Curriculum factors influencing knowledge of communication skills among medical students

Do educational interventions reduce the gender gap in communication skills?- a systematic review

BACKGROUND

Efficient doctor-patient communication is essential for improving patient care. The impact of educational interventions on the communication skills of male and female students has not been systematically reviewed. The aim of this review is to identify interventions used to improve communication skills in medical curricula and investigate their effectiveness in improving the communication skills of male and female medical students.

METHODS

A systematic review of the literature was conducted using the PRISMA guidelines. Inclusion criteria were as follows: used intervention strategies aiming to improve communication skills, participants were medical students, and studies were primary research studies, systematic reviews, or meta-analyses.

RESULTS

2913 articles were identified based on search terms. After title, abstract, and full-text review, 58 studies were included with interventions consisting of Training or Drama Courses, Curriculum-Integrated, Patient Learning Courses, and Community-Based Learning Courses. 69% of articles reported improved communication skills for both genders equally, 28% for women more than men, and 3% for men more than women. 16 of the 58 articles reported numerical data regarding communication skills pre-and post-intervention. Analysis revealed that post-intervention scores are significantly greater than pre-intervention scores for both male (p < 0.001) and female students (p < 0.001). While the post-test scores of male students were significantly lower than that of female students (p = 0.01), there is no significant difference between genders for the benefits, or difference between post-intervention and pre-intervention scores (p = 0.15), suggesting that both genders benefited equally.

CONCLUSION

Implementation of communication training into medical education leads to improvement in communication skills of medical students, irrespective of gender. No specific interventions benefitting male students have been identified from published literature, suggesting need of further studies to explore the phenomenon of gender gap in communication skills and how to minimize the differences between male and female students.

Students' Reflections During Training Workshops on Communication and Information Exchange in Audiology Consultations: An Exploratory Qualitative Study

PURPOSE

This clinical focus article outlines various communication challenges and scenarios related to information giving encountered by a group of audiology students, as reflected on during a series of communication skills workshops.

METHOD

We held two online training workshops during which students reflected on their clinical communication experiences and asked questions related to clinical scenarios. Third-year audiology students from a South African university participated in the workshops (17 in the first, 15 in the second). We analyzed these reflections using thematic analysis.

RESULTS

Students' reflections related to four themes: (a) balancing information giving, (b) managing shared decision making, (c) managing linguistic differences, and (d) relating bad news. The first theme was heavily prioritized in students' reflections. Providing students with time to practice skills introduced in the initial communication skills workshop enabled further reflection in the subsequent workshop. We discuss these themes using specific examples raised by students.

CONCLUSIONS

Our findings suggest that students first need to master basic information giving skills before they can move on to more advanced skills such as managing shared decision making, linguistic differences, and relating bad news. This study confirms that reflective skills need to be developed with students in an explicit manner, rather than as part of a hidden curriculum. Our approach to providing communication training and encouraging reflection on clinical experiences offers a starting point for clinical educators to support students in developing these skills.

What do we know about written assessment of health professionals' communication skills? A scoping review

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.

Acceptability and feasibility of video-based coaching to enhance clinicians' communication skills with patients

BACKGROUND

Despite a growing call to train clinicians in interpersonal communication skills, communication training is either not offered or is minimally effective, if at all. A critical need exists to develop new ways of teaching communication skills that are effective and mindful of clinician time pressures. We propose a program that includes real-time observation and video-based coaching to teach clinician communication skills. In this study, we assess acceptability and feasibility of the program using clinician interviews and surveys.

METHODS

The video-based coaching intervention targets five patient-centered communication behaviors. It uses trained communication coaches and live feed technology to provide coaching that is brief (less than 15 min), timely (same day) and theory-informed. Two coaches were trained to set up webcams and observe live video feeds of clinician visits in rooms nearby. As coaches watched and recorded the visit, they time stamped illustrative clips in real time. Video clips were a critical element of the program. During feedback sessions, coaches used video clips to promote discussion and self-reflection. They also used role play and guided practice techniques to enforce new tips. Clinicians included residents (n = 15), fellows (n = 4), attending physicians (n = 3), and a nurse practitioner (n = 1) at two primary care clinics in Houston, Texas. We administered surveys to clinicians participating in the program. The survey included questions on quality and delivery of feedback, and credibility of the coaches. We also interviewed clinicians following the intervention. We used rapid analysis to identify themes within the interviews.

