Specific Communication Skills Research Articles

Problem based learning better prepares students for practice

Medical graduates who have followed a problem based learning (PBL) course report that they have a different set of skills when they start working than students who have followed a traditional course (Medical Education 2005;39: 394-401). Katinka Prince and colleagues analysed responses from 1159 graduates from one PBL (239) and four non-PBL (917) medical schools in the Netherlands. (At the time of the study there was only one PBL medical school in the Netherlands.) Graduates answered a questionnaire 18 months after graduating. “We explored graduates' perceptions of how well their training had prepared them for medical practice, particularly in general competencies. We compared the opinions of graduates from PBL and non-PBL schools, because PBL is supposed to enhance general competencies,” Dr Prince explained. The PBL graduates rated their quality of training, and in turn, their preparation for practice, significantly more highly than their non-PBL counterparts. Non-PBL graduates (83%) ranked their own expert medical knowledge significantly more highly than the PBL graduates (72%). Most PBL graduates (83%) considered that they had competent communication skills in contrast to a minority of non-PBL graduates (41%). Dr Prince said, “This study showed that PBL graduates gave higher ratings for the connection between school and work and their preparation for practice. We expected this as PBL is supposed to enhance preparation for practice. We found it interesting that the PBL school appeared to provide better preparation with respect to several of the competencies needed in practice—profession specific skills, communication skills, and teamwork.” The study showed, however, that most graduates (46% PBL and 34% non-PBL) report a lack of training in computer work, planning and organisation skills, and leadership skills at medical school. Most graduates (53% PBL and 58% non-PBL) agreed that although they had attained most of their knowledge during medical school, they had learnt …

Patient-physician communication: why and how.

Patient-physician communication is an integral part of clinical practice. When done well, such communication produces a therapeutic effect for the patient, as has been validated in controlled studies. Formal training programs have been created to enhance and measure specific communication skills. Many of these efforts, however, focus on medical schools and early postgraduate years and, therefore, remain isolated in academic settings. Thus, the communication skills of the busy physician often remain poorly developed, and the need for established physicians to become better communicators continues. In this article, the authors briefly review the why and how of effective patient-physician communication. They begin by reviewing current data on the benefits of effective communication in the clinical context of physicians caring for patients. The authors then offer specific guidance on how to achieve effective communication in the patient-physician relationship.

Evaluation of a communication skills seminar for students in a Japanese medical school: a non-randomized controlled study

BackgroundLittle data exist for the effectiveness of communication skills teaching for medical students in non-English speaking countries. We conducted a non-randomized controlled study to examine if a short intensive seminar for Japanese medical students had any impact on communication skills with patients.MethodsThroughout the academic year 2001–2002, a total of 105 fifth-year students (18 groups of 5 to 7 students) participated, one group at a time, in a two-day, small group seminar on medical interviewing. Half way through the year, a five-station objective structured clinical examination (OSCE) was conducted for all fifth-year students. We videotaped all the students' interaction with a standardized patient in one OSCE station that was focused on communication skills. Two independent observers rated the videotapes of 50 students who had attended the seminar and 47 who had not. Sixteen core communication skills were measured. Disagreements between raters were resolved by a third observer's rating.ResultsThere was a statistically significant difference in proportions of students who were judged as 'acceptable' in one particular skill related to understanding patient's perspectives: asking how the illness or problems affected the patient's life, (53% in the experimental group and 30% in the control group, p = .02). No differences were observed in the other 15 core communication skills, although there was a trend for improvement in the skill for asking the patient's ideas about the illness or problems (60% vs. 40%, p = .054) and one of the relationship building skills; being attentive and empathic nonverbally (87% vs. 72%, p = .064).ConclusionThe results of this study suggest that a short, intensive small group seminar for Japanese medical students may have had a short-term impact on specific communication skills, pertaining to understanding patient's perspectives.

