Evaluating clinical communication skills of medical students, assistants, and professors.

BACKGROUND: The skill of communicating with the patient is one of the basic clinical skills and part of the necessary competencies for medical doctors. The present study aimed to evaluate the knowledge, attitude, and performance (KAP) of medical students, assistants, and professors of Shahrekord University of Medical Sciences regarding clinical communication skills with patients. METHOD: This cross-sectional study was conducted at the hospitals of Shahrekord University of Medical Sciences in Iran. The study included a total of 289 participants, consisting of 51 professors, 72 assistants, 90 external staff, and 76 interns who work at these hospitals. The participants were selected through a convenience sampling method. The data-gathering tools used included a questionnaire to collect demographic characteristics, a researcher-made questionnaire to assess knowledge, a communication skills attitude questionnaire, and a communication skills survey questionnaire. The data were analyzed using descriptive statistics such as mean, standard deviation, and frequency, as well as statistical tests that included one-way ANOVA and Pearson's correlation test. The significance level for the study was considered to be 0.05. RESULTS: The mean scores of knowledge of professors were higher compared to other groups (P = 0.002). All participating groups had a positive attitude toward learning communication skills. There were statistically significant differences between the mean scores of the communication performance of the study groups (P < 0.001). There was a positive relationship between positive attitude and communication performance, and a significant negative relationship was observed between negative attitude and communication performance. CONCLUSION: The results indicate the relatively favorable attitude and performance of the groups and their low knowledge. It is suggested that the doctor-patient communication skills courses be included as one of the necessary courses in the medical education curriculum.

Transfer of communication teaching skills from university to the clinical workplace - does it happen? A mixed methods study.

BACKGROUND: Communication skills learned in the classroom do not transfer easily into clinical practice because they are not reinforced by teachers in the workplace setting and because lack of faculty training restricts the transfer of communication skills in real patient encounters. Trained university-based communication skills teachers often work simultaneously as doctors in clinics. This study explored if and how the skills of these teachers play a role in communication skills training in the clinical workplace. METHODS: We used an exploratory sequential design: a mixed method approach that combined a survey with communication skills teachers, and qualitative individual interviews with these teachers and their educational leaders in clinical departments. The questionnaire was analysed using descriptive statistics. The interviews were analysed using content analysis. RESULTS: The response rate was 34 %. A majority (93 %) used their communication skills when communicating with patients and relatives. Less than half taught communication in clinical departments. Approximately half of the respondents stated that encouragement from their leaders or colleagues would inspire them to use their teaching skills in the workplace. However, only 20 % had told their leaders about their competencies in teaching communication. One third thought that they needed further teacher training to teach in the clinical workplace. Qualitative analysis showed that teaching opportunities existed but mainly consisted of random, one-off sessions that came about through the initiative of the communication skills teachers themselves. The teachers described several barriers, such as the challenge of teaching colleagues, as communication relates to identity and hierarchical structures, as well as a lack of requests from colleagues or management, and department culture prioritizing topics relating to medical expertise. None of the educational leaders made use of the teachers' specific communication skills in a structured way: some saw it as unimportant, while others saw it as a potential resource. CONCLUSION: Transfer of the teaching skills of communication skills teachers trained for university-based clinical communication training happened, but to a limited degree. Although both opportunities and barriers for transferring communication skills existed, barriers seemed to dominate, and opportunities for communication skills training in the workplace setting were not used to their full potential.

Assessment of medical students' integrated clinical communication skills: development of a tailor-made assessment tool.

