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

Complexity and objectivity in teaching interprofessional healthcare communication

OBJECTIVE

This article, based on a plenary presentation from ICCH 2024, examines the challenge of balancing objectivity and complexity, and the risk of violent simplification, when it comes to teaching and assessing interprofessional healthcare communication.

DISCUSSION

Interpersonal communication, that is, conversation, makes all aspects of human social life possible. Conversation is complex and is managed by participants in emergent and dynamic ways. To facilitate the practical needs of teaching and assessment, we simplify conversation into produced objectivities that reflect disciplinary and dominant cultural norms and values at the time of their creation. These objectivities do not necessarily adequately reflect the way in which conversations unfold in dynamic, participant-managed ways as they often list specific contextualized behaviors rather than the context-free system of conversation. Despite this, they often become standardized and used in ways that can lead to harm for students, patients and carers, and educators. This violent simplification is made possible through educational and healthcare systems that reinforce disciplinary silos and underinvest in communication education.

CONCLUSIONS

Engaging with the complexity of conversation within our educational practices is necessary to reduce the risk of harm. This involves explicit consideration of how objective tools are created and used in communication education, increased investment from education and healthcare sectors, and integrating knowledge about how conversation works from research of communication-in-practice.

Barriers and Unmet Educational Needs Regarding Implementation of Medication Adherence Management Across Europe: Insights from COST Action ENABLE

BACKGROUND

Medication adherence is essential for the achievement of therapeutic goals. Yet, the World Health Organization estimates that 50% of patients are nonadherent to medication and this has been associated with 125 billion euros and 200,000 deaths in Europe annually.

OBJECTIVE

This study aimed to unravel barriers and unmet training needs regarding medication adherence management across Europe.

DESIGN

A cross-sectional study was conducted through an online survey. The final survey contained 19 close-ended questions.

PARTICIPANTS

The survey content was informed by 140 global medication adherence experts from clinical, academic, governmental, and patient associations. The final survey targeted healthcare professionals (HCPs) across 39 European countries.

MAIN MEASURES

Our measures were barriers and unmet training needs for the management of medication adherence across Europe.

KEY RESULTS

In total, 2875 HCPs (pharmacists, 40%; physicians, 37%; nurses, 17%) from 37 countries participated. The largest barriers to adequate medication adherence management were lack of patient awareness (66%), lack of HCP time (44%), lack of electronic solutions (e.g., access to integrated databases and uniformity of data available) (42%), and lack of collaboration and communication between HCPs (41%). Almost all HCPs pointed out the need for educational training on medication adherence management.

CONCLUSIONS

These findings highlight the importance of addressing medication adherence barriers at different levels, from patient awareness to health system technology and to fostering collaboration between HCPs. To optimize patient and economic outcomes from prescribed medication, prerequisites include adequate HCP training as well as further development of digital solutions and shared health data infrastructures across Europe.

Interprofessional collaboration between medical imaging academics and linguists in developing communication skills

INTRODUCTION/BACKGROUND

Effective communication is critical in all healthcare professions, including medical imaging. This is demonstrated across the professional capability requirements outlined by regulatory bodies that represent medical radiation practitioners around the world. Thus, it is imperative that university curricula provide students with opportunities to develop their communication skills to ensure graduates are prepared to deliver high-quality person-centred care (PCC). The aim of this educational perspective paper is to discuss an interprofessional collaboration between academics from medical imaging and a linguist from the Faculty of Medicine, Nursing and Health Sciences' health communication unit to develop and deliver a pre-clinical communication skills program for undergraduate medical imaging students at Monash University. This innovative program aims to address the unique communication challenges encountered during medical imaging examinations.

DISCUSSION

Medical imaging programs tend to use a combination of lectures, role-play and structured workshops to teach communication skills to undergraduate students. These are normally run by medical imaging academics who have significant clinical experience as well as tacit intuitive understanding of communication challenges. This intuitive knowledge can be challenging to articulate to novice learners. In comparison, a linguist is an expert in the use and form of language in context, and can collaborate with medical imaging academics to support students in developing their understanding of communication as a tool for use in caring and compassionate practice as part of a PCC approach. This paper highlights an interprofessional collaboration between medical imaging academics and a linguist to develop and deliver an integrated communication skills program at Monash University, bringing together the expertise of both fields to support medical imaging students in effectively communicating with patients in the clinical context.

CONCLUSION

The interprofessional collaboration between medical imaging academics and a linguist at Monash University shows early promise. Our collaborative pre-clinical communication skills curriculum development and delivery pioneers an innovative method within the medical imaging curriculum which integrates best practice from both medical imaging and linguistic fields.

