Teaching and assessment of clinical communication skills: Lessons learned from a SWOT analysis of Portuguese Angolan and Mozambican Medical Education.

HIGHLIGHTS: CCS training lacks a formal structure with substantial variation of the teaching process.The interviews promoted, amongst important stakeholders, a rise in awareness of this situation and how these skills can enhance the quality of clinical practice, encouraging curricular change.A communication skills teaching model: CoSTProMed is suggested for curriculum integration. BACKGROUND: The importance of clinical communication skills (CCS) teaching and assessment is increasingly recognized in medical education. There is a lack of outcome-based research about CCS teaching and assessment processes in Portuguese medical education. Our goal is to conduct a SWOT analysis of this process in Portugal, Angola and Mozambique in order to contribute to the establishment of an action plan for more effective CCS teaching and assessment in medical curricula. METHODS: Between 2010 and 2012, semi-structured interviews focused on the state of the art of teaching and assessment of clinical communication skills were conducted with key stakeholders of medical courses in Portugal, Angola and Mozambique. The design corresponds to an exploratory, descriptive and cross-sectional study, with the analysis of the recorded interviews. Interview transcripts were analyzed to identify salient themes/coding template in their discussions of the CCS teaching process. The coding and analysis of the surveys is qualitative. RESULTS: 87 interviews were performed at the 8 Portuguese, 1 Angolan and 1 Mozambican medical schools. Results indicate that the teaching and assessment process of CCS is in the beginning stages with these commonalities noted: (i) Variability amongst faculty in the teaching and assessment methods, (ii) disconnection of CCS between basic and clinical cycles, (iii) content and process skills and (iv) faculty development. CONCLUSIONS: CCS training lacks a formal structure with considerable variation of the CCS teaching process in these countries. The interviews promoted a rise in awareness of this situation and how these skills can enhance the quality of curricular change. Some important opportunities for the development and implementation of a framework of an integrated communication skills curriculum such as curricular reforms and well-established cooperation and networks were identified. The acknowledgement of the importance of integrating these skills in ME by key stake-holders and students in institutions and the identification of champions motivated to commit to the effort are strengths that should be considered to integrate and enhance CCS in the medical curricula.

A Latin American, Portuguese and Spanish consensus on a core communication curriculum for undergraduate medical education.

BACKGROUND: To present learning outcomes in clinical communication for a Core Curriculum for medical undergraduate students in Latin America, Portugal and Spain (LAPS-CCC) and to establish an expert network to support a transnational implementation. METHODS: Through an iterative process, an international group of 15 experts developed an initial set of learning outcomes following a review and discussion of relevant international and local literature. A two-round Delphi survey involving 46 experts from 8 countries was performed. Quantative and qualitative analisis permited the definition of the final consensus. RESULTS: The initial proposal included 157 learning outcomes. The Delphi process generated 734 comments and involved the modification, deletion and addition of some outcomes. At the end of the process, a consensus was reached on 136 learning outcomes grouped under 6 competency domains with a high overall acceptance (95.1 %). CONCLUSIONS: The learning outcomes of this proposal provide a guide to introduce, support and develop communication curriculae for undergraduate medical studies in the countries involved or in other Spanish- or Portuguese-speaking countries.

Self-concept and obsessive-compulsiveness as moderators of anxiety and depression: a Portuguese prospective study.

