Communication Skills In Clinical Practice Research Articles

Место коммуникативных навыков в клинической практике врача-анестезиолога

В статье рассмотрены проблемы общения анестезиолога с пациентом и его родственниками в ключе возрастающего давления и повышения требований общества к медицинским работникам. С учетом особых условий и специфики работы врача-анестезиолога отмечена важность совершенствования навыков коммуникативной компетентности, приведены ключевые рекомендации из «Полного руководства по навыкам общения в клинической практике», рассмотрены особенности общения в периоперационном периоде и во время пребывания пациента в отделении реанимации и интенсивной терапии (ОРИТ). Во время периоперационного общения важно не только оценить состояние здоровья пациента и его готовность к оперативному вмешательству, но и заручиться доверием пациента, создать ощущение неусыпного врачебного контроля, максимально снизить уровень тревоги, сформировать партнерские взаимоотношения. Условия ОРИТ специфичны, для анестезиолога сложность общения связана с тяжестью состояния пациентов, наличием у них разного уровня сознания, которое может быть угнетено вследствие основного заболевания или на фоне седативных препаратов. Для пациента пребывание в ОРИТ — источник нравственных страданий и страха, это затрудняет сотрудничество с медицинским персоналом. Отдельно рассмотрены вопросы психологии медицинского персонала, подчеркнута важность профессионального сострадания, проведения манипуляций в оптимально комфортных и безопасных условиях. Работа в условиях постоянного стресса требует от врача-анестезиолога высокого профессионализма, морально-нравственной стойкости, навыков коммуникативной компетентности. Качественное общение с пациентом и его родственниками — значимый компонент многогранной профессии врача-анестезиолога, который позволяет найти правильные грани взаимодействия с коллегами, пациентами и осознать свою роль в сохранении личного и общественного здоровья.

Applying empathic communication skills in clinical practice: Medical students' experiences.

BackgroundStudies have demonstrated that empathic communication improves patient outcomes and helps doctors to deliver accurate symptom reports and diagnoses. These benefits emphasise the need for medical students to apply empathic communication skills during their interactions with patients. Focussed empathic communication skill workshops were introduced into the undergraduate medical students’ training at the Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa. This study aimed to explore students’ perceptions of applying these empathic communication skills during their clinical practice. We were interested in determining the factors that might influence the development of empathic communication skills. The findings could help curriculum developers to optimise these workshops for inclusion in a formal medical curriculum.MethodsThis study followed a qualitative, descriptive enquiry, exploring the perceptions of medical students through focus-group discussions. The students (N = 18) were selected using convenience sampling techniques. Recordings were transcribed, and the data were thematically analysed.ResultsThe two main themes identified relate to the students and the clinical learning environment. The students valued the knowledge and skills they acquired. However, feelings of emotional vulnerability, a lack of language proficiency and inadequate role modelling were highlighted as challenges when applying empathic communication during clinical practice.ConclusionThe students reported positively on the workshops as these improved both their patient and personal interactions. However, for students to develop these skills further for clinical practice, they need more intentional and supervised opportunities to practise, reflect and receive constructive feedback. These learning opportunities could help medical schools deliver graduates who can competently communicate with their patients in an empathic manner.

COMMUNICATIVE COMPETENCE IS AN INTEGRAL PART OF THE QUALITY PROFESSIONAL ACTIVITY OF ANESTHESIOLOGIST

Preamble. Last years there were noticeable increase of interest to communicative capability which is meaningful component of physician’s professional activity seeing its considerable influence on quality of process of medical treatment and patient satisfaction.Capable physician behavior towards patient and his/her family members increase success of medical treatment and patient trust in physician.Problems in communication of anesthesiologist with patient are discussed in this article considering continuous increase of intensity of work and society requirements to medical professionals. Significance of highly developed communication experience in prevention of complaints and judicial claims is underlined.The aim of this article is to summarize separate information about communicative capability, peculiarities of communication of anesthesiologist with patient and show practical doctors’ way how they can improve communication.Materials and methods. Given in this article evidence are based on information that was derived from PubMed database, on recommendations of American Society of Anesthesiologists and data from «The Complete Guide to Communication Skills in Clinical Practice», materials published in foreign and domestic issues, experience.Results. The review of modern data highlighted in the article reflects the difficulties and peculiarities of communication between an anesthesiologist and patients and their relatives, based on the specifics of his work in the perioperative period at different stages of anesthesiologic support of surgical interventions and in the conditions of medical care provided to patients in the intensive care unit (ICU).Attention is focused on the high tension in the work of medical personnel, the high severity of the patient’s condition, which is accompanied by a decrease in the possible time for communication with the patient and his relatives.The recommendations given in the article will help the anesthesiologist to improve the existing communication skills and increase his desire to further improve them.