A system of networks and continuing education for physical therapists in rheumatology: a feasibility study

To evaluate the feasibility of regional physical therapy networks including continuing education in rheumatology. The aim of these networks was to improve care provided by primary care physical therapists by improving specific knowledge, technical and communicative skills and the collaboration with rheumatologists. In two regions in The Netherlands continuing education (CE) programmes, consisting of a 5-day postgraduate training course followed by bimonthly workshops and teaching practices, were organised simultaneously. Network activities included consultations, newsletters and the development of a communication guideline. Endpoint measures included the participation rate, compliance, quality of the CE programme, teaching practices, knowledge, network activities, communication, number of patients treated and patient satisfaction. Sixty-three physical therapists out of 193 practices (33%) participated in the project. They all completed the education programmes and were formally registered. All evaluations of the education programmes showed positive scores. Knowledge scores increased significantly directly after the training course and at 18 months. A draft guideline on communication between physical therapists and rheumatologists was developed, and 4 newsletters were distributed. A substantial proportion of physical therapists and rheumatologists reported improved communication at 18 months. The mean number of patients treated by physical therapists participating in the networks increased significantly. Patients' satisfaction scores within the networks were significantly higher than those from outside the networks at 18 months. Setting up a system of networks for continuing education for physical therapists regarding the treatment of patients with rheumatic diseases is feasible. Further research will focus on the effectiveness of the system and its implementation on a larger scale.

The effects of communication training on teachers’ and students’ verbal behaviours during cooperative learning

The present study sought to compare the effects of training teachers in specific communication skills designed to promote thinking and scaffold learning on teachers’ and students’ verbal behaviours during cooperative group work. Thirty teachers and 826 children from years 5 to 7 participated in the study. The results show that when teachers are trained to use specific communication skills during cooperative learning (cooperative-interactional condition) they engage in more mediated-learning interactions, ask more questions, and make fewer disciplinary comments than teachers who have been trained to implement cooperative group work only (cooperative condition). In turn, the children in the cooperative-interactional groups modelled many of the responses they gave their teachers and provided more detailed explanations, shorter responses, and asked more questions than their peers in the cooperative only groups.

Identification of high-quality consultation practice in primary care: the effects of computer use on doctor-patient rapport.

If the practitioner uses a clinical computer during consultation with the patient there may be adverse effects on the quality of interpersonal communication in the consultation. Greatbach et al showed in 1995 that these adverse effects might be minimised when the practitioner is well-practised and able to put in the background the tasks involving the computer. In the subsequent seven years, as clinical computer systems have become more sophisticated, the clinician may be called on to pay more attention to the content displayed on the computer screen. This study shows that this required level of attention cannot be put in the background, and that general practitioners (GPs) are not able to multitask at this level. Clinicians can use specific communication skills to manage the consultation, so that they are not called on to concentrate on the computer screen and the patient at the same time. The two tasks can be accomplished in the same consultation, but not simultaneously.

A reflective stakeholder approach: Co‐orientation as a basis for communication and learning

Organisations are undergoing dramatic changes as stakeholder groups exert an ever‐increasing influence on the place and responsibilities of organisations in society. Important drivers in this process include the environmental movement, the search for total quality management, the concept of sustainable development, ethics and organisational learning. Because the various stakeholders can view these complex issues quite differently from the organisation, it is important that those working with communications are able to understand the underlying complexities of stakeholder relationships. Work in a number of diverse fields has provided an understanding of the factors involved in developing an effective communications strategy. Stakeholder theory is an important contributor in that it provides a means for uncovering the relevant participants in the process. The authors contend that, as part of this process, the co‐orientation model can provide a unifying framework for identifying the nature of the relationships between stakeholders or actors in a communication process. At the heart of this model lies the notion of “mental models” from the organisational learning literature and the recognition that in order for any communication process to be effective these models must be “oriented” properly. The authors build on research from the organisational learning field to gain a deeper understanding of the processes that influence our perceptions of stakeholder groups. Three specific communication skills are identified that enable the communications manager to engage stakeholders in a meaningful dialogue, and thereby enhance the effectiveness of the organisation’s communication efforts. These communication skills are reflection, inquiry and advocacy.

What Else Do You Need to Know? Practical Skills for Catalogers and Managers

SUMMARY Catalogers and those who manage cataloging operations need a broader practical knowledge base than can be reasonably acquired in library schools, especially since the availability of cataloging coursework in library schools has decreased over time. This paper is written from the perspective of a manager of cataloging operations, and considers the kinds of skills, education and training needed for both catalogers and managers. It concentrates primarily on library specific education, computer, and communication skills, and suggests how such skills can be acquired and maintained.

