Education in patient–physician communication: How to improve effectiveness?

Objective

Despite educational efforts expertise in communication as required by the CanMEDS competency framework is not achieved by medical students and residents. Several factors complicate the learning of professional communication.

Methods

We adapted the reflective–impulsive model of social behaviour to explain the complexities of learning professional communication behaviour. We formulated recommendations for the learning objectives and teaching methods of communication education. Our recommendations are based on the reflective–impulsive model and on the model of deliberate practice which complements the reflective–impulsive model. Our recommendations are substantiated by those we found in the literature.

Results

The reflective–impulsive model explains why the results of communication education fall below expectations and how expertise in communication can be attained by deliberate practice. The model of deliberate practice specifies learning conditions which are insufficiently fulfilled in current communication programmes.

Conclusion

The implementation of our recommendations would require a great deal of effort. Therefore we doubt whether expertise in professional communication can be fully attained during medical training.

Practice implications

We propose that the CanMEDS communication competencies not be regarded as endpoints in medical education but as guidelines to improve communication competency through deliberate practice throughout a professional career.     

Expert surgeon's quiet eye and slowing down: expertise differences in performance and quiet eye duration during identification and dissection of the recurrent laryngeal nerve

Background

Long quiet eye (QE) duration is central to expertise in sports, while cognitive “slowing down” has been identified as a perceptual skill possessed by skilled surgeons. Eye-tracking evidence is lacking about the relationship of QE duration to slowing down in surgeons. The aim of this study was to examine QE duration, hand movement time (MT), fixation location, and fixation duration in highly experienced (HE) and less experienced (LE) surgeons.

Methods

A mobile eye tracker and camera recorded coupled gaze and hand movements. Performance was quantified by blinded review.

Results

HE surgeons were rated higher than LE surgeons but did not differ in operating time or MT. HE and LE surgeons differed in fixation duration on the ligament of Berry during phases 1 and 2 and QE duration on the recurrent laryngeal nerve in phase 2.

Conclusions

Long-duration fixation on the ligament of Berry and long-duration QE on the recurrent laryngeal nerve combined with no significant differences in MT provide empirical evidence that HE surgeons cognitively slow down more than LE surgeons during critical phases of the operation.     

Quiet eye training improves surgical knot tying more than traditional technical training: a randomized controlled study

Background

We examined the effectiveness of technical training (TT) and quiet eye training (QE) on the performance of one-handed square knot tying in surgical residents.

Methods

Twenty surgical residents were randomly assigned to the 2 groups and completed pretest, training, retention, and transfer tests. Participants wore a mobile eye tracker that simultaneously recorded their gaze and hand movements. Dependent variables were knot tying performance (%), QE duration (%), number of fixations, total movement time (s), and hand movement phase time (s).

Results

The QE training group had significantly higher performance scores, a longer QE duration, fewer fixations, faster total knot tying times, and faster movement phase times compared with the TT group. The QE group maintained performance in the transfer test, whereas the TT group significantly decreased performance from retention to transfer.

Conclusions

QE training significantly improved learning, retention, and transfer of surgical knot tying compared with a traditional technical approach. Both performance effectiveness (performance outcome) and movement efficiency (hand movement times) were improved using QE modeling, instruction, and feedback.     

Expertises de l'article R. 4124-3 du CSP : suspension d'exercice pour un état pathologique

The implementation of article R. 4124-3 of the Public Health Code aims at suspending the activities of doctors deemed dangerous due to a pathological condition. The situations that may arise - alcoholism, drug addiction, mental pathologies - are always dramatic. The urgency dictated by the necessity of saving the patient's health imposes very short procedural delays that are then imposed in their turn to regional medical associations competent in these matters. This extreme shortness of delays has repercussions on the expertise to be given. As of now, the text of the article allows only one alternative for the decision that has to be made: aptitude or inaptitude to exercise the profession. The article does not allow restricting a doctor's activities so as to adapt them to his condition. The follow-up by other doctors that is sometimes ensured by departmental associations may allow to somewhat allay the rigor of the text.     

Unacknowledged adverse transfusion reactions: Are they a mine to dig?

Objectives

Haemovigilance has long tried to characterize and understand transfusion reactions in order to prevent them. Unacknowledged ones are now a minority but they question us. Are they the result of incomplete clinical setting and/or insufficient medical reasoning, or can they contain real new entities we have not yet understood?

Practice makes perfect: A systematic review of the expertise development of pharmacist and nurse independent prescribers in the United Kingdom

Background

Prescribing is a complex and error-prone task that demands expertise. McLellan et al.'s theory of expertise development model (“the model”), developed to assess medical literature on prescribing by medical students, proposes that in order to develop, individuals should deliberately engage their knowledge, skills and attitudes within a social context. Its applicability to independent prescribers (IP) is unknown.

Analysis of the procedures used to evaluate suicide crime scenes in Brazil: A statistical approach to interpret reports

This study uses statistical techniques to evaluate reports on suicide scenes; it utilizes 80 reports from different locations in Brazil, randomly collected from both federal and state jurisdictions. We aimed to assess a heterogeneous group of cases in order to obtain an overall perspective of the problem. We evaluated variables regarding the characteristics of the crime scene, such as the detected traces (blood, instruments and clothes) that were found and we addressed the methodology employed by the experts. A qualitative approach using basic statistics revealed a wide distribution as to how the issue was addressed in the documents. We examined a quantitative approach involving an empirical equation and we used multivariate procedures to validate the quantitative methodology proposed for this empirical equation. The methodology successfully identified the main differences in the information presented in the reports, showing that there is no standardized method of analyzing evidences.     

Réquisitions et expertises psychiatriques pénales : quelles exigences pour le psychiatre ?

The activity of forensic psychiatry is the essence of discipline at its birth, its history and its daily practice. The psychiatrist may be required to examine a person in custody by the district attorney or his substitute in the spot investigation or preliminary and to investigate the mental state of offenders at the very first stages of the penal process. The practice between the requisition and the forensic psychiatric examination represents a criminological challenge, which leads to a new kind of relationship between psychiatrists and law officers.