RESULTS

Survey measures showed high feasibility and acceptability ratings from clinicians, with mean item scores ranging from 6.4 to 6.8 out of 7 points. Qualitative analysis revealed that clinicians found that 1) coaches were credible and supportive, 2) feedback was useful, 3) video-clips allowed for self-reflection, 4) getting feedback on the same day was useful, and 5) use of real patients preferred over standardized patients.

CONCLUSIONS

Video-based coaching can help clinicians learn new communication skills in a way that is clinician-centered, brief and timely. Our study demonstrates that real-time coaching using live feed and video technology is an acceptable and feasible way of teaching communication skills.

Comparative Study of Attitudes towards Communication Skills Learning between Medical and Dental Students in Saudi Arabia

Background: Communication skills (CS) learning is a core skill in medical and dental education. The comparison of attitudes towards CS between dental and medical students based on the taught curriculum (problem-based learning vs. traditional teaching) in Saudi Arabia awaits investigation. Aims: (1) To assess the attitudes of both undergraduate dental and medical students towards communication skills (CS) learning and (2) to compare the attitudes towards CS between Medical and Dental students in relation to sociodemographic and education-related characteristics. Methods and Materials: A cross-sectional study, using an online survey, invited 260 conveniently sampled Taibah university medical and dental undergraduate students. The survey collected data on sociodemographic characteristics, education-related factors, and CS using Communication Skills Attitude Scale (CSAS) that assess positive and negative attitudes (PAS, NAS). Data analysis included descriptive statistics and the Mann–Whitney U test. Results: Of the distributed questionnaire 91% responded (145 dental and 91 medical students). There were, overall, non-significant scores’ differences between medical and dental students on PAS (Medicine Median 51 vs. Dentistry Median 50, p = 0.059) and NAS (Medicine Median 32 vs. Dentistry Median 32, p = 0.596). Older medical students, those at clinical levels and those who reported they need to improve their communication skills and student whose parents were not doctors, tended to score statistically significantly (p = 0.032, 0.017, 0.034, and 0.004, respectively) on PAS compared with dental students; on the other hand, medical students with doctor parents scored significantly high in NAS compared to dental students (p = 0.015). Conclusion: Demographic and education-related characteristics underpinned medical student positive attitude towards CS compared to dental students. Although medical and dental students showed no differences in self-rating their attitudes towards (CS). Different factors influence medical and dental students’ attitudes towards CS learning.

Inter-personal versus content: assessment of communication skills in Iraqi physicians

OBJECTIVES

The current study sought to evaluate the communication skills of Iraqi physicians from a patient perspective, differentiating between "interpersonal" and "content" components of communication. In the past century, the doctor-patient relationship has changed considerably, shifting from a paternalistic, physician-dominated approach to a more dynamic and patient-centered. In such a context, effective communication skills have become even more crucial for good medical practice and most accreditation organizations urge medical schools to teach and evaluate communication skills.

METHODS

A cross-sectional study was conducted at Baghdad Teaching Hospital's three major departments (Surgery, Medicine, Obs/ Gyne). The final sample included 270 participants. A factor analysis was performed and generated two dimensions ("interpersonal" and "content"). Statistical differences between the groups and between the two dimensions of the questionnaire were analysed through t-tests and ANOVA. In addition, a multiple linear regression model was used to study the effect of some variables on the dependent variable "communication".

RESULTS

The study showed a significant difference between "interpersonal" and "content" communication, with patients reporting higher satisfaction for the former. Reported satisfaction rates varied amongst the three departments with the Surgery specialty scoring significantly lower than the Medicine and the Obs/Gyne department. The duration of care under the current physician, a higher rank of specialty and the settings (inpatients versus outpatients) were positively and significantly associated with a higher quality of communication skills.

CONCLUSIONS

These findings have significant implications for training institutions.

