Communication Skills Training Course Research Articles

Development and initial validation of an assessment tool for communication skills in dietetics

Background: There is a growing interest in developing the communication skills of healthcare practitioners in order to promote health-related behaviour change (National Institute of Health and Clinical Excellence, 2007). Dietitians require a high level of communication skills and aim to build rapport with their patients to gain their trust and respect. A caring relationship involving active engagement, sharing and open communication is valued by clients as much as the clinical skills (Cant and Aroni, 2009). A difficulty with research in this area is assessing communication skills of dietitians because there are few validated tools available. This project is part of an ongoing research programme funded by Diabetes UK. The aim was to develop an evidence based, validated tool for the assessment of communication skills within dietetic patient consultations. Methods: Face validity was assessed by reviewing current tools in existence, the literature, tools used in undergraduate student training and via personal communication with experts in the field. Tools were mapped against each other and an item pool developed. Items were arranged in alignment with events in a routine dietetic consultation. Descriptors for each item were developed. Content validity was assessed by sending the resulting tool to an expert trainer for comment and revised. It was then sent to 31 dietitians with experience either with research in this area, facilitation of training courses for communication skills in dietetic consultations or assessment of students in practice. These people had relevant experience and may use such a tool but were independent from the research team. A questionnaire, descriptors and a DVD of a consultation were provided. Predictive validity was assessed by recruiting participants via five established post-registration communication skills training courses for dietitians. Information sheets were given and written consent was obtained. Participants completed a video recorded patient consultation before and after attending the course. Video recordings were assessed using the tool. Numerical results were inputted into SPSS for Windows, version 15 (SPSS Inc., Chicago, IL, USA) and paired t-tests were undertaken. Ethical approval was acquired from the University of Nottingham Medical School Ethics Committee. Results: Seventeen dietitians returned questionnaires commenting on the content validity of the tool. Fourteen considered that the tool included all of the key aspects of a dietetic consultation and 15 considered it had uses within dietetic practice. Changes required were minor wording changes to the tool and descriptors and a change in order of the items. Nine dietitians were assessed using the tool before and after a training course to look for predictive validity. A significant improvement in dietitians’ ability to listen to and demonstrate understanding of the client's story was found (P = 0.004) and also to summarise appropriately throughout the consultation (P = 0.04), although overall scores showed no significant change. Discussion: Preliminary results indicate that the assessment tool has content validity and may have some uses in future research into the role of communication skills in dietetic consultations. There was some evidence that the tool could predict changes in skill level following training in communication skills. Conclusions: An assessment tool for communication skills in dietetic consultations has been developed but work is required to further investigate validity and reliability of the tool.

Systematic development of a communication skills training course for physicians performing work disability assessments: from evidence to practice

BackgroundPhysicians require specific communication skills, because the face-to-face contact with their patients is an important source of information. Although physicians who perform work disability assessments attend some communication-related training courses during their professional education, no specialised and evidence-based communication skills training course is available for them. Therefore, the objectives of this study were: 1) to systematically develop a training course aimed at improving the communication skills of physicians during work disability assessment interviews with disability claimants, and 2) to plan an evaluation of the training course.MethodsA physician-tailored communication skills training course was developed, according to the six steps of the Intervention Mapping protocol. Data were collected from questionnaire studies among physicians and claimants, a focus group study among physicians, a systematic review of the literature, and meetings with various experts. Determinants and performance objectives were formulated. A concept version of the training course was discussed with several experts before the final training course programme was established. The evaluation plan was developed by consulting experts, social insurance physicians, researchers, and policy-makers, and discussing with them the options for evaluation.ResultsA two-day post-graduate communication skills training course was developed, aimed at improving professional communication during work disability assessment interviews. Special focus was on active teaching strategies, such as practising the skills in role-play. An adoption and implementation plan was formulated, in which the infrastructure of the educational department of the institute that employs the physicians was utilised. Improvement in the skills and knowledge of the physicians who will participate in the training course will be evaluated in a randomised controlled trial.ConclusionsThe feasibility and practical relevance of the communication skills training course that was developed seem promising. Such a course may be relevant for physicians in many countries who perform work disability assessments. The development of the first training course of this type represents an important advancement in this field.

