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Mahomed-Asmail F, Nicholson N, Metcalfe L, Rutherford C, Alet Graham M, Watson V, Regan C, Hussain S. Enhancing audiology students' understanding of person-centered care: insights from an multi-national virtual student conference. Int J Audiol 2024:1-7. [PMID: 38701177 DOI: 10.1080/14992027.2024.2344097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/11/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE This project sought to investigate the impact of a multi-national peer learning initiative in facilitating a student-led conference on person-centred care (PCC). The primary objective was to assess students' comprehension of PCC elements before and after engaging in the opportunity, with a concurrent evaluation of the efficacy of the opportunity. DESIGN A mixed-methods study protocol was followed. Following the conference, participants completed a four-part survey including (a) demographics, (b) retrospective pre-post Likert scale, (c) Likert rating of conference experience and (d) five open-ended questions. STUDY SAMPLE One hundred and four participants (92.4% female) with a mean age of 21 years (0.07 SD) participated in the study. RESULTS A significant difference in awareness pre-post conference was demonstrated across all topics (WSR, p < 0.001) with participants satisfied with the conference. Qualitative analysis revealed three main themes: (a) application of PCC; (b) perspectives of PCC; and () barriers to PCC; with nine sub-themes. CONCLUSION The conference was beneficial in enhancing students' awareness of topics and principles of PCC. Innovative pedagogical approaches should be considered in order to enhance healthcare education allowing future clinicians to better meet the dynamic needs of their clients.
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Affiliation(s)
- Faheema Mahomed-Asmail
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | | | - Louise Metcalfe
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | | | - Marien Alet Graham
- Department of Early Childhood Education, University of Pretoria, Pretoria, South Africa
| | - Victoria Watson
- School of Engineering, University of Southampton, Southampton, United Kingdom
| | - Catherine Regan
- Department of Audiology, Nova Southeastern University, Florida, USA
| | - Saira Hussain
- Department of Audiology, Aston University, Birmingham, United Kingdom
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Vanasse AM, Weiler T, Roth EA, Upadhya S, Toriello HV, VanLeuven AJ, Norris JR, Carey JC, Sobering AK. Teaching perspectives on the communication of difficult news of genetic conditions to medical students. Am J Med Genet A 2023; 191:299-305. [PMID: 36286987 PMCID: PMC10092636 DOI: 10.1002/ajmg.a.63003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/23/2022] [Accepted: 09/28/2022] [Indexed: 12/14/2022]
Abstract
Informing parents that their child has a diagnosis of Down syndrome (DS) is a common example of the delivery of unexpected or difficult news. Expectations and life planning will change, and if detected prenatally, discussions might include the option of pregnancy termination. Medical school curricula currently include training in breaking unexpected news; however, it is difficult to teach and assess. We use the perspectives of clinicians, educators, and a medical student who is the parent of a child with DS to frame a discussion on teaching, practicing, and assessing communication of difficult news in human genetics during medical school.
