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Mazouri-Karker S, Braillard O, Lüchinger R, Bajwa N, Achab S, Hudelson P, Dao MD, Junod-Perron N. Patients preferences for communication during video consultations. PATIENT EDUCATION AND COUNSELING 2023; 115:107894. [PMID: 37480793 DOI: 10.1016/j.pec.2023.107894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/24/2023]
Abstract
Objective The aim of our simulation-based study was to explore patient preferences for physician behaviours in video consultations METHODS: We conducted an exploratory study in outpatient setting in Geneva, Switzerland.Patients were invited to watch two variations videos of six simulated physician communication behaviours (camera framing, gaze orientation, initial talk at the opening phase, privacy reminder, pauses, empathy)and to indicate which one they preferred RESULTS: 417 patients watched three different video-recorded encounters. Most patients preferred framing with both face and bust (50.7 %) versus face alone (21.8 %). They valued eye gazing towards the camera (42.9 %) versus eye gazing shifting between screen and camera (13 %). The social talk related to the connection quality was appreciated (43.1 % vs 17.1 %) as well as the privacy reminder (80.8 % vs 6.5 %). Patients preferred short rather than long pauses after physician's statements (63.9 vs 14.9 %) as well as expressive rather than neutral nonverbal behaviour (46.7 % vs 17.6 %). CONCLUSION: Our results confirm that patients prefer the use of video specific communication behaviours recommended by experts except for shifting eye gaze and long pauses after physician's statements. PRACTICE IMPLICATIONS: Given the increasing use of video consultations, video communication "best practices"should be systematically addressed in physician training.
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Affiliation(s)
- Sanae Mazouri-Karker
- E-health and Telemedicine Division, Geneva University Hospitals, Geneva, Switzerland.
| | - Olivia Braillard
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Robin Lüchinger
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nadia Bajwa
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sophia Achab
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland; ReConnecte Unit, Addiction Division, University Hospitals, Geneva, Switzerland
| | - Patricia Hudelson
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Mélissa Dominicé Dao
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Noëlle Junod-Perron
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Timmerman A, Oerlemans M, van der Vleuten C, Pawlikowska T, Ram P, Muris J. Exploring typologies of consultation performance using authentic clinical experiences to support learning and assessment in postgraduate medical training. PATIENT EDUCATION AND COUNSELING 2022; 105:2276-2284. [PMID: 34810057 DOI: 10.1016/j.pec.2021.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To validate and refine typologies of consultation performance from previous research to identify learning needs associated with each typology. METHODS We performed a qualitative study in a General Practice Specialty Training programme, using a two-stage design. First, we selected four exemplars from 80 videotaped consultations of 7 first-year and 6 third-year trainees that reflected the four typologies. We subsequently held individual interviews with clinical supervisors (N = 20) who observed these consultations to identify recurrent trainee behaviours. RESULTS The 'doctor-patient interaction' dimension from previous research was specified to encompass relationship-building, exploring, structuring, and shared decision-making competencies. Medical expertise was a moderating factor. The attitude and consultation behaviours included in the typologies were validated and we formulated directions for learning based on learning needs identified per typology. CONCLUSION Supervisors have a shared frame of reference for the behaviours reflecting proficient consultation performance. Serving as a developmental road map, all learning needs emphasised contextual adaptation, calling for an improved balance between patient-centred relationship building and application of medical expertise. PRACTICE IMPLICATIONS By providing rich and tailored feedback on consultation performance, the refined typologies - albeit subject to additional refinement in future research - may promote the monitoring of individual competence development over time.
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Affiliation(s)
- Angelique Timmerman
- Maastricht University, Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands.
| | - Marjolein Oerlemans
- Maastricht University, Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Cees van der Vleuten
- Maastricht University, Department of Educational Development and Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Teresa Pawlikowska
- RCSI University of Medicine and Health Sciences, Health Professions Education Centre, Dublin, Ireland
| | - Paul Ram
- Maastricht University, Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Jean Muris
- Maastricht University, Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
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Perron NJ, Pype P, van Nuland M, Bujnowska-Fedak MM, Dohms M, Essers G, Joakimsen R, Tsimtsiou Z, Kiessling C. What do we know about written assessment of health professionals' communication skills? A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:1188-1200. [PMID: 34602334 DOI: 10.1016/j.pec.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/26/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim of this scoping review was to investigate the published literature on written assessment of communication skills in health professionals' education. METHODS Pubmed, Embase, Cinahl and Psychnfo were screened for the period 1/1995-7/2020. Selection was conducted by four pairs of reviewers. Four reviewers extracted and analyzed the data regarding study, instrument, item, and psychometric characteristics. RESULTS From 20,456 assessed abstracts, 74 articles were included which described 70 different instruments. Two thirds of the studies used written assessment to measure training effects, the others focused on the development/validation of the instrument. Instruments were usually developed by the authors, often with little mention of the test development criteria. The type of knowledge assessed was rarely specified. Most instruments included clinical vignettes. Instrument properties and psychometric characteristics were seldom reported. CONCLUSION There are a number of written assessments available in the literature. However, the reporting of the development and psychometric properties of these instruments is often incomplete. Practice implications written assessment of communication skills is widely used in health professions education. Improvement in the reporting of instrument development, items and psychometrics may help communication skills teachers better identify when, how and for whom written assessment of communication should be used.
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Affiliation(s)
- Noelle Junod Perron
- Unit of Development and Research in Medical Education, Geneva Faculty of Medicine and Institute of Primary Care, Geneva University Hospitals, Geneva, Switzerland.
