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Kiessling C, Perron NJ, van Nuland M, Bujnowska-Fedak MM, Essers G, Joakimsen RM, Pype P, Tsimtsiou Z. Does it make sense to use written instruments to assess communication skills? Systematic review on the concurrent and predictive value of written assessment for performance. PATIENT EDUCATION AND COUNSELING 2023; 108:107612. [PMID: 36603470 DOI: 10.1016/j.pec.2022.107612] [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: 08/01/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To evaluate possible associations between learners' results in written and performance-based assessments of communication skills (CS), either in concurrent or predictive study designs. METHODS Search included four databases for peer-reviewed studies containing both written and performance-based CS assessment. Eleven studies met the inclusion criteria. RESULTS Included studies predominantly assessed undergraduate medical students. Studies reported mainly low to medium correlations between written and performance-based assessment results (Objective Structured Clinical Examinations or encounters with simulated patients), and gave correlation coefficients ranging from 0.13 to 0.53 (p < 0.05). Higher correlations were reported when specific CS, like motivational interviewing were assessed. Only a few studies gave sufficient reliability indicators of both assessment formats. CONCLUSIONS Written assessment scores seem to predict performance-based assessments to a limited extent but cannot replace them entirely. Reporting of assessment instruments' psychometric properties is essential to improve the interpretation of future findings and could possibly affect their predictive validity for performance. PRACTICE IMPLICATIONS Within longitudinal CS assessment programs, triangulation of assessment including written assessment is recommended, taking into consideration possible limitations. Written assessments with feedback can help students and trainers to elaborate on procedural knowledge as a strong support for the acquisition and transfer of CS to different contexts.
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Affiliation(s)
- Claudia Kiessling
- Chair for the Education of Personal and Interpersonal Competencies in Health Care, Witten/Herdecke University, Witten, Germany.
| | - Noelle Junod Perron
- Unit of Development and Research in Medical Education and Department of community health and medicine, Geneva Faculty of Medicine and Medical Directorate, Geneva University Hospitals, Geneva, Switzerland
| | - Marc van Nuland
- Academic Center for General Practice, Leuven University, Leuven, Belgium
| | | | - Geurt Essers
- Network of GP Training Programs in the Netherlands, the Netherlands
| | - Ragnar M Joakimsen
- Department of Clinical Medicine, Faculty of Health Sciences, UIT The Arctic University of Norway and Department of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Zoi Tsimtsiou
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Bylund CL, Vasquez TS, Peterson EB, Ansell M, Bylund KC, Ditton-Phare P, Hines A, Manna R, Singh Ospina N, Wells R, Rosenbaum ME. Effect of Experiential Communication Skills Education on Graduate Medical Education Trainees' Communication Behaviors: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1854-1866. [PMID: 35857395 PMCID: PMC9712157 DOI: 10.1097/acm.0000000000004883] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE A better understanding of how communication skills education impacts trainees' communication skills is important for continual improvement in graduate medical education (GME). Guided by the Kirkpatrick Model, this review focused on studies that measured communication skills in either simulated or clinical settings. The aim of this systematic review was to examine the effect of experiential communication skills education on GME trainees' communication behaviors. METHOD Five databases were searched for studies published between 2001 and 2021 using terms representing the concepts of medical trainees, communication, training, and skills and/or behaviors. Included studies had an intervention design, focused only on GME trainees as learners, used experiential methods, and had an outcome measure of communication skills behavior that was assessed by a simulated or standardized patient (SP), patient, family member, or outside observer. Studies were examined for differences in outcomes based on study design; simulated versus clinical evaluation setting; outside observer versus SP, patient, or family member evaluator; and length of training. RESULTS Seventy-seven studies were ultimately included. Overall, 54 (70%) studies reported some positive findings (i.e., change in behavior). There were 44 (57%) single-group pre-post studies, 13 (17%) nonrandomized control studies, and 20 (26%) randomized control studies. Positive findings were frequent in single-group designs (80%) and were likely in nonrandomized (62%) and randomized (55%) control trials. Positive findings were likely in studies evaluating communication behavior in simulated (67%) and clinical (78%) settings as well as in studies with outside observer (63%) and SP, patient, and family member (64%) evaluators. CONCLUSIONS This review demonstrates strong support that experiential communication skills education can impact GME trainees' communication behaviors. Marked heterogeneity in communication trainings and evaluation measures, even among subgroups, did not allow for meta-analysis or comparative efficacy evaluation of different studies. Future studies would benefit from homogeneity in curricular and evaluation measures.
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Affiliation(s)
- Carma L Bylund
- C.L. Bylund is professor, Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Taylor S Vasquez
- T.S. Vasquez is a doctoral student, Department of Public Relations, College of Journalism and Communications, University of Florida, Gainesville, Florida
| | - Emily B Peterson
- E.B. Peterson is senior research analyst, University of Southern California, Los Angeles, California
| | - Margaret Ansell
- M. Ansell is associate university librarian and associate chair, Health Science Center Libraries, University of Florida, Gainesville, Florida
| | - Kevin C Bylund
- K.C. Bylund is associate professor, Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Philippa Ditton-Phare
- P. Ditton-Phare is medical education support officer (psychiatry), Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - April Hines
- A. Hines is journalism and mass communications librarian, George A. Smathers Libraries, University of Florida, Gainesville, Florida
| | - Ruth Manna
- R. Manna is associate director, Patient Experience Partnerships, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Naykky Singh Ospina
- N. Singh Ospina is associate professor, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Robert Wells
- R. Wells is science writer, Office of Research, University of Central Florida, Orlando, Florida
| | - Marcy E Rosenbaum
- M.E. Rosenbaum is professor, Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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How doctors make themselves understood in primary care consultations: A mixed methods analysis of video data applying health literacy universal precautions. PLoS One 2021; 16:e0257312. [PMID: 34547015 PMCID: PMC8454934 DOI: 10.1371/journal.pone.0257312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/30/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To mitigate the health risks that result from low health literacy and difficulty identifying patients with insufficient health literacy, health organizations recommend physicians apply health literacy universal precaution communication skills when communicating with all patients. Our aim was to assess how health literacy universal precautions are delivered in routine GP consultations, and explore whether there were differences in how GPs used universal precaution approaches according to areas of deprivation in England. METHODS This was a mixed methods study using video and interview data. Ten physicians conducted 217 consultations in primary care settings with adults over 50 years old between July 2017 and March 2018 in England. Eighty consultations (N = 80) met the inclusion criteria of new or persisting problems. Descriptive quantitative analysis of video-recorded consultations using an observation tool and qualitative thematic analysis of transcribed scripts. Meta-themes explored differences in physicians' communication by areas of deprivation. RESULTS Descriptive statistics showed physicians used a caring tone of voice and attitude (n = 73, 91.3%) and displayed comfortable body language (n = 69, 86.3%) but infrequently demonstrated profession-specific health literacy universal precaution communication skills, such as the teach-back technique (n = 3, 3.8%). Inferences about physicians' communication from qualitative analysis converged with the quantitative findings. Differences in physicians' communication varied according to areas of deprivation. CONCLUSIONS Physicians need health literacy universal precautions communication skills to improve population health.
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Tan XH, Foo MA, Lim SLH, Lim MBXY, Chin AMC, Zhou J, Chiam M, Krishna LKR. Teaching and assessing communication skills in the postgraduate medical setting: a systematic scoping review. BMC MEDICAL EDUCATION 2021; 21:483. [PMID: 34503497 PMCID: PMC8431930 DOI: 10.1186/s12909-021-02892-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 08/17/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Poor communication skills can potentially compromise patient care. However, as communication skills training (CST) programs are not seen as a priority to many clinical departments, there is a discernible absence of a standardised, recommended framework for these programs to be built upon. This systematic scoping review (SSR) aims to gather prevailing data on existing CSTs to identify key factors in teaching and assessing communication skills in the postgraduate medical setting. METHODS Independent searches across seven bibliographic databases (PubMed, PsycINFO, EMBASE, ERIC, CINAHL, Scopus and Google Scholar) were carried out. Krishna's Systematic Evidence-Based Approach (SEBA) was used to guide concurrent thematic and content analysis of the data. The themes and categories identified were compared and combined where possible in keeping with this approach and then compared with the tabulated summaries of the included articles. RESULTS Twenty-five thousand eight hundred ninety-four abstracts were identified, and 151 articles were included and analysed. The Split Approach revealed similar categories and themes: curriculum design, teaching methods, curriculum content, assessment methods, integration into curriculum, and facilitators and barriers to CST. Amidst a wide variety of curricula designs, efforts to develop the requisite knowledge, skills and attitudes set out by the ACGME current teaching and assessment methods in CST maybe categorised into didactic and interactive methods and assessed along Kirkpatrick's Four Levels of Learning Evaluation. CONCLUSIONS A major flaw in existing CSTs is a lack of curriculum structure, focus and standardisation. Based upon the findings and current design principles identified in this SSR in SEBA, we forward a stepwise approach to designing CST programs. These involve 1) defining goals and learning objectives, 2) identifying target population and ideal characteristics, 3) determining curriculum structure, 4) ensuring adequate resources and mitigating barriers, 5) determining curriculum content, and 6) assessing learners and adopting quality improvement processes.
