Doctor-patient Communication Skills Training Research Articles

Student review of doctor-patient communication skills training in a South African undergraduate medical programme

Background. Barriers to the training of doctor-patient communication in the South African (SA) context have been well explored through qualitative research at several SA medical schools. However, this aspect of training has not been reviewed in a systematic way by a large number of students. A student review of doctor-patient communication skills training in the undergraduate medical programme of a medical school in SA was obtained to improve training and identify further research needs.Objective. To investigate doctor-patient communication skills training in the undergraduate programme of a medical school in SA to identify shortcomings and further research needs.Methods. A descriptive, cross-sectional design was used. Data were collected through an anonymous questionnaire based on Harden’s extended vision of the curriculum. Printed anonymous questionnaires, distributed to all the fourth- and fifth-year undergraduate medical students, were analysed quantitatively. Open-ended questions were analysed qualitatively using grounded theory.Results. The sample comprised 106/132 fifth-year students (response rate 80.3%) and 65/120 fourth-year students (response rate 54.2%). Frequent training in history-taking was reported by >75% of students, while >60% reported infrequent training in breaking bad news. More than 50% of participants indicated that senior doctors seldom or never modelled patient-centred communication in the clinical teaching milieu. Students preferred experiential learning to didactic methods.Conclusion. Medical students want to see patient-centred communication unequivocally modelled in the clinical setting. A greater emphasis on practical training in context-specific communication skills is required. Positive role-modelling is needed in the clinical environment.

The use of peer role-play in doctor-patient communication skills training for medical students: A systematic review

The quality of communication is directly related to patient satisfaction and can influence health outcomes. However, most doctors still have poor communication skills. A systematic literature search in PubMed, Cochrane, and Science Direct was conducted to retrieve studies reporting the use of peer role-play (PRP) for doctor-patient communication skills training in medical students. The quality of each study was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. A total of 1,620 studies were obtained from electronic database search and screening of reference lists. After removing irrelevant studies and duplicates, one randomized control trial (RCT) and eight quasi-experimental studies were included in this systematic review. Peer role-play was perceived to be as useful as simulated patients (SP) training methods with comparable post-intervention objective structured clinical examination (OSCE) scores. Majority of students preferred PRP for learning communication skills over didactic lectures. The limitation of this review is the scarcity of eligible studies, high variability in the PRP programs across studies, and the lack of grey literature included. Peer role-play might be a cost-effective method to improve doctor-patient communication skills with comparable results (student’s perception and OSCE scores) with the expensive use of simulated patients. However, further study is needed to support this statement.

Discussion on the Necessity of Doctor-patient Communication Skills Training for Pharmaceutical Undergraduates under the New Doctor-patient Relationship

Discussion on the Necessity of Doctor-patient Communication Skills Training for Pharmaceutical Undergraduates under the New Doctor-patient Relationship

How physicians respond to negative emotions in high-risk preoperative conversations

ObjectiveTo investigate physicians’ responses to negative emotions in high-risk preoperative conversations; and to explore the influencing factors of these responses. MethodsOne hundred and sixty-two audio recordings were coded using the Chinese Verona Coding Definition of Emotional Sequences (VR-CoDES). Big Five Personality Inventory Brief Version and Emotional Intelligence Scale were administered to explore the influencing factors of physicians’ responses. SPSS 24.0 and R 3.6.3 LME4 Package were used for data analysis. ResultsReduce Space (83%), referring to physicians’ responses reducing the opportunities of patients to disclose emotions, was physicians’ most frequent response to patients or families’ emotions. The main responses were Information-advice (ERIa) and Ignoring (NRIa). Younger age, female, Agreeableness and Openness were factors positively associated with Explicit Provide Space (EP); Neuroticism was negatively correlated with EP. Extroversion was negatively correlated with Explicit Reduce Space (ER); Conscientiousness was negatively correlated with both EP and ER responses. Emotional intelligence had no significant influence on physicians’ responses. ConclusionThe majority of physicians were inclined to reduce space by providing information advice or ignoring. Physicians’ responses were correlated with their gender, age and personality traits. Practice implicationsThe trainees’ gender, age and personality should be considered when conducting doctor-patient communication skills training.

Effectiveness of clinical scenario dramas to teach doctor-patient relationship and communication skills

