Specific Communication Skills Research Articles

Expectations of Graduate Communication Skills in Professional Veterinary Practice.

Good communication skills are an important entry-level attribute of graduates of professional degrees. The inclusion of communication training within the curriculum can be problematic, particularly in programs with a high content load, such as veterinary science. This study examined the differences between the perceptions of students and qualified veterinarians with regards to the entry-level communication skills required of new graduates in clinical practice. Surveys were distributed to students in each of the four year levels of the veterinary science degree at the University of Melbourne and to recent graduates and experienced veterinarians registered in Victoria, Australia. Respondents were asked to rank the relative importance of six different skill sets: knowledge base; medical and technical skills; surgical skills; verbal communication and interpersonal skills; written communication skills; and critical thinking and problem solving. They were then asked to rate the importance of specific communication skills for new graduate veterinarians. Veterinarians and students ranked verbal communication and interpersonal skills as the most important skill set for an entry-level veterinarian. Veterinarians considered many new graduates to be deficient in these skills. Students often felt they lacked confidence in this area. This has important implications for veterinary educators in terms of managing the expectations of students and improving the delivery of communication skills courses within the veterinary curriculum.

Improving Resident Communication in the Intensive Care Unit. The Proceduralization of Physician Communication with Patients and Their Surrogates.

Effective communication between providers and patients and their surrogates in the intensive care unit (ICU) is crucial for delivery of high-quality care. Despite the identification of communication as a key education focus by the American Board of Internal Medicine, little emphasis is placed on teaching trainees how to effectively communicate in the ICU. Data are conflicting on the best way to teach residents, and institutions vary on their emphasis of communication as a key skill. There needs to be a cultural shift surrounding the education of medical residents in the ICU: communication must be treated with the same emphasis, precision, and importance as placing a central venous catheter in the ICU. We propose that high-stakes communications between physicians and patients or their surrogates must be viewed as a medical procedure that can be taught, assessed, and quality controlled. Medical residents require training, observation, and feedback in specific communication skill sets with the goal of achieving mastery. It is only through supervised training, practice in real time, observation, and feedback that medical residents can become skillful practitioners of communication in the ICU.

How do medical specialists value their own intercultural communication behaviour? A reflective practice study.

BackgroundIntercultural communication behaviour of doctors with patients requires specific intercultural communication skills, which do not seem structurally implemented in medical education. It is unclear what motivates doctors to apply intercultural communication skills. We investigated how purposefully medical specialists think they practise intercultural communication and how they reflect on their own communication behaviour.MethodsUsing reflective practice, 17 medical specialists independently watched two fragments of videotapes of their own outpatient consultations: one with a native patient and one with a non-native patient. They were asked to reflect on their own communication and on challenges they experience in intercultural communication. The interviews were open coded and analysed using thematic network analysis.ResultsThe participants experienced only little differences in their communication with native and non-native patients. They mainly mentioned generic communication skills, such as listening and checking if the patient understood. Many participants experienced their communication with non-native patients positively. The participants mentioned critical incidences of intercultural communication: language barriers, cultural differences, the presence of an interpreter, the role of the family and the atmosphere.ConclusionDespite extensive experience in intercultural communication, the participants of this study noticed hardly any differences between their own communication behaviour with native and non-native patients. This could mean that they are unaware that consultations with non-native patients might cause them to communicate differently than with native patients. The reason for this could be that medical specialists lack the skills to reflect on the process of the communication. The participants focused on their generic communication skills rather than on specific intercultural communication skills, which could either indicate their lack of awareness, or demonstrate that practicing generic communication is more important than applying specific intercultural communication. They mentioned well-known critical incidences of ICC: language barriers, cultural differences, the presence of an interpreter, the role of the family and the atmosphere. Nevertheless, they showed a remarkably enthusiastic attitude overall was noteworthy.A strategy to make doctors more aware of their intercultural communication behaviour could be a combination of experiential learning and ICC training, for example a module with reflective practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0727-9) contains supplementary material, which is available to authorized users.

