The Medical Skills Centre at the University of Calgary Medical School

The aim of the Medical Skills Centre at the University of Calgary is to provide a predictable learning environment and standardized teaching methods in the area of clinical skills teaching. The centre uses volunteer patients and trained actors for all levels of medical education and evaluation. A computer database enables easy access to groups of patients and varying medical issues. This article describes the organization and operation of the Medical Skills Centre and notes a variety of courses which use the unique facilities of the centre.     

Doctor-patient communication: a study of junior house officers

This study evaluates junior house officers' perceptions of their communication skills with cancer patients; the usefulness of their undergraduate communication skills training; and their sources of emotional support. All 42 junior house officers employed at Guy's and Lewisham Hospitals in August 1994 were interviewed using a study-specific, semi-structured interview. Sixty-seven per cent of junior house officers felt they had adequate communication skills in relation to medical issues, but only 36% felt they had adequate skills in relation to psychological issues. Thirty-one per cent of doctors reported that they never, or nearly never, enquired about the emotional adjustment of dying patients. Lack of time was the most commonly reported reason for avoiding asking about psychological problems (62% of junior house officers), followed by wishing to avoid awkward questions (51%) and inadequacy of skills to deal with such issues (44%). Ninety-eight per cent of junior house officers had attended the 1-week undergraduate communication skills course at Guy's and St Thomas's Hospital Medical School (UMDS). Sixty-seven per cent of those who had attended found the course helpful and 62% felt they would benefit from further training as junior house officers. Seventy-four per cent felt they could discuss their work-related concerns with colleagues and 95% felt they could talk to friends. In contrast only about 9% felt they could, if needed, talk to a counsellor. Although the majority of the junior house officers reported benefit from their communication skills training, the course does not appear to be meeting all their communication training needs. Junior house officers require further training opportunities at the undergraduate and postgraduate levels. Traditional counselling services for junior house officers may not be meeting their support needs.     

Learning to consult with computers

OBJECTIVE: To develop and evaluate a strategy to teach skills and issues associated with computers in the consultation. INTERVENTION: An overview lecture plus a workshop before and a workshop after practice placements, during the 10-week general practice (GP) term in the 5th year of the University of Melbourne medical course. DESIGN: Pre- and post-intervention study using a mix of qualitative and quantitative methods within a strategic evaluation framework. OUTCOME MEASURES: Self-reported attitudes and skills with clinical applications before, during and after the intervention. RESULTS: Most students had significant general computer experience but little in the medical area. They found the workshops relevant, interesting and easy to follow. The role-play approach facilitated students' learning of relevant communication and consulting skills and an appreciation of issues associated with using the information technology tools in simulated clinical situations to augment and complement their consulting skills. The workshops and exposure to GP systems were associated with an increase in the use of clinical software, more realistic expectations of existing clinical and medical record software and an understanding of the barriers to the use of computers in the consultation. CONCLUSIONS: The educational intervention assisted students to develop and express an understanding of the importance of consulting and communication skills in teaching and learning about medical informatics tools, hardware and software design, workplace issues and the impact of clinical computer systems on the consultation and patient care.     

Increased focus on the teaching of interactional skills to medical practitioners

The interaction which occurs between the doctor and patient has been described as the cornerstone of medial care. Research has shown that interactional skills can have a substantial impact on patient outcomes in a number of areas. However, as practitioners do not necessarily acquire such skills through clinical practice, the introduction of formal training programmes for both under and postgraduate medical practitioners should be more closely examined. This paper outlines a number of issues which need to be considered in the formal instruction of medical practitioners in interactional skills. These issues include the teaching of skills within a clinical context that will reflect actual medical practice, the use of all medical disciplines to teach the skills and the inclusion of formal assessment strategies based on the same rigorous criteria as other components of the medical curriculum.     

