Effectiveness of a communication skills training program for medical students to identify patients communicative clues

ObjectiveThis study explores whether an Experiential Training Programme (ETP) in communication skills (CS) improves students' ability to identify patients clues compared to those who follow a non-experiential training throughout their medical studies.MethodIntervention Group (IG): 85 4th-year medical students who received the ETP and Control Group (CG): 67 recently graduated students who did not receive it. Their immediate (written) response was requested to three expressions offered by patients containing communicative clues. The answers were grouped into 2 categories: Clue recognised and response patient-centred and the opposite. Three researchers analysed the answers.ResultsResponses 366 (65 from the CG and 77 from the IG): 280 did not recognise clues: 131 (62%) in IG and 149 (96%) in CG and 86 recognised them: 80 (37.9%) in IG and 6 (3.9%) in CG (p = 0.000). Some clues were more elusive than others (p = 0,003).ConclusionsThe students who received the ETP in CS showed greater ability to explore patients perspective taking advantage of different types of communicative clues than those who did not receive it in a non-relational context.Practice implicationsFurther research is needed to assess whether this ability is maintained in simulated or real clinical situations.     

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

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

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.     

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

Objective

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

Methods

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

Results

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

Conclusion

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

Practice implications

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

Barreras culturales y psicológicas en la relación clínica y educativa en estudiantes y residentes de medicina españoles (II)

Empathize, negotiate, shared decisions making or inform patients, represent important communication skills both for the doctor-patient relationship and for learning through experiential and significant educational strategies since they need a constant monitoring of the interaction, they favour the acquisition of a broader perspective that allows a deeper understanding of oneself and the other. However, in our cultural context, many students and residents present important difficulties for the development of this type of metacognitive skills, which affects the assumption and learning of a person centered in clinical practice with possible future consequences. The author uses his experience of more than 25 years in both clinical and educational contexts to exemplify some of these difficulties while highlighting the role that some cultural and psychological factors may have in their development. This paper is the second of two.     

Validation of the ComCare index for rater-based assessment of medical communication and interpersonal skills

ObjectivesTo develop and validate a short instrument to assess undergraduate medical students’ communication and interpersonal skills in videographed history taking situations with simulated patients.MethodsSixty-seven undergraduate medical students participating in an assessment including videographed physician-patient encounters for history taking with five simulated patients were included in this study. The last video of each participant’s consultation hour was rated by two independent assessors with the eight-item ComCare index for assessment of communication and interpersonal skills newly designed for the external rater perspective (ComCareR). We compared the sum scores of the ComCareR with ratings of the same videos with the Kalamazoo Communication Skills Assessment Form from an observational perspective (KCSAFd-video) and the Global Rating scale (GR), which also measure communication and interpersonal skills.ResultsThe ComCareR showed an excellent interrater reliability (ICC = .85). We found a small but significant correlation with the KCSAFd-video Interpersonal Competence (ρ = .34, 95% CI [.10,.54]) and a high positive correlation with the GR (ρ = .59, 95% CI [.40,.73]).ConclusionsThe ComCareR is a valid and brief index for holistic assessment of communication and interpersonal skills in physician-patient encounters.Practice implicationsThe ComCareR can be used for quick rater-based assessment of physicians’ communication and interpersonal skills.     

The impact of patient and physician computer mediated communication skill training on reported communication and patient satisfaction

Objective

The objective was to evaluate parallel patient and physician computer-mediated communication skill training on participants’ report of skill use and patient satisfaction.

Methods

Separate patient and clinician web-tools comprised of over 500, 10-s video clips demonstrating patient-centered skills in various ways. Four clinician members of the American Academy of Family Physicians National Research Network participated by enrolling 194 patients into a randomized patient trial and 29 physicians into a non-randomized clinician trial of respective interventions. All participants completed baseline and follow-up self-report measures of visit communication and satisfaction.

Results

Intervention patients reported using more skills than controls in five of six skill areas, including identification of problems/concerns, information exchange, treatment adherence, shared decision-making and interpersonal rapport (all p < .05); post intervention, physicians reported using more skills in the same 5 areas (all p < .01). Intervention group patients reported higher levels of satisfaction than controls in five of six domains (all p < .05).

Conclusion

Communication skill training delivered in a computer mediated format had a positive and parallel impact on both patient and clinician reported use of patient-centered communication and in patient satisfaction.

Practice Implications

Computer-mediated interventions are cost and time effective thereby increasing patient and clinician willingness to undertake training.     