Graduate Employability and Communication Competence

This research establishes the role of communication education in employability by determining how employers of graduates view communication, identifying communication skills that employers view as relevant, and establishing whether these skills are included in communication courses. To achieve these aims, local businesses were surveyed, and the results were compared with communication course descriptors. The research shows, consistent with worldwide trends, that local employers value communication competencies highly when recruiting new graduates, and specific communication skills required in an industry reflect course content. However, some skills are still lacking, and the research questions where the responsibility lies in developing these skills.

Specific technological communication skills and functional health literacy have no influence on self-reported benefits from enrollment in the TeleCare North trial

PurposeThe Danish TeleCare North trial has developed a telehealth system, Telekit, which is used for self-management by patients diagnosed with chronic obstructive pulmonary disease (COPD). Self-management is the engagement in one’s own illness and health by monitoring and managing one’s symptoms and signs of illness. The study examines the association between COPD patients’ use of Telekit and their functional health literacy and the association between their use of Telekit and their specific technological communication skills. MethodsA consecutive sample of participants (n=60) from the TeleCare North trial were recruited. Face-to-face interviews were conducted with each participant to collect demographic data. Functional health literacy was measured with the Danish TOFHLA test. Participants completed a non-standardised questionnaire about their health status, their use of the Telekit system, and their specific technological communication skills. Binary logistic regressions were performed to examine how functional health literacy and specific technological communication skills influenced the use of Telekit by giving users an enhanced sense of freedom, security, control, and a greater awareness of COPD symptoms. ResultsParticipants (27 women, 33 men) had a mean age of 70 (SD: 8.37) years. Functional health literacy levels were classified as inadequate in 14 (23%) participants, as marginal in 12 (20%), and as adequate in 34 (57%). Participants self-reported a feeling of increased security (72%), greater freedom (27%), more control (62%), and greater awareness of symptoms (50%) when using Telekit. The use of Telekit was not significantly associated with levels of functional health literacy or with the number of specific technological communication skills (p>0.05) based on the binary logistic regressions. ConclusionThe enhanced sense of security, freedom, control, and the greater awareness of COPD symptoms achieved by using Telekit were unassociated both with the patients’ score of functional health literacy and with their specific technological communication skills. On the basis of our results it seems that the specific technological communication skills and functional health literacy are not a prerequisite for the use of the Telekit system.

A Telephone Communication Skills Exercise for Veterinary Students: Experiences, Challenges, and Opportunities.

Evidence from human medicine shows a rise in telephone communication in support of after-hours services and in providing medical advice, follow-up information, etc. While specific training programs are continuously being developed for human medical education, limited publications are available on training veterinary students in telephone communication. Presented is our method of introducing a telephone communication skills exercise to third-year veterinary students. The exercise progressed over three phases and currently follows the principles of the Calgary-Cambridge Guide. Challenges and improvements on implementing a telephone communication exercise are discussed. Within veterinary communication curricula, attention should be given to the specific communication skills required for successful telephone consultations. In the absence of visual nonverbal cues and prompts during a telephone interaction, communication skills must be applied with greater intent and attention to achieve an effective consultation outcome.

Computer use in primary care and patient-physician communication

ObjectivesThis study evaluated how physicians and patients perceive the impact of computer use on clinical communication, and how a patient-centered orientation can influence this impact. MethodsThe study followed a descriptive cross-sectional design and included 106 family physicians and 392 patients. An original questionnaire assessed computer use, participants’ perspective of its impact, and patient centered strategies. ResultsPhysicians reported spending 42% of consultation time in contact with the computer. A negative impact of computer in patient–physician communication regarding the consultation length, confidentiality, maintaining eye contact, active listening to the patient, and ability to understand the patient was reported by physicians, while patients reported a positive effect for all the items. Physicians considered that the usual computer placement in their consultation room was significantly unfavorable to patient–physician communication. ConclusionsPhysicians perceive the impact of computer use on patient-physician communication as negative, while patients have a positive perception of computer use on patient-physician communication. Practice implicationsConsultation support can represent a challenge to physicians who recognize its negative impact in patient centered orientation. Medical education programs aiming to enhance specific communication skills and to better integrate computer use in primary care settings are needed.