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Affiliation(s)
- Ashley M Vanasse
- Department of Biochemistry, St. George's University, St. George's, Grenada.,Department of Pediatrics, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma, USA
| | - Tracey Weiler
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Elizabeth A Roth
- AU/UGA Medical Partnership Campus of the Medical College of Georgia, Athens, Georgia, USA
| | - Sharmila Upadhya
- Department of Biochemistry, St. George's University, St. George's, Grenada
| | - Helga V Toriello
- Department of Pediatrics and Human Development, Michigan State University - College of Human Medicine, East Lansing, Michigan, USA
| | - Ariel J VanLeuven
- AU/UGA Medical Partnership Campus of the Medical College of Georgia, Athens, Georgia, USA.,Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - John R Norris
- AU/UGA Medical Partnership Campus of the Medical College of Georgia, Athens, Georgia, USA
| | - John C Carey
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Andrew K Sobering
- Department of Biochemistry, St. George's University, St. George's, Grenada.,AU/UGA Medical Partnership Campus of the Medical College of Georgia, Athens, Georgia, USA.,Windward Islands Research and Education Foundation, True Blue, St. George's, Grenada
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3
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Donisi V, Perlini C, Mazzi MA, Rimondini M, Garbin D, Ardenghi S, Rampoldi G, Montelisciani L, Antolini L, Strepparava MG, Del Piccolo L. Training in communication and emotion handling skills for students attending medical school: Relationship with empathy, emotional intelligence, and attachment style. PATIENT EDUCATION AND COUNSELING 2022; 105:2871-2879. [PMID: 35715300 DOI: 10.1016/j.pec.2022.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To describe the Emoty-Com training, its impact on medical students' attitudes towards doctors' emotions and to explore the association between students' empathy, emotional intelligence (EI), and attachment style (AS) with post-training performance scores. METHODS The 16-hour Emoty-Com training was delivered to all second-year medical students of Verona and Milan (Italy) Universities. At pre-training, students filled out three questionnaires assessing empathy, AS and EI and responded to three questions on attitudes towards doctors' emotions in the doctor-patient encounter. The same three questions and a final evaluation test were proposed at post-training. RESULTS 264 students participated in the study. The training reduced students' worry about managing emotions during doctor-patient relationships. Gender was associated with specific subscales of empathy, EI, and AS. Final performance scores were associated with students' attitudes towards emotions but not with empathy, EI, and AS. CONCLUSION The Emoty-Com training increased students' self-efficacy in handling their own emotions during consultations. Students' performance scores were related to their attitude towards doctors' emotions in clinical encounters. PRACTICE IMPLICATIONS The Emoty-Com training suggests ways to teach and evaluate emotion-handling skills for medical students. Possible links between empathy, EI, AS, and the attitudes towards doctors' emotions during the years of education are highlighted.
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Affiliation(s)
- Valeria Donisi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Cinzia Perlini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Angela Mazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michela Rimondini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Davide Garbin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Ardenghi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, MB, Italy
| | - Giulia Rampoldi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, MB, Italy
| | - Laura Montelisciani
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, MB, Italy
| | - Laura Antolini
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, MB, Italy
| | - Maria Grazia Strepparava
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, MB, Italy; Department of Mental Health, Clinical Psychology Unit, San Gerardo Hospital, ASST-Monza, Monza, MB, Italy
| | - Lidia Del Piccolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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Kerr D, Martin P, Furber L, Winterburn S, Milnes S, Nielsen A, Strachan P. Communication skills training for nurses: Is it time for a standardised nursing model? PATIENT EDUCATION AND COUNSELING 2022; 105:1970-1975. [PMID: 35301988 DOI: 10.1016/j.pec.2022.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/10/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Debra Kerr
- Centre for Quality and Patient Safety, Institute for Health Transformation, Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia.
| | - Peter Martin
- Centre for Organisational Change in Person-Centred Healthcare, Deakin University, School of Medicine, Faculty of Health, Geelong, VIC, Australia; University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Lynn Furber
- Healthcare Communication Matters, London, UK
| | - Sandra Winterburn
- Norwich Medical School, University of East Anglia, Faculty of Medicine and Health Sciences, UK
| | - Sharyn Milnes
- University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Annegrethe Nielsen
- Department of Nursing, University College Copenhagen, Copenhagen, Denmark
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Bosméan L, Chaffanjon P, Bellier A. Impact of physician-patient relationship training on medical students' interpersonal skills during simulated medical consultations: a cross-sectional study. BMC MEDICAL EDUCATION 2022; 22:117. [PMID: 35193554 PMCID: PMC8862366 DOI: 10.1186/s12909-022-03171-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND In medicine, the patient-centered approach is based on interpersonal skills, including communication, structuring the medical interview, and empathy, which have an impact on health professionals' interpersonal relationships and the quality of care. Training courses on this issue are therefore being developed in universities. We hypothesized that specific training courses in the physician-patient relationship could improve interpersonal skills among medical students during simulated consultations and the immediate satisfaction of standardized patients. METHODS This cross-sectional study enrolled fourth-year medical students who participated in a simulated medical consultation session with standardized patients. The evaluation of interpersonal skills was carried out using the Four Habits Coding Scheme, producing a synthetic score out of 115 points used as the primary endpoint. Some students benefited from the training courses offered by the university or by other organizations, mainly based on communication, active listening, or patient-centered approach. A comparison was made with students from the same graduating class who had not received any training. RESULTS The analysis of the primary endpoint showed a difference of 5 points between the group of students who had attended at least one training course and those who did not (p = 0.001). This difference was even more marked when the students had completed several training courses, up to 14 points higher with three training courses (p = 0.001), each with positive results in different areas of the care relationship. CONCLUSIONS Physician-patient relationship training currently provided in initial education appears to be effective in improving interpersonal skills. A repetition of this training is necessary to increase its impact.