BackgroundThe doctor-patient relationship in China has deteriorated in recent years, and poor doctor-patient communication is one of the main reasons. How to effectively carry out doctor-patient communication training originated from the West among Chinese medical students still to be studied. In the past decade, Peking Union Medical College has adopted clinical scenario drama to teach doctor-patient relationship and clinical communication skills. The aim of this study was to introduce clinical scenario dramas and evaluate its effectiveness in promoting doctor-patient relationships and clinical communication skills through students’ self-perceptions in Chinese medical students.MethodsThis study was a retrospective, self-controlled study and conducted from March 2009 to October 2018. Doctor-patient relationship and communication skills training were administered to all sixth-year medical students, which involved lectures and various clinical scenario dramas. The program totaled 24 h, of which each class session was 3 h, with 8 sessions in total. All students were requested to complete an anonymous 5 likert self-rating survey including self-confidence in using communication skills and self-perceived learning attitude and ability before and at the end of the course. In addition, they were requested to evaluate the curriculum after completion of the course.ResultsClinical scenario dramas helped students improve their self-confidence in clinical communication skills except for psychosomatic history taking (p < 0.05). The interests for participation in clinical scenario dramas were higher compared to attending lectures (4.39 ± 0.610 Vs 4.07 ± 0.831, p<0.01). Study participants were highly satisfied in the course setting, teaching instructors and content (4.61 ± 0.546, 4.65 ± 0.535, 4.63 ± 0.534). The self-evaluation results demonstrated that clinical scenario dramas improved the learning ability of medical students (p < 0.05).ConclusionThe use of clinical scenario dramas was helpful in teaching doctor-patient communication skills.

Long-term outcomes of an educational intervention to reduce antibiotic prescribing for childhood upper respiratory tract infections in rural China: Follow-up of a cluster-randomised controlled trial.

BackgroundInappropriate antibiotic prescribing causes widespread serious health problems. To reduce prescribing of antibiotics in Chinese primary care to children with upper respiratory tract infections (URTIs), we developed an intervention comprising clinical guidelines, monthly prescribing review meetings, doctor–patient communication skills training, and education materials for caregivers. We previously evaluated our intervention using an unblinded cluster-randomised controlled trial (cRCT) in 25 primary care facilities across two rural counties. When our trial ended at the 6-month follow-up period, we found that the intervention had reduced antibiotic prescribing for childhood URTIs by 29 percentage points (pp) (95% CI −42 to −16).Methods and findingsIn this long-term follow-up study, we collected our trial outcomes from the one county (14 facilities and 1:1 cluster randomisation ratio) that had electronic records available 12 months after the trial ended, at the 18-month follow-up period. Our primary outcome was the antibiotic prescription rate (APR)—the percentage of outpatient prescriptions containing any antibiotic(s) for children aged 2 to 14 years who had a primary diagnosis of a URTI and had no other illness requiring antibiotics. We also conducted 15 in-depth interviews to understand how interventions were sustained.In intervention facilities, the APR was 84% (1,171 out of 1,400) at baseline, 37% (515 out of 1,380) at 6 months, and 54% (2,748 out of 5,084) at 18 months, and in control facilities, it was 76% (1,063 out of 1,400), 77% (1,084 out of 1,400), and 75% (2,772 out of 3,685), respectively. After adjusting for patient and prescribing doctor covariates, compared to the baseline intervention-control difference, the difference at 6 months represented a 6-month intervention-arm reduction in the APR of −49 pp (95% CI −63 to −35; P < 0.0001), and compared to the baseline difference, the difference at 18 months represented an 18-month intervention-arm reduction in the APR of −36 pp (95% CI −55 to −17; P < 0.0001). Compared to the 6-month intervention-control difference, the difference at 18 months represented no change in the APR: 13 pp (95% CI −7 to 33; P = 0.21). Factors reported to sustain reductions in antibiotic prescribing included doctors’ improved knowledge and communication skills and focused prescription review meetings, whereas lack of supervision and monitoring may be associated with relapse. Key limitations were not including all clusters from the trial and not collecting returned visits or sepsis cases.ConclusionsOur intervention was associated with sustained and substantial reductions in antibiotic prescribing at the end of the intervention period and 12 months later. Our intervention may be adapted to similar resource-poor settings.Trial registrationISRCTN registry ISRCTN14340536.

Effective doctor-patient communication skills training optimizes functional organization of intrinsic brain architecture: a restingstate functional MRI study

We studied the influence of doctor-patient communication skills training on brain functional architecture using resting-state functional MRI (rs-fMRI) with a regional homogeneity (ReHo) method. Ten medical students participated in the study. A 1-year long doctor-patient communication skills training program was conducted. Rs-fMRI data were collected at baseline, one month and one year after training. There was a significant increase in the communication skills test average scores between baseline and 1-month duration of training (P<0.001). After one month of communication skills training, medical students had decreased ReHo in the right superior temporal gyrus compared with the baseline. After one year of communication skills training, students had increased ReHo in multiple regions and decreased ReHo in several regions (P<0.05, Alphasim corrected). The change of ReHo values in the superior temporal gyrus negatively correlated with the change of communication skills scale score between one month after communication skills training and baseline (r=–0.734, P= 0.036). The training program we used can be an effective approach of improving doctor-patient communication skills, and the training resulted in functional plasticity of the brain's architecture toward optimizing locally functional organization.