Seeking the best training model for difficult conversations in neonatology.

We hypothesize that a formal simulation curriculum prepares neonatology fellows for difficult conversations better than traditional didactics. Single-center neonatology fellowship graduates from 1999 to 2013 were sent a retrospective web-based survey. Some had been exposed to a Difficult Conversations curriculum (simulation group), others had not (no simulation group). The simulation group participated in one workshop annually, consisting of lecture, simulation, and debriefing. Scenarios were customized to year of training. Epoch comparisons were made between the simulation and no simulation groups. Self-rated baseline effectiveness at discussing difficult topics was not different. The simulation group reported more supervised family meetings and feedback after fellow-led meetings. Simulations were rated very positively. The simulation group reported increased comfort levels. Strategic pause and body positioning were specific communication skills more frequently acquired in the simulation group. In both groups, the highest ranked contributors to learning were mentor observation and clinical practice. In the simulation group, simulation and debriefing outranked didactics or other experiences. Simulation-based workshops improve communication skills in high stakes conversations. However, they do not substitute for mentor observation and experience. Establishing a structured simulation-based difficult conversations curriculum refines vital communication skills necessary for the high stakes conversations neonatologists direct in clinical practice.

SPELTA: An expert system to generate therapy plans for speech and language disorders

Speech and Language Pathologists have to treat a wide spectrum of disorders, working with a large set of exercises and activities to design personalized therapy plans for their patients. This paper presents an expert system designed to provide support in that labor by automatically generating therapy plans containing semiannual activities in the areas of hearing, oral structure and function, linguistic formulation, expressive language+articulation, and receptive language. The system relies on an implementation of the Partition Around Medoids (PAM) algorithm to generate clusters of subject profiles with two levels of granularity, first considering broad diagnosis terms and medical conditions, and then looking at the specific communication skills affected. The proposal has been tested in collaboration with expert pathologists from three special education institutions of Ecuador, who were about 90% satisfied with the quality of the therapy plans provided. It was found that the two-level clustering is a crucial feature to tell apart individuals who have similar speech–language limitations, but arising from different medical conditions and, therefore, requiring different treatment.

Using the patient centered observation form: Evaluation of an online training program

ObjectiveThe Patient Centered Observation Form (PCOF) helps trainees identify and describe specific communication skills and enhance self-awareness about skill use. We studied the effectiveness and ease of use of the Improving Communication Assessment Program (ICAP), an online module that prepares trainees to use the PCOF. MethodsStudents, residents and medical educators viewed two videos (common and better skill use) of the same interaction and rated each video using the PCOF. Video sequence was randomized. We assessed agreement with experts, ease of use, concepts learned, and areas of confusion. ResultsTrainees (211) achieved strong agreement (.83) with experts and were highly satisfied (mean 4.18 out of 5). Viewing the common video first produced higher agreement (.87 vs .79; ES=.4) with experts and greater satisfaction (4.36 vs 4.02, ES .4) than viewing the better video first. Trainees reported diverse areas of learning and minimal confusion. ConclusionICAP training to use the PCOF may facilitate teaching and assessment of communication skills and enrich training through peer observation and feedback. We offer several educational strategies. Practice implicationsLearning to use the PCOF via the ICAP module may accelerate communication training for medical students, residents, medical educators and practicing clinicians.

