Existing instruments for assessing physician communication skills: Are they valid in a computerized setting?

Objectives

This study aims to highlight the differences in physicians’ scores on two communication assessment tools: the SEGUE and an EMR-specific communication skills checklist. The first tool ignores the presence of the EMR in the exam room and the second, though not formally validated, rather focuses on it.

Methods

We use the Wilcoxon Signed Ranks Test to compare physicians’ scores on each of the tools during 16 simulated medical encounters that were rated by two different raters.

Results

Results show a significant difference between physicians’ scores on each tool (z = −3.519, p < 0.05 for the first rater, and z = −3.521, p < 0.05 for the second rater), while scores on the EMR-specific communication skills checklist were significantly and consistently lower.

Conclusion

These results imply that current communication assessment tools that do not incorporate items that are relevant for communication tasks during EMR use may produce inaccurate results.

Practice implications

We therefore suggest that a new instrument, possibly an extension of existing ones, should be developed and empirically validated.     

Observed communication skills: how do they relate to the consultation content? A nation-wide study of graduate medical students seeing a standardized patient for a first-time consultation in a general practice setting

Background

In this study, we wanted to investigate the relationship between background variables, communication skills, and the bio-psychosocial content of a medical consultation in a general practice setting with a standardized patient.

Methods

Final-year medical school students (N = 111) carried out a consultation with an actor playing the role of a patient with a specific somatic complaint, psychosocial stressors, and concerns about cancer. Based on videotapes, communication skills and consultation content were scored separately.

Results

The mean level of overall communication skills had a significant impact upon the counts of psychosocial issues, the patient's concerns about cancer, and the information and planning parts of the consultation content being addressed. Gender and age had no influence upon the relationship between communication skills and consultation content.

Conclusion

Communication skills seem to be important for final-year students' competence in addressing sensitive psychosocial issues and patients' concerns as well as informing and planning with patients being representative for a fairly complex case in general practice. This result should be considered in the design and incorporation of communication skills training as part of the curriculum of medical schools.     

Drug labels: Are they a readable material?

OBJECTIVE: This study aims to evaluate cardiovascular drug labels from the perspective of how readable the text materials are. METHODS: Comparison of drug labels written in accordance with the 1997 Brazilian legislation with those written in accordance with the 2003 Brazilian legislation, with journalistic text and scientific essays using as tool the Flesch Index. RESULTS: The journalistic text had an average Flesch Index of 62.6%; the scientific essays, 23.5%; the drug labels written in accordance with the old legislation, 43.8%; and those written in accordance with the most recent legislation, 47.2%. CONCLUSION: Drug labels are more readable than scientific essays and less readable than journalistic texts; they were classified as difficult to read. PRACTICE IMPLICATIONS: Text readability formulas are an objective measure that may improve the search for better-written communication materials and thereby a greater understanding of drug labels by patients. However, a more detailed validation of an objective measure of text evaluation should be considered by the health authorities of each country, with their own language as basis.     

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.     

Responding to nurses’ communication challenges: Evaluating a blended learning program for communication knowledge and skills for nurses

ObjectivesTo evaluate the effectiveness of the Blended Communication Skills Training Program for Nurses (CSTN). The program aims to improve nurses’ knowledge about communication skills and structure for interactions with individuals who a have life limiting illness.MethodsThis was a quasi-experimental study using a pre- and post-test quiz and self-efficacy questionnaire undertaken in Victoria, Australia. Nurses employed across three wards participated. The Blended CSTN comprised two major components: Asynchronous Web-Based Education Program and Experiential Workshop. The program focused on specific communication challenges: Gathering Information, Dealing with Difficult Questions, and Articulating Empathy. The primary outcome was improvement in knowledge of communication skills and structure. Self-efficacy and perceived importance of communication skills were assessed as secondary outcomes.ResultsEighteen nurses completed both Web-Based and Workshop components. Statistically significant increases in knowledge regarding communication skills and structure were found, with a large effect size for Gathering Information (r = 0.80) and moderate effect for Articulating Empathy (r = 0.62), and Responding to Difficult Questions (r = 0.532). Self-efficacy significantly increased for all measured communication skills.ConclusionsKnowledge improvements and perceived self-efficacy in communication were observed after nurses participated in a blended education programPractice implicationsA blended CSTN may improve nurse-patient communication in the clinical setting, worthy of further study.     

