Teaching patient-centred communication skills during clinical procedural skill training - a preliminary pre-post study comparing international and local medical students

Abstract Background International medical students are frequently confronted with intercultural, psychosocial, and language barriers and often receive lower marks in written, oral, and clinical-practical examinations than fellow local students. Training communication competence in procedural skills, such as blood sampling, is further challenge in this particular group of medical students. This pre-post comparative intervention study aimed to investigate the effects of training communication skills during the performance of procedural skills (taking blood samples from a silicone model) in international and local students as part of their clinical practical medical training. Methods Study participants performed blood sampling on an arm prosthesis model (part-task trainer) before and after the communication skills training, focusing on accompanying communication with a simulation patient sitting next to the arm model. The pre- and post-evaluation video was assessed by two independent evaluators using a binary checklist, the Integrated Procedural Performance Instrument (IPPI) and global assessments of clinical professionalism in terms of procedural and communication performance. Linear models with mixed effects were used. Group differences regarding global competence levels were analysed with χ2-tests. Results International medical students did not perform as well as their local counterparts in the pre- and post-examinations. Both groups improved their performance significantly, whereby the international students improved more than their local counterparts in terms of their communication performance, assessed via binary checklist. Clinical professionalism evaluated via global assessments of procedural and communication performance highlights the intervention’s impact insofar as no international student was assessed as clinically not competent after the training. Conclusions Our results suggest that already a low-dose intervention can lead to improved communication skills in medical students performing procedural tasks and significantly increase their confidence in patient interaction.

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Teaching Patient-Centred Communication Skills During Clinical Procedural Skill Training - A Pre-Post Study Comparing International and Local Medical Students

10.21203/rs.3.rs-375588/v1 ◽

2021 ◽

Author(s):

Ede Nagy ◽

Gloria Matondo Miguel Luta ◽

Daniel Huhn ◽

Anna Cranz ◽

Jobst-Hendrik Schultz ◽

...

Keyword(s):

Medical Students ◽

Communication Skills ◽

Medical Training ◽

Skill Training ◽

Skills Training ◽

International Medical ◽

Blood Sampling ◽

Procedural Skills ◽

Communication Performance ◽

Local Students

Abstract Background: International medical students are frequently confronted with intercultural, psychosocial, and language barriers and often receive lower marks in written, oral, and clinical-practical examinations than fellow local students. Training communication competence in procedural skills, such as blood sampling, is further challenge in this particular group of medical students. This pre-post comparative intervention study aimed to investigate the effects of training communication skills during the performance of procedural skills (taking blood samples from a silicone model) in international and local students as part of their clinical practical medical training.Methods: Study participants performed blood sampling on an arm prosthesis model (part-task trainer) before and after the communication skills training, focusing on accompanying communication with a simulation patient sitting next to the arm model. The pre and post-evaluation video was assessed by two independent evaluators using a binary checklist, the Integrated Procedural Performance Instrument (IPPI) and global assessments of clinical professionalism in terms of procedural and communication performance. Linear models with mixed effects were used. Group differences regarding global competence levels were analysed with χ²-tests. Results: International medical students did not perform as well as their local counterparts in the pre- and post-examinations. Both groups improved their performance significantly, whereby the international students improved more than their local counterparts in terms of their communication performance, assessed via binary checklist. Clinical professionalism evaluated via global assessments of procedural and communication performance highlights the intervention's impact insofar as no international student was assessed as clinically not competent after the training. Conclusions: Our results suggest that already a low-dose intervention can lead to improved communication skills in medical students performing procedural tasks and significantly increase their confidence in patient interaction.

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Comparison of the effects of simulated patient clinical skill training and student roleplay on objective structured clinical examination performance among medical students in Australia

Journal of Educational Evaluation for Health Professions ◽

10.3352/jeehp.2019.16.3 ◽

2019 ◽

Vol 16 ◽

pp. 3 ◽

Cited By ~ 4

Author(s):

Silas Taylor ◽

Matthew Haywood ◽

Boaz Shulruf

Keyword(s):

Medical Students ◽

Physical Examination ◽

Communication Skills ◽

Skill Training ◽

Clinical Skill ◽

Skills Training ◽

Performance Outcomes ◽

Simulated Patient ◽

Procedural Skills ◽

Clinical Communication

Purpose: Optimal methods for communication skills training (CST) are an active research area, but the effects of CST on communication performance in objective structured clinical examinations (OSCEs) has not been closely studied. Student roleplay (RP) for CST is common, although volunteer simulated patient (SP) CST is cost-effective and provides authentic interactions. We assessed whether our volunteer SP CST program improved OSCE performance compared to our previous RP strategy. Methods: We performed a retrospective, quasi-experimental study of 2 second-year medical student cohorts’ OSCE data in Australia. The 2014 cohort received RP-only CST (N=182) while the 2016 cohort received SP-only CST (N=148). The t-test and analysis of variance were used to compare the total scores in 3 assessment domains: generic communication, clinical communication, and physical examination/procedural skills. Results: The baseline characteristics of groups (scores on the Australian Tertiary Admission Rank, Undergraduate Medicine and Health Sciences Admission Test, and medicine program interviews) showed no significant differences between groups. For each domain, the SP-only CST group demonstrated superior OSCE outcomes, and the difference between cohorts was significant (P<0.01). The superiority of volunteer SP CST over student RP CST in terms of OSCE performance outcomes was found for generic communication, clinical communication, and physical examination/procedural skills. Conclusion: The better performance of the SP cohort in physical examination/procedural skills might be explained by the requirement for patient compliance and cooperation, facilitated by good generic communication skills. We recommend a volunteer SP program as an effective and efficient way to improve CST among junior medical students.

