Clinical Communication Training Research Articles

An Investigation into Student Dietitians’ Professional Development through Video-Mediated Communication Training on Patient Counselling

ABSTRACT The aim of the study is to describe a student dietitian’s professional development process in a video-mediated communication skills training cycle designed for undergraduate nutrition and dietetics education and including activities such as simulated and real patient counseling, feedback, and reflection. The design of the training cycle is inspired by (reflective) interventionist Conversation Analysis (CA) through researcher and trainer collaboration, and the data comes from the screen-recordings of video-mediated meetings. CA is used to analyze the video-mediated interactions on a moment-by-basis and trace the student dietitian’s interactional change over time. CA examination of the data showed that the trainer identified listenership in simulated sessions as an improvable practice (i.e. due to repetitive overlaps and cutoffs) and used it as the basis for the intervention. In the post-intervention period, the student dietitian observably improved her listenership both in simulated and real patient counseling sessions. The video-mediated, interventionist, reflective, and data-led cycle played a role in the development of the interactional and professional practice of the student dietitian in ways transferrable to real patient counseling. The training cycle with evidence-based lectures, data-led interventions, and simulated/real patient counseling can be integrated to dietetics education curricula both for clinical communication training and preparing for future teleconsultation practices.

Effect of a person-centred goals-of-care form and clinical communication training on shared decision-making and outcomes in an acute hospital: a prospective longitudinal interventional study.

Patients with a life-limiting illness (LLI) requiring hospitalisation have a high likelihood of deterioration and 12-month mortality. To avoid non-aligned care, we need to understand our patients' goals and values. To describe the association between the implementation of a shared decision-making (SDM) programme and documentation of goals of care (GoC) for hospitalised patients with LLI. A prospective longitudinal interventional study of patients admitted to acute general medicine wards in an Australian tertiary hospital over 5 years was conducted. A SDM programme with a new GoC form, communication training and clinical support was implemented. The primary outcome was the proportion of patients with a documented person-centred GoC discussion (PCD). Clinical outcomes included hospital utilisation and 90-day mortality. 1343 patients were included. The proportion of patients with PCDs increased from 0% to 35.4% (adjusted odds ratio (aOR), 2.38; 95% confidence interval (CI), 2.01-2.82; P < 0.001). During this time, median hospital length of stay decreased from 8 days (interquartile range (IQR), 4-14) to 6 days (IQR, 3-11) (adjusted estimate effect, -0.38; 95% CI, -0.64 to -0.11; P = 0.005) and rapid response team activation from 28% to 13% (aOR, 0.87; 95% CI, 0.78-0.97; P value = 0.01). Documented treatment preference of high-dependency unit care decreased from 39.7% to 24.4% (aOR, 0.81; 95% CI, 0.73-0.89; P value < 0.001), and ward-based care increased from 31.9% to 55.1% (aOR, 1.24; 95% CI, 1.14-1.36; P value < 0.001). The implementation of a SDM programme was associated with increased documentation of person-centred GoC, changed patient treatment preference to lower intensity care and reduced hospital utilisation.

Timing of prognostic discussions in people with advanced cancer: a systematic review.

Many people with cancer (patients) want to know their prognosis (a quantitative estimate of their life expectancy) but this is often not discussed or poorly communicated. The optimal timing of prognostic discussions with people with advanced cancer is highly personalised and complex. We aimed to find, organise, and summarise research regarding the timing of discussions of prognosis with people with advanced cancer. We conducted a systematic review of publications from databases, clinical practice guidelines, and grey literature from inception to 2023. We also searched the reference lists of systematic reviews, editorials, and clinical trial registries. Eligibility criteria included publications regarding adults with advanced cancer that reported a timepoint when a discussion of prognosis occurred or should occur. We included 63 of 798 identified references; most of which were cross-sectional cohort studies with a range of 4-9105 participants. Doctors and patients agreed on several timepoints including at diagnosis of advanced cancer, when the patient asked, upon disease progression, when there were no further anti-cancer treatments, and when recommending palliative care. Most of these timepoints aligned with published guidelines and expert recommendations. Other recommended timepoints depended on the doctor's clinical judgement, such as when the patient 'needed to know' or when the patient 'seemed ready'. Prognostic discussions with people with advanced cancer need to be individualised, and there are several key timepoints when doctors should attempt to initiate these conversations. These recommended timepoints can inform clinical trial design and communication training for doctors to help improve prognostic understanding.