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Affiliation(s)
- Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Malia Alexandra Foo
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Shaun Li He Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Marie Bernadette Xin Yi Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Block MD 6, 14 Medical Drive, #05-01, Singapore, 117599, Singapore
| | - Jamie Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Lien Centre of Palliative Care, Duke-NUS Graduate Medical School, 8College Road, Singapore, 169857, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Centre of Biomedical Ethics, National University of Singapore, Block MD 11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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Quinonez SC, O’Connor BC, Jacobs MF, Mekonnen Tekleab A, Marye A, Bekele D, Yashar BM, Hanson E, Yeshidinber A, Wedaje G. The introduction of genetic counseling in Ethiopia: Results of a training workshop and lessons learned. PLoS One 2021; 16:e0255278. [PMID: 34297771 PMCID: PMC8301664 DOI: 10.1371/journal.pone.0255278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Over the past two decades non-communicable diseases (NCDs) have steadily increased as a cause of worldwide disability and mortality with a concomitant decrease in disease burden from communicable, maternal, neonatal and nutritional conditions. Congenital anomalies, the most common NCD affecting children, have recently become the fifth leading cause of under-five mortality worldwide, ahead of other conditions such as malaria, neonatal sepsis and malnutrition. Genetic counseling has been shown to be an effective method to decrease the impact of congenital anomalies and genetic conditions but is absent in almost all sub-Saharan Africa countries. To address this need for counseling services we designed and implemented the first broad-based genetic counseling curriculum in Ethiopia, launching it at St. Paul's Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia. METHODS The curriculum, created by Michigan Medicine and SPHMMC specialists, consisted of medical knowledge and genetic counseling content and was delivered to two cohorts of nurses. Curriculum evaluation consisted of satisfaction surveys and pre- and post-assessments covering medical knowledge and genetic counseling content. Following Cohort 1 training, the curriculum was modified to increase the medical knowledge material and decrease Western genetic counseling principles material. RESULTS Both cohorts reported high levels of satisfaction but felt the workshop was too short. No significant improvements in assessment scores were seen for Cohort 1 in terms of total scores and medical knowledge and genetic counseling-specific questions. Following curriculum modification, improvements were seen in Cohort 2 with an increase in total assessment scores from 63% to 73% (p = 0.043), with medical knowledge-specific questions increasing from 57% to 79% (p = 0.01) with no significant change in genetic counseling-specific scores. Multiple logistic, financial, cultural and systems-specific barriers were identified with recommendations for their consideration presented. CONCLUSION Genetics medical knowledge of Ethiopian nurses increased significantly following curriculum delivery though difficulty was encountered with Western genetic counseling material.
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Affiliation(s)
- Shane C. Quinonez
- Division of Pediatric Genetics, Metabolism and Genomic Medicine, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, United States of America
- Division of Genetic Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Bridget C. O’Connor
- Division of Pediatric Genetics, Metabolism and Genomic Medicine, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, United States of America
| | - Michelle F. Jacobs
- Division of Genetic Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Atnafu Mekonnen Tekleab
- Department of Pediatrics, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ayalew Marye
- Department of Obstetrics and Gynecology, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Delayehu Bekele
- Department of Obstetrics and Gynecology, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Beverly M. Yashar
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Erika Hanson
- Division of Genetic Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Abate Yeshidinber
- Department of Pediatrics, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Getahun Wedaje
- Department of Pediatrics, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Steenbruggen RA, van Heusden-Scholtalbers LA, Hoogeboom TJ, Maas M, Brand P, Wees PVD. Impact and feasibility of a tailor-made patient communication quality improvement programme for hospital-based physiotherapists: a mixed-methods study. BMJ Open Qual 2021; 10:bmjoq-2020-001286. [PMID: 33888470 PMCID: PMC8070875 DOI: 10.1136/bmjoq-2020-001286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/23/2021] [Accepted: 04/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background In tailoring a quality improvement programme for hospital-based physiotherapy, the original use of video recordings was replaced by using the tracer methodology. Objective To examine the impact of a tailor-made quality improvement programme addressing patient communication on the professional development of hospital-based physiotherapists, and to evaluate barriers and facilitators as determinants of feasibility of the programme. Methods A mixed-methods study was conducted. Participants were clustered in groups per hospital and linked with an equally sized group in a nearby hospital. Within the groups, fixed couples carried out a 2-hour tracer by directly observing each other’s daily work routine. This procedure was repeated 6 months later. Data from feedback forms were analysed quantitatively, and a thematic analysis of transcripts from group interviews was conducted. Results Fifty hospital-based physiotherapists from 16 hospitals participated. They rated the impact of the programme on professional development, on a scale from 1 (much improvement needed) to 5 (no improvement needed), as 3.99 (SD 0.64) after the first tracer and 4.32 (SD 0.63) 6 months later; a mean improvement of 0.33 (95% CI 0.16 to 0.50). Participants scored, on a scale ranging from 1 to 5 on barriers and facilitators (feasibility), a mean of 3.45 (SD 0.95) on determinants of innovation, 3.47 (SD 0.86) on probability to use and 2.63 (SD 1.07) on the user feedback list. All participants emphasised the added value of the tracer methodology and mentioned effects on self-reflection and awareness most. Conclusions The tailor-made quality improvement programme, based on principles of the tracer methodology, was associated with a significant impact on professional development. Barriers and facilitators as determinants of feasibility of the programme showed the programme being feasible.
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Affiliation(s)
- Rudi A Steenbruggen
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands .,School of Health, Saxion University of Applied Sciences, Enschede, The Netherlands
| | | | - Thomas J Hoogeboom
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marjo Maas
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Institute of Allied Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Paul Brand
- Medical Education, Isala Hospitals, Zwolle, The Netherlands.,Clinical Education, UMCG, Groningen, The Netherlands
| | - Philip van der Wees
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Twelve Years of the Italian Program to Enhance Relational and Communication Skills (PERCS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020439. [PMID: 33429873 PMCID: PMC7826793 DOI: 10.3390/ijerph18020439] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/22/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022]
Abstract
To describe the experience of the Italian Program to Enhance Relations and Communication Skills (PERCS-Italy) for difficult healthcare conversations. PERCS-Italy has been offered in two different hospitals in Milan since 2008. Each workshop lasts 5 h, enrolls 10–15 interdisciplinary participants, and is organized around simulations and debriefing of two difficult conversations. Before and after the workshops, participants rate their preparation, communication, relational skills, confidence, and anxiety on 5-point Likert scales. Usefulness, quality, and recommendation of the program are also assessed. Descriptive statistics, t-tests, repeated-measures ANOVA, and Chi-square were performed. A total of 72 workshops have been offered, involving 830 interdisciplinary participants. Participants reported improvements in all the dimensions (p < 0.001) without differences across the two hospitals. Nurses and other professionals reported a greater improvement in preparation, communication skills, and confidence, compared to physicians and psychosocial professionals. Usefulness, quality, and recommendation of PERCS programs were highly rated, without differences by discipline. PERCS-Italy proved to be adaptable to different hospital settings, public and private. After the workshops, clinicians reported improvements in self-reported competencies when facing difficult conversations. PERCS-Italy’s sustainability is based on the flexible format combined with a solid learner-centered approach. Future directions include implementation of booster sessions to maintain learning and the assessment of behavioral changes.
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Park YS, Kamin C, Son D, Kim G, Yudkowsky R. Differences in expectations of passing standards in communication skills for pre-clinical and clinical medical students. PATIENT EDUCATION AND COUNSELING 2019; 102:301-308. [PMID: 30245099 DOI: 10.1016/j.pec.2018.09.009] [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: 01/13/2018] [Revised: 09/05/2018] [Accepted: 09/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Communication and interpersonal skills (CIS) are essential elements of competency-based education. We examined defensible CIS passing levels for medical students completing basic sciences (second-year students) and clinical training (fourth-year students), using five standard setting methods. METHODS A 14-item CIS scale was used. Data from second-year (n = 190) and fourth-year (n = 170) students were analyzed using descriptive statistics and generalizability studies. Fifteen judges defined borderline CIS performance. Cut scores and fail rates from five standard setting methods (Angoff, Borderline-Group, Borderline-Regression, Contrasting-Groups, and Normative methods) were examined. RESULTS CIS performance was similar during second-year (Mean = 74%, SD = 6%) and fourth-year (Mean = 72%, SD = 5%) students. Judges using the Angoff method expected greater competence at the fourth-year level, as reflected in the Angoff cut scores (second-year = 53% with 0% fail, fourth-year = 66% with 10% fail). Cut scores from the remaining methods did not differentiate between training levels. We found evidence of case specificity. CONCLUSION Performance on CIS may be case specific. Passing standards for communication skills may require employing approaches such as the Angoff method that are sensitive to expectations of learner performance for different levels of training, competencies, and milestone levels. PRACTICE IMPLICATIONS Institutions that want to encourage continued growth in CIS should apply appropriate standard setting methods.
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Affiliation(s)
- Yoon Soo Park
- University of Illinois, College of Medicine at Chicago, Chicago, IL, USA.
| | - Carol Kamin
- University of Illinois, College of Medicine at Chicago, Chicago, IL, USA
| | - Daisuke Son
- Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Ginnie Kim
- Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Rachel Yudkowsky
- University of Illinois, College of Medicine at Chicago, Chicago, IL, USA
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Grome LJ, Banuelos RC, Lopez MA, Nicome RK, Leaming-Van Zandt KJ. Communication Course for Pediatric Providers Improves Self-efficacy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1964. [PMID: 30534504 PMCID: PMC6250465 DOI: 10.1097/gox.0000000000001964] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/08/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Communication is essential to building a trusting, clinician-patient relationship. Multiple studies have demonstrated the effects of experiential communication training on patient experience and provider well-being and resiliency. To date, no studies have described an organization-wide communication training program for pediatric clinicians. The objective of this study was to evaluate the impact of a pediatric-focused communication course on provider satisfaction, self-efficacy, and burnout. METHODS Texas Children's Hospital, in collaboration with the Academy on Communication in Healthcare, designed and implemented a pediatric focused communication course entitled Breakthrough Communication. Pre, immediate-post, and 3-month postcourse completion online surveys were sent to participants 1 day before, 1 day after, and 3 months after course completion. Participant demographic information, self-assessment of communication skills, the Maslach Burnout Inventory Human Services Survey, and postcourse satisfaction data were collected. RESULTS Participants reported high course satisfaction and improved self-efficacy in all measured skill sets both following and 3 months after course completion. Trends indicating a reduction in provider burnout improved in 2 of the 3 Maslach Burnout Inventory domains; however, statistical significance was not achieved. CONCLUSIONS A pediatric-focused communication course was well received by multi-specialty clinicians within a large, academic health care organization. This course enhanced clinician self-efficacy with newly learned pediatric encounter specific communication skills.
