Communication Skills Training Program Research Articles

The experiences of Chinese general practitioners in communicating with people with type 2 diabetes\u2014a focus group study

BackgroundChina has more ascertained cases of diabetes than any other country. Much of the care of people with type 2 diabetes (T2DM) in China is managed by GPs and this will increase with the implementation of health care reforms aimed at strengthening China’s primary health care system. Diabetes care requires effective communication between physicians and patients, yet little is known about this area in China. We aimed to explore the experiences of Chinese GPs in communicating with diabetes patients and how this may relate to communication skills training.MethodsFocus groups with Chinese GPs were undertaken. Purposive sampling was used to recruit 15 GPs from Guangzhou city in China. All data were audio-recorded and transcribed. A thematic analysis using the Framework Method was applied to code the data and identify themes.ResultsSeven males and 8 females from 12 general practices attended 4 focus groups with a mean age of 37.6 years and 7.5 years’ work experience. Four major themes were identified: diversity in diabetic patients, communication with patients, patient-doctor relationship, and communication skills training. GPs reported facing a wide variety of diabetes patients in their daily practice. They believed insufficient knowledge and misunderstanding of diabetes was common among patients. They highlighted several challenges in communicating with diabetes patients, such as insufficient consultation time, poor communication regarding blood glucose monitoring and misunderstanding the risk of complications. They used terms such as “blind spot” or “not on the same channel” to describe gaps in their patients’ understanding of diabetes and its management, and cited this as a cause of ineffective patient-doctor communication. Mutual understanding of diabetes was perceived to be an important factor towards building positive patient-doctor relationships. Although GPs believed communication skills training was necessary, they reported rarely received this.ConclusionsChinese GPs reported facing challenges in communicating with diabetes patients. Some of these were perceived as being due to the patients themselves, others were attributed to system constraints, and some were seen as related to a lack of clinician training. The study identified key issues for the development of primary care-based management of diabetes in China, and for developing appropriate communication skills training programs for the primary care workforce.

Co-creation and collaboration: A promising approach towards successful implementation. Experience from an integrated communication and mental health skills training programme for Japanese General Practice

IntroductionThis paper describes the co-creation and delivery of an integrated training programme in communication and depression assessment & management for Japanese GPs. MethodsExperts in communication and depression from EACH and WONCA developed a framework and filled it with content. Through iterative discussions with the Japanese participants and experts during delivery, the training was further adjusted to match local needs. It included didactic and experiential training methods with an emphasis on practicing and feedback. A “train-the-trainer” component helped participants develop their own trainer skills to enhance dissemination of the training in Japan. ResultsSix Japanese GPs participated in two one week training-modules in May and November 2018. To aid implementation participants received online supervision on depression management and on teaching between the two modules and after the second module. Evaluation of the content of the training, the teaching methods and the participatory approach was positive. More than two years after the training, many elements of the training continue to be used in daily practice with the GPs teaching communication as well as depression management skills. ConclusionThe method of co-creation is promising. Research is needed to confirm that it is effective in transfer to clinical practice.

Health care providers' knowledge, confidence, difficulties, and practices after completing a communication skills training program for advance care planning discussion in Japan.

Advance care planning (ACP) is an important factor that affects the quality of end-of-life. However, health care providers are not able to sufficiently support patients' ACP due to their lack of knowledge and psychological burden. This study investigated how the knowledge, attitudes, and practices of health care providers who completed a communication skills training (CST) program for ACP discussion changed before and after the course. Health care providers who participated in the Education for Implementing End of Life Discussion (E-FIELD) CST training program in Japan were surveyed at three time points: before, immediately after, and 6 months after training. The number of participants who completed all three surveys was 306. Knowledge, confidence, communication difficulties, number of discussions and completions of ACP were measured using a questionnaire. Participants' knowledge and confidence increased right after training compared with before training. The number of ACP discussions and completions increased significantly 6 months after training compared with before training and difficulties tended to decrease. Physicians maintained their confidence, which increased immediately after training until 6 months after training and their number of ACP discussions and completions also increased significantly 6 months after training compared with before training. The CST program for ACP, E-FIELD, has the potential to increase the knowledge, confidence, and number of ACP discussions and completions used by physicians, nurses, and social workers, and also lower their difficulties.

