Teaching communication skills in clinical settings: comparing two applications of a comprehensive program with standardized and real patients

Perceptions of medical students and their facilitators on clinical communication skills teaching, learning, and assessment

Introduction

Despite various efforts to develop communication skills (CS) in the classroom, the transfer of these skills into clinical practice is not guaranteed. This study aimed to identify barriers and facilitators of transferring CS from the classroom to clinical environments.

Methods

A qualitative study was conducted at one Australian medical school to explore the experiences and perceptions of facilitators and students in relation to teaching and learning clinical CS. Thematic analysis was used to analyze data.

Results

Twelve facilitators and sixteen medical students participated in semi-structured interviews and focus-group discussions, respectively. Primary themes included the value of teaching and learning, alignment between approaches to teaching and actual clinical practices and students' perceptions of practice, and challenges in different learning environments.

Discussion

This study reinforces the value of teaching and learning CS by facilitators and students. Classroom learning provides students with a structure to use in communicating with real patients, which can be modified to suit various situations. Students have limited opportunities, however, to be observed and receive feedback on their real-patient encounters. Classroom session that discussed CS experiences during clinical rotation is recommended to strengthen learning both the content and process of CS as well as transitioning to the clinical environment.

Doctor-patient communication during the Corona crisis - web-based interactions and structured feedback from standardized patients at the University of Basel and the LMU Munich

Background: Due to the pandemic-related restrictions in classroom teaching at the medical faculties of the LMU Munich and the University of Basel, teaching methods with standardized patients (SPs), were shifted to a digital, web-based format at short notice as of April 2020. We report on our experiences with the WebEncounter program, which was used for the first time in German-speaking countries. The program enables one-to-one encounters between SPs and students. Students receive an invitational email with brief instructions and background information on the case. SPs use case-specific criteria that are compliant with the learning objectives for digital evaluation during the encounter. A feedback session takes place immediately following the encounter. The SPs address the didactically relevant sections and can illustrate them with the corresponding video sequences. Finally, the students receive the links to the video recordings of the encounter and the feedback unit by email. Project description: The aim of this pilot study was to analyze the practicability of the program and its acceptance by students and SPs. In addition, we examined whether the operationalization of the learning objectives in the form of assessment items has an impact on the content and thematic development of courses in the area of doctor-patient communication. Methods: To implement the program, patient cases previously tested in communication seminars in Munich and Basel were rewritten and case-specific evaluation criteria were developed. SPs were trained to use the program, to present their patient figure online and to give feedback. The experience of those involved (faculty, SPs and SP trainers, students) in implementing the program was documented at various levels. The frequency and causes of technical problems were described. Student results on the patient cases and on the feedback items were collected quantitatively and, where possible, supplemented by free-text statements. Results: Data from 218/220 students in Basel and 120/127 students in Munich were collected and evaluated. Students were very satisfied with the patient cases, the encounter with the SPs and their feedback: 3.81±0.42. SPs experienced the training as an increase in their competence and the structured feedback as particularly positive. The training effort per SP was between 2.5 and 4 hours. The results show predominantly normally-distributed, case-specific sum scores of the evaluation criteria. The analysis of the individual assessment items refers to learning objectives that students find difficult to achieve (e.g. explicitly structuring the conversation). Problems in the technical implementation (<10 percent of the encounters) were due mainly to the use of insufficient hardware or internet connection problems. The need to define case-specific evaluation criteria triggered a discussion in the group of study directors about learning objectives and their operationalization. Summary: Web-based encounters can be built into the ongoing communication curriculum with reasonable effort. Training the SPs and heeding the technical requirements are of central importance. Practicing the virtual consultation was evaluated very positively by the students - in particular, the immediate feedback in the protected dialogue was appreciated by all involved.

Clinical Communication Skills Training in Dental Medical Education: The COVID-19 Pandemic Challenge

It is very important for healthcare professionals to have good clinical communication skills, especially dentists. Patient-centred care results in patient satisfaction, better outcomes, and less complaints from dental patients. Due to the onset of the COVID-19 pandemic, the clinical communications skills programme of the pre-graduate course in dental medicine at the University of Porto had to be transformed to an online format. Based on their role as faculty, the authors aimed to recount their initial reflections and concerns within this perspective, and to share how they adapted to the new reality of teaching clinical communication skills online, as well as the conclusions of our experience, in the hope that this will help others who may have to go through a similar process. The authors acknowledged that the students achieved the pre-established goals of the clinical communications skills programme through the new online format.

Educational programs to teach shared decision making to medical trainees: A systematic review

OBJECTIVE

Shared decision-making (SDM) is a process of collaboration between patients and clinicians. An increasing number of educational programs to teach SDM have been developed. We aimed to summarize and evaluate the body of evidence assessing the outcomes of these programs.

METHODS

We conducted a systematic review of studies that aimed to teach SDM to medical trainees. Reviewers worked independently and in duplicate to select studies, extract data and evaluate the risk of bias.

RESULTS

Eighteen studies were included. Most studies focused on residents/fellows (61 %) and combined a didactic component with a practical experience (50 % used a standardized patient). Overall, participants reported satisfaction with the courses. The effects on knowledge, attitudes/confidence and comfort with SDM were small; no clear improvement on SDM skills was noted. Evaluation of clinical behavior and outcomes was limited (3/18 studies). Studies had moderate risk of bias.

