Teaching inpatient communication skills to medical students: an innovative strategy.

At the University of Washington, a group of medical educators defined a set of communication skills, or "benchmarks," that are expected of second-year medical students conducting history and physical examinations on hospitalized patients. In order to teach the skills listed in the communication benchmarks, an educational strategy was devised that included training sessions for 30 medical teachers and the development of an innovative videotape tool used to train the teachers and their students. The benchmarks were designed in 2003 for the developmental level of the students and were based on key communication concepts and essential elements of medical communication. A set of five short videotaped scenarios was developed that illustrated various segments of a student history and physical examination. Each scenario consisted of an "OK" version of communication and a "better" version of the same scenario. The video scenarios were used in teaching sessions to help students identify effective communication techniques and to stimulate discussion about the communication benchmarks. After the training sessions, teachers and students were surveyed to assess the effectiveness of the educational methods. The majority of students felt that the educational design stimulated discussion and improved their understanding of communication skills. Faculty found the educational design useful and 95% felt that the curriculum and videotape contributed to their own education. The development of communication benchmarks illustrated with short videotaped scenarios contrasting "OK" with "better" communication skills is a useful technique that is transferable to other institutions.     

Third year medical students perceptions towards learning communication skills: implications for medical education

Objective

To analyze students’ perceptions towards learning communication skills pre-and-post training in a Communication and Clinical Skills Course (CCSC) at a Portuguese Medical School.

Methods

Content analysis was used to describe and systematically analyze the content written by students (n = 215 from a total of 229) in an open-ended survey. In addition, content analysis association rules were used to identify meaning units.

Results

Students’ pre-training definitions of communication skills were not specific; their post-training definitions were more precise and elaborated. Students perceived communications skills in Medicine as important (61%), but recommended that teaching methodologies (52%) be restructured. There appeared to be no connection between criticism of teaching skills performance and perceptions of the other aspects of the course.

Conclusion

Students’ experiences at CCSC are associated with their perceptions of communications skills learning. Content analysis associations indicated that these perceptions are influenced by context.

Practice implications

Improvement of curricula, teaching and assessment methods, and investment in faculty development are likely to foster positive perceptions towards learning communication skills in these students.     

First-year medical students' assessment of their own communication skills: a video-based, open-ended approach

OBJECTIVE: Interpersonal and communication skills are a core area of competency for medical students, residents, and practicing physicians. As reflection and self-assessment are essential components of skill-building, we examined the content of medical students' assessments of their own developing communication skills. METHODS: Between 2000 and 2003, a total of 674 first-year medical students completed self-assessments of their communication skills after viewing videotapes of their interaction with simulated patients. Self-assessment forms were open-ended, providing ample space for students to write about the strengths and weaknesses they observed. Completed forms were coded by two members of the research team trained in content analysis. Students identified an average of 5.0 things that went well (range 1-15, S.D.=2.2) and 2.8 areas for improvement (range 1-9, S.D.=1.3). RESULTS: The most frequently observed strengths were: elicited information/covered important topics (54%); made a personal connection/established rapport (51%); was supportive/encouraging/helpful (40%); attended to conversational flow and transitions (34%); ensured patient comfort (32%). The most frequently noted weaknesses involved problems with: eliciting information/covering important topics (35%); paralanguage, particularly in terms of tone, rate, volume, and disfluencies such as "uh", "um" (32%); discussing health risks (26%); attending to conversational flow and transitions (23%); students' own comfort/organization/preparation (20%). CONCLUSION: We observed that a video-based, open-ended approach to self-assessment is feasible, practical, and informative. While the self-assessments covered a broad scope, students clearly attended to tasks and skills relevant to effective communication and relationship building. PRACTICE IMPLICATIONS: Videotaped clinical encounters allow learners to review their own behavior and make specific comments supported by tangible examples. An open-ended approach to self-assessment of communication skills can serve as one important component of a systematic education and evaluation program.     

Professional approaches in clinical judgements among senior and junior doctors: implications for medical education

Background  

Clinical experience has traditionally been highly valued in medical education and clinical healthcare. On account of its multi-faceted nature, clinical experience is mostly difficult to articulate, and is mainly expressed in clinical situations as professional approaches. Due to retirement, hospitals in Scandinavia will soon face a substantial decrease in the number of senior specialist doctors, and it has been discussed whether healthcare will suffer an immense loss of experienced-based knowledge when this senior group leaves the organization. Both senior specialists and junior colleagues are often involved in clinical education, but the way in which these two groups vary in professional approaches and contributions to clinical education has not been so well described. Cognitive psychology has contributed to the understanding of how experience may influence professional approaches, but such studies have not included the effect of differences in position and responsibilities that junior and senior doctors hold in clinical healthcare. In the light of the discussion above, it is essential to describe the professional approaches of senior doctors in relation to those of their junior colleagues. This study therefore aims to describe and compare the professional approaches of junior and senior doctors when making clinical judgements.     