Evaluation of a presentation skills course for pharmacists

AbstractAs the role of the pharmacist develops, expands and changes, it is crucial that those involved in the provision of education and training programmes address areas of current need. One such area is that of delivering presentations to groups, since this is a task which pharmacists are increasingly expected to perform. This paper describes a communication skills training (CST) course for pharmacists, targeting on the area of presentation skills. Starting with a brief overview of the content of the course, where five specific presentation strategies are elaborated, the article goes on to describe the key instructional techniques used. Programme evaluation was through analysis of a post-course questionnaire designed to assess the perceived effects of the training on participants. Against the stated criteria the course achieved an overall 85 per cent score. Strategies for introducing, structuring and concluding a presentation, and for defining new terms scored highest in terms of skill use outcome whereas techniques for engaging audience participation obtained the lowest scores. The implications of these results are discussed, together with recommendations as to how this type of training can be optimised.

Evaluating a nursing communication skills training course: The relationships between self-rated ability, satisfaction, and actual performance

Effective communication is a vital component of nursing care, however, nurses often lack the skills to communicate with patients, carers and other health care professionals. Communication skills training programs are frequently used to develop these skills. However, there is a paucity of data on how best to evaluate such courses. The aim of the current study was to evaluate the relationship between student self rating of their own ability and their satisfaction with a nurse training course as compared with an objective measure of communication skills. 209 first year nursing students completed a communication skills program. Both qualitative and quantitative data were collected and associations between measures were investigated. Paired samples t-tests showed significant improvement in self-rated ability over the course of the program. Students generally were very satisfied with the course which was reflected in both qualitative and quantitative measures. However, neither self-rated ability nor satisfaction was significantly correlated with the objective measure of performance, but self-rated ability and satisfaction were highly correlated with one another. The importance of these findings is discussed and implications for nurse education are proposed.

Use of the OSCE to Evaluate Brief Communication Skills Training for Dental Students

Although communications competency is recommended by the American Dental Education Association, only a few (n=5) dental schools report evaluating students' skills using a competency examination for communication. This study used an objective structured clinical examination (OSCE) to evaluate dental students' competency in interpersonal and tobacco cessation communication skills. All students were evaluated on their interpersonal communication skills at baseline and at six months post-OSCE by standardized patients and on their tobacco cessation communication skills by two independent raters. First- and second-year dental students (n=104) were randomized to a control or intervention group. One month after the baseline OSCE, students in the intervention group participated in a two-hour training session in which faculty members communicated with a standardized patient during a head and neck examination and counseled the patient about tobacco cessation. There were no statistically significant differences from baseline to post-test between the intervention and control group students as measured by the OSCE. However, among first-year students, both the intervention (n=23) and control (n=21) groups significantly increased in tobacco cessation communication scores. Second-year students in both intervention (n=24) and control (n=28) groups declined in interpersonal communication skills from baseline to post-test. Overall, this one-shot intervention was not successful, and results suggest that a comprehensive communication skills training course may be more beneficial than a single, brief training session for improving dental students' communication skills.

Development, Teaching, and Evaluation of a Consultation Structure Model for Use in Veterinary Education