Verbal Glasgow Coma Scale as predictor of persistent disorder of consciousness: Insights for improving accuracy and reliability in clinical practice

This brief report discusses the relationship between verbal function, disorders of consciousness, and neurological follow-up after acute brain injury. It provides valuable insights for improving the accuracy and reliability of Verbal Glasgow Coma Scale scoring in clinical practice. The report addresses the need for standardized training and underlines the importance of physiological stabilization before assessment. Clarity in communication, recognition of non-verbal cues, and serial assessments are emphasized as critical factors to reduce the Verbal Glasgow Coma Scale inconsistencies. It also promotes interdisciplinary collaboration and cultural sensitivity to refine the Verbal Glasgow Coma Scale evaluation, improving the prediction of long-term neurological outcomes after acute brain injury and optimizing effective rehabilitation programs. Possible strategies to implement in the routine clinical practice the provided tips are discussed.

The design and evaluation of gamified online role-play as a telehealth training strategy in dental education: an explanatory sequential mixed-methods study

To evaluate user perceptions and educational impact of gamified online role-play in teledentistry as well as to construct a conceptual framework highlighting how to design this interactive learning strategy, this research employed an explanatory sequential mixed-methods design. Participants were requested to complete self-perceived assessments toward confidence and awareness in teledentistry before and after participating in a gamified online role-play. They were also asked to complete a satisfaction questionnaire and participate in an in-depth interview to investigate their learning experience. The data were analyzed using descriptive statistics, paired sample t-test, one-way analysis of variance, and framework analysis. There were 18 participants who completed self-perceived assessments and satisfaction questionnaire, in which 12 of them participated in a semi-structured interview. There were statistically significant increases in self-perceived confidence and awareness after participating in the gamified online role-play (P < 0.001). In addition, the participants were likely to be satisfied with this learning strategy, where usefulness was perceived as the most positive aspect with a score of 4.44 out of 5, followed by ease of use (4.40) and enjoyment (4.03). The conceptual framework constructed from the qualitative findings has revealed five key elements in designing a gamified online role-play, including learner profile, learning settings, pedagogical components, interactive functions, and educational impact. The gamified online role-play has demonstrated its potential in improving self-perceived confidence and awareness in teledentistry. The conceptual framework developed in this research could be considered to design and implement a gamified online role-play in dental education. This research provides valuable evidence on the educational impact of gamified online role-play in teledentistry and how it could be designed and implemented in dental education. This information would be supportive for dental instructors or educators who are considering to implement teledentistry training in their practice.

Clinical preparedness programme as perceived by first-year diagnostic radiography students in South Africa

INTRODUCTION

There is an increasing emphasis on exploring ways to improve students' transition from the classroom into the clinical environment. Diagnostic radiography (DR) students undergo rigorous theoretical and practical training before they are exposed to the clinical environment. It has been found that when DR students commence clinical learning in the workplace for the very first time, they experience difficulties in this transition. At the site of investigation, a newly integrated and dedicated clinical preparedness (CP) programme was offered; however, little is known about the DR students' perceptions of this programme.

METHODS

A qualitative approach coupled with a self-developed, cross-sectional research tool was employed. First-year DR students were purposefully sampled against the inclusion and exclusion criteria. The principle of voluntary participation was upheld throughout the data collection process. The data were analysed using Braun and Clarke's six steps of thematic analysis.

RESULTS

Forty-two responses were collected. Following a thematic analysis, two overarching themes were developed, namely: (1) reflections on the CP programme and (2) suggestions for future CP programmes.

CONCLUSION

This study demonstrated the need for effective CP programmes as an approach to ease the transition of first-year DR students from the classroom into the clinical environment. Several suggestions, for example, an extended CP programme and a clinical information pack were made for the offering of similar programmes in the future.

The impact of education/training on nurses caring for patients with stroke: a scoping review

BACKGROUND

Stroke survivors have complex needs that necessitate the expertise and skill of well-trained healthcare professionals to provide effective rehabilitation and long-term support. Limited knowledge exists regarding the availability of specialized education and training programs specifically designed for nurses caring for stroke patients.

AIM

This review aims to assess the content and methods of training for nurses caring for stroke patients, examine its impact on both nurses and patients, and identify key facilitators and barriers to its implementation.

METHODS

We conducted a comprehensive scoping review by reviewing multiple databases, including PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Embase, Web of Science, Scopus, ProQuest Dissertations and Theses, Google Scholar, and Cochrane databases. Data extraction and narrative synthesis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines.

RESULTS

Seventeen articles were included in this review. We found that education/training not only enhanced patients' self-care abilities, nursing outcomes, and satisfaction, but also had a positive impact on the knowledge, skills, and practices of nurses. The obstacles to education/training included feasibility and cost-effectiveness, while the driving factors were management support and participation, professional education/training, and controlled environment creation.

CONCLUSIONS

This review highlights the crucial role of education/training in enhancing stroke care provided by nurses. Effective education/training integrates various educational methods and management support to overcome implementation barriers and optimize clinical practice benefits. These findings indicate the necessity of universal and consistent stroke education/training for nurses to further improve patient outcomes in stroke care.