Teaching communication skills to medical students,a challenge in the curriculum?

INTRODUCTION: As communication skills become more and more important in medical practice, the new medical curriculum at Ghent University (1999) implemented a communication curriculum. METHOD: Communication training or experiences in 'real life' settings are provided every year of the medical curriculum. The training starts with simple basic skills but gradually slips into medical communication or consultation training and results in communication in different contextual situations or with special groups of patients. Rehearsal is important and seen as inevitable. Poorly performing students get extra training. Several didactical methods are used: the skills are demonstrated by means of videotapes and paper cases of patient stories. Skills are trained in small groups (10-15 students), with focus on role-playing with colleague students or simulated patients (SP). Videotapes of real consultations give an idea of the performance of each student. Every year the students are assessed by means of an OSCE (objective structured clinical examination). CONCLUSION: After 6 years of experience with the new curriculum, several remarks and questions need to be answered. Small group training gives a huge workload and with different trainers discrepancies between groups can appear. Choosing the most suitable trainer for communication skills is not easy; several options are available: specialists in communication like psychologists with interest in medical practice, GPs with interest in medical communication, medical specialists for communication topics concerning medical problems within their domain. As the most important didactical approach lies in practising the skills, the selection and training of simulated patients remains a challenge. PRACTICE IMPLICATION: A communication continuum during the whole curriculum seems to be worthwhile. Students with specific communicative problems are detected early, remediation is provided. Rehearsal every year seems to lead to better acquisition. The most positive point is that communication is embedded in a global patient-, student- and community-oriented curriculum and that communication skills are seen as core elements of good doctoring.     

Normoblasts in pleural fluid: Are they significant?

The hemopoietic cell elements in body fluids is a rare encounterance. From among the normal bone marrow inhabitants, only megakaryocytes are occasionally seen in pleural and peritoneal fluids due to extramedullary hemopoiesis as a result of myeloproliferative disorders. The finding of isolated normoblasts in body fluids with no other marrow elements is described here for the first time in pleural fluid from two patients. The normoblasts which have a close resemblance morphologically to mesothelial cells, need to be differentiated from one another. A supravital stain is of help when in doubt. Because of their close resemblance, normoblasts may get missed during evaluation. This report highlights the need for a larger number of positive cases with emphasis on their course details to understand the significance of normoblasts in body fluids.     

Medical students’ communication skills in clinical education: Results from a cohort study

ObjectiveTo assess students’ communication skills during clinical medical education and at graduation.MethodsWe conducted an observational cohort study from 2007 to 2011 with 26 voluntary undergraduate medical students at Hamburg University based on video-taped consultations in year four and at graduation. 176 consultations were analyzed quantitatively with validated and non-validated context-independent communication observation instruments (interrater reliability ≥0.8). Based on observational protocols each consultation was also documented in free-text comments, salient topics were extracted afterwards.Results26 students, seven males, were enrolled in the survey. On average, graduates scored higher in differential-diagnostic questioning and time management but showed deficiencies in taking systematic and complete symptom-oriented histories, in communication techniques, in structuring consultations and in gathering the patients’ perspectives. Patient-centeredness and empathy were rather low at graduation. Individual deficiencies could barely be eliminated.ConclusionMedical students were able to enhance their clinical reasoning skills and their time management. Still, various communication deficiencies in final year students became evident regarding appropriate history taking, communication skills, empathy and patient-centeredness.Practice implicationsThe necessity of developing a longitudinal communication curriculum with enhanced communication trainings and assessments became evident. A curriculum should ensure that students’ communication competencies are firmly achieved at graduation.     