Reducing Health Disparities Among African American and Black Caribbean Patients by Improving the Communication Practices of Clinical Research Coordinators

ABSTRACT This manuscript focuses on the communication factors that affect the willingness of African Americans and Black Caribbean patients to participate in clinical trials and research studies. Low rates of research participation by members of communities of color have long been linked to health disparities. While there are many factors that contribute to low rates of accrual of African American and Black patients to clinical trials, a lack of attention to communication factors that enhance or inhibit the recruitment process is central to the problem. In this study, we describe results from the analysis of six focus groups (N = 31) consisting of African American (k = 3) and Black Caribbean (k = 3) participants. Our analyses focus on verbal and nonverbal communication behaviors and how they affect participants’ willingness to participate in clinical trials. Specifically, when clinical research coordinators (CRCs) had a professional appearance, made the effort to explain a study in detail, made eye contact, took the time to listen and answer questions patiently, and gave the sense that the CRC was being truthful and transparent, patients felt respected and valued. Additionally, participants emphasized the importance of the process of developing and maintaining a trusting relationship between study participants and CRCs. The results of this study will be used to develop a clinical trial communication training program designed to enhance the communication skills of clinical research coordinators who discuss research participation with African American and Caribbean Black patients.

O.22.4 - (WIP) Simulated patients' dramatic performance: perceived impact on clinical communication training: Presenter(s): Margarida Figueiredo-Braga, Faculdade de Medicina da Universidade do Porto, Portugal

O.22.4 - (WIP) Simulated patients' dramatic performance: perceived impact on clinical communication training: Presenter(s): Margarida Figueiredo-Braga, Faculdade de Medicina da Universidade do Porto, Portugal

Effect of communication skills training on documentation of shared decision-making for patients with life-limiting illness: An observational study in an intensive care unit

ObjectivesThis article aims to examine the association between a shared decision-making (SDM) clinical communication training program and documentation of SDM for patients with life-limiting illness (LLI) admitted to intensive care. MethodsThis article used a prospective, longitudinal observational study in a tertiary intensive care unit (ICU). Outcomes included the proportion of patients with SDM documented on an institutional Goals of Care Form during hospital admission, as well as characteristics, outcomes, and factors associated with an SDM admission. InterventionClinical communication skills training (iValidate) and clinical support program are the intervention for this study. ResultsA total of 325 patients with LLI were admitted to the ICU and included in the study. Overall, 184 (57%) had an SDM admission, with 79% of Goals of Care Form completed by an iValidate-trained doctor. Exposure to an iValidate-trained doctor was the strongest predictor of an ICU patient with LLI having an SDM admission (odds ratio: 22.72, 95% confidence interval: 11.91–43.54, p < 0.0001). A higher proportion of patients with an SDM admission selected high-dependency unit–level care (29% vs. 12%, p < 0.001) and ward-based care (36% vs. 5%, p < 0.0001), with no difference in the proportion of patients choosing intensive care or palliative care. The proportion of patients with no deterioration plan was higher in the non-SDM admission cohort (59% vs. 0%, p < 0.0001). ConclusionsClinical communication training that explicitly teaches identification of patient values is associated with improved documentation of SDM for critically ill patients with LLI. Understanding the relationship between improved SDM and patient, family, and clinical outcomes requires appropriately designed high-quality trials randomised at the patient or cluster level.

