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Brewer ML, Jackson E, Bartle E. How do universities support communication skills for clinical placements with culturally and linguistically diverse students? A scoping review. Nurse Educ Pract 2024; 74:103848. [PMID: 38039712 DOI: 10.1016/j.nepr.2023.103848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/23/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023]
Abstract
AIM The aim of this scoping review was to examine and synthesise contemporary research on clinical communication interventions for tertiary students from a culturally and linguistically diverse background enrolled in a health professional qualification. BACKGROUND Clinical communication competence is essential to high quality healthcare and thus is a critical component of all health professional education. The rise in tertiary students from non-English speaking backgrounds in Australia and many other countries has escalated concern over the communication skills required for success in clinical placements and future practice as a health professional. DESIGN A scoping review was conducted using Arskey and O'Malley's methodological framework. METHODS The search targeted journal articles published in English between 2010 and 2022 in the databases Medline, CINAHL, ProQuest, Scopus, and Google Scholar. A total of 105 full texts were independently reviewed by the team of researchers, and hand-searching of the references in these studies was conducted. Eighteen articles were eligible for inclusion. RESULTS The majority of studies involved a small scale (<30 participants) intervention with nursing students in Australian universities. A small number of studies involved medical, physiotherapy and dentistry students. Most interventions were a voluntary face-to-face workshop(s) focused on experiential learning of either literacy-based skills (reading and writing) or communication skills for specific clinical procedures. Self-reported outcomes were the most commonly cited outcome measure. CONCLUSIONS While a critical appraisal was not conducted, concerns over the quality of the research were highlighted, and most interventions were not replicable due to the lack of detail provided. Further research to address the gaps in current knowledge identified in this review is warranted.
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Affiliation(s)
- Margo L Brewer
- School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australian 6845, USA.
| | - Emily Jackson
- School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australian 6845, USA
| | - Emma Bartle
- Health Professions Education, School of Allied Health, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
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Granchi N, Reid J, Foley K, Couteur AL, Edwards S, Feo R, Trochsler M, Bruening M, Maddern G. Improving surgical excellence: first experience of a video-based intervention in outpatients. ANZ J Surg 2022; 92:2868-2872. [PMID: 36052856 PMCID: PMC9825861 DOI: 10.1111/ans.18012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND There are limited opportunities for surgeons to engage in active learning programs once they achieve Fellowship, especially for non-technical skills such as communication. This study aims to address this gap by evaluating a peer-based coaching program in non-technical skill using video-recorded patient consultations from a routine outpatient clinic. METHODS Standard outpatient consultations between consultant surgeons and patients were video recorded. The surgeon viewed the videos with a peer-coach (senior surgeon) who helped identify areas of strength and areas for improvement. To test the effect of the coaching session, outpatient consultations were recorded roughly 1 month later. Pre and post-coaching videos were assessed using the Maastricht History-Taking and Advice Scoring - Global Rating List (MAAS), a common tool for evaluating non-technical skills in clinicians. RESULTS A total of 12 surgeons consented to participate. Coaching significantly improved MAAS scores (mean difference = -0.61; 95% CI (-0.88, -0.33); P < 0.0001). Surgeons were generally positive about the experience. All found the method of learning suitable, and most thought the process improved their skills. Most thought that coaching would improve patient outcomes and the majority thought they would participate in ongoing coaching as part of their employment. CONCLUSION This supports the concept of surgical coaching as an effective tool to improve communication skills and the quality of surgical consultation. The next step is to expand beyond a voluntary cohort and link surgical coaching to improved patient outcomes.
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Affiliation(s)
- Nelson Granchi
- Discipline of SurgeryThe University of Adelaide, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
| | - Jessica Reid
- Discipline of SurgeryThe University of Adelaide, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
| | - Katarina Foley
- Discipline of SurgeryThe University of Adelaide, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
| | - Amanda Le Couteur
- School of PsychologyThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment, School of Public HealthThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Rebecca Feo
- College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Markus Trochsler
- Discipline of SurgeryThe University of Adelaide, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
| | - Martin Bruening
- Discipline of SurgeryThe University of Adelaide, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
| | - Guy Maddern
- Discipline of SurgeryThe University of Adelaide, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
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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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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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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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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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Communication with patients and the duration of family medicine consultations. Aten Primaria 2017; 50:621-628. [PMID: 29054462 PMCID: PMC6837038 DOI: 10.1016/j.aprim.2017.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 06/12/2017] [Accepted: 07/18/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the distribution of consultation times, the factors that determine their length, and their relationship with a more participative, patient-centred consulting style. DESIGN Cross-sectional multicentre study. LOCATION Primary Healthcare Centres in Andalusia, Spain. PARTICIPANTS A total of 119 tutors and family medicine physician residents. PRINCIPAL MEASUREMENTS Consultation length and communication with the patient were analysed using the CICCAA scale (Connect, Identify, Understand, Consent, Help) during 436 interviews in Primary Care. RESULTS The mean duration of consultations was 8.8min (sd: 3.6). The consultation tended to be longer when the physician had a patient-centred approach (10.37±4.19min vs 7.54±2.98min; p=0.001), and when there was joint decision-making (9.79±3.96min vs 7.73±3.42min: p=0.001). In the multivariable model, longer consultations were associated with obtaining higher scores on the CICAA scale, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and a smaller number of daily visits (r2=0.32). There was no correlation between physician or patient gender, or problem type. CONCLUSION A more patient centred medical profile, increased shared decision-making, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and less professional pressure all seem to be associated with a longer consultation.
