Assessment Of Communication Skills Research Articles

Performance of Cardiovascular Physical Exam Skills by Internal Medicine Residents

BackgroundFew studies have assessed the ability of internal medicine residents to perform a cardiovascular physical examination using real patients. MethodsFirst year internal medicine interns from 2 large academic medical centers in Maryland examined the same patient with aortic insufficiency as part of the Assessment of Physical Examination and Communication Skills (APECS). Interns were assessed on 5 clinical domains: physical exam technique, identifying physical signs, generating a differential diagnosis, clinical judgment, and maintaining patient welfare. Spearman's correlation test was used to describe associations between clinical domains. Preceptor comments were examined to identify common errors in physical exam technique and identifying physical signs. ResultsOne hundred nine interns examined the same patient with aortic insufficiency across 14 APECS sessions. Only 58 interns (53.2%) correctly identified the presence of a diastolic murmur, and only 52 interns (47.7%) included aortic insufficiency on their differential diagnosis. There was a significant and positive correlation between physical exam technique and identification of the correct physical findings (r = 0.42, P < .001). Both technique (r = 0.34, P = .003) and identifying findings (r = 0.42, P < .001) were significantly associated with generating an appropriate differential diagnosis. Common errors in technique included auscultating over the gown, timing the cardiac cycle with the radial pulse, and failing to palpate for the apical impulse. ConclusionsInternal medicine interns had variable skills in performing and interpreting the cardiovascular physical exam. Improving cardiovascular exam skills would likely lead to increased identification of relevant cardiovascular findings, inform clinical decision making and improve overall patient care.

Reliability of the Gap–Kalamazoo communication skills assessment form in occupational therapy

Introduction: The Gap–Kalamazoo Communication Skills Assessment Form (GKCSAF) is widely used in medical education, yet its reliability in real occupational therapy clinical settings remains unexplored. This study aimed to assess the intra-rater and inter-rater reliability, as well as random measurement error, of the GKCSAF in occupational therapy. Method: Five independent raters evaluated audio-recordings and transcripts of conversations involving 30 patients treated by 22 assessors (7 therapists and 15 students). Both direct and coded ratings were used. Results: For direct ratings, intra-rater reliability was moderate for total score (intraclass correlation coefficient (ICC) = 0.76), but poor for inter-rater (ICC = 0.31). minimal detectable change (MDC%) was acceptable for the same rater (17.8%) but not for different raters (38.3%). Weighted kappa values indicated poor to fair reliability (−0.01 to 0.34) for each domain score. Coded ratings showed moderate intra-rater reliability (ICC = 0.69) and poor inter-rater reliability (ICC = 0.22). MDC% was acceptable for the same rater (24.8%) but not for different raters (65.5%). Weighted kappa values indicated poor to fair reliability (−0.02 to 0.33) for each domain score. Conclusion: GKCSAF displays acceptable intra-rater but poor inter-rater reliability in occupational therapy clinical scenarios. Multiple raters are advised for enhanced reliability, while coding might not significantly enhance it. It is advisable to use the GKCSAF cautiously in occupational therapy education, ensuring adequate training, and possibly incorporating multiple raters for assessment consistency.

Development of a Simulation-Based Mastery Learning Curriculum for Late Goals of Care Discussions

IntroductionFellows in critical care medicine (CCM) routinely help patients and families navigate complex decisions near the end of life. These “late goals of care” (LGOC) discussions require rigorous skills training and impact patient care. Innovation is needed to ensure that fellow training in leading these discussions is centered on reproducible competency-based standards. The aims of this study were to (1) describe the development of a simulation-based mastery learning (SBML) curriculum for LGOC discussions and (2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners. InnovationWe developed an SBML curriculum for CCM fellows structured around REMAP, a mnemonic outlining foundational components of effective communication around serious illness. A multidisciplinary expert panel iteratively created an LGOC discussion assessment tool. Pilot testing was completed to refine the checklist, set the MPS, and assess skill acquisition. OutcomesThe LGOC discussion assessment tool included an 18-item checklist and 6 scaled items. The tool produced reliable data (k ≥ 0.7 and ICC of ≥ 0.7). Using the Mastery Angoff method, the panel set the MPS at 87%. Ten CCM fellows participated in the pilot study. Performance on the checklist significantly improved from a median score of 52% (IQR 44%–72%) at pretest to 96% (IQR 82%–97%) at post-test (P = 0.005). The number of learners who met the MPS similarly improved from 10% during pre-testing to 70% during post-testing (P = 0.02). CommentWe describe the development of a LGOC SBML curriculum for CCM fellows which includes a robust communication skills assessment and the delineation of a defensible MPS.