Introduction It is now widely accepted that veterinary graduates should enter their profession with high-quality communication skills. Until recently, however, this has not been reflected in undergraduate training. Recently, the Veterinary Faculty at the University of Liverpool, in collaboration with the profession's indemnity insurers (the Veterinary Defence Society), has developed one of the first specific communication skills training courses for veterinary undergraduates. For the first three years it has been run, the aim of this course has been to increase students’ awareness of the importance of good communication in the veterinary profession. The course is based on best practice as currently defined in medical education, making extensive use of actors as simulated clients. As well as watching acted-out consultations, the students also role-play scenarios designed to expose them to all aspects of the veterinary consultation (including introductions, history taking, breaking bad news, fee issues, and dealing with anger). Feedback on the role plays is facilitated by members of stbio. Evaluation of the first year of this course has been published and has shown it achieves its aims of increasing the students’ awareness of the importance of good communication with their clients.1 However, regular facilitators became aware that the students’ learning experience was very variable and, perhaps more importantly, could not be defined. This was felt to be a critical limitation to further development of the course, particularly in the area of student learning and assessment. It was recognized that one of the major obstacles to further development was the lack of a teaching model suitable for the veterinary consultation. Such models are routinely used in medical education. However, their direct application to veterinary education is limited because they do not reflect the diversity of clients with whom the veterinarian/veterinary surgeon communicates (e.g., farmers, companion animal owners), nor do they take into account the two important, and often difficult, areas of euthanasia and finances. The aim of this project was to develop a consultation model for veterinary education based on the Calgary-Cambridge model of the medical consultation. The model was adapted, recognizing both the considerable overlap and also the likely differences between the veterinary and medical consultations. Subsequently, this model has been used to train communication skills facilitators and undergraduates. Here we present the model and provide results of evaluation of its use within the communication skills program for veterinary undergraduates at the University of Liverpool.

Communication training for health professionals who care for patients with cancer: a systematic review of effectiveness.

Effective communication is increasingly recognised as a core clinical skill. However, there is evidence that health and social care professionals still lack basic communication skills. To assess the effectiveness of different communication skills training courses for health professionals in cancer care. We searched six computerised databases and augmented this with a follow-up of references and grey (unpublished) literature. We included all studies evaluating communication training and assessed methodological quality according to the standard grading system of the Clinical Outcomes Group. Data on author, year, setting, objectives, study design and results were extracted and compared in tabular format. A total of 47 studies potentially assessing communication training in the area of cancer care were identified. Sixteen papers were included describing 13 interventions. Four were randomised controlled trials (RCTs) (grade I), with samples ranging from 72 to 233 subjects. The others were all grade III. Eleven interventions trained health professionals, two trained medical students. The outcomes measured included communication skills as assessed on audio or video, professionals' self-report and patient assessment. All the interventions demonstrated modest improvements (effect sizes ranged 0.15-2) and one found deterioration in the outcomes measured. Communication training improves basic communication skills. Positive attitudes and beliefs are needed to maintain skills over time in clinical practice and to effectively handle emotional situations.

Long term benefits of communication skills training for cancer doctors

To assess satisfaction and learning accomplishments after communication skills training courses for cancer doctors in the Nordic countries. 155 physicians from the five Nordic countries participated in a communication skills training course. Questionnaires were completed at baseline, at course completion and at follow-up after 2 to 6 years. 94% of the physicians indicated satisfaction with the course. Physicians who had participated in the whole course (as opposed to those who had participated only in parts of the course) and physicians from Denmark and Sweden were most satisfied with the course. Whereas physicians at baseline most frequently reported a need to learn specific aspects of communication, often with emphasis on psychiatric problems, at follow-up they most typically reported that they had learnt basic communication skills (i.e. to listen and to pose open-ended questions). The majority of the physicians reported at follow-up that they applied the learnt skills to patient-related work, in relation to colleagues and on a personal level. Communication skills courses for senior clinicians with no previous formal training in this field should emphasise basic communication skills as well as the handling of difficult situations in doctor-patient interaction.

Description and evaluation of an education and communication skills training course in HIV and AIDS for dental consultants.

A 2-day course was organised for dental hospital consultants as part of a project on raising awareness of dental staff about HIV and AIDS. The course comprised an information update, practical experience in the diagnosis of oral conditions and a "hands-on" exercise in infection control. The 2nd day of the course consisted of experiential communication skills training using rôle-play with actors and video feedback. Evaluation of the course showed that the consultants perceived the course to be valuable. There was a general improvement in dentists' confidence in their knowledge, ability to communicate with HIV-positive patients and in talking to staff who are unwilling to provide treatment. These changes are statistically significant and these skills are still being utilized and maintained 2 years later. Information and training packs prepared by multidisciplinary groups using a variety of teaching methods should be made available to those involved in training dental staff.

Teaching senior oncologists communication skills: results from phase I of a comprehensive longitudinal program in the United Kingdom.

