11 Filling the void: preparing future junior doctors for challenging conversations

2018 ◽  
Vol 8 (3) ◽  
pp. 363.3-364
Author(s):  
Hannah Costelloe ◽  
Alice Copley ◽  
Andrew Greenhalgh ◽  
Andrew Foster ◽  
Pratik Solanki
Keyword(s):  
Palliative Care ◽  
Medical Education ◽  
Medical Students ◽  
Small Group ◽  
End Of Life ◽  
Communication Skills ◽  
Skills Training ◽  
Junior Doctors ◽  
List Type ◽  
The Impact

Evidence demonstrates that medical students have limited experience in developing ‘higher-order communication skills’ (Kaufman et al. 2000). Anecdotally many do not feel confident in their ability to conduct difficult conversations often due to a lack of exposure to such scenarios in practice or a pervasive notion that these scenarios are inappropriate for students and beyond the scope of a junior doctor’s role and thus not a focus of curriculums (Noble et al. 2007). There is however a correlation between level of clinical experience and improved confidence for medical students (Morgan and Cleave-Hogg 2002).We surveyed a group of final year medical students to assess their confidence using a 10-point Likert scale in tackling common palliative and end of life care scenarios. Our intervention comprised a study day of 10 practical small-group teaching simulation and OSCE-style stations designed to provide exposure to common experiences in a controlled setting. We reassessed the confidence of students after delivery and objectively explored the impact of the day by asking participants to complete a validated assessment before and after the course. All results showed significant improvement on t-testing: confidence in end of life communication in an OSCE setting improved by 42.2% and assessment marks improved by 24.7% (p=0.039).Palliative care is an area in which students approaching the end of undergraduate training feel underprepared. Our findings demonstrate that small group sessions improve confidence by facilitating communication practice in a controlled environment and providing crucial exposure to common palliative care scenarios they will face as doctors.References. Kaufman D, Laidlaw T, Macleod H. Communication skills in medical school: Exposure confidence and performance. Academic Medicine [online] 2000;75(10):S90–S92. Available at https://journals.lww.com/academicmedicine/Fulltext/2000/10001/Communication_Skills_in_Medical_School__Exposure.29.aspx [Accessed: 30 May 2018]. Morgan P, Cleave-Hogg D. Comparison between medical students’ experience confidence and competence. Medical Education [online] 2002;36(6):534–539. Available at https://doi.org/10.1046/j.1365-2923.2002.01228.x [Accessed: 30 May 2018]. Noble L, Kubacki A, Martin J, Lloyd M. The effect of professional skills training on patient-centredness and confidence in communicating with patients. Medical Education [online] 2007;41(5):432–440. Available at https://doi.org/10.1111/j.1365-2929.2007.02704.x [Accessed: 30 May 2018]

scholarly journals The effectiveness of communication-skills training interventions in end-of-life noncancer care in acute hospital-based services: A systematic review

2015 ◽  
Vol 14 (4) ◽  
pp. 433-444 ◽  
Author(s):  
Laura Lord ◽  
David Clark-Carter ◽  
Amy Grove
Keyword(s):  
Systematic Review ◽  
End Of Life ◽  
Communication Skills ◽  
Self Efficacy ◽  
Skills Training ◽  
Communication Skills Training ◽  
Training Interventions ◽  
Staff Behavior ◽  
The Impact ◽  
End Of Life Communication

