Developing communication curricula in healthcare education: An evidence-based guide

ObjectiveTo present a guide for communication curriculum development in healthcare professions for educators and curriculum planners.MethodsWe collated a selection of theories, frameworks and approaches to communication curriculum development to provide a roadmap of the main factors to consider when developing or enhancing communication skills curricula.ResultsWe present an evidence-based guide for developing and enhancing communication curriculum that can be applied to undergraduate and postgraduate healthcare education. Recommended steps to consider during the communication curricula development process include thoughtful examination of current communication education, needs assessment, focused learning goals and objectives, incorporation of experiential educational strategies allowing for skills practice and feedback and use of formative and summative assessment methods. A longitudinal, developmental and helical implementation approach contributes to reinforcement and sustainment of learners’ knowledge and skills.Conclusion and practice implicationsDrawing on best practices in developing communication curricula can be helpful in ensuring successful approaches to communication skills training for any level of learner or healthcare profession. This position paper provides a guide and identifies resources for new and established communication curriculum developers to reflect on strengths and opportunities in their own approaches to addressing the communication education needs of their learners.     

Education and training methods for healthcare professionals to lead conversations concerning deceased organ donation: An integrative review

ObjectivesTo determine which training methods positively influenced healthcare professionals’ communication skills and families’ deceased organ donation decision-making.MethodsAn integrative review using systematic methods and narrative synthesis for data analysis. Electronic databases of PubMed, Cumulative Index to Nursing and Allied Health Literature (EBSCO), Embase (OVID) and ProQuest Dissertations & Theses Global, were searched between August 1997 and March 2020, retrieving 1019 papers. Included papers (n = 14) were appraised using the Medical Education Research Study Quality Instrument.ResultsTraining programmes offered theory, experiential learning, feedback and debriefing including self-reflection, the opportunity to role-play and interact with simulated participants within realistic case scenarios. Programmes reported observed and self-rated improvements in communication learning and confidence. The methodological quality score averaged 13, (72% of maximum); few studies used an experimental design, examined behavioural change or families’ perspectives. Weak evidence suggested training could increase organ donation authorisation/consent rates.ConclusionsMultiple training strategies are effective in improving interprofessional healthcare professionals’ confidence and learning of specialised communication. Methodological limitations restricted the ability to present definitive recommendations and further research is warranted, inclusive of family decision-making experiences.Practice implicationsLearning of specialised communication skills is enhanced by using multiple training strategies, including role-play and debriefing.     

A Cost-Effectiveness Analysis of Blended Versus Face-to-Face Delivery of Evidence-Based Medicine to Medical Students

BackgroundBlended learning describes a combination of teaching methods, often utilizing digital technologies. Research suggests that learner outcomes can be improved through some blended learning formats. However, the cost-effectiveness of delivering blended learning is unclear.ObjectiveThis study aimed to determine the cost-effectiveness of a face-to-face learning and blended learning approach for evidence-based medicine training within a medical program.MethodsThe economic evaluation was conducted as part of a randomized controlled trial (RCT) comparing the evidence-based medicine (EBM) competency of medical students who participated in two different modes of education delivery. In the traditional face-to-face method, students received ten 2-hour classes. In the blended learning approach, students received the same total face-to-face hours but with different activities and additional online and mobile learning. Online activities utilized YouTube and a library guide indexing electronic databases, guides, and books. Mobile learning involved self-directed interactions with patients in their regular clinical placements. The attribution and differentiation of costs between the interventions within the RCT was measured in conjunction with measured outcomes of effectiveness. An incremental cost-effectiveness ratio was calculated comparing the ongoing operation costs of each method with the level of EBM proficiency achieved. Present value analysis was used to calculate the break-even point considering the transition cost and the difference in ongoing operation cost.ResultsThe incremental cost-effectiveness ratio indicated that it costs 24% less to educate a student to the same level of EBM competency via the blended learning approach used in the study, when excluding transition costs. The sunk cost of approximately AUD $40,000 to transition to the blended model exceeds any savings from using the approach within the first year of its implementation; however, a break-even point is achieved within its third iteration and relative savings in the subsequent years. The sensitivity analysis indicates that approaches with higher transition costs, or staffing requirements over that of a traditional method, are likely to result in negative value propositions.ConclusionsUnder the study conditions, a blended learning approach was more cost-effective to operate and resulted in improved value for the institution after the third year iteration, when compared to the traditional face-to-face model. The wider applicability of the findings are dependent on the type of blended learning utilized, staffing expertise, and educational context.     

