1
|
Ng YK, Shah NM, Chen TF, Loganadan NK, Kong SH, Cheng YY, Sharifudin SSM, Chong WW. Impact of a training program on hospital pharmacists' patient-centered communication attitudes and behaviors. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100325. [PMID: 37694168 PMCID: PMC10485631 DOI: 10.1016/j.rcsop.2023.100325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/12/2023] Open
Abstract
Background Effective communication that integrates the value of patient-centered care is important in healthcare encounters. Communication skills training (CST) has been indicated as effective in improving patient-centered communication behaviors. However, there is a paucity of studies on the impact of CST among Malaysian hospital pharmacists. Objective This study aimed to evaluate the effects of a patient-centered CST program on patient-centered communication scores, communication self-efficacy, and attitudes toward concordance among pharmacists in public hospitals. Methods A communication skills training (CST) program was conducted among hospital pharmacists. This training intervention was developed based on patient-centered communication frameworks and techniques, namely the Four Habits Model and motivational interviewing. A pre-test/post-test quasi-experimental design was implemented for the evaluation. Pharmacists underwent pre-test/post-test audiotaped simulated consultations and completed questionnaires, including the Revised United States-Leeds Attitudes Toward Concordance scale (RUS-LATCon) and Communication Self-Efficacy scale. The Four Habits Coding Scheme (FHCS) was used to evaluate patient-centered communication scores from the audiotapes, and the Wilcoxon signed-rank test was used to analyze for differences in the pre- and post-intervention scores. Results A total of 38 pharmacists from four tertiary hospitals participated in this study and completed the pre-test. However, due to the impact of COVID-19, only 23 pharmacists completed the post-test data collection. Improvements were noted in the FHCS scores post-training, including items related to exploring patients' concerns, acceptability, and barriers to treatment. Based on the questionnaire, there was an improvement in recognizing patients' needs and potential medication uncertainty and an increase in the overall communication self-efficacy scores after the training. Conclusions CST may help improve the adoption of patient-centered communication in pharmacists' consultations with patients.
Collapse
Affiliation(s)
- Yew Keong Ng
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Noraida Mohamed Shah
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Timothy F. Chen
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Navin Kumar Loganadan
- Department of Pharmacy, Hospital Putrajaya, Ministry of Health, Pusat Pentadbiran Kerajaan Persekutuan Presint 7, 62250 Putrajaya, Malaysia
| | - Shue Hong Kong
- Department of Pharmacy, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Yi Yun Cheng
- Department of Pharmacy, Hospital Ampang, Ministry of Health, Jalan Mewah Utara, Taman Pandan Mewah, 68000 Ampang Jaya, Selangor, Malaysia
| | - Siti Shahida Md Sharifudin
- Department of Pharmacy, Hospital Kuala Lumpur, Ministry of Health, Jalan Pahang 50586, Kuala Lumpur, Malaysia
| | - Wei Wen Chong
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| |
Collapse
|
2
|
The Use of Simulated Patients Is more Effective than Student Role Playing in Fostering Patient-Centred Attitudes during Communication Skills Training: A Mixed Method Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1498692. [PMID: 36573197 PMCID: PMC9789908 DOI: 10.1155/2022/1498692] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022]
Abstract
Objective While simulated patients (SPs) are considered a standard tool in communication skills training, there is no evidence thus far of their comparative benefit to the more cost-effective option of student role playing. We compared the effectiveness of both approaches in developing patient-centred attitudes in students. Methods We retrospectively compared students who participated in the clinical communication course (CCC), based on student role playing (CCCsp-, n = 160), to students who participated in the CCC with SPs (CCCsp+, n = 146), and students with no formal CCC (CCC-, n = 122). We used validated questionnaires to assess patient centredness. We also conducted focus group interviews (FGI) to better understand the impact of CCC with sp. Results Students after the CCC with simulated patients achieved a significantly higher score in the patient-practitioner orientation scale than other groups (p < 0.001). Conclusions There is a strong positive correlation between the implementation of simulated patients and patient-centred attitudes among students. Data from the FGI revealed that students perceived training with SP as more realistic, safe, and engaging than student role playing. Practice Implications. Our research provides evidence to justify costs and resources invested in simulated patient programs.
Collapse
|
3
|
Bansal A, Greenley S, Mitchell C, Park S, Shearn K, Reeve J. Optimising planned medical education strategies to develop learners' person-centredness: A realist review. MEDICAL EDUCATION 2022; 56:489-503. [PMID: 34842290 PMCID: PMC9306905 DOI: 10.1111/medu.14707] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 05/31/2023]
Abstract
CONTEXT Person-centeredness is a stated aim for medical education; however, studies suggest this is not being achieved. There is a gap in our understanding of how, why and in what circumstances medical education interventions that aim to develop person-centredness are successful. METHODS A realist review was conducted with a search of Medline, Embase, HMIC and ERIC databases and the grey literature using the terms 'medical education' and 'person-centred' and related synonyms. Studies that involved a planned educational intervention in medical education with data on outcomes related to person-centredness were included. The analysis focused on how and why different educational strategies interact with biomedical learner perspectives to trigger mechanisms that may or may not lead to a change in perspective towards person-centredness. RESULTS Sixty-one papers representing fifty-three interventions were included in the final synthesis. Nine context-intervention-mechanism-outcome configuration (CIMOc) statements generated from the data synthesis make up our refined programme theory. Where educational interventions focused on communication skills learning or experiences without person-centred theory, learners experienced dissonance with their biomedical perspective which they resolved by minimising the importance of the learning, resulting in perspective endurance. Where educational interventions applied person-centred theory to meaningful experiences and included support for sense making, learners understood the relevance of person-centeredness and felt able to process their responses to learning, resulting in perspective transformation towards person-centredness. CONCLUSION Our findings offer explanations as to why communication skills-based interventions may be insufficient to develop learners' person-centredness. Integrating experiential person-centred learning with theory on why person-centredness matters to clinical practice and enabling learners to make sense of their responses to learning, may support perspective transformation towards person-centredness. Our findings offer programme and policymakers testable theory to inform the development of medical education strategies that aim to support person-centredness.
Collapse
Affiliation(s)
- Aarti Bansal
- Academy of Primary Care, Hull York Medical SchoolUniversity of HullHullUK
| | - Sarah Greenley
- Institute of Clinical and Applied Health ResearchUniversity of HullHullUK
| | - Caroline Mitchell
- Academic Unit of Medical EducationSam Fox House, Northern General HospitalSheffieldUK
| | - Sophie Park
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Katie Shearn
- Health and Wellbeing Research Institute – Postgraduate Research CentreSheffield Hallam UniversitySheffieldUK
| | - Joanne Reeve
- Academy of Primary Care, Hull York Medical SchoolUniversity of HullHullUK
| |
Collapse
|
4
|
Bejarano G, Csiernik B, Young JJ, Stuber K, Zadro JR. Healthcare students' attitudes towards patient centred care: a systematic review with meta-analysis. BMC MEDICAL EDUCATION 2022; 22:324. [PMID: 35477455 PMCID: PMC9047330 DOI: 10.1186/s12909-022-03371-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Patient centred care is commonly recommended in clinical practice guidelines to improve patient outcomes and reduce healthcare costs. Identifying measurement tools used to assess healthcare students' attitudes towards patient centered care and determining their attitudes is the first step to ensuring patient centred care is provided in the future. The primary aim of this review was to describe the measurement tools used to assess healthcare students' attitudes towards patient centred care. The secondary aim was to quantify healthcare students' attitudes towards patient centred care. METHODS An electronic database search was conducted in MEDLINE, EMBASE, CINAHL from inception until March 1, 2021, with combined terms relating to 'patient centred care', 'attitudes', and 'healthcare students'. Studies that quantitatively assessed healthcare students' attitudes towards patient centred care were included. Measurement tools used in the included studies were qualitatively described. Meta-analysis was conducted to quantify healthcare students' attitudes towards patient centred care and assess the respective influence of gender, profession, and study geographical location on healthcare students' attitudes towards patient centred care. RESULTS The electronic search identified 3948 total studies. One hundred twenty-nine full texts were screened, and 49 studies were included. There were 16 measurement tools used to assess healthcare students' attitudes towards patient centered care. Most studies (53%, n = 26) used the Patient-Practitioner Orientation Scale (PPOS) to assess patient centered care. Meta-analyses of 20 studies with 26 total groups resulted in a pooled mean PPOS score of 4.16 on a 0-6 scale (95% Confidence Interval [CI]: 3.95, 4.37), indicating low attitudes towards patient centered care. Additional analyses found that women have significantly higher attitudes towards patients centred care than men (pooled effect 0.14 [95% CI: 0.05, 0.23], n = 8 studies) and mean PPOS scores appear similar among sub-groups of only medical students (pooled mean 4.13, 95% CI: 3.85, 4.42, n = 13 studies) and only American healthcare students (pooled mean 4.49, 95% CI: 4.35, 4.64, n = 5 studies). CONCLUSIONS Several different measurement tools have been used to assess healthcare students' attitudes towards patient centred care, but the most commonly used is the PPOS. Our results indicate that healthcare students have low attitudes towards patient centred care. Future studies should evaluate if attitudes towards patient centred care can be improved during healthcare education.
