Clinical Communication Skills Training Research Articles

Integrating medical and practical skills in communication skills training: Do students feel it supports them with transfer from classroom to practice?

To describe innovations in a clinical communication skills training (CCST) program, aimed at facilitating transfer of communication skills from classroom to clinical practice and report student's evaluations regarding this program. To facilitate transfer, we integrated CCS with medical and practical skills, and we developed simulation sessions closely resembling clinical practice in case-history's, length of consultation, and patient-population. Feedback was given on communication skills and medical knowledge and skills. Student's opinions about whether these elements were helpful, were evaluated using a questionnaire. Responses of 144 students were analyzed. The majority of the respondents agreed that this CCST program helped them with transfer of CCS from classroom to clinical practice, as did the feedback on medical content and communication skills in the same session. Students indicate that simulations resembling clinical practice and feedback on both CST and medical content facilitate the transfer of their skills to clinical practice. This CCST program is innovative because it integrates medical and practical skills, with elements aiming to create an educational environment resembling clinical practice as closely as possible in order to facilitate transfer to clinical practice.

Teaching clinical communication skills in postgraduate medical education with particular emphasis on palliative medicine

Clinical communication skills have been taught and researched for more than 40 years. This set of processes and communication skills with patients and/or their family, and other healthcare professionals, improves the quality of healthcare services, increases patient involvement in the treatment process and improves job satisfaction. It seems particularly important for physicians working in palliative care to have these skills. The process of pre-graduate and post-graduate training was analysed in terms of teaching clinical communication and the expectations of healthcare professionals, with a particular focus on palliative medicine. The results were compared with those of a survey of 123 physicians who identified their training needs in clinical communication. The results show that there is a significant gap between physicians' expectations of their clinical communication skills training and the requirements of the curricula. It is therefore reasonable to modify the existing clinical communication curricula.

Use of a Standardized Tracheostomy Patient Simulation to Evaluate Student Clinical Communication Skills

Simulation is a valid pedagogical tool used to teach students, observe student clinical skills, and to assess clinical competencies. During the COVID-19 pandemic, a lack of medical speech-language pathology placements required graduate programs to re-examine clinical training. Simulation has proven useful in providing an alternative and safe learning modality. Standardized patients, which are one simulation modality, provide increased standardization and higher fidelity than medical manikins. This is particularly true in the context of both student learning and demonstration of clinical communication skills (CCS) within a simulated learning environment where the simulated patient can interact authentically with the student clinician. CCS are important because they can lead to better treatment outcomes and strengthen the therapeutic alliance. The purpose of this study was to evaluate the evidence for a CCS training in the context of a speaking valve trial with a standardized tracheostomy patient. Results showed that students are demonstrating emerging skills or have already developed CCS in this context. Student questionnaire ratings suggest that this simulation was helpful to their learning as it provided a safe environment for them to practice valuable clinical skills. Simulation appears to be a viable modality to use when training CSD students to improve their CCS.

Peer assessment approach to promote clinical communication skills in a blended learning course of early clinical exposure

Background: Blended learning offers opportunities for the complexity of learning in clinical education. Student peer assessment is widely used as a form of formative assessment in early clinical exposure programs, especially clinical communication skills training. This study aimed to describe clinical communication skills competencies of second-year students and to identify the relationships between peer and faculty assessment of communication skills in a blended learning program format. Methods: A total of 474 second-year general medical students and dental students participated in the study. Peer and lecturer assessment forms with a 5-point Likert scale according to the Calgary-Cambridge guide format were used to evaluate students’ performance of basic communication skills, relationship building, and history taking. Pearson’s correlation coefficients and paired t-test were applied. A p-value < 0.05 was considered statistically significant. Results: Most of students were rated at distinction level (score at 7-8.4) in communication skills. Mean of the overall score by peer and faculty assessment were 7.46 ± 1.03 and 7.17 ± 0.68, respectively. Peers rarely provided negative ratings on subcategories of communication skills. Skills of understanding the patient’s perspectives and gathering information were the most reported skills needed to improve among students. Significant positive correlations were found between peer and faculty evaluations for building relationship, establishing initial rapport, and gathering information domains (p < 0.01). Students tended to grade their colleagues higher for building relationship (3.88 ± 0.62) and establishing initial rapport domains (3.72 ± 0.61) than other domains, meanwhile, teachers tended to grade building relationship (3.80 ± 0.55) and gathering information domains (3.64 ± 0.38) higher than other domains. Conclusion: The findings suggest that student peer evaluation can be valuable for clinical education. As part of a formative assessment, it can be also used for faculty to evaluate students’ clinical communication skills performance in innovative medical education programs. Key words: peer assessment, clinical communication skills, practice of medicine, early clinical practice, blended learning.