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Marc van Nuland
- Academic Center for General Practice, Leuven University, Leuven, Belgium
| | | | | | - Geurt Essers
- Network of GP Training Programs in the Netherlands, Utrecht, The Netherlands
| | - Ragnar Joakimsen
- Department of Clinical Medicine, Faculty of Health Sciences, UIT The Artic University of Norway and Department of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Zoi Tsimtsiou
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Claudia Kiessling
- Personal and Interpersonal Development in Health Care Education, Witten/Herdecke University, Witten, Germany
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Tan XH, Foo MA, Lim SLH, Lim MBXY, Chin AMC, Zhou J, Chiam M, Krishna LKR. Teaching and assessing communication skills in the postgraduate medical setting: a systematic scoping review. BMC MEDICAL EDUCATION 2021; 21:483. [PMID: 34503497 PMCID: PMC8431930 DOI: 10.1186/s12909-021-02892-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 08/17/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Poor communication skills can potentially compromise patient care. However, as communication skills training (CST) programs are not seen as a priority to many clinical departments, there is a discernible absence of a standardised, recommended framework for these programs to be built upon. This systematic scoping review (SSR) aims to gather prevailing data on existing CSTs to identify key factors in teaching and assessing communication skills in the postgraduate medical setting. METHODS Independent searches across seven bibliographic databases (PubMed, PsycINFO, EMBASE, ERIC, CINAHL, Scopus and Google Scholar) were carried out. Krishna's Systematic Evidence-Based Approach (SEBA) was used to guide concurrent thematic and content analysis of the data. The themes and categories identified were compared and combined where possible in keeping with this approach and then compared with the tabulated summaries of the included articles. RESULTS Twenty-five thousand eight hundred ninety-four abstracts were identified, and 151 articles were included and analysed. The Split Approach revealed similar categories and themes: curriculum design, teaching methods, curriculum content, assessment methods, integration into curriculum, and facilitators and barriers to CST. Amidst a wide variety of curricula designs, efforts to develop the requisite knowledge, skills and attitudes set out by the ACGME current teaching and assessment methods in CST maybe categorised into didactic and interactive methods and assessed along Kirkpatrick's Four Levels of Learning Evaluation. CONCLUSIONS A major flaw in existing CSTs is a lack of curriculum structure, focus and standardisation. Based upon the findings and current design principles identified in this SSR in SEBA, we forward a stepwise approach to designing CST programs. These involve 1) defining goals and learning objectives, 2) identifying target population and ideal characteristics, 3) determining curriculum structure, 4) ensuring adequate resources and mitigating barriers, 5) determining curriculum content, and 6) assessing learners and adopting quality improvement processes.
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Affiliation(s)
- Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Malia Alexandra Foo
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Shaun Li He Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Marie Bernadette Xin Yi Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Block MD 6, 14 Medical Drive, #05-01, Singapore, 117599, Singapore
| | - Jamie Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Lien Centre of Palliative Care, Duke-NUS Graduate Medical School, 8College Road, Singapore, 169857, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Centre of Biomedical Ethics, National University of Singapore, Block MD 11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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Møller JE, Kjaer LB, Helledie E, Nielsen LF, Malling BV. Transfer of communication teaching skills from university to the clinical workplace - does it happen? A mixed methods study. BMC MEDICAL EDUCATION 2021; 21:433. [PMID: 34404388 PMCID: PMC8369612 DOI: 10.1186/s12909-021-02834-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/15/2021] [Indexed: 05/30/2023]
Abstract
BACKGROUND Communication skills learned in the classroom do not transfer easily into clinical practice because they are not reinforced by teachers in the workplace setting and because lack of faculty training restricts the transfer of communication skills in real patient encounters. Trained university-based communication skills teachers often work simultaneously as doctors in clinics. This study explored if and how the skills of these teachers play a role in communication skills training in the clinical workplace. METHODS We used an exploratory sequential design: a mixed method approach that combined a survey with communication skills teachers, and qualitative individual interviews with these teachers and their educational leaders in clinical departments. The questionnaire was analysed using descriptive statistics. The interviews were analysed using content analysis. RESULTS The response rate was 34 %. A majority (93 %) used their communication skills when communicating with patients and relatives. Less than half taught communication in clinical departments. Approximately half of the respondents stated that encouragement from their leaders or colleagues would inspire them to use their teaching skills in the workplace. However, only 20 % had told their leaders about their competencies in teaching communication. One third thought that they needed further teacher training to teach in the clinical workplace. Qualitative analysis showed that teaching opportunities existed but mainly consisted of random, one-off sessions that came about through the initiative of the communication skills teachers themselves. The teachers described several barriers, such as the challenge of teaching colleagues, as communication relates to identity and hierarchical structures, as well as a lack of requests from colleagues or management, and department culture prioritizing topics relating to medical expertise. None of the educational leaders made use of the teachers' specific communication skills in a structured way: some saw it as unimportant, while others saw it as a potential resource. CONCLUSION Transfer of the teaching skills of communication skills teachers trained for university-based clinical communication training happened, but to a limited degree. Although both opportunities and barriers for transferring communication skills existed, barriers seemed to dominate, and opportunities for communication skills training in the workplace setting were not used to their full potential.
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Affiliation(s)
- Jane Ege Møller
- Department of Clinical Medicine, Aarhus University, INCUBA Skejby, Palle Juul- Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Louise Binow Kjaer
- Centre for Health Sciences Education, Aarhus University, INCUBA Skejby, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Emma Helledie
- Palliative Care Unit, Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Lone Folmer Nielsen
- Department of Clinical Medicine, Aarhus University, INCUBA Skejby, Palle Juul- Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Bente Vigh Malling
- Department of Clinical Medicine, Aarhus University, INCUBA Skejby, Palle Juul- Jensens Boulevard 82, 8200 Aarhus N, Denmark
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A qualitative exploration of clinicians' strategies to communicate risks to patients in the complex reality of clinical practice. PLoS One 2020; 15:e0236751. [PMID: 32790675 PMCID: PMC7425874 DOI: 10.1371/journal.pone.0236751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Risk communication, situated in the model of shared decision making (SDM), is an essential element in daily clinical practice. The scientific literature makes a number of generic recommendations. Yet the application of risk communication remains a challenge in patient-clinician encounters. How clinicians actually communicate risk during consultations is not well understood. We aimed to explore the risk communication strategies used by clinicians and extract narratives and visualizations of those strategies to help inform medical education. METHODS In this qualitative descriptive study, we interviewed fifteen purposely sampled clinicians from several medical disciplines, who were familiar with the concept of SDM. Deductive and inductive content analysis was used during an iterative data collection and analyses process. RESULTS Our study identified various strategies reported to be used by clinicians to address the complexities of risk communication such as dealing with uncertainty. These included verbal, numerical and visual risk communication and framing. Clinicians were familiar with recommended risk formats such as natural frequencies and population pictograms. However, it became clear that clinicians' expertise and communication goals also play an important role in the risk talk. Clinicians try to lay a foundation for balanced decision-making and to incorporate patient preferences while faced with several challenges such as the dilemma of raising awareness but triggering anxiety or fan fear in patients. Consequently, they also use communication goals such as influencing mindset and reassuring patients. Additionally, clinicians frequently have to account for the illusion of certainty in the risk talk. CONCLUSION Risk communication is a multi-faceted construct that cannot be dealt with in isolation from the clinical context. For future research we recommend considering a more practical framework within the clinical setting and to take a goal-directed approach into account when investigating and teaching the topic. The patient perspective should also be addressed in further research.