Development and pilot test of a physician-focused cancer clinical trials communication training intervention

We describe the development and pilot test of a physician-focused, web-based training module designed to improve physician communication related to clinical trials in a diverse cancer patient population. Researchers and stakeholders developed the training module, which included a video explaining patient-centered communication strategies for discussing trials, and re-enactments of actual clinical interactions. For the pilot test, the module was provided to physician participants in the Partnering Around Cancer Clinical Trials (PACCT) trial at two major urban cancer centers. Questionnaires assessed change in beliefs, behavioral attitudes, knowledge and comfort; and perceptions of the module. Nineteen physicians participated in the pilot test. Most were experienced in discussing trials. Assessments of change were mixed regarding beliefs; they showed marginal improvement in attitudes, and significant improvement in knowledge, but no change in comfort. Feedback on the module was favorable. This stakeholder-developed physician communication training module was acceptable and effective, albeit in this small and highly-experienced physician sample. Future research should determine its effectiveness on communication in clinical settings. This is the first physician training module to focus on communicating about clinical trials in a diverse patient population. It offers a web-based format and re-enactments of naturally-occurring clinical interactions. Trial Registration Number: NCT02906241

Immersive virtual reality simulated learning environment versus role-play for empathic clinical communication training.

IntroductionThe use of immersive virtual reality simulated learning environments (VR SLEs) for improving clinical communication can offer desirable qualities including repetition and determinism in a safe environment. The aim of this study was to establish whether the mode of delivery, VR SLE versus clinical role‐play, could have a measurable effect on clinical empathic communication skills for MRI scenarios.MethodsA split‐cohort study was performed with trainee practitioners (n = 70) and qualified practitioners (n = 9). Participants were randomly assigned to four groups: clinician VR (CVR), clinician role‐play (CRP), trainee VR (TVR), and trainee RP (TRP). Clinical communication skills were assessed using two methods: firstly, a self‐reported measure – the SE‐12 communication questionnaire and, secondly, a training and assessment tool developed by a panel of experts.ResultsParticipants in the VR trainee (TVR) and clinician (CVR) groups reported 11% (P < 0.05) and 7.2% (P < 0.05) improvements in communication confidence post training, whereas trainees assigned to the role‐play (TRP) intervention reported a 4.3% (P < 0.05) improvement. Empirical assessment of communication training scores assessing a participant’s ability to select empathic statements showed the TVR group performed 5% better on average than their role‐play counterparts (P < 0.05).ConclusionThe accuracy of participant's selection of appropriate empathic responses was shown to differ significantly following the training intervention designed to improve interactions with patients that present for an MRI scan. The results may demonstrate the capacity for immersion into an emotional narrative in a VR environment to increase the user’s susceptibility for recalling and selecting empathic terminology.

Exploring the role of pharmacy students using entrustable professional activities to complete medication histories and deliver patient counselling services in secondary care

Entrustable professional activities (EPAs) allow tasks to be delegated to trainees. A new model of pharmacy placements was developed that used EPAs to appropriately supervise students providing patient counselling for inhalers, anticoagulation and simple analgesia at a tertiary care hospital. Students were provided with clinical communication training (e.g. how to do the counselling) as well as mandatory occupational training (e.g. fire safety). Data was collected (by students and placement facilitators) relating to the number of consultations (n = 1361) and patients who received counselling (n = 308) carried out by students (n = 71) over a 20 week period. Students documented these consultations, recording information such as the patient identification details, subjective and objective history, their assessment of the patients' need, as well as any action taken and any further planned action that was required. These notes were analysed using a Quality and Utility Assessment Framework by three clinical pharmacists. Data was analysed using simple descriptive statistical analysis on Microsoft Excel. Documentation was deemed High Quality (41%), Medium Quality (35%) and Low Quality (24%). The results indicate that pharmacy students can use entrustable professional activities to contribute to clinical services, completing high-quality patient consultations that have utility in clinical practice. Further work is needed to evaluate impact on clinical service delivery and establish the educational utility of using EPAs to support the pharmacy workforce to develop their consultation skills.