Clinical Communication Skills Training in Third‐ and Fourth‐Year Medical Students: A Qualitative Study

Healthcare professionals require strong clinical communication skills (CCS), yet many healthcare workers demonstrate discrepancies between their self‐rated competency in communication skills and patient satisfaction. These communication skill deficiencies may cause increased stress and anxiety in healthcare professionals, which in turn adversely affects patient compliance and long‐term health outcomes. According to the Transaction Model of Communication, communication can be shaped by social, relational, and cultural contexts. This study sought to identify the factors that influence how medical students gained CCS and how those factors evolved over the course of the medical school experience. Semi‐structured interviews of third‐ and fourth‐year medical students were conducted at the University of Mississippi Medical Center. Qualitative responses underwent deductive thematic analysis using the Transaction Model of Communication with iterative open coding to identity and name themes. Results indicated that students felt there were profound differences in CCS training between the preclinical versus clinical years. They suggested preclinical CCS training, while valuable, often falls short in preparing them for the challenges of navigating real patient care. Medical students also recognized the value of CCS for safe and effective healthcare practice, but strongly advocated for changes to the current CCS curriculum, including earlier exposure to real patients, increased cultural awareness training, explicit telehealth training, and increased opportunities to practice “delivering bad news”, even in simulated settings. The findings of this study have provided new insights into the individual medical student experience, which speak to the experiences of medical students and practitioners throughout the global healthcare field. This study’s findings may be used to inform curricular changes such as increased training on select topics and earlier access to real patient experiences, which may improve students’ confidence and competency in their clinical communication abilities, thereby improving patient care.

Maximizing Student Clinical Communication Skills in Dental Education-A Narrative Review.

Dental student training in clinical communication skills and behavioral aspects of treatment are lauded as clinically meaningful in the dental education literature. However, many dental school curricula still only provide didactic, one-time coursework with multiple choice examination assessment and little or no student skill-activating activities. This article aims to review literature relevant to optimizing clinical communication and behavioral skills in dental education. The review summarizes findings of several relevant reviews and usable models to focus on four themes: (1) special characteristics of dentistry relevant to communication skill needs, (2) essential components of dental student learning of communications skills, (3) clinical consultation guides or styles and (4) optimal curricular structure for communication learning effectiveness. Contexts of communications in the dental chair differ from medical and other allied health professions, given the current mostly dentist-dominant and patient-passive relationships. Patient-centered communication should be trained. Dental students need more practical learning in active listening and patient-centered skills including using role-play, videotaping and ultimately, real patient training. Medical consultation guides are often unwieldy and impractical in many dental contexts, so a shortened guide is proposed. Communication skills need to be learned and taught with the same rigor as other core dental skills over the entire course of the dental curriculum.

'This Adds Another Perspective': Qualitative Descriptive Study Evaluating Simulation-Based Training for Health Care Assistants, to Enhance the Quality of Care in Nursing Homes.

Much of the UK’s ageing population lives in care homes, often with complex care needs including dementia. Optimal care requires strong clinical leadership, but opportunities for staff development in these settings are limited. Training using simulation can enable experiential learning in situ. In two nursing homes, Health Care Assistants (HCAs) received training in clinical communication skills (Situation-Background-Assessment-Recommendation Education through Technology and Simulation, SETS: group training with an actor simulating scenarios); and dementia (A Walk Through Dementia, AWTD: digital simulation, delivered one-to-one). In this qualitative descriptive study, we evaluated the potential of this training to enhance HCAs’ clinical leadership skills, through thematic analysis of 24 semi-structured interviews with HCAs (before/after training) and their managers and mentors. Themes were checked by both interviewers. HCAs benefitted from watching colleagues respond to SETS scenarios and reported greater confidence in communicating with registered healthcare professionals. Some found role-play participation challenging. AWTD sensitised HCAs to the experiences of residents with dementia, and those with limited dementia experience gained a fuller understanding of the disease’s effects. Staffing constraints affected participation in group training. Training using simulation is valuable in this setting, particularly when delivered flexibly. Further work is needed to explore its potential on a larger scale.