Preschooler Screen Time During the Pandemic Is Prospectively Associated With Lower Achievement of Developmental Milestones.

The aim of this study was to assess the developmental risks associated with total screen time, and specifically newer mobile devices, in the context of the pandemic. This study uses parent-reported data from a prospective cohort of Canadian preschool-age children. The exposure variable is child daily screen time measured at the age of 3.5 years categorized as light (<1 hr/d), moderate (1-4 hr/d), or intensive (>4 hr/d) use (N = 315). Time spent on mobile devices was considered separately as a continuous variable. Our outcome is child global development scores, which combine assessments of communication, cognitive, personal-social, and motor skills measured at the age of 4.5 years using the Ages and Stages Questionnaire (ASQ) (N = 249, 79% retained). ASQ scores were dichotomized to distinguish children at risk of developmental delays (below the 15th percentile) from those not at risk. We estimate associations between child screen time and later global development using multiple regressions adjusted for child sex and temperament, and parent education. We also examine whether associations are moderated by child and parent characteristics. Logistic regressions revealed that intensive users were more at risk of global developmental delays compared with light users (OR = 4.29, p = 0.020). Mobile device use was also associated with lower global scores (β = -3.064; p = 0.028), but not with risk of delays. We found no evidence that associations were moderated by child sex and temperament, or parent education. The findings suggest that intensive screen time may be associated with delays in child global development. Early childhood professionals should encourage families with preschoolers to prioritize screen-free activities to promote optimal cognitive, language, social, and motor development.

Cerebellar tDCS enhances functional communication skills in chronic Aphasia

ABSTRACT Background Transcranial direct current stimulation (tDCS) has emerged as a possible neuromodulatory tool to augment language therapy in post-stroke aphasia. However, there is limited information on whether tDCS may help to improve everyday functional communication. Aims To investigate whether cerebellar tDCS combined with computerized aphasia treatment improves functional communication skills in individuals with chronic aphasia. Methods and Procedures In a randomized, double-blind, sham-controlled, within-subject crossover study, participants received 15 sessions of anodal (n = 14) or cathodal (n = 14) cerebellar tDCS plus computerized aphasia treatment then sham plus computerized aphasia treatment, or the opposite order. Linear mixed-effects regression models were performed to evaluate (1) the effect of tDCS treatment on change in functional communication skills on the two dimensions of the American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults (ASHA-FACS): Communication Independence (CI) scale and Qualitative Dimension of Communication (QDC) scale, and (2) the relationship between functional communication skills and trained and untrained naming abilities. Outcomes and Results The results showed significant tDCS-induced gains for the overall QDC mean score, but not for the overall CI mean score. Cerebellar stimulation was more effective than sham for the overall QDC mean score immediately post-treatment, 2-weeks post-treatment and 2-months post-treatment. Follow up analysis separated by group showed that the change in the overall QDC mean score (combining both phases) were similar in participants receiving anodal or cathodal stimulation. We also found a significant linear association between the ASHA-FACS overall CI mean change scores and trained and untrained naming change scores for the tDCS condition but not sham. Conclusions Our study provides preliminary evidence that cerebellar tDCS coupled with computerized aphasia treatment has the potential to improve the overall qualitative dimensions of functional communication skills in individuals with chronic aphasia. Clinical Trial Registration Cerebellar Transcranial Direct Current Stimulation and Aphasia Treatment [NCT02901574]

Communication Skills of Teacher Trainees Having Hearing Impairment with Their Peers

This research aims to investigate the impact of communication skills among teacher trainees with hearing impairment in comparison to their peers, considering both age and disability status. The study will employ a quantitative research design, utilizing surveys and assessments to collect data. Participants will include teacher trainees with hearing impairment and their peers without hearing impairment, categorized based on age groups and disability status. The research will assess communication skills through various measures such as verbal proficiency, non-verbal communication, and overall interpersonal effectiveness. Statistical analyses, including ANOVA and regression, will be employed to examine the relationship between communication skills, age, and disability status. The findings aim to contribute valuable insights into the specific challenges faced by teacher trainees with hearing impairment in their interactions with peers, shedding light on potential areas for improvement in teacher education programs and fostering inclusivity within educational environments.

