interview analysis have meant that robust and objective ways of assessing interview behaviours are now available; however, these systems in themselves do not provide a model for assessing competency. As adequacy in interviewing is contextually driven, this paper discusses the potential of using patient centeredness to address the issue. It suggests two ways in which patient centeredness may be operationally defined, permitting data available from current rating systems, and from a new system shortly to be available, to be used to assess interviewing competency.

Early patient contact in primary care: a new challenge

BACKGROUND

The Medical School of Lund University, Sweden, has introduced an early patient contact course, including training in communication and examination skills. The course runs parallel with theoretical subjects during the students' first two-and-a-half years. General practitioner (GP) participation is gradually increasing, and in the last half-year of the course GPs in all health centres in the area are involved. Little is known about the GPs' interest, competence and time for this new task.

AIM

To describe the GPs' attitudes towards teaching and the rewards and problems they experience.

SUBJECTS

30 GPs teaching third-year medical students.

METHOD

Semistructured interview study. Data analysis by a method described by Malterud.

RESULTS

The attitude towards teaching was mostly positive and the teachers were confident about teaching examination procedure. Among rewards of teaching, improved quality of clinical practice was the main theme, but imparting knowledge to others, contact with enthusiastic students, and gains in self-esteem were also mentioned. Problems with teaching were mostly due to external factors such as lack of time and space, but concern about a negative effect on patient care was also recognized. Educational objectives of the course were not completely accepted. GPs were not fully aware about what to expect from the students, with subsequent problems concerning how to assess students' performance and how to give effective feedback.

CONCLUSIONS

The teaching of junior medical students is maintained by the GPs' enthusiasm for teaching. However, teacher training is required and the crucial issues of time and space have to be considered.

Faculty attitudes towards medical communication and their perceptions of students' communication skills training at Dalhousie University

SETTING

Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

OBJECTIVES

(1) To assess the attitudes of full-time clinical faculty members towards medical communication using the newly developed Attitudes Towards Medical Communication Scale; (2) to determine faculty members' perceptions of communications training for students and residents.

METHODS

An anonymous self-completion survey was sent to 233 full-time clinical faculty members. The questionnaire asked about faculty attitudes towards medical communication, and assessed faculty members' views of student and resident training in communication.

RESULTS

Faculty scored highly in the Attitudes Towards Medical Communication Scale, with a mean score of 51.5 (SD 4.1) out of a possible 60. In univariate analysis, rating of personal enjoyment of teaching, rating of the importance of teaching, and having attended at least one faculty communications workshop in the previous 5 years were significantly associated with higher scale scores. When these factors were assessed using linear regression, only having attended a workshop and higher rating of the importance of teaching remained significant. Faculty assessed student training in communications skills poorly overall. When assessing seven specific communications areas, more than 20% rated this training as poor for six of the areas for third- and fourth-year students and for five of the areas for residents.

CONCLUSIONS

Clinical faculty at Dalhousie have very positive attitudes towards medical communication, and more highly positive attitudes are found in those who have attended a communications workshop. Despite this evidence that faculty appreciate the importance of medical communication skills, many assessed students' training in this curriculum area as poor.

Patient-centred consultations: a comparison of student experience and understanding in two clinical environments

OBJECTIVES

To explore students' perspectives on doctor-patient communication.

DESIGN

We interviewed students in focus groups before and after their placements. In semistructured interviews they were asked about their experiences of learning through clinical contact, with particular emphasis on patient-centred consultations, on the wards and during their community attachment. Students whose clinical skills training remained hospital-based were also interviewed to compare the range of experiences.

SETTING

Leeds University.

SUBJECTS

Third-year medical students.

RESULTS

During hospital training students are rarely introduced, either through teaching or observation, to the idea of patient-centred consultations. In contrast both the principles underpinning and/or the practice of such consultations were routinely encountered during the general practice placement. Students considered the community attachment to have helped them appreciate the value of exploring patients' concerns both in terms of enhancing the patients' overall healthcare experience and promoting effective clinical management. While they considered the nature and purpose of hospital care to be qualitatively different from that conducted in the community, the relevance of adopting a patient-centred approach on the wards was confirmed.

CONCLUSIONS

Recommendations for clinical training are made. The relevance and best use of community and hospital-based attachments need to be evaluated further.

The clinical skills unit

Clinical skills units offer exciting and innovative ways of learning about clinical skills. Links between theoretical knowledge and clinical practice are appropriate for both undergraduate and postgraduate training. Students and doctors can practice and acquire technical and examination skills in a standardised and protected environment without being concerned about the distress such learning may cause real patients. Models and simulators used in skills units are being developed to keep pace with demand, with a corresponding increase in standards of quality and durability. As undergraduate medical courses respond to the demands of modern clinical practice the use of such facilities will increase. This paper describes the functions of skills units and provides practical examples of educational strategies in use.