Collapse
Affiliation(s)
- Geronimo Bejarano
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), 1616 Guadalupe Street, Austin, TX, 78702, USA.
| | - Ben Csiernik
- Canadian Memorial Chiropractic College, Toronto, Canada
| | - James J Young
- Canadian Memorial Chiropractic College, Toronto, Canada
- Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Kent Stuber
- Canadian Memorial Chiropractic College, Toronto, Canada
| | - Joshua R Zadro
- Sydney School of Public Health, Faculty of Medicine and Health, Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, New South Wales, Australia
| |
Collapse
|
5
|
Rutledge M, Link K, Zapata I, Carter S. Medical student confidence when training for a female genitourinary exam using models and standardized patients. J Obstet Gynaecol Res 2022; 48:1466-1474. [PMID: 35272394 DOI: 10.1111/jog.15222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
Abstract
AIM The purpose of this study is to investigate what factors make students feel confident and competent when performing a female genitourinary exam (FGUE) with normal, nonpathologic findings. We anticipated that students would increase their confidence and perceived competence from the first year to the second year of medical school, would prefer the use of specialized standardized patients (SSPs) over models, and that the results would vary by student demographics. METHODS Student confidence and perceived competence were measured using voluntary survey methods pre- and postinterventions. Interventions were defined as learning the FGUE on models alone for first-year medical students and learning the FGUE on SSPs with prior experience using models for second-year students. Survey responses were evaluated via generalized linear mixed models for numeric responses. RESULTS The results demonstrated that first- and second-year medical students of racial and ethnic minorities rated themselves as more confident and competent than Caucasian counterparts, which was in many cases more extensive than the effect of an additional year of medical education. Students felt that using SSPs alone was the best mode of learning the exam than either models alone or the combination of models and SSPs. Students' current specialty of choice did not correlate with increased confidence or perceived competence. CONCLUSION This study highlights how cultural differences have an impact on confidence and perceived competence in medical students as they prepare for performing a procedure as intimate to the patient as the FGUE.
Collapse
Affiliation(s)
- Mallory Rutledge
- Office of Simulation in Medicine and Surgery, Rocky Vista University, Parker, CO, USA
| | - Kelsey Link
- Office of Simulation in Medicine and Surgery, Rocky Vista University, Parker, CO, USA
| | - Isain Zapata
- Department of Biomedical Sciences, Rocky Vista University, Parker, CO, USA
| | - Susan Carter
- Office of Simulation in Medicine and Surgery, Rocky Vista University, Parker, CO, USA
| |
Collapse
|
6
|
Silverberg R, Averkiou P, Servoss J, Eyez M, Martinez LC. Training Preclerkship Medical Students on History Taking in Transgender and Gender Nonconforming Patients. Transgend Health 2022; 6:374-379. [PMID: 34993309 DOI: 10.1089/trgh.2020.0117] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The purpose of the study is to introduce a standardized patient (SP) activity focusing on communication with transgender and gender nonconforming (TGNC) individuals. Using an SP script, preclerkship medical students obtained medical histories from TGNC SPs, followed by a panel discussion. In total, 126 students participated in the SP encounter for a period of 2 years. After completion, 92.2% of students felt more confident using patient's pronouns and 95.4% indicated improved confidence with the overall experience of taking a history from a transgender patient. This study demonstrated that partnering with local LGBTQ+ community partners can create authentic simulated clinical experiences for preclerkship medical students, improving their confidence in communication and interpersonal skills with TGNC patients.
Collapse
Affiliation(s)
- Rachael Silverberg
- Department of Integrated Medical Sciences and Florida Atlantic University, Boca Raton, Florida, USA
| | - Peter Averkiou
- Department of Pediatrics, Florida Atlantic University, Boca Raton, Florida, USA
| | - Julie Servoss
- Department of Integrated Medical Sciences and Florida Atlantic University, Boca Raton, Florida, USA
| | - Misty Eyez
- Sunserve, Inc., Ft. Lauderdale, Florida, USA
| | - Lisa C Martinez
- Department of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| |
Collapse
|
7
|
Experiences of GP trainees in undertaking telephone consultations: a mixed-methods study. BJGP Open 2020; 4:bjgpopen20X101008. [PMID: 32019774 PMCID: PMC7330189 DOI: 10.3399/bjgpopen20x101008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/24/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Primary care telephone consultations are increasingly used for patient triage, reviews, and providing clinical information. They are also a key postgraduate training component yet little is known about GP trainees' preparation for, or experiences and perceptions of, them. AIM To understand the experiences, perceptions, and training of GP trainees in conducting telephone consultations. DESIGN & SETTING A mixed-methods study was undertaken of North Central and East London (NCEL) GP trainees. METHOD A cross-sectional electronic survey of trainees was performed with subsequent semi-structured interviews. Survey data were analysed using descriptive statistics, and qualitative data using thematic analysis. RESULTS The survey response was 16% (n = 100/618), and 10 participated in semi-structured interviews. Trainees felt least confident with complicated telephone consulting, and there was a strong positive correlation between the percentage reporting having received training and their confidence (R 2 = 0.71, P<0.0001). Positive experiences included managing workload and convenience. Negative experiences included complex encounters, communication barriers, and absence of examination. Trainees reported that training for telephone consultations needed strengthening, and that recently introduced audio-clinical observation tools (COTs) were useful. Positive correlations were found between the length of out-of-hours (OOH) but not in-hours training and the level of supervision or feedback received for telephone consultations. CONCLUSION This project sheds light on GP trainees' current experiences of telephone consultations and the need to enhance future training. The findings will inform a wider debate among stakeholders and postgraduate learners regarding training for telephone consultations, and potentially for other remote technologies.