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Kiessling C, Tsimtsiou Z, Essers G, van Nuland M, Anvik T, Bujnowska-Fedak MM, Hovey R, Joakimsen R, Perron NJ, Rosenbaum M, Silverman J. General principles to consider when designing a clinical communication assessment program. PATIENT EDUCATION AND COUNSELING 2017; 100:1762-1768. [PMID: 28396057 DOI: 10.1016/j.pec.2017.03.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 02/26/2017] [Accepted: 03/25/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Assessment of clinical communication helps teachers in healthcare education determine whether their learners have acquired sufficient skills to meet the demands of clinical practice. The aim of this paper is to give input to educators when planning how to incorporate assessment into clinical communication teaching by building on the authors' experience and current literature. METHODS A summary of the relevant literature within healthcare education is discussed, focusing on what and where to assess, how to implement assessment and how to choose appropriate methodology. RESULTS Establishing a coherent approach to teaching, training, and assessment, including assessing communication in the clinical context, is discussed. Key features of how to implement assessment are presented including: establishing a system with both formative and summative approaches, providing feedback that enhances learning and establishing a multi-source and longitudinal assessment program. CONCLUSIONS The implementation of a reliable, valid, credible, feasible assessment method with specific educational relevance is essential for clinical communication teaching. PRACTICE IMPLICATIONS All assessment methods have strengths and limitations. Since assessment drives learning, assessment should be aligned with the purpose of the teaching program. Combining the use of different assessment formats, multiple observations, and independent measurements in different settings is advised.
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Affiliation(s)
- Claudia Kiessling
- Department Assessment, Brandenburg Medical School, Neuruppin, Germany
| | - Zoi Tsimtsiou
- Department of Hygiene, School of Medicine, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece.
| | - Geurt Essers
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marc van Nuland
- Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Tor Anvik
- UiT The Arctic University of Norway, Tromsø, Norway
| | | | | | | | - Noëlle Junod Perron
- Unit of Development and Research in Medical Education, Geneva Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Marcy Rosenbaum
- Department of Family Medicine and Office of Consultation and Research in Medical Education, University of Iowa Carver College of Medicine, Iowa City, USA
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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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Weyers S, Jemi I, Karger A, Raski B, Rotthoff T, Pentzek M, Mortsiefer A. Workplace-based assessment of communication skills: A pilot project addressing feasibility, acceptance and reliability. GMS JOURNAL FOR MEDICAL EDUCATION 2016; 33:Doc70. [PMID: 27990466 PMCID: PMC5135413 DOI: 10.3205/zma001069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/24/2016] [Accepted: 07/22/2016] [Indexed: 05/22/2023]
Abstract
Background: Imparting communication skills has been given great importance in medical curricula. In addition to standardized assessments, students should communicate with real patients in actual clinical situations during workplace-based assessments and receive structured feedback on their performance. The aim of this project was to pilot a formative testing method for workplace-based assessment. Our investigation centered in particular on whether or not physicians view the method as feasible and how high acceptance is among students. In addition, we assessed the reliability of the method. Method: As part of the project, 16 students held two consultations each with chronically ill patients at the medical practice where they were completing GP training. These consultations were video-recorded. The trained mentoring physician rated the student's performance and provided feedback immediately following the consultations using the Berlin Global Rating scale (BGR). Two impartial, trained raters also evaluated the videos using BGR. For qualitative and quantitative analysis, information on how physicians and students viewed feasibility and their levels of acceptance was collected in written form in a partially standardized manner. To test for reliability, the test-retest reliability was calculated for both of the overall evaluations given by each rater. The inter-rater reliability was determined for the three evaluations of each individual consultation. Results: The formative assessment method was rated positively by both physicians and students. It is relatively easy to integrate into daily routines. Its significant value lies in the personal, structured and recurring feedback. The two overall scores for each patient consultation given by the two impartial raters correlate moderately. The degree of uniformity among the three raters in respect to the individual consultations is low. Discussion: Within the scope of this pilot project, only a small sample of physicians and students could be surveyed to a limited extent. There are indications that the assessment can be improved by integrating more information on medical context and student self-assessments. Despite the current limitations regarding test criteria, it is clear that workplace-based assessment of communication skills in the clinical setting is a valuable addition to the communication curricula of medical schools.