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Cox A, Li S. The medical consultation through the lenses of language and social interaction theory. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:241-257. [PMID: 30715620 PMCID: PMC7018671 DOI: 10.1007/s10459-018-09873-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 12/26/2018] [Indexed: 05/20/2023]
Abstract
The well-structured medical communication models that are typically described in textbooks are relevant to practice, but the actual messy interactional realities of consultations are often a far cry away from them. As a result, medical trainees frequently encounter difficulties when applying communication skills acquired during training to medical practice. This paper reflects on how clinical communication research and courses can incorporate the growing need for context-bound communication skills training. This paper illustrates how concepts from the research field of language and social interaction can facilitate the description and analysis of communication in clinical encounters, drawing on a real-life example from an increasingly common clinical scenario: a consultation in the emergency department involving a patient who does not speak the same language as the clinician. The proposed way of looking at clinical communication can enrich clinical skills training as it provides a tool to study, analyze, visualize and discuss communication from a different perspective that simultaneously accounts for interactional and clinical reasoning aspects of medical consultations.
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Affiliation(s)
- Antoon Cox
- Research Group Interpreting Studies, Faculty of Arts, KU Leuven, Louvain, Belgium
- Brussels Institute of Applied Linguistics and Linguistics and Literary Studies, Faculty of Arts and Philosophy, Vrije Universiteit Brussel, Brussels, Belgium
- Centre for Medical Education, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Shuangyu Li
- Centre for Medical Education, Faculty of Life Sciences and Medicine, King’s College London, London, UK
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Giroldi E, Timmerman A, Veldhuijzen W, Muris J, van der Vleuten C, van der Weijden T. How doctors recognise that their patients are worried: A qualitative study of patient cues. PATIENT EDUCATION AND COUNSELING 2020; 103:220-225. [PMID: 31585821 DOI: 10.1016/j.pec.2019.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/28/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Recognising patient cues indicating worry is essential for successful reassurance. To obtain more insight into the variety and nature of patient cues that may arise in practice, this study explores doctors' reflections on patient cues they recognise during consultations. METHODS We performed a qualitative study during which GPs participated in stimulated recall interviews, using their own video-recorded consultations to enhance reflection. First, we reanalysed an existing dataset of 15 interviews during which GPs elaborated on the doctor-patient interaction. Additionally, 12 GPs were interviewed specifically about recognising patients' cues. RESULTS GPs described four categories of patient cues that indicate worry. GPs recognised worry based on non-verbal cues such as visible bodily reactions, and verbal cues that can be further categorised by type of worry (e.g. about serious disease). Moreover, GPs described behavioural cues, e.g. the patient bringing a list of symptoms. Lastly, GPs recognise worry based on prior knowledge about the patient. CONCLUSIONS GPs reflections have given insight into a wide variety of non-verbal -, verbal -, behavioural- and foreknowledge-based cues. PRACTICE IMPLICATIONS The identified cues can guide other clinicians in recognising worries and inform medical communication training and future research on the effectiveness of recognising cues and patient reassurance.
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Affiliation(s)
- Esther Giroldi
- Department of Family Medicine, Care and Public Health Research Institute CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands.
| | - Angelique Timmerman
- Department of Family Medicine, Care and Public Health Research Institute CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Wemke Veldhuijzen
- Department of Family Medicine, Care and Public Health Research Institute CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands.
| | - Jean Muris
- Department of Family Medicine, Care and Public Health Research Institute CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Cees van der Vleuten
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands.
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute CAPHRI), Maastricht University, Maastricht, the Netherlands.
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van der Vleuten C, van den Eertwegh V, Giroldi E. Assessment of communication skills. PATIENT EDUCATION AND COUNSELING 2019; 102:2110-2113. [PMID: 31351785 DOI: 10.1016/j.pec.2019.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/06/2019] [Indexed: 05/26/2023]
Abstract
OBJECTIVE This paper addresses how communication skills can best be assessed. Since assessment and learning are strongly connected, the way communication skills are best learned is also described. RESULTS Communication skills are best learned in a longitudinal fashion with ample practice in an authentic setting. Confrontation of behavior initiates the learning process and should be supported by meaningful feedback through direct observation. When done appropriately a set of (learned) communication skills become integrated skilled communication, being versatilely used in purposeful goal-oriented clinical communication. The assessment of communication skills should follow a modern approach to assessment where the learning function of assessment is considered a priority. Individual assessments are feedback-oriented to promote further learning and development. The resulting rich information may be used to make progression decisions, usually in a group or committee decision. CONCLUSION This modern programmatic approach to assessment fits the learning of skilled communication well. PRACTICE IMPLICATIONS Implementation of a programmatic assessment approach to communication will entail a major innovation to education.
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Affiliation(s)
- Cees van der Vleuten
- Maastricht University, Department of Educational Development and Research, School of Health Professions Education(SHE), Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands.
