A preliminary exploration of the interactional skills of trainee surgeons

Interactional skills training in undergraduate medical education: ten principles for guiding future research

BACKGROUND

High-quality healthcare requires practitioners who have technical competence and communication skills. Medical practitioners need interpersonal skills for gathering and transferring information to their patients, in addition to general consultation skills. Appropriate information gathering increases the likelihood of an accurate diagnosis. Transferring information should be performed in a way that promotes patient understanding and increases the probability of adherence to physician recommendations. This applies to: (i) primary prevention such as smoking cessation; (ii) secondary prevention including preparation for potentially threatening interventions; and (iii) tertiary care, including breaking bad news regarding treatment and prognosis.

DISCUSSION

This debate paper delineates factors associated with undergraduate medical communication skills training where robust research is needed. Ten key principles are presented and discussed, which are intended to guide future research in this field and ensure high quality studies with methodological rigour are conducted. The literature on communication skills training for medical school undergraduates continues to grow. A considerable portion of this output is represented by commentaries, descriptive studies or poorly designed interventions. As with any field of healthcare, quality research interventions are required to ensure practice is grounded in high-level evidence.

Selecting the best from the rest

The current method for selecting surgeons of the future is neither objective nor relevant to present day needs. An assessment is needed which ranks potential trainees according to aptitude, motivation and diligence, all of which is validated. This task should be a core duty for the Royal Colleges of Surgeons working in close co-operation with surgical specialty associations.

Breaking bad news--development of a hospital-based training workshop

The skills required to break bad news have been written about extensively and are taught in medical schools. Recent initiatives have concentrated on improving the skills of doctors and nurses in senior positions, who act as role models for their junior colleagues. A multiprofessional learning situation can be a threatening environment, in which colleagues may worry about exposing some of the weaknesses in their knowledge and skills regarding communication with patients. We describe the initiation, running, and evaluation of successful training workshops on breaking bad news in a large British district hospital.

The development of undergraduate curricula in surgery: II. Generic surgery

The present paper focuses upon the issues in curricular reform that have specific relevance for surgeons. A central theme is that, taking into account the dual diminution of general surgery and large central teaching hospitals, there is a need to have a clear vision of what should be included in surgical curricula and how we can adjust to new methods of teaching and learning.

Preventive and other interactional skills of general practitioners, surgeons, and physicians: perceived competence and endorsement of postgraduate training

BACKGROUND

Perceived competencies and support for formal postgraduate training across a range of preventive and other interactional skills were examined in three medical groups.

METHODS

All eligible final year students and recent graduates of the three major Australian medical colleges (n = 767) were mailed a questionnaire examining communication skills in four domains: preventive, educational, therapeutic, and general.

RESULTS

Overall consent rate was 45%. For most items, at least one-third of each group reported low competence. On preventive items, low competence ratings ranged from 5 to 39% in general practice, 38 to 67% in surgery, and 33 to 51% in the speciality physician group. Significant intergroup differences occurred on eight competence items. Agreement with training on preventive topics ranged from 80 to 91% in general practice, 48 to 69% in surgery, and 72 to 82% in the specialty physician group. On all 11 training items where significant differences occurred, the general practice group reported the highest level and the surgeon group the lowest level of endorsement for formal training and assessment.

CONCLUSIONS

Substantial proportions in the general practice, surgery, and the physician specialty report lack of competence in common interactional skills. There were high levels of support for formal training in preventive and other interactional skills. The strong endorsement supports the development of effective, tailored interactional skills training programs.