Medical Residents Perceptions of Communication Skills a Workshop on Breaking Bad News

ABSTRACT Introduction Breaking bad news althoughfrequent among healthcare professionals and their patients is still considered a very difficult task. These communication skill main determinants in the physician-patient relationship. Objective In view of the need to promote academic spaces that provide opportunities to learn breaking bad news , thisstudy aims to evaluate the medical residentsin relation to their interest in learning communication skills, as well as their skills in breaking bad news, before and after a workshop on the topic. Methods All the medical residents in the first year ofnternal edicine of a public general hospital in Belém-Pará, Brazil inwere invited to answer a questionnaire sociodemographic data and questions about their communication skills in clinical practice, as well as the Communication Skills Attitude Scale (CSAS), which addressed their interest in learning communication skills. The questionnaire. This research uses both uantitative and qualitative methods. The quantified data were statisticallyanalyzed by the Wilcoxon test (),Chi-Square test G-test adherence (quantitative variables of the questionnaire on communication skills). The qualitative evaluation Content Analysis based on Bardin. Results Ten residents attended the workshop. The results show that after taking part in the workshop, the resident’s perceptions of the practice of breaking bad news had improved (in 80% of the participants), as well as their attitudes to learning communication skills ( CSAS = 99.5 and 105, before and after the course, respectively p = 0.0039). Conclusion Eighty percent of residents (n = 08) considered their communication skills have improved as a result of the workshop (p = 0.0078). Most of the participantsbecame more aware of the importance of considering the patient’s perspective, and admitted positive changes following the course. Conclusion A positive effect on the participants’ perceptions of communication skills and on their interest in learning these skills, were identified after an intervention focused on the context of breaking bad news.

Clinical empathy with cancer patients: a content analysis of oncology nurses' perception.

BackgroundEmpathy is one of the most important communication skills in clinical practice, specifically in the field of oncology. Empathic competences have a significant meaning for caring and therapeutic relations in nurses’ responsibilities. Clinical empathy brings positive performance, thus patients’ emotions are perceived and expressed more easily. Clinical empathy is contextual, interpersonal and affective, but it is also difficult to study. Awareness of oncology nurses’ perception of this phenomenon might help them to plan for more effective patient-centered consultations within interventional programs. Therefore, the aim of this study was to explore the content of clinical empathy with cancer patients from the perspective of oncology nurses.Patients and methodsIn this qualitative study, 15 oncology nurses were selected by purposive sampling. A semi-structured face-to-face interview was conducted with each of the participants. After data collection, all interviews were transcribed and reviewed, and then primary codes, sub-categories and categories were extracted. The data were analyzed with the conventional content analysis method by MAXQDA 10 software.ResultsClinical empathy showed a composite construct with five main categories, including co-presence (physical and emotional presence), metacognition (self-awareness of mental processes), perception (knowing about awareness of individuals), inherent (genetic) and didactic (instructive) nature.ConclusionClinical empathy as an effective strategy can be taught through three areas of “co-presence”, “metacognition” and “perception” in the context of cancer care. Thus, clinical empathy should be considered as one of the competency standards which can be taught to oncology nurses.

Long-term Effects of a Health Literacy Curriculum for Family Medicine Residents.

Improving education about health literacy for health care professionals has been recommended, and many US family medicine residency programs have developed such curricula. Few studies have evaluated the effectiveness of health literacy curricula for health care professionals. This pilot study aimed to determine whether a longitudinal health literacy curriculum for family medicine residents could achieve long-term sustained improvements in health literacy knowledge and clear communication practices. Self-reported pre- and postassessments were conducted for a series of four health literacy didactic and experiential trainings over 11 months with a cohort of 12 first-year family medicine residents (study adequately powered for cohort of 10 or more). Five out of five health literacy knowledge items showed sustained significant improvement immediately after the initial didactic training. Two out of eight clear communication behaviors (eliciting patients' questions through an open-ended approach, and using a teach-back method to check for patients' understanding) showed sustained significant improvements in the 11-month follow-up period. The remaining six behaviors demonstrated a saw-tooth pattern, wherein each training session produced improvements in planned behaviors, which were, however, not maintained at subsequent follow-up assessments. These data suggest that residents learned the cognitive material related to health literacy and clear communication easily, but had difficulty integrating many trained skills into clinical practice, despite the use of experiential learning techniques. Future studies should use an observational design to assess clear communication behaviors, and should include assessment of potential barriers to implementing clear communication skills in clinical practice.