Psychodynamic approaches to teaching medical students about the doctor–patient relationship: randomised controlled trial

Aims and method

To evaluate the effectiveness of two psychodynamic psychotherapy teaching methods, a student psychotherapy scheme (SPS) and participation in a Balint group, in teaching first-year clinical medical students about doctor–patient communication and the doctor–patient relationship. The 28 students, who were randomly allocated to three groups (SPS group, Balint group starting at baseline and Balint group starting at 3 months and acting as partial controls), were rated on a questionnaire testing their knowledge of emotional and psychodynamic aspects of the doctor–patient relationship administered at baseline, at 3 months and at 1 year.

Results

At 3 months, students in the SPS and Balint groups scored higher than the partial control group, the difference approaching significance at the 5% level. At 1 year, participation in either teaching method led to significantly higher scores compared with baseline.

Clinical implications

Psychodynamic psychotherapy teaching methods are effective in increasing students' knowledge of the doctor-patient relationship and potentially also improving their communication skills.

Has the inclusion of a longitudinally integrated communication skills program improved consultation skills in medical students? A pilot study

Background:

Evidence highlights a lack of communication skills in doctors leading to dysfunctional consultations. To address this deficit, a private medical college instituted curricular reforms with inclusion of a longitudinal communication skills program. A pilot study was undertaken to evaluate the effectiveness of this program by comparing the consultation skills of medical students of this college with a medical college without a communication skills program.

Methods:

A 4-station Objective Structured Clinical Examination (OSCE) was conducted in the third and final year. Mann–Whitney U-test was used to compare the difference in the distribution between OSCE stations total and construct scores.

Results:

At the end of the third year, 21 (31.34%), students of the study site (medical college 1 [college with integrated longitudinal communication skills program]) and 31 (46.26%) students from the comparison site (medical college 2 [comparable college without communication skills program]) consented. Medical college 1 achieved a significantly higher overall mean total station score of 68.0% (standard deviation [SD] =13.5) versus 57.2% (SD = 15.4) (P < 0.001). Significantly higher mean scores were achieved on three stations. At the end of the final year, 19 students (29.3%) from medical college 1 and 22 (34%) students from medical college 2 consented. The difference in overall mean total station score reduced from 9.2% to 7.1% (70.2) (SD = 13.7) versus 63.1 (SD = 15.2) (P = 0.004). The mean scores of both colleges decreased in “Patient presenting with Hepatitis C Report” station (P values 0.004 and 0.775) and in “Patient Request for Faith Healing Therapy in Diabetes Mellitus” station (P values 0.0046 and 0.036), respectively.

Conclusion:

Longitudinal communication skills in an undergraduate curriculum positively impacted consultation skills. Community-based training and faculty development are required to develop effective patient-centered consultation skills.

The effects of scenario-based communication training on nurses' communication competence and self-efficacy and myocardial infarction knowledge

OBJECTIVE

The aim of the study was to determine the effects of a simulated communication training course on nurses' communication competence, self-efficacy, communication performance, myocardial infarction knowledge, and general satisfaction with their learning experience.

METHODS

A randomized controlled trial was conducted with a pre-test and two post-tests. The experimental group underwent simulated communication training course and the control group received a case-based communication training course.

RESULTS

The experimental group made more significant improvement in competence and self-efficacy in communication from pre-test to the second post-test than the control group. Although both groups' satisfaction with their learning experience significantly increased from the first post-test to the second post-test, the experimental group was found to be more satisfied with their learning experience than the control group. No significant differences in communication performance and myocardial infarction knowledge between the two groups were identified.

CONCLUSION

Scenario-based communication training can be more fully incorporated into in-service education for nurses to boost their competence and self-efficacy in communication and enhance their communication performance in myocardial infarction patient care.

PRACTICE IMPLICATIONS

Introduction of real-life communication scenarios through multimedia in communication education could make learners more motivated to practice communication, hence leading to improved communication capacity.

Student attitude towards communication skills learning in a Caribbean medical school

BACKGROUND

Medical student attitudes towards communication skills are important for curriculum planners and teachers. Xavier University School of Medicine (XUSOM) is a private medical school admitting students mainly from the United States and Canada.

AIMS

Attitude of students towards communication skills has not been previously studied in the institution. Hence the present study was carried out.