Conversation Analysis Based Simulation (CABS): A method for improving communication skills training for healthcare practitioners

BACKGROUND

Actors portraying simulated patients are widely used in communication skills training in healthcare, but debates persist over the authenticity of these interactions. However, healthcare professionals value simulation-based training because of the opportunity to think and react in real time, which alternatives cannot provide.

OBJECTIVE

To describe a method for the use of simulation which maximises authenticity by grounding training in real, observed, patterns of patient communication.

DESIGN

Naturally occurring care interactions were video recorded and analysed using conversation analysis (CA) to identify communication patterns. We focused on sites of recurring interactional trouble as areas for training, and identified more and less effective ways of dealing with these. We used the CA findings to train actors portraying simulated patients, based on the observed interactional patterns.

SETTINGS AND PARTICIPANTS

Patients living with dementia and healthcare practitioners (HCPs) on two acute healthcare of the elderly wards in the English East Midlands.

OUTCOME MEASURES

One month later HCPs reported using the skills learned in clinical practice. Masked-ratings of before and after simulated patient encounters confirmed these self-reports in relation to one key area of training.

RESULTS

The Conversation Analysis Based Simulation (CABS) method used in this setting showed positive results across a range of quantitative and qualitative outcome measures. What is significant for the transferability of the method is that qualitative feedback from trainees highlighted the ability of the method to not only illuminate their existing effective practices, but to understand why these were effective and be able to articulate them to others.

DISCUSSION/CONCLUSION

While the CABS method was piloted in the dementia care setting described here, it has potential applicability across healthcare settings where simulated consultations are used in communication skills training. Grounding simulated interaction in the observed communication patterns of real patients is an important means of maximising authenticity.

PATIENT AND PUBLIC CONTRIBUTION

The VideOing to Improve dementia Communication Education (VOICE) intervention which piloted the CABS method was developed by a multidisciplinary team, including three carers of people with dementia. People living with dementia were involved in the rating of the before and after video simulation assessments.

Companion responses to diagnosis in Chinese outpatient clinical interaction

Patients regularly attend clinical consultations with companions in Chinese outpatient clinics. Despite companions' significant influence on clinical consultations, how companions respond to diagnosis and their contributions to the activity of diagnosis in Chinese outpatient clinical interaction remain under-researched. The present study, by adopting the method of conversation analysis, investigated clinicians' diagnostic deliveries and companions' subsequent responses in Chinese outpatient clinical interaction. The data for this study consisted of 79 video recordings of clinical consultations in the Chinese orthopedic outpatient clinic, approximately lasting 12 h and involving three male clinicians, 79 patients (37 male/42 female), and 91 companions (51 male/40 female). Three basic categories of companion responses to diagnosis were identified: minimal verbal responses, embodied responses, and extended responses. It was demonstrated that these distinct responses allowed companions to challenge clinicians' medical authority in the activity of diagnosis by delivering their own diagnostic judgments, resisting clinicians' diagnoses, and orienting to clinicians' accounts for their diagnostic statements and reasoning, thus displaying companion agency in the Chinese outpatient clinical decision-making and indicating a transition from a paternalistic model to a family-centered model of the doctor-patient relationship in the Chinese orthopedic outpatient interaction. This study furthers current knowledge of companion involvement across healthcare contexts and contributes to raising clinicians' awareness of the significance of companions' contributions in Chinese outpatient clinical interaction.

How student healthcare providers in a communication skills course respond to standardized patient resistance

Encountering and responding to patient resistance can be especially challenging for student healthcare providers. Navigating who ultimately holds the authority to know and understand a health concern, make recommendations for a course of action, and accept or resist these recommendations are all part of how epistemic authority is negotiated in medical settings. The purpose of this paper is to systematically examine how student providers enrolled in a communication skills course at an American university responded to standardized patient resistance. The data for this study were 121 video-recorded and transcribed final objective structured clinical examinations from the fall 2019 course. We used discourse analysis informed by principles of conversation analysis to identify several discursive strategies used by the students, including: 1) asking for clarification; 2) expressing uncertainty and offering to gather additional resources; 3) aligning with and offering an account for the resistance; 4) recommending a new course of action; and 5) confronting the resistance. Our findings point to the value of including instruction for both student healthcare providers and standardized patients on how to respond to resistance they encounter in ways that may help improve healthcare outcomes.

Empathic communication between clinicians, patients, and care partners in palliative care encounters

OBJECTIVE

Palliative care encounters often involve empathic opportunities conveyed by patients and their care partners. In this secondary analysis, we examined empathic opportunities and clinician responses with attention to how presence of multiple care partners and clinicians shapes empathic communication.

METHODS

We used the Empathic Communication Coding System (ECCS) to characterize emotion-focused, challenge-focused, and progress-focused empathic opportunities and responses in 71 audio-recorded palliative care encounters in the US.