Collapse
|
8
|
Michael K, Dror MG, Karnieli-Miller O. Students' patient-centered-care attitudes: The contribution of self-efficacy, communication, and empathy. PATIENT EDUCATION AND COUNSELING 2019; 102:2031-2037. [PMID: 31257098 DOI: 10.1016/j.pec.2019.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 05/10/2019] [Accepted: 06/07/2019] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Patient-centered-care (PCC) attitudes are important to enhance PCC behavior, but research on perceptions and attitudes that contribute to PCC attitudes is limited. We tested a new model, assessing whether the association between self-efficacy and PCC attitudes is mediated by communication and empathy attitudes. Furthermore, we assessed medical-school-stage and gender differences in these variables. METHODS Medical/dentistry students (N = 653) completed self-reported questionnaires. Analyses were performed using Pearson's-correlations, PROCESS macro, and independent samples t-tests. RESULTS The association between communication self-efficacy and PCC attitudes was completely mediated by communication and empathy attitudes. Students in clinical years had more positive attitudes toward PCC and empathy, and higher communication self-efficacy. Females had more positive attitudes toward PCC, communication, and empathy. CONCLUSIONS The results emphasize the importance of communication self-efficacy and the mediating role of communication and empathy attitudes in enhancing PCC attitudes. This highlights the need to focus on learners' affective matter (what they feel/think) about their competencies and attitudes. PRACTICE IMPLICATIONS Educational interventions should improve understanding of the benefits of applying good communication skills, of learning the importance of empathy and its relevance to patient care, and strengthening students' confidence in applying these skills. Attention to these is important for enhancing students' PCC attitudes.
Collapse
Affiliation(s)
- Keren Michael
- Department of Human Services, The Max Stern Yezreel Valley Academic College, Yezreel Valley, Israel.
| | | | | |
Collapse
|
9
|
Langberg EM, Dyhr L, Davidsen AS. Development of the concept of patient-centredness - A systematic review. PATIENT EDUCATION AND COUNSELING 2019; 102:1228-1236. [PMID: 30846206 DOI: 10.1016/j.pec.2019.02.023] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Patient-centredness is often linked to high-quality patient care, but the concept is not well-defined. This study aims to provide an overview of how patient-centredness has been defined in the literature since Mead and Bower's review in 2000, and to provide an updated definition of the concept. METHOD & DESIGN We performed a systematic literature search in PubMed to identify original articles with a sufficient definition of patient-centredness. We analysed extracted data defining patient-centredness. RESULTS Eighty articles were included. The dimensions "biopsychosocial", "patient-as-person", "sharing power and responsibility" and "therapeutic alliance" corresponded to four of five dimensions described by Mead and Bower. "Coordinated care" was a new dimension. CONCLUSION The identified dimensions are encompassed by three elements: the patient, the doctor-patient relationship and the framework of care i.e. the health care system. The additional focus on coordinated care could reflect increasing complexity of the health care system. PRACTICE IMPLICATIONS Narrowing down the understanding of patient-centredness to these three focus areas, viz. 1) understanding of the patients' experience of the illness in their life situation, 2) the professional's relationship with the patient, and 3) coordination of care in the system, could make the operationalisation and implementation of a patient-centred approach more manageable.
Collapse
Affiliation(s)
- Emil Mørup Langberg
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark.
| | - Lise Dyhr
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark.
| | - Annette Sofie Davidsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark.
| |
Collapse
|
10
|
Pettit KE, Turner JS, Pollard KA, Buente BB, Humbert AJ, Perkins AJ, Hobgood CD, Kline JA. Effect of an Educational Intervention on Medical Student Scripting and Patient Satisfaction: A Randomized Trial. West J Emerg Med 2018; 19:585-592. [PMID: 29760860 PMCID: PMC5942029 DOI: 10.5811/westjem.2018.1.35992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/11/2018] [Accepted: 01/17/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Effective communication between clinicians and patients has been shown to improve patient outcomes, reduce malpractice liability, and is now being tied to reimbursement. Use of a communication strategy known as "scripting" has been suggested to improve patient satisfaction in multiple hospital settings, but the frequency with which medical students use this strategy and whether this affects patient perception of medical student care is unknown. Our objective was to measure the use of targeted communication skills after an educational intervention as well as to further clarify the relationship between communication element usage and patient satisfaction. METHODS Medical students were block randomized into the control or intervention group. Those in the intervention group received refresher training in scripted communication. Those in the control group received no instruction or other intervention related to communication. Use of six explicit communication behaviors were recorded by trained study observers: 1) acknowledging the patient by name, 2) introducing themselves as medical students, 3) explaining their role in the patient's care, 4) explaining the care plan, 5) providing an estimated duration of time to be spent in the emergency department (ED), and 6) notifying the patient that another provider would also be seeing them. Patients then completed a survey regarding their satisfaction with the medical student encounter. RESULTS We observed 474 medical student-patient encounters in the ED (231 in the control group and 243 in the intervention group). We were unable to detect a statistically significant difference in communication element use between the intervention and control groups. One of the communication elements, explaining steps in the care plan, was positively associated with patient perception of the medical student's overall communication skills. Otherwise, there was no statistically significant association between element use and patient satisfaction. CONCLUSION We were unable to demonstrate any improvement in student use of communication elements or in patient satisfaction after refresher training in scripted communication. Furthermore, there was little variation in patient satisfaction based on the use of scripted communication elements. Effective communication with patients in the ED is complicated and requires further investigation on how to provide this skill set.
Collapse
Affiliation(s)
- Katie E Pettit
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Joseph S Turner
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Katherine A Pollard
- Washington University School of Medicine, Department of Medicine, St. Louis, Missouri
| | - Bryce B Buente
- Marion University College of Osteopathic Medicine, Indianapolis, Indiana
| | - Aloysius J Humbert
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Anthony J Perkins
- Indiana University Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Sciences Institute, Indianapolis, Indiana
| | - Cherri D Hobgood
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Jeffrey A Kline
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| |
Collapse
|
11
|
Nicholls D, Sweet L, Muller A, Hyett J. A model to teach concomitant patient communication during psychomotor skill development. NURSE EDUCATION TODAY 2018; 60:121-126. [PMID: 29096384 DOI: 10.1016/j.nedt.2017.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 06/18/2017] [Accepted: 09/08/2017] [Indexed: 06/07/2023]
Abstract
Many health professionals use psychomotor or task-based skills in clinical practice that require concomitant communication with a conscious patient. Verbally engaging with the patient requires highly developed verbal communication skills, enabling the delivery of patient-centred care. Historically, priority has been given to learning the psychomotor skills essential to clinical practice. However, there has been a shift towards also ensuring competent communication with the patient during skill performance. While there is literature outlining the steps to teach and learn verbal communication skills, little is known about the most appropriate instructional approach to teach how to verbally engage with the patient when also learning to perform a task. A literature review was performed and it identified that there was no model or proven approach which could be used to integrate the learning of both psychomotor and communication skills. This paper reviews the steps to teach a communication skill and provides a suggested model to guide the acquisition and development of the concomitant -communication skills required with a patient at the time a psychomotor skill is performed.
Collapse
Affiliation(s)
- Delwyn Nicholls
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Sydney Ultrasound for Women, Sydney, Australia.
| | - Linda Sweet
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Amanda Muller
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Jon Hyett
- RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, Australia; Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Australia
| |
Collapse
|
12
|
Taveira-Gomes I, Mota-Cardoso R, Figueiredo-Braga M. Communication skills in medical students - An exploratory study before and after clerkships. Porto Biomed J 2016; 1:173-180. [PMID: 32258571 PMCID: PMC6806961 DOI: 10.1016/j.pbj.2016.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 08/01/2016] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Effective communication is the cornerstone of a fruitful patient-physician relationship. Teaching clinical communication has become a pivotal goal in medical education. However, approaches measuring the maintenance of learned skills are needed since a decline in some communication skills during medical school has been reported. OBJECTIVE Explore medical students' communication skills in a simulated clinical encounter before and after clerkships. METHODS Two-hundred-fifty-five undergraduate students attending the second year of medical course, at the Faculty of Medicine of University of Porto, completed a 1.5-h per week course over 4 months on basic communication skills. The students' final evaluation consisted in an interview with a simulated patient, assessed by a teacher using a standardized framework. Three years later, while attending clerkships, 68 students from the same population completed a re-evaluation interview following the same procedure. RESULTS Medical students maintained a communication skill mean level similar to that of the original post-training evaluation, but significant differences in specific communication abilities were detected in this group of students. Empathic attitudes and ability to collect information improved whereas interview structure and non-verbal behavior showed a decline during clerkships expressing a balance between the competencies that improved, those that declined, and those that remained unchanged. CONCLUSION Present findings emphasize the importance of patient contact, context and clinical role models on the maintenance of learned skills, underscoring the importance of an integrated approach of clinical communication teaching throughout medical school.