| | - Valerie van den Eertwegh
- Maastricht University, Skillslab, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands
| | - Esther Giroldi
- Maastricht University, Department of Educational Development and Research, School of Health Professions Education(SHE), Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands; Maastricht University, Department of Family Medicine, Care and Public, Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands
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Salmon P, Young B. Qualitative methods can test and challenge what we think we know about clinical communication - if they are not too constrained by methodological 'brands'. PATIENT EDUCATION AND COUNSELING 2018; 101:1515-1517. [PMID: 30037663 DOI: 10.1016/j.pec.2018.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
| | - Bridget Young
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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Bangalore Sathyananda R, de Rijk A, Manjunath U, Krumeich A, van Schayck CP. Primary health Centres' performance assessment measures in developing countries: review of the empirical literature. BMC Health Serv Res 2018; 18:627. [PMID: 30092842 PMCID: PMC6085632 DOI: 10.1186/s12913-018-3423-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 07/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background It is universally accepted that primary healthcare is essential for achieving public health and that assessment of its performance is critical for continuous improvement. The World Health Organization’s (WHO’s) framework for performance assessment is a comprehensive global standard, but difficult to apply in developing countries because of financial and data constraints. This study aims to review the empirical literature on measures for Primary Health Centre (PHC) performance assessment in developing countries, and compare them for comprehensiveness with the aspects described by the WHO Framework. Methods Research articles published in English scientific journals between January 1979 and October 2016 were reviewed systematically. The reporting quality of the article and the quality of the measures were assessed with instruments adapted for the purpose of this study. Data was categorized and described. Results Fifteen articles were included in the study out of 4359 articles reviewed. Nine articles used quantitative methods, one article used qualitative methods exclusively and five used mixed methods. Fourteen articles had a good description of the measurement properties. None of the articles presented validity tests of the measures but eleven articles presented measures that were well established. Mostly studies included components of personnel competencies (skilled/ non-skilled) and centre performance (patient satisfaction/cost /efficiency). Conclusions In comparison to the WHO framework, the measures in the articles were limited in scope as they did not represent all service components of PHCs. Hence, PHC performance assessment should include system components along with relevant measures of personnel performance beyond knowledge of protocols. Existing measures for PHC performance assessment in developing countries need to be validated and concise measures for neglected aspects need to be developed. Electronic supplementary material The online version of this article (10.1186/s12913-018-3423-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Bangalore Sathyananda
- Department of Primary Care, CAPHRI, Maastricht University, Maastricht, The Netherlands. .,, Present address: No 18, 3rd Main, 1stCross, Navodaya Layout, Shakambari Nagar, Sarakki, J P Nagar 1st Phase, Bengaluru, Karnataka, 560070, India.
| | - A de Rijk
- Department of Social Medicine, research institute CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - U Manjunath
- Institute of Health Management Research, Bangalore, India
| | - A Krumeich
- Department of Health Ethics and Society, research institute CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - C P van Schayck
- Department of Primary Care, CAPHRI, Maastricht University, Maastricht, The Netherlands
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Giroldi E, Veldhuijzen W, Geelen K, Muris J, Bareman F, Bueving H, van der Weijden T, van der Vleuten C. Developing skilled doctor-patient communication in the workplace: a qualitative study of the experiences of trainees and clinical supervisors. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:1263-1278. [PMID: 28220333 PMCID: PMC5663797 DOI: 10.1007/s10459-017-9765-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 02/14/2017] [Indexed: 05/16/2023]
Abstract
To inform the development of recommendations to facilitate learning of skilled doctor-patient communication in the workplace, this qualitative study explores experiences of trainees and supervisors regarding how trainees learn communication and how supervisors support trainees' learning in the workplace. We conducted a qualitative study in a general practice training setting, triangulating various sources of data to obtain a rich understanding of trainees and supervisors' experiences: three focus group discussions, five discussions during training sessions and five individual interviews. Thematic network analysis was performed during an iterative process of data collection and analysis. We identified a communication learning cycle consisting of six phases: impactful experience, change in frame of reference, identification of communication strategies, experimentation with strategies, evaluation of strategies and incorporation into personal repertoire. Supervisors supported trainees throughout this process by creating challenges, confronting trainees with their behaviour and helping them reflect on its underlying mechanisms, exploring and demonstrating communication strategies, giving concrete practice assignments, creating safety, exploring the effect of strategies and facilitating repeated practice and reflection. Based on the experiences of trainees and supervisors, we conclude that skilled communication involves the development of a personal communication repertoire from which learners are able to apply strategies that fit the context and their personal style. After further validation of our findings, it may be recommended to give learners concrete examples, opportunities for repeated practise and reflection on personal frames of reference and the effect of strategies, as well as space for authenticity and flexibility. In the workplace, the clinical supervisor is able to facilitate all these essential conditions to support his/her trainee in becoming a skilled communicator.
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Affiliation(s)
- Esther Giroldi
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - Wemke Veldhuijzen
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Kristel Geelen
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jean Muris
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Frits Bareman
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Herman Bueving
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Cees van der Vleuten
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
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Salmon P, Young B. A new paradigm for clinical communication: critical review of literature in cancer care. MEDICAL EDUCATION 2017; 51:258-268. [PMID: 27995660 PMCID: PMC5324633 DOI: 10.1111/medu.13204] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/18/2016] [Accepted: 08/15/2016] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To: (i) identify key assumptions of the scientific 'paradigm' that shapes clinical communication research and education in cancer care; (ii) show that, as general rules, these do not match patients' own priorities for communication; and (iii) suggest how the paradigm might change to reflect evidence better and thereby serve patients better. METHODS A critical review, focusing on cancer care. We identified assumptions about patients' and clinicians' roles in recent position and policy statements. We examined these in light of research evidence, focusing on inductive research that has not itself been constrained by those assumptions, and considering the institutionalised interests that the assumptions might serve. RESULTS The current paradigm constructs patients simultaneously as needy (requiring clinicians' explicit emotional support) and robust (seeking information and autonomy in decision making). Evidence indicates, however, that patients generally value clinicians who emphasise expert clinical care rather than counselling, and who lead decision making. In denoting communication as a technical skill, the paradigm constructs clinicians as technicians; however, communication cannot be reduced to technical skills, and teaching clinicians 'communication skills' has not clearly benefited patients. The current paradigm is therefore defined by assumptions that that have not arisen from evidence. A paradigm for clinical communication that makes its starting point the roles that mortal illness gives patients and clinicians would emphasise patients' vulnerability and clinicians' goal-directed expertise. Attachment theory provides a knowledge base to inform both research and education. CONCLUSIONS Researchers will need to be alert to political interests that seek to mould patients into 'consumers', and to professional interests that seek to add explicit psychological dimensions to clinicians' roles. New approaches to education will be needed to support clinicians' curiosity and goal-directed judgement in applying this knowledge. The test for the new paradigm will be whether the research and education it promotes benefit patients.