BACKGROUND: Since patient-centered communication is directly connected to clinical performance, it should be integrated with medical knowledge and clinical skills. Therefore, clinical communication skills should be trained and assessed as an integral part of the student's clinical performance. We were unable to identify a tool, which helps when assessing patient-centered communication skills as an integrated component of medical history taking ('the integrated medical interview'). Therefore, we decided to design a new tailor-made assessment tool, the BOCC (BeOordeling Communicatie en Consultvoering (Dutch), Assessment of Communication and Consultation (English) to help raters assess students' integrated clinical communication skills with the emphasis on patient-centred communication combined with the correct medical content. This is a first initiative to develop such a tool, and this paper describes the first steps in this process. METHODS: We investigated the tool in a group of third-year medical students (n = 672) interviewing simulated patients. Internal structure and internal consistency were assessed. Regression analysis was conducted to investigate the relationship between scores on the instrument and general grading. Applicability to another context was tested in a group of fourth-year medical students (n = 374). RESULTS: PCA showed five components (Communication skills, Problem clarification, Specific History, Problem influence and Integration Skills) with various Cronbach's alpha scores. The component Problem Clarification made the strongest unique contribution to the grade prediction. Applicability was good when investigated in another context. CONCLUSIONS: The BOCC is designed to help raters assess students' integrated communication skills. It was assessed on internal structure and internal consistency. This tool is the first step in the assessment of the integrated medical interview and a basis for further investigation to reform it into a true measurement instrument on clinical communication skills.

A program to train medical physicists for direct patient care responsibilities.

OBJECTIVES: To develop a training program designed to meet the specific needs of medical physicists as they transition into a clinical role with direct patient care responsibilities. MATERIALS AND METHODS: The training program was designed in collaboration with the faculty at the UC San Diego School of Medicine and incorporates training techniques that have been shown to be effective in improving communication skills. The program emphasizes experiential, practice-based learning over didactic presentations. RESULTS: The training program is comprised of 5 components: 1) a 1-day Clinician-Patient Communication Workshop run by the UC San Diego School of Medicine, 2) Communication Strategies for Radiation Oncology, which consists of two, 2-hour sessions designed to provide trainees with patient communication skills that are specific to patient interactions in radiation oncology, 3) Simulated Patient Interactions, in which trainees perform mock physicist-patient consults with trained patient actors, 4) Faculty-Observed Patient Consults, and 5) a Case-Based Treatment Toxicity Course. A competency assessment mechanism was also developed to provide a clear set of objectives and to guide trainer feedback. [Correction added after first online publication on November 7, 2018: The phrase ", which consists of two, 2-hour" was added above.] CONCLUSIONS: The training program that we have developed incorporates an array of established education techniques and provides a comprehensive, accessible, means of improving medical physicists' patient communication skills.

Evaluating Dog- and Cat-Owner Preferences for Calgary-Cambridge Communication Skills: Results of a Questionnaire.

Veterinary client retention by companion animal practices is influenced by whether the client feels connected to the healthcare provider. Effective communication between the veterinarian and the client facilitates that connection. To prepare new graduates for success in clinical practice, many colleges of veterinary medicine are now incorporating communication into the curriculum to emphasize its importance in establishing and maintaining the veterinarian-client relationship. A 2016 focus group study by Englar et al. evaluated dog and cat owner communication preferences for Calgary-Cambridge Guide (CCG) communication skills and concluded that dog and cat owners may have different communication needs. This study was conducted to confirm whether species-based communication preferences exist among veterinary clients. A questionnaire was distributed online and on-site, within veterinary teaching hospitals and private practices. Based upon 215 submissions from dog owners and 166 from cat owners, the communication preferences of dog and cat owners overlap. Both dog and cat owners prioritize reflective listening as the most important foundational CCG communication skill, and both prioritize asking permission as the most important core CCG skill. However, dog owners valued open-ended questions more than cat owners, and cat owners valued empathy more than dog owners. Survey limitations were largely demographic: participants were predominantly female and between the ages of 18-40 years. Survey data may therefore not be representative of the perspective of males and/or those >40 years of age.

Perceptions of medical students and their facilitators on clinical communication skills teaching, learning, and assessment.

Introduction: Despite various efforts to develop communication skills (CS) in the classroom, the transfer of these skills into clinical practice is not guaranteed. This study aimed to identify barriers and facilitators of transferring CS from the classroom to clinical environments. Methods: A qualitative study was conducted at one Australian medical school to explore the experiences and perceptions of facilitators and students in relation to teaching and learning clinical CS. Thematic analysis was used to analyze data. Results: Twelve facilitators and sixteen medical students participated in semi-structured interviews and focus-group discussions, respectively. Primary themes included the value of teaching and learning, alignment between approaches to teaching and actual clinical practices and students' perceptions of practice, and challenges in different learning environments. Discussion: This study reinforces the value of teaching and learning CS by facilitators and students. Classroom learning provides students with a structure to use in communicating with real patients, which can be modified to suit various situations. Students have limited opportunities, however, to be observed and receive feedback on their real-patient encounters. Classroom session that discussed CS experiences during clinical rotation is recommended to strengthen learning both the content and process of CS as well as transitioning to the clinical environment.