RESULTS

Patients expressed more emotion-focused empathic opportunities than did care partners; care partners expressed more challenge-focused empathic opportunities than did patients. Care partners initiated empathic opportunities more frequently when more care partners were present, though they expressed fewer as the number of clinicians increased. When more care partners and more clinicians were present, clinicians had fewer low-empathy responses.

CONCLUSION

The number of care partners and clinicians present affect empathic communication. Clinicians should be prepared for empathic communication focal points to shift depending on the number of care partners and clinicians present.

PRACTICE IMPLICATIONS

Findings can guide development of resources to prepare clinicians to meet emotional needs in palliative care discussions. Interventions can coach clinicians to respond empathically and pragmatically to patients and care partners, particularly when multiple care partners are in attendance.

Definition, management, and training in impacted fetal head at cesarean birth: a national survey of maternity professionals

INTRODUCTION

This study assessed views, understanding and current practices of maternity professionals in relation to impacted fetal head at cesarean birth, with the aim of informing a standardized definition, clinical management approaches and training.

MATERIAL AND METHODS

We conducted a survey consultation including the range of maternity professionals who attend emergency cesarean births in the UK. Thiscovery, an online research and development platform, was used to ask closed-ended and free-text questions. Simple descriptive analysis was undertaken for closed-ended responses, and content analysis for categorization and counting of free-text responses. Main outcome measures included the count and percentage of participants selecting predefined options on clinical definition, multi-professional team approach, communication, clinical management and training.

RESULTS

In total, 419 professionals took part, including 144 midwives, 216 obstetricians and 59 other clinicians (eg anesthetists). We found high levels of agreement on the components of an impacted fetal head definition (79% of obstetricians) and the need for use of a multi-professional approach to management (95% of all participants). Over 70% of obstetricians deemed nine techniques acceptable for management of impacted fetal head, but some obstetricians also considered potentially unsafe practices appropriate. Access to professional training in management of impacted fetal head was highly variable, with over 80% of midwives reporting no training in vaginal disimpaction.

CONCLUSIONS

These findings demonstrate agreement on the components of a standardized definition for impacted fetal head, and a need and appetite for multi-professional training. These findings can inform a program of work to improve care, including use of structured management algorithms and simulation-based multi-professional training.

Training for managing impacted fetal head at caesarean birth: multimethod evaluation of a pilot

BACKGROUND

Implementation of national multiprofessional training for managing the obstetric emergency of impacted fetal head (IFH) at caesarean birth has potential to improve quality and safety in maternity care, but is currently lacking in the UK.

OBJECTIVES

To evaluate a training package for managing IFH at caesarean birth with multiprofessional maternity teams.

METHODS

The training included an evidence-based lecture supported by an animated video showing management of IFH, followed by hands-on workshops and real-time simulations with use of a birth simulation trainer, augmented reality and management algorithms. Guided by the Kirkpatrick framework, we conducted a multimethod evaluation of the training with multiprofessional maternity teams. Participants rated post-training statements about relevance and helpfulness of the training and pre-training and post-training confidence in their knowledge and skills relating to IFH (7-point Likert scales, strongly disagree to strongly agree). An ethnographer recorded sociotechnical observations during the training. Participants provided feedback in post-training focus groups.

RESULTS

Participants (N=57) included 21 midwives, 25 obstetricians, 7 anaesthetists and 4 other professionals from five maternity units. Over 95% of participants agreed that the training was relevant and helpful for their clinical practice and improving outcomes following IFH. Confidence in technical and non-technical skills relating to managing IFH was variable before the training (5%-92% agreement with the pre-training statements), but improved in nearly all participants after the training (71%-100% agreement with the post-training statements). Participants and ethnographers reported that the training helped to: (i) better understand the complexity of IFH, (ii) recognise the need for multiprofessional training and management and (iii) optimise communication with those in labour and their birth partners.

CONCLUSIONS

The evaluated training package can improve self-reported knowledge, skills and confidence of multiprofessional teams involved in management of IFH at caesarean birth. A larger-scale evaluation is required to validate these findings and establish how best to scale and implement the training.

Nursing students' views of the impact of geriatric role-play workshops on professional competencies: survey

BACKGROUND

Simulation and role-playing are the most commonly used experiential teaching methods in nursing education. The purpose of the study was to describe the impact of geriatric role-play workshops on the knowledge and skills of nursing students. We set one hypothesis: Students believe that learning through experiential role-play improves their professional competencies.

METHODS

We conducted a descriptive quantitative study, collecting the data with a questionnaire. The study included 266 first-year nursing students who underwent 10 h of role-playing workshops in geriatric nursing in 2021. The questionnaire was compiled for the purpose of the present study, and its' internal consistency was 0.844 (n = 27). We used descriptive and correlation statistical analysis.