Collapse
Affiliation(s)
- Isabel Taveira-Gomes
- Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal
- Child and Adolescent Psychiatry Resident at Centro Hospitalar do Porto, Portugal
| | - Rui Mota-Cardoso
- Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal
| | - Margarida Figueiredo-Braga
- Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal
- I3S Instituto de Investigação e Inovação em Saúde, University of Porto, Portugal
| |
Collapse
|
13
|
Turner JS, Pettit KE, Buente BB, Humbert AJ, Perkins AJ, Kline JA. Medical student use of communication elements and association with patient satisfaction: a prospective observational pilot study. BMC MEDICAL EDUCATION 2016; 16:150. [PMID: 27209065 PMCID: PMC4875631 DOI: 10.1186/s12909-016-0671-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 05/14/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Effective communication with patients impacts clinical outcome and patient satisfaction. We measure the rate at which medical students use six targeted communication elements with patients and association of element use with patient satisfaction. METHODS Participants included fourth year medical students enrolled in an emergency medicine clerkship. A trained observer measured use of six communication elements: acknowledging the patient by name, introducing themselves by name, identifying their role, explaining the care plan, explaining that multiple providers would see the patient, and providing an estimated duration of time in the emergency department. The observer then conducted a survey of patient satisfaction with the medical student encounter. RESULTS A total of 246 encounters were documented among forty medical student participants. For the six communication elements evaluated, in 61% of encounters medical students acknowledged the patient, in 91% they introduced themselves, in 58 % they identified their role as a student, in 64% they explained the care plan, in 80% they explained that another provider would see the patient, and in only 6% they provided an estimated duration of care. Only 1 encounter (0.4%) contained all six elements. Patients' likelihood to refer a loved one to that ED was increased when students acknowledged the patient and described that other providers would be involved in patient care (P = 0.016 and 0.015 respectively, Chi Square). Likewise, patients' likelihood to return to the ED was increased when students described their role in patient care (P = 0.035, Chi Square). CONCLUSIONS This pilot study demonstrates that medical students infrequently use all targeted communication elements. When they did use certain elements, patient satisfaction increased. These data imply potential benefit to additional training for students in patient communication.
Collapse
Affiliation(s)
- Joseph S Turner
- Department of Emergency Medicine, Indiana University, 720 Eskenazi Ave, Indianapolis, IN, 46037, USA.
| | - Katie E Pettit
- Department of Emergency Medicine, Indiana University, 720 Eskenazi Ave, Indianapolis, IN, 46037, USA
| | - Bryce B Buente
- Fairbanks School of Public Health, IUPUI, Indianapolis, IN, USA
| | - Aloysius J Humbert
- Department of Emergency Medicine, Indiana University, 720 Eskenazi Ave, Indianapolis, IN, 46037, USA
| | - Anthony J Perkins
- Department of Emergency Medicine, Indiana University, 720 Eskenazi Ave, Indianapolis, IN, 46037, USA
| | - Jeffrey A Kline
- Department of Emergency Medicine, Indiana University, 720 Eskenazi Ave, Indianapolis, IN, 46037, USA
| |
Collapse
|
14
|
Carney PA, Palmer RT, Fuqua Miller M, Thayer EK, Estroff SE, Litzelman DK, Biagioli FE, Teal CR, Lambros A, Hatt WJ, Satterfield JM. Tools to Assess Behavioral and Social Science Competencies in Medical Education: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:730-42. [PMID: 26796091 PMCID: PMC4846480 DOI: 10.1097/acm.0000000000001090] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Behavioral and social science (BSS) competencies are needed to provide quality health care, but psychometrically validated measures to assess these competencies are difficult to find. Moreover, they have not been mapped to existing frameworks, like those from the Liaison Committee on Medical Education (LCME) and Accreditation Council for Graduate Medical Education (ACGME). This systematic review aimed to identify and evaluate the quality of assessment tools used to measure BSS competencies. METHOD The authors searched the literature published between January 2002 and March 2014 for articles reporting psychometric or other validity/reliability testing, using OVID, CINAHL, PubMed, ERIC, Research and Development Resource Base, SOCIOFILE, and PsycINFO. They reviewed 5,104 potentially relevant titles and abstracts. To guide their review, they mapped BSS competencies to existing LCME and ACGME frameworks. The final included articles fell into three categories: instrument development, which were of the highest quality; educational research, which were of the second highest quality; and curriculum evaluation, which were of lower quality. RESULTS Of the 114 included articles, 33 (29%) yielded strong evidence supporting tools to assess communication skills, cultural competence, empathy/compassion, behavioral health counseling, professionalism, and teamwork. Sixty-two (54%) articles yielded moderate evidence and 19 (17%) weak evidence. Articles mapped to all LCME standards and ACGME core competencies; the most common was communication skills. CONCLUSIONS These findings serve as a valuable resource for medical educators and researchers. More rigorous measurement validation and testing and more robust study designs are needed to understand how educational strategies contribute to BSS competency development.
Collapse
Affiliation(s)
- Patricia A Carney
- P.A. Carney is professor of family medicine and of public health and preventive medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. R.T. Palmer is assistant professor of family medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. M.F. Miller is senior research assistant, Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. E.K. Thayer is research assistant, Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. S.E. Estroff is professor, Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina. D.K. Litzelman is D. Craig Brater Professor of Medicine and senior director for research in health professions education and practice, Indiana University School of Medicine, Indianapolis, Indiana. F.E. Biagioli is professor of family medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. C.R. Teal is assistant professor, Department of Medicine, and director, Educational Evaluation and Research, Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, Texas. A. Lambros is active emeritus associate professor, Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina. W.J. Hatt is programmer analyst, Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. J.M. Satterfield is professor of clinical medicine, University of California, San Francisco, School of Medicine, San Francisco, California
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Buck E, Holden M, Szauter K. A Methodological Review of the Assessment of Humanism in Medical Students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:S14-S23. [PMID: 26505097 DOI: 10.1097/acm.0000000000000910] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Humanism is a complex construct that defies simplistic measurement. How educators measure humanism shapes understanding and implications for learners. This systematic review sought to address the following questions: How do medical educators assess humanism in medical students, and how does the measurement impact the understanding of humanism in undergraduate medical education (UME)? METHOD Using the IECARES (integrity, excellence, compassion, altruism, respect, empathy, and service) Gold Foundation framework, a search of English literature databases from 2000 to 2013 on assessment of humanism in medical students revealed more than 900 articles, of which 155 met criteria for analysis. Using descriptive statistics, articles and assessments were analyzed for construct measured, study design, assessment method, instrument type, perspective/source of assessment, student level, validity evidence, and national context. RESULTS Of 202 assessments reported in 155 articles, 162 (80%) used surveys; 164 (81%) used student self-reports. One hundred nine articles (70%) included only one humanism construct. Empathy was the most prevalent construct present in 96 (62%); 49 (51%) of those used a single instrument. One hundred fifteen (74%) used exclusively quantitative data; only 48 (31%) used a longitudinal design. Construct underrepresentation was identified as a threat to validity in half of the assessments. Articles included 34 countries; 87 (56%) were from North America. CONCLUSIONS Assessment of humanism in UME incorporates a limited scope of a complex construct, often relying on single quantitative measures from self-reported survey instruments. This highlights the need for multiple methods, perspectives, and longitudinal designs to strengthen the validity of humanism assessments.