Individualized coaching in health system-wide provider communication training

ObjectivesMost practicing health professionals lack communication skills training (CST). Increasingly health care systems have implemented CST programs, mainly through single workshops which are limited in creating meaningful change in communication behaviors in practice. This paper describes a provider CST program which includes coaching to reinforce skills learned in CST workshops. MethodIn 2017, a pilot CST workshop was implemented in a large Midwestern US health system. In 2018, a modified program was launched for all physicians, physician assistants and advanced practice nurses and included in-person clinical coaching for each provider 30- and 60-days post-workshop. Evaluation measures included pre and post-program aggregate patient satisfaction scores and coaching evaluation surveys. Results248 providers completed the workshop plus coaching program between October 2018 – March 2020. Aggregated patient satisfaction Top Box ratings increased from 73.9% to 75.1% following the pilot and to 79.5% following workshop plus coaching. Participants rated coaching positively and reported more confidence in using the workshop skills in clinical practice. ConclusionOur data show that coaching can help facilitate and reinforce skills learned in CST workshops and can lead to improvements in patient satisfaction scores. Practical implicationsIncorporating coaching as part of CST can help facilitate meaningful skills transfer.

Oncologists' experience with discussing cancer prognosis with patients and families: perspectives from India.

Nondisclosure of prognosis of advanced cancer is commonly practiced in some Asian cultures including India; but research is limited. To describe experiences of Indian oncologists in discussing cancer prognosis with people with cancer and their caregivers, with a focus on barriers and facilitators of prognostic discussions. Thirty oncologists practicing in South India, Hyderabad participated in semi-structured interviews; and analyzed using Interpretative Phenomenological Analysis. Barriers included system-level, patient-level, and physician-level challenges as obstructions to open and honest interactions around cancer prognosis. Most of the barriers focused on communication-related challenges. Lack of communication skills training for providers coupled with over-reliance on use of euphemisms, hesitation in communicating with "weak" patient, and struggles to establish healthcare proxy described communication-related barriers. The study also described factors including family involvement in cancer care and empathic communication as facilitators of honest and open communication about prognosis. In particular, rapport building and getting to know the patient, use of empathic communication, engaging in gradual and individualized disclosure, and balancing hope with honesty were communication-related facilitators that aid open communication with patients with cancer and their caregivers about prognosis and plan of care. Results provide implications for development of communication skills trainings for oncology physicians in India. Adapting, delivering, and evaluating existing communication skills training programs, particularly around discussions of prognosis and goals of care is a requisite step for providing patient-centered and supportive care to patients with cancer and their caregiving families.

Effectiveness of Communication Skills Training Program in Developing Some Visual Perception and Writing Readiness Skills for Kindergarten Children

ABSTRACT The aim of the paper is to explore the effectiveness of Communication Skills Training Program in Developing Some Visual Perception and Writing Readiness Skills for Kindergarten Children. A semi-experimental, pre-post-test for the two groups (experimental and control) was employed. Participants were 30 children. They aged between 5 and 5.7 years (M=5.3 years, SD=0.984). Two groups were constructed with equal number of children for each (experimental = 15 children, of which 9 were girls, while 6 were boys, and control = 15 children, of which 10 were girls, while 5 were boys). A program was applied to the experimental group (12 sessions; 3 sessions per week; each session lasts for 20-25 minutes, total period or application = 4 weeks, that is a month). Results advocate the effectiveness of the employed raining program.