The nurse-patient communication: voices from nursing students.

Effective communication skills have been found to be one of the pivotal factors in building positive interpersonal relationships. Little is known about nursing undergraduates' perspectives on communicating with patients. This study aimed to explore nursing students' perspectives and experiences of nurse-patient communication in their clinical placement. The participants included 21 second-year undergraduates and 21 first-year master's students. Interviews were conducted in Cantonese and then transcribed in Chinese and translated into English. A content analysis approach was adopted to analyze the data. Five themes emerged from the interview data. 'The necessity of nurse-patient communication' reveals why the students valued nurse-patient communication. 'The conversation contents' describes the content of the conversations that students typically had with patients. The third theme is 'self-reflection on the nurse-patient communication'. The last two themes, 'the communication pattern in different hospital settings' and 'the obstacles impeding nurse-patient communication', are about the students' communication styles in different hospitals and the barriers they encounter. To improve students' communication skills, educators and clinical staff should listen to students, enhance students' reflective skills and strengthen their confidence. Through understanding students' difficulties in the nurse-patient communication experience and the skills that they lack, educators can provide them with helpful recommendations to improve their communication skills in clinical practice. The results of this study reveal that students' nurse-patient communication skills need to be improved.

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.

Impact of postgraduate training on communication skills teaching: a controlled study.

BackgroundObservation of performance followed by feedback is the key to good teaching of communication skills in clinical practice. The fact that it occurs rarely is probably due to clinical supervisors’ perceived lack of competence to identify communication skills and give effective feedback. We evaluated the impact of a faculty development programme on communication skills teaching on clinical supervisors’ ability to identify residents’ good and poor communication skills and to discuss them interactively during feedback.MethodsWe conducted a pre-post controlled study in which clinical supervisors took part to a faculty development program on teaching communication skills in clinical practice. Outcome measures were the number and type of residents’ communication skills identified by supervisors in three videotaped simulated resident-patient encounters and the number and type of communication skills discussed interactively with residents during three feedback sessions.Results48 clinical supervisors (28 intervention group; 20 control group) participated. After the intervention, the number and type of communication skills identified did not differ between both groups. There was substantial heterogeneity in the number and type of communication skills identified. However, trained participants engaged in interactive discussions with residents on a significantly higher number of communication items (effect sizes 0.53 to 1.77); communication skills items discussed interactively included both structural and patient-centered elements that were considered important to be observed by expert teachers.ConclusionsThe faculty development programme did not increase the number of communication skills recognised by supervisors but was effective in increasing the number of communication issues discussed interactively in feedback sessions. Further research should explore the respective impact of accurate identification of communication skills and effective teaching skills on achieving more effective communication skills teaching in clinical practice.

Effectiveness of a training program in supervisors’ ability to provide feedback on residents’ communication skills

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.

A comunicação na consulta. Uma proposta prática para o seu aperfeiçoamento contínuo

Introduction: Interpersonal communication skills are fundamental to all clinical practice, but this is especially true in relationshipbased disciplines such as family medicine. Training in communication skills is an integral part of medical education especially during specialty training. Objectives: To develop and test a model for the analysis and training of communication skills in clinical practice based on behavioural elements. Methods: The authors proposed a model for the development of communication skills in clinical practice. This model was developed between 2009 and 2010 from consultations observed in a family practice vocational training clinic. A reflexive observational cycle approach was adopted. This process combined reflexive critical practice, bibliographic study, and the discussion of behavioural elements in clinical communication. Some consultations were recorded on video for this purpose. A selective approach was used to identify aspects of clinical communication distinct from those related to the doctor-patient relationship or with the process of the clinical consultation. The authors intended to describe the “pure” communication behaviours in depth in order to observe and enhance them. Results: Observation and reflection on consultations revealed 55 behavioural skills. These skills were organized into a model composed of 12 communication skills categories. Four skills were considered central. These included listening, questioning, putting oneself in the patient’s place, and confirming and reformulating. The remaining skills were opening, observing, leading the consultation, harmonizing, explaining, summarizing, reaching agreement, and concluding. Conclusions: Clinical communication is much more rich and complex that the simple sum of the behavioural components identified. However, the proposed model was found to be relevant and useful for the improvement of doctor-patient communication skills in this setting. It also has been useful for the design of self-assessment exercises and for external assessment using video recording. Successful communication is related to the doctor’s genuine interest in each patient as a unique person, to the doctor’s will and motivation to improve their interpersonal communication skills, and to a dedicated effort to improve the large range of complex skills required for effective doctor-patient communication.