Collapse
|
16
|
Setyonugroho W, Kennedy KM, Kropmans TJB. Reliability and validity of OSCE checklists used to assess the communication skills of undergraduate medical students: A systematic review. PATIENT EDUCATION AND COUNSELING 2015; 98:S0738-3991(15)00277-3. [PMID: 26149966 DOI: 10.1016/j.pec.2015.06.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 05/27/2015] [Accepted: 06/06/2015] [Indexed: 05/11/2023]
Abstract
OBJECTIVES To explore inter-rater agreement between reviewers comparing reliability and validity of checklist forms that claim to assess the communication skills of undergraduate medical students in Objective Structured Clinical Examinations (OSCEs). METHODS Papers explaining rubrics of OSCE checklist forms were identified from Pubmed, Embase, PsycINFO, and the ProQuest Education Databases up to 2013. Included were those studies that report empirical validity or reliability values for the communication skills assessment checklists used. Excluded were those papers that did not report reliability or validity. RESULTS Papers focusing on generic communication skills, history taking, physician-patient communication, interviewing, negotiating treatment, information giving, empathy and 18 other domains (ICC -0.12-1) were identified. Regarding the validity and reliability of the communication skills checklists, agreement between reviewers was 0.45. CONCLUSIONS Heterogeneity in the rubrics used in the assessment of communication skills and a lack of agreement between reviewers makes comparison of student competences within and across institutions difficult. PRACTICE IMPLICATIONS Consideration should be afforded to the adoption of a standardized measurement instrument to assess communication skills in undergraduate medical education. Future research will focus upon evaluating the potential impact of adoption of a standardized measurement instrument.
Collapse
Affiliation(s)
- Winny Setyonugroho
- Faculty of Medicine and Health Sciences of the Universitas Muhammadiyah Yogyakarta, Bantul, Indonesia.
| | - Kieran M Kennedy
- School of Medicine, College or Medicine, Nursing & Health Sciences, National University of Ireland Galway, Galway, Ireland.
| | - Thomas J B Kropmans
- School of Medicine, College or Medicine, Nursing & Health Sciences, National University of Ireland Galway, Galway, Ireland.
| |
Collapse
|
17
|
Lee YM, Lee YH. Evaluating the short-term effects of a communication skills program for preclinical medical students. KOREAN JOURNAL OF MEDICAL EDUCATION 2014; 26:179-87. [PMID: 25805260 PMCID: PMC8813368 DOI: 10.3946/kjme.2014.26.3.179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 07/30/2014] [Accepted: 08/01/2014] [Indexed: 05/31/2023]
Abstract
PURPOSE Regardless of the growing importance of communication skills as a core clinical competence, few studies have determined the effects of communication skills courses in undergraduate medical curricula in Asian medical schools. The purpose of this study was to examine the effectiveness of a communication skills program for preclinical medical students. METHODS A communication skills course was provided to 111 second-year medical students in a medical college in Korea. Students' self-assessed competency of communication skills was evaluated by a questionnaire survey. To examine the improvement in observed communication skills, the students' encounters with standardized patients (SPs) were assessed at the first session and at the final course assessment. A structured checklist, consisting of 25 communication skills items, was used for the assessment. RESULTS Students' self-assessed competency of communication skills increased significantly after completion of the course (p<0.001). The observed communication skills scores also improved significantly at the end of the course; the mean scores of the first SPs encounters was 49.6 (standard deviation [SD], 11.1), and those of cases A and B at the final assessment were 61.5 (SD, 8.4) and 69.6 (SD, 7.8), respectively (F61=269.54, p<0.001). CONCLUSION Even a short period of medical communication skills course was beneficial in developing and improving communication skills competency in preclinical medical students. Further studies should be followed to examine whether the acquisition of communication skills during preclinical studies can be sustained into clerkship and actual practice.
Collapse
Affiliation(s)
- Young-Mee Lee
- Corresponding Author: Young-Mee Lee (http://orcid.org/0000-0002-4685-9465) Department of Medical Education, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 136-705, Korea Tel: +82.2.920.6098 Fax: +82.2.928.1647
| | | |
Collapse
|
18
|
Perry J, Watkins M, Gilbert A, Rawlinson J. A systematic review of the evidence on service user involvement in interpersonal skills training of mental health students. J Psychiatr Ment Health Nurs 2013; 20:525-40. [PMID: 22845684 DOI: 10.1111/j.1365-2850.2012.01955.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Service user involvement has become a common feature of education programmes for mental health students. However, little is known about the effects of this type of education on the interpersonal skills of students taking part. This paper reports findings from a systematic review that formed part of a wider investigation into service user involvement in teaching interpersonal skills. The review aimed to locate and assess the quality of the published evidence relating to the effects of service user involvement on mental health students interpersonal skills and to synthesize results, using a definition of interpersonal skill that includes attitudes, empathy and skills as its key components. Results from this study indicate that the quality of evidence in this area is poor. However, sufficient synthesis of the evidence base was possible to allow conclusions and recommendations for both research and practice. Conclusions were that the involvement of service users in this area is both acceptable and valuable for students and had specific impacts on attitudes, empathy and skills. Some difficulties and reservations about the style of involvement are discussed. Recommendations for the conduct of future research are also made.
Collapse
Affiliation(s)
- J Perry
- School of Nursing and Midwifery, Plymouth University, Plymouth, UK.
| | | | | | | |
Collapse
|
19
|
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]
|
20
|
Predictors of satisfaction with treatment decision, decision-making preferences, and main treatment goals in patients with advanced cancer. Support Care Cancer 2013; 21:3085-93. [PMID: 23828394 DOI: 10.1007/s00520-013-1886-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 06/19/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study investigated satisfaction with treatment decision (SWTD), decision-making preferences (DMP), and main treatment goals, as well as evaluated factors that predict SWTD, in patients receiving palliative cancer treatment at a Swiss oncology network. PATIENTS AND METHODS Patients receiving a new line of palliative treatment completed a questionnaire 4-6 weeks after the treatment decision. Patient questionnaires were used to collect data on sociodemographics, SWTD (primary outcome measure), main treatment goal, DMP, health locus of control (HLoC), and several quality of life (QoL) domains. Predictors of SWTD (6 = worst; 30 = best) were evaluated by uni- and multivariate regression models. RESULTS Of 480 participating patients in eight hospitals and two private practices, 445 completed all questions regarding the primary outcome measure. Forty-five percent of patients preferred shared, while 44 % preferred doctor-directed, decision-making. Median duration of consultation was 30 (range: 10-200) minutes. Overall, 73 % of patients reported high SWTD (≥24 points). In the univariate analyses, global and physical QoL, performance status, treatment goal, HLoC, prognosis, and duration of consultation were significant predictors of SWTD. In the multivariate analysis, the only significant predictor of SWTD was duration of consultation (p = 0.01). Most patients indicated hope for improvement (46 %), followed by hope for longer life (26 %) and better quality of life (23 %), as their main treatment goal. CONCLUSION Our results indicate that high SWTD can be achieved in most patients with a 30-min consultation. Determining the patient's main treatment goal and DMP adds important information that should be considered before discussing a new line of palliative treatment.