RESULTS

Respondents were convinced that they gained and consolidated knowledge and connected theory with practice through role-playing. They especially emphasized the abilities they acquired to communicate in a group, engage in constructive reflection, be more sensitive to one's own emotions, and feel empathy.

CONCLUSIONS

Respondents understand the use of the role-play method as an effective form of learning in geriatric nursing. They are convinced that they will be able to use the experience when working with an elderly patient in a clinical setting.

Learning patient-centredness with simulated/standardized patients: A realist review: BEME Guide No. 68

BACKGROUND

Given the positive outcomes of patient-centred care on health outcomes, future doctors should learn how to deliver patient-centred care. The literature describes a wide variety of educational interventions with standardized patients (SPs) that focus on learning patient-centredness. However, it is unclear which mechanisms are responsible for learning patient-centredness when applying educational interventions with SPs.

OBJECTIVE

This study aims to clarify how healthcare learners and professionals learn patient-centredness through interventions involving SPs in different healthcare educational contexts.

METHODS

A realist approach was used to focus on what works, for whom, in what circumstances, in what respect and why. Databases were searched through 2019. Nineteen papers were included for analysis. Through inductive and deductive coding, CIC'MO configurations were identified to build partial program theories. These CIC'MOs describe how Interventions with SPs change the Context (C→C') such that Mechanisms (M) are triggered that are expected to foster patient-centredness as Outcome.

RESULTS

Interventions with SPs create three contexts which are 'a safe learning environment,' 'reflective practice,' and 'enabling people to learn together.' These contexts trigger the following seven mechanisms: feeling confident, feeling a sense of comfort, feeling safe, self-reflection, awareness, comparing & contrasting perspectives, combining and broadening perspectives. A tentative final program theory with mechanisms belonging to three main learning components (cognitive, regulative metacognitive and affective) is proposed: Interventions with SPs create a safe learning environment (C') in which learners gain feelings of confidence, comfort and safety (affective M). This safe learning environment enables two other mutual related contexts in which learners learn together (C'), through comparing & contrasting, combining and broadening their perspectives (cognitive M) and in which reflective practice (C') facilitates self-reflection and awareness (metacognitive M) in order to learn patient-centeredness.

CONCLUSION

These insights offer educators ways to deliberately use interventions with SPs that trigger the described mechanisms for learning patient-centredness.

Adaptation and translation of a scalable measure for assessing health worker competence to deliver a brief psychological intervention: A case study from central India of its comparison to a performance-based measure

Efforts to reduce the global burden of common mental disorders have focused on scaling up evidence-based training programs for non-specialist providers to deliver brief psychological interventions. To evaluate these provider training programs, appropriate and scalable assessments of competency need to be developed alongside them. We followed a systematic approach for the cultural adaptation and translation into Hindi of a valid, English, multiple-choice applied knowledge measure to assess non-specialists' competence to deliver a brief psychological intervention for depression in rural India. We then explored the relationship between the performance of 30 non-specialist providers on the same written measure compared with a structured performance-based measure consisting of two role-plays. The results of the multiple-choice assessment had an overall mean score of 37.40 (SD = 11.31) compared to the mean scores of role-play A (the easier role-play) of 43.25 (SD = 14.50) and role-play B (the more difficult role-play) of 43.25 (SD = 13.00). Role-play performance-based measures and written applied knowledge measures represent different approaches with unique strengths and challenges to measuring competence. Scaling up training programs requires the development of scalable methods for competency assessment. Exploring the relationship between these two measures, our team found no apparent differences between the two modes of assessment. Continued comparison of these approaches is needed to determine the consistency of outcomes across the two formats and to link the scores on these measures with clinical performance as reflected by the quality of care and patient outcomes.Trial Registration: ClinicalTrials.gov Identifier: NCT04157816; 8th November 2019.

Older adults' refusal speech act in cognitive assessment: A multimodal pragmatic perspective

This paper explores how older adults with different cognitive abilities perform the refusal speech act in the cognitive assessment in the setting of memory clinics. The refusal speech act and its corresponding illocutionary force produced by nine Chinese older adults in the Montreal Cognitive Assessment-Basic was annotated and analyzed from a multimodal perspective. Overall, regardless of the older adults' cognitive ability, the most common discursive device to refuse is the demonstration of their inability to carry out or continue the cognitive task. Individuals with lower cognitive ability were found to perform the refusal illocutionary force (hereafter RIF) with higher frequency and degree. Additionally, under the pragmatic compensation mechanism, which is influenced by cognitive ability, multiple expression devices (including prosodic features and non-verbal acts) interact dynamically and synergistically to help older adults carry out the refusal behavior and to unfold older adults' intentional state and emotion as well. The findings indicate that both the degree and the frequency of performing the refusal speech act in the cognitive assessment are related to the cognitive ability of older adults.