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Affiliation(s)
- Luke J. Grome
- From the Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine Division of Plastic Surgery, Baylor College of Medicine, Houston, Tex
| | - Rosa C. Banuelos
- Texas Children’s Hospital Outcomes & Impact Service (TCHOIS), Houston, Tex
| | - Michelle A. Lopez
- Department of Pediatrics, Section of Pediatric Hospital Medicine, Texas Children’s Hospital/Baylor College of Medicine, Houston, Tex
| | - Roger K. Nicome
- Department of Pediatrics, Section of Pediatric Hospital Medicine, Texas Children’s Hospital/Baylor College of Medicine, Houston, Tex
| | - Katherine J. Leaming-Van Zandt
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Texas Children’s Hospital/Baylor College of Medicine, Houston, Tex
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Studerus L, Ahrens R, Häuptle C, Goeldlin A, Streit S. Optional part-time and longer GP training modules in GP practices associated with more trainees becoming GPs - a cohort study in Switzerland. BMC FAMILY PRACTICE 2018; 19:5. [PMID: 29304729 PMCID: PMC5756440 DOI: 10.1186/s12875-017-0706-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 12/27/2017] [Indexed: 11/21/2022]
Abstract
Background Switzerland, like many other countries, has a shortage of General Practitioners (GPs). Optional GP training modules in GP practices were offered during the at least 5-year GP training program to increase student and trainee interest in becoming a GP. The training modules had not yet been evaluated. We determined how many Swiss GP trainees became practicing GPs after they completed optional training modules, and if longer modules were associated with higher rates of GP specialization. Methods In this population-based cohort study, we included GP trainees who chose an optional GP training module in GP practice, provided by the Foundation to Promote Training in General Practice (WHM) between 2006 and 2015. GP trainees were invited to complete an online survey to assess the primary outcome (becoming a practicing GP by 2016). Data on non-responders was collected via an internet search. We calculated univariate time-to-event curves to become a practicing GP, stratified by trainee’s gender, length, part-time training, and number of years after graduation until training modules were completed. We used a multivariate model to adjust for characteristics of participants, training, and satisfaction with training modules. Results We assessed primary outcome for 351 (92.1%) of 381 former GP trainees who participated in a WHM program between 2006 and 2015. Of these 218 (57%) were practicing GPs by 2016. When focusing on the trainees who had completed training between 2006 and 2010, the rate of practicing GPs was even 73%. Longer (p = 0.018) and part-time training modules (p = 0.003) were associated with higher rates of being a practicing GP. Most (81%) practicing GPs thought their optional GP training module was (very) important in their choice of specialty. Conclusion GP trainees who spent more time training in a GP practice, or who trained part-time were more likely to become practicing GPs. Most (80%) rated their training module as (very) important in their choice of career, highlighting that these modules effectively encourage the interests of those already inclined towards the GP specialty. Longer GP training modules and more opportunities for part-time training may attract and retain more interested trainees, and possibly increase the number of practicing GPs. Electronic supplementary material The online version of this article (10.1186/s12875-017-0706-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lara Studerus
- Institute of Primary Health Care Bern (BIHAM), University of Bern, Gesellschaftsstrasse 49, 3012, Bern, Switzerland
| | - Regina Ahrens
- Institute of Primary Health Care Bern (BIHAM), University of Bern, Gesellschaftsstrasse 49, 3012, Bern, Switzerland
| | - Christian Häuptle
- Foundation to Promote Training in General Practice (WHM), Bern, Switzerland
| | - Adrian Goeldlin
- Institute of Primary Health Care Bern (BIHAM), University of Bern, Gesellschaftsstrasse 49, 3012, Bern, Switzerland
| | - Sven Streit
- Institute of Primary Health Care Bern (BIHAM), University of Bern, Gesellschaftsstrasse 49, 3012, Bern, Switzerland.
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Giroldi E, Veldhuijzen W, Geelen K, Muris J, Bareman F, Bueving H, van der Weijden T, van der Vleuten C. Developing skilled doctor-patient communication in the workplace: a qualitative study of the experiences of trainees and clinical supervisors. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:1263-1278. [PMID: 28220333 PMCID: PMC5663797 DOI: 10.1007/s10459-017-9765-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 02/14/2017] [Indexed: 05/16/2023]
Abstract
To inform the development of recommendations to facilitate learning of skilled doctor-patient communication in the workplace, this qualitative study explores experiences of trainees and supervisors regarding how trainees learn communication and how supervisors support trainees' learning in the workplace. We conducted a qualitative study in a general practice training setting, triangulating various sources of data to obtain a rich understanding of trainees and supervisors' experiences: three focus group discussions, five discussions during training sessions and five individual interviews. Thematic network analysis was performed during an iterative process of data collection and analysis. We identified a communication learning cycle consisting of six phases: impactful experience, change in frame of reference, identification of communication strategies, experimentation with strategies, evaluation of strategies and incorporation into personal repertoire. Supervisors supported trainees throughout this process by creating challenges, confronting trainees with their behaviour and helping them reflect on its underlying mechanisms, exploring and demonstrating communication strategies, giving concrete practice assignments, creating safety, exploring the effect of strategies and facilitating repeated practice and reflection. Based on the experiences of trainees and supervisors, we conclude that skilled communication involves the development of a personal communication repertoire from which learners are able to apply strategies that fit the context and their personal style. After further validation of our findings, it may be recommended to give learners concrete examples, opportunities for repeated practise and reflection on personal frames of reference and the effect of strategies, as well as space for authenticity and flexibility. In the workplace, the clinical supervisor is able to facilitate all these essential conditions to support his/her trainee in becoming a skilled communicator.
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Affiliation(s)
- Esther Giroldi
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - Wemke Veldhuijzen
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Kristel Geelen
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jean Muris
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Frits Bareman
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Herman Bueving
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Cees van der Vleuten
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
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Van Nuland M, Hannes K, Cools F, Goedhuys J. Educational interventions for improving the communication skills of general practice trainees in the clinical consultation. Hippokratia 2017. [DOI: 10.1002/14651858.cd005559.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Marc Van Nuland
- Catholic University Leuven; Academic Centre for General Practice; Kapucijnenvoer 33 blok j - bus 7001 Leuven Belgium 3000
| | - Karin Hannes
- KU Leuven University; Social Research Methodology Group, Centre for Sociological Research, Faculty of Social Sciences; Parkstraat 45 Leuven Belgium BE 3000
| | - Filip Cools
- CEBAM, Belgian Centre for Evidence-Based Medicine; Kapucijnenvoer 33, blok J, bus 7001 Leuven Vlaams-Brabant Belgium 3000
| | - Jozef Goedhuys
- Catholic University Leuven; Academic Centre for General Practice; Kapucijnenvoer 33 blok j - bus 7001 Leuven Belgium 3000
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Zetterqvist A, Aronsson P, Hägg S, Kjellgren K, Reis M, Tobin G, Booth S. On the pedagogy of pharmacological communication: a study of final semester health science students. BMC MEDICAL EDUCATION 2015; 15:186. [PMID: 26502921 PMCID: PMC4621880 DOI: 10.1186/s12909-015-0467-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 10/16/2015] [Indexed: 06/02/2023]
Abstract
BACKGROUND There is a need to improve design in educational programmes for the health sciences in general and in pharmacology specifically. The objective of this study was to investigate and problematize pharmacological communication in educational programmes for the health sciences. METHODS An interview study was carried out where final semester students from programmes for the medical, nursing and specialist nursing in primary health care professions were asked to discuss the pharmacological aspects of two written case descriptions of the kind they would meet in their everyday work. The study focused on the communication they envisaged taking place on the concerns the patients were voicing, in terms of two features: how communication would take place and what would be the content of the communication. A phenomenographic research approach was used. RESULTS The results are presented as outcome spaces, sets of categories that describe the variation of ways in which the students voiced their understanding of communication in the two case descriptions and showed the qualitatively distinct ways in which the features of communication were experienced. CONCLUSIONS The results offer a base of understanding the students' perspectives on communication that they will take with them into their professional lives. We indicate that there is room for strengthening communication skills in the field of pharmacology, integrating them into programmes of education, by more widely implementing a problem-based, a case-oriented or role-playing pedagogy where final year students work across specialisations and there is a deliberate effort to evoke and assess advanced conceptions and skills.
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Affiliation(s)
- Ann Zetterqvist
- Department of Pedagogical, Curricular and Professional Studies, University of Gothenburg, Gothenburg, Sweden.
| | - Patrik Aronsson
- Department of Pharmacology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Staffan Hägg
- Department of Medical and Health Sciences, Division of Drug Research/Clinical Pharmacology, Linköping University, Linköping, Sweden.
| | - Karin Kjellgren
- Department of Medical and Health Sciences, Division of Drug Research/Clinical Pharmacology, Linköping University, Linköping, Sweden.
| | - Margareta Reis
- Department of Medical and Health Sciences, Division of Drug Research/Clinical Pharmacology, Linköping University, Linköping, Sweden.
| | - Gunnar Tobin
- Department of Pharmacology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Shirley Booth
- Department of Pedagogical, Curricular and Professional Studies, University of Gothenburg, Gothenburg, Sweden.
- School of Education, University of the Witwatersrand, Johannesburg, South Africa.
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Wouda JC, van de Wiel HBM. Supervisors' and residents' patient-education competency in challenging outpatient consultations. PATIENT EDUCATION AND COUNSELING 2015; 98:1084-1091. [PMID: 26074498 DOI: 10.1016/j.pec.2015.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/07/2015] [Accepted: 05/11/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES We compared supervisors' and residents' patient-education competency in challenging consultations in order to establish whether supervisors demonstrate sufficient patient-education competency to act credibly as role models and coaches for residents. METHODS All consultations conducted at one, two, or three of the outpatient clinics of each of the participating physicians were videoed. Each participant selected two challenging consultations from each clinic for assessment. We assessed their patient-education competency using the CELI instrument, we calculated net consultation length for all videoed consultations and we measured patient opinion about the patient education received using a questionnaire. RESULTS Forty-four residents and fourteen supervisors participated in the study. They selected 230 consultations for assessment. On average, supervisors and residents demonstrated similar patient-education competency. Net consultation length was longer for supervisors. Patient opinion did not differ between supervisors and residents. CONCLUSIONS Supervising consultants generally do not possess sufficient patient-education competency to fulfill their teaching roles in workplace-based learning that is aimed at improving residents' patient-education competency. PRACTICE IMPLICATIONS Not only residents but also supervising consultants should improve their patient-education competency. Workplace-based learning consisting of self-assessment of and feedback on videoed consultations could be useful in attaining this goal.
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Affiliation(s)
- Jan C Wouda
- University of Groningen, University Medical Center Groningen, The Netherlands.