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Affiliation(s)
- Peter Salmon
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolUK
| | - Bridget Young
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolUK
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Oerlemans M, Dielissen P, Timmerman A, Ram P, Maiburg B, Muris J, van der Vleuten C. Should we assess clinical performance in single patient encounters or consistent behaviors of clinical performance over a series of encounters? A qualitative exploration of narrative trainee profiles. MEDICAL TEACHER 2017; 39:300-307. [PMID: 28049379 DOI: 10.1080/0142159x.2017.1270427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND A variety of tools have been developed to assess performance which typically use a single clinical encounter as a source for making competency inferences. This strategy may miss consistent behaviors. We therefore explored experienced clinical supervisors' perceptions of behavioral patterns that potentially exist in postgraduate general practice trainees expressed as narrative profiles to aid the grading of clinical performance. METHODS We conducted semistructured interviews with clinical supervisors who had frequently observed clinical performance in trainees. Supervisors were asked to describe which behavioral patterns they had discerned in excellent and underperforming trainees, during different stages of training, in their careers as clinical supervisor. We analyzed the interviews using a grounded theory approach. RESULTS The analysis resulted in a conceptual framework that distinguishes between desirable and undesirable narrative profiles. The framework consists of two dimensions: doctor-patient interaction and medical expertise. Personal values appear to be a moderating factor. CONCLUSIONS According to experienced clinical supervisors, consistent behaviors do exist in GP trainees when observing clinical performance over time. The conceptual framework has to be validated by further observational studies to assess its potential for making robust and fair assessments of clinical performance and monitor the development of consultation performance over time.
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Affiliation(s)
- Marjolein Oerlemans
- a Department of Family Medicine , Maastricht University , Maastricht , the Netherlands
| | - Patrick Dielissen
- b Department of Primary and Community Care , Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Angelique Timmerman
- a Department of Family Medicine , Maastricht University , Maastricht , the Netherlands
| | - Paul Ram
- a Department of Family Medicine , Maastricht University , Maastricht , the Netherlands
| | - Bas Maiburg
- a Department of Family Medicine , Maastricht University , Maastricht , the Netherlands
| | - Jean Muris
- a Department of Family Medicine , Maastricht University , Maastricht , the Netherlands
| | - Cees van der Vleuten
- c School of Health Professions Education , Maastricht University , the Netherlands
- d School of Medicine, Flinders University , Adelaide , Australia
- e University of the Witwatersrand , Johannesburg , South Africa
- f Curtin University , Perth , Australia
- g Northumbria University , Newcastle upon Tyne , UK
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Paternotte E, Scheele F, Seeleman CM, Bank L, Scherpbier AJJA, van Dulmen S. Intercultural doctor-patient communication in daily outpatient care: relevant communication skills. PERSPECTIVES ON MEDICAL EDUCATION 2016; 5:268-275. [PMID: 27638395 PMCID: PMC5035277 DOI: 10.1007/s40037-016-0288-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Intercultural communication (ICC) between doctors and patients is often associated with misunderstandings and dissatisfaction. To develop ICC-specific medical education, it is important to find out which ICC skills medical specialists currently apply in daily clinical consultations. METHODS Doctor-patient consultations of Dutch doctors with non-Dutch patients were videotaped in a multi-ethnic hospital in the Netherlands. The consultations were analyzed using the validated MAAS-Global assessment list in combination with factors influencing ICC, as described in the literature. RESULTS In total, 39 videotaped consultations were analyzed. The doctors proved to be capable of practising many communication skills, such as listening and empathic communication behaviour. Other skills were not practised, such as being culturally aware and checking the patient's language ability. CONCLUSION We showed that doctors did practice some but not all the relevant ICC skills and that the ICC style of the doctors was mainly biomedically centred. Furthermore, we discussed the possible overlap between intercultural and patient-centred communication. Implications for practice could be to implement the relevant ICC skills in the existing communication training or develop a communication training with a patient-centred approach including ICC skills.
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Affiliation(s)
- Emma Paternotte
- Department of Healthcare Education, OLVG Hospital, Amsterdam, The Netherlands.
| | - Fedde Scheele
- Department of Healthcare Education, OLVG Hospital, Amsterdam, The Netherlands
- Medical School of Sciences, Vu University Medical Centre, Amsterdam, The Netherlands
| | - Conny M Seeleman
- Department of Social Medicine, University Medical Centre, Utrecht, The Netherlands
| | - Lindsay Bank
- Department of Healthcare Education, OLVG Hospital, Amsterdam, The Netherlands
| | - Albert J J A Scherpbier
- Institute for Medical Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for health services research), Utrecht, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Centre, NIjmegen, The Netherlands
- Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
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Gauthier G, St-Onge C, Tavares W. Rater cognition: review and integration of research findings. MEDICAL EDUCATION 2016; 50:511-22. [PMID: 27072440 DOI: 10.1111/medu.12973] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 07/20/2015] [Accepted: 11/13/2015] [Indexed: 05/21/2023]
Abstract
BACKGROUND Given the complexity of competency frameworks, associated skills and abilities, and contexts in which they are to be assessed in competency-based education (CBE), there is an increased reliance on rater judgements when considering trainee performance. This increased dependence on rater-based assessment has led to the emergence of rater cognition as a field of research in health professions education. The topic, however, is often conceptualised and ultimately investigated using many different perspectives and theoretical frameworks. Critically analysing how researchers think about, study and discuss rater cognition or the judgement processes in assessment frameworks may provide meaningful and efficient directions in how the field continues to explore the topic. METHODS We conducted a critical and integrative review of the literature to explore common conceptualisations and unified terminology associated with rater cognition research. We identified 1045 articles on rater-based assessment in health professions education using Scorpus, Medline and ERIC and 78 articles were included in our review. RESULTS We propose a three-phase framework of observation, processing and integration. We situate nine specific mechanisms and sub-mechanisms described across the literature within these phases: (i) generating automatic impressions about the person; (ii) formulating high-level inferences; (iii) focusing on different dimensions of competencies; (iv) categorising through well-developed schemata based on (a) personal concept of competence, (b) comparison with various exemplars and (c) task and context specificity; (v) weighting and synthesising information differently, (vi) producing narrative judgements; and (vii) translating narrative judgements into scales. CONCLUSION Our review has allowed us to identify common underlying conceptualisations of observed rater mechanisms and subsequently propose a comprehensive, although complex, framework for the dynamic and contextual nature of the rating process. This framework could help bridge the gap between researchers adopting different perspectives when studying rater cognition and enable the interpretation of contradictory findings of raters' performance by determining which mechanism is enabled or disabled in any given context.