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Affiliation(s)
- Lucie Bosméan
- Department of Family Medicine, University of Grenoble Alpes, Grenoble, France
| | | | - Alexandre Bellier
- School of Medicine, University of Grenoble Alpes, Grenoble, France.
- Clinical Epidemiology Unit, Grenoble Alpes University Hospital, CS10217, Cedex 09, 38043, Grenoble, France.
- Computational and Mathematical Biology Team, TIMC UMR 5525, CNRS, University of Grenoble Alpes, Grenoble, France.
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Bellier A, Labarère J, Putkaradze Z, Cavalie G, Carras S, Pelen F, Paris A, Chaffanjon P. Effectiveness of a multifaceted intervention to improve interpersonal skills of physicians in medical consultations (EPECREM): protocol for a randomised controlled trial. BMJ Open 2022; 12:e051600. [PMID: 35168969 PMCID: PMC8852665 DOI: 10.1136/bmjopen-2021-051600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Interpersonal skills, encompassing communication and empathy, are key components of effective medical consultations. Although many organisations have implemented structured training programmes, limited evidence exists on their effectiveness in improving physician interpersonal skills. This study aims to evaluate the effectiveness of a standardised, multifaceted, interpersonal skills development programme for hospital physicians. METHODS AND ANALYSIS This study is a prospective, randomised (with a 1:1 allocation ratio), controlled, open-label, two parallel arm, superiority trial conducted at a single university hospital. Physicians will be randomised to receive either a multifaceted training programme or no intervention. The experimental intervention combines two 4-hour training sessions, dissemination of interactive educational materials, review of video-recorded consultations and individual feedback. The primary outcome measure is the overall 4-Habits Coding Scheme score assessed by two independent raters blinded to the study arm, based on video-recorded consultations, before and after intervention. The secondary outcomes include patient satisfaction, therapeutic alliance, physician self-actualisation and the length of medical consultation. ETHICS AND DISSEMINATION The study protocol was approved on 21 October 2020 by the CECIC Rhône-Alpes Auvergne, Clermont-Ferrand, France (IRB 5891). All participants will provide written informed consent. Efforts will be made to release the primary results within 6 to 9 months of study completion, regardless of whether they confirm or deny the research hypothesis. TRIAL REGISTRATION NUMBER NCT04703816.