Development and Evaluation of an Inter-professional Education Course at a Medical School in Korea

BackgroundInterprofessional collaborative practice (IPCP) is emphasized in medical care for patient safety. As patient care is provided by teams, interprofessional competence is required to ensure the quality and safety of care and should be taught as early as possible. In this study, we introduced a 2-week interprofessional education (IPE) curriculum and attempted to describe and evaluate its effectiveness among medical students.MethodsWe developed a 2-week IPE course and gave it to third- or fourth-year medical students (n = 166) from 2018 to 2019. The curriculum was composed of interactive lectures, discussions, small-group discussions, and simulation and was given to diverse medical students. Students were asked to report their satisfaction with the IPE program, write a reflection paper, and complete readiness for interprofessional learning scale (RIPLS) questionnaires before, immediately after, and 4 months after the curriculum. We also obtained 360° evaluations of the students by other health professionals 1 year after the training.ResultsThe IPE program changed students'' attitudes about interprofessional learning, from less favorable to more favorable. The 360° evaluation by nurses revealed that students became more favored as teammates (overall satisfaction with them as teammates increased from 3.1/5 to 3.4/5) compared to medical interns before IPE training, and complaints from nurses about medical interns were significantly less frequent 1 year after the training.ConclusionThe IPE program was effective in preparing medical students for team based collaborative practice even though it was short and exposed once in the curriculum. Further extension to other medical schools is recommended.     

Development and validation of the healthcare providers patient-activation scale

ObjectiveIt has become increasingly important to assess healthcare providers’ role in chronic disease self-management (CDSM) and patient activation (PA). The present study extends previous work relating to patients’ behaviours by assessing healthcare providers’ own behaviours in supporting PA.Method50 items were generated: half assessed a PA approach; half reflected a non-patient-activation approach. 105 healthcare providers working in cardiac rehabilitation who were participants in a CDSM online training program completed the items pre- and post-training. Factor analysis determined the presence of higher order factors. Item responses pre- and post-training were compared to assess sensitivity to change.ResultsResults indicated the presence of two factors: ‘patient-activation approach’ and ‘non-patient-activation approach’. While both demonstrated good internal consistency, the’ non-PA approach’ had superior discriminatory validity and sensitivity to change.ConclusionHealthcare providers’ beliefs about the importance of patient-activation behaviours can be measured by 40-item Healthcare Provider-Patient Activation Scale (HP-PAS). The scale could be easily converted to measure healthcare providers’ actual PA behaviours.Practice implicationsThe HP-PAS could be used to assess the effectiveness of clinician training for healthcare providers working in cardiac rehabilitation and other areas of CDSM. Further reliability and validity testing within other healthcare provider samples is warranted.     

Patients’ expectations for and experiences with primary healthcare services received from a patient centered medical home

ObjectiveExpectations for and experiences with healthcare services are summarized for 1143 patients receiving care in a statewide demonstration of Patient Centered Medical Homes (PCMH).MethodsPatients were recruited from 91 primary care clinics for semi-structured interviews to determine what patients expect, what they plan to do and how they intend to execute their plans in partnership with their healthcare team.ResultsThe majority (78%) of patients defined the patient-team partnership as a collaborative and problem-solving effort. Overall, 68% defined responsibility for own health as a personal responsibility; 55% defined listening to patient’s concerns and answering questions as a responsibility of their healthcare team. Diet and exercise came up most frequently whether as a personal responsibility, issues for receiving additional help from their clinic, or plans for personal change.ConclusionPatients’ preferred a collaborative, problem-solving healthcare team partnership but also had boundaries for what additional services they wanted from this team.Practice Implications: Patients’ expectations for a collaborative partnership, acceptance of personal responsibility and interest in diet and exercise expands opportunities for patient education and teamwork. Clinics’ engagement with broader resources would be needed to address patients’ many and varied challenges to taking care of their health.     

