Teaching clinically experienced communication skills. A review of evaluation studies

Utrecht University, Utrecht, Utrecht, Netherlands
Medical Education (Impact Factor: 3.2). 10/1999; 33(9):655-68. DOI: 10.1046/j.1365-2923.1999.00519.x
Source: PubMed


Interest 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.
This review provides an overview of evaluation studies of communication skills training programmes for clinically experienced physicians who have finished their undergraduate medical education. The review focuses on the training objectives, the applied educational methods, the evaluation methodology and instruments, and training results.
CD-ROM searches were performed on MedLine and Psychlit, with a focus on effect-studies dating from 1985.
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 designs report the fewest positive training effects.
Several reasons are discussed to explain the limited findings. Future research may benefit from research methods which focus on factors that inhibit and facilitate the physicians' implementation of skills into actual behaviours in daily practice.

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    • "Several studies published during the last three decades have shown that communication skills training has a positive effect on the communication style of health professionals [1] [2] [3] [4] and influences patient outcome [3,5–7], although the impact on patient outcomes is less convincing due to the methodologic challenge of measuring indirect outcomes [8]. The studies have typically been conducted in individual departments, often by implementing single interventions and without any follow-up [4] [9]. "
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    ABSTRACT: In 2010 a communication program that included mandatory communication skills training for all employees with patient contact was developed and launched at a large regional hospital in Denmark. We describe the communication program, the implementation process, and the initial assessment of the process to date. Method The cornerstone of the program is a communication course based on the Calgary Cambridge Guide and on the experiences of several efficacy and effectiveness studies conducted at the same hospital. The specific elements of the program are described in steps and a preliminary assessment based on feedback from the departments will be presented. Results The elements of the communication program are as follows: 1) education of trainers; 2) courses for health professionals employed in clinical departments; 3) education of new staff; 4) courses for health professionals in service departments; and 5) maintenance of communication skills. Thus far, 70 of 86 staff have become certified trainers and 17 of 18 departments have been included in the program. Conclusion Even though the communication program is resource-intensive and competes with several other development projects in the clinical departments, the experiences of the staff and the managers are positive and the program continues as planned.
    Full-text · Article · Jun 2014 · Patient Education and Counseling
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    • "The main influencing variables found in other studies are a supportive social environment, time constraints, fatigue, and existing beliefs and attitudes [20] [21] [22] [23] [24] [25]. Exactly how this complex interaction of factors seems to be influencing the acquisition and application of new skills and knowledge is not fully understood yet. "
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    ABSTRACT: Contextual factors are known to influence the acquisition and application of communication skills in clinical settings. Little is known about residents' perceptions of these factors. This article aims to explore residents' perceptions of contextual factors affecting the acquisition and application of communication skills in the medical workplace. We conducted an exploratory study comprising seven focus groups with residents in two different specialities: general practice (n=23) and surgery (n=18). Residents perceive the use of summative assessment checklists that reduce communication skills to behavioural components as impeding the learning of their communication skills. Residents perceive encouragement to deliberately practise in an environment in which the value of communication skills is recognised and support is institutionalised with appropriate feedback from role models as the most important enhancing factors in communication skills learning. To gradually realise a clinical working environment in which the above results are incorporated, we propose to use transformative learning theory to guide further studies. Provided it is used continuously, an approach that combines self-directed learning with observation and discussion of resident-patient consultations seems an effective method for transformative learning of communication skills.
    Full-text · Article · Jan 2014 · Patient Education and Counseling
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    • "However, none of these studies included a control group. Feedback on physicians' behavior is a common and effective strategy used in communication skills training programs (Hulsman 1999; Berkhof et al. 1999). Direct observation followed by well-intentioned, detailed and descriptive feedback is considered to be one of the most powerful ways to teach communication skills in clinical practice (Aspegren 1999; Kurtz et al. 2005). "
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    ABSTRACT: Teaching communication skills (CS) to residents during clinical practice remains problematic. Direct observation followed by feedback is a powerful way to teach CS in clinical practice. However, little is known about the effect of training on feedback skills in this field. Controlled studies are scarce as well as studies that go beyond self-reported data. The aim of the study was to develop and assess the effectiveness of a training program for clinical supervisors on how to give feedback on residents' CS in clinical practice. The authors designed a pretest-posttest controlled study in which clinical supervisors working in two different medical services were invited to attend a sequenced and multifaceted program in teaching CS over a period of 6-9 months. Outcome measures were self-perceived and observed feedback skills collected during questionnaires and three videotaped objective structured teaching encounters. The videotaped feedbacks made by the supervisors were analysed using a 20-item feedback rating instrument. Forty-eight clinical supervisors participated (28 in the intervention, 20 in the control group). After training, a higher percentage of trained participants self-reported and demonstrated statistically significant improvement in making residents more active by exploring residents' needs, stimulating self-assessment, and using role playing to test strategies and checking understanding, with effect sizes ranging from 0.93 to 4.94. A training program on how to give feedback on residents' communication skills was successful in improving clinical supervisors' feedback skills and in helping them operate a shift from a teacher-centered to a more learner-centered approach.
    Full-text · Article · Nov 2012 · Advances in Health Sciences Education
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