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Affiliation(s)
- Alexandre Bellier
- Computational and Mathematical Biology Team, TIMC-IMAG UMR 5525, CNRS, Université Grenoble Alpes, Saint-Martin-d'Heres, Rhône-Alpes, France
- Clinical Epidemiology Unit, CHU Grenoble Alpes, Grenoble, Auvergne-Rhone-Alpes, France
- CIC 1406, INSERM, Université Grenoble Alpes, Saint-Martin-d'Heres, Rhône-Alpes, France
| | - José Labarère
- Computational and Mathematical Biology Team, TIMC-IMAG UMR 5525, CNRS, Université Grenoble Alpes, Saint-Martin-d'Heres, Rhône-Alpes, France
- Clinical Epidemiology Unit, CHU Grenoble Alpes, Grenoble, Auvergne-Rhone-Alpes, France
- Medical School, Université Grenoble Alpes, Saint-Martin-d'Heres, Rhône-Alpes, France
| | - Zaza Putkaradze
- CIC 1406, INSERM, Université Grenoble Alpes, Saint-Martin-d'Heres, Rhône-Alpes, France
| | - Guillaume Cavalie
- Clinical Research Department, CHU Grenoble Alpes, Grenoble, Auvergne-Rhone-Alpes, France
| | - Sylvain Carras
- Clinical Research Department, CHU Grenoble Alpes, Grenoble, Auvergne-Rhone-Alpes, France
| | - Félix Pelen
- Clinical Research Department, CHU Grenoble Alpes, Grenoble, Auvergne-Rhone-Alpes, France
| | - Adeline Paris
- CIC 1406, INSERM, Université Grenoble Alpes, Saint-Martin-d'Heres, Rhône-Alpes, France
| | - Philippe Chaffanjon
- Medical School, Université Grenoble Alpes, Saint-Martin-d'Heres, Rhône-Alpes, France
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7
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Younas A, Khan RA, Yasmin R. Entrustment in physician-patient communication: a modified Delphi study using the EPA approach. BMC MEDICAL EDUCATION 2021; 21:497. [PMID: 34544394 PMCID: PMC8454034 DOI: 10.1186/s12909-021-02931-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Competency based curricula across the globe stress on the importance of effective physician patient communication. A variety of courses have been used to train physicians for this purpose. However, few of them link competencies with practice resulting in confusions in implementation and assessment. This issue can be resolved by treating certain specific patient communication related tasks as acts of entrustment or entrustable professional activities (EPAs). In this study, we aimed to define a competency-based framework for assessing patient physician communication using the language of EPAs. METHODS A modified Delphi study was conducted in three stages. The first stage was an extensive literature review to identify and elaborate communication related tasks which could be treated as EPAs. The second stage was content validation by medical education experts for clarity and representativeness. The third stage was three iterative rounds of modified Delphi with predefined consensus levels. The McNemar test was used to check response stability in the Delphi Rounds. RESULTS Expert consensus resulted in development of 4 specific EPAs focused on physician-patient communication with their competencies and respective assessment strategies all aiming for level 5 of unsupervised practice. These include Providing information to the patient or their family about diagnosis or prognosis; Breaking Bad news to the patient or their family; Counseling a patient regarding their disease or illness; Resolving conflicts with patients or their families. CONCLUSIONS The EPAs for Physician-patient communication are a step toward an integrative, all-inclusive competency-based assessment framework for patient-centered care. They are meant to improve the quality of physician patient interaction by standardizing communication as a decision of entrustment. The EPAs can be linked to competency frameworks around the world and provide a useful assessment framework for effective training in patient communication. They can be integrated into any post graduate curriculum and can also serve as a self-assessment tool for postgraduate training programs across the globe to improve their patient communication curricula.