Assessment of Clinical Communication Skills of Medical Students Through the Simulated Patient Approach

Background: Good communication skill is as crucial for the medical practitioner as medical knowledge for better patient outcome. Incorporating simulated patients for teaching communication skills and assessment can be beneficial for the learners as it gives them learning opportunities under a controlled environment. Objectives: 1. To assess the improvement in communication skills with the use of simulated patients after communication skills training. 2. To obtain feedback from simulated patients about patient satisfaction. 3. To obtain feedback from students and faculties about communication skills training intervention and simulated patients for assessment. Methods: After a thorough introduction and explanation of the study, out of total of 139 students from the fifth-semester bachelor of medicine and bachelor of surgery (MBBS), 44 students gave the willingness to participate. Students were divided into two groups of 22 students; one group acted as doctors, and the other group acted as a standardized patient group. Each simulated patient was randomly assigned to one doctor to make a pair; thus, 22 random pairs of doctor and patients were formed. Before and after giving communication skills training, each doctor-patient pair's consultation was analyzed for clinical communication skills using the Kalamazoo scale adapted version by trained observers. After each consultation, each patient was given a patient satisfaction questionnaire to fill. Results: In this study, students were improved significantly in each competency of the Kalamazoo scale after communication skills training. Before giving this training, the total mean communication skills score of students was 49.86 (SD=10.73), and after training, it significantly improved to 75.45 (SD=15.78) (P < 0.05). Before the training, the mean patient's satisfaction score was 48.95 (SD=12.18), which significantly improved after training to 60.36 (SD=3.99) (P < 0.05). Students as well as observers, found the Kalamazoo scale very useful for communication skills training and assessment. In feedback, they mentioned that the simulated patient approach for the assessment of communication skills was useful. Conclusions: This study showed that the clinical communication skills training with a structured scale was helpful for medical students. Students were found interested in learning such new skills; thus, clinical communication skills training should be an integral part of medical education. Simulated patients were found useful and can be used for the assessment of other clinical skills in medical education.

Clinical Communication Skills Training in Dental Medical Education: The COVID-19 Pandemic Challenge

It is very important for healthcare professionals to have good clinical communication skills, especially dentists. Patient-centred care results in patient satisfaction, better outcomes, and less complaints from dental patients. Due to the onset of the COVID-19 pandemic, the clinical communications skills programme of the pre-graduate course in dental medicine at the University of Porto had to be transformed to an online format. Based on their role as faculty, the authors aimed to recount their initial reflections and concerns within this perspective, and to share how they adapted to the new reality of teaching clinical communication skills online, as well as the conclusions of our experience, in the hope that this will help others who may have to go through a similar process. The authors acknowledged that the students achieved the pre-established goals of the clinical communications skills programme through the new online format.

Student-informed directives for clinical communication skills training in undergraduate healthcare programmes: Perspectives from a South African university

Background. Clinical communication skills (CCS) are fundamental to good-quality healthcare and health outcomes, but remain problematic for healthcare students – in particular in the multilingual, multicultural South African context. As CCS can be taught, the importance of CCS training in healthcare programmes, as the basis of clinical practice, is well known. Objectives. To suggest practical, student-informed directives for CCS training, we explored current challenges of undergraduate healthcare students and their CCS training. Methods. The research was conducted in two phases. A mixed-methods approach was followed in phase 1, including a questionnaire survey ( n =38) and semi-structured interviews ( n =19), among third-year physiotherapy students. A quantitative questionnaire survey was conducted in phase 2 among final-year allied healthcare students ( n =105). Results. Results from phase 1 indicated that students found it difficult to communicate with other members of the healthcare team (64%) and with patients’ families (82%). Students indicated that language barriers influenced their treatment of patients negatively. In phase 2 of the research, only 43% of students indicated previous exposure to CCS training, and they supported the inclusion of specific CCS training methods throughout their undergraduate education. Conclusions. CCS training directives, which are specifically focused on patient, family, interdisciplinary and written communication and enhancement of the student voice in the training, are suggested for inclusion in undergraduate healthcare programmes.