Collapse
|
21
|
Ferguson LM, Ward H, Card S, Sheppard S, McMurtry J. Putting the ‘patient’ back into patient-centred care: An education perspective. Nurse Educ Pract 2013; 13:283-7. [DOI: 10.1016/j.nepr.2013.03.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 03/07/2013] [Accepted: 03/19/2013] [Indexed: 11/29/2022]
|
22
|
Montemurro D, Vescovo G, Negrello M, Frigo AC, Cirillo T, Picardi E, Chiminazzo C, El Mazloum D, De Caro R, Benato M, Ferretti A, Mazza A, Marcolongo A, Rubello D. Medical professional values and education: a survey on italian students of the medical doctor school in medicine and surgery. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2013; 5:134-9. [PMID: 23641376 PMCID: PMC3624715 DOI: 10.4103/1947-2714.107535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: The values such as participation/empathy, communication/sharing, self-awareness, moral integrity, sensitivity/trustfulness, commitment to ongoing professional development, and sense of duty linked to the practice of the medical professionalism were defined by various professional oaths. Aims: The aim of this study was to evaluate how these values are considered by the students of the degree course of medicine. Materials and Methods: Four hundred twenty three students (254 females, 169 males) taking part of the first, fourth, and fifth years of the degree course in medicine were asked to answer seven questions. Pearson's Chi-square, Wilcoxon rank sum test, and Kruskal–Wallis test were used for the statistical analysis. Results: The survey showed a high level of knowledge and self-awareness about the values and skills of medical profession. In particular, the respect, accountability, and the professional skills of competence were considered fundamental in clinical practice. However, the students considered that these values not sufficiently present in their educational experience. Conclusions: Teaching methods should be harmonized with the contents and with the educational needs to ensure a more complex patient-based approach and the classical lectures of teachers should be more integrated with learning through experience methods.
Collapse
|
23
|
Deledda G, Moretti F, Rimondini M, Zimmermann C. How patients want their doctor to communicate. A literature review on primary care patients' perspective. PATIENT EDUCATION AND COUNSELING 2013; 90:297-306. [PMID: 22709720 DOI: 10.1016/j.pec.2012.05.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 05/03/2012] [Accepted: 05/05/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To review the literature on the communicative behaviours primary care patients want from a "good" physician. METHODS An electronic search used the key words doctor-patient relation AND patient desires OR patient expectations OR patient preferences (from now on referred to as expectations). The qualitative and quantitative articles meeting the selection criteria were analysed separately, comparing methods, definitions, measures and outcomes. The physician behaviours desirable from a patient perspective were grouped by linking them to the communicative functions of an effective medical encounter as defined from a professional perspective. RESULTS Twenty-seven studies were included. Critical issues were the heterogeneity of definitions and measures and the lack of integration between quantitative and qualitative findings. Most of the expectations in qualitative studies were related to the function "Fostering the relationship". Similar expectations arose less often in quantitative studies. CONCLUSIONS Patients do have concrete expectations regarding each of the functions to be met in the medical encounters. The research approach tends to bias the results. PRACTICE IMPLICATIONS The collected expectations suggest how physicians may perform each of their tasks according to the patient perspective. Future research on patients' communicative expectations needs to overcome the gap between qualitative and quantitative findings.
Collapse
Affiliation(s)
- Giuseppe Deledda
- Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | | | | | | |
Collapse
|
24
|
Utilization of an Integrated Clinical Experience in a Physical Therapist Education Program. ACTA ACUST UNITED AC 2013. [DOI: 10.1097/00001416-201301000-00009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
25
|
Blanch-Hartigan D. An effective training to increase accurate recognition of patient emotion cues. PATIENT EDUCATION AND COUNSELING 2012; 89:274-80. [PMID: 22906744 DOI: 10.1016/j.pec.2012.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 06/29/2012] [Accepted: 08/02/2012] [Indexed: 05/23/2023]
Abstract
OBJECTIVE For healthcare providers, accurate perception of patients, particularly accurate recognition of patient emotions, is an ability associated with better patient care and more satisfied patients. Despite the importance of accurately recognizing patient cues for provider-patient communication, research on clinically relevant training programs is limited. The effectiveness of a multi-component training program designed to enhance emotion cue recognition ability was experimentally assessed. METHODS The comprehensive training included raising awareness about the importance of emotion cues in healthcare interactions, providing instruction on increasing emotion cue recognition accuracy, and practicing emotion recognition while receiving feedback. Undergraduate participants were randomly assigned to one of five training conditions or an untrained control condition to experimentally test the efficacy of the comprehensive training and each training component. RESULTS Participants were significantly more accurate on a standardized test of patient emotion cue recognition in the comprehensive condition, as compared to those participants in the control condition, with Practice with Feedback emerging as the most effective component. CONCLUSIONS Results suggest that a 30-min emotion recognition training intervention can significantly improve emotion recognition accuracy. PRACTICE IMPLICATIONS The results can be used to guide development and implementation of future research and programs aimed at increasing providers' emotion recognition.
Collapse
|
26
|
Bourquin C, Stiefel F, Berney A, Singy P. Dunno if you've any plans for the future: medical student indirect questioning in simulated oncology interviews. BMC MEDICAL EDUCATION 2012; 12:8. [PMID: 22385555 PMCID: PMC3310746 DOI: 10.1186/1472-6920-12-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 03/02/2012] [Indexed: 05/31/2023]
Abstract
BACKGROUND This exploratory study investigated the motives of medical students (N = 63) for using indirect questions of the type I don't know if [you have already heard about chemotherapies], I don't know how [you are], or I don't know what [you do for a living] in simulated patient interviews during a communication skills course. METHODS I don't know questions (IDK-Qs) were observed during the initial evaluation of students' communication skills; they were systematically identified through video screening and subjected to a qualitative content and discourse analysis considering their context, their content, their intent and their effect on the simulated patients. To evaluate the specificity of medical students' IDK-Qs, the data were compared with a data set of oncologists (N = 31) conducting simulated patient interviews in the context of a Communication Skills Training (CST). RESULTS During the interviews, 41.3% of the students asked 1-6 IDK-Qs. The IDK-Qs were attributed to three content categories: medical/treatment questions (N = 24); lifestyle/psychosocial questions (N = 18); and "inviting questions" questions (N = 11). Most of the IDK-Qs had an exploratory function (46/53), with simulated patients providing detailed responses or asking for more information (36/53). IDK-Qs were rare in the oncologist sample compared to the student sample (5 vs. 53 occurrences). CONCLUSIONS IDK-Qs showed a question design difference between medical students and oncologists in simulated patient interviews. Among other reasons for this difference, the possible function of IDK-Qs as a protective linguistic strategy and marker for psychological discomfort is discussed.
Collapse
Affiliation(s)
- Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital, Les Allières, 1011 Lausanne-CHUV, Switzerland
| | - Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital, Les Allières, 1011 Lausanne-CHUV, Switzerland
| | - Alexandre Berney
- Psychiatric Liaison Service, Lausanne University Hospital, Les Allières, 1011 Lausanne-CHUV, Switzerland
| | - Pascal Singy
- Psychiatric Liaison Service, Lausanne University Hospital, Les Allières, 1011 Lausanne-CHUV, Switzerland
| |
Collapse
|
27
|
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.