A qualitative study examining tensions in interdoctor telephone consultations

OBJECTIVE: Communication skills have gained increasing attention in medical education. Much of the existing literature and medical curricula addresses issues of doctor-patient communication. The critical importance of communication between health professionals, however, is now coming under the spotlight. The interdoctor telephone consultation is a common health care setting in which health professional communication skills are exercised. Breakdowns in this communication commonly occur and, surprisingly, this skill is not formally addressed in medical training. This study sought to clarify the communication issues that can occur during interdoctor telephone consultations in order to inform future educational initiatives in this domain. METHODS: Data were collected and triangulated among 3 sources: documentation of 129 telephone consults received; 51 hours of field observations of consultants, and semi-structured interviews of 12 callers and 12 consultants. Analysis was performed using grounded theory methodology. RESULTS: Overwhelmingly, participants described tensions with telephone consultation communication. Recurrent theme analysis revealed 5 key sources of tension: discursive features; context; fragmented clinical process; reason for call, and responsibility. Often, callers and consultants viewed similar instances in different and opposite manners, contributing to difficulties in the exchange. Further, a vicious cycle in which a participant's strategies to mitigate tension actually increased tension for the other participant was identified. CONCLUSIONS: Interdoctor telephone consultation has become an integral part of medical practice; however, tensions within this exchange can undermine its effectiveness. The results of this study provide a preliminary theory upon which an educational intervention to improve this communication skill can be based.     

Trigger segments: towards improving listening skills?†

Written 'trigger' segments depicting emotionally charged clinical situations arising from real patient encounters, and ending with a pertinent statement by the parent, were prepared and presented to senior medical students, postgraduate medical and allied professionals. They were asked to record their immediate reactions, how they would have responded and on reflection, how they ought to have responded. General discussion followed, highlighting various issues dealing with patient management. Trigger segments, a relatively simple teaching approach, allow students to experience difficult clinical situations and learn, in a relatively supportive environment of their peers, their own responses. Such triggers as part of a wider programme, may provide a further method to improve listening skills and increase personal understanding of the professional's own responses.     

UK consensus statement on the content of communication curricula in undergraduate medical education

Context The teaching and assessment of clinical communication have become central components of undergraduate medical education in the UK. This paper recommends the key content for an undergraduate communication curriculum. Designed by UK educationalists with UK schools in mind, the recommendations are equally applicable to communication curricula throughout the world. Objectives This paper is intended to assist curriculum planners in the design, implementation and review of medical communication curricula. The document will also be useful in the education of other health care professionals. Designed for undergraduate education, the consensus statement also provides a baseline for further professional development. Methods The consensus statement, based on strong theoretical and research evidence, was developed by an iterative process of discussion between communication skills leads from all 33 UK medical schools conducted under the auspices of the UK Council of Clinical Communication Skills Teaching in Undergraduate Medical Education. Discussion How this framework is used will inevitably be at the discretion of each medical school and its implementation will be determined by different course designs. Although we believe students should be exposed to all the areas described, it would be impractical to set inflexible competency levels as these may be attained at different stages which are highly school‐dependent. However, the framework will enable all schools to consider where different elements are addressed, where gaps exist and how to generate novel combinations of domains within the communication curriculum. It is hoped that this consensus statement will support the development and integration of teaching, learning and assessment of clinical communication.     

Assessing the educational needs of community sexual healthcare practitioners

There is wide variation in the quality and nature of community sexual health service delivery in the UK, which has led to a number of professional and Government-led directives to improve service provision. One key target is the provision of appropriate training and updating of staff in order to maintain an appropriate skill level. To identify the educational development needs of community sexual health nursing and medical staff, preparatory to commissioning appropriate educational provision, a training needs analysis survey was conducted. This involved using a customised psychometrically valid and reliable instrument, which was administered to all relevant staff for self-completion. Fifty-four (67.5%) of all doctors and nurses working in a community sexual health directorate responded. For the whole sample, the following categories of development need were identified: professional development; research; legal issues; clinical practice; and communication/interpersonal skills. When the nursing and medical subsamples were analysed separately, the same generic training needs emerged, although the nurses and doctors identified 22 and 25 significant training needs, respectively. The reported skills deficits cluster into super-ordinate groups which resonate with other available literature. This suggests that each category could be reliably used to inform a short course or series of modules, either for the whole sample or for each professional group. The results also suggest that the instrument is viable for use with healthcare professionals working in this specialty. Consequently, if this approach to identifying skill deficits was adopted, limited educational budgets could be used to provide courses which would meet the real training needs of staff, and if offered as a shared learning opportunity, could promote multidisciplinary team-working. In this way, improved local healthcare provision could be readily realised, with the potential for reducing current variations in the quality of community sexual health provision.     