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van den Eertwegh V, van der Vleuten C, Stalmeijer R, van Dalen J, Scherpbier A, van Dulmen S. Exploring residents' communication learning process in the workplace: a five-phase model. PLoS One 2015; 10:e0125958. [PMID: 26000767 PMCID: PMC4441458 DOI: 10.1371/journal.pone.0125958] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/27/2015] [Indexed: 11/18/2022] Open
Abstract
Context Competency-based education is a resurgent paradigm in professional medical education. However, more specific knowledge is needed about the learning process of such competencies, since they consist of complex skills. We chose to focus on the competency of skilled communication and want to further explore its learning process, since it is regarded as a main competency in medical education. Objective This study aims to explore in more detail the learning process that residents in general practice go through during workplace-based learning in order to become skilled communicators. Methods A qualitative study was conducted in which twelve GP residents were observed during their regular consultations, and were interviewed in-depth afterwards. Results Analysis of the data resulted in the construction of five phases and two overall conditions to describe the development towards becoming a skilled communicator: Confrontation with (un)desired behaviour or clinical outcomes was the first phase. Becoming conscious of one’s own behaviour and changing the underlying frame of reference formed the second phase. The third phase consisted of the search for alternative behaviour. In the fourth phase, personalization of the alternative behaviour had to occur, this was perceived as difficult and required much time. Finally, the fifth phase concerned full internalization of the new behaviour, which by then had become an integrated part of the residents’ clinical repertoire. Safety and cognitive & emotional space were labelled as overall conditions influencing this learning process. Conclusions Knowledge and awareness of these five phases can be used to adjust medical working and learning environments in such a way that development of skilled medical communication can come to full fruition and its benefits are more fully reaped.
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Affiliation(s)
| | - Cees van der Vleuten
- Department of Educational Development and Research, Maastricht University, Maastricht, the Netherlands
| | - Renée Stalmeijer
- Department of Educational Development and Research, Maastricht University, Maastricht, the Netherlands
| | - Jan van Dalen
- Skillslab, Maastricht University, Maastricht, the Netherlands
| | - Albert Scherpbier
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands institute for health services research), Utrecht, the Netherlands
- Radboud University Medical Centre, Nijmegen, the Netherlands
- Buskerud and Vestfold University College, Drammen, Norway
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Essers G, Dielissen P, van Weel C, van der Vleuten C, van Dulmen S, Kramer A. How do trained raters take context factors into account when assessing GP trainee communication performance? An exploratory, qualitative study. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2015; 20:131-147. [PMID: 24858236 DOI: 10.1007/s10459-014-9511-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 05/05/2014] [Indexed: 06/03/2023]
Abstract
Communication assessment in real-life consultations is a complex task. Generic assessment instruments help but may also have disadvantages. The generic nature of the skills being assessed does not provide indications for context-specific behaviour required in practice situations; context influences are mostly taken into account implicitly. Our research questions are: 1. What factors do trained raters observe when rating workplace communication? 2. How do they take context factors into account when rating communication performance with a generic rating instrument? Nineteen general practitioners (GPs), trained in communication assessment with a generic rating instrument (the MAAS-Global), participated in a think-aloud protocol reflecting concurrent thought processes while assessing videotaped real-life consultations. They were subsequently interviewed to answer questions explicitly asking them to comment on the influence of predefined contextual factors on the assessment process. Results from both data sources were analysed. We used a grounded theory approach to untangle the influence of context factors on GP communication and on communication assessment. Both from the think-aloud procedure and from the interviews we identified various context factors influencing communication, which were categorised into doctor-related (17), patient-related (13), consultation-related (18), and education-related factors (18). Participants had different views and practices on how to incorporate context factors into the GP(-trainee) communication assessment. Raters acknowledge that context factors may affect communication in GP consultations, but struggle with how to take contextual influences into account when assessing communication performance in an educational context. To assess practice situations, raters need extra guidance on how to handle specific contextual factors.
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Affiliation(s)
- Geurt Essers
- Department of Public Health and Primary Care, Leiden University Medical Centre, Hippocratespad 21, 2333 ZP, Leiden, The Netherlands,
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18
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Gillis AE, Morris MC, Ridgway PF. Communication skills assessment in the final postgraduate years to established practice: a systematic review. Postgrad Med J 2014; 91:13-21. [DOI: 10.1136/postgradmedj-2014-132772] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wouda JC, van de Wiel HBM. The effects of self-assessment and supervisor feedback on residents' patient-education competency using videoed outpatient consultations. PATIENT EDUCATION AND COUNSELING 2014; 97:59-66. [PMID: 24993839 DOI: 10.1016/j.pec.2014.05.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To determine the effects of residents' communication self-assessment and supervisor feedback on residents' communication-competency awareness, on their patient-education competency, and on their patients' opinion. METHODS The program consisted of the implementation of a communication self-assessment and feedback process using videoed outpatient consultations (video-CAF). Residents wrote down communication learning objectives during the instruction and after each video-CAF session. Residents' patient-education competency was assessed by trained raters, using the CELI instrument. Participating patients completed a questionnaire about the contact with their physician. RESULTS Forty-four residents and 21 supervisors participated in 87 video-CAF sessions. After their first video-CAF session, residents wrote down more learning objectives addressing their control and rapport skills and their listening skills. Video-CAF participation improved residents' patient-education competency, but only in their control and rapport skills. Video-CAF participation had no effect on patients' opinion. CONCLUSIONS Video-CAF appears to be a feasible procedure and might be effective in improving residents' patient-education competency in clinical practice. PRACTICE IMPLICATIONS Video-CAF could fill the existing deficiency of communication training in residency programs.
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Affiliation(s)
- Jan C Wouda
- University of Groningen, University Medical Center Groningen, The Netherlands.
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Courteille O, Josephson A, Larsson LO. Interpersonal behaviors and socioemotional interaction of medical students in a virtual clinical encounter. BMC MEDICAL EDUCATION 2014; 14:64. [PMID: 24685070 PMCID: PMC4229991 DOI: 10.1186/1472-6920-14-64] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 03/18/2014] [Indexed: 05/22/2023]
Abstract
BACKGROUND The virtual clinical encounter (VCE) may function as an important support for medical students in or prior to clinical practice to train and ease communication and socioemotional interactions with patients. Few studies have however focused on the dynamics of interpersonal behaviors in clinical interviewing with a virtual patient (VP) and the affective responses evoked by such a learning experience. The study was designed to investigate the dynamics and congruence of interpersonal behaviors and socioemotional interaction exhibited during the learning experience in a VCE, and to evaluate which interaction design characteristics contribute most to the behavioral and affective engagement in medical students. METHODS Thirty medical students (sixth semester) participated voluntarily in an exploratory observational study with a highly interactive VP case based on a trustworthy VP encounter with a natural and realistic dialogue interface. Students worked collaboratively in pairs. They were videotaped for further behavioral analysis and self-reported (in both a survey and an interview) their personal opinions, perceptions and attitudes about the VCE. A mixed methods approach was applied. RESULTS All participants demonstrated an adequate, respectful and relevant clinical case management and to obtain psychosocial history. The collaborative workspace played its role and led to dynamic and engaged discussions fostering thus shared understanding. The results suggest that the VCE studied was perceived as a meaningful, intrinsically motivational and activating learning environment, and was found to socially and emotionally engage learners. We also found that VCEs have the potential to support the development of relevant and congruent interpersonal communication skills in trainees. CONCLUSIONS By taking advantage of socioemotional interaction, VCEs promote not only critical reflection skills or strategy-selection skills, but also to develop listening and nonverbal skills, induce self-awareness and target coping behaviours. We believe that, if applied in early medical education, this learning approach may facilitate clinical encounters at an early stage and contribute to responsible clinical decision making.
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Affiliation(s)
- Olivier Courteille
- Department of Learning, Informatics, Management & Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Anna Josephson
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lars-Olof Larsson
- Division of Respiratory Medicine, Department of Medicine, Karolinska University Hospital, Stockholm, and Angered Hospital, Gothenburg, Sweden
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Junod Perron N, Cullati S, Hudelson P, Nendaz M, Dolmans D, van der Vleuten C. Impact of a faculty development programme for teaching communication skills on participants’ practice. Postgrad Med J 2014; 90:245-50. [DOI: 10.1136/postgradmedj-2012-131700] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Several factors complicate the attainment of expertise in clinical communication. Medical curricula and postgraduate training insufficiently provide the required learning conditions of deliberate practice to overcome these obstacles. In this paper we provide recommendations for learning objectives and teaching methods for the attainment of professional expertise in patient education. Firstly, we propose to use functional learning objectives derived from the goals and strategies of clinical communication. Secondly, we recommend using teaching and assessment methods which: (1) contain stimulating learning tasks with opportunities for immediate feedback, reflection and corrections, and (2) give ample opportunity for repetition, gradual refinements and practice in challenging situations. Video-on-the-job fits these requirements and can be used to improve the competency in patient education of residents and medical staff in clinical practice. However, video-on-the-job can only be successful if the working environment supports the teaching and learning of communication and if medical staff which supervises the residents, is motivated to improve their own communication and didactic skills.
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Affiliation(s)
- Jan C Wouda
- University of Groningen, University Medical Centre, Groningen, The Netherlands.
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Essers G, van Dulmen S, van Es J, van Weel C, van der Vleuten C, Kramer A. Context factors in consultations of general practitioner trainees and their impact on communication assessment in the authentic setting. PATIENT EDUCATION AND COUNSELING 2013; 93:567-72. [PMID: 24041713 DOI: 10.1016/j.pec.2013.08.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 08/12/2013] [Accepted: 08/25/2013] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Acquiring adequate communication skills is an essential part of general practice (GP) specialty training. In assessing trainee proficiency, the context in which trainees communicate is usually not taken into account. The present paper aims to explore what context factors can be found in regular GP trainee consultations and how these influence their communication performance. METHODS In a randomly selected sample of 44 videotaped, real-life GP trainee consultations, we searched for context factors previously identified in GP consultations and explored how trainee ratings change if context factors are taken into account. Trainee performance was rated twice using the MAAS-Global, first without and then with incorporating context factors. Item score differences were calculated using a paired samples t-test and effect sizes were computed. RESULTS All previously identified context factors were again observed in GP trainee consultations. In communication assessment scores, we found a significant difference in 5 out of 13 MAAS-Global items, mostly in a positive direction. The effect size was moderate (0.57). CONCLUSIONS GP trainee communication is influenced by contextual factors; they seem to adapt to context in a professional way. PRACTICE IMPLICATIONS GP specialty training needs to focus on a context-specific application of communication skills. Communication raters need to be taught how to incorporate context factors into their assessments.