Longitudinal study: Impact of communication skills training and a traineeship on medical students’ attitudes toward communication skills

ObjectivesTo study longitudinally students’ attitudes towards communication skills (CS) in order to examine whether CS training (CST) has an enduring impact on medical students’ attitudes toward being a lifelong learner of CS.Methods105 students completed the Communication Skills Attitude Scale at 4 times: before CST, after CST and before and after a traineeship.ResultsOur final sample size is 105 students. CST improved the attitudes of our students toward CS, and the traineeship stabilised those attitudes. However, while the improvement in positive attitudes was sustained over time, negative attitudes increased 6 months after CST.ConclusionCST using experiential methods in a safe environment has the potential to improve students’ attitudes towards CS. A short traineeship in general medicine allows students to quickly integrate CST into clinical practice, without deteriorating their attitudes toward CS. However, 6 months of medical lessons without CST reinforces students’ negative attitudes.Practice implicationsTo avoid the deterioration of attitudes over time, CST should be continuous or at least spaced at intervals less than 6 months and supported by the institutional authorities. In addition, placing the CST close to an observation traineeship in general practice seems an interesting way to prevent further deterioration of attitudes.     

Can a brief two-hour interdisciplinary communication skills training be successful in undergraduate medical education?

Objective

To pilot-test feasibility, acceptance and learning-outcomes of a brief interdisciplinary communication skills training program in undergraduate medical education.

Methods

A two-hour interdisciplinary communication skills program with simulated patients was developed and pilot-tested with clinical students at Hamburg University. Five psychosocial specialties facilitated the training. Composite effects were measured qualitatively and quantitatively.

Results

Eighty students volunteered to participate in the pilot-program (intervention-group). Their evaluations of the program were very positive (1.1 on a six-point scale). Benefits were seen in feedback, increase of self-confidence, cross-disciplinary clinical and communication experience. Students who did not volunteer (n = 206) served as the control-group. The intervention-group performed significantly better (p = 0.023) in a primary care communication examination and female students performed better than males. Clinical teachers evaluated the pilot-training very positively with regard to learning-outcomes and feasibility. The positive results from the pilot-training led to implementation into the regular curriculum.

Conclusions

A two-hour interdisciplinary communication skills training program is beneficial for medical students with regard to communication competencies, self-confidence and learning-outcomes.

Practice implication

The training is feasible within given time-frames and limited staff resources. The high teaching load for small-group-training are split between five specialties. The concept might be an interesting option for other faculties.     

Cancer screening adherence: Does physician–patient communication matter?

Objective

The objective of this study was to examine the separate contributions of patients and physicians to their communication regarding cancer screening.

Methods

Research design and subjects: The authors conducted a cross-sectional analysis of survey data collected from 63 community-based primary care physicians and 904 of their female patients in Los Angeles.

Results

Patients who perceived their physicians to be enthusiastic (at any level) in their discussions of mammography or fecal occult blood tests (FOBT) were significantly more likely to report a recent test than patients who reported no discussions.

Conclusion

Physician discussions of cancer screening are important and effective even when, as in the case of mammography, screening rates are already high, or, as in the case of FOBT, rates have tended to remain low. The value of communication about screening should be taught and promoted to primary care physicians who serve as gatekeepers to screening.

Practice implications

Those who train physicians in communication skills should take into account our finding that the communication style of physicians (e.g., enthusiasm for screening) was the only patient or physician variable that both influenced screening adherence and that could be taught.     

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?

Are fixed-rate step tests medically safe for assessing physical fitness?

Maximal oxygen uptake (VO_2max) can be predicted by fixed-rate step tests. However, it remains to be analyzed as to what exercise intensities are reached during such tests to address medical safety. In this study, we compared the physiological response to a standardized fixed-rate step test with maximal cardiopulmonary exercise testing (CPET). One hundred and thirteen healthy adults executed a maximal CPET on bike, followed by a standardized fixed-rate step test 1 week later. During these tests, heart rate (HR) and VO₂ were monitored continuously. From the maximal CPET, the ventilatory threshold (VT) was calculated. Next, the physiological response between maximal CPET and step testing was compared. The step test intensity was 85 ± 24% CPET VO_2max and 88 ± 11% CPET HR_max (VO_2max and HR_max were significantly different between CPET and step testing; p < 0.01). In 41% of the subjects, step test exercise intensities >95% CPET VO_2max were noted. A greater step testing exercise intensity (%CPET VO_2max) was independently related to higher body mass index, and lower body height, exercise capacity (p < 0.05). Standardized fixed-rate step tests elicit vigorous exercise intensities, especially in small, obese, and/or physically deconditioned subjects. Medical supervision might therefore be required during these tests.