A systematic review of medical skills laboratory training: where to from here?

OBJECTIVES: The aim of this review was to evaluate the effectiveness of medical skills laboratories or simulators. In particular, it aimed to determine if performance in medical skills laboratories is transferable to actual clinical performance and maintained over time. METHODS: A range of databases was utilised to search for relevant papers published from 1998 to June 2006. Articles were included in the review if they met a number of criteria that included the evaluation of a skills laboratory or simulator for the purpose of procedural skills training, that participants were either undergraduate medical students or postgraduate medical trainees, and that the study used a randomised, controlled trial (RCT) research design in evaluation. RESULTS: A total of 44 RCTs were identified for inclusion in the review. Overall, 32 (70%) studies reported that simulator training significantly improved procedural skills performance in comparison with standard or no training. Twenty (45%) RCTs assessed the transfer of simulator performance to clinical skills performance; however, 8 of these used animal models, not real patients. Only 2 studies assessed the maintenance of skills post-intervention, both at 4-month follow-up periods. CONCLUSIONS: Medical skills laboratories do lead to improvement in procedural skills compared with standard or no training at all when assessed by simulator performance and immediately post-training. However, there is a lack of well designed trials addressing the crucial issues of transferability to clinical practice and retention of skills over time. Further research must be carried out to address these matters if medical skills laboratories are to remain an integral component of medical education.     

Language background,English language proficiency and medical communication skills of medical students

Associations between language background, English language proficiency and medical communication skills were investigated in a group of 149 third year undergraduate medical students studying at an Australian university. Written and aural English proficiency were assessed with the Screening Test for Adolescent Language (STAL). Medical communication skills and the fluency of spoken language were scored during an Observed Structured Clinical Interview (OSCI), rated by a standardized patient and a clinician. An association was found between language background, performance on the STAL and spoken language proficiency. Satisfactory performance in medical communication skills was not associated with language background or overall performance on the STAL. In this study it was the global rating of unsatisfactory spoken language fluency that was associated with poorer performance in medical communication skills under examination conditions.     

Assessing the clinical effectiveness of preventive maneuvers: analytic principles and systematic methods in reviewing evidence and developing clinical practice recommendations. A report by the Canadian Task Force on the Periodic Health Examination

This paper examines a process for evaluating clinical effectiveness and developing recommendations in which systematic methods are used to review evidence from published clinical research and to reach sound conclusions about appropriate medical policy. The methodology addresses four important components of the analytic process: (1) the criteria that must be satisfied for a clinical practice to be considered effective; (2) proper methods for reviewing evidence from published clinical research to determine whether a clinical practice meets these criteria (including methods for performing comprehensive literature reviews, for judging the quality of individual studies, and for synthesizing or pooling the results of multiple studies); (3) theoretical and practical concerns in translating the results of the scientific review into sound clinical practice recommendations; and (4) the importance of documentation, guidelines, and other safeguards to minimize the effect the reviewers themselves have on the objectivity and consistency of the analytic methods.     

Longitudinal and Concentrated Communication Skills Programmes: Two Dutch Medical Schools Compared

Aim of the study:The communication skills of students of the Dutch medical schools of Maastricht and Leiden were compared, to assess the effectiveness of these schools' different approaches to communication skills training. Both schools have a six-year undergraduate medical curriculum, divided into four preclinical years and two years of clinical clerkships. The Maastricht problem-based curriculum offers an integrated clinical skills training programme, including communication skills, which runs throughout the first four years. Communication skills training in Leiden is concentrated in courses in the preclinical phase, at the beginning of the clinical phase and preceding two clerkships. Method:Communication skills of fourth-year and sixth-year students (N = 161) of both universities were assessed using four OSCE stations in which students did entire consultations with standardised patients. Trained observers rated these consultations, using a checklist. Results:Maastricht students of both year groups obtained significantly higher checklist scores for their communication skills than their Leiden colleagues. The Leiden students' scores increase between years 4 and 6, whereas those of the Maastricht students showed no significant change. Discussion:The higher scores obtained by the Maastricht students indicate a greater overall effectiveness of a longitudinal, integrated approach compared with concentrated courses. Absence of formal training in the clinical phase in Maastricht leads to stabilisation of communication skills, whereas the increase in the Leiden students' scores between years 4 and 6 offers evidence that formal communication skills training during the clinical phase does pay off. These findings suggest that the preferred approach to communication skills training would be an integrated, longitudinal programme, which continues during the clinical years. This revised version was published online in June 2006 with corrections to the Cover Date.     