The interaction of nurses with patients and family when expressing difficult news: A study using video recordings

Objectives: To evaluate and explore nurses’ communication skills when providing difficult news to patients and their family members. Methods: A cross-sectional study was performed. The study employed a combination of qualitative and quantitative observations to analyze 49 videos recorded nurses’ interaction with standardized patients in a communication training course from 2019 to 2021. A validated checklist named The Liverpool Communication Skills Assessment Scale was used to quantitatively evaluate the level of nurses’ communication skills, and qualitative comments provided by observers were explored to explain quantitative results found. Results: The “nonverbal behavior” component of nurses’ communication was at acceptable levels, however, other components including “introduction”, “respect and empathy”, “questioning” and “giving information” were at poor levels. Conclusion: Communication skills of “introduction”, “respect and empathy”, “questioning” and “giving information” of nurses in adverse situations need to be improved, and hospital’s leader board should have viable measures to raise nurses’ awareness about providing truth to the patients or family.

Teaching and assessment of communication skills in dietetics: a scoping review.

Communication is a core element of dietetic practice, and although communication skills are a prominent feature of dietetic curricula, research suggests a need for more consistent approaches. The evidence on how communication skills are taught and assessed in dietetics has not been synthesised leaving uncertainty about best practice. This scoping review aimed to examine and map the research literature relating to the teaching and assessment of communication skills in dietetics. The review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. Five electronic databases, two theses databases and eight conference proceedings were systematically searched for research on how communication skills are taught and assessed in dietetics. The search had no geographical or time limits. Studies were independently screened by two authors, summarised thematically using the Kirkpatrick Model and narratively synthesised. The 45 included studies were organised thematically into three categories: (i) the inclusion of communication skills education in dietetics, suggesting that dietitians have variable experiences; (ii) approaches to teaching communication skills in dietetics, characterised predominantly by a move away from didactic approaches in favour of experiential opportunities for learning such as simulation; and (iii) assessment of communication skills in dietetics, including the use of both dietetic-specific and generic tools. The included studies demonstrate that although a variety of teaching strategies are used in the development of communication skills in dietetics, there is potential for more robust evaluation and more diverse approaches to support dietetic educators to prepare the dietetic workforce.

Do parent media habits contribute to child global development?

Parents of preschoolers' report using screen media frequently. More frequent screen use by parents may undermine child development by displacing time for foundational parent-child interactions. The objective of the present study is to examine the extent to which parent screen use contributes to child global development 1 year later. Data are from a cohort of 315 preschoolers from Nova Scotia, Canada and their parents during the COVID-19 pandemic. Parents reported the number of hours per day they spent using screens, as well as child screen time and sex, and parent educational attainment. Our outcome is child global development scores, which combine assessments of communication, cognitive, personal-social, and motor skills measured at 4.5 using the Ages and Stages Questionnaire (ASQ) (N = 249, 79% retained). Parents in our sample spent on average 6.35 h per day using screen media outside of work (SD = 3.07) and children spent on average 3.43 h per/day using screens. Multivariate linear regression indicated that each 1-h increase in parents daily screen media use, corresponded to a 1.25 decrease in child global development scores, B = -1.25 p < 0.05, 95% CI between -2.37 and -0.13. Our results indicate that parent screen use may represent a key component of children's media ecology. Given the importance of global development in early childhood for later health and achievement, the present results suggest that interventions should include parent screen use habits in media wellness interventions.

