Effective training strategies for teaching communication skills to physicians: An overview of systematic reviews

Objective

Physicians need good communication skills to communicate effectively with patients. The objective of this review was to identify effective training strategies for teaching communication skills to qualified physicians.

Methods

PubMED, PsycINFO, CINAHL, and COCHRANE were searched in October 2008 and in March 2009. Two authors independently selected relevant reviews and assessed their methodological quality with AMSTAR. Summary tables were constructed for data-synthesis, and results were linked to outcome measures. As a result, conclusions about the effectiveness of communication skills training strategies for physicians could be drawn.

Results

Twelve systematic reviews on communication skills training programmes for physicians were identified. Some focused on specific training strategies, whereas others emphasized a more general approach with mixed strategies. Training programmes were effective if they lasted for at least one day, were learner-centred, and focused on practising skills. The best training strategies within the programmes included role-play, feedback, and small group discussions.

Conclusion

Training programmes should include active, practice-oriented strategies. Oral presentations on communication skills, modelling, and written information should only be used as supportive strategies.

Practice implications

To be able to compare the effectiveness of training programmes more easily in the future, general agreement on outcome measures has to be established.     

Communication skills training for general practitioners to promote patient coping: The GRIP approach

Objective

To develop, perform and test the effects of a communication skills training program for general practitioners (GPs). The program specifically addresses the patients’ coping and resources despite more or less severe psychological or physical illness.

Methods

A training model was developed, based on cognitive therapy and solution-focused therapy. The training was given the acronym GRIP after its main content:

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Get a measure of the patient's subjective complaints and illness attributions.

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Respond to the patient's understanding of the complaints.

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Identify resources and solutions.

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Promote positive coping.

The study involved a quasi-experimental design in which 266 consultations with 25 GPs were video recorded. Forty hours of communication skills training were given to the intervention group.

Results

Consultation duration, patient age and distress determined the frequency of the GRIP communication. There was a significant effect of training on four particular subcategories of the GRIP techniques. The effect of the training was most evident in a subgroup of GPs who used little or no resource-oriented communication before training.

Conclusion

This pilot training model may help change the GPs’ communicative pattern with patients in some situations.

Practice implication

Communication skills training programmes that emphasize patient attributions and personal resources should be developed further and tested in general practice settings with an aim to promote patient coping.     

Communication skills training for healthcare professionals in providing genetic counseling: A scoping literature review

ObjectiveGenetic counselors need advanced communication skills, particularly when discussing tests involving massively parallel sequencing. Increasingly, non-genetic healthcare professionals (HCPs) also need to provide genetic counseling. Communication skills training (CST) may equip HCPs with the required communication skills. This scoping review provides an overview of the content, approach, effectiveness and effective features of CSTs aimed at improving genetic and non-genetic HCPs’ communication skills in providing genetic counseling.MethodsFollowing the PRISMA-ScR statement, four databases were searched for articles. Two researchers independently screened titles and abstracts, and extracted data. When applicable, information on effectiveness and effective features of CST was collated.ResultsTwenty-three articles were included. Sixteen CSTs targeted non-genetic HCPs, five targeted genetic HCPs and two targeted both. Most CSTs addressed multiple communication behaviors and consisted of role play. CSTs were found to be effective for improving HCPs (mainly self-reported) attitudes and skills. Limited evidence on specific effective features of CST was found.ConclusionsThere is a clear need for evidence on the effectiveness of CST on improving both HCPs’ communication skills in the context of genetic counseling, and patient outcomes, and its specific effective features.Practice implicationsClinical practice could benefit from evidence-based CST for genetic and non-genetic HCPs.     