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Affiliation(s)
- Ayesha Younas
- Department of Medical and Dental Education, Shifa College of Dentistry, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
| | - Rehan Ahmed Khan
- Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan
| | - Raheela Yasmin
- RARE Department, Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan
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VanLangen KM, Sahr MJ, Salvati LA, Meny LM, Bright DR, Sohn M. Viability of Virtual Skills-based Assessments Focused on Communication. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2021; 85:8378. [PMID: 34544738 PMCID: PMC8499660 DOI: 10.5688/ajpe8378] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/26/2021] [Indexed: 05/12/2023]
Abstract
Objective To evaluate faculty and student perceptions of and performance on virtual skills-based assessments focused on communication compared to in-person assessments.Methods In spring 2020, virtual skills-based assessments were conducted. After all assessments were completed, two 12-item questionnaires, one for students and one for the faculty members who conducted the assessment, were designed to assess perceptions of virtual skills-based assessments. The surveys were distributed via an online platform to second- and third-year (P2 and P3) pharmacy students and to faculty who had participated in a virtual skills-based assessment. Scores from the spring 2020 virtual skills-based assessment were compared to scores on the in-person skills-based assessment that took place in spring 2019.Results Of the 19 faculty and 279 students invited to participate, 18 (94.7%) faculty and 241 (86.4%) students responded. The majority of faculty (88.9%) and students (63.5%) perceived the virtual skills-based assessments to be effective at simulating an interaction. However, only 33.3% of faculty and 28.6% of students preferred the virtual environment. There was not a significant difference in student performance between in-person and virtual assessments for patient consultation and SOAP note skills.Conclusion Providing sufficient formative and summative feedback to pharmacy students is a challenge, particularly in the context of skills-based assessments. Students and faculty reported that the virtual assessment provided an opportunity for an appropriate assessment of student communication skills. However, a strong preference for using virtual skills-based assessments in the future was not observed.
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Affiliation(s)
- Kali M VanLangen
- Ferris State University, College of Pharmacy, Grand Rapids, Michigan
| | - Michelle J Sahr
- Ferris State University, College of Pharmacy, Big Rapids, Michigan
| | - Lisa A Salvati
- Ferris State University, College of Pharmacy, Grand Rapids, Michigan
| | - Lisa M Meny
- Ferris State University, College of Pharmacy, Grand Rapids, Michigan
| | - David R Bright
- Ferris State University, College of Pharmacy, Big Rapids, Michigan
| | - Minji Sohn
- Ferris State University, College of Pharmacy, Big Rapids, Michigan
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Society of Critical Care Medicine 50th Anniversary Review Series: Critical Care Education. Crit Care Med 2021; 49:1241-1253. [PMID: 34261924 DOI: 10.1097/ccm.0000000000005130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Prediger S, Harendza S. Perspective matters: assessment of medical students' communication and interpersonal skills by simulated patients from the internal and external patient perspective. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc82. [PMID: 34056071 PMCID: PMC8136342 DOI: 10.3205/zma001478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 12/16/2020] [Accepted: 02/16/2021] [Indexed: 06/12/2023]
Abstract
Background: Communication and interpersonals skills are important qualities of professionalism in medicine. In medical curricula, they are usually acquired in communication trainings and assessed in OSCEs. Studies show correlations as well as differences between communication ratings of examiners and simulated patients. In our study, simulated patients assessed medical students' communication and interpersonal skills after a consultation hour from the internal and the external patient perspective. Methods: In December 2019, 52 final-year medical students participated in a consultation hour as part of a simulated first day of residency assessment. They were assessed twice with a questionnaire for communication and interpersonal skills (ComCare) by the simulated patients: directly after each consultation from the internal perspective of the patient's view (internal perspective) and four month later from the 208 consultation videos from an external perspective of the patient's view (external perspective). All eight ComCare items were assessed on a five-point Likert scale (1=full disagreement to 5=full agreement). Differences between the item means of internal and external perspective were examined by paired t-tests. Results: Overall, significantly higher ratings were found for all ComCare items from the external perspective except for the item "Interest". Ratings for the items "Language" and "Listening" were significantly higher from the external perspective for all simulated patients. Significantly higher ratings for all items from the external perspective were observed for two simulated patients. Conclusion: Simulated patients' ratings after a conversation seem to represent a more authentic view on students' communication and interpersonal skills because of the emotionally experienced situation. The evaluation of those skills from a simulated patient perspective could be a valuable complement to communication ratings by examiners.