General Practitioners' Own Traumatic Experiences and Their Skills in Addressing Patients' Past History of Adversities: A Cross-Sectional Study in Portugal.

Addressing trauma has been found to be important for primary care patients, as it can improve their health-related outcomes. We aimed to assess how Portuguese general practitioners' (GPs) past history of traumatic events (TEs) and adverse childhood experiences (ACEs) influence their clinical communication skills when addressing their patients' past history of adversities. An online survey was circulated by email to GPs' associations and through GPs' social media groups. A sample of 143 GPs participated in this study. GPs' exposure to ACEs and TEs was assessed using the Childhood Trauma Questionnaire-Short Form and the Life Events Checklist for the DSM-5. To evaluate clinical communication skills, we adapted the Self-confidence Scale and used the Jefferson Scale of Physician Empathy. GPs identified barriers to addressing trauma routinely, including a lack of time (86.7%) and a fear of causing further patient suffering (56.6%). GPs' exposure to TEs and ACEs was positively correlated with scores in some dimensions of self-confidence and empathy (r values varying from 0.170 to 0.247). GPs exposed to traumatic experiences felt more confident when addressing their patients' adversities and were more empathic when conducting therapeutic relationships. This study shows that GPs with a history of traumatic experiences are able to address their patients' adversities; however, they lack proper training and better patient care conditions, such as more time and more resources available for patient guidance.

Integrating medical and practical skills in communication skills training: Do students feel it supports them with transfer from classroom to practice?

Objective: To describe innovations in a clinical communication skills training (CCST) program, aimed at facilitating transfer of communication skills from classroom to clinical practice and report student's evaluations regarding this program. Methods: To facilitate transfer, we integrated CCS with medical and practical skills, and we developed simulation sessions closely resembling clinical practice in case-history's, length of consultation, and patient-population. Feedback was given on communication skills and medical knowledge and skills. Student's opinions about whether these elements were helpful, were evaluated using a questionnaire. Results: Responses of 144 students were analyzed. The majority of the respondents agreed that this CCST program helped them with transfer of CCS from classroom to clinical practice, as did the feedback on medical content and communication skills in the same session. Conclusion: Students indicate that simulations resembling clinical practice and feedback on both CST and medical content facilitate the transfer of their skills to clinical practice. Innovation: This CCST program is innovative because it integrates medical and practical skills, with elements aiming to create an educational environment resembling clinical practice as closely as possible in order to facilitate transfer to clinical practice.

Application of the Six-Step Standard Communication Process in the Communication Training for Newly Recruited Nurses in Cancer Specialist Hospitals.

PURPOSE: Discuss the application effect of the six-step standard communication process in the communication ability training of newly recruited nurses. METHODS: This is a before and after control study. The control group included 45 newly recruited nurses in our hospital in 2019, and the observation group included 40 newly recruited nurses in our hospital in 2020. The control group completed the training according to the existing communication training program, and the observation group implemented a training program based on the "six-step standard communication process" on the basis of the existing communication training. The training period was 12 months. The training effect of the two groups of new nurses was compared. RESULTS: After training, the total scores of clinical communication skills of the new nurses in the control group and observation group were 252.56 ± 24.950 and 268.05 ± 19.335 points, respectively; the total scores of communication behavior were 39.00 ± 4.676 and 48.08 ± 2.515 points, respectively; the total scores of general self-efficacy were 26.89 ± 3.017 and 31.25 ± 5.027 points, respectively; the satisfaction scores of communication training were 17.56 ± 2.018 and 19.45 ± 0.986 points, respectively, and the differences were statistically significant (P < 0.05). CONCLUSION: The implementation of a training program based on the "six-step standard communication process" can effectively improve the clinical communication skills and self-efficacy of newly recruited nurses, and can be promoted and applied to the communication training of newly recruited nurses.