Complicated grief: Knowledge,attitudes, skills and training of mental health professionals: A systematic review

ObjectiveA systematic review and qualitative synthesis was undertaken to deduce the knowledge, attitudes, skills and training of mental health professionals regarding complicated grief (CG).MethodsPsychInfo, Embase, Medline, CINAHL, PBSC, Web of Science and ERIC databases were used to identify relevant literature. Searches were executed from inception to September 2014.ResultsThe electronic search yielded 305 results. Forty-one papers were selected for full text review, 20 were included for analysis. 6 examined primary data, the remaining 14 being reviews, opinion or guideline pieces.ConclusionsDespite the lack of consensus on terminology, criteria and diagnosis, it appears that there is more than sufficient agreement within the CG research community regarding the knowledge and skills required to assist someone presenting with CG. A palpable fear of medicalising grief exists, but this would seem to be based on a conflation of normal grief and CG. This review highlights the mainly unidirectional nature of current research, the voice of the practitioner being largely unheard. A need for and an interest in training in CG was expressed.Practice implicationsThere is an urgent need to translate research findings into clinical practice. Training must take account of attitudinal barriers to implementation, balancing evidence and stories.     

Translating knowledge into practice for communication skills training for health care professionals

Despite the evidence that person-centred communication underpins all that we do in our interactions with patients, caregivers and team members, the knowledge about the implementation of systematic communication skills training is still in its infancy. This position paper describes some of the main contextual facilitators for translating knowledge about communication skills training for health care professionals (HCP) and recommends ways to guide practical implementation. Based on the literature that has been published over the last two decades, it seems evident that communication skills training programs should be underpinned by clinician self-reflection, be experiential, and focused on behaviour change and implementation of new skills into practice. The programs should be delivered by trainers possessing an understanding of communication micro skills, the skills and confidence to observe interactions, and coach learners through the rehearsal of alternative approaches. Communication skills programs should be flexible to adapt to individual learners, local needs, and circumstances. Interventions should not be limited to the empowerment of individual HCP but should be a part of the organisational quality assurance framework, e.g., by including communication skills in clinical audits.Implementation science frameworks may provide tools to align programs to the context and to address the determinants important for a sustained implementation process. Programs need to be embedded as ‘core business’, otherwise the culture change will be elusive and sustainability under threat if they are only dependent on provisional funding.     

医院护士心肺复苏术培训方法研究进展

心跳呼吸骤停是临床上最紧急的危险情况,心肺复苏术（cardiopulmonary resuscitation,CPR）就是对此所采用的最初级急救措施。有研究表明,院内病人心脏骤停发生时大部分是护士首先发现的。也有研究证实,     

Communication skills training in undergraduate medicine

Good communication with patients is now recognised as the cornerstone in effective medical practice. Medical students do not automatically acquire the art of good communication through clinical training. A new course to promote the development of communication skills at undergraduate level is described. The course was provided at the juncture between pre-clinical and clinical training. Course evaluation illustrated the value of the course as perceived by students themselves and highlighted the areas of greatest need for students in communication skills training.     

The effect of communication skills training on residents’ physiological arousal in a breaking bad news simulated task

Objective

Breaking bad news (BBN) is a complex task which involves dealing cognitively with different relevant dimensions and a challenging task which involves dealing with intense emotional contents. No study however has yet assessed in a randomized controlled trial design the effect of a communication skills training on residents’ physiological arousal during a BBN task.

Methods

Residents’ physiological arousal was measured, in a randomized controlled trial design, by heart rate and salivary cortisol before, during and after a BBN simulated task.

Results

Ninety-eight residents were included. MANOVA showed significant group-by-time effects. Trained residents’ mean heart rate levels remained elevated after training and cortisol areas under the curve increased after training compared to untrained residents.

Conclusion

Communication skills training has an effect on residents’ physiological arousal. Residents’ self-efficacy and communication skills improvements in a BBN simulated task are associated with an elevated physiological arousal, which becomes proportional to the complexity of the task and reflects a better engagement and performance.

Practice implications

Residents should be informed that, to perform a task, they need to engage in the task with a physiological arousal proportional to the complexity of this task. Communication skills training should be adapted.     

Outcome of parent-physician communication skills training for pediatric residents

Objective

Communication skills represent an essential component of clinical competence. In the field of pediatrics, communication between physicians and patients’ parents is characterized by particular difficulties. To investigate the effects of a parent-physician communication skills training program on OSCE performance and self-efficacy in a group control design.