Transfer of communication teaching skills from university to the clinical workplace \u2013 does it happen? A mixed methods study

BackgroundCommunication 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.MethodsWe 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.ResultsThe 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.ConclusionTransfer 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.

A pilot of modified Conversation Analytic Role-play Method for one-to-one clinical communication training

ObjectiveIt can be difficult to identify specific skills to improve communication, particularly if feedback is generalised or vague. With the aim of providing specific feedback for improved doctor-patient communication, we piloted a modified Conversation Analytic Roleplay Method (CARM) for one-to-one training. MethodsWe recorded one surgical registrar during ward rounds in a hospital. These seven consultations were then analysed and an individualised CARM workshop, utilising the findings and related published evidence, was developed and delivered. One month after this workshop, another nine consultations were recorded and analysed. ResultsThere were three “trainables” identified in the initial analysis that formed the basis of the personalised workshop. Analysis of the post-training recordings showed that the verbal behaviours were mostly modified but the non-verbal behaviour generally was not. ConclusionBy facilitating reflection on and close analysis of his own interaction using CARM, we were able to assist this doctor in modifying some of his communication behaviours. Practice implicationsPersonalised video-based training enables the identification of an individual’s practice, allowing for specific feedback and engaging participants with the analysis of their own talk. This makes it potentially an ideal method for helping those struggling to improve with other training methods.

Online Synchronous Clinical Communication Training During the COVID-19 Pandemic [Letter

Online Synchronous Clinical Communication Training During the COVID-19 Pandemic [Letter

Online Synchronous Clinical Communication Training During the Covid-19 Pandemic.

PurposeAs the COVID-19 pandemic outbreak occurred, most structured clinical communication training were transformed from in-person to remote seminars. The aim of our study was to evaluate the usefulness and feasibility of online synchronous clinical communication training from both students’ and tutors’ perspectives.Patients and MethodsWe conducted a cross-sectional study. Geneva Faculty of Medicine’ 3rd year medical students and tutors involved in clinical communication were asked to respond to an online survey.ResultsEighty-five of 149 students and 15/16 tutors responded. Students highly valued both online seminars and reported little technical difficulty. They felt that tutors were well prepared and actively involved them in experiential learning. Tutors globally reported little technical difficulty and felt rather well prepared to do so online. Although both students and tutors preferred the in-person format, half of them could still consider using an online format in the future outside the pandemic but mentioned it required specific rules.ConclusionOur results suggest that clinical communication can be taught and practiced online and that tutors can quickly adapt to such changes.

Body-oriented gestures as a practitioner's window into interpreted communication

With increasing global migration, health care providers and patients may lack a shared language. Interpreters help to secure understanding. Doctors and patients cannot evaluate how the interpreter translates their utterances; however, they can see hand movements, which can provide a window into the interpretation process. While research on natural language use has acknowledged the semiotic contribution of co-speech gestures (i.e., spontaneous hand and arm movements that are tightly synchronized with speech), their role in interpreted interactions is unstudied. We aimed to reveal whether gestures could shed light on the interpreting process and to develop a systematic methodology for investigating gesture-use in interpreted encounters. Using data from authentic, interpreted clinical interactions, we identified and analyzed gestures referring to the body (i.e., body-oriented gestures). Data were 76 min of video-recorded doctor-patient consultations at two UK inner-city general practices in 2009. Using microanalysis of face-to-face dialogue, we revealed how participants used body-oriented gestures and how interpreters transmitted them. Participants used 264 body-oriented gestures (doctors = 113, patients = 54, interpreters = 97). Gestures served an important semiotic function: On average, 70% of the doctors' and patients' gestures provided information not conveyed in speech. When interpreters repeated the primary participants’ body-oriented gestures, they were highly likely to accompany the gesture with speech that retained the overall utterance meaning. Conversely, when interpreters did not repeat the gesture, their speech tended to lack that information as well. A qualitative investigation into the local effect of gesture transmission suggested a means for quality control: visible discrepancies in interpretation generated opportunities to check understanding. The findings suggest that clinical communication training could benefit from including skills to understand and attend to gestures. The analysis developed here provides a promising schema and method for future research informing clinical guidelines and training.