Research on practical teaching reform of humanities and social science in medical colleges and universities based on post competency — take "modern Chinese" course as an example

Modern course in the Third Military Medical University adhered to post competency oriented function for curriculum. It simplified, merged and enhanced the traditional Chinese teaching content, to help students to establish a standardized use of language awareness, and establish a sense of cultural identity, which helped medical students learn and appreciate literary works from all countries and famous narrative medical text, improved their moral sentiments, and aroused their empathy and empathy for the response. Under the guidance of the basic theory of spoken language, scientific, systematic, strict oral expression skills and effective doctor-patient communication skills training were carried out for medical students, so as to cultivate medical students' humanistic spirit and the scientific spirit. Key words: Post competency; Humanities and social sciences; Modern Chinese

Discussion on development orientation of normalization education of doctor-patient communi-cation skills in higher medical education

This paper analyzed and discussed on the importance of doctor-patient communica-tion skills and the differences between foreign countries and China. Meanwhile, it pointed out the drawbacks of doctor-patient communication skills training for medical students in China and proposed some countermeasures including finding out influence factors, searching for reference books, provid-ing guide for doctor-patient communication theory and skills, formulating teaching pattern, building evaluation mechanism, and establishing a communication platform of doctor-patient communication skills for medical students. Key words: Higher medical education; Standardized education; Doctor-patient communi-cation

Responding to patient anger: Development and evaluation of an oncology communication skills training module

The purpose of this study was to develop a communication skills training (CST) module for oncology healthcare professionals on how to more effectively respond to patient anger. We also sought to evaluate the module in terms of participant self-efficacy and satisfaction. The development of this module was based on a systematic review of the literature and followed the Comskil model previously used for other doctor-patient CST. Using an anonymous 5-point Likert scale, participants rated their pre-post self-efficacy in responding to patient anger as well as their satisfaction with the course. Data were analyzed using a paired sample t test. During the academic years 2006-2009, 275 oncology healthcare professionals participated in a CST that focused on responding to patient anger. Participants' confidence in responding to patient anger increased significantly (p < 0.001) after attending the workshop. They also agreed or strongly agreed to five out of six items assessing course satisfaction 92-97% of the time. We have developed a CST module on how to respond to patient anger, which is both effective and useful. Training healthcare professionals to respond more effectively to patient anger may have a positive impact on the patient-physician relationship.

Discussing prognosis in an oncology setting: initial evaluation of a communication skills training module

Although cancer patients from Western countries have high needs for prognostic information, the frequency of such discussions in oncology consultations is variable. Prognosis is a difficult discussion area for both physicians and patients. Physician focused Communication Skills Training (CST) has been suggested as a means to aid these discussions. We developed and tested a CST module about discussing prognosis. Training consisted of didactic teaching, exemplary video and role-play sessions. The study aim was to develop the module and evaluate the effectiveness of the training. One hundred and forty-two clinicians from Memorial Sloan-Kettering Cancer Center and the New York City area voluntarily participated in the training module over a two-year period. The module was based on current literature and followed the Comskil model previously utilized for other doctor-patient CSTs. Participants completed pre and post surveys to evaluate their own confidence as well as the helpfulness of the module. Based on a retrospective pre-post measure, participants reported an increase in their confidence about discussing prognosis (t(141)=-9.331, p<0.001). At least 92% of participants reported their satisfaction with components of the module by either agreeing or strongly agreeing with 5/6 different statements included in their evaluation forms. This short training program demonstrated success in improving physician confidence to discuss prognosis and self-efficacy. This result, coupled with the participant's intent to utilize new skills in clinical encounters, suggests that this is a useful module. Future research will target changes in patient outcomes as a result of the physician training.

Interviewing patients using interpreters in an oncology setting: initial evaluation of a communication skills module

ObjectivesTo develop a communication skills training (CST) module for health care professionals, particularly in the area of oncology, on how to conduct interviews using interpreters and to evaluate the module in terms of participant’s self-efficacy and satisfaction. MethodsForty-seven multi-specialty health care providers from the New York Metropolitan Area attended a communication skills module at a Comprehensive Cancer Care Center about how to conduct clinical interviews utilizing interpreters. The development of this module was on the basis of current literature and followed the Comskil model previously utilized for other doctor–patient CSTs. Participants were given pre- and post-surveys to evaluate their own confidence as well as the helpfulness of the module. ResultsOn the basis of a retrospective pre–post measure, participants reported an increase in their confidence about interviewing patients via translators. In addition, at least 80% of participants reported their satisfaction with the various components of the module by either agreeing or strongly agreeing with the different statements. ConclusionsWe have developed a module that trains clinicians in effective collaboration with professional medical interpreters and shown its ability to increase the confidence of clinician's to work with limited English proficiency patients. Our approach intends to minimize not only the language barrier but also the cultural barriers that could potentially interfere with patients’ care. Practice implicationsThis work has important practice implications in the oncology setting, where cultural sensitivity is paramount and empathic exchange with the patient optimizes their sense of being well supported by their health care team. We believe that this model is generalizable to many other medical settings where use needs to be made of a professional interpreter.