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Affiliation(s)
| | - Christina St-Onge
- Medecine interne, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Walter Tavares
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
- Centennial College, School of Community and Health Studies, Toronto, Ontario, Canada
- ORNGE Transport Medicine, Faculty of Medicine, Mississauga, Ontario, Canada
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Giroldi E, Veldhuijzen W, Dijkman A, Rozestraten M, Muris J, van der Vleuten C, van der Weijden T. How to gather information from talkative patients in a respectful and efficient manner: a qualitative study of GPs' communication strategies. Fam Pract 2016; 33:100-6. [PMID: 26601673 DOI: 10.1093/fampra/cmv094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Gathering information from talkative patients presents a challenge to clinicians. Empirical evidence on how to effectively deal with this challenge is scant. OBJECTIVE This study explores communication strategies and their underlying mechanisms that GPs consider effective when gathering information from talkative patients in order to inform the development of best practices. METHODS We conducted a qualitative study with experienced GPs. We held individual stimulated-recall interviews (SRIs) with six GPs using their videotaped consultations as a stimulus. The transcripts that ensued were triangulated with data from three focus-group discussions (FGs). We performed a thematic network analysis during an iterative process of data collection and analysis. RESULTS To deal with talkative patients during consultations, GPs first try to pinpoint the cause of patients' talkativeness before deciding on the approach to take. Moreover, they resort to the familiar communication strategies, however, in doing so adopt take a more directive attitude. To prevent such attitude from damaging the relationship, GPs take a stepped approach in which they try not to be overly directive, make the patient co-responsible for efficient time management and make use of empathic interrupting. CONCLUSIONS In the absence of evidence, this description of GPs' communication strategies can guide clinicians, residents and students in gathering information from talkative patients in an efficient, yet empathic and respectful manner. When developing best practices, heed should be paid to the causes of patients' talkativeness and the tension between taking a directive approach and building a doctor-patient relationship.
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Affiliation(s)
- Esther Giroldi
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI) and Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
| | - Wemke Veldhuijzen
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI) and Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Annika Dijkman
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI) and
| | - Maxime Rozestraten
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI) and
| | - Jean Muris
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI) and
| | - Cees van der Vleuten
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI) and
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Wouda JC, van de Wiel HBM. Supervisors' and residents' patient-education competency in challenging outpatient consultations. PATIENT EDUCATION AND COUNSELING 2015; 98:1084-1091. [PMID: 26074498 DOI: 10.1016/j.pec.2015.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/07/2015] [Accepted: 05/11/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES We compared supervisors' and residents' patient-education competency in challenging consultations in order to establish whether supervisors demonstrate sufficient patient-education competency to act credibly as role models and coaches for residents. METHODS All consultations conducted at one, two, or three of the outpatient clinics of each of the participating physicians were videoed. Each participant selected two challenging consultations from each clinic for assessment. We assessed their patient-education competency using the CELI instrument, we calculated net consultation length for all videoed consultations and we measured patient opinion about the patient education received using a questionnaire. RESULTS Forty-four residents and fourteen supervisors participated in the study. They selected 230 consultations for assessment. On average, supervisors and residents demonstrated similar patient-education competency. Net consultation length was longer for supervisors. Patient opinion did not differ between supervisors and residents. CONCLUSIONS Supervising consultants generally do not possess sufficient patient-education competency to fulfill their teaching roles in workplace-based learning that is aimed at improving residents' patient-education competency. PRACTICE IMPLICATIONS Not only residents but also supervising consultants should improve their patient-education competency. Workplace-based learning consisting of self-assessment of and feedback on videoed consultations could be useful in attaining this goal.
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Affiliation(s)
- Jan C Wouda
- University of Groningen, University Medical Center Groningen, The Netherlands.
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Giroldi E, Veldhuijzen W, de Leve T, van der Weijden T, Bueving H, van der Vleuten C. 'I still have no idea why this patient was here': An exploration of the difficulties GP trainees experience when gathering information. PATIENT EDUCATION AND COUNSELING 2015; 98:837-42. [PMID: 25858631 DOI: 10.1016/j.pec.2015.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 03/09/2015] [Accepted: 03/21/2015] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Collecting information during patient encounters is essential for the delivery of patient-centered care. To obtain insight into areas that require more attention in medical communication training, this study explores what difficulties GP trainees encounter when gathering information. METHODS In this phenomenological study, we observed a morning clinic of 15 GP trainees. To explore trainees' experiences with information-gathering, we held brief interviews after every consultation and a lengthier interview directly after the morning clinic. The resulting data were analyzed using template analysis. RESULTS From trainees' reflections, we distilled five difficulties that trainees experience when gathering information: (1) Goal conflicts; (2) Ineffectiveness of trained communication skills in specific situations; (3) Trainees' distress hampers open communication; (4) Untrustworthy information; (5) Tunnel vision. CONCLUSION Information-gathering is difficult for GP trainees. Current generic communication skills training does not seem to support trainees sufficiently to handle effectively the challenges they encounter during consultations. PRACTICE IMPLICATIONS Medical communication training needs to support trainees in handling their goal-conflicts and feelings that hamper information-gathering, while also providing them with communication strategies adapted to handling specific challenging situations.
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Affiliation(s)
- Esther Giroldi
- Department of Family Medicine, Maastricht University, School for Public Health and Primary Care (CAPHRI), Maastricht, The Netherlands; Department of Educational Development and Research, Maastricht University, School of Health Professions Education (SHE), Maastricht, The Netherlands.
| | - Wemke Veldhuijzen
- Department of Family Medicine, Maastricht University, School for Public Health and Primary Care (CAPHRI), Maastricht, The Netherlands; Department of Educational Development and Research, Maastricht University, School of Health Professions Education (SHE), Maastricht, The Netherlands.
| | - Tijme de Leve
- Department of Family Medicine, Maastricht University, School for Public Health and Primary Care (CAPHRI), Maastricht, The Netherlands.
| | - Trudy van der Weijden
- Department of Family Medicine, Maastricht University, School for Public Health and Primary Care (CAPHRI), Maastricht, The Netherlands.
| | - Herman Bueving
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - Cees van der Vleuten
- Department of Educational Development and Research, Maastricht University, School of Health Professions Education (SHE), Maastricht, The Netherlands.