Peer assessment in medical communication skills training in programmatic assessment: A qualitative study examining faculty and student perceptions

Introduction Current literature recommends assessment of communication skills in medical education combining different settings and multiple observers. There is still a gap in understanding about whether and how peers assessment facilitates learning in communication skills training. Methods We designed a qualitative study using focus group interviews and thematic analysis, in a medical course in the Netherlands. We aimed to explore medical students’ and teachers’ experiences, perceptions, and perspectives about challenges and facilitating factors in PACST (Peer assessment in medical communication skills training). Results Most of the participants reported that peer feedback was a valuable experience when learning communication skills. The major challenges for the quality and credibility of PACST reported by the participants are the question whether peer feedback is critical enough for learning and the difficulty of actually engaging students in the assessment process. Conclusion Teachers reviewing students’ peer assessments may improve the quality and their credibility and the reviewed assessments can best be used for learning purposes. We suggest to pay sufficient attention to teachers’ roles in PACST, ensuring a safe and trustworthy environment and additionally helping students to internalize the value of being vulnerable during the evaluation process.

Evaluation of communication skills of physicians working in a training and research hospital: A cross-sectional study

Communication; is a two-way process of reaching mutual understanding in which information is exchanged, produced and interpreted. The main component of the diagnosis and treatment process between patient and physician is communication. In this study, we aimed to evaluate the communication skills of physicians according to various variables. The cross-sectional and descriptive study was conducted with physicians working at Haydarpaşa Numune Training and Research Hospital (HNH TRH) between May and August 2012. A total of 156 physicians who completed the scales and personal information form and met the inclusion criteria constituted the sample of the study. A total of 156 physicians with a mean age of 31.73±5.88 years participated in the study. Seventy-nine (50.6%) of the physicians reported that they could not devote enough time to themselves and their families, 118 (75.6%) physicians reported that they had communication problems with their patients in the past year, and only 56 physicians (35.9%) found themselves productive in their jobs. Sixty-five physicians (41.7%) felt exhausted, 116 (74.4%) of them reported that the reason for the communication problems they had was lack of time. There was a weak positive correlation between age and overall assessment of communication skills (p&lt;0.05). There was a positive and weak correlation between age and mental and emotional communication skills (p&lt;0.01). Limited time and low economic income negatively affect communication skills. Lowering patient density in hospitals and giving sufficient importance to primary health care services are needed. Focusing on communication skills training in medical schools and continuing this education throughout professional life can have positive effects on the patient-physician relationship.

Assessment of Therapeutic Communication Skills and Barriers Between Nursing Students and Patients

Introduction: The ability of the nurse to communicate with patients has been long recognized as an essential pillar of nursing care. This study aimed to assess the therapeutic communication skills and barriers among nursing students and patients. Methods: A cross-sectional descriptive research design based on a quantitative approach is used in this study. The participants of the study were selected purposively from level 4 to level 8 students in nursing program from Mohammed Al-Mana College for Medical Sciences. An observation checklist named Health Communication Assessment tool was used to assess the communication skills of nursing students. The second tool was a survey questionnaire-the barriers to nursing student-patient communication questionnaire which identified the barriers to therapeutic communication between the nursing students and the patients. Results: A total of one hundred six (N = 106) nursing students were involved in the study. The students’ mean score in the assessment of their communication skills showed average scores in therapeutic communication skills (M = 3.32, SD =0.69). The students’ opinions regarding the common communication barriers between them and their patients, were moderate, with an overall average of (M = 2.58, SD = 0.53). The average and middle scores for both communication skills (M = 6.65 ± 1.37, Md = 6.73) and communication barriers (M =6.37 ± 1.39, Md = 6.37) were almost equal. The Pearson correlation test revealed a statistically significant positive weak correlation (rs = 0.242, p = &lt; 0.012) between the students' scores in therapeutic communication skills and their scores in communication barriers. Conclusion: Recognizing the relationship between therapeutic communication skills and perceived communication barriers can inform targeted educational programs aimed at addressing both skill development and barrier reduction. It’s essential to acknowledge that while a statistically significant correlation was found, the strength of the correlation is weak. Further research, including longitudinal studies or qualitative interventions, may provide deeper insights into the nature of the relationship between therapeutic communication skills and perceived barriers among nursing students.