CONCLUSION

Very low quality evidence suggests that educational programs for teaching SDM to medical trainees are viewed as satisfactory and have a small impact on knowledge and comfort with SDM. Their impact on clinical skills, behaviors and patient outcomes is less clear.

PRACTICAL IMPLICATIONS

Integration of formal and systematic outcomes evaluation (effects on behavior/clinical practice) should be part of future programs.

Using conversation analysis to inform role play and simulated interaction in communications skills training for healthcare professionals: identifying avenues for further development through a scoping review

BACKGROUND

This paper responds to previously published debate in this journal around the use of sociolinguistic methods in communication skills training (CST), which has raised the significant question of how far consultations with simulated patients reflect real clinical encounters. This debate concluded with a suggestion that sociolinguistic methods offer an alternative analytic lens for evaluating CST. We demonstrate here that the utility of sociolinguistic methods in CST is not limited to critique, but also presents an important tool for development and delivery.

METHODS

Following a scoping review of the use of role play and simulated interaction in CST for healthcare professionals, we consider the use of the specific sociolinguistic approach of conversation analysis (CA), which has been applied to the study of health communication in a wide range of settings, as well as to the development of training.

DISCUSSION

Role play and simulated interaction have been criticised by both clinicians and sociolinguists for a lack of authenticity as compared to real life interactions. However they contain a number of aspects which healthcare professionals report finding particularly useful: the need to think on one's feet in real time, as in actual interaction with patients; the ability to receive feedback on the simulation; and the ability to watch and reflect on how others approach the same simulation task in real time. Since sociolinguistic approaches can help to identify inauthenticity in role play and simulation, they can also be used to improve authenticity. Analysis of real-life interactions using sociolinguistic methods, and CA in particular, can identify actual interactional practices that are used by particular patient groups. These practices can then be used to inform the training of actors simulating patients. In addition, the emphasis of CA on talk as joint activity means that proper account can be taken of the way in which simulated interaction is co-constructed between simulator and trainee. We suggest that as well as identifying potential weaknesses in current role play and simulation practice, conversation analysis offers the potential to enhance and develop the authenticity of these training methods.

Physiotherapists' management of challenging situations in guiding people with rheumatoid arthritis to health-enhancing physical activity

OBJECTIVES

To explore strategies used by physiotherapists (PTs) in guiding people with rheumatoid arthritis to health-enhancing physical activity (HEPA) in a group setting during a 1-year intervention study.

METHODS

Exploratory design with qualitative video analysis performed in three steps. Eleven female PTs were video recorded while leading support group sessions aiming at facilitating HEPA (twice-weekly exercise sessions at public gyms and 150 weekly minutes of moderately intense aerobic physical activity).

RESULTS

Three categories of challenging situations emerged. They occurred when the HEPA intervention participants reported barriers to performing physical activity, when they neglected to use the planning tool for physical activity as intended in the program, and when they received negative results from physical capacity tests. PTs used different strategies to manage these challenges, with main focus either on information-giving, corresponding to a traditional health professional approach, or utilizing group resources by organizing participation.

CONCLUSIONS

This study provides detailed descriptions of PTs' clinical behavior in video-recorded sessions. The results imply that motivated PTs can, despite their biomedical and practitioner-focused training, learn to adapt their communication strategies to different situations, altering between traditional information-giving and utilizing group resources by organizing participation.

Twelve tips for just in time teaching of communication skills for difficult conversations in the clinical setting

The ability to communicate well with patients and other members of the healthcare team is a vital skill for physicians to have, but one that is often not emphasized in medical education. Learners of all levels can obtain and develop good communication skills regardless of their natural ability in this area, and the clinical setting represents an underutilized resource to accomplish this task. With this in mind, we have reviewed the growing body of literature on the subject and organized our findings into twelve tips to help educators capitalize on these missed opportunities. While our emphasis is helping learners with difficult discussions, these tips can be easily adapted to any other clinical encounter requiring clear communication. Teaching effective communication skills in the clinical setting requires some extra time, but the steps outlined should not take more than a few minutes to complete. Taking the time to develop these skills in our learners will make a significant difference not only their lives but also their patients and their families.

One-Year Progress in Ophthalmic Education: Annual Review

PURPOSE

The aim of this study was to update the practicing ophthalmologist on the English language literature about medical education from the prior year.

DESIGN

A search of English language literature was performed on PubMed from January 1, 2014, to December 31, 2014.

METHODS

Because the search using the main topic of the review "medical education" came up with 7394 citations, authors finally decided to narrow the search to 3 topics of their interest:1. Current state of competency-based education and teaching methods of competencies. This section included ophthalmic/ophthalmology education, core competencies, competency-based education, teaching strategies, tools and methods in medical education.2. E-learning. This section included e-learning, online learning, online teaching, Web-based teaching, Web-based learning, and flipped classroom.3.

ASSESSMENTS

This section included assessment of medical students, residents, fellows, faculty, attending physicians, and medical teachers, assessment of medical student ophthalmology programs, ophthalmology residency programs, residency programs, and fellowship programs.

RESULTS

The authors reviewed and summarized articles published in 2014 examining or describing the 3 main areas of the review described previously.

CONCLUSIONS

This review updates the comprehensive ophthalmologist on advances in ophthalmic medical education. Ophthalmic educators could apply the ideas presented in this review according to their possibilities in their own settings and programs.