AbstractObjective:A systematic review was conducted in order to explore the effectiveness of communication-skills training interventions in end-of-life care with noncancer acute-based healthcare staff.Method:Articles were included if they (1) focused on communication-skills training in end-of-life/palliative care for noncancer acute-based staff and (2) reported an outcome related to behavior change with regard to communication. Sixteen online databases were searched, which resulted in 4,038 potential articles. Screening of titles left 393 articles that met the inclusion criteria. Abstracts (n = 346) and full-text articles (n = 47) were reviewed, leaving 10 papers that met the criteria for our review. All articles explored the effect of communication-skills training on aspects of staff behavior; one study measured the effect on self-efficacy, another explored the impact on knowledge and competence, and another measured comfort levels in discussing the end of life with patients/families. Seven studies measured a number of outcomes, including confidence, attitude, preparedness, stress, and communication skills.Results:Few studies have focused on end-of-life communication-skills training in noncancer acute-based services. Those that do have report positive effects on staff behavior with regard to communication about the end of life with patients and families. The studies varied in terms of the population studied and the health services involved, and they scored only moderately or weakly on quality. It is a challenge to draw a definite conclusion about the effectiveness of training interventions in end-of-life communication because of this. However, the findings from our review demonstrate the potential effectiveness of a range of training interventions with healthcare professionals on confidence, attitude, self-efficacy, and communication skills.Significance of results:Further research is needed to fully explore the effectiveness of existing training interventions in this population, and evidence using objective measures is particularly needed. Ideally, randomized controlled trials or studies using control groups and longer follow-ups are needed to test the effectiveness of interventions.

Respecting patient choices: using the ’Go Wish' cards as a teaching tool

2017 ◽  
Vol 8 (2) ◽  
pp. 194-197 ◽  
Author(s):  
Hibah Osman ◽  
Katia El Jurdi ◽  
Ramzi Sabra ◽  
Thalia Arawi
Keyword(s):  
Palliative Care ◽  
Medical Education ◽  
Medical Students ◽  
End Of Life ◽  
Thematic Analysis ◽  
Death And Dying ◽  
Teaching Tool ◽  
Student Reflection ◽  
Second Year ◽  
Self Discovery

BackgroundIndividuals have different values and priorities that can have an important impact on their medical management. Understanding this concept can help physicians provide medical care that is in line with the goals of their patients. Communicating this message effectively to students is challenging.ObjectiveTo report our experience with using Go Wish cards in the medical education setting.DesignA thematic analysis of student reflection papers using grounded theory.Setting/SubjectsSecond-year medical students participated in an activity using the Go Wish cards as part of a course module on palliative care. The activity aimed to encourage students to reflect on their own choices at the end of life and to highlight that different people have different priorities.ResultsForty-two students (42%) mentioned the Go Wish activity in their reflections on the module. They reported that the activity demonstrated the different priorities at the end of life, it illustrated the importance of providing personalised care, it promoted self-discovery, it transformed their view of death and dying, and it increased their appreciation of the importance of palliative care.ConclusionGo Wish cards can be used to help illustrate the variability in priorities of patients. They can be used as an effective to teach medical students about the importance of considering patient preferences when illness progresses.

Metadiscourse, materiality and morality in communication skills training with simulated patients

2021 ◽  
Vol 16 (3) ◽  
Author(s):  
Grace Peters
Keyword(s):  
Medical Education ◽  
Medical Students ◽  
Communication Skills ◽  
Clinical Skills ◽  
Standardized Patients ◽  
Skills Training ◽  
The United States ◽  
Simulated Patient ◽  
Simulated Patients ◽  
Communication Skills Training

Simulated patients (also known as standardized patients) are commonly employed by institutions of medical education to train medical students and assess their communication skills. This article demonstrates that such patients are not translational devices that enact prima facie standards of communication skills as laid out by the institutions that use them, but rather metadiscursively transform communication practices. This is shown via a case study that closely examines a series of interactions between a simulated patient and a third-year medical student during a practice exam designed for the United States Medical Licensing Examination Step 2 Clinical Skills. I use discourse analysis to show how communication skills are transformed in three practices: (1) simulated consultations between standardized patients and medical students; (2) spoken evaluations offered by standardized patients after simulated consultations between standardized patients and medical students; and (3) written evaluations offered by standardized patients in assessment forms. In particular, by attending to how a simulated patient makes the act of draping the patient a relevant communication skill, I explicate the material elements and moral implications of clinical communication. Finally, I consider the instructive role simulated patients play in medical education and how their standards build on and often stand in contrast to communication skills techniques. I conclude by making practical suggestions for communication skills training with simulated patients in medical education.