Assessment of patient communication skills during OSCE: examining effectiveness of a training program in minimizing inter-grader variability

Objective

To assess effectiveness of a training program in reducing inter-grader variability in grading communication skills during an objective structured clinical exam (OSCE).

Methods

Global communication (GC) skills are assessed by standardized participants (SP) and faculty during each OSCE using a 6 item rubric. Despite criteria delineated in the GC rubric, inter-grader variability was observed. During 2008-2009 academic year, a training program was implemented before each OSCE to achieve more consistent interpretation and grading in GC skills. GC grades between SP and faculty for 2nd and 3rd level student OSCEs during 2008-2009 (post-training) were compared to 2007-2008 (pre-training). Data was analyzed using repeated measures ANOVA.

Results

274 and 281 students participated in OSCEs during 2007-2008 and 2008-2009 academic years, respectively. Training significantly (P < .001) decreased grader variability between SPs and faculty. There was a greater mean difference between faculty vs. SP before training (faculty 14.68, SP 15.87) compared to after training (faculty 13.51, SP 13.78). Mean GC scores for both faculty and SPs also decreased significantly after training.

Conclusion and practice implications

A training program may be necessary to reduce inter-rater variability in assessment of OSCE communication skills if it is to be truly helpful to student pharmacists learning to counsel patients.     

Improving patient emotional functioning and psychological morbidity: Evaluation of a consultation skills training program for oncologists

Objective

To evaluate whether a consultation skills training (CST) program with oncologists and trainees would improve skills in detecting and responding to patient distress, thereby improving their patients’ emotional functioning and reducing psychological distress.

Methods

Randomized-controlled trial with 29 medical and radiation oncologists from Australia randomized to CST group (n = 15) or usual-care group (n = 14). The CST consisted of a 1.5-day face-to-face workshop incorporating presentation of principles, a DVD modelling ideal behaviour and role-play practice, and four 1.5 h monthly video-conferences. At the CST conclusion, patients of participating doctors were recruited (n = 192 in CST group, n = 183 in usual-care group), completing telephone surveys at baseline, 1 week and 3 months to assess quality of life, anxiety, depression and unmet psychosocial needs.

Results

Despite high patient functioning at baseline, anxiety significantly improved at 1-week follow-up in the CST group, compared to the control group. There were no statistically significant differences in emotional functioning, depression or unmet supportive care need between the groups.

Conclusion

Consistent trends for greater improvements were observed in intervention compared to control group patients, suggesting the CST program deserves wider evaluation.

Practice implications

Video-conferencing after a short training course may be an effective strategy for delivering CST.     

A randomized controlled trial assessing behavioral,cognitive, emotional and physiological changes resulting from a communication skills training in physicians caring for cancer patients

ObjectiveThis randomized study assesses behavioral, cognitive, emotional and physiological changes resulting from a communication skills training (CST) for physicians caring for cancer patients.MethodsMedical specialists (N = 90) were randomly assigned in groups to complete a manualized 30-h CST or to a waiting list. Assessments included behavioral (communication skills), cognitive (self-efficacy, sense of mastery), emotional (perceived stress) and physiological (heart rate) measures. Assessments were made at baseline (both groups), after CST program (training group), and four months after (waiting list group). All assessments were conducted before, during, and after a complex communication task with an advanced-stage cancer simulated patient (SP).ResultsTrained physicians had higher levels of communication skills (from RR=1.32; p = .003 to RR=41.33; p < .001), self-efficacy (F=9.3; p = .003), sense of mastery (F=167.9; p < .001) and heart rate during the SP encounter (from F=7.4; p = .008 to F=4; p = .050) and same levels of perceived stress (F=3.1; p = .080).ConclusionA learner-centered, skills-focused and practice-oriented manualized 30-h CST induced multilevel changes indicating physician engagement in a learning process.Practice implicationsTrainers should consider the CST multilevel benefits (behavioral, cognitive, emotional and physiological) before, during and after a complex communication simulated task as an innovative way to assess the efficacy of a communication skills learning process.     

Development and evaluation of a risk communication curriculum for medical students

Objective

To develop, pilot, and evaluate a curriculum for teaching clinical risk communication skills to medical students.

Methods

A new experience-based curriculum, “Risk Talk,” was developed and piloted over a 1-year period among students at Tufts University School of Medicine. An experimental study of 2nd-year students exposed vs. unexposed to the curriculum was conducted to evaluate the curriculum's efficacy. Primary outcome measures were students’ objective (observed) and subjective (self-reported) risk communication competence; the latter was assessed using an Observed Structured Clinical Examination (OSCE) employing new measures.