Empathy, Introversion and the OSCE. Reflections of a 2nd Year Medical Student.

This article was migrated. The article was marked as recommended. Clinical communication skills training is a key element of modern medical education as it has been shown to have multiple benefits in delivering healthcare. Various factors affect clinical communication and we believe that personality is a major one. As an introverted second year medical student who has recently failed his Objectively Structured Clinical Examination (OSCE) despite passing the written knowledge examination with flying colours, I reflect on my OSCE experience and try to understand the reasons that caused my failure. Methods for improving communication skills such as role plays, systematic desensitisation and remediation are suggested. Although there is one study that has shown that introverted students score lower in OSCEs compared to extroverted students, more research is needed in this area in order to draw meaningful conclusions. Therefore, a research study is suggested to look into the correlation between personality traits and OSCE results. If a correlation is indeed found, it may suggest that medical schools should provide additional support in communication skills for introverted students.

Collaborative care for the detection and management of depression among adults with hypertension in South Africa: study protocol for the PRIME-SA randomised controlled trial

BackgroundThe high co-morbidity of mental disorders, particularly depression, with non-communicable diseases (NCDs) such as cardiovascular disease (CVD), is concerning given the rising burden of NCDs globally, and the role depression plays in confounding prevention and treatment of NCDs. The objective of this randomised control trial (RCT) is to determine the real-world effectiveness of strengthened depression identification and management on depression outcomes in hypertensive patients attending primary health care (PHC) facilities in South Africa (SA).Methods/designThe study design is a pragmatic, two-arm, parallel-cluster RCT, the unit of randomisation being the clinics, with outcomes being measured for individual participants. The 20 largest eligible clinics from one district in the North West Province are enrolled in the trial. Equal numbers of hypertensive patients (n = 50) identified as having depression using the Patient Health Questionnaire (PHQ-9) are enrolled from each clinic, making up a total of 1000 participants with 500 in each arm. The nurse clinicians in the control facilities receive the standard training in Primary Care 101 (PC101), a clinical decision support tool for integrated chronic care that includes guidelines for hypertension and depression care. Referral pathways available include referrals to PHC physicians, clinical or counselling psychologists and outpatient psychiatric and psychological services. In the intervention clinics, this training is supplemented with strengthened training in the depression components of PC101 as well as training in clinical communication skills for nurse-led chronic care. Referral pathways are strengthened through the introduction of a facility-based behavioural health counsellor, trained to provide structured manualised counselling for depression and adherence counselling for all chronic conditions. The primary outcome is defined as at least 50% reduction in PHQ-9 score measured at 6 months.DiscussionThis trial should provide evidence of the real world effectiveness of strengtheneddepression identification and collaborative management on health outcomes of hypertensive patients withcomorbid depression attending PHC facilities in South Africa.Trial registrationSouth African National Clinical Trial Register: SANCTR (http://www.sanctr.gov.za/SAClinicalTrials) (DOH-27-0916-5051). Registered on 9 April 2015. ClinicalTrials.gov: ID: NCT02425124. Registered on 22 April 2015.