Tell Me More®: A medical student focused humanistic communication model to enhance student professional identity formation through meaningful patient encounters

IntroductionThe Tell Me More (TMM)® program provides a template for guided interviews to help providers procure an expansive social history from patients and connect with them as people beyond their illness. (TMM)® may provide a dual benefit: it improves the patient’s experience with their healthcare team and the medical students' experience in developing their identity as a physician. Our aim was to characterize the impact of the patient-student conversations in TMM® on the participating medical students through analysis of their written reflections throughout the program.MethodsStudents conducted interviews with hospitalized patients using the TMM® template, Through narrative medicine and individualized posters, patients were able to highlight their unique qualities.ResultsQualitative analyses of 63 journal reflections from 14 students, across 7 hospital settings, identified 6 themes. These included connection, humanism, discovery, impact, privilege, and perspective.ConclusionReflective practice as a learning pedagogy created an opportunity to enhance the medical students’ awareness of empathy and compassion during the TMM® program. Documentation of reflections assured students would process the encounter as a profound learning experience and develop their professional identity formation as a student preparing to become a physician.Practical implicationsTMM® provides an opportunity for medical students to practice and apply their interpersonal and communication skills through authentic patient encounters.     

Using Low-Fidelity Simulation to Maintain Competency in Central Line Care

PurposeMany healthcare facilities require staff nurses to complete annual competency assessments on central line care. However, the question arises, could simulation provide a better assessment of competency and possibly help nurses retain competence longer?Review of Relevant LiteratureA thorough review of the literature revealed that limited investigation has been done regarding the perception or effectiveness of simulation as a tool for competency evaluation. Multiple authors have identified simulation as an advantageous method for training health care providers in central line care. Several studies have linked simulation based training with decreased central line associated bacteremia rates. There is also evidence in the literature that simulation has great potential as a competency validation technique.DiscussionA sample of staff nurses participated in one of four central line care scenarios in a simulation environment. The participants were asked to complete a demographics survey as well as a self-assessment on central line competency prior to the simulation experience. Debriefing followed the simulation, offering the participant feedback on performance and verification of correct and incorrect actions. The self-assessment was then repeated to measure participant perception post-simulation.Implications for Clinical PracticeNo significant difference of performance in the simulation was inferred from baccalaureate-prepared nurses versus diploma or associate-prepared nurses. Almost all participants rated their competence in caring for a central line as either “competent” or “highly competent.” However upon demonstration of central line skills in the simulation, all but two participants omitted a critical step. Omitting these steps places the patient at risk for infection or other complications.     

Training healthcare professionals in LGBTI cultural competencies: Exploratory findings from the Health4LGBTI pilot project

ObjectivesLesbian, gay, bisexual, trans and intersex (LGBTI) people experience health inequalities and barriers to accessing healthcare at a greater rate than the general population. This paper aims to present the Health4LGBTI training course for healthcare workers and the results of its pilot implementation.MethodsFunded by the European Parliament, the training course was developed by a multidisciplinary team including LGBTI organisations as part of the Health4LGBTI Project. 110 healthcare professionals from diverse medical fields attended the pilot training in six European Member States. Knowledge and attitudes were compared on the basis of a pre-post evaluation design utilising an ad hoc questionnaire.ResultsKnowledge scores increased after the training, irrespective of age and sexual orientation of participants. Attitudes scores generally improved, particularly in terms of inclusivity and a greater acknowledgement of LGBTI health needs and self-competence.ConclusionThe Health4LGBTI training course is both feasible and effective in training healthcare professionals and support staff to improve cultural competence and thereby promoting inclusive healthcare practice.Practice ImplicationsThe Health4LGBTI training course can be implemented in different healthcare contexts. Piloting of the course provided an opportunity for healthcare professionals and for support staff to improve their knowledge of, and attitudes towards, LGBTI people.     

Learning communication from erroneous video-based examples: A double-blind randomised controlled trial

ObjectiveAppropriate training strategies are required to equip undergraduate healthcare students to benefit from communication training with simulated patients. This study examines the learning effects of different formats of video-based worked examples on initial communication skills.MethodsFirst-year nursing students (N = 36) were randomly assigned to one of two experimental groups (correct v. erroneous examples) or to the control group (no examples). All the groups were provided an identical introduction to learning materials on breaking bad news; the experimental groups also received a set of video-based worked examples. Each example was accompanied by a self-explanation prompt (considering the example’s correctness) and elaborated feedback (the true explanation).ResultsParticipants presented with erroneous examples broke bad news to a simulated patient significantly more appropriately than students in the control group. Additionally, they tended to outperform participants who had correct examples, while participants presented with correct examples tended to outperform the control group.ConclusionThe worked example effect was successfully adapted for learning in the provider-patient communication domain.Practice ImplicationsImplementing video-based worked examples with self-explanation prompts and feedback can be an effective strategy to prepare students for their training with simulated patients, especially when examples are erroneous.     