Medical Students' Personalities: A Critical Factor for Doctor-Patient Communication.

The aim of this study was to assess the level of creativity and personality traits and their mutual influence on medical students using the DECAS and BWAS. We performed a prospective descriptive study on 119 medical students from Târgu Mureș, Romania between November 2020 and July 2021, who answered questions relating to the BWAS and DECAS scales to evaluate their creativity and personality traits. Our findings pointed out a reverse correlation between age and both the original and revised BWAS (r = -0.2037, p = 0.0263; r = -0.1931, p = 0.0354). In terms of extraversion, we found a significant positive correlation for both openness (r = 0.3032, p = 0.0008) and emotional stability (r = 0.2868, p = 0.0016) and a negative correlation between extraversion and agreeability (r = -0.2394, p = 0.0087). Regarding creativity, we found positive correlations between emotional stability and both the original and revised BWAS (r = 0.20, p = 0.0279; r = 0.20, p = 0.0245). Medical students' creativity might be positively influenced by emotional stability and seems to decrease with age. Higher extraversion scores could be related to increased openness and emotional stability as well as decreased agreeability.

Clinical Communication Skills Training in Dental Medical Education: The COVID-19 Pandemic Challenge.

It is very important for healthcare professionals to have good clinical communication skills, especially dentists. Patient-centred care results in patient satisfaction, better outcomes, and less complaints from dental patients. Due to the onset of the COVID-19 pandemic, the clinical communications skills programme of the pre-graduate course in dental medicine at the University of Porto had to be transformed to an online format. Based on their role as faculty, the authors aimed to recount their initial reflections and concerns within this perspective, and to share how they adapted to the new reality of teaching clinical communication skills online, as well as the conclusions of our experience, in the hope that this will help others who may have to go through a similar process. The authors acknowledged that the students achieved the pre-established goals of the clinical communications skills programme through the new online format.

Strategies for Teaching Linguistic Preparedness for Physicians: Medical Spanish and Global Linguistic Competence in Undergraduate Medical Education.

In accordance with Liaison Committee on Medical Education (LCME) curriculum content standards, medical schools are expected to teach physician communication skills and cultural competence. Given the sustained U.S. Spanish-speaking population growth, importance of language in diagnosis, and benefits of patient-physician language concordance, addressing LCME standards equitably should involve linguistic preparedness education. The authors present strategies for implementation of linguistic preparedness education in medical schools by discussing (1) examples of institutional approaches to dedicated medical Spanish courses that meet best practice guidelines and (2) a partnership model with medical interpreters to implement integrated global linguistic competencies in undergraduate medical curricula.

Cross cultural training in primary mental health care consultations in Moldova - The tEACH perspective.

OBJECTIVE: This article reports experiences and challenges encountered in a cross-cultural training project in Moldova that was undertaken by tEACH, the teaching subcommittee of EACH: International Association for Communication in Healthcare, in cooperation with local and international stakeholders. As part of a major health policy reform, the aim was to equip a group of trainers with the skills to train Moldovan professionals in skills for primary mental health care, including communication skills. METHODS: The project consisted of 3 weeks of training using mainly experiential teaching methods to allow participants to practice content and methods, including interactive lecturing, roleplay, feedback and video. RESULTS: A majority of the participants reported that they acquired key facilitation skills. They valued the opportunity to practice and receive feedback. However, some reported that there was too much focus on communication skills, which was thought to be less relevant in a Moldovan context. Furthermore our learner-centered approach was occasionally experienced as a lack of structure CONCLUSION: The tEACH expertise plays an important role in supporting trainers in cross-cultural contexts with effective communication skills methods. PRACTICE IMPLICATIONS: Teaching in a cross-cultural context is only successful through continuous dialogue with stakeholders and demands attention to cultural differences.

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.