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Affiliation(s)
- Sarah Prediger
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Hamburg, Germany
| | - Sigrid Harendza
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Hamburg, Germany
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Kennedy L, Cunin L. Should eloquence be taught as part of the undergraduate medical curriculum? MEDEDPUBLISH 2021; 10:87. [PMID: 38486561 PMCID: PMC10939647 DOI: 10.15694/mep.2021.000087.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
This article was migrated. The article was marked as recommended. The integration of the humanities into the medical curriculum over the past two decades has been widely adopted in the stream of communication usually within the realms of doctor-patient relationship. However, its integration within medical curriculum is inconsistent, and may only be present as an optional component in certain selected modules. The study of eloquence within medicine has not been described previously, we propose that its inclusion into the medical curricula will increase equality and diversity in medical training. We aim to debate the roles of medical humanities and the integration of eloquence into the medical curriculum. Integration of eloquence into the medical curriculum with the aim of developing written prose and oration could improve our interprofessional communication and bridge the gap for those from a wider social background accessing medicine.
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Boyd LAP, Waller AE, Hill D, Sanson-Fisher RW. Psychosocial well-being of brain cancer patients and support persons: A mapping review of study types over time. Eur J Cancer Care (Engl) 2021; 30:e13446. [PMID: 33772936 DOI: 10.1111/ecc.13446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This review examined the: (1) number of publications exploring psychosocial outcomes of adults with brain cancer and/or support persons between 1999 and 2019 and whether there has been a change in the type of research over time; and (2) proportion of intervention studies meeting Cochrane Effective Practice and Organisation of Care (EPOC) research design criteria. METHODS Embase, The Cochrane Library, Medline and PsycINFO databases were electronically searched January 1999 to December 2019. Articles were examined against inclusion/exclusion criteria and coded into measurement, descriptive or intervention categories. Intervention studies were assessed against the EPOC design criteria. RESULTS 220 eligible publications were identified. The number of total publications significantly increased by an average of 1 each year (95%CI = 0.7-1.3; p < 0.001). There was no significant change in the proportion of publications by study type across three time periods. Descriptive research represented the majority within each time period. Of the 17 intervention studies, only 7(41%) met EPOC design criteria. CONCLUSIONS Published literature on brain cancer psychosocial outcomes has increased significantly. However, descriptive research dominates research output. To increase high-level knowledge that can guide psychosocial care of people with brain cancer, there is a need to undertake methodologically rigorous intervention trials.
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Affiliation(s)
- Lucy A P Boyd
- Health Behaviour Research Collaborative, Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton, NSW, Australia.,Department of General Practice and Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Amy E Waller
- Health Behaviour Research Collaborative, Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - David Hill
- Health Behaviour Research Collaborative, Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,School of Population and Global Health and School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Rob W Sanson-Fisher
- Health Behaviour Research Collaborative, Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton, NSW, Australia
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Bion J, Brookes O, Brown C, Tarrant C, Archer J, Buckley D, Buckley LM, Clement I, Evison F, Smith FG, Gibbins C, Hayton EJ, Jones J, Lilford R, Mullhi R, Packer G, Perkins GD, Shelton J, Snelson C, Sullivan P, Vlaev I, Wolstenholme D, Wright S. A framework and toolkit of interventions to enhance reflective learning among health-care professionals: the PEARL mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background
Although most health care is high quality, many patients and members of staff can recall episodes of a lack of empathy, respect or effective communication from health-care staff. In extreme form, this contributes to high-profile organisational failures. Reflective learning is a universally promoted technique for stimulating insight, constructive self-appraisal and empathy; however, its efficacy tends to be assumed rather than proven. The Patient Experience And Reflective Learning (PEARL) project has used patient and staff experience to co-design a novel reflective learning framework that is based on theories of behaviour and learning.
Objective
To create a toolkit to help health-care staff obtain meaningful feedback to stimulate effective reflective learning that will promote optimal patient-, family- and colleague-focused behaviours.
Design
A 3-year developmental mixed-methods study with four interlinked workstreams and 12 facilitated co-design meetings. The Capability, Opportunity, Motivation – Behaviour framework was used to describe factors influencing the behaviour of reflection.