Methods

Parallel to their daily work in the outpatient department, intervention-group experienced clinicians in practice (n = 14) participated in a communication training with standardized parents. Control-group physicians (n = 14) did not receive any training beyond their daily work. Performance was assessed by independent video ratings of an OSCE. Both groups rated their self-efficacy prior to and following training.

Results

Regarding OSCE performance, the intervention group demonstrated superior skills in building relationships with parents (p < .024) and tended to perform better in exploring parents’ problems (p < .081). The communication training program led to significant improvement in self-efficacy with respect to the specific training objectives in the intervention group (p < .046).

Conclusion

Even in physicians with considerable experience, structured communication training with standardized parents leads to significant improvement in OSCE performance and self-efficacy.

Practise implications

Briefness and tight structure make the presented communication training program applicable even for experienced physicians in daily clinical practice.     

Designing a curriculum for communication skills training from a theory and evidence-based perspective

Objective

Because quality health care delivery requires effective clinician–patient communication, successful training of health professionals requires communication skill curricula of the highest quality. Two approaches for developing medical communication curricula are a consensus approach and a theory driven approach. We propose a theory-driven, communication function framework for identifying important communication skills, one that is focused on the key goals and outcomes that need to be accomplished in clinical encounters. We discuss 7 communication functions important to medical encounters and the types of skills needed to accomplish each.

Discussion

The functional approach has important pedagogical implications including the importance of distinguishing the performance of a behavior (capacity) from the outcome of that behavior in context (effectiveness) and the recognition that what counts as effective communication depends on perspective (e.g., observer, patient).

Conclusion

Consensus and theory-driven approaches to medical communication curricula are not necessarily contradictory and can be integrated to further enhance ongoing development and improvements in medical communication education.

Practice implications

A functional approach should resonate with practicing clinicians and continuing education initiatives in that it is embraces the notion that competent communication is situation-specific as clinicians creatively use communicative skills to accomplish the key goals of the encounter.     

Working alliance in communication skills training for oncology clinicians: A controlled trial

Objective

The aim of this study was to evaluate the impact of communication skills training (CST) on working alliance and to identify specific communicational elements related to working alliance.

Methods

Pre- and post-training simulated patient interviews (6-month interval) of oncology physicians and nurses (N = 56) who benefited from CST were compared to two simulated patient interviews with a 6-month interval of oncology physicians and nurses (N = 57) who did not benefit from CST. The patient–clinician interaction was analyzed by means of the Roter Interaction Analysis System (RIAS). Alliance was measured by the Working Alliance Inventory – Short Revised Form.

Results

While working alliance did not improve with CST, generalized linear mixed effect models demonstrated that the quality of verbal communication was related to alliance. Positive talk and psychosocial counseling fostered alliance whereas negative talk, biomedical information and patient's questions diminished alliance.

Conclusion

Patient–clinician alliance is related to specific verbal communication behaviors.

Practice implications

Working alliance is a key element of patient–physician communication which deserves further investigation as a new marker and efficacy criterion of CST outcome.     

The value of training in communication skills for continuing medical education

Objective

Question arises as to what extent communication skills are considered in continuing medical education (CME).

Methods

Analysis for CME-courses in communication skills in the area of the Chamber of Physicians North Rhine (ÄkNo), Germany. Supply Arm(A): CME events (n = 19,320) certified in 2007 were evaluated. Demand Arm(B): course participation of 850 family physicians in the period 2002-2007 was analyzed (n = 37,724). Tests were calculated to the level 0.05 using Mann-Whitney U-test.

Results

(A) 388 (2.0%) events were concerned with the topic communications. 59.3% involved active cooperation of the participants. 0.5% events devoted more than 50% of their duration to the topic communication. Proportions in the subjects of internal medicine, general medicine and pediatrics amounted to 0.2%. (B) 803 (2.1%) events with a focus on communication were identified. Women took part in significantly more events than men (p < 0.002) and selected more interactive courses.

Conclusion

Content on communication training was small. Increasing experience does not automatically improve communication skills but an extent of deliberate praxis seems to be necessary and must be sought and developed.