Specificity revisited: how far should we go now?

ESP has become central to the teaching of English in university contexts and there can be little doubt of its success as an approach to understanding language use. This success is largely due to ESP's distinctive approach to language teaching based on identification of the specific language features, discourse practices and communicative skills of target groups, and on teaching practices that recognize the particular subject-matter needs and expertise of learners. Unfortunately, however, this strength is increasingly threatened by conceptions of ESP which move it towards more general views of literacy, emphasizing the idea of ‘generic’ skills and features which are transferable across different disciplines or occupations. In this paper I argue the case for specificity: that ESP must involve teaching the literacy skills which are appropriate to the purposes and understandings of particular academic and professional communities. The paper traces the arguments for a specific view, outlines some supporting research, and advocates the need to reaffirm our commitment to research-based language education.

From evidence to practice: factors affecting the specialist breast nurse's detection of psychological morbidity in women with breast cancer.

Psychological morbidity is high for women with breast cancer and is often undetected and untreated. Encouragingly, there are well-evaluated strategies to help improve psychological outcomes, but the challenge remains as to how to transfer these to routine care settings. The National Health and Medical Research Council (NHMRC) National Breast Cancer Centre used evidence-based psychosocial clinical practice guidelines and breast cancer treatment guidelines to develop a comprehensive specialist breast nurse (SBN) model of care and conducted a feasibility study to observe its implementation in diverse clinical conditions. Seven SBNs at four Australian cancer treatment centres implemented the model of care to support 196 women with a new diagnosis of early or locally advanced breast cancer. The SBN role in detecting women's psychological difficulties is reported here. Two months after diagnosis, 36% of women had a likely psychological disorder on the General Health Questionnaire 12-item (GHQ12) version. The SBNs detected as many as 85% and as few as 20% of high GHQ12 scorers, depending upon a woman's psychosocial risk factors and consultation factors. Few women were referred to psychological services, suggesting other barriers to care. More specific communication skills training, psychological symptom screening questionnaires and better access to psychological services may help the implementation of the model of care.

Personalized Remedial Intensive Training of One Medical Student in Communication and Interview Skills

Background: Medical students found to be deficient in communication and interview skills pose a difficult remediation challenge. There is no standard way to address such deficiencies. The authors describe the development and implementation of an intensive remedial curriculum. Description: A 2nd-year student found deficient in communication skills was held back for a year and paired with a clinical preceptor for intensive skills training, including a weekly precepted clinic, structured readings, standardized patient (SP) exercises, communications workshops, and end-of-year standardized clinical evaluations. Evaluation: The student's self-assessment and the preceptor's assessments of communication skill gradually improved over the year. The student improved through a progression of SP exercises focusing on specific communication skills. The student passed a final evaluation exercise with an excellent rating from the SP and the preceptor. Conclusions: This multistrategy approach to improve communication skills can be applied to other students and in other institutions. Based on the Bayer Institute communication workshops and integrated coaching techniques, the material forms a framework to help deficient students to become proficient in communication and interviewing skills.

A Critical Evaluation of the Contradictions for Disabled Workers Arising from the Emergence of the Flexible Labour Market in Britain

In Britain, as in all industrialised countries 'paid work' or employment is central to the economy of the state. This perspective raises important implications for theories of disability and work, and for further research in this area. This paper attempts to provide a critical evaluation of the contradictions arising from the flexible labour market for disabled workers and how the concept of the Disabled State has been eroded along with notions of disabled people as the 'deserving poor'. Policies now demonstrate a commitment to a labour market free from restrictive practices and regulation. It appears that new technologies and specific personal communication skills, initiative, flexibility and adaptability will play an increasing part in new labour working trends. In short, theories of disability and work must change focus from 'production' to 'process'.

Employer Satisfaction with Job Skills of Business College Graduates and Its Impact on Hiring Behavior

ABSTRACT This study analyzed which job-applicant skills employers perceive to be important when hiring, as well as how effective business schools are perceived to be in preparing students with these skills. A research instrument was developed to measure employers' satisfaction with 4 areas: specific skills, core skills, personal characteristics, and communication skills. The results indicate that employers want the same basic “core skills,” irrespective of their size and type of business, and that satisfaction with these core skills is the most important determinant of their inclination to hire. Recommendations for improving the effectiveness of business programs are included in the report.