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Affiliation(s)
- Geurt Essers
- Department of Primary & Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Spagnoletti CL, Bui T, Fischer GS, Gonzaga AMR, Rubio DM, Arnold RM. Implementation and evaluation of a web-based communication skills learning tool for training internal medicine interns in patient-doctor communication. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/cih.2009.2.2.159] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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M van Es J, Wieringa-de Waard M, Visser MRM. Differential growth in doctor-patient communications skills. MEDICAL EDUCATION 2013; 47:691-700. [PMID: 23746158 DOI: 10.1111/medu.12175] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 01/04/2013] [Indexed: 06/02/2023]
Abstract
CONTEXT Although doctor-patient communication is considered a core competency for medical doctors, the effect of training has not been unequivocally established. Moreover, knowledge about the variance in the growth of different skills and whether certain patterns in growth can be detected could help us to develop more efficient programmes. We therefore investigated the growth in general practitioner (GP) trainees' doctor-patient communication skills in their first year and whether the growth was different for distinct categories of skills. METHODS Seventy-one first-year GP trainees were invited to participate in a study aimed at measuring their consultation skills at the beginning (baseline) and at the end of their first year (follow-up). Consultation skills were assessed with the MAAS-Global rating list for consultation skills. RESULTS Data on 29 general practitioner trainees were collected. MAAS-Global scores showed a significant growth on all items but one. Patient-oriented skills showed significantly more growth than task-oriented skills. Empathy as a separate skill seems to be mastered predominantly before the start of training. CONCLUSIONS Three patterns in the growth in skills were distinguished: (i) low baseline, relatively high follow-up, (ii) moderate baseline, moderate growth and (iii) high baseline, hardly any growth. Patient-oriented skills follow either pattern (i) or (iii), whereas task-oriented skills follow pattern (ii). These findings may help to define where the focus should lie in the training of doctor-patient communication skills.
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Affiliation(s)
- Judith M van Es
- Academic Medical Center, Department of General Practice, Amsterdam, the Netherlands.
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Essers G, Kramer A, Andriesse B, van Weel C, van der Vleuten C, van Dulmen S. Context factors in general practitioner-patient encounters and their impact on assessing communication skills--an exploratory study. BMC FAMILY PRACTICE 2013; 14:65. [PMID: 23697479 PMCID: PMC3688246 DOI: 10.1186/1471-2296-14-65] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 05/15/2013] [Indexed: 01/26/2023]
Abstract
Background Assessment of medical communication performance usually focuses on rating generically applicable, well-defined communication skills. However, in daily practice, communication is determined by (specific) context factors, such as acquaintance with the patient, or the presented problem. Merely valuing the presence of generic skills may not do justice to the doctor’s proficiency. Our aim was to perform an exploratory study on how assessment of general practitioner (GP) communication performance changes if context factors are explicitly taken into account. Methods We used a mixed method design to explore how ratings would change. A random sample of 40 everyday GP consultations was used to see if previously identified context factors could be observed again. The sample was rated twice using a widely used assessment instrument (the MAAS-Global), first in the standard way and secondly after context factors were explicitly taken into account, by using a context-specific rating protocol to assess communication performance in the workplace. In between first and second rating, the presence of context factors was established. Item score differences were calculated using paired sample t-tests. Results In 38 out of 40 consultations, context factors prompted application of the context-specific rating protocol. Mean overall score on the 7-point MAAS-Global scale increased from 2.98 in standard to 3.66 in the context-specific rating (p < 0.00); the effect size for the total mean score was 0.84. In earlier research the minimum standard score for adequate communication was set at 3.17. Conclusions Applying the protocol, the mean overall score rose above the level set in an earlier study for the MAAS-Global scores to represent ‘adequate GP communication behaviour’. Our findings indicate that incorporating context factors in communication assessment thus makes a meaningful difference and shows that context factors should be considered as ‘signal’ instead of ‘noise’ in GP communication assessment. Explicating context factors leads to a more deliberate and transparent rating of GP communication performance.
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Affiliation(s)
- Geurt Essers
- Department of Primary & Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Gulbrandsen P, Jensen BF, Finset A, Blanch-Hartigan D. Long-term effect of communication training on the relationship between physicians' self-efficacy and performance. PATIENT EDUCATION AND COUNSELING 2013; 91:180-5. [PMID: 23414658 PMCID: PMC3622152 DOI: 10.1016/j.pec.2012.11.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 11/13/2012] [Accepted: 11/20/2012] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To examine the long term impact of a communication skills intervention on physicians' communication self-efficacy and the relationship between reported self-efficacy and actual performance. METHODS 62 hospital physicians were exposed to a 20-h communication skills course according to the Four Habits patient-centered approach in a crossover randomized trial. Encounters with real patients before and after the intervention (mean 154 days) were videotaped, for evaluation of performance using the four habits coding scheme. Participants completed a questionnaire about communication skills self-efficacy before the course, immediately after the course, and at 3 years follow-up. Change in self-efficacy and the correlations between performance and self-efficacy at baseline and follow-up were assessed. RESULTS Communication skills self-efficacy was not correlated to performance at baseline (r=-0.16; p=0.22). The association changed significantly (p=0.01) and was positive at follow-up (r=0.336, p=0.042). The self-efficacy increased significantly (effect size d=0.27). High performance after the course and low self-efficacy before the course were associated with larger increase in communication skills self-efficacy. CONCLUSION A communication skills course led to improved communication skills self-efficacy more than 3 years later, and introduced a positive association between communication skills self-efficacy and performance not present at baseline. PRACTICE IMPLICATIONS Communication skills training enhances physicians' insight in own performance.
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Affiliation(s)
- Pål Gulbrandsen
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.
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Veldhuijzen W, Ram PM, van der Weijden T, van der Vleuten CPM. Communication guidelines as a learning tool: an exploration of user preferences in general practice. PATIENT EDUCATION AND COUNSELING 2013; 90:213-219. [PMID: 23116969 DOI: 10.1016/j.pec.2012.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 09/25/2012] [Accepted: 10/03/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To explore characteristics of written communication guidelines that enhance the success of training aimed at the application of the recommendations in the guidelines. METHODS Seven mixed focus groups were held consisting of communication skill teachers and communication skill learners and three groups with only learners. Analysis was done in line with principles of grounded theory. RESULTS Five key attributes of guidelines for communication skill training were identified: complexity, level of detail, format and organization, type of information, and trustworthiness/validity. The desired use of these attributes is related to specific educational purposes and learners' expertise. The low complexity of current communication guidelines is appreciated, but seems ad odds with the wish for more valid communication guidelines. CONCLUSIONS Which guideline characteristics are preferred by users depends on the expertise of the learners and the educational purpose of the guideline. PRACTICE IMPLICATIONS Communication guidelines can be improved by modifying the key attributes in line with specific educational functions and learner expertise. For example: the communication guidelines used in GP training in the Netherlands, seem to offer an oversimplified model of doctor patient communication. This model may be suited for undergraduate learning, but does not meet the validity demands of physicians in training.
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Affiliation(s)
- Wemke Veldhuijzen
- CAHPRI School for Public Health and Primary Care Research, Maastricht University, Maastricht, Netherlands.
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Wouda JC, van de Wiel HBM. Education in patient-physician communication: how to improve effectiveness? PATIENT EDUCATION AND COUNSELING 2013; 90:46-53. [PMID: 23068910 DOI: 10.1016/j.pec.2012.09.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 08/30/2012] [Accepted: 09/16/2012] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Despite educational efforts expertise in communication as required by the CanMEDS competency framework is not achieved by medical students and residents. Several factors complicate the learning of professional communication. METHODS We adapted the reflective-impulsive model of social behaviour to explain the complexities of learning professional communication behaviour. We formulated recommendations for the learning objectives and teaching methods of communication education. Our recommendations are based on the reflective-impulsive model and on the model of deliberate practice which complements the reflective-impulsive model. Our recommendations are substantiated by those we found in the literature. RESULTS The reflective-impulsive model explains why the results of communication education fall below expectations and how expertise in communication can be attained by deliberate practice. The model of deliberate practice specifies learning conditions which are insufficiently fulfilled in current communication programmes. CONCLUSION The implementation of our recommendations would require a great deal of effort. Therefore we doubt whether expertise in professional communication can be fully attained during medical training. PRACTICE IMPLICATIONS We propose that the CanMEDS communication competencies not be regarded as endpoints in medical education but as guidelines to improve communication competency through deliberate practice throughout a professional career.
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Affiliation(s)
- Jan C Wouda
- Wenckebach Institute, University of Groningen, University Medical Center, Groningen, The Netherlands.
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Wearne S, Dornan T, Teunissen PW, Skinner T. General practitioners as supervisors in postgraduate clinical education: an integrative review. MEDICAL EDUCATION 2012; 46:1161-73. [PMID: 23171258 DOI: 10.1111/j.1365-2923.2012.04348.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
CONTEXT General practice supervisors are said to serve as the cornerstones of general practice postgraduate education and therefore it is important to clearly define their roles and what makes them effective. The commonly used definition of a supervisor is not primarily based on general practice and does not cover aspects predicted to be important according to work-based learning theory. METHODS We searched for papers published between 1991 and 2011 inclusive, categorised them according to whether they provided empirical evidence, descriptions or recommendations, open-coded the empirical evidence, and used the resulting coding scheme as an analytic framework within which to present a narrative summary of findings. RESULTS Recommendations and descriptions far outweighed empirical evidence, which showed how supervisors intertwined clinical and educational activities and formed educational alliances with resident doctors that provided a foundation for learning. Residents needed a balance of challenge, usually provided by patients, and support, provided by supervisors. Supervisors established learning environments, assessed residents' learning needs, facilitated learning, monitored the content and process of learning and the well-being of residents, and summarised learning in ways that turned 'know that' into 'know how'. CONCLUSIONS General practice must be expert in ensuring patients are well cared for 'by proxy' and in giving residents just the right amount of support they need to face the challenges posed by those patients. As general practice responds to contemporary clinical demands and rising numbers of undergraduate medical students, it is essential that the ability of general practice supervisors to develop and sustain supportive supervisory relationships with residents is preserved.
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Affiliation(s)
- Susan Wearne
- Department of Medicine, Faculty of Health Sciences, Flinders University, Adelaide, South Australia, Australia.