To determine the communication difficulties experienced by clinicians in cancer medicine and to develop, implement, and evaluate communication skills training courses. One hundred seventy-eight senior clinicians attended 1 1/2- or 3-day residential courses designed to enhance skills development, knowledge acquisition, and personal awareness. Course content included structured feedback, video review of interviews, interactive group demonstrations, and discussion in groups of four led by trained facilitators. The main outcomes were self-rated confidence in key aspects of communication, attitudinal shift toward more patient-centered interviewing, perceived changes in personal practice, and initiation of teaching programs for junior staff. Less than 35% of the participants had received any previous communications training. Time, experience, and seniority had not improved skills; before the course, oncologists expressed difficulty with 998 different communication issues. Primary problems concerned giving complex information, obtaining informed consent, and handling ethnic and cultural differences. Confidence ratings for key communication areas were significantly improved postcourse (P < .01). Three months postcourse, 95% of the physicians reported significant changes in their practice of medicine. Seventy-five percent had started new teaching initiatives in communication for junior clinicians. Clinicians showed positive shifts in attitude toward patients' psychosocial needs (P=.0002) and were more patient centered (P=.03). The courses were highly rated and 97% would "definitely" recommend them to colleagues. Oncologists are hampered by inadequate communication skills training and will give up time to correct this. Subjective improvements reported immediately postcourse were maintained at 3 months. Resources for educational initiatives are needed to help both patients and their physicians.

Communication skills training courses in dental education.

In this article, some reasons for teaching communication skills in dental schools are discussed. An overview of 3 courses at the Amsterdam dental school is presented, along with the results of a student evaluation. Students evaluated these courses as useful and relevant for dental practice. It is concluded that this is especially so when the students recognize direct applicability of the courses to dental practice.

Steps towards an integration of basic therapeutic skills: a qualitative study of the development of the ideas of 15 social work students about being helpful to clients

Social work students (n=39) were shown 10 videotaped client situations prior to and after participating in a communication skills training course. At both times, they were asked to write proposals for helpful answers for each of these situations. Proposals made by a sample of 15 students were analyzed with regard to patterns in their answers before and after the training course. These 15 were selected by using quantitative data identifying those students who changed their level of communicated empathy during the training course and those who did not. The communication course is described. Patterns in the proposals are examined and discussed in relation to central concepts of helping; such as acknowledging, empathic communication and working alliance. Three steps in the development of skillfulness are described and suggested as more general steps in the acquisition of therapeutic competence. The validity and reliability of the study are discussed, as well as possible implications of the findings for social work education.

Communication skills training early in the medical curriculum: The UAE experience

The aim of the current study was to investigate the effectiveness of a five-day communication skills training course held during the second year of a six-year medical program. The 26 students (10 male, 16 female) who completed the 1994 course were videotaped interviewing matched simulated patients before and after training. Communication experts blindly rated the film segments in terms of global performance and six specified component interview skills using a 10-point scale (0 ‘skill not used’, 1 ‘poor’, 5 ‘pass’ [skill acceptable for a graduate doctor], 9 ‘excellent’). All facets were significantly improved after training (t, p < 0.05). Judges were more often concordant (rs, p < 0.05) when rating pre-training pegormances. Ability to establish rapport was the best predictor of skill in other components. Neither pre-training pegormance, English grade nor overall academic performance for the year was predictive of post-training performance.

Influencing and persuading skills at the interprofessional interface: Training for action

At the practitioner-practitioner interface, the concepts of teamwork and interprofessional collaboration are of increasing importance. This emphasis has incumbent demands and challenges, not least of which is the necessity to negotiate one’s own needs, roles, and responsibilities within the context of optimal patient care. Being able to influence others and persuade them to accept one’s point of view will thus be at the heart of effective interprofessional communication. Against this background, this paper presents a description of a communication skills training (CST) course for pharmacists targeting the area of influencing and persuading skills. Starting with a brief overview of the content of the course, where nine specific influencing strategies are elaborated, the article goes on to describe the key instructional techniques used, incorporating both pedagogic and andragogic models of education. Program evaluation is reported through analysis of a postcourse questionnaire designed to assess the perceived effects of the training on participants. Against the stated criteria, the course achieved an overall 86% score. Use of the relationship and logical argument strategies scored highest in terms of skill use outcome, matched by the ability to recognize influence attempts made by others. Conversely, the negative influencing techniques of threat/fear and aversive stimulation scored lowest. The implications of these results are discussed together with the advantages and disadvantages of experiential training, with recommendations made as to how this type of training can be optimized.