Collapse
Affiliation(s)
- Carol A Lunney
- The Human Development Institute, University of Kentucky, Lexington, Kentucky, USA.
| | | | | | | |
Collapse
|
28
|
Bombeke K, Symons L, Vermeire E, Debaene L, Schol S, De Winter B, Van Royen P. Patient-centredness from education to practice: the 'lived' impact of communication skills training. MEDICAL TEACHER 2012; 34:e338-48. [PMID: 22452275 DOI: 10.3109/0142159x.2012.670320] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND Although communication skills training (CST) enhances patient-centred skills and attitudes, the literature indicates a problematic transfer of these from education into practice. AIM We explored 'lived' experiences of medical students and doctors to gain a better understanding of the impact of CST on patient-centredness in the transition to real practice. METHODS From a phenomenological perspective, we conducted 15 interviews and 11 focus groups with 4-9 participants/group (n = 67) at two universities and carried out constant comparative analysis. RESULTS The gap between education and practice is the central phenomenon. Although CST raises students' communication awareness and self-efficacy in an 'ideal' context, this paradoxically seems to jeopardize their ability to bridge the gulf. In addition, CST does not come to grips with students' attitudes. However, CST appears to be successful in equipping students with long-lasting 'handles'. Yet students need more support to mould the provided 'ideal' models into their own unique style of context-specific patient-centred behaviour. This implies: raising students' awareness of own attitudes and communication styles, offering a more realistic training ground, integrating CST with clinical experience and translating the primary-care-rooted concept of patient-centredness into various specialization contexts. CONCLUSION CST could raise its impact by supporting students' recycling processes towards a personal style of context-sensitive patient-centredness.
Collapse
Affiliation(s)
- Katrien Bombeke
- Department of Primary and Interdisciplinary Care, University of Antwerp, Campus Drie Eiken, R3.11, Universiteitsplein 1, B-2610 Wilrijk, Belgium.
| | | | | | | | | | | | | |
Collapse
|
29
|
Bombeke K, Van Roosbroeck S, De Winter B, Debaene L, Schol S, Van Hal G, Van Royen P. Medical students trained in communication skills show a decline in patient-centred attitudes: an observational study comparing two cohorts during clinical clerkships. PATIENT EDUCATION AND COUNSELING 2011; 84:310-8. [PMID: 21482064 DOI: 10.1016/j.pec.2011.03.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 03/05/2011] [Accepted: 03/07/2011] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Literature indicates a decline in patient-centredness in medical students, especially during clinical clerkships. We examined the impact of preclinical communication skills training (CST) on students' development of patient-centred attitudes and attitudes toward CST during clerkships. METHODS We prospectively compared two cohorts before and after clerkships: one cohort (n=48) had not received CST, whereas the other (n=37) had received a five-year CST. We assessed the impact using five validated questionnaires. RESULTS Communication trained students slightly but significantly declined in patient-centred attitudes (3/4 scales) and attitudes toward CST during clerkships, whereas the scores of the untrained students remained stable (5/5 scales). Both cohorts did not differ in attitudes before clerkships. In the trained cohort, males mostly showed a sharper decline than females. In the total group (n=85), females demonstrated higher attitude scores toward CST, and in 1/4 scales measuring patient-centred attitudes. CONCLUSION This cohort study suggests that CST might make students more vulnerable to decline in attitude scores during clerkships. PRACTICE IMPLICATIONS These remarkable findings, contrary to what educators would expect to result from their efforts, challenge medical education to address the new questions that are raised about the validity of the questionnaires, the impact of CST and the learning processes involved in the development of patient-centredness.
Collapse
Affiliation(s)
- Katrien Bombeke
- University of Antwerp, Department of Primary and Interdisciplinary Care, Wilrijk, Belgium.
| | | | | | | | | | | | | |
Collapse
|
30
|
Tsimtsiou Z, Benos A, Garyfallos AA, Hatzichristou D. Predictors of physicians' attitudes toward sharing information with patients and addressing psychosocial needs: a cross-sectional study in Greece. HEALTH COMMUNICATION 2011; 27:257-263. [PMID: 21879812 DOI: 10.1080/10410236.2011.578333] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Sharing information with patients and addressing their psychosocial needs are recognized as fundamental practices of patient-centered physicians. Our study explored predictors of physicians' patient-centered attitudes and yielded a better understanding of the relative influences of job satisfaction, employment status, specialty, previous communication skills training, and sociodemographic factors. Physicians who participated in 13 identical workshops offered throughout Greece were invited to complete a battery of anonymous questionnaires (demographics, job satisfaction scale, Patient-Practitioner Orientation Scale-Sharing subscale, and Physician Belief Scale). Prediction models were used to identify predictors of patient-centered attitudes. In total, 400 fully completed questionnaires were returned (response rate 79.8%). Job satisfaction, previous training in communication skills, younger age and lower socioeconomic status were predictors of positive attitudes toward sharing information with patients. Job satisfaction, previous training in communication skills, and stronger religious beliefs were predictors of higher psychosocial orientation. Job satisfaction and training in communication skills should be ensured in the effort to develop and maintain patient-centered attitudes in physicians. Religious beliefs, age, and socioeconomic status should be taken into consideration in the effort to help physicians become aware of their biases.
Collapse
Affiliation(s)
- Zoi Tsimtsiou
- Unit for the Study of Urologic Diseases, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | | | | | | |
Collapse
|
31
|
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.
Collapse
Affiliation(s)
- Bryan Burford
- Medical Education Research Group, Durham University, UK.
| | | | | | | | | | | | | |
Collapse
|
32
|
Joekes K, Noble LM, Kubacki AM, Potts HWW, Lloyd M. Does the inclusion of 'professional development' teaching improve medical students' communication skills? BMC MEDICAL EDUCATION 2011; 11:41. [PMID: 21708000 PMCID: PMC3141797 DOI: 10.1186/1472-6920-11-41] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 06/27/2011] [Indexed: 05/15/2023]
Abstract
BACKGROUND This study investigated whether the introduction of professional development teaching in the first two years of a medical course improved students' observed communication skills with simulated patients. Students' observed communication skills were related to patient-centred attitudes, confidence in communicating with patients and performance in later clinical examinations. METHODS Eighty-two medical students from two consecutive cohorts at a UK medical school completed two videoed consultations with a simulated patient: one at the beginning of year 1 and one at the end of year 2. Group 1 (n = 35) received a traditional pre-clinical curriculum. Group 2 (n = 47) received a curriculum that included communication skills training integrated into a 'professional development' vertical module. Videoed consultations were rated using the Evans Interview Rating Scale by communication skills tutors. A subset of 27% were double-coded. Inter-rater reliability is reported. RESULTS Students who had received the professional development teaching achieved higher ratings for use of silence, not interrupting the patient, and keeping the discussion relevant compared to students receiving the traditional curriculum. Patient-centred attitudes were not related to observed communication. Students who were less nervous and felt they knew how to listen were rated as better communicators. Students receiving the traditional curriculum and who had been rated as better communicators when they entered medical school performed less well in the final year clinical examination. CONCLUSIONS Students receiving the professional development training showed significant improvements in certain communication skills, but students in both cohorts improved over time. The lack of a relationship between observed communication skills and patient-centred attitudes may be a reflection of students' inexperience in working with patients, resulting in 'patient-centredness' being an abstract concept. Students in the early years of their medical course may benefit from further opportunities to practise basic communication skills on a one-to-one basis with patients.