Sleep problems in children with autism spectrum disorder and attention-deficit/hyperactivity disorder: A comparative study and effects on communication skills.

Sleep disturbances are highly prevalent among children with neurodevelopmental disorders, like Autism Spectrum Disorder (ASD) and Attention-Deficit/Hiperactivity Disorder (ADHD). The first objective of this study is to examine the differences in sleep problems between a group of children with ASD without intellectual disabilities, a group with ADHD and a typically developing (TD) group. A second objective is aimed at analyzing the effects of sleep problems and symptom severity on their communication skills. Participants were 122 children between 7 and 12 years old distributed in three groups: 32 TD children, 47 children with ASD and 43 children with ADHD, matched on age and intelligence. Parents completed different questionnaires that measured sleep disturbances and communication skills. Findings show significant differences between the clinical groups and the TD group in most types of sleep disorders. Moreover, the group with ADHD showed significantly more sleep breathing disorders and hyperhidrosis in comparison with ASD and TD, as well as more total sleep problems. In contrast to ASD, the predictive power of sleep problems on communication difficulties was greater in the group with ADHD. The results of the mediation analysis indicate that in both groups, sleep problems partially mediate the relationship between symptoms and communication. This investigation highlights the need of considering sleep disorders when assessing communication skills in ASD and ADHD, given its indirect influence in this domain. Understanding the sleep dysfunctions of both conditions and their repercussions is crucial to develop adjusted interventions.

An online communication skills education program for midwifery students: A quasi-experimental study

BackgroundCommunication and entrepreneurship skills, which have a very important place among the 21st century skills, are among the basic skills that a midwife should have. ObjectiveThis study was carried out to investigate the effect of the Communication Skills Education Program on the communication and entrepreneurship skills of the midwifery students. DesignThis study was designed a quasi-experimental study. SettingsOnline. ParticipantsFirst grade Bachelor of Midwifery Science students (n = 117). MethodsIn this study, the Communication Skills Education Program was given to midwifery students. The Communication Skills Assessment Scale and University Students Entrepreneurship Scale were administered before the education program was implemented (pre-test), when the training program was completed (post-test), and six months after the education program was completed (post-test). Classified data were given in numbers and percentage distribution. Pearson correlation coefficient was used to determine the relationship between the variables. In order to test the significance of the difference between pre-test, post-test and follow-test the repeated measures Analysis of Variance (ANOVA) was performed.Results: The mean age of the participating students was 19.46 ± 1.74 (min. 18.0, max: 31.0) years. While 8.5 % of the students received training on communication previously, 7.7 % of the students received education on entrepreneurship previously. Statistically significant differences were determined between the scores the students obtained at the pre-test, post-test and follow-up test [F = 224.38, p = .00/F = 325.13, p = .00]. The Bonferroni test performed to find out from which tests the difference stemmed demonstrated that there was a significant difference between the mean scores obtained at all the tests. According to the analysis of the relationship between the mean scores the students obtained from the scales, there was a moderately significant positive correlation only between their pre-test mean scores. ConclusionsIn conclusion, we determined that the Communication Skills Education Program improved the students' communication and entrepreneurship skills.

The Examination of Communication Skills and Self-Efficacy of Coaches

This study was conducted to examine the communication skills and self-efficacy levels of individuals working as coaches. The population of this study, which was conducted using a descriptive research model, consisted of coaches working actively in Turkey, while the sample group consisted of a total of 697 coaches, 203 women and 494 men, on a voluntary basis. The data were obtained by using "Personal Information Form", "General Self-Efficacy Scale" and "Communication Skills Assessment Scale". Independent Samples t test, One Way ANOVA test, Person correlation analysis were used to reach statistical results. It was concluded that the self-efficacy score averages of the coaches participating in the study were higher than the averages of communication skills sub-dimensions. While there was a statistical difference between the education level of the male coaches participating in the study and the communication principles and basic skills sub-dimensions of communication skills, no difference was found in other sub-dimensions. While there was no statistical difference in the communication skills sub-dimensions and the education level of female coaches, a significant difference was found in general self-efficacy scores. Significant differences were found in the coaching levels of male coaches participating in the study and in the sub-dimension of general self-efficacy and communication. In addition, significant differences were found in the coaching levels of female coaches and in the sub-dimensions of self-expression, active listening and non-verbal communication and willingness to communicate. As a result, there is a parallelism between the self-efficacy and communication skills of the coaches participating in the study. In other words, it can be said that as the competence of male and female coaches in their jobs increases, their communication skills also increase.