Evaluation of a communication skills seminar for students in a Japanese medical school: a non-randomized controlled study

Background  

Little data exist for the effectiveness of communication skills teaching for medical students in non-English speaking countries. We conducted a non-randomized controlled study to examine if a short intensive seminar for Japanese medical students had any impact on communication skills with patients.     

Comparing self-reported communication skills of medical students in traditional and integrated curricula: a nationwide study

OBJECTIVES: To investigate medical students' self-assessments of their communication skills through medical school related to background factors, curriculum design and perceived medical school stress. METHODS: Medical students at all year levels attending Norwegian universities in the spring of 2003 were mailed the Oslo Inventory of Self-reported Communication Skills (OSISCS) developed by the authors. Of the total number of students (N=3055), 60% responded. One school had a traditional curriculum, the other three ran integrated models. RESULTS: Students assessed their instrumental communication skills to increase linearly year by year, while the relational skills showed a curve-linear trajectory reaching the optimum level half-way into the curriculum. Students attending the traditional school reported lower levels of instrumental skills compared to the students from the integrated schools. In relational skills, a similar difference was maintained half-way into the curriculum, but disappeared towards the end. Perceived medical school stress correlated to the self-reported end point levels of the two types of communication skills. DISCUSSION: The trajectories of self-reported instrumental and relational skills indicate significant variations in facilitating mechanisms between curricula, cognitive processing and perceived medical school stress. CONCLUSIONS: Self-reported instrumental and relational communication skills develop differently in medical students over the years according to the type of curriculum. PRACTICE IMPLICATIONS: Curricula should be evaluated for improvement implementations.     

Using standardized patients to assess the geriatrics medicine skills of medical students, internal medicine residents, and geriatrics medicine fellows.

PURPOSE: Medical schools and residency programs are placing additional emphasis on including clinical geriatrics competencies within their curricula. An eight-station, Geriatric Medicine Standardized Patient Examination (GSPX) was studied as a method to assess bedside geriatrics clinical skills over the continuum of medical education from medical school through residency and fellowship training. METHOD: The GSPX was administered to 39 medical students, 49 internal medicine residents, and 11 geriatrics medicine fellows in 2001-02. Reliability of standardized patient (SP) checklists and rating scales used to assess examinees' performance was measured by Cronbach's alpha. Validity was measured by surveying the examinees' assessment of fairness, individual case length, difficulty, and believability, and by faculty standard setting for each level of trainee. RESULTS: Reliability was high (alpha =.89). All levels of examinees found the SPs to be believable, station lengths to be adequate, and rated the GSPX as a fair assessment. Students rated the cases as more difficult. Previous experience with similar real patients increased significantly with level of training (Pearson's r =.48, p <.0001). Faculty set passing scores that increased from students to residents to fellows. However, GSPX scores decreased with level of training (r = -.25, p =.01). CONCLUSION: The GSPX is a reliable measure of geriatrics medicine skills with adequate face validity for examinees at all levels. However, GSPX scores did not increase with level of training, suggesting that a single form of the examination cannot be used across the continuum of training. Potential modifications to the GSPX that might provide more discrimination between levels of training are currently being explored.     

Training in communication and emotion handling skills for students attending medical school: Relationship with empathy,emotional intelligence,and attachment style

ObjectiveTo describe the Emoty-Com training, its impact on medical students’ attitudes towards doctors’ emotions and to explore the association between students’ empathy, emotional intelligence (EI), and attachment style (AS) with post-training performance scores.MethodsThe 16-hour Emoty-Com training was delivered to all second-year medical students of Verona and Milan (Italy) Universities. At pre-training, students filled out three questionnaires assessing empathy, AS and EI and responded to three questions on attitudes towards doctors’ emotions in the doctor-patient encounter. The same three questions and a final evaluation test were proposed at post-training.Results264 students participated in the study. The training reduced students’ worry about managing emotions during doctor-patient relationships. Gender was associated with specific subscales of empathy, EI, and AS. Final performance scores were associated with students’ attitudes towards emotions but not with empathy, EI, and AS.ConclusionThe Emoty-Com training increased students’ self-efficacy in handling their own emotions during consultations. Students' performance scores were related to their attitude towards doctors’ emotions in clinical encounters.Practice ImplicationsThe Emoty-Com training suggests ways to teach and evaluate emotion-handling skills for medical students. Possible links between empathy, EI, AS, and the attitudes towards doctors’ emotions during the years of education are highlighted.     