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Tromp F, Vernooij-Dassen M, Grol R, Kramer A, Bottema B. Assessment of CanMEDS roles in postgraduate training: the validation of the Compass. PATIENT EDUCATION AND COUNSELING 2012; 89:199-204. [PMID: 22796085 DOI: 10.1016/j.pec.2012.06.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 06/14/2012] [Accepted: 06/25/2012] [Indexed: 05/25/2023]
Abstract
OBJECTIVE In medical education the focus has shifted from gaining knowledge to developing competencies. To effectively monitor performance in practice throughout the entire training, a new approach of assessment is needed. This study aimed to evaluate an instrument that monitors the development of competencies during postgraduate training in the setting of training of general practice: the Competency Assessment List (Compass). METHODS The distribution of scores, reliability, validity, responsiveness and feasibility of the Compass were evaluated. RESULTS Scores of the Compass ranged from 1 to 9 on a 10-point scale, showing excellent internal consistency ranging from .89 to .94. Most trainees showed improving ratings during training. Medium to large effect sizes (.31-1.41) were demonstrated when we compared mean scores of three consecutive periods. Content validity of the Compass was supported by the results of a qualitative study using the RAND modified Delphi Method. The feasibility of the Compass was demonstrated. CONCLUSION The Compass is a competency based instrument that shows in a reliable and valid way trainees' progress towards the standard of performance. PRACTICE IMPLICATIONS The programmatic approach of the Compass could be applied in other specialties provided that the instrument is tailored to specific needs of that specialism.
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Affiliation(s)
- Fred Tromp
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Butalid L, Verhaak PFM, Boeije HR, Bensing JM. Patients' views on changes in doctor-patient communication between 1982 and 2001: a mixed-methods study. BMC FAMILY PRACTICE 2012; 13:80. [PMID: 22873783 PMCID: PMC3460773 DOI: 10.1186/1471-2296-13-80] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 08/02/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Doctor-patient communication has been influenced over time by factors such as the rise of evidence-based medicine and a growing emphasis on patient-centred care. Despite disputes in the literature on the tension between evidence-based medicine and patient-centered medicine, patients' views on what constitutes high quality of doctor-patient communication are seldom an explicit topic for research. The aim of this study is to examine whether analogue patients (lay people judging videotaped consultations) perceive shifts in the quality of doctor-patient communication over a twenty-year period. METHODS Analogue patients (N = 108) assessed 189 videotaped general practice consultations from two periods (1982-1984 and 2000-2001). They provided ratings on three dimensions (scale 1-10) and gave written feedback. With a mixed-methods research design, we examined these assessments quantitatively (in relation to observed communication coded with RIAS) and qualitatively. RESULTS 1) The quantitative analyses showed that biomedical communication and rapport building were positively associated with the quality assessments of videotaped consultations from the first period, but not from the second. Psychosocial communication and personal remarks were related to positive quality assessments of both periods; 2) the qualitative analyses showed that in both periods, participants provided the same balance between positive and negative comments. Listening, giving support, and showing respect were considered equally important in both periods. We identified shifts in the participants' observations on how GPs explained things to the patient, the division of roles and responsibilities, and the emphasis on problem-focused communication (first period) versus solution-focused communication (last period). CONCLUSION Analogue patients recognize shifts in the quality of doctor-patient communication from two different periods, including a shift from problem-focused communication to solution-focused communication, and they value an egalitarian doctor-patient relationship. The two research methods were complementary; based on the quantitative analyses we found shifts in communication, which we confirmed and specified in our qualitative analyses.
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Affiliation(s)
- Ligaya Butalid
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500, BN, Utrecht, The Netherlands
| | - Peter F M Verhaak
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500, BN, Utrecht, The Netherlands
- Department of General Practice, Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Hennie R Boeije
- Department of Methodology and Statistics, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jozien M Bensing
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500, BN, Utrecht, The Netherlands
- Department of Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
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Lunney CA, Kleinert HL, Ferguson JE, Campbell L. Effectively training pediatric residents to deliver diagnoses of Down syndrome. Am J Med Genet A 2012; 158A:384-90. [PMID: 22246816 DOI: 10.1002/ajmg.a.34422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 11/15/2011] [Indexed: 11/10/2022]
Abstract
Physicians and parents report a need for pediatricians to have additional training in delivering a diagnosis of Down syndrome (DS). This study tested a web-based tutorial to assess its effectiveness in improving physicians' perceived comfort with both ambiguous and more medically factual situations as they deliver diagnoses of DS. Based on this web tutorial that integrated prenatal and postnatal information into virtual patient scenarios, the study assessed pediatrics residents' knowledge and comfort in delivering a diagnosis of DS pre and postnatally. A separate survey, given at the same time, asked for residents' perception of their need for this training. Ninety-one volunteer residents from 10 pediatric training programs across the country participated. The tutorial yielded significant improvement in knowledge and a significant decrease in perceived level of discomfort in both ambiguous situations and more medically certain contexts related to a DS diagnosis. In addition, across all pediatric resident groups (by year, gender, and performance on the knowledge test and the comfort scale), residents strongly agreed that this type of training was beneficial for themselves, other residents, practicing physicians, and other medical professionals. This study suggests that web-based, interactive, multi-media training may be an effective tool for improving resident physician comfort with both ambiguous and more medically certain situations in delivering a diagnosis of DS to families.
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Affiliation(s)
- Carol A Lunney
- The Human Development Institute, University of Kentucky, Lexington, Kentucky, USA.
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Wouda JC, van de Wiel HBM. The communication competency of medical students, residents and consultants. PATIENT EDUCATION AND COUNSELING 2012; 86:57-62. [PMID: 21501942 DOI: 10.1016/j.pec.2011.03.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 03/09/2011] [Accepted: 03/13/2011] [Indexed: 05/17/2023]
Abstract
OBJECTIVE The model of expert performance predicts that neither physicians in training nor experienced physicians will reach an expert level in communication. This study tested this hypothesis. METHODS Seventy-one students, twenty-five residents and fourteen consultants performed a 'breaking bad news' exercise with a simulated patient. Their communication competency was assessed with the CELI instrument. Actor assessments were also obtained. The differences in communication competency between students, residents and consultants were established. RESULTS The mean performance scores ranged from bad to adequate. An expert level of performance was seldom reached. Novice students scored lower than the other groups in their competency and in the actor assessment. First-year students scored lower than the consultants in their competency and in the actor assessment. No differences in performance were found between third-year students, interns, residents and consultants. CONCLUSION Students acquire a 'satisfactory' level of communication competency early in the curriculum. Communication courses in the curriculum do not enhance this level. Clinical experience has also a limited effect. PRACTICE IMPLICATIONS The learning conditions for deliberate practice must be fulfilled in medical curricula and in postgraduate training in order to provide medical students and physicians the opportunity to attain an expert level in communication.
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Affiliation(s)
- Jan C Wouda
- Wenckebach Institute, University Medical Centre, Groningen, The Netherlands.
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van Es JM, Schrijver CJW, Oberink RHH, Visser MRM. Two-dimensional structure of the MAAS-Global rating list for consultation skills of doctors. MEDICAL TEACHER 2012; 34:e794-9. [PMID: 22938687 DOI: 10.3109/0142159x.2012.709652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND The MAAS-Global (MG) is widely used to assess doctor-patient communication skills. Reliability and validity have been investigated, but little is known about its dimensionality. Assuming physicians tend to adopt certain styles or preferences in their communication with patients, a multi-dimensional structure of the MG can be hypothesized. AIM This study investigates the dimensional structure of the MG and explores the validity of this structure by studying the relationship between potential MG sub-scales and general practice speciality trainees' personal characteristics. METHODS Communication skills of 68 first-year trainees in a two-station objective structured clinical examination were assessed. Exploratory factor analysis was conducted on the resulting MG item-scores. With t-tests and correlational analysis, the relationship between MG scores and trainees' personal characteristics was examined. RESULTS Two well-interpretable factors were found, representing patient-oriented and task-oriented communication skills. Being born in the Netherlands and empathy were positively associated with overall communication skills. Prior communication skills training was exclusively related to task-oriented communication skills. Empathy was associated with patient-oriented, but not with task-oriented communication skills. CONCLUSION The two-dimensional structure of the MG may be valuable in gaining a better understanding of factors influencing the acquisition of communication skills. This may be used to optimize teaching methods in communication skills training.
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Affiliation(s)
- Judy M van Es
- Department of General Practice, Academic Medical Centre, University of Amsterdam, 1100 DE Amsterdam, the Netherlands.
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Essers G, van Dulmen S, van Weel C, van der Vleuten C, Kramer A. Identifying context factors explaining physician's low performance in communication assessment: an explorative study in general practice. BMC FAMILY PRACTICE 2011; 12:138. [PMID: 22166064 PMCID: PMC3262758 DOI: 10.1186/1471-2296-12-138] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 12/13/2011] [Indexed: 12/04/2022]
Abstract
Background Communication is a key competence for health care professionals. Analysis of registrar and GP communication performance in daily practice, however, suggests a suboptimal application of communication skills. The influence of context factors could reveal why communication performance levels, on average, do not appear adequate. The context of daily practice may require different skills or specific ways of handling these skills, whereas communication skills are mostly treated as generic. So far no empirical analysis of the context has been made. Our aim was to identify context factors that could be related to GP communication. Methods A purposive sample of real-life videotaped GP consultations was analyzed (N = 17). As a frame of reference we chose the MAAS-Global, a widely used assessment instrument for medical communication. By inductive reasoning, we analyzed the GP behaviour in the consultation leading to poor item scores on the MAAS-Global. In these cases we looked for the presence of an intervening context factor, and how this might explain the actual GP communication behaviour. Results We reached saturation after having viewed 17 consultations. We identified 19 context factors that could potentially explain the deviation from generic recommendations on communication skills. These context factors can be categorized into doctor-related, patient-related, and consultation-related factors. Conclusions Several context factors seem to influence doctor-patient communication, requiring the GP to apply communication skills differently from recommendations on communication. From this study we conclude that there is a need to explicitly account for context factors in the assessment of GP (and GP registrar) communication performance. The next step is to validate our findings.
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Affiliation(s)
- Geurt Essers
- Department of Primary & Community Care, Radboud University Nijmegen Medical Centre, (Geert Groteplein 21), Nijmegen, (6525 EP), The Netherlands.
