Engagement and listening skills: identifying learning needs

Abstract

Context and setting Communication during difficult medical interactions is often taught and assessed as a series of discrete tasks, the sum of which comprise the interaction. Just as important, however, are less tangible aspects of communication such as engagement and emotional presence. In particular, good listening skills have been identified as predictive of family satisfaction during the delivery of bad news. We sought to gain a sense of the relative communication strengths and deficiencies present in paediatric and neonatal critical care doctor trainees using a 360-degree tool. Why the idea was necessary The Accreditation Council for Graduate Medical Education (ACGME) has identified communication skills as an area requiring more focused teaching and assessment. Recent literature has identified listening skills and engagement as crucial to an effective interaction, yet these aspects can be more difficult to teach. Determining the relative strengths and weaknesses of trainees in different aspects of communication will allow the development of appropriate educational interventions. What was done We developed a 360-degree evaluation instrument based on ‘Essential Elements: the Communication Checklist’, created by the Kalamazoo Consensus Statement group. The survey consists of nine items on dimensions of communication (Builds a Relationship, Opens the Discussion, Gathers Information, Understands the Patient’s and Family’s Perspective, Shares Information, Reaches Agreement, Provides Closure, Demonstrates Empathy, Communicates Accurate Information) assessed by 5-point Likert scales, followed by two forced-choice questions assessing relative areas of strength and need for improvement. Seven paediatric and neonatal intensive care fellows were each evaluated by 11–18 multidisciplinary raters (108 assessments) after delivering difficult information during the simulation-based Programme to Enhance Relational and Communication Skills at the Children’s Hospital, Boston. Scores are given as percentage of subjects showing strength or a need for improvement in a given dimension. Evaluation of results and impact The dimensions most frequently identified as strengths were Shares Information (in 86% of subjects), followed by Communicates Accurate Information (71%), Demonstrates Empathy (57%), and Opens the Discussion (43%). The dimensions identified as needing improvement were Understands the Patient’s and Family’s Perspective (in 71% of subjects) and Gathers Information (43%). The remaining dimensions of communication were not identified as either strengths or areas needing improvement in more than 14% of subjects. The above distribution is significant in that it suggests a predisposition towards delivering information and away from listening, gathering information and sufficient engagement to understand the patient’s and family’s perspective. In two cases, subjects were ranked poorly in understanding the family’s perspective but highly in demonstrating empathy. This finding may reflect the presence of empathic attitudes and statements in the subject’s delivery that nevertheless were concurrent with deficiencies in their listening skills. Based on this sample, it appears that some paediatric and neonatal critical care fellows may lack well-developed listening and engagement skills. Further research is necessary to determine if this pattern holds over larger groups of trainees. Such data could be used to drive specific educational interventions targeting the development of listening and engagement capacities.