Clinical communication training for the general practice of medicine – A case for including discourse analytical findings from real-world practice

Communication is central to the clinical training of doctors preparing for Fellowship of the Royal Australian College of General Practitioners. Currently, medical educators use a comprehensive problem-solving methodology that includes engaging registrars in role-plays of consultations as a means for reflection on practice. To date, however, this interactive training has made little use of the evidence from real-life clinical encounters that discourse analysis affords. This paper presents a case for the use of discourse analytical findings to complement existing training processes. Drawing from ethnographic observations of clinical communication training and focusing particularly on the development of empathic communication, the paper looks closely at current training practice. Turning to discourse analytical findings from real-life practice, and focusing on moments of empathic opportunity, the paper brings to light the impact of a doctor's selective empathic formulations on the direction and outcomes of the consultation, in order to make visible what constitutes clinically ineffective empathy. The paper goes on to suggest a training approach that deploys such discourse analytical findings as a means to enhance clinical communication training and to support processes of critical reflection on practice.

Researching in doctor-patient communication courses for internship of medical students

Currently medical students are short in ability of doctor-patient communication and lack of professional training in doctor-patient communication. It is essential to explore ways and means of teaching clinical doctor-patient communication for medical students. Clinical doctor-patient communication training courses were carried out with internships by way of explaining the establishment of a good doctor-doctor-patient communication relationship, preparation and investigation analysis of doctor-patient communication information, doctor-patient communication skills, evaluation and adjustment of doctor-doctor-patient communication, doctor-doctor-patient communication in the legal and regulatory issues. Medical students were trained in the good doctor-doctor-patient communication relationship building, information collection, information giving, respect and understanding, ending doctor-patient communication skills. And after the training medical students' doctor-patient communication ability obtained a certain improvement, which means this curriculum of clinical doctor-patient communication training courses is worthy of further promotion. Key words: Doctor-patient communication training; Set elicit give understand end framework; Standardized patient

The application of the Practitioners in Applied Practice Model during breaking bad news communication training for medical students: a case study

Breaking bad news is a key skill within clinical communication and one which can impact outcomes for both the patient and practitioner. The evidence base for effective clinical communication training in breaking bad news is scarce. Frameworks have been found to assist the practitioner, such as SPIKES; however, the pedagogical approach used alongside such frameworks can vary. This study sought to examine the impact of utilising the Practitioners in Applied Practice Model (PAPM) alongside the SPIKES framework for training undergraduate medical students in breaking bad news. A case study approach is used to highlight the impact of training based on the PAPM and SPIKES on patient-centred communication and simulated patient satisfaction with the clinical communication behaviour. Results showed that following training, both patient-centred behaviour and patient satisfaction improved. With detailed communication behaviour changes, a balance was established between rapport building behaviour, lifestyle and psychosocial talk alongside biomedical information. This case study shows how the PAPM could be utilised alongside the SPIKES framework to improve breaking bad news communication in medical undergraduate students and describes the behavioural basis of the improvement. Further research is required to show the generalisability of this training intervention.

Teaching communication skills: beyond wishful thinking.