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van den Eertwegh V, van der Vleuten C, Stalmeijer R, van Dalen J, Scherpbier A, van Dulmen S. Exploring residents' communication learning process in the workplace: a five-phase model. PLoS One 2015; 10:e0125958. [PMID: 26000767 PMCID: PMC4441458 DOI: 10.1371/journal.pone.0125958] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/27/2015] [Indexed: 11/18/2022] Open
Abstract
Context Competency-based education is a resurgent paradigm in professional medical education. However, more specific knowledge is needed about the learning process of such competencies, since they consist of complex skills. We chose to focus on the competency of skilled communication and want to further explore its learning process, since it is regarded as a main competency in medical education. Objective This study aims to explore in more detail the learning process that residents in general practice go through during workplace-based learning in order to become skilled communicators. Methods A qualitative study was conducted in which twelve GP residents were observed during their regular consultations, and were interviewed in-depth afterwards. Results Analysis of the data resulted in the construction of five phases and two overall conditions to describe the development towards becoming a skilled communicator: Confrontation with (un)desired behaviour or clinical outcomes was the first phase. Becoming conscious of one’s own behaviour and changing the underlying frame of reference formed the second phase. The third phase consisted of the search for alternative behaviour. In the fourth phase, personalization of the alternative behaviour had to occur, this was perceived as difficult and required much time. Finally, the fifth phase concerned full internalization of the new behaviour, which by then had become an integrated part of the residents’ clinical repertoire. Safety and cognitive & emotional space were labelled as overall conditions influencing this learning process. Conclusions Knowledge and awareness of these five phases can be used to adjust medical working and learning environments in such a way that development of skilled medical communication can come to full fruition and its benefits are more fully reaped.
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Affiliation(s)
| | - Cees van der Vleuten
- Department of Educational Development and Research, Maastricht University, Maastricht, the Netherlands
| | - Renée Stalmeijer
- Department of Educational Development and Research, Maastricht University, Maastricht, the Netherlands
| | - Jan van Dalen
- Skillslab, Maastricht University, Maastricht, the Netherlands
| | - Albert Scherpbier
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands institute for health services research), Utrecht, the Netherlands
- Radboud University Medical Centre, Nijmegen, the Netherlands
- Buskerud and Vestfold University College, Drammen, Norway
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Essers G, Dielissen P, van Weel C, van der Vleuten C, van Dulmen S, Kramer A. How do trained raters take context factors into account when assessing GP trainee communication performance? An exploratory, qualitative study. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2015; 20:131-147. [PMID: 24858236 DOI: 10.1007/s10459-014-9511-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 05/05/2014] [Indexed: 06/03/2023]
Abstract
Communication assessment in real-life consultations is a complex task. Generic assessment instruments help but may also have disadvantages. The generic nature of the skills being assessed does not provide indications for context-specific behaviour required in practice situations; context influences are mostly taken into account implicitly. Our research questions are: 1. What factors do trained raters observe when rating workplace communication? 2. How do they take context factors into account when rating communication performance with a generic rating instrument? Nineteen general practitioners (GPs), trained in communication assessment with a generic rating instrument (the MAAS-Global), participated in a think-aloud protocol reflecting concurrent thought processes while assessing videotaped real-life consultations. They were subsequently interviewed to answer questions explicitly asking them to comment on the influence of predefined contextual factors on the assessment process. Results from both data sources were analysed. We used a grounded theory approach to untangle the influence of context factors on GP communication and on communication assessment. Both from the think-aloud procedure and from the interviews we identified various context factors influencing communication, which were categorised into doctor-related (17), patient-related (13), consultation-related (18), and education-related factors (18). Participants had different views and practices on how to incorporate context factors into the GP(-trainee) communication assessment. Raters acknowledge that context factors may affect communication in GP consultations, but struggle with how to take contextual influences into account when assessing communication performance in an educational context. To assess practice situations, raters need extra guidance on how to handle specific contextual factors.
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Affiliation(s)
- Geurt Essers
- Department of Public Health and Primary Care, Leiden University Medical Centre, Hippocratespad 21, 2333 ZP, Leiden, The Netherlands,
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van Loon KA, Driessen EW, Teunissen PW, Scheele F. Experiences with EPAs, potential benefits and pitfalls. MEDICAL TEACHER 2014; 36:698-702. [PMID: 24804911 DOI: 10.3109/0142159x.2014.909588] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Reforms in postgraduate medical education (PGME) exposed a gap between educational theory and clinical practice. Entrustable Professional Activities (EPAs) were introduced to assist clinicians in bridging this gap and to create better consonance between the intended and the enacted curriculum. In this viewpoint paper, we discuss the potential and the pitfalls of using EPAs in PGME. EPAs promise an effective way of teaching abstract competencies in a curriculum based on real-life professional activities that are suitable for clinical assessment. Summative judgement is used to entrust a resident step by step in a certain EPA, resulting in an increase of independent practice. However, we argue that the success of EPAs depends on (1) a balance: brief focussed descriptions against the requirements for detail and (2) a precondition: a mature and flexible workplace for learning.
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Giroldi E, Veldhuijzen W, Leijten C, Welter D, van der Weijden T, Muris J, van der Vleuten C. 'No need to worry': an exploration of general practitioners' reassuring strategies. BMC FAMILY PRACTICE 2014; 15:133. [PMID: 25001991 PMCID: PMC4118274 DOI: 10.1186/1471-2296-15-133] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/30/2014] [Indexed: 11/10/2022]
Abstract
Background In view of the paucity of evidence regarding effective ways of reassuring worried patients, this study explored reassuring strategies that are considered useful by general practitioners (GPs). Methods In a study using a qualitative observational design, we re-analysed an existing dataset of fifteen stimulated recall interviews in which GPs elaborated on their communication with patients in two videotaped consultations. Additionally we held stimulated recall interviews with twelve GPs about two consultations selected for a strong focus on reassurance. Results To reassure patients, GPs pursued multiple goals: 1. influencing patients’ emotions by promoting trust, safety and comfort, which is considered to be reassuring in itself and supportive of patients’ acceptance of reassuring information and 2. influencing patients’ cognitions by challenging patients’ belief that their symptoms are indicative of serious disease, often followed by promoting patients’ belief that their symptoms are benign. GPs described several actions to activate mechanisms to achieve these goals. Conclusions GPs described a wealth of reassuring strategies, which make a valuable contribution to the current literature on doctor-patient communication. This detailed description may provide practicing GPs with new tools and can inform future studies exploring the effectiveness of reassurance strategies.
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Affiliation(s)
- Esther Giroldi
- Department of Family Medicine, Maastricht University, School of Public Health and Primary Care (CAPHRI), P,O, Box 616, Maastricht, The Netherlands.