48 Junior doctors and end of life care: a systematic review and narrative synthesis

2018 ◽  
Vol 8 (3) ◽  
pp. 378.1-378
Author(s):  
Aamena Bharmal ◽  
Tessa Morgan ◽  
Stephen Barclay
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Empirical Literature ◽  
Junior Doctors ◽  
List Type ◽  
Narrative Synthesis ◽  
Life Care ◽  
Dying Patients

BackgroundNearly 50% of all deaths in the UK occur in hospitals.1 The majority of these patients die in a generalist setting2 where their medical care is predominately provided by junior doctors. There is a growing recognition of a need to embed palliative care into doctors’ training.3Little evidence exists, however, concerning junior doctors’ current experiences of palliative care.AimsTo review the empirical literature between 2000 and 2018 concerning junior doctors experience of and preparation for palliative and end of life care.MethodsSystematic review and narrative synthesis of qualitative and quantitative studies within six databases to find empirical studies on junior doctors experience of adult palliative care in inpatient hospital or hospice settings.ResultsFrom the initial 6308 titles identified, 32 studies met the inclusion criteria with a further five identified from reference searching.Three key themes were identified:‘Significance of death and dying’‘Thrown into the deep end’‘Addressing the gaps’. All the studies provided evidence that junior doctors care for many dying patients very early in their career. Junior doctors do not feel adequately prepared to care for dying patients and feel unsupported when doing so. Junior doctors report emotional distress when caring for their first few dying patients, memories of which continue to affect them throughout their careers. Their attitudes towards end–of–life care varied: some reported it as a privilege while others associated it with a culture of disengagement that stigmatised dying patients.ConclusionsJunior doctors need further support, education and preparation for their exposure to palliative care. Experiential learning, reflective practice and role modelling are described as the most effective ways to learn palliative care and this also teaches them other transferrable skills such as communication, teamwork and professionalism that are vital for their future careers.References. Office for National Statistics Deaths Registered in England and Wales2016.. Gomes B, Higginson I. Where people die (1974–2030): Past trends, future projections and implications for care. Palliative Med2008;22:33–41.. General Medical Council. Tomorrow’s doctors: Recommendations on undergraduate medical education 2002 (2nd ed.). London: GMC.

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

2020 ◽  
Vol 19 (3) ◽  
Author(s):  
Nilesh Chavda ◽  
Priti Solanky ◽  
Jatin V Dhanani ◽  
Aashal Shah ◽  
Nirav Patel ◽  
...  
Keyword(s):  
Medical Education ◽  
Patient Satisfaction ◽  
Medical Students ◽  
Communication Skills ◽  
Skills Training ◽  
Simulated Patient ◽  
Simulated Patients ◽  
Communication Skills Training ◽  
Clinical Communication ◽  
Good Communication Skill

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.

scholarly journals Impact of COVID-19 on medical undergraduate students’ academics and its ramifications

2020 ◽  
Vol 0 ◽  
pp. 1-4
Author(s):  
Arshi Syal ◽  
Yajur Arya ◽  
Monica Gupta
Keyword(s):  
Medical Education ◽  
Medical Students ◽  
Online Teaching ◽  
Clinical Skills ◽  
Univariate Analysis ◽  
Skills Training ◽  
Online Questionnaire ◽  
Medical Undergraduate ◽  
Hands On ◽  
The Impact

Objectives: COVID-19 pandemic has dramatically affected undergraduate medical education all over the world. This effect is most noteworthy on the medical students as clinical orientation and hands-on training are crucial toward development of basic medical skills. Various modifications to the methods of online teaching have been adopted in response to this pandemic to maintain continuity of medical education; however, we do not yet know the implications of this change. Material and Methods: To study the impact of this pandemic on medical students and to have a first-hand estimate of the adversities and challenges faced by them, an online questionnaire-based survey was conducted, administered through Google Forms maintaining anonymity. They were asked a series of multiple choice questions pertaining to the effects of this pandemic on their curriculum and academic activities. The responses received were analyzed by univariate analysis. Results: Almost half (46.4%) of students reported a decreased interest in medicine after suspension of hands on teaching/practical classes. A total of 136 respondents (69.38%) felt that they became less productive in studies during the pandemic. Approximately 74% respondents felt less motivated to study at home. More than two-thirds of the respondents felt that on graduation, their clinical skills will be inferior to the students who graduated during the “non-COVID” era. About 84.69% of students believed that their examinations should be postponed hoping to get appropriate clinical experience once things normalize. Conclusion: Majority of the students feel less motivated and less productive, amidst the transition. The major area that has been compromised is the clinical skills training, a crucial adjunct to theoretical teaching in medical schools, and almost all students believe that their clinical skills in the long term would remain inferior to those who graduated before this pandemic.