Pilot to Design an Observed Structured Clinical Examination (OSCE) for the Communication Skill of Cultivating Prognostic Awareness (FR469-D)

•Discuss the developed case and scoring system that measures the skill of cultivating prognostic awareness.•Discuss how we evaluated how well our program taught this skill to our interprofessional fellowship class. As palliative care develops as a field, palliative-care specific communication skills are becoming more clearly defined. Helping patients to cultivate prognostic awareness to make informed medical decisions is one such skill. This skill requires clinicians to disclose prognostic information honestly and empathically while titrating the disclosure to the patient’s information preferences and enabling the patient to continue to hope. We developed a case and scoring system for an OSCE. The OSCE was administered to 11 interprofessional fellows at the beginning and end of fellowship. The case and scoring system were adjusted based on our observations and fellow feedback during this pilot phase so that the scores captured the desired expertise. Statistical analysis was performed on a program level to evaluate the fellowship program’s effectiveness in teaching this skill. The final version of the OSCE has three parts. Part 1 contains six communication steps to cultivate prognostic awareness. Part 2 contains one global rating of expertise. Part 3 is the NURSE scoring system for empathic communication. An OSCE provided a standardized measure for our fellowship’s effectiveness in teaching the skill of cultivating prognostic awareness. In addition to being more likely to discuss prognosis, more expert communicators were observed to use more NURSE skills and to disclose prognosis iteratively, repeatedly titrating the prognostic disclosure to the patient’s information preferences and ability to tolerate the discussion and integrate the information. Formal validation of the OSCE will require a larger number of participants, which we are in the process of accruing.

Perceptions of Italian student nurses of the concept of professional respect during their clinical practice learning experience

This research explored the perceptions of third-year undergraduate nursing students in Italy in relation to the perceptions they had about factors that promoted or diminished the development of professional identity and the professional respect in themselves, and in nursing during their clinical training. Clinical training was meaningful to develop specific knowledge, communication skills, and interpersonal and inter-professional relationships in the area considered. It was also found to be equally important to have good role models to foster the moral development and build a solid professional identity for nursing students. Building a professional identity is an ongoing process and depends on social contexts and on the students' development of the ability to act morally. In this framework, student nurses have to be strongly supported to develop their identity as moral agents in spite of the conflicting demands on them in hostile settings that often do not make them feel respected for their actions. Based on our evidence, we identified two conceptual areas: positive role models and supportive working environments; both have to be strongly connected each other if the student nurses have to develop a strong respect for the ethical values of their profession.

Video Review in Self-Assessment of Pharmacy Students’ Communication Skills

The objectives of this study were to develop a student self-assessment activity of a video-recorded counseling session and evaluate its impact on student self-perceptions of specific communication skills. This activity was incorporated into a core-communications course within the third professional year of a Doctor of Pharmacy curriculum. Student counseling sessions were video-recorded and released to students for self-assessment review. After watching their recorded counseling sessions, students completed an eight-question, paper-based survey which evaluated the impact of self-assessment on communication skill perceptions. Most students (95.6%) agreed or strongly agreed that their self-assessment process was valuable in developing their communication skills. The greatest change in assessment was associated with the use of eye contact (49.5%). Approximately 40% of students noted changes in perceptions for appropriate rate of speech (42.1%), voice volume (39.8%), and facial expressions (37.2%). Overall, self-assessment of video-recorded counseling sessions impacted students’ perceptions of both verbal and non-verbal communication skills.

Leading the Way to Wiser Choices: Communicating with Your Team, Institution, and Community About AAHPM’s List of “Five Things Physicians and Patients Should Question in HPM” (TH335)