An experimental comparison of three courses in history-taking skills for medical students

Since clinical training often fails to equip medical students with essential history-taking skills, more effective teaching methods require to be developed. As previous work had suggested that training which included televised demonstrations of history-taking and practice with simulated patients might be superior to traditional methods, it was decided to evaluate this experimentally. Thirty students beginning the Oxford Clinical Course were randomly selected and allocated to a traditional or one of two experimental courses. Both experimental courses used television and simulation but differed in the way the history-taking demonstrations were presented. After completing these courses, each student was asked to take a history from a simulated patient. Ratings of the videotapes of these interviews showed that the two experimental groups obtained much more information and used many more of the required skills than students assigned to the traditional course. The experimental students were also rated more favourably by the simulators and recorded more data in their case histories. It is concluded that these short courses were practical, very effective, and could be augmented by a self-teaching programme in history-taking skills.     

Attitudes toward learning communication skills among medical students of a university in Iran

Communication skills play a paramount role in clinical practice. In every clinical setting, medical doctors need to interview their patients efficiently and be persuasive toward their health issues. This study aimed at assessing the attitudes of medical students toward learning communication skills at Hormozgan University of Medical Sciences in Iran. In this cross-sectional study, the questionnaires were distributed to 210 medical students. Twenty eight students were excluded since they either did not return the questionnaires or filled them out incompletely. So, totally 182 questionnaires were analyzed (response rate=%86.6). Data was collected using communication skills attitude scale (CSAS) which consists of 26 items, 13 indicative of positive attitude and 13 indicative of negative attitude toward learning communication skills. Data were analyzed using SPSS16 software. The mean age of the participants was 21.7 (SD=2.7). Male and female students accounted for 38.5% and 61.5% of the participants respectively. The mean scores for positive attitude was 54.8 (SD=7.3) out of 65, and the mean scores for negative attitude was 35.3 (SD=5.9) out of 65. There were statistically significant differences between male and female students and between basic sciences and pathophysiology students on the one hand and clinical course students on the other as regards their attitudes toward learning communication skills (P<0.05). Although students had strongly positive attitudes toward learning communication skills, curriculum planners should not lose sight of negative attitudes and measures need to be taken to minimize or if possible eliminate them.     

Peer assessment feedback marking in a large medical anatomy class

Peer assessment is a valuable tool for developing student skills whereby they gain insight into evaluating their own level of understanding within a subject. It encourages student participation in the processes of learning and assessment, but is not widely utilized. This paper reports on the issues raised by this method of assessment when used to mark clinical case studies in a large anatomy class of first year medical students.     

Investigating community-based health and health promotion for homeless people: a mixed methods review

Homeless people are susceptible to a range of health problems, yet in terms of health promotion, tend to be a hard-to-reach, marginalized group. Robust evidence regarding the ability to engage with this population via effective health promotion programmes is essential if policy and practice are to be informed to improve the health of homeless people. A structured review was conducted with the aim of examining what is known about community-based health promotion for homeless people. Six databases were searched and 8435 records screened. Thirteen studies met the inclusion criteria. A mixed-methods 'combined separate synthesis' approach was used to accommodate both quantitative and qualitative evidence within one review. Three themes emerged: (i) incorporating homelessness, (ii) health improving and (iii) health engaging. The review has implications for health promotion design, with evidence suggesting that as part of a tailored approach, homeless people must be actively involved in intervention development, ensuring that appropriate, acceptable and potentially effective individual elements are incorporated into community-based interventions.     

