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.     

A pilot of modified Conversation Analytic Role-play Method for one-to-one clinical communication training

ObjectiveIt can be difficult to identify specific skills to improve communication, particularly if feedback is generalised or vague. With the aim of providing specific feedback for improved doctor-patient communication, we piloted a modified Conversation Analytic Roleplay Method (CARM) for one-to-one training.MethodsWe recorded one surgical registrar during ward rounds in a hospital. These seven consultations were then analysed and an individualised CARM workshop, utilising the findings and related published evidence, was developed and delivered. One month after this workshop, another nine consultations were recorded and analysed.ResultsThere were three “trainables” identified in the initial analysis that formed the basis of the personalised workshop. Analysis of the post-training recordings showed that the verbal behaviours were mostly modified but the non-verbal behaviour generally was not.ConclusionBy facilitating reflection on and close analysis of his own interaction using CARM, we were able to assist this doctor in modifying some of his communication behaviours.Practice implicationsPersonalised video-based training enables the identification of an individual’s practice, allowing for specific feedback and engaging participants with the analysis of their own talk. This makes it potentially an ideal method for helping those struggling to improve with other training methods.     

Impact of a brief faculty training to improve patient-centered communication while using electronic health records

Objective

Despite rapid EHR adoption, few faculty receive training in how to implement patient-centered communication skills while using computers in exam rooms. We piloted a patient-centered EHR use training to address this issue.

Lost in translation: Cultural divides in communication skills teaching identified in the ICCH 2016 student symposium

ObjectiveTo provide a platform for learners’ voices at an international conference on communication in healthcare.MethodsA group of medical students were invited to explore their experiences with communication skills learning at a symposium at the 2016 International Conference on Communication in Healthcare in Heidelberg, DE.ResultsStudents from the US, Denmark, Germany, and Russia discussed their experiences with communication skills curriculum at their institutions. We identified divides that have challenged our ability to develop and maintain strong communication skills: 1) valuation of communication skills vs. other topics, 2) curricular theory vs. practice, 3) evaluation vs. feedback, 4) preclinical vs. clinical learning, and 5) the medical student vs. practicing clinician role.ConclusionThe points of transition we identified on the road of communication skills teaching highlight opportunities to strengthen the educational experience for students. Without an effort to address these divides, however, our communication skills may be lost in translation.Practice implicationsStudents value communication skills teaching during their medical education and there are opportunities to translate this to countries that currently lack robust curricula and to the real-life post-graduate setting. Support is necessary from students, teachers, and administrators, and focus on translation of skills during role transitions is needed.     

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.     

Motivational interviewing training for medical students: A pilot pre-post feasibility study

Objective

To evaluate the impact of brief training in motivational interviewing (MI) from a non-specialist professional for medical students.

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.     

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.     

Monitoring communication skills progress of medical students: Establishing a baseline has value,predicting the future is difficult

Objective

To provide evidence for the validity of an Introductory Clinical Experience (ICE) that was implemented as a baseline assessment of medical students’ clinical communication skills to support progression of skills over time.

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.     

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.     

The reliability of a modified Kalamazoo Consensus Statement Checklist for assessing the communication skills of multidisciplinary clinicians in the simulated environment

Objective

With increased recognition of the importance of sound communication skills and communication skills education, reliable assessment tools are essential. This study reports on the psychometric properties of an assessment tool based on the Kalamazoo Consensus Statement Essential Elements Communication Checklist.

Methods

The Gap-Kalamazoo Communication Skills Assessment Form (GKCSAF), a modified version of an existing communication skills assessment tool, the Kalamazoo Essential Elements Communication Checklist-Adapted, was used to assess learners in a multidisciplinary, simulation-based communication skills educational program using multiple raters. 118 simulated conversations were available for analysis. Internal consistency and inter-rater reliability were determined by calculating a Cronbach's alpha score and intra-class correlation coefficients (ICC), respectively.

Results

The GKCSAF demonstrated high internal consistency with a Cronbach's alpha score of 0.844 (faculty raters) and 0.880 (peer observer raters), and high inter-rater reliability with an ICC of 0.830 (faculty raters) and 0.89 (peer observer raters).

Conclusion

The Gap-Kalamazoo Communication Skills Assessment Form is a reliable method of assessing the communication skills of multidisciplinary learners using multi-rater methods within the learning environment.

Practice implications

The Gap-Kalamazoo Communication Skills Assessment Form can be used by educational programs that wish to implement a reliable assessment and feedback system for a variety of learners.     

Medical and psychology students' self-assessed communication skills: A pilot study

Objective

The purpose of this study was to describe how psychology and medical students assess their own competency and skills before and after training, in which role-play was used to teach interpersonal and communication skills.

Method

Interpersonal and communication skills were assessed with a semi-structured questionnaire before and after the training.