Teaching clinical reasoning and decision-making skills to nursing students: Design,development, and usability evaluation of a serious game

BackgroundSerious games (SGs) are a type of simulation technology that may provide nursing students with the opportunity to practice their clinical reasoning and decision-making skills in a safe and authentic environment. Despite the growing number of SGs developed for healthcare professionals, few SGs are video based or address the domain of home health care.AimsThis paper aims to describe the design, development, and usability evaluation of a video based SG for teaching clinical reasoning and decision-making skills to nursing students who care for patients with chronic obstructive pulmonary disease (COPD) in home healthcare settings.MethodsA prototype SG was developed. A unified framework of usability called TURF (Task, User, Representation, and Function) and SG theory were employed to ensure a user-centered design. The educational content was based on the clinical decision-making model, Bloom’s taxonomy, and a Bachelor of Nursing curriculum. A purposeful sample of six participants evaluated the SG prototype in a usability laboratory. Cognitive walkthrough evaluations, a questionnaire, and individual interviews were used for the usability evaluation. The data were analyzed using qualitative deductive content analysis based on the TURF framework elements and related usability heuristics.ResultsThe SG was perceived as being realistic, clinically relevant, and at an adequate level of complexity for the intended users. Usability issues regarding functionality and the user–computer interface design were identified. However, the SG was perceived as being easy to learn, and participants suggested that the SG could serve as a supplement to traditional training in laboratory and clinical settings.ConclusionsUsing video based scenarios with an authentic COPD patient and a home healthcare registered nurse as actors contributed to increased realism. Using different theoretical approaches in the SG design was considered an advantage of the design process. The SG was perceived as being useful, usable, and satisfying. The achievement of the desired functionality and the minimization of user–computer interface issues emphasize the importance of conducting a usability evaluation during the SG development process.     

Introducing integrative primary health care to an interprofessional audience: Feasibility and impact of an asynchronous online course

BackgroundAlthough there is mounting clinical and cost-effectiveness evidence supporting integrative healthcare (IH), a significant knowledge gap hinders widespread adoption by primary care professionals.InterventionBased on IH competencies developed by an interprofessional team and a needs assessment, a 32-h online interprofessional IH course, Foundations in Integrative Health, was developed. Trainees learn to conduct an IH assessment and how patients are assessed and treated from the diverse professions in integrative primary care.MethodsThe course was pilot-tested with educational program trainees, faculty and clinical staff at graduate level primary care training programs (primary care residencies, nursing, pharmacy, public health, behavioral health, and licensed complementary and IH programs).Outcome measuresPrior to and following the course, participants completed an IH knowledge test, an IH efficacy self-assessment, and validated measures of IH attitudes, interprofessional learning, provider empathy, patient involvement, resiliency, self-care, wellness behaviors, and wellbeing. Evaluation surveys were administered following each unit and the course.ResultsAlmost one-half (n = 461/982, 47%) completed the course. Pre/post course improvements in IH knowledge, IH self-efficacy, IH attitudes, interprofessional learning, provider empathy, resiliency, self-care, several wellness behaviors, and wellbeing were observed. The course was positively evaluated with most (93%) indicating interest in applying IH principles and that the course enhanced their educational experience (92%).ConclusionThis study demonstrates the feasibility and effectiveness of a multi-site, online curriculum for introducing IH to a diverse group of primary care professionals. Primary care training programs have the ability to offer an interprofessional, IH curriculum with limited on-site faculty expertise.     