Objectives 1. Identify the need for communication skills assessment tools for the Accreditation Council for Graduate Medical Education Next Accreditation System. 2. Define specific communication skills and the essential dimensions of each skill. 3. Utilize the communication skills assessment tool to identify communication skills and provide formative feedback; delineate other uses for the communication skills assessment tool, including its potential use with other levels of learners (eg, residents, medical students). Advancing communication skills is a core component of hospice and palliative medicine fellowship training. Emerging evidence suggests that discussions with patients and families about the patient’s prognosis and plan of care, led by expert skilled communicators, result in improved outcomes. Because communication skills are critical for medical trainees, communication skills assessment is central to the American College of Graduate Medical Education’s (ACGME) Next Accreditation System (NAS). This session will train palliative care faculty to evaluate trainees’ communication skills using a direct, real-time family meeting observation tool. In this session, we will present background on the need for communication skills assessment for hospice and palliative medicine fellowship programs within the context of the NAS. We will define the communication skills used commonly in the fields of hospice and palliative medicine and present the essential dimensions of each skill. In addition, we will orient the participants to FaMCAT, the newly developed, realtime direct observation communication skills assessment tool, and present the data on its feasibility, reliability, evaluator satisfaction, and ease of identification of areas for further training. We will link FaMCAT to NAS proposed competencies in communication. Next, we will train participants in communication skills assessment with FaMCAT using a mock family meeting. While observing the mock family meeting, the participants will complete the assessment tool. We will then break into four small groups, with one panel member moderating each group, and review the FaMCAT to reach consensus on the identification of each communication skill. Finally, we will demonstrate how using this tool will allow educators to provide formative feedback and need-based training, a NAS core principle. We will also provide time for a discussion of other potential uses for FamCAT, including the benefits and barriers to its use with other learners, including residents and medical students.

Dynamics of Parent–Adolescent Communication on Sexual Health and HIV/AIDS in Tanzania

Communication between parents and their adolescent children has been identified as one of the potential protective factors for adolescent sexual health. Qualitative exploration of sexual health communication with adolescents aged 12-15 (N=114) and a sub-group of the parents (N=20) was carried out. Four major themes emerged: reasons for parent-adolescent communications, or lack thereof; the focus of parental messages; the moral of the message; and the barriers to communication between parents and adolescents. Findings revealed similarities and discrepancies in views and perceptions between parents and adolescents. Adolescents and parents suggested that some sexual health communication was happening. Parents were reportedly likely to use fear to ensure that their children do not engage in risky sexual activities, while adolescents reported that conversations with their parents were mostly ambiguous and filled with warnings about the dangers of HIV/AIDS. Several communication barriers were reported by parents and adolescents. Parents of adolescents would benefit from HIV/AIDS specific communication skills.

Improving quality of life in aphasia—Evidence for the effectiveness of the biographic-narrative approach

Background: Caused by the constraints in communication, people with aphasia experience a pronounced decrease in quality of life (QoL). Beyond that identity negotiation is hindered which is crucial for QoL. This increases the severe loss of QoL. In sociocultural theories, it is postulated that identity is created through social interaction with others. In telling life stories, people build meaning and affirm identity. Biographic-narrative approaches use such life stories to support identity (re)development after disruptive events like stroke. Specific communication skills are needed for this, i.e., biographic-narrative competency. Therefore, such approaches have to be modified for the use in people with aphasia.Aims: We target on the development and evaluation of an interdisciplinary multimodal approach of biographic-narrative work. The primary aim is to improve QoL through identity renegotiation.Methods & Procedures: Five face-to-face interviews and seven group sessions were conducted in a before and after design over 10 weeks, with a follow-up assessment after three months. The intervention took place in ambulant rehabilitation units and at the Catholic University of Applied Sciences Mainz, Germany. The interviews comprise three narrative in-depth interviews, allowing participants to tell their life narration and two further semi-structured interviews to engross issues and prepare group topics. Narrations were supported by a multimodal approach, e.g., by pictures. To measure QoL, the Aachen Life Quality Inventory (ALQI), the Satisfaction with Life Scale (SWLS) and the Visual Analogue Mood Scales (VAMS) were used. Additionally, qualitative data was ascertained by semi-structured interviews with questions targeting personal growth or identity change. Seventeen participants, recruited consecutively from ambulant rehabilitation units and aphasia support groups, participated in the study. Almost all had a chronic but different type of aphasia (mean time post-stroke 40.82 months).Outcomes & Results: We found a significant improvement in health-related QoL measured by the ALQI (p < .05), which remained stable after three months without intervention. Also the self-reported mood state “happiness” grew significantly, “confused” and “tense” sank significantly (p < .05). As expected, overall life satisfaction which is a very broadly based and stable judgment did not change. According to self-reports in semi-structured interviews at the end of the intervention participants experienced a change in perspective accompanied by a change in quality of participation.Conclusions: QoL in people with aphasia can be improved by means of biographic-narrative intervention.