Results

The students of both medicine and psychology estimated their skill levels to be higher after the course. The psychology students estimated their skills for communication, motivating interviewing, empathy and reflection, and change orientation to be better at the end of the course. Medical students estimated their communication skills, motivating interviewing skills, and change orientation skills to be better at the end of the course.

Conclusion

Even a short period of training in interpersonal and communication skills can positively affect the self-assessed skills of the medical students.

Practice implications

In the future, it would be worthwhile to pay attention to reflective teaching practices in the training of both medical and psychology students. The cognitive and emotional components of these practices help students to develop their own communication skills.     

Consensus statement on an updated core communication curriculum for UK undergraduate medical education

Objectives

Clinical communication is a core component of undergraduate medical training. A consensus statement on the essential elements of the communication curriculum was co-produced in 2008 by the communication leads of UK medical schools. This paper discusses the relational, contextual and technological changes which have affected clinical communication since then and presents an updated curriculum for communication in undergraduate medicine.

A rigorous evaluation of an institutionally-based communication skills program for post-graduate oncology trainees

Objective

Integrating education about physician-patient communication into oncology specialists’ education is important to improve quality of care. Our aim was to rigorously evaluate a 4-year institutionally-based patient communication skills program for oncology post-graduate trainees.

Ignitions of empathy. Medical students feel touched and shaken by interacting with patients with chronic conditions in communication skills training

ObjectiveTo explore what and how medical students learn from patients with chronic conditions in the context of communication skills training.MethodsSemi-structured interviews and focus groups with 32 medical students. Interviews were recorded, transcribed, analyzed inductively and organized into four main narrative themes.ResultsLearning from patients provided medical students opportunities to see the world through the patients’ eyes, understand the diversity of patients’ needs, and recognize the importance of matching patients’ and doctors’ perspectives. Consequently, students expressed emotional responses on challenges in interactions with the patients related to performing the role as ‘medical expert’. Difficulty empathizing became visible in the students’ interaction with patients.ConclusionThe patients’ authentic contributions provided the students with unique opportunities to engage with their own emotions and capacity for empathy. However, for students to benefit from this affective practical training, they need guidance to balance professional and personal aspects in encounters. There is a need to introduce the ‘doctor as person’ in medical education.Practice implicationsPatients with chronic conditions strengthen students’ learning of empathy as part of transformative learning. Doing so with patients is a challenging way of learning. Thus, faculty and educators must provide explicit guidance for students to benefit.     

The effect on reliability and sensitivity to level of training of combining analytic and holistic rating scales for assessing communication skills in an internal medicine resident OSCE

ObjectiveAlthough previous research has compared checklists to rating scales for assessing communication, the purpose of this study was to compare the effect on reliability and sensitivity to level of training of an analytic, a holistic, and a combined analytic-holistic rating scale in assessing communication skills.MethodsThe University of Alberta Internal Medicine Residency runs OSCEs for postgraduate year (PGY) 1 and 2 residents and another for PGY-4 residents. Communication stations were scored with an analytic scale (empathy, non-verbal skills, verbal skills, and coherence subscales) and a holistic scale. Authors analyzed reliability of individual and combined scales using generalizability theory and evaluated each scale's sensitivity to level of training.ResultsFor analytic, holistic, and combined scales, 12, 12, and 11 stations respectively yielded a Phi of 0.8 for the PGY-1,2 cohort, and 16, 16, and 14 stations yielded a Phi of 0.8 for the PGY-4 cohort. PGY-4 residents scored higher on the combined scale, the analytic rating scale, and the non-verbal and coherence subscales.ConclusionA combined analytic-holistic rating scale increased score reliability and was sensitive to level of training.Practice implicationsGiven increased validity evidence, OSCE developers should consider combining analytic and holistic scales when assessing communication skills.     

Averting adverse events in communication skills training: A case series

Objective

To document cases of adverse or near adverse events in communication skills training (CST) and to identify risk factors and strategies to reduce the likelihood of their occurrence.

Methods

Six physician CST cases meeting criteria for an adverse or near adverse collected from experienced facilitators are analyzed and discussed.

Results

Three types of adverse CST events are described: traumatic personal experiences or losses evoked by training; perception that feedback is not empathic; and where trainees are referred for remedial CST as a risk management strategy.

Conclusion

Early identification of risk factors and emotional cues of trainees is a key first step that facilitates implementation of remedial strategies to avert potential adverse events. Consideration of ways that physicians’ personal experiences impact communication and good feedback techniques are vital. The implications of physicians sent to CST for risk management purposes is a new scenario that deserves special consideration.

Practice implications

To make CST safer and to optimize learning, early recognition of potential adverse events is essential. Specific feedback techniques should be mastered by all CST facilitators.