Efficacy Testing of a Multi-Access Metaverse-Based Early Onset Schizophrenia Nursing Simulation Program: A Quasi-Experimental Study

This study investigated the effects of a multi-access, metaverse-based early onset schizophrenia nursing simulation program based on Raskin and Rogers' person-centered therapy. The program's effectiveness was tested using a nonequivalent control group pre-test/post-test design. A quasi-experimental simulation study with both pre- and post-test designs was adopted. The experimental group (n = 29) used the simulation program, whereas the control group (n = 29) received only an online lecture on schizophrenia nursing. Changes in scores among experimental and control groups were compared using independent t-tests and analyses of covariance with PASW SPSS-WIN 27.0. Post-intervention, the knowledge regarding patients with early onset schizophrenia, critical thinking ability, and the ability to facilitate communication increased significantly in the experimental group compared with the control group. The nursing simulation program for children with early onset schizophrenia using a metaverse improved nursing students' knowledge, critical thinking ability, and ability to facilitate communication. This training method should be adapted without spatiotemporal constraints by partially supplementing clinical and simulation-based practice. In clinical nursing training, metaverse technical limitations should be identified, and training topics should be selected. Employing EduTech in a metaverse environment can provide clinical education to nurses in psychiatric wards and improve therapeutic communication with their psychiatric patients.

The Use of Simulated Patients Is more Effective than Student Role Playing in Fostering Patient-Centred Attitudes during Communication Skills Training: A Mixed Method Study

Objective

While simulated patients (SPs) are considered a standard tool in communication skills training, there is no evidence thus far of their comparative benefit to the more cost-effective option of student role playing. We compared the effectiveness of both approaches in developing patient-centred attitudes in students.

Methods

We retrospectively compared students who participated in the clinical communication course (CCC), based on student role playing (CCCsp-, n = 160), to students who participated in the CCC with SPs (CCCsp+, n = 146), and students with no formal CCC (CCC-, n = 122). We used validated questionnaires to assess patient centredness. We also conducted focus group interviews (FGI) to better understand the impact of CCC with sp.

Results

Students after the CCC with simulated patients achieved a significantly higher score in the patient-practitioner orientation scale than other groups (p < 0.001).

Conclusions

There is a strong positive correlation between the implementation of simulated patients and patient-centred attitudes among students. Data from the FGI revealed that students perceived training with SP as more realistic, safe, and engaging than student role playing. Practice Implications. Our research provides evidence to justify costs and resources invested in simulated patient programs.

Practice Makes Perfect: MSW Students Reflect on Skill-Based Teaching Methods in Clinical Social Work Education

In the current focus-group study, we consider student experiences with and perceptions of teaching methods that involve practice observation, demonstration, and performance assessment and feedback (i.e., skill-based teaching methods). Focus groups included masters of social work students (N = 40) from six universities in the United States. Students were, on average, 34 years of age (range 21 to 58) with 75% female, 20% male, and two non-binary students. Students identified as White (50%), Latinx/Latine (20%), Black (12.5%), and multi-racial (12.2%). A framework-guided content analysis was used, and revealed four broad themes: 1) classroom-based opportunities for practice observation and feedback, 2) field-based opportunities for practice observation and feedback, 3) other methods such as standardized patient simulations and computer simulations, and 4) attitudes about these methods. Experiences with these methods were quite diverse with classroom-based role plays being the most common. Attitudes were generally positive, though lack of authenticity and performance anxiety were perceived as drawbacks. Student reflections on their experiences yielded several teaching recommendations specific to preparation, the nature of the simulated client role, and feedback.

Patient-to-Patient Interactions During the Pain Management Programme: The Role of Humor and Venting in Building a Socially Supportive Community

Objectives

Social support is most positively perceived when there is an optimal match between a patient's need for communication and the purpose of their interaction. Maladaptive communication patterns may inhibit social bonding or mutual support, negatively impacting clinical outcomes. This study aimed to identify how people with chronic pain naturalistically converse together about their pain in the context of a Pain Management Programme (PMP).

Methods

Seven participants (4 females; 3 males) with ongoing chronic pain who were attending a PMP in a regional hospital in the United Kingdom were audio/video recorded during breaks in their PMP. Interactions were transcribed using Jeffersonian Transcription and analyzed using Conversation Analysis.

Results

Two conversational mechanisms were identified: (1) Conversational humor; and (2) A venting cycle. Participants used their pain-related experiences construct a motive for a joke, then proceeded to deliver the joke, which initiated a joke return from observers. The sequence was completed by a collaborative punchline. In the venting cycle, an initial complaint was escalated by the sharing of comparable experiences, after which the vent was concluded through a joke punchline, acting as a pivot to move the conversation forwards, terminating the venting.