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Burford B, Greco M, Bedi A, Kergon C, Morrow G, Livingston M, Illing J. Does questionnaire-based patient feedback reflect the important qualities of clinical consultations? Context, benefits and risks. PATIENT EDUCATION AND COUNSELING 2011; 84:e28-36. [PMID: 20943343 DOI: 10.1016/j.pec.2010.07.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 07/27/2010] [Accepted: 07/29/2010] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To explore perceptions of clinical consultations and how they relate to questionnaire-based patient feedback. METHODS Telephone interviews with 35 junior doctors and 40 general practice patients who had used the Doctors' Interpersonal Skills Questionnaire (DISQ). RESULTS Doctors and patients had similar views of 'good consultations' as relying on doctors' listening and explaining skills. Preferences for a consultation style focused on an outcome or on the doctor-patient relationship may be independent of informational and/or affective consultation content. Respondents felt the important consultation elements were similar in different contexts, and so DISQ feedback would be useful in different settings. Benefits of feedback were identified in the form of patient empowerment and doctors' learning. Risks were identified in the inappropriate use of feedback, both inadvertent and deliberate. CONCLUSION The style and content of consultations may be considered as separate dimensions, an approach that may help doctors adapt their communication appropriately to different consultations. Patient feedback focused on communication skills is appropriate, but there are potential risks. PRACTICE IMPLICATIONS Doctors should consider the transactional or relational preference of a patient in approaching a consultation. Patient feedback can deliver benefits to doctors and patients, but risks must be acknowledged and mitigated against.
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Affiliation(s)
- Bryan Burford
- Medical Education Research Group, Durham University, UK.
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Reinders ME, Blankenstein AH, van Marwijk HWJ, Knol DL, Ram P, van der Horst HE, de Vet HCW, van der Vleuten CPM. Reliability of consultation skills assessments using standardised versus real patients. MEDICAL EDUCATION 2011; 45:578-84. [PMID: 21564197 DOI: 10.1111/j.1365-2923.2010.03917.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Training in and assessment of consultation skills are high on the agenda of vocational training institutes for postgraduate training. There is a need to establish valid and reliable instruments to assess consultation skills in authentic settings. We investigated the number of assessors and observations needed to achieve reliable assessments of the consultation skills of general practice trainees (GPTs) using a communication instrument (MAAS-Global) and either standardised patient (SP) encounters or videotaped real patient (RP) encounters. METHODS Eight teachers at the Vrije Universiteit (VU) University Medical Centre in Amsterdam attended a training course on the use of the MAAS-Global instrument, which they subsequently used to assess the consultation skills of 53 GPTs in 176 videotaped consultations (102 with SPs, 74 with RPs). All consultations were randomly allocated and assessed by two teachers independently. The reliability of the ratings was estimated using generalisability theory. RESULTS It was easier to obtain acceptable reliability using RP consultations than SP consultations. Two assessors and five consultations were required to achieve minimal reliability (generalisability coefficient 0.7) with RPs, whereas three assessors and 30 consultations were needed to achieve minimal reliability with SPs. CONCLUSIONS Inter-observer and context variability in the assessment of the consultation skills of GPTs remains high. To achieve acceptable levels of reliability, large samples of observations are required in both formats, but, interestingly, RP encounters require a smaller sample than SP encounters.
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Affiliation(s)
- Marcel E Reinders
- EMGO Institute for Health and Care Research, Vrije Universiteit University Medical Centre, Amsterdam, The Netherlands.
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Woodward-Kron R, Stevens M, Flynn E. The medical educator, the discourse analyst, and the phonetician: a collaborative feedback methodology for clinical communication. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:565-570. [PMID: 21436658 DOI: 10.1097/acm.0b013e318212feaf] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Frameworks for clinical communication assist educators in making explicit the principles of good communication and providing feedback to medical trainees. However, existing frameworks rarely take into account the roles of culture and language in communication, which can be important for international medical graduates (IMGs) whose first language is not English. This article describes the collaboration by a medical educator, a discourse analyst, and a phonetician to develop a communication and language feedback methodology to assist IMG trainees at a Victorian hospital in Australia with developing their doctor-patient communication skills. The Communication and Language Feedback (CaLF) methodology incorporates a written tool and video recording of role-plays of doctor-patient interactions in a classroom setting or in an objective structured clinical examination (OSCE) practice session with a simulated patient. IMG trainees receive verbal feedback from their hospital-based medical clinical educator, the simulated patient, and linguists. The CaLF tool was informed by a model of language in context, observation of IMG communication training, and process evaluation by IMG participants during January to August 2009. The authors provided participants with a feedback package containing their practice video (which included verbal feedback) and the completed CaLF tool.The CaLF methodology provides a tool for medical educators and language practitioners to work collaboratively with IMGs to enhance communication and language skills. The ongoing interdisciplinary collaboration also provides much-needed applied research opportunities in intercultural health communication, an area the authors believe cannot be adequately addressed from the perspective of one discipline alone.
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Affiliation(s)
- Robyn Woodward-Kron
- Medical Education Unit, Melbourne Medical School, University of Melbourne, Victoria, Australia.
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Noordman J, Verhaak P, van Dulmen S. Web-enabled video-feedback: a method to reflect on the communication skills of experienced physicians. PATIENT EDUCATION AND COUNSELING 2011; 82:335-40. [PMID: 21146342 DOI: 10.1016/j.pec.2010.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 11/01/2010] [Accepted: 11/03/2010] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To describe our web-enabled video-feedback method designed to reflect on the communication skills of experienced physicians. METHODS Participating physicians (n=28) received a 'personal web link' to two of their video-recorded consultations. After watching the consultations physicians received feedback by telephone or in a face-to-face meeting, structured around an individualized feedback report. This report contained scores on the communication behavior of the physician in comparison with colleagues and their own communication behavior observed in a previous study, as well as patients' opinions about their physician's communication behavior. The physicians were asked to reflect on their communication skills and to comment on the usefulness and efficiency of the feedback method. RESULTS Almost all physicians were satisfied with the feedback method and in particular valued the web-enabled link to the video-recorded consultations and the structured written report. Feedback by telephone or face-to-face feedback was considered equally appropriate. CONCLUSION This web-enabled video-feedback method is a useful and structured design to reflect on the communication skills of physicians. PRACTICE IMPLICATIONS As part of continuing medical education, feedback on communication skills should become a recurrent activity for experienced physicians. This method can also be used to reflect on the communication skills of medical students.
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Affiliation(s)
- Janneke Noordman
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
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Joos S, Roos M, Ledig T, Bilger S, Szecsenyi J, Steinhäuser J. [Perspectives and experiences of vocational trainers in General Practice: a survey in Baden-Wuerttemberg]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2010; 105:97-104. [PMID: 21496777 DOI: 10.1016/j.zefq.2010.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 10/29/2010] [Accepted: 11/02/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND In order to ensure the delivery of primary care part of the vocational medical training must take place in the general practice setting. In Germany, this requires the authorization to provide general practitioner (GP) training. While in many countries specific qualification programmes for GP trainers are obligatory, this does not yet apply in Germany. The aim of this survey was to explore perspectives and experiences of GP trainers focusing on their needs in view of a possible qualification course. METHODS A three-page questionnaire was developed and sent to all 1,780 GP trainers in the federal state of Baden-Wuerttemberg, Germany. RESULTS Of the 1,780 GP trainers 656 responded (response rate: 37%), 18% of them being female trainers. About a quarter of the respondents had a vocational trainee, while 36% were looking for one at the time of the survey. The reason most frequently given for not having a vocational trainee was "no applicants" (n=323). Motivational reasons for involvement as a GP trainer were most commonly "interpersonal co-operation" (83%) and "enthusiasm for education" (69%). Only 2% of the respondents reported a bad experience with vocational trainees. Special needs were expressed regarding both legal and fiscal issues with vocational trainees in general practice and the development of a curriculum. CONCLUSIONS For the first time the perspectives and experiences of GP trainers have been explored in the present study. The results may provide a basis for the development of a qualification programme for GP trainers in Germany.
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Affiliation(s)
- Stefanie Joos
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung, Heidelberg und Kompetenzzentrum Allgemeinmedizin Baden-Württemberg.
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Liénard A, Merckaert I, Libert Y, Bragard I, Delvaux N, Etienne AM, Marchal S, Meunier J, Reynaert C, Slachmuylder JL, Razavi D. Transfer of communication skills to the workplace during clinical rounds: impact of a program for residents. PLoS One 2010; 5:e12426. [PMID: 20865055 PMCID: PMC2928743 DOI: 10.1371/journal.pone.0012426] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 08/03/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Communication with patients is a core clinical skill in medicine that can be acquired through communication skills training. Meanwhile, the importance of transfer of communication skills to the workplace has not been sufficiently studied. This study aims to assess the efficacy of a 40-hour training program designed to improve patients' satisfaction and residents' communication skills during their daily clinical rounds. METHODS Residents were randomly assigned to the training program or to a waiting list. Patients' satisfaction was assessed with a visual analog scale after each visit. Transfer of residents' communication skills was assessed in audiotaped actual inpatient visits during a half-day clinical round. Transcripted audiotapes were analyzed using content analysis software (LaComm). Training effects were tested with Mann-Whitney tests and generalized linear Poisson regression models. RESULTS Eighty-eight residents were included. First, patients interacting with trained residents reported a higher satisfaction with residents' communication (Median=92) compared to patients interacting with untrained residents (Median=88) (p=.046). Second, trained residents used more assessment utterances (Relative Risk (RR)=1.17; 95% Confidence intervals (95%CI)=1.02-1.34; p=.023). Third, transfer was also observed when residents' training attendance was considered: residents' use of assessment utterances (RR=1.01; 95%CI=1.01-1.02; p=.018) and supportive utterances (RR=0.99; 95%CI=0.98-1.00; p=.042) (respectively 1.15 (RR), 1.08-1.23 (95%CI), p<.001 for empathy and 0.95 (RR), 0.92-0.99 (95%CI), p=.012 for reassurance) was proportional to the number of hours of training attendance. CONCLUSION The training program improved patients' satisfaction and allowed the transfer of residents' communication skills learning to the workplace. Transfer was directly related to training attendance but remained limited. Future studies should therefore focus on the improvement of the efficacy of communication skills training in order to ensure a more important training effect size on transfer.