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Essers G, van Dulmen S, van Es J, van Weel C, van der Vleuten C, Kramer A. Context factors in consultations of general practitioner trainees and their impact on communication assessment in the authentic setting. PATIENT EDUCATION AND COUNSELING 2013; 93:567-72. [PMID: 24041713 DOI: 10.1016/j.pec.2013.08.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 08/12/2013] [Accepted: 08/25/2013] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Acquiring adequate communication skills is an essential part of general practice (GP) specialty training. In assessing trainee proficiency, the context in which trainees communicate is usually not taken into account. The present paper aims to explore what context factors can be found in regular GP trainee consultations and how these influence their communication performance. METHODS In a randomly selected sample of 44 videotaped, real-life GP trainee consultations, we searched for context factors previously identified in GP consultations and explored how trainee ratings change if context factors are taken into account. Trainee performance was rated twice using the MAAS-Global, first without and then with incorporating context factors. Item score differences were calculated using a paired samples t-test and effect sizes were computed. RESULTS All previously identified context factors were again observed in GP trainee consultations. In communication assessment scores, we found a significant difference in 5 out of 13 MAAS-Global items, mostly in a positive direction. The effect size was moderate (0.57). CONCLUSIONS GP trainee communication is influenced by contextual factors; they seem to adapt to context in a professional way. PRACTICE IMPLICATIONS GP specialty training needs to focus on a context-specific application of communication skills. Communication raters need to be taught how to incorporate context factors into their assessments.
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Affiliation(s)
- Geurt Essers
- Department of Primary & Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Essers G, Kramer A, Andriesse B, van Weel C, van der Vleuten C, van Dulmen S. Context factors in general practitioner-patient encounters and their impact on assessing communication skills--an exploratory study. BMC FAMILY PRACTICE 2013; 14:65. [PMID: 23697479 PMCID: PMC3688246 DOI: 10.1186/1471-2296-14-65] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 05/15/2013] [Indexed: 01/26/2023]
Abstract
Background Assessment of medical communication performance usually focuses on rating generically applicable, well-defined communication skills. However, in daily practice, communication is determined by (specific) context factors, such as acquaintance with the patient, or the presented problem. Merely valuing the presence of generic skills may not do justice to the doctor’s proficiency. Our aim was to perform an exploratory study on how assessment of general practitioner (GP) communication performance changes if context factors are explicitly taken into account. Methods We used a mixed method design to explore how ratings would change. A random sample of 40 everyday GP consultations was used to see if previously identified context factors could be observed again. The sample was rated twice using a widely used assessment instrument (the MAAS-Global), first in the standard way and secondly after context factors were explicitly taken into account, by using a context-specific rating protocol to assess communication performance in the workplace. In between first and second rating, the presence of context factors was established. Item score differences were calculated using paired sample t-tests. Results In 38 out of 40 consultations, context factors prompted application of the context-specific rating protocol. Mean overall score on the 7-point MAAS-Global scale increased from 2.98 in standard to 3.66 in the context-specific rating (p < 0.00); the effect size for the total mean score was 0.84. In earlier research the minimum standard score for adequate communication was set at 3.17. Conclusions Applying the protocol, the mean overall score rose above the level set in an earlier study for the MAAS-Global scores to represent ‘adequate GP communication behaviour’. Our findings indicate that incorporating context factors in communication assessment thus makes a meaningful difference and shows that context factors should be considered as ‘signal’ instead of ‘noise’ in GP communication assessment. Explicating context factors leads to a more deliberate and transparent rating of GP communication performance.
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Affiliation(s)
- Geurt Essers
- Department of Primary & Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Veldhuijzen W, Mogendorff K, Ram P, van der Weijden T, Elwyn G, van der Vleuten C. How doctors move from generic goals to specific communicative behavior in real practice consultations. PATIENT EDUCATION AND COUNSELING 2013; 90:170-176. [PMID: 23218241 DOI: 10.1016/j.pec.2012.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 10/04/2012] [Accepted: 10/07/2012] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To understand how recommendations for communication can be brought into alignment with clinical communication routines, we explored how doctors select communicative actions during consultations. METHODS We conducted stimulated recall interviews with 15 GPs (general practitioners), asking them to comment on recordings of two consultations. The data analysis was based on the principles of grounded theory. RESULTS A model describing how doctors select communicative actions during consultations was developed. This model illustrates how GPs constantly adapt their selection of communicative actions to their evaluation of the situation. These evaluations culminate in the selection of situation-specific goals. These multiple and often dynamic goals require constant revision and adaptation of communication strategies, leading to constant readjustments of the selection of communicative actions. When selecting consultation goals GPs weigh patients' needs and preferences as well as the medical situation and its consequences. CONCLUSIONS GPs' selection of communicative actions during consultations is situational and goal driven. PRACTICE IMPLICATIONS To help doctors develop communicative competence tailored to the specific situation of each consultation, holistic communication training courses, which pay attention to the selection of consultation goals and matching communication strategies besides training specific communication skills, seem preferable to current generic communication skills training.
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Affiliation(s)
- Wemke Veldhuijzen
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
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Essers G, Van Weel-Baumgarten E, Bolhuis S. Mixed messages in learning communication skills? Students comparing role model behaviour in clerkships with formal training. MEDICAL TEACHER 2012; 34:e659-65. [PMID: 22643019 DOI: 10.3109/0142159x.2012.687483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Medical students learn professional communication through formal training and in clinical practice. Physicians working in clinical practice have a powerful influence on student learning. However, they may demonstrate communication behaviours not aligning with recommendations in training programs. AIMS This study aims to identify more precisely what differences students perceive between role model communication behaviour during clerkships and formal training. METHOD In a cross-sectional study, data were collected about physicians' communication performance as perceived by students. Students filled out a questionnaire in four different clerkships in their fourth and fifth year. RESULTS Just over half of the students reported communication similar to formal training. This was especially true for students in the later clerkships (paediatrics and primary care). Good examples were seen in providing information corresponding to patients' needs and in shared decision making, although students often noted that in fact the doctor made the decision. Bad examples were observed in exploring cognitions and emotions, and in providing information meeting patient's pace. CONCLUSIONS Further study is needed on actual physician behaviour in clinical practice. From our results, we conclude that students need help in reflecting on and learning from the gap in communication patterns they observe in training versus clinical practice.
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Affiliation(s)
- Geurt Essers
- Radboud University Nijmegen Medical Centre, Department of Primary & Community Care, Nijmegen, The Netherlands.
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