Collapse
Affiliation(s)
- Katherine Joekes
- Division of Medical Education, UCL, Archway Campus, Highgate Hill, London, N19 5LW, UK
- Division of Population Health Sciences and Education, St George's, University of London, Hunter Wing, Cranmer Terrace, London, SW17 0RE, UK
| | - Lorraine M Noble
- Division of Medical Education, UCL, Archway Campus, Highgate Hill, London, N19 5LW, UK
| | - Angela M Kubacki
- Division of Medical Education, UCL, Archway Campus, Highgate Hill, London, N19 5LW, UK
- Division of Population Health Sciences and Education, St George's, University of London, Hunter Wing, Cranmer Terrace, London, SW17 0RE, UK
| | - Henry WW Potts
- Centre for Health Informatics and Multiprofessional Education, UCL, Archway Campus, Highgate Hill, London, N19 5LW, UK
| | - Margaret Lloyd
- Research Department of Primary Care and Population Health, UCL, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| |
Collapse
|
33
|
Maxfield H, Delzell JE, Chumley H. Eliciting the patient's perspective: does experience or type of case make a difference? PATIENT EDUCATION AND COUNSELING 2011; 82:222-225. [PMID: 20452166 DOI: 10.1016/j.pec.2010.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 03/19/2010] [Accepted: 03/31/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Patient-centered interviewing is an increasingly important aspect of medical education. One way to quantify this skill is the Four Habits Model, which helps to organize medical interviewing. The Four Habits are: invest in the beginning, elicit the patient's perspective, demonstrate empathy and invest in the end. In a previous study at our institution, students were competent in all of the habits but "eliciting the patient's perspective" during a standardized patient case. Based on this study, we hypothesized that the students' poor performance could be related to the type of case or to clinical experience. METHODS We placed three "eliciting the patient's perspective" items on the checklist for two standardized patients, one with and one without a clear diagnosis. We planned to compare group performance between cases and semesters of the third year. We hypothesized that students would be more patient-centered earlier in the year and with an ambiguous diagnosis. RESULTS Students were more patient-centered with the ambiguous diagnosis and later in their third year. Patient-centeredness was measured by an eliciting the patient's perspective (EPP) score based on the checklist items. CONCLUSION Our results provide information that may help guide curriculum development and future study to advance patient-centered interviewing skills.
Collapse
Affiliation(s)
- Hannah Maxfield
- Department of Family Medicine, University of Kansas School of Medicine, Kansas City, KS 66160, USA.
| | | | | |
Collapse
|
34
|
Bombeke K, Symons L, Debaene L, De Winter B, Schol S, Van Royen P. Help, I'm losing patient-centredness! Experiences of medical students and their teachers. MEDICAL EDUCATION 2010; 44:662-73. [PMID: 20636585 DOI: 10.1111/j.1365-2923.2010.03627.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Despite all educational efforts, the literature shows an ongoing decline in patient-centredness during medical education. This study explores the experiences of medical students and their teachers and supervisors in relation to patient-centredness in order to gain a better understanding of the factors that determine its development. METHODS We conducted 11 focus groups on the subject of learning and teaching about patient-centredness. We then carried out a constant comparative analysis of prior theory and the qualitative data collected in the focus groups using the 'sensitising concepts' provided by the Attitude-Social Influence-Self-Efficacy (ASE) model. RESULTS Although students express positive attitudes towards patient-centredness and acquire patient-centred skills during medical education, this study indicates that these are not sufficient to attain the level of competent behaviour needed in today's challenging hospital environment. Clinical clerkships do provide students with ample opportunity to encounter patients and practise patient-centred skills. However, when students lack self-efficacy, when they face barriers (time pressure, tiredness) or when they are surrounded by non-patient-centred role models and are overwhelmed by powerful experiences, they lose their patient-centred focus. The study suggests that communication skills training protects students from negative social influences. Moreover, personal development, including developing the ability to deal with emotions and personal suffering, self-awareness and self-care are important qualities of the central phenomenon of the 'doctor-as-person', which is identified as a missing concept in the ASE model. The student-supervisor relationship is found to be key to learning patient-centredness and has several functions: it facilitates the direct transmission of patient-centred skills, knowledge and attitudes; it provides social support of students' patient-centred behaviour; it provides support of the 'student-as-person'; it mirrors patient-centredness by being student-centred, and, lastly, it addresses supervisor vulnerability. Finally, participants recommend that student-centred education and guidance be offered, self-awareness be fostered and more opportunities to encounter patients be created, including more time in general practice. CONCLUSIONS Supportive student-doctor relationships, student-centred education and guidance that addresses the needs of the doctor-as-person are central to the development of patient-centredness. Medical education requires patient-centred, self-caring and self-aware role models.
Collapse
Affiliation(s)
- Katrien Bombeke
- Department of Primary and Interdisciplinary Care, University of Antwerp, Wilrijk, Belgium.
| | | | | | | | | | | |
Collapse
|
35
|
Improving patient-centered care for people with dementia in medical encounters: an educational intervention for old age psychiatrists. Int Psychogeriatr 2010; 22:129-38. [PMID: 19615123 DOI: 10.1017/s1041610209990482] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Health care professionals are recommended to deliver patient-centered care in dementia; however, guidance and training on how to do this in practice is currently lacking. The aim of this study was to develop and evaluate pragmatically an educational intervention for old age psychiatrists to promote patient-centered care in their consultations with people with dementia and their carers. METHODS We used a range of methods to (i) identify the theoretical components of patient-centered care (literature review) and (ii) observe actual practice (video recording of 53 consultations between old age psychiatrists and people with dementia and their family carers). We also interviewed participants from (ii) including 7 old age psychiatrists, 25 people with dementia and 44 carers. From this we developed a workshop for old age psychiatrists and piloted and evaluated it. Pre- and post-workshop questionnaires were completed; the latter included an assessment of planned and subsequent behavior change by participants. RESULTS The educational workshop, attended by 41 old age psychiatrists, focused on how best to structure the consultation and the most effective communication skills to use in consultation with people with dementia. Three months after the workshop, 59% had made one or more changes to the structure of their consultations, 71% had used new communication skills and 56% had reflected further on their practice. CONCLUSIONS We developed an educational intervention with both a theoretical and empirical basis. The workshops resulted in many changes to self-reported practice; whether this was noticeable to patients and carers requires further study.
Collapse
|
36
|
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.
Collapse
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.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Klemenc-Ketis Z, Kersnik J, Ojstersek J. Perceived difficulties in managing ethical problems in family practice in Slovenia: cross-sectional study. Croat Med J 2009; 49:799-806. [PMID: 19090605 DOI: 10.3325/cmj.2008.49.799] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To determine the prevalence of difficulties in managing ethical dilemmas in family practice. METHODS The study included a random sample of 259 family medicine physicians, representing 30% of the population of family physicians in Slovenia. Participants were given a self-administered questionnaire on perceived ethical dilemmas in their practice, with responses on a 5-point scale and a maximum score of 100. The main outcome measure was the percentage of family physicians reporting difficulties in solving perceived ethical dilemmas. RESULTS The response rate was 55%. Physicians reported having difficulties in solving ethical dilemmas often or very often (mean score+/-standard deviation, 56.1+/-12.1). The most difficult ethical issue included abandoned and unattended patients and patients with insufficient means of support (48.6%), followed by suspicion of physical abuse, sexual abuse, or other criminal behavior (40.9%), and use of limited health care resources (21.1%). Female physicians reported greater difficulties in solving ethical dilemmas than male physicians (57.7+/-10.6 vs 53.0+/-14.1, P=0.036, t test). Older physicians solved ethical issues more easily than younger ones (53.9+/-12.6 vs 58.2+/-11.2, P=0.043, t test). Specialists and residents in family medicine considered solving ethical dilemmas to be more difficult than general practitioners without specialization (57.3+/-11.6 vs 47.1+/-11.8, P=0.001, t test). Multivariate regression analysis of physician and practice characteristics did not yield any significant model to explain the differences in the perceived level of difficulties in solving ethical dilemmas. CONCLUSION Although managing ethical dilemmas is an important part of daily work of family physicians in Slovenia, it is perceived as a considerable burden in their work. Family physicians need more training in addressing and managing ethical issues.
Collapse
Affiliation(s)
- Zalika Klemenc-Ketis
- Department of Family Medicine, Medical Faculty, University of Maribor, Kersnikova cesta 1, Velenje, Slovenia.
| | | | | |
Collapse
|