Using children as simulated patients in communication training for residents and medical students: a pilot program.

Medical schools are charged with the challenge of teaching effective communication skills, a core competency for residents and medical students. Especially challenging is the task of developing effective methods for training residents and students to communicate with children with mental health issues. The authors describe a pilot program at Mercer University School of Medicine that used pediatric standardized patients (SPs), ages 9-19, to aid in training residents and medical students in complex interviewing skills addressing mental health issues. New curriculum components for four pediatric problems, anorexia nervosa, depression, separation anxiety, and attention deficit hyperactivity disorder (ADHD), were designed and implemented by the authors in 2002-04. The training sessions were evaluated by the participating SPs as well as the residents and medical students in training. The components of the training were a lecture and subsequent practice using pediatric SPs and adults acting as their mothers. Evaluation included the qualitative analysis of SPs' reactions to participation in the training as described during a posttraining-session focus-group, as well as questionnaire responses by residents and medical students. The children role-playing the scenario of a difficult-to-manage situation and their adult "parent" actors voiced strongly positive reactions to participating in training residents and medical students. The reactions of physicians in training were also positive. The authors thus conclude that child and adolescent actors can be effectively used as SPs to train residents and students in complex interviewing skills, even in cases involving children with challenging mental health issues.     

An interdisciplinary course in the basic sciences for senior medical and PhD students.

Integrating clinical and basic sciences throughout the medical school curriculum has become a major objective of various innovations in medical education. While early clinical exposure has evolved as an efficient means of introducing clinical studies in the preclinical years, interdisciplinary integration of basic sciences during the clinical years remains a challenge. The authors describe their three years of experience with an interdisciplinary course designed to demonstrate the continuum of medical information from the clinic to the basic sciences. In this course, sixth-year medical students are required to choose one of three to four different one-week programs, each of which requires them to conduct an in-depth investigation of a defined clinical topic. Program coordinators are encouraged to work in clinician-basic scientist teams and to use a variety of teaching methods, with an emphasis on tutored individual and group learning based on critical readings of original papers. Coordinators are also encouraged to enable graduate research students to participate. From 1998 to 2000, students participated in nine programs, seven of which were coordinated by interdisciplinary teams. Several clinical and basic science disciplines were represented in each program, and various teaching methods were used. Graduate students participated in two of the programs. Evaluation of the programs (a debriefing discussion as well as short written evaluations) indicated moderate to good achievement of the course objectives.     

Teaching medical students and residents skills for delivering bad news: a review of strategies.

Although delivering bad news is something that occurs daily in most medical practices, the majority of clinicians have not received formal training in this essential and important communication task. A variety of models are currently being used in medical education to teach skills for delivering bad news. The goals of this article are (1) to describe these available models, including their advantages and disadvantages and evaluations of their effectiveness; and (2) to serve as a guide to medical educators who are initiating or refining curriculum for medical students and residents. Based on a review of the literature and the authors' own experiences, they conclude that curricular efforts to teach these skills should include multiple sessions and opportunities for demonstration, reflection, discussion, practice, and feedback.     

Viewpoint: suggestions for a shift in teaching clinical skills to medical students: the reflective clinical examination.

How medical students are taught physical examination (PE) skills appears to have changed little since the 1950s. Textbooks are organized according to organ systems and describe methods of eliciting and recording history and PE data using a routine format. In many medical schools, the preclinical teaching programs for clinical examination skills similarly emphasize an orderly collection of data. Teaching students to use diagnostic reasoning is postponed until students have learned history-taking and PE skills. The authors propose three modifications to this educational approach. First, rather than performing the clinical examination using a routine format, students should be encouraged to form diagnostic hypotheses early on while listening to the patient's narrative, and conduct the subsequent search for history and PE data in a reflective way in order to confirm or refute these hypotheses. Second, the authors propose that interviewing patients and conducting the PE be taught by one-on-one tutoring until students achieve mastery. Last, they suggest that the PE be guided not only by students' diagnostic hypotheses, but also by patients' expectations. These modifications are consistent with current trends in medical education that encourage a reflective practice and problem-based learning (PBL), and they also introduce medical students to the precepts of clinical reasoning. The authors suggest that challenging students to seek specific physical findings may increase the likelihood of detecting findings when they are present, and may transform patient interviewing and conducting the PE from routine activities into intellectually exciting experiences.     

Illness in context and families as teachers: a year-long project for medical students.