Is jargon deterrent to effective communication in dental practice? the budding dentists' outlook

Background: Patient–professional communication is a fundamental skill of medical practice. Health-care professionals have to be aware of their own communication practices and need to undergo periodic appraisal of the same. Overzealous and unrepressed use of jargon hinders effective communication between the doctors and patients, leading to a series of misunderstanding. The aim of the study was to assess the use of jargon and its acceptance in clinical history taking among dental students and interns in a dental teaching hospital of Bhubaneswar, Odisha, India. Materials and Methods: A cross-sectional questionnaire-based survey was carried out, consisting of 16 questions on BDS 3rd-year, 4th-year dental students and dental interns. Both descriptive and inferential statistics were computed. Differences between groups were examined using Chi-square test. The level of statistical significance was set at P ≤ 0.05. Results: Two hundred and sixty-seven individuals participated in the present survey, representing an overall response rate of 92.4%. Nearly, 78.9%, 89.6%, and 78% of BDS 3rd-year, 4th-year, and dental interns, respectively, used jargon in case history taking. Almost 61.6% of dental interns admitted that they always used jargon and 22% admitted that they used jargon only when there was a lack of time. Conclusion: This study showed widespread use of jargon/abbreviations in case history taking among the respondents. More medical/dental schools, residency programs, and continuing education programs for practicing physicians need to include training in clinical communication skills to enhance health outcomes.

Evaluation of clinical communication skills training program for medical interns at a tertiary care teaching hospital, Puducherry

Evaluation of clinical communication skills training program for medical interns at a tertiary care teaching hospital, Puducherry

A Web-Based Telehealth Training Platform Incorporating Automated Nonverbal Behavior Feedback for Teaching Communication Skills to Medical Students: A Randomized Crossover Study.

BackgroundIn the interests of patient health outcomes, it is important for medical students to develop clinical communication skills. We previously proposed a telehealth communication skills training platform (EQClinic) with automated nonverbal behavior feedback for medical students, and it was able to improve medical students’ awareness of their nonverbal communication.ObjectiveThis study aimed to evaluate the effectiveness of EQClinic to improve clinical communication skills of medical students.MethodsWe conducted a 2-group randomized crossover trial between February and June 2016. Participants were second-year medical students enrolled in a clinical communication skills course at an Australian university. Students were randomly allocated to complete online EQClinic training during weeks 1–5 (group A) or to complete EQClinic training during weeks 8–11 (group B). EQClinic delivered an automated visual presentation of students’ nonverbal behavior coupled with human feedback from a standardized patient (SP). All students were offered two opportunities to complete face-to-face consultations with SPs. The two face-to-face consultations were conducted in weeks 6–7 and 12–13 for both groups, and were rated by tutors who were blinded to group allocation. Student-Patient Observed Communication Assessment (SOCA) was collected by blinded assessors (n=28) at 2 time points and also by an SP (n=83). Tutor-rated clinical communications skill in face-to-face consultations was the primary outcome and was assessed with the SOCA. We used t tests to examine the students’ performance during face-to-face consultations pre- and postexposure to EQClinic.ResultsWe randomly allocated 268 medical students to the 2 groups (group A: n=133; group B: n=135). SOCA communication skills measures (score range 4–16) from the first face-to-face consultation were significantly higher for students in group A who had completed EQClinic training and reviewed the nonverbal behavior feedback, compared with group B, who had completed only the course curriculum components (P=.04). Furthermore, at the second face-to-face assessment, the group that completed a teleconsultation between the two face-to-face consultations (group B) showed improved communication skills (P=.005), and the one that had teleconsultations before the first face-to-face consultation (group A) did not show improvement.ConclusionsThe EQClinic is a useful tool for medical students’ clinical communication skills training that can be applied to university settings to improve students clinical communication skills development.

Attitudes of Portuguese medical residents’ towards clinical communication skills

ObjectiveTo explore the attitudes and perceptions of Portuguese residents towards Clinical Communication Skills (CCS) and the need for complementary training. Methods78 medical residents responded to an on-line questionnaire which comprised demographic data, open-ended questions and a Portuguese version of the Communication Skills Attitude Scale (CSAS). ResultsResidents gave significantly higher scores (P<0.001) on CSAS1 (attitudes towards communication skills in general, compared to CSAS2 (attitudes towards the teaching/learning process of CCS). Residents doing their residency training in other parts of the country, other than the north, reveal a higher perception of insufficient training (72.7% vs. 38.7%, P=0.036). ConclusionResidents showed more positive attitudes towards communication skills than towards the teaching/learning process. They admit to need more training in CCS in their residency year and highlight that the clinical cycle of undergraduate education should integrate these topics. Content analysis indicates that residents’ perceptions are context-influenced. Practice implicationsIntegration of CCS in the undergraduate education, enhanced during post-graduate training. Training of clinical faculty and supervisors/tutors and the role that stakeholders have to play in order to promote continuous training in CCS; encourage patient-centeredness and reflective practice, as to facilitate transfer of acquired skills to clinical practice.