The effect of Humanitude care methodology on improving empathy: a six-year longitudinal study of medical students in Japan

BackgroundEmpathy, which involves understanding another person’s experiences and concerns, is an important component for developing physicians’ overall competence. This longitudinal study was designed to test the hypothesis that medical students’ empathy can be enhanced and sustained by Humanitude Care Methodology, which focuses on perception, emotion and speech.MethodsThis six-year longitudinal observational study examined 115 students who entered Okayama University Medical School in 2013. The study participants were exposed to two empathy-enhancing programs: (1) a communication skills training program (involving medical interviews) and (2) a Humanitude training program aimed at enhancing their empathy. They completed the Jefferson Scale of Empathy (JSE) seven times: when they entered medical school, before participation in the first program (medical interview), immediately after the first program, before the second program (Humanitude exercise), immediately after the second program, and in the 5th and 6th year (last year) of medical school. A total of 79 students (69% of the cohort) completed all seven test administrations of the JSE.ResultsThe mean JSE scores improved significantly after participation in the medical interview program (p < 0.01) and the Humanitude training program (p = 0.001). However, neither program showed a sustained effect.ConclusionsThe Humanitude training program as well as medical interview training program, had significant short-term positive effects for improving empathy among medical students. Additional reinforcements may be necessary for a long-term sustained effect.

The Weight of Words: A Mixed Methods Study to Understand Indian Doctors’ Perspectives and Experiences of Patient Communication

Background: Effective doctor communication can lead to increased treatment adherence and improved self-management among individuals living with diabetes. Yet, there is limited research in India which examines how doctors communicate, especially in terms of verbal and nonverbal communication. Aims: (1) To examine communication in clinic (verbal, nonverbal and basic content) among Indian doctors specialized in diabetes and endocrine care, and (2) to explore doctors’ styles of verbal and nonverbal communication. Methods: Using a mixed methods design, a survey containing quantitative (n=834) and qualitative (n=648) elements was filled out by doctors specialized in the fields of diabetes and endocrinology in India. Questions in the quantitative section included questions such as addressing patients’ illness-related concerns, acknowledging challenges of using insulin, and non-verbal behaviours. The qualitative section focussed on elaborating some responses made to the quantitative section, such as questions about explaining the cause of illness, listing words and phrases that may potentially impact patients, and explaining why the patients need to be initiated on insulin. The data was analysed using descriptive statistics and qualitative content analysis, respectively. Results: The findings of the quantitative study showed that the majority of the doctors (i) always greeted their patient as they entered the room (43.2%), (ii) addressed the risk of developing diabetes with patients’ siblings/children (87.9%), (iii) always acknowledged the challenges of using insulin (42.8%), and (iv) never asked patients’ experiences at the end of the consultation (31.9%). All common communication cues were rated as extremely important; eye contact (48.7%), tone of voice (41.5%), body language (39.6%), and words and phrases (41.8%). The qualitative findings revealed that doctors preferred to use verbal communication such as using authoritative language, educating patients using facts, analogies and behavioural information, employing empathetic language on occasion. Doctors also reported using negative words that portrayed fear, blame and disengagement in order to promote adherence. Discussion and Conclusion: The findings suggest that doctors rely on verbal rather than nonverbal communication when interacting with patients, with fear messages being a favoured means of ensuring adherence. It is possible that this may be because, while recognizing the value of nonverbal methods, doctors lack training in using these techniques in communication. Therefore, developing a communication skill training program for Indian doctors focussed on empathic and nonverbal communication can help to improve consultation and patient outcomes (e.g., adherence, patient satisfaction).

COMSKIL: a communication skills training program for medical students.

Objectives: Training communication skills has come to be recognized as a vital aspect of medical school education. A medical communication course based on the COMSKIL Communication Skills Training (CST) Program was developed, integrated into the core curriculum, and evaluated at the Leipzig University Medical School. Methods: Between October 2016 and July 2017, 312 medical students (mean age 21.80 years; 62% male) participated in the medical communication course. Each course unit was evaluated via questionnaires specifically designed to address the theoretical and practical content of the curriculum. The items correspond to the material covered in each course unit. Students responded using a 5-point-Likert scale (1=“not at all helpful”, 5=“extremely helpful”) to rate the degree to which the course helped them learn about the subject matter and train the skills covered in the curriculum. Results: The average score for the first part of the course (theoretical foundations) was M=3.69 (SD=0.35). The second part received a similar rating (M=3.84; SD=0.73). The role play exercises with actor-patients received a score of M=4.27 (SD=0.62). In an overall evaluation at the end of the course, students rated the administration of the course (setting, etc), knowledge gained, and skills trained with a score of M=4.11 (SD=0.66). The role play exercises received an overall score of M=4.36 (SD=0.61). Conclusion: A new curriculum for teaching medical students patient-physician communication skills based on the COMSKIL CST program was established at the University of Leipzig. The goal of this course is to teach students about the kinds of communication scenarios they will encounter in their future working lives as care providers and equip them with the fundamental communication techniques and skills they need to successfully handle those situations. A formal evaluation of the program resulted in satisfactory findings, indicating that it is well suited for use in medical universities.