Conclusions

Humorous interpersonal interactions about chronic pain provided a forum for social support-building within the PMP. Humor was affiliative and built social collaboration, helping individuals to together make sense of their pain in a prosocial atmosphere, approaching pain-related experiences with levity. Patient-to-patient interactions within the PMP were strongly prosocial and inclusive, potentially facilitating enhanced PMP clinical outcomes through collaboration.

Interprofessional communication in medical simulation: findings from a scoping review and implications for academic medicine

BACKGROUND

Interprofessional communication is fundamental to the delivery of healthcare and can be taught in medical school and other health professional schools through interprofessional education (IPE) activities. Simulation centers have become a predominant location for simulation IPE activities with infrastructure able to support high fidelity activities in a controlled environment. In this secondary analysis of a scoping review conducted on simulation-based IPE, we describe the characteristics of previously reported simulation IPE activities involving undergraduate medical students in a simulation center focused on interprofessional communication.

METHODS

Electronic searches of PubMed, CINAHL, and ERIC databases in accordance with PRISMA-ScR guidelines were conducted to isolate relevant articles from 2016-2020. In total, 165 peer-reviewed articles met inclusion criteria and data extraction linked to four research questions was applied by one individual and the accuracy was confirmed by a second individual. A secondary analysis was performed to describe what existing approaches for simulation IPE in simulation center settings have been used to explicitly achieve interprofessional communication competencies in undergraduate medical education. A sub-dataset was developed from the original scoping review and identified 21 studies describing simulation IPE activities that took place in dedicated simulation centers, targeted the IPEC interprofessional communication domain, and involved undergraduate medical students.

RESULTS

Though diverse, the majority of simulation IPE activities described high-fidelity approaches involving standardized patients and utilized assessment tools with established validity evidence in IPE activities to measure learning outcomes. A minority of simulation IPE activities were described as hybrid and utilized more than one resource or equipment for the activity and only two were longitudinal in nature. Learning outcomes were focused predominantly on modification of attitudes/perceptions and few targeted higher levels of assessment.

CONCLUSIONS

Educators charged with developing simulation IPE activities for medical students focused on interprofessional communication should incorporate assessment tools that have validity evidence from similar activities, target higher level learning outcomes, and leverage hybrid models to develop longitudinal simulation IPE activities. Though an ideal environment to achieve higher level learning outcomes, simulation centers are not required for meaningful simulation IPE activities.

"I Guess I Didn't Like That Word Unfortunately": Standardized Patients' Unscripted Techniques for Training Medical Students

INTRODUCTION

This article explores tacit techniques embedded in standardized patients' (SPs) unscripted dialog in a context of breaking bad news (BBN) education. It identifies a technique in which the SP explicitly repeats 1 or more of the medical student's words and analyzes the function and impact of this technique.

METHODS

This film-based ethnographic inquiry used conversation analysis to examine so-called echo utterances, through which the SP repeats all or part of what the student has said. The data set includes 9 student encounters with 2 female SPs who specialize in the BBN simulation.

RESULTS

The authors identified a technique of "repair request" used by the SPs to provide an opportunity for the student to reformulate their utterance in character. Repair requests emerged from 4 main types of student speech: speculative language, inappropriate utterances, awkward timing, and medical jargon.

CONCLUSIONS

The technique of repair request is used to heighten the student's language sensitivity and foster the ability to respond to criticism or misunderstanding in character. Discovery of the tacit, unscripted technique of repair request in this study provides an opportunity to disseminate this technique in SP training for BBN and other simulation scenarios. These findings suggest the need for further research to identify additional tacit techniques used by SPs to improve medical education.

Hirshfield L. The Resurgence of Medical Education in Sociology: A Return to Our Roots and an Agenda for the Future

From 1940 to 1980, studies of medical education were foundational to sociology, but attention shifted away from medical training in the late 1980s. Recently, there has been a marked return to this once pivotal topic, reflecting new questions and stakes. This article traces this resurgence by reviewing recent substantive research trends and setting the agenda for future research. We summarize four current research foci that reflect and critically map onto earlier projects in this subfield while driving theoretical development elsewhere in the larger discipline: (1) professional socialization, (2) knowledge regimes, (3) stratification within the profession, and (4) sociology of the field of medical education. We then offer six potential future directions where more research is needed: (1) inequalities in medical education, (2) socialization across the life course and new institutional forms of gatekeeping, (3) provider well-being, (4) globalization, (5) medical education as knowledge-based work, and (6) effects of the COVID-19 pandemic.

Improving Palliative Care Conversations Through Targeted Education and Mentorship

Health care provider communication proficiency is critical in the initiation and revisitation of these discussions throughout the trajectory of chronic illness. The delivery of palliative care (PC) throughout the continuum of illness has traditionally been underutilized. Nurses have the ability to significantly improve PC utilization through the use of advance care planning strategies to confidently initiate conversations with patients and families at multiple points throughout the continuum of illness. Nurses are uniquely positioned to contribute to the improvement of care provided to terminally and chronically ill patients because of the relationship developed and the knowledge of patient-specific disease progression that unfolds during the time spent with patients. In this study, nurses improved communication efficacy by learning to utilize advance care planning-specific interview strategies inclusive of scripting and cued language when initiating PC conversations. The preintervention/postintervention confidence levels of nurses in initiating early PC conversations significantly increased to improve the delivery of PC to patients.