Developing a virtual patient: design, usability, and learning effect in communication skills training

BackgroundLiterature shows that Virtual Patients (VPs) find extensive usage in the field of health sciences, especially in the post-pandemic period. VPs are successfully utilized in developing various effective skills like medical interview. However, this technology is quite new in Turkey and has not yet been used in communication skills training in a structured form. This research aimed to develop a virtual patient to improve the communication skills of medical students.MethodsDevelopmental research method was used in the study. The implementation phase involved the one group posttest quasi-experimental design. The study group comprised of experts in various fields and 213 medical students. Needs Analysis Form, Scenario Building Form, System Validation Form, Communication Skills Assessment Form, and Interview Form were used as data collection tools. The research primarily concentrated on ensuring minimal errors within the system and enhancing students’ communication skill scores.ResultsThe study found that VP was effective in teaching communication skills. Communication skills improved from a mean score of 36.74 in the first interview with 15 students to 74.2 in the final application with 198 students. It was determined that the students who practiced repeatedly (n = 26) made 17% more effective interviews than their first practices (score: 89.2). The script matching of the VP was 83%. Other data obtained from the students generally showed that the VP application was developed in accordance with the purpose, that it was user-friendly, and that the scenarios were adequate.ConclusionVPs like this have the potential to develop skills such as history taking, clinical reasoning, etc., which are very important in the field of health sciences.

Current State and Proposal of Best Practices of Standardized Patients for Spanish-Language Objective Structured Clinical Encounters in US Medical Schools.

Medical Spanish programs commonly engage Spanish-speaking standardized patients (SPs) for communication skills assessment, yet no studies address SP recruitment, selection, or training. We sent questionnaires to medical Spanish faculty at 20 US medical schools to gauge their practices in recruiting and selecting Spanish-language SPs. We invited faculty to distribute a separate questionnaire to Spanish-language SPs to gather SP language abilities, training, and experience. We analyzed data using descriptive statistics and qualitative content analysis. When available, we reviewed SP video encounters to formally assess participating SPs' linguistic performance using the SP Oral Language Observation Matrix, a rating tool adapted from the Physician Oral Language Observation Matrix to assess oral medical Spanish proficiency. Eighty percent of faculty (16/20) responded. Standardized patient recruitment sources included institutional English-language SPs, Hispanic student groups and professional organizations, communities, and language professionals. Faculty-reported strategies to determine language readiness included interviewing SP candidates in Spanish and asking them to self-rate language skills using a validated scale. Fifteen SPs (54%, 15/28) from 5 schools responded to the SP questionnaire, and one third (5/15) reported that their Spanish was not assessed before being selected as an SP. In addition, one third (5/15) did not receive any initial training before performing a medical Spanish case. Raters assessed 11 different SPs using the SP Oral Language Observation Matrix, and 6 were rated as linguistically "ready" for the SP role. Current approaches to recruitment, training, and language assessment of SPs vary. We propose strategies to ensure that medical Spanish encounters authentically reflect Spanish-speaking patients.

Effectiveness of Participatory Teaching Methods in the Standardized Training of Respiratory Medicine Residents