OBJECTIVE: Research shows a high prevalence of psychopathology among medical students. This study aims to assess the time trend of depression, anxiety, self-concept and obsessive-compulsiveness in medical students within the first year (short-run) and over the years (long-run) of medical school, and to measure if self-concept and obsessive-compulsiveness predict anxiety and depression trends. METHODS: At baseline, 183 freshman students that enrolled at FMUP in the 2002/03 academic year were recruited; from these, 71 (39%) participated in the short-run study and were assessed at the beginning and at the end of the first year and 151 (83%) participated in the long-run study (assessed in the first, third and fifth year). Participants answered three self-report questionnaires: the Hospital Anxiety Depression Scale (HADS), the Maudsley Obsessive-Compulsive Inventory (MOCI) and a self-concept scale. RESULTS: In the long-run, there was a negative linear trend with time for the MOCI score (B = -0.68, p < 0.001) and for the HADS anxiety score (B = -0.28, p < 0.001), a positive linear trend for self-concept (B = 1.37, p < 0.001) and no association with depression (B = -0.05). The short-run results were opposite given that anxiety, depression and obsessive-compulsiveness increased and no differences were found for self-concept.After adjusting for self-concept and obsessive-compulsiveness, there was no effect of time on anxiety but there was a negative interaction between self-concept and time on depression scores. CONCLUSIONS: The effect of time on depression is moderated by a protective effect of self-concept, while obsessive-compulsiveness explained time trends on anxiety scores.It is important to understand and find the pathways of anxiety and depression to improve medical students' mental health.

Competências de Comunicação Clínica: Objetivos de Ensino-Aprendizagem para um Currículo Nuclear nas Áreas da Saúde / Clinical Communication Skills: Teaching-Learning Objectives for a Core Curriculum in the Areas of Health

RESUMO Este ensaio destaca a importância das competências de comunicação clínica (CCC) nas ciências da saúde. Estas competências podem ser ensinadas, aprendidas e avaliadas, e vários estudos evidenciam para as vantagens de uma formação específica nesta área, potenciando a relação que os profissionais da área da saúde estabelecem com os pacientes, cuidadores informais e equipas de saúde, com resultados melhorados nos indicadores de saúde e cuidados mais humanizados. Confrontados com dificuldades na integração de programas específicos de comunicação nos curricula, assim como um défice no processo de avaliação e feedback estruturado, é crucial um investimento na formação pedagógica e no desenvolvimento curricular. Conscientes da escassez de trabalhos sistemáticos que apontam para um consenso sobre as competências e objetivos de ensino-aprendizagem das CCC, o sub-grupo Core Curriculum do comité de ensino (tEACH) da Associação Europeia de Comunicação em Saúde (EACH) desenvolveu e alcançou um consenso para um currículo nuclear nas diferentes áreas da saúde. Neste contexto, surgiu o Health Professions Core Communication Curriculum – HPCCC, que pode servir como referencial flexível de acordo com as necessidades específicas e contribuir para uma maior sistematização das iniciativas de CCC em saúde em língua portuguesa.

ABSTRACT This essay addresses the importance of clinical communication skills (CCC) in the health sciences. These skills can be taught, learned and assessed, and several studies have shown the advantages of specific training in this area, enhancing the relationship that healthcare professionals establish with patients, informal careers and health teams, with improved results in health indicators and more humanized care. Faced with difficulties in integrating specific communication programs in the curricula, as well as a deficit in the assessment process and structured feedback, an investment in teacher training and curriculum development is crucial. Aware of the lack of systematic studies that point to a consensus on the skills and CCC teaching-learning objectives, the Core Curriculum sub-group of the Teaching Committee (tEACH) of the European Association of Communication in Health (EACH) developed and achieved a consensus for a core curriculum in the different areas of healthcare. In this context, the Health Professions Core Curriculum Communication – HPCCC emerged, which can serve as a flexible framework in accordance with the specific needs and contribute to greater systematization of CCC initiatives in healthcare spoken in Portuguese.

Attitudes of Portuguese medical residents' towards clinical communication skills.