Improving Physicians' Interviewing Skills and Reducing Patients' Emotional Distress

Despite high prevalence, emotional distress among primary care patients often goes unrecognized during routine medical encounters. To explore the effect of communication-skills training on the process and outcome of care associated with patients' emotional distress. A randomized, controlled field trial was conducted with 69 primary care physicians and 648 of their patients. Physicians were randomized to a no-training control group or one of two communication-skills training courses designed to help physicians address patients' emotional distress. The two training courses addressed communication through problem-defining skills or emotion-handling skills. All office visits of study physicians were audiotaped until five emotionally distressed and five nondistressed patients were enrolled based on patient response to the General Health Questionnaire. Physicians were also audiotaped interviewing a simulated patient to evaluate clinical proficiency. Telephone monitoring of distressed patients for utilization of medical services and General Health Questionnaire scores was conducted 2 weeks, 3 months, and 6 months after their audiotaped office visits. Audiotape analysis of actual and simulated patients showed that trained physicians used significantly more problem-defining and emotion-handling skills than did untrained physicians, without increasing the length of the visit. Trained physicians also reported more psychosocial problems, engaged in more strategies for managing emotional problems with actual patients, and scored higher in clinical proficiency with simulated patients. Patients of trained physicians reported reduction in emotional distress for as long as 6 months. Important changes in physicians' communication skills were evident after an 8-hour program. The training improved the process and outcome of care without lengthening the visits.

Communication Skills Training and Patients' Satisfaction

Effective physician-patient encounters require the doctor to have consulting skills that facilitate communication flow. When adequate communication does not occur, patients express dissatisfaction with their medical interactions. Many medical students show interview behaviors that may not contribute to patients' satisfaction. Poor communication skills reduce the reliability of elicited medical information and lead to reduced satisfaction for both patients and students. In the present study, a communication skills training course was evaluated using ratings of students' videotaped history-taking interviews with patients and patients' satisfaction ratings. Trained students showed significantly improved consultation skills and techniques compared with a group of control students who displayed few changes in behavior over the course of the study. Satisfaction ratings given by patients of students improved significantly after training, whereas ratings given by patients of control group students decreased over the same period.

Effectiveness of a Communication Skills Training Course in Continuing Pharmaceutical Education in Northern Ireland: A Longitudinal Study

Effectiveness of a Communication Skills Training Course in Continuing Pharmaceutical Education in Northern Ireland: A Longitudinal Study

Communication as a Focus in the Continuing Education of Pharmacists

This paper describes some of the problems of pharmaceutical continuing education, and examines the needs of pharmacists in relation to on-going education and training. Communication skills training is identified as a specific need to be addressed in both undergraduate and postgraduate programmes. Among the reasons for this are, the evolution of the clinical pharmacy movement, profession review, the legitimate claims of the behavioural sciences for inclusion in pharmacy curricula, and the findings of research into Patient-practitioner communication. To address the interpersonal dimension of pharmacy practice, 4 communication skills training course has been introduced in Northern Ireland as part of a systematic continuing education programme for community and hospital pharmacists. The nature, content and function of this course is described, and the importance of such education and training analysed in the context of the changing roles of both hospital and community pharmacist practitioners. Recommendations are also made as to how this form of training can be utilised to develop interpersonal skills in other professional groups. In particular, attention is drawn to the need for learner participation at all stages of course design and implementation, the involvement of an applied psychologist, and the use of time and video resources. Furthermore, the advantages of this training method in terms of its adaptability, flexibility, convenience and practitioner and practice focus, are highlighted, allied to its applicability to professions other than pharmacy.