That was a game changer: clinical impact of an emergency department-based palliative care communication skills training workshop

2019 ◽  
pp. emermed-2019-208567
Author(s):  
Rebecca Wright ◽  
Bradley Hayward ◽  
Emmett Kistler ◽  
Victoria Vaughan Dickson ◽  
Corita Grudzen
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Communication Skills ◽  
Skills Training ◽  
Training Workshop ◽  
Feedback Environment ◽  
Goals Of Care ◽  
Difficult Conversations ◽  
Communications Skills ◽  
The Impact

ObjectiveTo explore the impact of an adapted goals-of-care communications skills workshop created for ED physicians from the physicians’ perspective.MethodsSemi-structured, one-on-one audio-recorded interviews lasting 30–60 min were conducted with twelve physicians who had completed the training workshop. Interviews explored the experience of undertaking the workshop, its impact on their clinical practice and their ability to teach new skills to other clinicians using learnt techniques. Descriptive content analysis was performed on interview transcripts.ResultsParticipants reported positive experiences of the workshop. The analysis identified four main themes and ten subthemes dealing with workshop content and its impact on subsequent ED-based clinical practice. There were: 1) value and future improvements for the course; 2) value of the course to practice; 3) value of the course for teaching residents and 4) barriers to application of learning. Specifically recommended components include the use of mnemonics, mechanisms to introduce difficult conversations and a positive feedback environment. Participant-recommended refinements to the workshop included emphasising urgency, replicating the chaotic ED environment and expanding content to include more ED-focused goals-of-care discussions.ConclusionA short, focused training workshop directed at improving palliative care communication skills among ED clinicians appears to be welcomed and useful.

scholarly journals The impact of integrating environmental health into medical school curricula: a survey-based study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Benjamin Kligler ◽  
Genevieve Pinto Zipp ◽  
Carmela Rocchetti ◽  
Michelle Secic ◽  
Erin Speiser Ihde
Keyword(s):  
Climate Change ◽  
Medical Education ◽  
Medical Students ◽  
Medical School ◽  
Environmental Health ◽  
School Curriculum ◽  
Learning Objectives ◽  
Lead Contamination ◽  
Institute Of Medicine ◽  
The Impact

Abstract Background Inclusion of environmental health (EH) in medical education serves as a catalyst for preparing future physicians to address issues as complex as climate change and health, water pollution and lead contamination. However, previous research has found EH education to be largely lacking in U.S. medical education, putting future physicians at risk of not having the expertise to address patients’ environmental illnesses, nor speak to prevention. Methods Environmental health (EH) knowledge and skills were incorporated into the first-year medical school curriculum at Hackensack Meridian School of Medicine (Nutley, New Jersey), via a two-hour interactive large group learning module with follow up activities. Students completed the Environmental Health in Med School (EHMS) survey before and after the year 1 EH module. This survey evaluates medical students’ attitudes, awareness and professionalism regarding environmental health. In year 2, students completed the Environmental Health Survey II, which measured students’ perceptions of preparedness to discuss EH with future patients. The research team created both surveys based upon learning objectives that broadly aligned with the Institute of Medicine six competency-based environmental health learning objectives. Results 36 year 1 students completed both the pre and post EHMS surveys. McNemar’s test was used for paired comparisons. Results identified no statistically significant changes from pre to post surveys, identifying a dramatic ceiling. When comparing year 2, EHS II pre-survey (n = 84) and post-survey (n = 79) responses, a statistically significant positive change in students’ self-reported sense of preparedness to discuss environmental health with their patients following the curriculum intervention was noted. Conclusions Our conclusion for the EHMS in Year 1 was that the current generation of medical students at this school is already extremely aware of and concerned about the impact of environmental issues on health. Through the EHS II in Year 2, we found that the six-week environmental health module combining didactic and experiential elements significantly increased medical students’ self-reported sense of preparedness to discuss environmental health issues, including climate change, with their patients.