Objective: To explore and analyze the application effect of participatory teaching method in the standardized training of respiratory medicine residents. Methods: The study period was from May 2022 to May 2023. 20 doctors in the standardized training of respiratory medicine residency in our hospital were taken as research subjects and grouped into the participatory group (n = 10) and the routine group (n = 10) by using the random number lottery method. The participatory group practised participatory teaching methods, and the routine group practised routine teaching methods. The results of discharge assessment, teaching evaluation, and mini-Clinical Evaluation Exercise (mini-CEX) assessment were compared between the groups. Results: The theoretical assessment, operational assessment, and total scores of the participatory group were significantly higher than those of the routine group, and the difference was statistically significant (P &lt; 0.05). The teaching evaluation of independent learning, theoretical mastery, teamwork, clinical thinking, communication, and learning interest of the participatory group was significantly higher than that of the routine group, and the difference was statistically significant (P &lt; 0.05). The mini-CEX assessments of history inquiry, organizational effectiveness, professionalism, physical examination, clinical diagnosis, communication skills, and overall clinical competence of the participatory group were significantly better than those of the routine group, and the difference was statistically significant (P &lt; 0.05). The teaching satisfaction of the participatory group was significantly higher than that of the routine group, the difference was statistically significant (P &lt; 0.05). Conclusion: Participatory teaching methods can improve the overall level of doctors in the respiratory medicine residency standardized training, and the teaching satisfaction is improved.

A47Supporting internationally educated nurses reach their full career potential and deliver safe and effective patient care through simulation-based communication skills training

Between April and September 2022, 11,496 internationally educated nurses (IENs) registered with the NMC for the first time, which is 606 less than those domestically educated within the same timeframe [1]. To register, IENs must pass OSCEs and although globally assessed, there is no specific communication skills assessment [2]. A literature review identified challenges associated with integration into culturally different healthcare systems, most notably communication barriers; however, it found that with good support it is possible for IENs to achieve their full career potential [3]. To support local healthcare trusts and IENs, our organization designed a simulation-based educational programme to address the aforementioned barriers. To ensure a non-paternalistic approach, IENs lived experiences allowed the development of authentic, co-produced simulated scenarios. Actors were trained for the roles, and learning outcomes and debriefing processes were shared in advance. To assist participants with their skills, a model of communication was introduced, enabling them reference to a framework whilst participating and observing. Eight groups of six IENs have participated over eight months. Thematic analysis identified themes in which IENs wanted to be upskilled, these were integrated into multi-faceted simulated scenarios: Distressed relatives – IENs reported struggling setting appropriate boundaries and dealing with conflict with emotive relatives. Difficult conversations with patients – IENs felt ill equipped to communicate with challenging patients due to anxiety through language and cultural barriers leading to avoidance of engagement, further exacerbating the issues. Differing patient agenda – IENs struggled to manage patients who were not engaging with recommended multi-disciplinary interventions, due to a poor understanding of the MDT agenda. Hierarchical adjustment – IENs typically came from countries with a more established hierarchy and did not feel confident clarifying doctor’s decisions even if concerned. Evaluation linked to the learning outcomes; a rating scale from 1 (no ability/confidence) to 5 (excellent ability/confidence). 48 IENs have undertaken this training and all report progression in ability and confidence, with ongoing applicability of their learning within the workplace. The number of IENs is increasing within the NHS with recent records indicating NMC registrations being equal between domestic and internationally educated nursing staff. A repeatable simulation-based communication skills workshop has been developed based upon the lived experiences reported by IENs. Further deliveries are planned with subsequent quantitative and qualitative analysis. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Assessment of Attitudes, Ethics and Communication Skills in a Competency-Based Undergraduate Medical Curriculum

Affective learning outcomes are difficult to objectively analyse and assess as they refer to feelings and internal processes of the mind and heart. These cannot be quantified by traditional testing methods. The available methods rely on qualitative self-reflection and the observation of simple to complex internally consistent qualities of character. Just as in the other domains of learning, the validity and reliability of these assessments need to be ensured. The assessment of the affective domain requires careful observation of specified behaviours by multiple observers. Miller’s pyramid, Krathwohl’s levels and Epstein’s conceptual frameworks can be used to devise suitable assessment plans for the complex and varied competencies in this domain. Many techniques including paper-based tests, self-administered rating scale, faculty and peer assessment, simulations, reflections, portfolios, observed clinical encounters, collated views of co-workers, record of incidents of unprofessionalism, critical incident reports, patient surveys and global view of supervisor have been used for assessment of affective domain. The effective utilization of these assessment tools needs to factor in the ground realities that exist in different medical colleges. The acceptability and feasibility of using resource intensive assessment methods needs to be carefully balanced against their contributions towards increasing validity and reliability