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Affiliation(s)
- Simone Weyers
- Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf - Centre for Health and Society (CHS), Institut für Medizinische Soziologie, Düsseldorf, Germany
- *To whom correspondence should be addressed: Simone Weyers, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf - Centre for Health and Society (CHS), Institut für Medizinische Soziologie, Universitätsstraße 1, D-40225 Düsseldorf, Germany, Phone: +49 (0)211/81-14825, Fax: +49 (0)211/81-12390, E-mail:
| | - Iman Jemi
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - André Karger
- Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Klinisches Institut für Psychosomatische Medizin und Psychotherapie, Düsseldorf, Germany
| | - Bianca Raski
- Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Klinisches Institut für Psychosomatische Medizin und Psychotherapie, Düsseldorf, Germany
| | - Thomas Rotthoff
- Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Studiendekanat, Düsseldorf, Germany
- Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Klinik für Endokrinologie und Diabetologie, Düsseldorf, Germany
| | - Michael Pentzek
- Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Institut für Allgemeinmedizin, Düsseldorf, Germany
| | - Achim Mortsiefer
- Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Institut für Allgemeinmedizin, Düsseldorf, Germany
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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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12
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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.
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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.
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13
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Sandal LF, Thorlund JB, Ulrich RS, Dieppe PA, Roos EM. Exploring the effect of space and place on response to exercise therapy for knee and hip pain--a protocol for a double-blind randomised controlled clinical trial: the CONEX trial. BMJ Open 2015; 5:e007701. [PMID: 25818278 PMCID: PMC4386269 DOI: 10.1136/bmjopen-2015-007701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Context effects are described as effects of a given treatment, not directly caused by the treatment itself, but rather caused by the context in which treatment is delivered. Exercise is a recommended core treatment in clinical guidelines for musculoskeletal disorders. Although moderately effective overall, variation is seen in size of response to exercise across randomised controlled trial (RCT) studies. Part of this variation may be related to the fact that exercise interventions are performed in different physical environments, which may affect participants differently. The study aims to investigate the effect of exercising in a contextually enhanced physical environment for 8 weeks in people with knee or hip pain. METHODS AND ANALYSIS The study is a double-blind RCT. Eligible participants are 35 years or older with persisting knee and/or hip pain for 3 months. Participants are randomised to one of three groups: (1) exercise in a contextually enhanced environment, (2) exercise in a standard environment and (3) waiting list. The contextually enhanced environment is located in a newly built facility, has large windows providing abundant daylight and overlooks a recreational park. The standard environment is in a basement, has artificial lighting and is marked by years of use; that is, resembling many clinical environments. The primary outcome is the participant's global perceived effect rated on a seven-point Likert scale after 8 weeks exercise. Patient-reported and objective secondary outcomes are included. ETHICS AND DISSEMINATION The Regional Scientific Ethical Committee for Southern Denmark has approved the study. Study findings will be disseminated in peer-reviewed publications and presented at national and international conferences. TRIAL REGISTRATION NUMBER NCT02043613.
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Affiliation(s)
- Louise Fleng Sandal
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | | | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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14
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Hulsman RL, van der Vloodt J. Self-evaluation and peer-feedback of medical students' communication skills using a web-based video annotation system. Exploring content and specificity. PATIENT EDUCATION AND COUNSELING 2015; 98:356-63. [PMID: 25433967 DOI: 10.1016/j.pec.2014.11.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 10/16/2014] [Accepted: 11/11/2014] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Self-evaluation and peer-feedback are important strategies within the reflective practice paradigm for the development and maintenance of professional competencies like medical communication. Characteristics of the self-evaluation and peer-feedback annotations of medical students' video recorded communication skills were analyzed. METHOD Twenty-five year 4 medical students recorded history-taking consultations with a simulated patient, uploaded the video to a web-based platform, marked and annotated positive and negative events. Peers reviewed the video and self-evaluations and provided feedback. Analyzed were the number of marked positive and negative annotations and the amount of text entered. Topics and specificity of the annotations were coded and analyzed qualitatively. RESULTS Students annotated on average more negative than positive events. Additional peer-feedback was more often positive. Topics most often related to structuring the consultation. Students were most critical about their biomedical topics. Negative annotations were more specific than positive annotations. Self-evaluations were more specific than peer-feedback and both show a significant correlation. Four response patterns were detected that negatively bias specificity assessment ratings. CONCLUSION Teaching students to be more specific in their self-evaluations may be effective for receiving more specific peer-feedback. PRACTICE IMPLICATIONS Videofragmentrating is a convenient tool to implement reflective practice activities like self-evaluation and peer-feedback to the classroom in the teaching of clinical skills.
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Affiliation(s)
- Robert L Hulsman
- Academic Medical Centre, Department of Medical Psychology, Amsterdam, The Netherlands.
| | - Jane van der Vloodt
- Academic Medical Centre, Department of Medical Psychology, Amsterdam, The Netherlands
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15
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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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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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