Communication Skills Training Program and its Effect on Head Nurses' Assertiveness and Self-Esteem

Communication Skills Training Program and its Effect on Head Nurses' Assertiveness and Self-Esteem

Effect of Infertility Clinic Nurse Communication Skills Training on Women Satisfaction

Background: Effective communications skills are necessary in each area of life, but of particular importance in the field of nursing. Communication is the process of transmitting thoughts, feelings, and facts It is an essential element of the nurse-patient relationship. Nurses are core in strengthening the health system through effective communication with women which affects their level satisfaction. Aim: to evaluate the effect of infertility clinic nurse communication skills training on women satisfaction. Methods: Research Design: quasi experimental design (pre-post training). Setting: Private infertility center (Elbasma center). Sample: A purposive sample of all nurses working in the previously mentioned center; 20 nurses evaluated by 200 women were recruited for the study. Instruments: Four instruments were used for data collection a) Two interviewing questionnaires b) Communication skills assessment instrument c) Satisfaction assessment instrument. Results: This study revealed that there was a high significant difference at nurses communication skills and women satisfaction scores pre and post the training program. Conclusion: Communication skills training program had high significant effect on improving total communication skills of nurses and women satisfaction scores. Recommendations: On- going education for infertility clinic nurses regarding communication skills and its positive effect on women satisfaction and replication of the study with large sample size to further settings.

ПРЕДСТАВЛЕНИЯ ОРДИНАТОРОВ О КОММУНИКАТИВНЫХ НАВЫКАХ ВРАЧА

Purpose: to describe the residents’ views about the communication skills of a doctor. Research question: What are the residents' perceptions of physician communication skills from the perspective of the Calgary-Cambridge Model of Medical Consultation? Methods: Qualitative Research. The data collection method was a focus group discussion. The study used qualitative-quantitative deductive content analysis and used OpenCode 4.02 to encode and categorize text units. Analytical triangulation served as a data validation strategy. Results: The study found that residents had an idea of the communication skills required by a doctor at all stages of a medical consultation using the Calgary-Cambridge model. Informants are most knowledgeable about the skills in the "start consultation", "examination" and "explain and planning" phases. Residents' knowledge of the communication skills required by the doctor at the “information gathering” and “consultation completion” stages is virtually non-existent. Practical relevance: the research results can be used in the design of communication skills training programs in a medical university.

Assessing communication skills during OSCE: need for integrated psychometric approaches

BackgroundPhysicians’ communication skills (CS) are known to significantly affect the quality of health care. Communication skills training programs are part of most undergraduate medical curricula and are usually assessed in Objective Structured Clinical Examinations (OSCE) throughout the curriculum. The adoption of reliable measurement instruments is thus essential to evaluate such skills.MethodsUsing Exploratory Factor Analysis (EFA), Multi-Group Confirmatory Factor Analysis (MGCFA) and Item Response Theory analysis (IRT) the current retrospective study tested the factorial validity and reliability of a four-item global rating scale developed by Hodges and McIlroy to measure CS among 296 third- and fourth-year medical students at the Faculty of Medicine in Geneva, Switzerland, during OSCEs.ResultsEFA results at each station showed good reliability scores. However, measurement invariance assessments through MGCFA across different stations (i.e., same students undergoing six or three stations) and across different groups of stations (i.e., different students undergoing groups of six or three stations) were not satisfactory, failing to meet the minimum requirements to establish measurement invariance and thus possibly affecting reliable comparisons between students’ communication scores across stations. IRT revealed that the four communication items provided overlapping information focusing especially on high levels of the communication spectrum.ConclusionsUsing this four-item set in its current form it may be difficult to adequately differentiate between students who are poor in CS from those who perform better. Future directions in best-practices to assess CS among medical students in the context of OSCE may thus focus on (1) training examiners so to obtain scores that are more coherent across stations; and (2) evaluating items in terms of their ability to cover a wider spectrum of medical students’ CS. In this respect, IRT can prove to be very useful for the continuous evaluation of CS measurement instruments in performance-based assessments.