scholarly journals Medical Studies during the COVID-19 Pandemic: The Impact of Digital Learning on Medical Students’ Burnout and Mental Health

2021 ◽  
Vol 18 (1) ◽  
pp. 349
Author(s):  
Panagiotis Zis ◽  
Artemios Artemiadis ◽  
Panagiotis Bargiotas ◽  
Antonios Nteveros ◽  
Georgios M. Hadjigeorgiou
Keyword(s):  
Mental Health ◽  
Medical Students ◽  
Emotional Exhaustion ◽  
Short Form ◽  
Maslach Burnout Inventory ◽  
Junior Doctors ◽  
Digital Learning ◽  
Student Survey ◽  
Medical Studies ◽  
The Impact

Objectives: The aim of this ecological study was to investigate what the impact of digital learning due to the COVID-19 pandemic was on the burnout and overall mental health (MH) of medical students. Background: During the unprecedented era of the COVID-19 pandemic, the majority of countries worldwide adopted very strong measures. Universities closed their doors, and education continued through digital learning lectures. Methods: An anonymous questionnaire was administered to all 189 eligible candidates before and during the COVID-19 pandemic. Mental health was assessed via the MH domain of the 36-item Short Form Health Survey (SF-36) and burnout with the Maslach Burnout Inventory—Student Survey (MBI-SS). Results: The overall response rate was 81.5%. The overall burnout prevalence did not differ significantly between the two periods (pre-COVID-19 18.1% vs. COVID-19 18.2%). However, the burnout prevalence dropped significantly in year 4 (pre-COVID-19 40.7% vs. COVID-19 16.7%, p = 0.011), whereas it increased significantly in year 6 (pre-COVID-19 27.6% vs. COVID-19 50%, p = 0.01). When looking at each MBI-SS dimension separately, we found that emotional exhaustion decreased significantly in year 4 but increased in year 6, and cynicism increased in all years. The overall MH deteriorated significantly between the two periods (pre-COVID-19 58.8 ± 21.6 vs. COVID-19 48.3 ± 23, p < 0.001). Conclusions: Digital learning in medical studies carries significant risks. Not only does the MH deteriorate, but cynicism levels also increase. Emotional exhaustion was found to increase particularly in final year students, who struggle with the lack of clinical experience just before they start working as qualified junior doctors.

scholarly journals Medical education challenges and innovations during COVID-19 pandemic

2021 ◽  
pp. postgradmedj-2021-140032
Author(s):  
Michail Papapanou ◽  
Eleni Routsi ◽  
Konstantinos Tsamakis ◽  
Lampros Fotis ◽  
Georgios Marinos ◽  
...  
Keyword(s):  
Medical Education ◽  
Medical Students ◽  
Student Assessment ◽  
Well Being ◽  
Educational Institutions ◽  
Healthcare Staff ◽  
Academic Trajectories ◽  
Traditional Structure ◽  
Physical Presence ◽  
The Impact

COVID-19 pandemic has undoubtedly disrupted the well-established, traditional structure of medical education. Τhe new limitations of physical presence have accelerated the development of an online learning environment, comprising both of asynchronous and synchronous distance education, and the introduction of novel ways of student assessment. At the same time, this prolonged crisis had serious implications on the lives of medical students including their psychological well-being and the impact on their academic trajectories. The new reality has, on many occasions, triggered the ‘acting up’ of medical students as frontline healthcare staff, which has been perceived by many of them as a positive learning and contributing experience, and has led to a variety of responses from the educational institutions. All things considered, the urgency for rapid and novel adaptations to the new circumstances has functioned as a springboard for remarkable innovations in medical education,including the promotion of a more “evidence-based” approach.

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