Dental Student Attitudes Towards Communication Skills Instruction and Clinical Application

This study investigated dental students' attitudes towards communication skills instruction and clinical application and explored the impact of a one-semester course and year in school on students' attitudes, measured by the Communication Skills Attitude Scale. Demographic characteristics and self-assessment of communication skills were also analyzed. The study employed a pretest-posttest survey design combined with cross-sectional data. Participants were first- and fourth-year students at a U.S. dental school. Out of a possible 120 students, 106 (fifty-seven D1 and forty-nine D4) participated in the pretest, an 88 percent response rate; out of a possible 121 students, 115 (fifty-seven D1 and fifty-eight D4) participated in the posttest, a 95 percent response rate. In the results, D4 students consistently demonstrated less positive attitudes towards communication skills instruction and more negative attitudes regarding the importance of interpersonal skills in clinical encounters than did their D1 counterparts. A single communications course had no discernible effect on attitudes or self-assessments for either cohort. Females reported more positive attitudes towards clinical application of interpersonal skills than did males. Gender significantly interacted with two demographic variables: primary language and parent as health care professional. Female children of health care professionals reported poorer attitudes towards clinical communication skills training and application than did their male counterparts. Generally, parental occupation in health care moderated the decrease in positive attitudes over time towards clinical usefulness of communication skills. The D4 students rated their communication skills higher than did the D1 students. Students who demonstrated more positive attitudes towards communication skills training and application were more likely to say their own skills needed improvement.

Impact of a faculty development programme for teaching communication skills on participants’ practice

Purpose of the studyA 6-month faculty development programme was designed to improve supervisors’ feedback to junior doctors on their clinical communication skills (CS) and included both CS and teaching skills...

Interdisciplinary collaboration for clinical skills acquisition in the transition to ward-based learning

Internationalization of higher education affects strategies accommodating different learning styles and the provision of communication and learning support to students. This paper describes clinical communication skills training initiatives developed by linguists in collaboration with clinicians for undergraduate medical students on their first clinical placement. This approach deconstructs the language, underlying behavioural factors, argumentation and interactional features of professional tasks, serving several pedagogical purposes: learning needs analysis; deconstruction of tutor modelling; and concrete strategies to improve learner performance. Communication frameworks and their application are described with two illustrative cases. Three years of evaluation data determined impacts on students and tutors. Students report increased confidence in communication, capacity to practise clinical skills independently and supported integration of medical knowledge into clinical practice. Co-delivery enriched teaching methodology for tutors. Collaboration between linguists and clinicians provides a useful model for clinical and communication skills teaching in a wide range of undergraduate and graduate clinical and health discipline training contexts.

Curricular disconnects in learning communication skills: What and how students learn about communication during clinical clerkships

ObjectiveIn many medical schools, formal training in clinical communication skills (CCS) mainly occurs during pre-clinical training prior to clinical rotations. The current research examined student perceptions of both what and how they learn about CCS during clinical rotations. MethodsDuring 2008 and 2009, 4th year medical students were invited to participate in interviews focused on learning of CCS during clinical rotations. Interview transcripts were analyzed to identify salient themes in their discussions of CCS in clinical learning experiences. Results107 senior students participated and reported learning CCS during clinical rotations mainly by: (1) observing faculty and residents; (2) conducting interviews themselves; and (3) through feedback on patient presentations. Teacher role modeling tended to not reinforce what they had learned pre-clinically about CCS and clinical teachers rarely discussed CCS. Feedback on patient presentations affected students’ communication styles, at times prompting them to omit use of CCS they had learned pre-clinically. ConclusionsStudents reported that clinical learning experiences often do not reinforce the CCS they learn pre-clinically. Practical implicationsDisconnects between pre-clinical and clinical CCS teaching need to be reconciled through more explicit pedagogical attention to CCS issues during clinical rotations both in the formal and informal curriculum.