The effectiveness of a person-centred communication skills training programme for the health care professionals of a large hospital in Denmark

ObjectiveAs a part of an evaluation of a large-scale communication skills training (CST) programme, this study aimed to investigate the effect on health care professionals’ (HCPs) self-efficacy (SE) and perceived importance (PI) of the skills taught. MethodsA pre-post intervention design was used, and 1647 HCPs responded to the SE-12 questionnaire. Changes in self-efficacy were examined at an item and scale level. ResultsThe responses of 74% of the HCPs who replied to at least two of the three questionnaires were analysed. A significant increase in the SE-12 scale scores by 12.45 points between Q1 (baseline) and Q2 (immediately after the intervention) across all professions was found. There was a small albeit statistically significant decrease in the SE-12 scale scores by 2.06 points between Q2 and Q3 (24 weeks after the intervention). ConclusionThe implementation of the CST course significantly improved the self-efficacy of HCPs. The findings were supported by an increase in the number of HCPs who considered the skills that they had acquired to be very important. Practice implicationsThe findings suggest that the large-scale implementation of evidence-based CST programmes can yield the same outcomes that have been observed in smaller and better controlled studies.

Development and preliminary evaluation of a communication skills training programme for hospital physicians by a specialized palliative care service: the \u2018Teach to Talk\u2019 programme

BackgroundThere is widespread agreement about the importance of communication skills training (CST) for healthcare professionals caring for cancer patients. Communication can be effectively learned and improved through specific CST. Existing CSTs have some limitations with regard to transferring the learning to the workplace. The aim of the study is developing, piloting, and preliminarily assessing a CST programme for hospital physicians caring for advanced cancer patients to improve communication competences.MethodsThis is a Phase 0-I study that follows the Medical Research Council framework; this paper describes the following sections: a literature review on CST, the development of the Teach to Talk training programme (TtT), the development of a procedure for assessing the quality of the implementation process and assessing the feasibility of the implementation process, and the pilot programme. The study was performed at a 900-bed public hospital. The programme was implemented by the Specialized Palliative Care Service. The programme was proposed to 19 physicians from 2 departments.ResultsThe different components of the training course were identified, and a set of quality indicators was developed. The TtT programme was implemented; all the physicians attended the lesson, videos, and role-playing sessions. Only 25% of the physicians participated in the bedside training. It was more challenging to involve Haematology physicians in the programme.ConclusionsThe programme was completed as established for one of the two departments in which it was piloted. Thus, in spite of the good feedback from the trainees, a re-piloting of a different training program will be developed, considering in particular the bed side component.The program should be tailored on specific communication attitude and believes, probably different between different specialties.

Can an online clinical communication course impact learner behaviour?

Background: Effective communication between doctors and patients leads to better compliance, health outcomes and higher doctor and patient satisfaction. Although in-person communication skills training programs are effective, they require high resource utilisation and may provide variable learner experiences due to challenges in standardisation. Objective: This study aimed to develop and implement an evidence-based, self-directed and interactive online communication skills training course to determine if the course would improve learner application of communication skills in real clinical encounters. Methods: The course design utilised the Kalamazoo Consensus framework and included videos based on common paediatric clinical scenarios. Final year medical students in academic year 2017/2018 undergoing a two-week paediatric clerkship were divided into two groups. Both groups received standard clerkship educational experiences, but only the intervention group (88 out of 146 total students) was enrolled into the course. Caregiver/patient feedback based on students’ clinical communication was obtained, together with pre- and post-video scenario self-reported confidence levels and course feedback. Results: There were minimal differences in patient feedback between intervention and control groups, but the control group was more likely to confirm caregivers’/patients’ agreement with management plans and provide a summary. However, caregivers/patients tended to feel more comfortable with the intervention compared to the control group. Median confidence levels increased post-video scenarios and learners reported gains in knowledge, attitudes and skills in paediatric-specific communication. Conclusion: Although online video-based communication courses are useful standardisation teaching tools, complementation with on-the-job training is essential for learners to demonstrate effective communication.