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Affiliation(s)
- Aurore Liénard
- Institut Jules Bordet, Brussels, Belgium
- Faculté des Sciences Psychologiques et de l'Éducation, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Merckaert
- Institut Jules Bordet, Brussels, Belgium
- Faculté des Sciences Psychologiques et de l'Éducation, Université Libre de Bruxelles, Brussels, Belgium
| | - Yves Libert
- Institut Jules Bordet, Brussels, Belgium
- Faculté des Sciences Psychologiques et de l'Éducation, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Nicole Delvaux
- Faculté des Sciences Psychologiques et de l'Éducation, Université Libre de Bruxelles, Brussels, Belgium
- Faculté de Psychologie, Université de Liège, Liège, Belgium
- Hôpital Erasme, Brussels, Belgium
| | | | - Serge Marchal
- C.P.O. (Centre de Psycho-Oncologie), Brussels, Belgium
| | - Julie Meunier
- Faculté des Sciences Psychologiques et de l'Éducation, Université Libre de Bruxelles, Brussels, Belgium
- Faculté de Psychologie, Université de Liège, Liège, Belgium
- Hôpital Erasme, Brussels, Belgium
- C.P.O. (Centre de Psycho-Oncologie), Brussels, Belgium
| | - Christine Reynaert
- Faculté de Psychologie et des Sciences de l'Éducation, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | | | - Darius Razavi
- Institut Jules Bordet, Brussels, Belgium
- Faculté des Sciences Psychologiques et de l'Éducation, Université Libre de Bruxelles, Brussels, Belgium
- * E-mail:
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43
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Paulis W, Beekman-Evers MS, van der Wouden JC. Re: does patient feedback improve the consultation skills of general practice trainees? MEDICAL EDUCATION 2010; 44:845. [PMID: 20633224 DOI: 10.1111/j.1365-2923.2010.03717.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Reinders ME, Blankenstein AH, van der Horst HE, Knol DL, Schoonheim PL, van Marwijk HWJ. Does patient feedback improve the consultation skills of general practice trainees? A controlled trial. MEDICAL EDUCATION 2010; 44:156-164. [PMID: 20059676 DOI: 10.1111/j.1365-2923.2009.03569.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
CONTEXT This study aimed to assess if an additional patient feedback training programme leads to better consultation skills in general practice trainees (GPTs) than regular communication skills training, and whether process measurements (intensity of participation in the programme) predict the effect of the intervention. METHODS We carried out a controlled trial in which two sub-cohorts of GPTs were allocated to an intervention group (n = 23) or a control group (n = 30), respectively. In 2006, allocated first-year GPTs in the VU University Medical Centre attended a patient feedback training programme in addition to the regular communication skills training. The control group attended only regular communication skills training. Trainees were assessed by simulated patients who visited the practices and videotaped the consultations at baseline and after 3 months. The videotapes were randomly assigned to eight trained staff members. The MAAS-Global Instrument (range 0-6) was used to assess (a change in) trainee consultation skills. RESULTS were analysed using a multi-level, linear mixed-model analysis. Results Data on 50 GPTs were available for the follow-up analysis. Both intervention group and control group GPTs improved their consultation skills: mean MAAS-Global scores for all participants were 3.29 (standard deviation [SD] 0.75) at baseline and 3.54 (SD 0.66) at follow-up (P = 0.047). The improvement in MAAS-Global scores in the intervention group did not differ significantly from the improvement in the control group. The analysis showed a trend for intensity of participation in the patient feedback programme to predict greater improvement in MAAS-Global scores. DISCUSSION Although the baseline scores were already in the high range, consultation skills in both groups improved significantly. This is reassuring for current teaching methods. The patient feedback programme did not improve consultation skills more than regular communication skills training. However, a subgroup of GPTs who participated intensively in the programme did improve their consultation skills further in comparison with the less motivated subgroup.
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Affiliation(s)
- Marcel E Reinders
- EMGO Institute for Health and Care Research, Vrije Universiteit (VU) University Medical Centre, Amsterdam, The Netherlands.
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Young K, Duggan L, Franklin P. Effective consulting and history-taking skills for prescribing practice. ACTA ACUST UNITED AC 2009; 18:1056-61. [PMID: 19798005 DOI: 10.12968/bjon.2009.18.17.44160] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is increasing emphasis on the need for nurses to develop history-taking and consultation skills for prescribing and advanced clinical practice roles. This article discusses both theoretical and practical aspects that could facilitate the development of these skills using safe and structured approaches. It explores some of the origins of consultation theory, and the challenge that nurses face in integrating new consultation skills with existing nursing assessment practice. This article outlines practical generic approaches to history taking in the clinical consultation and considers the main areas that need to be covered to support safe prescribing decisions.
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Affiliation(s)
- Kim Young
- School of Nursing and Midwifery, University of Plymouth, Knowledge Spa, Royal Cornwall Hospital, Truro
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Gude T, Vaglum P, Anvik T, Baerheim A, Fasmer OB, Grimstad H, Hjortdahl P, Holen A, Nordøy T, Eide H. Do physicians improve their communication skills between finishing medical school and completing internship? A nationwide prospective observational cohort study. PATIENT EDUCATION AND COUNSELING 2009; 76:207-12. [PMID: 19135826 DOI: 10.1016/j.pec.2008.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 10/06/2008] [Accepted: 12/06/2008] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To test whether young physicians improve their communication skills between graduating from medical school and completing clinical internship, and to explore contributing background and/or internship factors. METHODS Norwegian medical students graduating June 2004 were invited to take part in a videotaped standardized patient interview February 2004. Of the 111 students who originally participated, 62 completed a second interview February 2006. Observed communication skills were assessed with the Arizona Communication Interview Rating Scale (ACIR). RESULTS The level of communication skills increased significantly during the period for participants overall; and for females but not males. General social skills reached significantly higher levels than specific professional skills, both types of skill improving during the study. Independent predictors were working in local hospitals, learning atmosphere and low stress. At school completion, 50% reached a level defined as 'advanced beginner'. Towards the end of the internship, 58% reached 'capable' and 27% 'competent' levels of communication skills. CONCLUSIONS Female physicians improved most in communication skills, the gender difference being multivariate mediated through low stress levels and learning atmosphere. The findings support the division of communication skills into general social and specific professional skills. PRACTICE IMPLICATIONS The relatively low proportion of young physicians, especially males, developing the capability to practise independently at internship completion indicates a need for more effective training in communication skills, during both medical school and internship.
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Affiliation(s)
- Tore Gude
- Department of Behavioral Sciences in Medicine and Institute of General Practice and Community Medicine, Faculty of Medicine, University of Oslo, Norway.
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van Marwijk H. How to improve mental health competency in general practice training?: A SWOT analysis. Eur J Gen Pract 2009; 10:61-5. [PMID: 15232526 DOI: 10.3109/13814780409094234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
It is quite evident there is room for improvement in the primary care management of common mental health problems. Patients respond positively when GPs adopt a more proactive role in this respect. The Dutch general practice curriculum is currently being renewed. The topics discussed here include the Strengths, Weaknesses, Opportunities and Threats (SWOT) of present primary mental healthcare teaching. What works well and what needs improving? Integrated teaching packages are needed to help general practice trainees manage various presentations of psychological distress. Such packages comprise training videotapes, in which models such as problem-solving treatment (PST) are demonstrated, as well as roleplaying material for new skills, self-report questionnaires for patients, and small-group video feedback of consultations. While GP trainees can effectively master such skills, it is important to query the level of proficiency required by registrars. Are these skills of use only to connoisseur GPs, or to all? More room for specialisation and differentiation among trainees may be the way forward. We have just developed a new curriculum for the obligatory three-month psychiatry housemanship. It is competency oriented, self-directed and assignment driven. This new curriculum will be evaluated in due course.
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Affiliation(s)
- Harm van Marwijk
- Department of General Practice, VU University Medical Centre, Institute for Research in Extramural Health, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
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Al-Wahaibi A, Almahrezi A. An application of educational theories and principles of teaching and learning communication skills for general practitioners in oman. Oman Med J 2009; 24:119-27. [PMID: 22334856 DOI: 10.5001/omj.2009.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2008] [Accepted: 02/14/2009] [Indexed: 11/03/2022] Open
Abstract
This article discusses the crucial role of teaching and learning communication skills for general practitioners, based on the theory of experiential and self-directed learning. It also outlines the proposed ways and methods to teach these communication skills in this project.The patient-doctor interview or what is known as office visit in some countries and consultation in others is the cornerstone of the entire General Practice (GP) or Family Medicine. It is from this process and outcome that the reputation is gained or destroyed. The analysis of the consultation is complicated and varied but is most usefully employed to assess effecacy in terms of achieving the means that are mutually desired by patients and their carers.
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Back AL, Arnold RM, Baile WF, Tulsky JA, Barley GE, Pea RD, Fryer-Edwards KA. Faculty development to change the paradigm of communication skills teaching in oncology. J Clin Oncol 2009; 27:1137-41. [PMID: 19171703 DOI: 10.1200/jco.2008.20.2408] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anthony L Back
- Seattle Cancer Care Alliance, 825 Eastlake Ave East, Seattle, WA 98109-1023, USA.
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Kinnersley P, Edwards A, Hood K, Ryan R, Prout H, Cadbury N, MacBeth F, Butow P, Butler C. Interventions before consultations to help patients address their information needs by encouraging question asking: systematic review. BMJ 2008; 337:a485. [PMID: 18632672 PMCID: PMC2500196 DOI: 10.1136/bmj.a485] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To assess the effects on patients, clinicians, and the healthcare system of interventions before consultations to help patients or their representatives gather information in consultations by question asking. DESIGN Systematic review with meta-analysis. DATA SOURCES Electronic literature searches of seven databases and hand searching of one journal and bibliographies of relevant articles. Review methods Inclusion criteria included randomised controlled trials. MAIN OUTCOME MEASURES Primary outcomes were question asking; patients' anxiety, knowledge, and satisfaction; and length of consultation. RESULTS 33 randomised trials of variable quality involving 8244 patients were identified. A few studies showed positive effects. Meta-analyses showed small and statistically significantly increases in question asking (standardised mean difference 0.27, 95% confidence interval 0.19 to 0.36) and patients' satisfaction (0.09, 0.03 to 0.16). Non-statistically significant changes occurred in patients' anxiety before consultations (weighted mean difference -1.56, -7.10 to 3.97), patients' anxiety after consultations (standardised mean difference -0.08, -0.22 to 0.06), patients' knowledge (-0.34, -0.94 to 0.25), and length of consultation (0.10, -0.05 to 0.25). Interventions comprising written materials had similar effects on question asking, consultation length, and patients' satisfaction as those comprising the coaching of patients. Interventions with additional training of clinicians had little further effect than those targeted at patients alone for patients' satisfaction and consultation length. CONCLUSIONS Interventions for patients before consultations produce small benefits for patients. This may be because patients and clinicians have established behaviours in consultations that are difficult to change. Alternatively small increases in question asking may not be sufficient to make notable changes to other outcomes.
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Affiliation(s)
- Paul Kinnersley
- Neuadd Meirionydd, School of Medicine, Cardiff University, Cardiff CF14 4XN.
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