中外医学期刊继续医学教育模式调查分析

【目的】 探索医学期刊开展继续医学教育(Continuing Medical Education, CME)的模式,以提升医学期刊服务行业发展的能力。【方法】 通过期刊网站调查分析国外3种(Annals of Internal Medicine、JAMA、BMJ)和国内9种医学期刊(包括《中华医学杂志》《中华外科杂志》《中华儿科杂志》等)的CME模式,调查内容包括CME课程素材、主题、内容、结构及形式等。【结果】 3种国外期刊均在网站上创建了完善的CME平台/版块,包括多种主题和形式的CME课程,课程素材不仅局限于期刊文章;课程主题多样,包括医学专业知识和技能、医学伦理规范和医患沟通技巧等;均采用图文、音频和视频等多种媒体形式;测试内容兼顾实践能力评估,学分申领过程简便。相比之下,国内医学期刊网站缺乏完善的CME平台/版块,课程主题相对局限;素材仅来自期刊少数栏目的文章;形式相对单一,以纯文本为主;测试内容仅重视专业知识,且学分申领过程相对繁琐。【结论】 国内医学期刊应从课程素材、内容、形式及测试环节等方面改进以提高CME质量,从而推动医学知识向临床实践转化。     

Attention to gender in communication skills assessment instruments in medical education: a review

Medical Education 2011: 45 : 239–248 Context Gender is increasingly regarded as an important factor in doctor–patient communication education. This review aims to assess if and how gender is addressed by current assessment instruments for communication skills in medical education. Methods In 2009 at Radboud University Nijmegen Medical Centre, an online search was conducted in the bibliographic databases PubMed, PsycINFO and ERIC for references about communication skills assessment instruments designed to be completed by trained faculty staff and used in medical education. The search strategy used the following search terms: ‘consultation skills’; ‘doctor–patient communication’; ‘physician–patient relations’; ‘medical education’; ‘instruments’; ‘measurement’, and ‘assessment’. Papers published between January 1999 and June 2009 were included. The assessment instruments identified were analysed for gender‐specific content. Results The search yielded 21 communication skills assessment instruments. Only two of the 17 checklists obtained explicitly considered gender as a communication‐related issue. Only six of 21 manuals considered gender in any way and none gave specific details to explain which aspects of communication behaviour should be assessed with regard to gender. Conclusions Very few communication assessment instruments in medical education focus on gender. Nevertheless, interest exists in using gender in communication skills assessment. The criteria for and purpose of assessing gender in communication skills in medical education are yet to be clarified.     

Medical students' perspective on the teaching of medical statistics in the undergraduate medical curriculum

Two undergraduate medical students at the University of Bristol commented on their experiences of learning medical statistics. In general, medical students' focus is on acquiring skills needed to practice clinical medicine, and great care must be taken to explain why disciplines such as statistics and epidemiology are relevant to this. Use of real examples and an emphasis on the need for evidence has meant that medical students are increasingly aware of the pressure on clinicians to justify their treatment decisions, and the associated need to be able to understand and critically appraise medical research. It was felt that medical statistics courses should focus on critical appraisal skills rather than on the ability to analyse data, which can be acquired by particular students when they need to do this. Medical statistics should be taught early in the curriculum, but there is a need to reinforce such skills throughout the course. Teaching and assessment methods should recognize that what is being taught is a practical skill of clinical relevance. This means that problem based small groups, data interpretation exercises and objective structured clinical examinations will be more productive than traditional teaching and examination methods.     

Clinical skills assessment with standardized patients

Previous projects (Combell I & II) to assess clinical skills were conducted in medical schools in Catalonia, in order to introduce a model of such an assessment using standardized patients (SP). The aim of this study (Combell III) was to measure selected characteristics of our model. Seventy-three medical students in the final year at the Bellvitge teaching unit of the University of Barcelona participated in a clinical skills assessment (CSA) project that used 10 SP cases. The mean group scores for the four components of clinical skills for each day of testing were studied, and ratings for each student in the 10 sequential encounters were checked. The study also compared the clinical skills scores with their academic grades. The total case mean score (mean score of history-taking, physical examination and patient notes scores) was 51.9%, and the mean score for communication skills was 63.6%. The clinical skills scores over the 8 testing days showed no day-to-day differences. The study did not find differences among the sequential encounters for each student (training effect). There was a lack of correlation between clinical skill scores and academic grades. The project demonstrated the feasibility of the method for assessing clinical skills, confirmed its reliability, and showed that there is no correlation between scores with this method and academic examinations that mainly reflect knowledge.