OBJECTIVE: To explore the attitudes and perceptions of Portuguese residents towards Clinical Communication Skills (CCS) and the need for complementary training. METHODS: 78 medical residents responded to an on-line questionnaire which comprised demographic data, open-ended questions and a Portuguese version of the Communication Skills Attitude Scale (CSAS). RESULTS: Residents gave significantly higher scores (P<0.001) on CSAS1 (attitudes towards communication skills in general, compared to CSAS2 (attitudes towards the teaching/learning process of CCS). Residents doing their residency training in other parts of the country, other than the north, reveal a higher perception of insufficient training (72.7% vs. 38.7%, P=0.036). CONCLUSION: Residents showed more positive attitudes towards communication skills than towards the teaching/learning process. They admit to need more training in CCS in their residency year and highlight that the clinical cycle of undergraduate education should integrate these topics. Content analysis indicates that residents' perceptions are context-influenced. PRACTICE IMPLICATIONS: Integration of CCS in the undergraduate education, enhanced during post-graduate training. Training of clinical faculty and supervisors/tutors and the role that stakeholders have to play in order to promote continuous training in CCS; encourage patient-centeredness and reflective practice, as to facilitate transfer of acquired skills to clinical practice.

A European consensus on learning objectives for a core communication curriculum in health care professions.

OBJECTIVE: To develop learning objectives for a core communication curriculum for all health care professions and to survey the acceptability and suitability of the curriculum for undergraduate European health care education. METHODS: Learning objectives for a Health Professions Core Communication Curriculum (HPCCC) in undergraduate education were developed based on international literature and expert knowledge by an international group of communication experts representing different health care professions. A Delphi process technique was used to gather feedback and to provide a consensus from various health care disciplines within Europe. RESULTS: 121 communication experts from 15 professional fields and 16 European countries participated in the consensus process. The overall acceptance of the core communication curriculum was high. 61 core communication objectives were rated on a five-point scale and found to be relevant for undergraduate education in health care professions. A thematic analysis revealed the benefits of the HPCCC. CONCLUSIONS AND PRACTICE IMPLICATIONS: Based on a broad European expert consensus, the Health Professions Core Communication Curriculum can be used as a guide for teaching communication inter- and multi-professionally in undergraduate education in health care. It can serve for curriculum development and support the goals of the Bologna process.

Attitudes and anxiety levels of medical students towards the acquisition of competencies in communication skills.

OBJECTIVE: Results of third year medical students' attitudes and stress levels towards the acquisition of communication skills before and after a Communication and Clinical Skills Course (CCSC) at the Faculty of Medicine of the University of Porto (FMUP), Portugal, are presented. METHODS: 115 students attending third-year CCSC completed a demographic questionnaire, State-Trait Anxiety Inventory, Communication Skills Attitudes Scale and Interpersonal Behavior Survey. RESULTS: Significant negative correlation was found between anxiety levels and attitudes towards learning communication skills in general as well as the teaching and learning process. At the end of the Course students reported that when compared to the start, their communication skills are less sufficient. CONCLUSION: At the end of this CCSC at FMUP, students recognized its major importance and how they need to invest and improve communication skills. However, it seems important to monitor the attitudes and anxiety levels of students towards patient care and communication during the medical course and to identify ways of overcoming barriers towards learning communication skills. PRACTICE IMPLICATIONS: It is recommended that there should be a complete (transversal and vertical) integration of communication skills, including effective teaching methods, assessments, and examinations in order to be valued by the students. This would necessitate curricular changes.

Third year medical students perceptions towards learning communication skills: implications for medical education.

OBJECTIVE: To analyze students' perceptions towards learning communication skills pre-and-post training in a Communication and Clinical Skills Course (CCSC) at a Portuguese Medical School. METHODS: Content analysis was used to describe and systematically analyze the content written by students (n=215 from a total of 229) in an open-ended survey. In addition, content analysis association rules were used to identify meaning units. RESULTS: Students' pre-training definitions of communication skills were not specific; their post-training definitions were more precise and elaborated. Students perceived communications skills in Medicine as important (61%), but recommended that teaching methodologies (52%) be restructured. There appeared to be no connection between criticism of teaching skills performance and perceptions of the other aspects of the course. CONCLUSION: Students' experiences at CCSC are associated with their perceptions of communications skills learning. Content analysis associations indicated that these perceptions are influenced by context. PRACTICE IMPLICATIONS: Improvement of curricula, teaching and assessment methods, and investment in faculty development are likely to foster positive perceptions towards learning communication skills in these students.