Communication skills tend to decline with time unless they are regularly recalled and practiced. However, most medical schools still deliver clinical communication training only during pre-clinical years although the clinical environment is considered to be ideal for acquiring and teaching clinical communication. The aim of this article is to review the barriers that prevent communication skills teaching and training from occurring in clinical practice and describe strategies that may help enhance such activities. Barriers occur at several levels: students, junior doctors and clinical supervisors sometimes have negative attitudes towards communication training; structured training in communication skills is often insufficient; clinical supervisors behave as poor role models and lack effective communication and teaching skills; finally, there are organisational constraints such as lack of time, competing priorities, weak hierarchy support and lack of positive incentives for using, training or teaching good communication skills in clinical practice. Given the difficulty of assessing transfer of communication skills in practice, only few studies describe successful educational interventions. In order to optimise communication skills learning in practice, there is need to: (1.) modify the climate and structure of the working environment so that that use, training and teaching of good communication skills in clinical practice becomes valued, supported and rewarded; (2.) extend communication skills training to any field of medicine; (3.) provide regular structured trainings and tailor them to trainees' needs. Practical implications of such findings are discussed at the end of this review.

Health Communication iOS APP: A Free Resource for Interprofessional Curriculum Training (FR469-C)

•Educate and support the communication training of palliative care team members.•Provide skills-based guidance about relational communication in the clinical context.•Identify concrete communication practices for challenging topics in palliative care.•Disseminate evaluation findings of the Health Communication APP. With the influx of palliative education programs during the last decade, the inclusion of mobile device support remains limited, and the study of mobile app usability and feasibility is even more rare. To increase clinical communication training exposure to a variety of team members and expand palliative care training beyond health education, the Health Communication APP features over 100 specific communication strategies as well as a search by scenario menu. Two primary features are included: first, a quick reference guide for what to say and how to say it in a variety of circumstances, and second, a communication toolkit that helps clinicians effectively respond to difficult conversations with patients and caregivers. App content is derived from theory and evidence resulting from 10 years of research in a variety of healthcare contexts. The content of the App is based on the COMFORT Communication Curriculum. The curriculum has been peer reviewed and tested among palliative care audiences (undergraduate and graduate education as well as clinical audiences); all studies have demonstrated significant change in communication confidence, comfort, knowledge, and efficacy. Findings from feasibility and usability tests of the APP will be presented. Results are based on feedback data from clinicians who have downloaded and used the APP. Initial feedback has demonstrated high satisfaction with APP content and ease of use. To meet the growing dependence on mobile devices for information and support, the Health Communication APP provides learners and clinicians with a resource for learning about palliative care communication. This educational tool can be used to provide interprofessional education, supplement communication instruction, and to guide clinical observations as well as curriculum development. The Health Communication APP mobile content is an innovative tool for palliative care communication training. Clinicians and students find it easy to use and valuable to their practice.

Women's experiences of their pregnancy and postpartum body image: a systematic review and meta-synthesis.

BackgroundPregnancy-related physical changes can have a significant impact on a woman’s body image. There is no synthesis of existing literature to describe the intricacies of women’s experiences of their body, and relevant clinical implications.MethodsFour electronic databases were searched in February 2014 using predefined search terms. English-language, qualitative studies published between January 1992 and December 2013 exploring pregnancy and postpartum body image were included. Following quality appraisal, 17 papers were synthesised using the interpretive thematic synthesis approach within a social constructionist framework.ResultsThree themes were highlighted: “Public Event: ‘Fatness’ vs. Pregnancy”, “Control: Nature vs. Self”, and “Role: Woman vs. Mother”. Women perceived the pregnant body to be out of their control and as transgressing the socially constructed ideal, against which they tried to protect their body image satisfaction. Women perceived the physical manifestation of the mothering role as incongruent to their other roles as a wife or partner, or working woman. Body dissatisfaction dominated the postpartum period.ConclusionsWomen’s perception of their pregnancy body image is varied and depends on the strategies they use to protect against social constructions of female beauty. Women have unrealistic expectations for their postpartum body, highlighting this as an area where women need better support. Attending to women’s narratives about their pregnant body may identify at-risk women and provide an opportunity for health professionals to provide support to either address or accept body image dissatisfaction. Clinical communication training may enable health professionals to explore body image concerns with women and guide them in identifying ways of accepting or reducing any dissatisfaction.