Practice implications

Communication skills are still insufficiently provided in CME-courses and should be more directed to focus as treatment strategies and scientifically investigated for outcome improvements.     

Public health education by emergency nurses: A scoping review and narrative synthesis

ObjectiveTo identify the extent, range, and nature of the evidence on public health education provided by emergency nurses.MethodsA scoping review, using the methodological guidance of Joanna Briggs Institute, was conducted to scope and map the literature and research activity. Using predetermined criteria, databases, grey literature, and reference lists were searched for eligible sources. At least two authors reviewed each article. A narrative synthesis methodology was utilised to analyse and report the findings.ResultsThere was significant methodological heterogeneity between sources (n = 6). Three themes were identified: 1) Benefits of the system: An opportunity to inform the public, 2) The barriers: Time pressures and being prepared and 3) The strategies: Plan for structured and created teachable momentsConclusionLimited research is being conducted in this area. Further research is needed to understand emergency nurse’s practice and attitudes towards providing public health messages.Practice implicationsEmergency nurses need to utilise the ‘teachable moment‘ for every emergency admission, providing opportunistic preventative education to improve health outcomes and reduce demand on the healthcare system.     

Promoting patient participation in healthcare interactions through communication skills training: A systematic review

ObjectiveTo present literature on training patients in the use of effective communication skills.MethodsSystematic searches were conducted in six databases. References were screened for inclusion through several phases. Extracted data included intervention study design, sample characteristics, content and structure of training programs, outcomes assessed, and findings reported.ResultsA total of 32 unique intervention studies were included. Most targeted primary care or cancer patients and used a randomized controlled study design. Interventions used a variety of training formats and modes of delivering educational material. Reported findings suggest that communication training is an effective approach to increase patients’ total level of active participation in healthcare interactions and that some communication behaviors may be more amenable to training (e.g., expressing concerns). Trained patients do not have longer visits and tend to receive more information from their providers. Most studies have found no relationship between communication training and improved health, psychosocial wellbeing, or treatment-related outcomes.ConclusionsFindings reinforce the importance and potential benefits of patient communication training.Practice implicationsAdditional research is warranted to determine the most efficacious training programs with the strongest potential for dissemination.     

Communication skills in context: Trends and perspectives

Objective

Doctor–patient communication has been well researched. Less is known about the educational background of communication skills training. Do we aim for optimal performance of skills, or rather attempt to help students become skilled communicators?

Methods

An overview is given of the current view on optimal doctor–patient communication. Next we focus on recent literature on how people acquire skills. These two topics are integrated in the next chapter, in which we discuss the optimal training conditions.

Results

A longitudinal training design has more lasting results than incidental training. Assessment must be in line with the intended learning outcomes. For transfer, doctor–patient communication must be addressed in all stages of health professions training.

Conclusion

Elementary insights from medical education are far from realised in many medical schools. Doctor–patient communication would benefit strongly from more continuity in training and imbedding in the daily working contexts of doctors.

Practice implications

When an educational continuum is realised and attention for doctor–patient communication is embedded in the working context of doctors in training the benefits will be strong. Training is only a part of the solution. In view of the current dissatisfaction with doctor–patient communication a change in attitude of course directors is strongly called for.     

Assessment of resident physicians in professionalism, interpersonal and communication skills: a multisource feedback

Objective: To assess the internal validity and reliability of a multisource feedback (MSF) program by China Medical Board for resident physicians in China.Method: Multisource feedback was used to assess professionalism, interpersonal and communication skills. 258 resident physicians were assessed by attending doctors, self-evaluation, resident peers, nurses, office staffs, and patients who completed a sealed questionnaire at 19 hospitals in China. Cronbach''s alpha coefficient was used to assess reliability. Validity was assessed by exploratory factor analyses and by profile ratings.Results: 4128 questionnaires were collected from this study. All responses had high internal consistency and reliability (Cronbach''s α> 0.90), which suggests that both questions and form data were internally consistent. The exploratory factor analysis with varimax rotation for the evaluators'' questionnaires was able to account for 70 to 74% of the total variance.Conclusion: The current MSF assessment tools are internally valid and reliable for assessing resident physician professionalism and interpersonal and communication skills in China.     