Inventário de Fontes de Estresse Acadêmico no Curso de Medicina (IFSAM) / An Inventory of Sources of Stress During Medical Education (IASSME)

O Inventário de Fontes de Estresse Acadêmico no Curso de Medicina (IFSAM) foi desenvolvido para caracterizar as principais fontes de estresse acadêmico dos estudantes da Faculdade de Medicina da Universidade do Porto (FMUP) e a intensidade com que são experienciadas. O inventário (31 itens) foi construído por meio de entrevistas semiestruturadas a estudantes (n = 80) dos seis anos da licenciatura. Suas propriedades psicométricas foram testadas num estudo com 251 estudantes dos seis anos do curso (160 do sexo feminino e 91 do sexo masculino). A validade de constructo foi avaliada mediante análise fatorial que resultou numa solução de cinco fatores ("exigências do curso", "exigências humanas", "estilos de vida", "competição" e "adaptação") com 54,8 por cento da variância explicada e boa representatividade do constructo. O IFSAM total evidencia ainda uma boa fidelidade, com um coeficiente de consistência interna de.88. Os resultados revelam que o IFSAM apresenta boas características psicométricas na amostra, podendo constituir um instrumento útil na avaliação das fontes e intensidade de estresse acadêmico do curso de Medicina noutras instituições.

The Inventory of Academic Sources of Stress in Medical Education (IASSME) was developed to characterize the main sources of academic stress for students at the School of Medicine, University of Porto (FMUP), as well as the intensity with which they experience such stress. The 31-item inventory resulted from semi-structured interviews with students (n = 80) from all six years of medical school. The inventory's psychometric properties were tested on 251 students from the six years (160 females and 91 males). Construct validity was assessed by means of factor analysis, resulting in a five-factor solution ("course demands", "human demands", "lifestyle", "academic competition", and "academic adjustment"), with a total of 54.8 percent of the total variance explained as well as good representation of the construct. The total inventory showed good reliability and internal consistency of 0.88. Based on the findings, the IASSME displayed good psychometric characteristics in this sample and can be a useful instrument for assessing sources of academic stress and their intensity in other medical schools.

[The relationship between stress and life-style of students at the Faculty of Medicine of Oporto]. / A relação entre o stress e os estilos de vida nos estudantes de medicina da Faculdade de Medicina do Porto.

Different studies have demonstrated that there are significant changes in the health and habits/life-style of university students, and it seems that Medical students also reveal a significant vulnerability to the adoption of health risk behaviours. The present study aims to (1) characterize the main sources of academic stress of the Medical School students of the University of Porto as well as the intensity with which they are experienced, (2) investigate the variations in academic stress and psychosocial variables, due to gender, year of course and displacement from home and (3) contribute, for the first time, to the understanding of stress and life-style of medical students in Portugal. The empirical study included a sample of 251 students from all 6 years of the course (160 females and 91 males), evaluated by the following instruments: (1) The Inventory of Sources of Academic Stress in Medical Education (ISASME), and the Portuguese versions of (2) the Brief Personal Survey (BPS), (3) the General Health Questionnaire 12 (GHQ-12), and (4) the Interpersonal Behaviour Survey-Brief (ICIBrief). In terms of overall levels of stress (GHQ-12), a prevalence of 58.2% of clinically significant stress symptoms was found, with the students from the basic cycle and those who are living away from home, presenting higher levels of stress. In terms of life-style, 47% of the students revealed health risk behaviours, with eating habits, physical exercise, alcohol and drug consumption, and body image being the main problem areas. Gender and year of course seem to have a significant influence on the variables studied, being the female students those who present higher levels of academic stress, stress responses (pressure/overload, physical distress, anxiety, anger/frustration, inefficiency, depression and loss of control), and low levels of coping confidence; the students of the basic cycle reveal higher levels of stress in managing their life-style (academic stress), general stress symptoms and stress responses. This study calls attention for the need of preventive intervention with medical students in order to prevent negative consequences of stress and improve their life-style by promoting individual and social resources.