Setting
This took place at five acute medical units and three intensive care units in three urban acute hospital trusts in England.
Participants
Patients and relatives, medical and nursing staff, managers and researchers took part.
Data sources
Two anonymous surveys, one for patients and one for staff, were developed from existing UK-validated instruments, administered locally and analysed centrally. Ethnographers undertook interviews and observed clinical care and reflective learning activities in the workplace, as well as in the co-design meetings, and fed back their observations in plenary workshops.
Main outcome measures
Preliminary instruments were rated by participants for effectiveness and feasibility to derive a final set of tools. These are presented in an attractively designed toolbox with multiple sections, including the theoretical background of reflection, mini guides for obtaining meaningful feedback and for reflecting effectively, guides for reflecting ‘in-action’ during daily activities, and a set of resources.
Results
Local project teams (physicians, nurses, patients, relatives and managers) chaired by a non-executive director found the quarterly reports of feedback from the patient and staff surveys insightful and impactful. Patient satisfaction with care was higher for intensive care units than for acute medical units, which reflects contextual differences, but in both settings quality of communication was the main driver of satisfaction. Ethnographers identified many additional forms of experiential feedback. Those that generated an emotional response were particularly effective as a stimulus for reflection. These sources of data were used to supplement individual participant experiences in the nine local co-design meetings and four workshops to identify barriers to and facilitators of effective reflection, focusing on capability, opportunity and motivation. A logic model was developed combining the Capability, Opportunity, Motivation – Behaviour framework for reflection and theories of learning to link patient and staff experience to changes in downstream behaviours. Participants proposed practical tools and activities to enhance reflection ‘in-action’ and ‘on-action’. These tools were developed iteratively by the local and central project teams.
Limitations
Paper-based surveys were burdensome to administer and analyse.
Conclusions
Patients and health-care staff collaborated to produce a novel reflective learning toolkit.
Future work
The toolkit requires evaluating in a cluster randomised controlled trial.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 32. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Julian Bion
- Department of Anaesthesia & Intensive Care Medicine, University of Birmingham, Birmingham, UK
| | - Olivia Brookes
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Celia Brown
- Population Evidence and Technologies, University of Warwick, Coventry, UK
| | - Carolyn Tarrant
- Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Julian Archer
- Royal Australasian College of Surgeons, Melbourne, VIC, Australia
| | - Duncan Buckley
- Patient and Public Involvement Representative, Birmingham, UK
| | | | - Ian Clement
- Critical Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Felicity Evison
- Informatics Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Fang Gao Smith
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Chris Gibbins
- Acute Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Emma-Jo Hayton
- Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jennifer Jones
- Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Richard Lilford
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Randeep Mullhi
- Critical Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Greg Packer
- Critical Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gavin D Perkins
- Critical Care Medicine, Warwick Medical School, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Jonathan Shelton
- Critical Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Catherine Snelson
- Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Critical Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul Sullivan
- Acute Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ivo Vlaev
- Behavioural Science Group, University of Warwick, Coventry, UK
| | - Daniel Wolstenholme
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber, Sheffield, UK
| | - Stephen Wright
- Critical Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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14
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Brookes O, Brown C, Tarrant C, Archer J, Buckley D, Buckley LM, Clement I, Evison F, Gao Smith F, Gibbins C, Hayton E, Jones J, Lilford R, Mullhi R, Packer G, Perkins G, Shelton J, Snelson C, Sullivan P, Vlaev I, Wolstenholme D, Wright SE, Bion J. Patient experience and reflective learning (PEARL): a mixed methods protocol for staff insight development in acute and intensive care medicine in the UK. BMJ Open 2019; 9:e030679. [PMID: 31345985 PMCID: PMC6661565 DOI: 10.1136/bmjopen-2019-030679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/19/2019] [Accepted: 06/25/2019] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Patient and staff experiences are strongly influenced by attitudes and behaviours, and provide important insights into care quality. Patient and staff feedback could be used more effectively to enhance behaviours and improve care through systematic integration with techniques for reflective learning. We