Problem-solving and communication skills in clinical practice: A reflection

As part of pre-registration midwifery education, the Nursing and Midwifery Council stipulates that students need to progressively develop essential key skills including problem-solving and communication. It is insufficient for these skills to be understood on a purely academic level; they need to be applied in clinical practice. This reflective account illustrates how progression and attainment of these skills and the application thereof is an achievable standard. Additionally it demonstrates the requirement for students to build on these skills so that they learn to effect positive outcomes in challenging situations which occur frequently in the midwifery profession.

Clinical supervisors’ perceived needs for teaching communication skills in clinical practice

Background: Lack of faculty training is often cited as the main obstacle to post-graduate teaching in communication skills.Aims: To explore clinical supervisors’ needs and perceptions regarding their role as communication skills trainers.Methods: Four focus group discussions were conducted with clinical supervisors from two in-patient and one out-patient medical services from the Geneva University Hospitals. Focus groups were audio taped, transcribed verbatim and analyzed in a thematic way using Maxqda© software for qualitative data analysis.Results: Clinical supervisors said that they frequently addressed communication issues with residents but tended to intervene as rescuers, clinicians or coaches rather than as formal instructors. They felt their own training did not prepare them to teach communication skills. Other barriers to teach communication skills include lack of time, competing demands, lack of interest and experience on the part of residents, and lack of institutional priority given to communication issues. Respondents expressed a desire for experiential and reflective training in a work-based setting and emphasised the need for a non-judgmental learning atmosphere.Conclusions: Results suggest that organisational priorities, culture and climate strongly influence the degree to which clinical supervisors may feel comfortable to teach communication skills to residents. Attention must be given to these contextual factors in the development of an effective communication skills teaching program for clinical supervisors.

Changes with school years in the characteristics of nursing students' communication skills in clinical practice

Changes with school years in the characteristics of nursing students' communication skills in clinical practice

Communication Skills in Clinical Practice for a Successful Health Care System

Communication Skills in Clinical Practice for a Successful Health Care System

Effects of a Course on Ophthalmologist Communication Skills: A Pilot Study

Although the issue of communication skills is now considered crucial for ophthalmology, no previous research has discussed training in this field. This study aimed to discuss the effects of a 16 hour communication skills course for ophthalmologists. In particular the study assessed the interest of participants with respect to the topic and the efficacy on participants' communication skills, at least in a laboratory setting. Eleven ophthalmologists participated in the course. Learner satisfaction was evaluated using a questionnaire with a six-point Likert scale. Course efficacy was assessed by a comparison between communicative behaviour of ophthalmologists in videoed role playing before and immediately after attending the course. Videoed consultations were coded using the Patient Centred Score Sheet (PCSS) and the Roter Interaction Analysis System (RIAS). The Wilcoxon signed rank test was used for statistical analysis. The course obtained high satisfaction in participants (mean score 5.1). In the post test role playing, patient centredness increased significantly (p < 0.01). Furthermore, ophthalmologists improved their competence in using open ended questions (p < 0.02), process categories (e.g. orientation statement) (p < 0.05) and social communication categories (e.g. personal statement) (p < 0.01). According to our findings, ophthalmologists did show satisfaction for the course. Results also indicate that the course positively influenced ophthalmologist communication competence, at least in a laboratory setting. After the course, participants became more attentive to patients' psychosocial needs, both in terms of general quality of consultation (patient centredness) and in terms of using specific interpersonal skills. Present results are considered preliminary, and further research is needed with a larger sample and including an evaluation of the effects on ophthalmologists' communication skills in clinical practice.

Review and Commentary: A Practical Guide to Communication Skills in Clinical Practice

Review and Commentary: A Practical Guide to Communication Skills in Clinical Practice

A Practical Guide to Communication Skills in Clinical Practice

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A Practical Guide to Communication Skills in Clinical PracticeA Practical Guide to Communication Skills in Clinical Practice, by Robert Buckman , Barbara Korsch , and Walter Baile . Four CD-ROMs along with a pocket sized guide to communication skills. Medical Audiovisual Communications Inc., Niagara Falls, NY, 1998. Order phone Number: 1-800-757-4868 (E-mail: DWC® MABC.com).

A Practical Guide to Communication Skills in Clinical PracticeA Practical Guide to Communication Skills in Clinical Practice, by Robert Buckman , Barbara Korsch , and Walter Baile . Four CD-ROMs along with a pocket sized guide to communication skills. Medical Audiovisual Communications Inc., Niagara Falls, NY, 1998. Order phone Number: 1-800-757-4868 (E-mail: DWC® MABC.com).