Diseño, elaboración y validación de un caso clínico simulado-online para uso en simulación evaluativa dirigido a estudiantes de medicina de último curso en el área de ginecología / Design, elaboration and validation of online-simulated clinical case for evaluative simulation in last level medical students in the area of gynecology

OBJETIVO. Construir y validar un Caso Clínico Simulado-Online (CCS-Online) como herramienta de evaluación de Habilidades Clínicas de Comunicación (HCC) y Razonamiento Clínico (RC) en un Examen de Competencias Objetivamente Estructurado (ECOE) dirigido a estudiantes de medicina de la asignatura de Ginecología. MATERIAL Y MÉTODOS. Estudio cuantitativo descriptivo, en una prueba piloto se puso a consideración de jueces expertos y estudiantes un Caso Clínico Simulado-Online (CCS-Online) con 3 componentes básicos del diseño de Casos Clínicos Simulados con fines evaluativos: 1) Correlación entre objetivos de la evaluación y la herramienta evaluativa, 2) Coherencia interna de los elementos que conforman el CCS y 3) Fidelidad del Escenario Simulado, todos ellos recogidos en un cuestionario estructurado de 16 elementos, con asignación de rangos ordinales del 1 al 5 en una escala de Likert. Se utilizó el coeficiente Kappa de Fleiss y la escala de Landis para determinar el grado de acuerdo y la fuerza de concordancia entre los expertos consultados; y el test U de Mann-Whitney para comparar diferencias entre grupos. RESULTADOS. Jueces expertos y estudiantes concuerdan que el instrumento CCS-Online contiene en su diseño componentes y elementos que permiten evaluar las competencias de RC y HCC en un escenario virtual (Kappa 0,688 /0,757 p<0,001). La valoración media global fue de 4,65/5 y 4,41/5, para jueces y estudiantes respectivamente. CONCLUSION. Jueces expertos y estudiantes calificaron al CCSOnline como una herramienta de evaluación que cumple con un buen nivel los criterios de diseño necesarios para evaluar las competencias de Habilidades Clínicas de Comunicación (HCC) y el Razonamiento Clínico (RC) en el área de Ginecología.

OBJECTIVE. Build and validate a Simulated Clinical Case-Online (SCC-Online) as an evaluation tool for Clinical Communication Skills (CCS) and Clinical Reasoning (CR) in medical students of Gynecology, in an Objectively Structured Competency Examination (OSCE). Material and methods. Quantitative descriptive study, in a pilot test a Simulated Clinical Case-Online (SCC-Online) was submitted to the judment of a group of expert judges and students, the following 3 basic components of the design of Simulated Clinical Cases were presented 1) Correlation between the evaluation objectives and the evaluation tool, 2) Internal coherence of the elements that make up the SCC and 3) Fidelity of the Simulated Scenario, all of them collected in a structured questionnaire of 16 elements, with assignment in an ordinal ranks from 1 to 5 on a Likert scale. The Fleiss Kappa coefficient and the Landis scale were used to determine the degree of agreement and the strength of concordance between the experts consulted; and the Mann-Whitney U test to compare differences between groups. RESULTS. Expert judges and students agree that the SCC-Online is an instrument that contains in its design components and elements that allow the evaluation of CR and CCS competencies in a virtual scenario (Kappa 0.688 /0.757 p<0.001). The overall mean score was 4.65/5 and 4.41/5, for judges and students, respectively. CONCLUSION. Expert judges and students qualified the SCC Online as a good level evaluation tool, that meets the necessary design criteria to evaluate Clinical Communication Skills and Clinical Reasoning competences in the area of Gynecology.

Is linking research, teaching and practice in communication in health care the way forward?

This paper is based on the keynote lecture given at the ICCH conference in New Orleans in October 2015. With as background the observation that even though research and teaching of communication have been receiving attention for some time now, patients still encounter many problems when they visit clinicians because of health problems, it subsequently touches upon research on integration of communication with correct medical content, person centered communication and the role of placebo on outcomes. For teaching it emphasizes methods working best to teach clinical communication skills and lead to behavior changes in professionals: experiential teaching methods but taking care of a balance with cognitive methods. It then discusses the challenge of transfer to clinical practice and what is needed to overcome these challenges: learning from reflecting on undesired outcomes in clinical practice, feedback from clinicians who are open to communication and support learners with effective feedback in that specific context. It adds suggestions about where linking more between research, teaching and clinical practice could help moving communication in health care forward and builds the case for involving policymakers and members of hospital boards to help manage the necessary climate change in clinical settings.

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.