Results

Twenty-eight 2nd-year students completed the curriculum, and exhibited significantly greater (p < .001) objective and subjective risk communication competence than a convenience sample of 24 unexposed students. New observational measures of objective competence in risk communication showed promising evidence of reliability and validity. The curriculum was resource-intensive.

Conclusion

The new experience-based clinical risk communication curriculum was efficacious, although resource-intensive. More work is needed to develop the feasibility of curriculum delivery, and to improve the measurement of competence in clinical risk communication.

Practice implications

Risk communication is an important advanced communication skill, and the Risk Talk curriculum provides a model educational intervention and new assessment tools to guide future efforts to teach and evaluate this skill.     

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.     

Maximizing your Patient Education Skills (MPES): A multi-site evaluation of an innovative patient education skills training course for oncology health care professionals

Objective

To evaluate the acceptability and relevance of the Maximizing your Patient Education Skills (MPES) course and to determine whether it significantly improved knowledge regarding patient education (PE) theory, self-assessed PE competencies, and PE skills using case based vignettes.

Methods

1-Group, multi-site, pre-post-intervention. Participants completed a pre-assessment (T1), participated in the 4-h MPES course, and then a 3-month post-assessment (T2). A focus group was conducted with sub-set of participants.

Results

98 (75%) of participants completed both time points. Participants were highly satisfied with MPES and found it to be relevant. Results showed that MPES had a significant impact on all of our outcome measures.

Conclusion

Findings from this study show that oncology HCPs knowledge of patient education theory, self-assessed competencies and skills can improve after participating in a brief problem-focused and interactive workshop.

Practice implications

Given the evidence that well-planned education and support can contribute to a number of positive health outcomes and the evidence that HCPs may lack the skills to teach and support patients and their families effectively, these results suggest that MPES course may be of value to oncology professionals. Efforts to further develop this course include exploring alternative funding models and using different learning platforms.     

Assessment of surgeon communication skills from the patient perspective: A national evaluation using the Communication Assessment Tool

ObjectiveThe Communication Assessment Tool (CAT) has previously been translated and adapted to the Italian context. This national study aimed to validate the CAT and evaluate communication skills of practicing surgeons from the patient perspective.MethodsCAT consists of 14 items associated with a 5-point scale (5 = excellent); results are reported as the percent of ‘‘excellent’’ scores. It was administered to 920 consenting outpatients aged 18–84 in 26 Italian surgical departments.ResultsThe largest age group was 45–64 (43.8%); 52.2% of the sample was male. Scores ranged from 44.6% to 66.6% excellent. The highest-scoring items were “Treated me with respect” (66.6%), “Gave me as much information as I wanted” (66.3%) and “Talked in terms I could understand” (66.0%); the lowest was “Encouraged me to ask questions” (44.6%). Significant differences were associated with age (18–24 year old patients exhibited the lowest scores) and geographical location (Northern Italy had the highest scores).ConclusionCAT is a valid tool for measuring communication in surgical settings.Practice ImplicationsResults suggest that expectations of young people for communication in surgical settings are not being met. While there is room to improve communication skills of surgeons across Italy, patients highlighted the greatest need in the Central and Southern regions.     

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.     

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.     

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.     

The effect of training in communication skills on medical doctors' and nurses' self-efficacy. A randomized controlled trial

OBJECTIVE: To investigate the effect of communication skills training on doctors' and nurses' self-efficacy, to explore how training courses influence the initial experience of self-efficacy and to identify determinants of health professionals' self-efficacy. METHODS: The study was conducted as a randomized trial. Clinicians in the intervention group received a 5 day communication course and the control group received no intervention. The impact of the intervention was evaluated by means of questionnaires measuring the effect of communication courses on changes in doctors' and nurses' self-efficacy. RESULTS: Clinicians who participated in the communication course improved their self-efficacy for specific communication tasks with up to 37%. The improvements remained constant for the following 6 months. The training course did not influence the initial experience of self-efficacy. CONCLUSION: Communication skills training can improve clinicians' evaluation of his or her ability to perform a specific communication task - measured as self-efficacy. PRACTICE IMPLICATIONS: Communication courses can be used to improve doctors' and nurses' ability to perform some of the essential communicative demands they are facing in daily praxis.