aim to develop a reflective learning framework and toolkit for healthcare staff to improve patient, family and staff experience. METHODS & ANALYSIS Local project teams including staff and patients from the acute medical units (AMUs) and intensive care units (ICUs) of three National Health Service trusts will implement two experience surveys derived from existing instruments: a continuous patient and relative survey and an annual staff survey. Survey data will be supplemented by ethnographic interviews and observations in the workplace to evaluate barriers to and facilitators of reflective learning. Using facilitated iterative co-design, local project teams will supplement survey data with their experiences of healthcare to identify events, actions, activities and interventions which promote personal insight and empathy through reflective learning. Outputs will be collated by the central project team to develop a reflective learning framework and toolkit which will be fed back to the local groups for review, refinement and piloting. The development process will be mapped to a conceptual theory of reflective learning which combines psychological and pedagogical theories of learning, alongside theories of behaviour change based on capability, opportunity and motivation influencing behaviour. The output will be a locally-adaptable workplace-based toolkit providing guidance on using reflective learning to incorporate patient and staff experience in routine clinical activities. ETHICS & DISSEMINATION The PEARL project has received ethics approval from the London Brent Research Ethics Committee (REC Ref 16/LO/224). We propose a national cluster randomised step-wedge trial of the toolkit developed for large-scale evaluation of impact on patient outcomes.
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Affiliation(s)
- Olivia Brookes
- Research, Development & Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Celia Brown
- Warwick Medical School (WMS), The University of Warwick, Warwick, UK
| | | | - Julian Archer
- Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
- Peninsula College of Medicine and Dentistry, Plymouth, UK
| | | | | | - Ian Clement
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Felicity Evison
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Fang Gao Smith
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Chris Gibbins
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Emma Hayton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Richard Lilford
- Division of Health and Population Sciences, University of Warwick, Coventry, UK
| | - Randeep Mullhi
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Greg Packer
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gavin Perkins
- Clinical Trials Unit, University of Warwick, Birmingham, UK
| | - Jonathan Shelton
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | | | - Ivo Vlaev
- Warwick Business School, Coventry, UK
| | | | - Stephen E Wright
- Anaesthesia, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Julian Bion
- Intensive Care Medicine, University of Birmingham, Birmingham, UK
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15
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Sanson-Fisher R, Hobden B, Carey M, Mackenzie L, Hyde L, Shepherd J. Interactional skills training in undergraduate medical education: ten principles for guiding future research. BMC MEDICAL EDUCATION 2019; 19:144. [PMID: 31092235 PMCID: PMC6521390 DOI: 10.1186/s12909-019-1566-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 04/22/2019] [Indexed: 05/10/2023]
Abstract
BACKGROUND High-quality healthcare requires practitioners who have technical competence and communication skills. Medical practitioners need interpersonal skills for gathering and transferring information to their patients, in addition to general consultation skills. Appropriate information gathering increases the likelihood of an accurate diagnosis. Transferring information should be performed in a way that promotes patient understanding and increases the probability of adherence to physician recommendations. This applies to: (i) primary prevention such as smoking cessation; (ii) secondary prevention including preparation for potentially threatening interventions; and (iii) tertiary care, including breaking bad news regarding treatment and prognosis. DISCUSSION This debate paper delineates factors associated with undergraduate medical communication skills training where robust research is needed. Ten key principles are presented and discussed, which are intended to guide future research in this field and ensure high quality studies with methodological rigour are conducted. The literature on communication skills training for medical school undergraduates continues to grow. A considerable portion of this output is represented by commentaries, descriptive studies or poorly designed interventions. As with any field of healthcare, quality research interventions are required to ensure practice is grounded in high-level evidence.
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Affiliation(s)
- Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Breanne Hobden
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Mariko Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Lisa Mackenzie
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Lisa Hyde
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Jan Shepherd
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
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