Mixed messages in learning communication skills? Students comparing role model behaviour in clerkships with formal training (original) (raw)
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(2018): Teaching future doctors to communicate: a communication intervention for medical students in their clinical year, Journal of Communication in Healthcare, ABSTRACT Background: Effective patient-provider communication enables shared decision-making and leads to improved patient satisfaction, treatment adherence, and health outcomes. The ideal time for developing effective patient-provider communication skills is during a student's clinical training, yet few medical schools have a formal communication curriculum during the clinical year. Methods: We developed a communication curriculum for third-year medical students during clinical training, involving videotaped mock patient interactions and direct instruction by a communication professor. The final mock interviews of the intervention group (n = 10) and the control group (n = 9) were assessed by three blinded communication professors using a communication assessment tool. Results: Students who received the communication intervention scored higher than controls overall and in each of four subcategories (identification convergence, information seeking, information giving, nonverbal behaviors), a pattern statistically significant using a one-tailed sign test (P = 0.031). The intervention group's subscore for information giving was also significantly higher (Wilcoxon Rank Sum test, P = 0.047). Discussion: The communication intervention was successful in improving the students' communication skills, especially information giving, which is critical to enabling patients to make informed decisions in shared decision-making. A curriculum emphasizing the practical application of communication skills in the clinical year can produce measurable improvements in medical students' communication.
Teaching clinically experienced physicians communication skills. A review of evaluation studies
Medical Education, 1999
Context Interest 1 in the teaching of communication skills in medical schools has increased since the early seventies but, despite this growing interest, relatively limited curricular time is spent on the teaching of communication skills. The limited attention to the teaching of these skills applies even more to the physicians' clinical years, when attention becomes highly focused on biomedical and technical competence. Continuing training after medical school is necessary to refresh knowledge and skills, to prohibit decline of performance and to establish further improvements. Objective This review provides an overview of evaluation studies of communication skills training programmes for clinically experienced physicians who have ®nished their undergraduate medical education. The review focuses on the training objectives, the applied educational methods, the evaluation methodology and instruments, and training results. Methods CD-ROM searches were performed on Med-Line and Psychlit, with a focus on effect-studies dating from 1985. Results Fifteen papers on 14 evaluation studies were located. There appears to be some consistency in the aims and methods of the training programmes. Course effect measurements include physician self-ratings, independent behavioural observations and patient outcomes. Most of the studies used inadequate research designs. Overall, positive training effects on the physicians' communication behaviour are found on half or less of the observed behaviours. Studies with the most adequate 2 designs report the fewest positive training effects. Conclusion Several reasons are discussed to explain the limited ®ndings. Future research may bene®t from research methods which focus on factors that inhibit and facilitate the physicians' implementation of skills into actual behaviours in daily practice.
Teaching communication skills to medical students, a challenge in the curriculum
Patient Education and Counseling, 2005
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.
Who should assess medical students' communication skills: their academic teachers or their patients?
Medical Education, 1998
The objective of this study was to compare the assessment of medical students communication skills made by their academic teachers, with the assessment made by their role-playing`patients'. It was a cross-sectional study, conducted at the Department of General Practice, University of Sydney, Australia, and consisted of 519 undergraduate medical students. Teachers rated students' communication skills using ten speci®c criteria, each marked on a ®ve-point Likert scale. Teachers then rated students' overall performance using a 10-point scale. Patients rated students' overall performance on the same 10-point Likert scale. Only two of the 10 criteria, as rated by the academic teachers, correlated with the role-playing patients' overall score, and all 10 criteria accounted for only 10á1% of the variance in that score. The academic assessors' overall score accounted for only 9á7% of the variance of the patients' overall score. The communications skills emphasized by academic teachers do not re¯ect the skills considered to be important by role-playing patients.
Academic Medicine, 2004
Medical educators have a responsibility to teach students to communicate effectively, yet ways to accomplish this are not well-defined. Sixty-five percent of medical schools teach communication skills, usually in the preclinical years; however, communication skills learned in the preclinical years may decline by graduation. To address these problems the New School collaborated to develop, establish, and evaluate a comprehensive communication skills curriculum. This work was funded by the Josiah P. Macy, Jr. Foundation and is therefore referred to as the Macy Initiative in Health Communication. The three schools use a variety of methods to teach third-year students in each school a set of
Trained lay observers can reliably assess medical students’ communication skills
Medical Education, 2009
CONTEXT Our project investigated whether trained lay observers can reliably assess the communication skills of medical students by observing their patient encounters in an outpatient clinic. METHODS During a paediatrics clerkship, trained lay observers (standardised observers [SOs]) assessed the communication skills of Year 3 medical students while the students interviewed patients. These observers accompanied students into examination rooms in an outpatient clinic and completed a 15-item communication skills checklist during the encounter. The reliability of the communication skills scores was calculated using generalisability analysis. Students rated the experience and the validity of the assessment. The communication skills scores recorded by the SOs in the clinic were correlated with communication skills scores on a paediatrics objective structured clinical examination (OSCE). RESULTS Standardised observers accompanied a total of 51 medical students and watched 199 of their encounters with paediatric patients. The reliability of the communication skills scores from nine observed patient encounters was calculated to be 0.80. There was substantial correlation between the communication skills scores awarded by the clinic observers and students' communication skills scores on their OSCE cases (r = 0.53, P < 0.001). Following 83.8% of the encounters, students strongly agreed that the observer had not interfered with their interaction with the patient. After 95.8% of the encounters, students agreed or strongly agreed that the observers' scoring of their communication skills was valid. CONCLUSIONS Standardised observers can reliably assess the communication skills of medical students during clinical encounters with patients and are well accepted by students.
BMC Medical Education, 2015
Background: In medical education, teaching methods offering intensive practice without high utilization of faculty resources are needed. We investigated whether simulated patients' (SPs') satisfaction with a consultation could predict professional observers' assessment of young doctors' communication skills. Methods: This was a comparative cross-sectional study of 62 videotaped consultations in a general practice setting with young doctors who were finishing their internship. The SPs played a female patient who had observed blood when using the toilet, which had prompted a fear of cancer. Immediately afterwards, the SP rated her level of satisfaction with the consultation, and the scores were dichotomized into satisfaction or dissatisfaction. Professional observers viewed the videotapes and assessed the doctors' communication skills using the Arizona Communication Interview Rating Scale (ACIR). Their ratings of communication skills were dichotomized into acceptable versus unacceptable levels of competence. Results: The SPs' satisfaction showed a predictive power of 0.74 for the observers' assessment of the young doctors and whether they reached an acceptable level of communication skills. The SPs' dissatisfaction had a predictive power of 0.71 for the observers' assessment of an unacceptable communication level. The two assessment methods differed in 26 % of the consultations. When SPs felt relief about their cancer concern after the consultation, they assessed the doctors' skills as satisfactory independent of the observers' assessment. Conclusions: Accordance between the dichotomized SPs' satisfaction score and communication skills assessed by observers (using the ACIR) was in the acceptable range. These findings suggest that SPs' satisfaction scores may provide a reliable source for assessing communication skills in educational programs for medical trainees (students and young doctors). Awareness of the patient's concerns seems to be of vital importance to patient satisfaction.