Patients' Perceptions of Physicians Communication and Outcomes of the Accrual to Trial Process

The purpose of this study was to examine the relations among patients' perceptions of their physicians' communicative behavior during the informed consent interview, the patient's feeling of being confirmed by the physician and satisfied with care delivered by the physician, and the patient's decision to participate in a clinical trial or not. Respondents included 130 cancer patients who were eligible for a clinical trial and who had recently discussed trial participation with their physicians. Results indicated that a linear combination of the variables physician affiliative style, physician dominant or controlling style, patient satisfaction, patient confirmation, patient preference for decision making, patient desire for information, and patient age discriminate between patients who agree to participate in clinical trials and patients who refuse to participate. Physicians' affiliative communicative behaviors and patient satisfaction were clearly important to patients who agreed to participate. Motivations for patients who declined to participate in trials were less clear. Implications for physicians who offer clinical trials to their patients are that specific communication skills may enhance their patients' satisfaction and may help increase enrollment in clinical trials.

Excellent Communication Skills Are an Essential Part of Being an Accountant

While we know that communication skills are needed to secure employment and to be successful in the business world, it is important to identify skills that accounting students will be most likely to need in their entry level accounting positions. The purpose of this study was to examine more closely the specific communication skills required of accounting professionals. Clear messages are vitally important so the client and the accountant understand each other and the content of discussions. Whatever method of communication used, accounting professionals represent their company every time they write a letter or make a personal contact with a client.

Communication and the medical interview. Strategies for learning and teaching.

The broad goal of this article is to direct clinician-educators to ways to improve their knowledge about medical interviewing and their communication skills, as well as to note ideas and resources for teaching in this area. Our specific objectives are to outline the knowledge base, specific skills, and attitudes and values relevant to effective communication in the context of the clinical interview, and to suggest strategies and resources that can be used by clinician-educators to learn and teach them. The article is not intended to be a critical review of the literature on communication and interviewing, nor is it an in-depth discussion of the knowledge base and skills to be learned. For these we refer the reader to specific references, texts, and other resources. This article will provide a summary road atlas to the broad field of communication and medical interviewing; cited literature and suggested learning resources will provide local detail maps for readers who are interested in more in-depth treatments of specific areas. Why should clinician-educators be interested in communication and interviewing? Effective communication in clinical settings increases the likelihood that (1) the information gathered from patients to make diagnostic assessments is accurate and reliable; (2) patients recognize that the physician is genuinely interested in them and their care; (3) physicians and patients reach common ground on diagnosis and treatment; and (4) patients are motivated to play an active role in their own care.1,2 In this way, the interview determines the accuracy of the diagnostic assessment as well as the quality of the doctor-patient relationship, thereby affecting the entire diagnostic-therapeutic process. In short, better communication leads to better diagnosis and treatment. Better communication leads to better outcomes. Research has documented that communication during the interview is positively related to specific illness outcomes,3,4 as well as to satisfaction among patients5,7 and physicians.8 On the other hand, poor communication has been related to such adverse events as malpractice suits9,10 and patient decisions to leave practices or health care organizations.11 In the clinical setting, most physicians and their patients benefit from high-quality, effective communication skills. Clinician educators will find it especially valuable to improve their communication skills, as strong skills will also bring important benefits in the educational and academic settings in which they work. In the educational setting, effective teaching and learning depend greatly on the exchange of information and quality of the relationship between students and teachers.12,13 Skills that promote effective communication in the clinical setting are also effective in the educational setting. Clinician-educators are in a unique position to use this overlap of skills. It is often possible to model specific communication skills for students during teaching sessions, then explicitly point out their parallel use with patients. This can result in powerful experiential learning. Students who directly experience effective communication (e.g., through the teacher's expressions of empathy or partnership, or encouragement of active participation and autonomy) may be more likely to use those skills with their patients. The benefits of effective communication also extend to academic life. As clinician-educators interact with peers and superiors in the academic environment, they benefit from their own communication skills such as attentive listening, empathy, negotiation, and limit setting. Again, what is learned in one setting can be appropriately applied to others. Continuing mentoring and reflection will facilitate this transfer of skills among clinical, educational, and academic settings. Some have argued that being an effective communicator is part of the “art” of medicine, implying that the ability to communicate is a natural talent with which one is or is not born.14 We disagree. Communication skills are specific and observable, and can be evaluated objectively. There is ample evidence that continuing education programs designed for physicians in practice improve skills,15 18 and research with medical students has shown that the benefits from training persist years after the course has been completed.19 Knowledge and skills associated with effective communication and interviewing can be improved through practice, using the strategies and resources we outline in this article.