Definitions and use of the teach-back method in healthcare consultations with patients: A systematic review and thematic synthesis

ObjectiveTo review and synthesise definitions of the teach-back method in the literature. The second aim is to synthesise the barriers, facilitators and perceptions of teach-back use in healthcare consultations with patients. MethodsA systematic review and thematic synthesis following Braun and Clarke’s method. ResultsThe primary search found 1429 citations and the secondary search added 221 citations. Screening identified 66 citations eligible for data extraction. We contrasted and synthesised operational definitions of the teach-back method. The synthesis generated seven themes related to healthcare provider (HCP) and patient perceptions of teach-back (effectiveness, stigma and time-related perceptions), the universal application of teach-back, patient health outcomes and healthcare provider training. DiscussionOperational definitions of the teach-back method varied in the literature and contained implied steps. HCPs and patient perceptions of teach-back operated as both enablers and barriers to its use. HCPs training programs for the teach-back method were identified as beneficial for altering HCPs perceptions about the method and increased its use with patients. Practice implicationsStandardising operational definitions of the teach-back method can support replicability of research and enhance HCPs communication skills training programs. HCPs training on teach-back use can support the increased use of the technique with broader patient populations.

Implementation of the TeamSTEPPS Curriculum With Baccalaureate Nursing and Social Work Students Utilizing Student Trainers: A Qualitative and Quantitative Study.

Nursing and social work education programs are seeking innovative ways to prepare students to function as collaborative members of interprofessional teams upon graduation. Communication is a key linked to a decrease in medical errors, which compromise patient safety. In response to nursing students' concerns about clinical experiences in which they had witnessed poor communication with the potential to jeopardize patient care, faculty members identified a communication skills training program designed to improve team performance. Senior nursing and social work students at the beginning of their last semester of school were trained in selected modules of the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) training program and subsequently trained their student colleagues. The goal was to emphasize communication skills and strategies in a sustainable student trainer model. Qualitative and quantitative data about participant experiences revealed significant improvement in teamwork attitudes and communication skills following the training.

Evaluation of a Patient Communication Skills Training Program for Medical Physicists

To evaluate the efficacy of a training program designed to teach medical physicists how to communicate with patients effectively in the clinical environment. The training program was offered 3 times between 2016 and 2019. Participants were asked to rank their level of confidence in 5 categories relevant to patient communication on a 5-point Likert scale at 3 separate time points over the course of the training program. Participants were also asked to provide written responses to 5 common questions from patients at 2 separate time points, and these responses were numerically scored using the Constant Comparative Method. Competency in patient communication was assessed during simulated patient consults using a 9-element clinical competency assessment form. Changes in participants' stated level of confidence over the course of the training program and differences between faculty and residents were analyzed using the Student t test, and participants' scored responses to common questions were analyzed using analysis of variance. Fifteen medical physicists participated in the training program: 6 resident physicists (4 first year and 2 second year) and 9 faculty physicists. Mean participant-stated level of confidence increased significantly across all categories (P < .05) between the first and second training intervention and between the second and third training intervention. There was no significant difference in mean participant-stated level of confidence between faculty and resident medical physicists. We observed statistically significant improvements in scored responses to common patient questions between the 2 assessment time points (P < .05). Of the 15 participants, 14 met competency assessment goals during simulated patient consults. The patient communication skills training program increases medical physicists' level of confidence across 5 patient communication categories and improves their responses to common questions from patients. In addition, the program can discern differences in communication competency between physicists.

African American Communities Speak to Palliative Care Clinicians: Evaluation of an Innovative Community-Developed Communication Skills Training Program (GP726)

African American Communities Speak to Palliative Care Clinicians: Evaluation of an Innovative Community-Developed Communication Skills Training Program (GP726)