METHOD

The study was carried out among the first, second, third and fourth semester undergraduate medical (MD) students at XUSOM, Aruba during July 2013 using the communication skills attitude scale (CSAS). Respondents' age, gender, nationality, occupation of parents, place of residence of family, semester of study were noted. The positive and negative attitude scale scores were calculated and compared among different subgroups of respondents (p<0.05).

RESULTS

Fifty-one of the seventy-three students (69.9 per cent) participated. The majority were between 20 to 25 years of age, of American nationality, from metro cities and had excellent or good self-perceived verbal and written communication skills. The mean positive attitude scale (PAS) score was 47.65 (maximum being 65) and the mean negative attitude scale (NAS) score was 31.06 (maximum 65). PAS score was significantly higher among respondents whose fathers were not in health related professions. NAS scores were significantly lower among the third and fourth semester respondents.

CONCLUSION

Students overall had a positive attitude towards communication skills but negative attitudes were also noted Based on results of the study and a review of literature we are planning to start communication skills learning in the institution right from the first semester and students will be provided opportunities for supervised practice during early clinical exposure, hospital observership and with standardised patients. The medical humanities module will be expanded and communication skills learning will continue during the clinical years with higher order skills being taught.

"Best practice" for patient-centered communication: a narrative review

BACKGROUND

Communicating with patients has long been identified as an important physician competency. More recently, there is a growing consensus regarding the components that define physician-patient communication. There continues to be emphasis on both the need to teach and to assess the communication skills of physicians.

OBJECTIVE

This narrative review aims to summarize the work that has been conducted in physician-patient communication that supports the efficacy of good communications skills. This work may also help to define the physician-patient communication skills that need to be taught and assessed.

RESULTS

A review of the literature shows it contains impressive evidence supporting positive associations between physician communication behaviors and positive patient outcomes, such as patient recall, patient understanding, and patient adherence to therapy. There is a consensus about what constitutes "best practice" for physician communication in medical encounters: (1) fostering the relationship, (2) gathering information, (3) providing information, (4) making decisions, (5) responding to emotions, and (6) enabling disease- and treatment-related behavior.

CONCLUSIONS

Evidence supports the importance of communication skills as a dimension of physician competence. Effort to enhance teaching of communication skills to medical trainees likely will require significant changes in instruction at undergraduate and graduate levels, as well as changes in assessing the developing communication skills of physicians. An added critical dimension is faculty understanding of the importance of communication skills, and their commitment to helping trainees develop those skills.

A conceptual framework for interdisciplinary curriculum design: a case study in neuroscience

Teaching of interdisciplinary fields of study poses a challenge to course organizers. Often interdisciplinary courses are taught by different departments, and hence, at best provide a multidisciplinary overview. Scientific progress in neuroscience, for instance, is thought to depend heavily on interdisciplinary investigations. If students are only taught to think in particular disciplines without integrating these into a coherent framework to study the nervous system, it is unlikely that they will truly develop interdisciplinary thinking. Yet, it is this interdisciplinary thinking that is at the heart of a holistic understanding of the brain. It is, therefore, important to develop a conceptual framework in which students can be taught interdisciplinary, rather than multidisciplinary, thinking. It is also important to recognize that not all teaching needs to be interdisciplinary, but that the type of curriculum design is dependent on the aims of the course, as well as on the background of the students. A rational curriculum design that aligns learning and teaching objectives is, therefore, advocated.

Medical and psychology students' self-assessed communication skills: A pilot study

OBJECTIVE

The purpose of this study was to describe how psychology and medical students assess their own competency and skills before and after training, in which role-play was used to teach interpersonal and communication skills.

METHOD

Interpersonal and communication skills were assessed with a semi-structured questionnaire before and after the training.

RESULTS

The students of both medicine and psychology estimated their skill levels to be higher after the course. The psychology students estimated their skills for communication, motivating interviewing, empathy and reflection, and change orientation to be better at the end of the course. Medical students estimated their communication skills, motivating interviewing skills, and change orientation skills to be better at the end of the course.

CONCLUSION

Even a short period of training in interpersonal and communication skills can positively affect the self-assessed skills of the medical students.

PRACTICE IMPLICATIONS

In the future, it would be worthwhile to pay attention to reflective teaching practices in the training of both medical and psychology students. The cognitive and emotional components of these practices help students to develop their own communication skills.