Position paper: Teaching breaking bad news (BBN) to undergraduate medical students

Sharing new medical information that is perceived as seriously effecting people’s lives, i.e., breaking bad news (BBN) is important in caring for patients and relatives and is challenging for healthcare professionals. Optimal BBN requires incorporation and implementation of multiple professional competencies acquired gradually throughout years of training. The BBN encounter has implications for all participants: the patient, family members, their close social environments, and the deliverer of the news. Due to these implications and the accountability involved, medical schools invest educational resources in helping medical students develop this competency.The current paper summarizes literature, research, and teaching experiences while suggesting practical guidelines for designing and teaching a BBN course to undergraduate students.The following principles lie behind the recommendations: stepwise spiral continuity of exposure to and teaching of communication skills in various contexts while focusing on BBN in the advanced clinical years; relating the developing skills to broader humanistic studies; enhancing awareness of self-perspectives and beliefs regarding BBN; connecting to patients’ and family members experiences and needs; providing a BBN protocol and opportunities for structured experiential learning followed by reflection and feedback; using observation and reflection to address gaps between theory and real-life practice; and creating continuity of learning about BBN through undergraduate, graduate, and continuing medical education. Applying this learning process can help enhance the management of these difficult conversations to improve patients’ care during these difficult, life-changing encounters, and physicians’ well-being.     

A stitch in time saves nine: Perceptions about colorectal cancer screening after a non-cancer colonoscopy result. Qualitative study

ObjectivesTo explore perceptions of colorectal cancer (CRC) screening among participants who have experienced a ‘false alarm’ for CRC, and to explore perceptions about the relevance of screening for themselves or others.MethodsSemi-structured interviews with screening participants who had participated in the Danish CRC screening program and experienced a ‘false alarm’ for colorectal cancer. A thematic analysis was performed, based on an interpretive tradition of ethnography.ResultsPerceptions about CRC screening after a non-cancer colonoscopy result were characterized by trust in the colonoscopy result showing no CRC, and satisfaction with the screening offer despite the risk for ‘false alarm’. The patient-involving behavior of the healthcare professionals during the examination was for most participants a cornerstone for trusting the validity of the colonoscopy result showing no CRC. Strong notions about perceived obligation to participate in screening were common.ConclusionsProminent themes were trust in the result, satisfaction with the procedure, and moral obligations to participate both for themselves and for others.Practice implicationsInformation to future invitees after a ‘false alarm’ experience could build on peoples’ trust in the validity of a previous non-cancer result and should underscore the importance of subsequent screening even after a ‘false alarm’ for cancer.     

Identifying residents’ educational needs to optimising postgraduate medical education about shared decision-making

ObjectiveTo investigate how to optimise resident engagement during workplace learning of shared decision-making (SDM) by understanding their educational needs.MethodsA qualitative multicentre study was conducted using video-stimulated interviews with 17 residents in General Practice. Video recordings of residents’ recent clinical encounters were used to facilitate reflection on their educational needs.ResultsData analysis resulted in five themes regarding residents’ educational needs for learning SDM: acquiring knowledge and skills needed to perform SDM; practising SDM; reflection and feedback; longitudinal and integrated training; and awareness and motivation for performing SDM.ConclusionResidents expressed a need for continuous attention to be paid to SDM during postgraduate medical education. That would help them engage in two parallel learning processes: acquiring the knowledge and skills necessary to perform SDM, and practising SDM in the clinical workplace. Alignment between the educational curriculum, workplace learning and resident learning activities is essential to operationalise SDM attitude, knowledge and skills into clinical performance.Practice ImplicationsThe identified educational needs provide ingredients for fostering the development of SDM proficiency. The findings suggest that residents and clinical supervisors need parallel training to bridge the gap between education and clinical practice when learning SDM.     

The effect of a relationship-centered communication program on patient experience and provider wellness

ObjectivesDespite evidence of the central importance of communication to patient experience, health outcomes, and provider wellness, communication training for clinicians is not a standard part of clinical education. The study explores the impact of an 8-hour relationship-centered communication (RCC) training program on patient experience and provider wellness.Methods636 healthcare providers participated in 48 workshops conducted January-August 2018. 481 (76%) agreed to participate in research. Participants completed a pre/post assessment that included a wellness survey, the Professional Fulfillment Index (PFI). We conducted chi-squared analyses comparing wellness data immediately prior to the course to 3 months following course participation. Patient experience, assessed using Press Ganey likelihood to recommend care provider (PG-LTR CP) scores, were examined prior to an individual’s course participation and following participation up to September 2019.Results104 participants completed the three-month PFI (22% response rate). Participants demonstrated marked improvements in professional wellness after 3 months. In bivariate analyses, PG-LTR CP significantly increased and persisted more than 7 months following program completion.ConclusionsThe RCC training program, a low-cost communication intervention, led to significant, beneficial changes in provider wellness and patient experience.Practice implicationsImplementing a RCC course for providers may improve patient experience and provider wellness.