Therapeutic communication training in long-term care institutions: recommendations for future research

Objective

The purpose of this review is to critique contemporary experimental research and to recommend future directions for research interventions on nursing aides’ therapeutic communication with older adults who have cognitive impairment and/or dementia in institutional long-term care settings.

Methods

This literature review covers 13 journal articles (1999–2006) and focuses on the strengths and weaknesses of experimental research interventions to improve nursing aides’ therapeutic communication with older adults who have cognitive impairment and/or dementia in long-term care settings.

Results

Based on this review, recommendations for improved experimental designs include a minimum of two groups with one being a control and randomization of subjects at the care unit level, an average 3–5 h of total training, a minimum of a 6-month total evaluation period, and objective outcomes relevant to both nursing aides and residents. Findings from studies in this review indicate that the following therapeutic communication techniques can be taught and can benefit staffs and older adults’ quality of life: verbal and non-verbal communication behaviors including open-ended questions, positive statements, eye contact, affective touch, and smiling.

Conclusions

Some evidence exists to support that nursing aides can improve their therapeutic communication during care.

Practice Implications

Nursing aides need not only more training in therapeutic communication but also ongoing, dedicated supervision in psychosocial aspects of care.     

Training faculty to facilitate communication skills training: development and evaluation of a workshop

OBJECTIVE: To develop a workshop for training faculty to facilitate small group role play sessions for a communication skills training program and assess the impact of that workshop on the trainees' self-efficacy about facilitation skills. METHODS: A multi-specialty group of 33 attending physicians at a Comprehensive Cancer Center were trained in a Facilitating Communication Skills Training workshop in order to prepare them to facilitate small group role play with fellows and residents. The workshop curriculum was based on theory and literature on teaching communication skills. RESULTS: The workshop had a significant effect on participants' self-efficacy in facilitating communication skills training. At least 75% of participants reported feeling comfortable facilitating communication skills training small groups. CONCLUSION: This facilitation workshop was successful in providing participants with confidence to successfully facilitate small group role play sessions in communication skills training. PRACTICE IMPLICATIONS: In order to evaluate the effectiveness of communication skills training programs, it is important to have trained facilitators who adhere to a set of facilitation guidelines. Workshops on facilitation skills provide the background and practice time necessary as a first step in the training process.     

Epidemiology of severe sepsis in the emergency department and difficulties in the initial assistance

BACKGROUND: The aim of this study was to determine the occurrence rate, demographics, clinical characteristics, and outcomes of patients with severe sepsis admitted to the emergency department. METHODS: A prospective study evaluating all patients admitted to the emergency department unit in a public hospital of tertiary complexity in a six-month period was conducted. During this period, the emergency team was trained to diagnose sepsis. Patients who met the diagnostic criteria for severe sepsis were followed until their discharge from the hospital. RESULTS: A total of 5,332 patients were admitted to the emergency department, and 342 met the criteria for severe sepsis/septic shock. The median (interquartile range) age of patients was 74 (65-84) years, and 52.1% were male. The median APACHE II and SOFA scores at diagnosis were 19 (15-25) and 5 (3-7), respectively. The median number of dysfunctional organ systems per patient was 2 (1-3). The median hospital length of stay was 10 (4.7-17) days, and the hospital mortality rate was 64%. Only 31% of the patients were diagnosed by the emergency department team as septic. About 33.5% of the 342 severe sepsis patients admitted to the emergency department were referred to an ICU, with a median time delay of 24 (12-48) hours. Training improved diagnosis and decreased the time delay for septic patients in arriving at the ICU. CONCLUSIONS: The occurrence rate of severe sepsis in the emergency department was 6.4%, and the rate of sepsis diagnosed by the emergency department team as well as the number of patients transferred to the ICU was very low. Educational campaigns are important to improve diagnosis and, hence, treatment of severe sepsis.