Scoping reviews in medical education: A scoping review

OBJECTIVES

Over the last two decades, the number of scoping reviews in core medical education journals has increased by 4200%. Despite this growth, research on scoping reviews provides limited information about their nature, including how they are conducted or why medical educators undertake this knowledge synthesis type. This gap makes it difficult to know where the field stands and may hamper attempts to improve the conduct, reporting and utility of scoping reviews. Thus, this review characterises the nature of medical education scoping reviews to identify areas for improvement and highlight future research opportunities.

METHOD

The authors searched PubMed for scoping reviews published between 1/1999 and 4/2020 in 14 medical education journals. The authors extracted and summarised key bibliometric data, the rationales given for conducting a scoping review, the research questions and key reporting elements as described in the PRISMA-ScR. Rationales and research questions were mapped to Arksey and O'Malley's reasons for conducting a scoping review.

RESULTS

One hundred and one scoping reviews were included. On average, 10.1 scoping reviews (SD = 13.1, median = 4) were published annually with the most reviews published in 2019 (n = 42). Authors described multiple reasons for undertaking scoping reviews; the most prevalent being to summarise and disseminate research findings (n = 77). In 11 reviews, the rationales for the scoping review and the research questions aligned. No review addressed all elements of the PRISMA-ScR, with few authors publishing a protocol (n = 2) or including stakeholders (n = 20). Authors identified shortcomings of scoping reviews, including lack of critical appraisal.

CONCLUSIONS

Scoping reviews are increasingly conducted in medical education and published by most core journals. Scoping reviews aim to map the depth and breadth of emerging topics; as such, they have the potential to play a critical role in the practice, policy and research of medical education. However, these results suggest improvements are needed for this role to be fully realised.

Training in communication skills for self-efficacy of health professionals: a systematic review

BACKGROUND

Communication skills are essential for health professionals to establish a positive relationship with their patients, improving their health and quality of life. In this perspective, communication skills training can be effective strategies to improve the care provided by professionals in patient care and the quality of health services.

OBJECTIVE

To identify the best available evidence on training programs in communication skills to promote changes in attitude and behavior or self-efficacy of health professionals.

METHODS

Systematic searches were performed in eight databases, evaluating Randomized Controlled Trials and quasi-experimental studies with a control group, focusing on training communication skills for health professionals, who assessed self-efficacy or behaviors related to these skills. The phases of study selection and data extraction were carried out by two independent researchers, and the conflicts were resolved by a third. The risk of bias was assessed using the Cochrane method.

RESULTS

Eight studies were included in the review. Most programs lasted between 4½ h and 2 days, involved information about communication skills and the content was applied to the health professionals' context. Several teaching strategies were used, such as lectures, videos and dramatizations and the evaluation was carried out using different instruments. Improvements in the performance and in the self-efficacy of communication skills were observed in the trained groups. The RCT had a low risk of bias and the quasi-experimental studies had a moderate risk.

CONCLUSION

Training in communication skills can improve the performance and self-efficacy of health professionals. Programs that approach the conceptual issues and promote the space for experiential learning could be effective in communication skills training for professionals.

PROSPERO

CRD42019129384.

The educational benefits of drama in nursing education: A critical literature review

BACKGROUND

With the increasing use of technology in nursing, the importance of interpersonal skills can often be forgotten. Patient safety can also be compromised if these skills are not emphasised in nursing education.

OBJECTIVES

This review explores how drama in undergraduate and postgraduate nursing education can enhance the development of interpersonal skills such as empathy, emotional intelligence and communication.

DESIGN

A critical review of qualitative literature.

DATA SOURCES

Seven databases (CINAHL, MEDLINE, Scopus, Eric, Psycinfo, and databases dedicated to the Arts, Modern Language Association (MLA) and JSTOR were searched.

REVIEW METHODS

Studies were screened against inclusion and exclusion criteria. Data from studies selected for the review were extracted using a summary table and a thematic analysis was conducted to identify major themes to answer the research question.

RESULTS

1275 studies were identified. Following a rigorous screening process, 29 studies met the inclusion criteria and were critically appraised using the CASP tool. Of the 29 studies, 17 were excluded due to their methodological quality. A final 12 studies were included in this review. Four themes demonstrated the value of drama in nursing education. These were an understanding of the patient experience, the development of professional identity, the enhancement of communication skills and increased self-reflection and critical thinking.

CONCLUSIONS

Interpersonal skills are at the core of nursing and educational interventions that use drama can enhance the development of these skills.