Talking about adherence

Talking about adherence

Comparison of the medical students’ perceived self-efficacy and the evaluation of the observers and patients

BackgroundThe accuracy of self-assessment has been questioned in studies comparing physicians’ self-assessments to observed assessments; however, none of these studies used self-efficacy as a method for self-assessment.The aim of the study was to investigate how medical students’ perceived self-efficacy of specific communication skills corresponds to the evaluation of simulated patients and observers.MethodsAll of the medical students who signed up for an Objective Structured Clinical Examination (OSCE) were included. As a part of the OSCE, the student performance in the “parent-physician interaction” was evaluated by a simulated patient and an observer at one of the stations. After the examination the students were asked to assess their self-efficacy according to the same specific communication skills.The Calgary Cambridge Observation Guide formed the basis for the outcome measures used in the questionnaires.A total of 12 items was rated on a Likert scale from 1–5 (strongly disagree to strongly agree).We used extended Rasch models for comparisons between the groups of responses of the questionnaires. Comparisons of groups were conducted on dichotomized responses.ResultsEighty-four students participated in the examination, 87% (73/84) of whom responded to the questionnaire. The response rate for the simulated patients and the observers was 100%.Significantly more items were scored in the highest categories (4 and 5) by the observers and simulated patients compared to the students (observers versus students: -0.23; SE:0.112; p=0.002 and patients versus students:0.177; SE:0.109; p=0.037). When analysing the items individually, a statistically significant difference only existed for two items.ConclusionThis study showed that students scored their communication skills lower compared to observers or simulated patients. The differences were driven by only 2 of 12 items.The results in this study indicate that self-efficacy based on the Calgary Cambridge Observation guide seems to be a reliable tool.

Preparing Teachers: Expectations and Existing Situation at Faculties of Education

In-depth interviews were conducted to research the expectations of teacher educators from the prospective teachers and their opinions on the existing facilities provided by the faculty of education. Content analysis, performed on the data collected from a sample of eight teacher educators from different departments in one of the faculties of education, suggested that the expectations from teacher candidates had seven dimensions: content knowledge, pedagogical content knowledge, country specific realities, communication skills, teacher characteristics, scientific knowledge and research skills, and professional development. Regarding the results, implications for teacher education programs were discussed, and suggestions for further research were made

Student-patient communication during physical examination

Communication during the physical examination has been understudied. Explicit, evidence-based guidance is not available as to the most effective content or process of communication while performing physical examination, or indeed how to teach this to medical students. The objective of this exploratory study was to explore how medical students communicate with patients when performing a physical examination in the absence of formal teaching on how to communicate in this situation. We recorded 15 senior UK medical students as they performed physical examinations with real patients in general practice situations. The transcriptions were analysed for linguistic functions to identify the use of different categories of utterances. Student utterances fell into four categories: minimising language; using positive evaluative language; repeating the patient; and stating intentions or explanations and requesting consent. Students would often preface an explanation or action by phrases showing 'togetherness', by using 'we' rather than 'you'. They also used linguistic 'hedges' to minimise the impact of an utterance. Senior medical students speak very little during the physical examination. When they do, they use a taxonomy of utterances that reflects those reported in doctor-patient interactions. Identifying how medical students communicate when carrying out the physical examination is the first step in planning how to best teach specific communication skills. Further work is needed to identify how best to explore communication during physical examination, and how this is taught and learned.