Insights into Ourselves and Our Culture

Insights into Ourselves and Our Culture

The Managing Affect and Differences Scale (MADS): A self-report measure assessing conflict management in couples.

In this article, the authors present a newly developed self-report measure that assesses specific communication skills that couples may use, particularly during conflict discussions. The authors present preliminary findings from 2 studies on this measure to support its validity and use in guiding and measuring the effectiveness of clinical interventions with couples. Specific clinical implications related to the development of this measure are discussed.

The art of interviewing

This article focuses on the skills, attitudes, and goals required for effective history-taking during comprehensive health assessment in the primary care setting. The approach presented is characterized as “patient-centered” in that the woman is engaged in the problem-solving process. Specific communication skills are discussed, and attitudes and goals that enable primary care providers to adopt a patient-centered approach to relationship-centered care are included.

The Performance Appraisal Interview: A Multi-Purpose Communication Assignment

The performance appraisal has become a standard topic in business or management curriculum, most frequently covered in personnel, management, human resources, or organizational behavior classes. Students learn such things as types of employee appraisal systems, how to create appraisal instruments, and how performance appraisals fit into larger employment cycle. What these students seldom have an opportunity to acquire or to practice, however, are specific communication skills necessary to effectively implement systems they study. However knowledgeable our graduates may be in principles and theory of performance appraisal, their ability to effectively execute these systems, particularly under difficult circumstances, is often limited unless they have acquired accompanying competence in oral and written communication. Importantly, communication skills and attitudes most critical to effective performance appraisal are same skills and attitudes that are needed in a wide range of other on-the-job management communication situations. Students who develop communication competencies necessary for conducting challenging performance appraisals will be well-served as they train, coach, counsel, direct, and motivate employees in other daily work contexts. A brief examination of goals and methods of performance appraisal may be helpful in providing a context for following assignment, which is designed to help students choose and practice some of most essential management communication skills and strategies. Further information may be found in Dessler (1983), Napier and Latham (1986), Smith (1986), DeGreforio and Fisher (1988), add Mohrmann, Resnick-West, & Lawler (1989). PERFORMANCE APPRAISALS Performance appraisals have become a primary management tool for improving employee performance, setting total quality standards, and communicating organizational values. Although performance appraisal serves several functions, its primary purpose is to improve individual performance, most often through a. Clarifying job requirements and standards b. Providing feedback to employee regarding his or her progress toward meeting these standards c. Guiding future performance by formulating an action-plan and allocating rewards and opportunities. An effective appraisal, therefore, accomplishes a variety of specific tasks while maintaining a positive relationship between supervisor and employee. The difficulty of this task, from manager's viewpoint, is largely dependent upon type of appraisal interview required. In some cases, employee performance is satisfactory and manager's goal is to either help employee maintain his or her current level of performance (when no promotion is possible) or to assist in development of a realistic career path. The interview assignment as described below, however, pertains only to those situations where performance is unsatisfactory. The management task is to communicate performance problems to an employee who, for any number of reasons, may not be completely receptive to manager's efforts. In preparation for appraisal interview, managers assemble and review all relevant data, make decisions regarding various aspects of appraisal itself and prepare employee for up-coming meeting. Of wide range of appraisal methods, three most frequently used instruments are rating scales, critical incidents, or a combination of two called behaviorally anchored rating scales (BARS). BARS anchor points of rating scale with fictional sample critical incidents - examples of what employee's performance looks like for each value of rating scale and for each dimension being evaluated. On a five-point scale covering typing accuracy, for instance, critical incident for 1 may be the employee submits work with approximately an error per page at least half of time. …