The authors describe a program for second-year students in Tel Aviv University's six-year medical school. The program's aim is to teach students the importance of context and interactions in patient care by exposing them to a real patient-family-doctor interaction using narrative-based methods to encourage reflective learning. Each student meets five times a year with a volunteer family, one of whose members suffers from a chronic disease. The program endorses a "patients as teachers" approach, as families are considered to be teachers for the students and not as objects of investigation and assessment. The students receive supervision in small groups, to enhance learning and reflection. To appraise the extent to which students had obtained the required knowledge, skills, and attitudes, the authors extracted reflections regarding the learning experience from students' essays. Major themes identified were becoming "family sensitive," building and improving communication skills, questioning intrusiveness, adopting a nonpatronizing and nonjudgmental attitude, developing reflective skills, creating a future professional model, and experiencing and appreciating continuity of care. The authors argue that learning to listen to patients' narratives, developing a reflective attitude, and being sensitive to patient-family-doctor interactions are of value to all doctors, and therefore programs similar to theirs should be established as part of general medical school education and not just in the context of family medicine.     

Self-care in medical education: effectiveness of health-habits interventions for first-year medical students.

PURPOSE: To examine changes in health habits (sleep, alcohol, and exercise) and the effects of an educational intervention promoting self-care on the emotional and academic adjustment of first-year medical students. METHOD: Fifty-four medical students completed questionnaires that assessed various health habits, alcohol use, depression severity, and areas of life satisfaction at the beginning of the semester, at mid-term, and at finals. Approximately half of the students received written feedback or participated in an educational discussion group at mid-term. RESULTS: The students demonstrated significant changes in health habits, with increases in alcohol consumption and decreases in exercise and socialization. The changes in health habits were predictive of both emotional and academic adjustment, with students who decreased in positive health habits, particularly socialization, being more depressed at finals. The feedback and educational interventions influenced some sleep and exercise behaviors, but the groups did not differ in overall emotional or academic adjustment. CONCLUSIONS: First-year medical students show significant changes in health habits as they adjust to medical school. An educational intervention demonstrated promising effects in changing these patterns, but self-care needs to be further elaborated to address the specific challenges associated with acute adjustment as well as with long-term stressors.     

The article critique as a problem-based teaching method for medical students early in their training: a French example using anatomy

In France, “article critique” became a particular teaching method in the second part of the medical curriculum. It approaches a reading exercise of scientific medical papers similar to that of journal club. It could be compared to reviewing a paper as performed by reviewers of a scientific journal. We studied the relevancy of that teaching method for the youngest medical students. Our questions were about the understanding and the analyzing ability of a scientific paper while students have just learned basic medical sciences as anatomy. We have included 54 “article critique” written by voluntary students in second and third years of medical cursus. All of the IMRaD structure items (introduction, materials and methods, results and discussion) were analyzed using a qualitative scale for understanding as for analyzing ability. For understanding, 89–96% was good or fair and for the analyzing ability, 93–100% was good or fair. The anatomical papers were better understood than therapeutic or paraclinical studies, but without statistical difference, except for the introduction chapter. Results for analyzing ability were various according to the subject of the papers. This teaching method could be compared to a self-learning method, but also to a problem-based learning method. For the youngest students, the lack of medical knowledge aroused the curiosity. Their enthusiasm to learn new medical subjects remained full. The authors would insist on the requirement of rigorous lessons about evidence-based medicine and IMRaD structure and on a necessary companionship of the students by the teachers.     

Caring for medical students as patients: access to services and care-seeking practices of 1,027 students at nine medical schools. Collaborative Research Group on Medical Student Healthcare.

PURPOSE: The personal health care of medical students is an important but neglected issue in medical education. Preliminary work suggests that medical student-patients experience special barriers to health care services and report problematic care-seeking practices that merit further inquiry. METHOD: A self-report questionnaire was piloted, revised, and distributed to students at nine medical schools in 1996-97. The survey included questions regarding access to health services, care-seeking practices, and demographic information. RESULTS: A total of 1,027 students participated (52% response rate). Ninety percent reported needing care for various health concerns. Fifty-seven percent did not seek care at times, in part due to training demands, and 48% had encountered difficulties in obtaining care. A majority had received treatment at their training institutions, and students commonly pursued informal or "curbside" care from medical colleagues. Almost all participants (96%) were insured. Differences in responses were associated with level of training, gender, and medical school. CONCLUSION: Medical schools shoulder the responsibility not only of educating but also of providing health services for their students. Students encounter barriers to care and engage in problematic care-seeking practices. Greater attention to issues surrounding medical student health may benefit students and their future patients.