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Mind Your Language: Factors Enhancing Students’ English Language Skills in an International Medical Programme (IMP)

10.21203/rs.3.rs-657183/v1 ◽

2021 ◽

Author(s):

Sharon Min Hui Chan ◽

Norul Hidayah Mamat ◽

Vishna Devi Nadarajah

Keyword(s):

Medical Students ◽

Communication Skills ◽

Language Proficiency ◽

English Language ◽

Medical Training ◽

Language Skills ◽

International Medical ◽

Group Interviews ◽

Context Specific ◽

English Language Skills

Abstract Background Language proficiency is crucial for doctors as they communicate with patients, peers and other healthcare professionals. Although proficiency in English is part of admission requirements, there is a gap of knowledge on medical students’ perception of factors enhancing English language (EL) skills during training in international medical programmes (IMP). The gap prevents educators and policy makers from helping students who struggle with communication skills during medical training. This study therefore explores factors that enable enhancement of English language skills from medical students’ perspectives Methods Six focus group interviews with 24 medical students of an IMP were conducted. Data were analysed using Braun and Clarke’s framework of thematic analysis. Results Results established three main factors enhancing EL skills namely use of EL in medical training and practice, influence of university culture in EL mastery and individual EL proficiency with eight themes demonstrating the factors as perceived by medical students Conclusions Findings of this study informs how students perceived enhancement of EL skills as a professional and social requirement during medical training and for future practice. It also informs that setting English language admission pre requisites needs to be complemented with opportunities to practice context specific communication skills. Thus, international medical programmes should embed diverse and inclusive strategies to support and develop medical students’ English language skills.

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A Canadian Perspective of simulation-based skill attainment in Internal Medicine Residency (Preprint)

10.2196/preprints.12260 ◽

2018 ◽

Author(s):

Tamer Abdel Moaein ◽

Chirsty Tompkins ◽

Natalie Bandrauk ◽

Heidi Coombs-Thorne

Keyword(s):

Internal Medicine ◽

Residency Training ◽

Training Programs ◽

Skill Training ◽

Skills Training ◽

Skill Learning ◽

Comfort Level ◽

Procedural Skills ◽

Internal Medicine Training ◽

Simulation Based

BACKGROUND Clinical simulation is defined as “a technique to replace or amplify real experiences with guided experiences, often immersive in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion”. In medicine, its advantages include repeatability, a nonthreatening environment, absence of the need to intervene for patient safety issues during critical events, thus minimizing ethical concerns and promotion of self-reflection with facilitation of feedback [1] Apparently, simulation based education is a standard tool for introducing procedural skills in residency training [3]. However, while performance is clearly enhanced in the simulated setting, there is little information available on the translation of these skills to the actual patient care environment (transferability) and the retention rates of skills acquired in simulation-based training [1]. There has been significant interest in using simulation for both learning and assessment [2]. As Canadian internal medicine training programs are moving towards assessing entrustable professional activities (EPA), simulation will become imperative for training, assessment and identifying opportunities for improvement [4, 5]. Hence, it is crucial to assess the current state of skill learning, acquisition and retention in Canadian IM residency training programs. Also, identifying any challenges to consolidating these skills. We hope the results of this survey would provide material that would help in implementing an effective and targeted simulation-based skill training (skill mastery). OBJECTIVE 1. Appraise the status and impact of existing simulation training on procedural skill performance 2. Identify factors that might interfere with skill acquisition, consolidation and transferability METHODS An electronic bilingual web-based survey; Fluid survey platform utilized, was designed (Appendix 1). It consists of a mix of closed-ended, open-ended and check list questions to examine the attitudes, perceptions, experiences and feedback of internal medicine (IM) residents. The survey has been piloted locally with a sample of five residents. After making any necessary corrections, it will be distributed via e-mail to the program directors of all Canadian IM residency training programs, then to all residents registered in each program. Two follow up reminder e-mails will be sent to all participating institutions. Participation will be voluntarily and to keep anonymity, there will be no direct contact with residents and survey data will be summarized in an aggregate form. SPSS Software will be used for data analysis, and results will be shared with all participating institutions. The survey results will be used for display and presentation purposes during medical conferences and forums and might be submitted for publication. All data will be stored within the office of internal medicine program at Memorial University for a period of five years. Approval of Local Research Ethics board (HREB) at Memorial University has been obtained. RESULTS Pilot Results Residents confirmed having simulation-based training for many of the core clinical skills, although some gaps persist There was some concern regarding the number of sim sessions, lack of clinical opportunities, competition by other services and lack of bed side supervision Some residents used internet video to fill their training gaps and/or increase their skill comfort level before performing clinical procedure Resident feedback included desire for more corrective feedback, and more sim sessions per skill (Average 2-4 sessions) CONCLUSIONS This study is anticipated to provide data on current practices for skill development in Canadian IM residency training programs. Information gathered will be used to foster a discourse between training programs including discussion of barriers, sharing of solutions and proposing recommendations for optimal use of simulation in the continuum of procedural skills training.

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Start the Way You Want to Finish: An Intensive Diversity, Equity, Inclusion Orientation Curriculum in Undergraduate Medical Education

Journal of Medical Education and Curricular Development ◽

10.1177/23821205211000352 ◽

2021 ◽

Vol 8 ◽

pp. 238212052110003

Author(s):

Denise L. F. Davis ◽

DoQuyen Tran-Taylor ◽

Elizabeth Imbert ◽

Jeffrey O. Wong ◽

Calvin L. Chou

Keyword(s):

Medical Students ◽

Communication Skills ◽

Personal Narratives ◽

Skills Training ◽

Lessons Learned ◽

Relationship Building ◽

Cultural Humility ◽

Mindfulness Skills ◽

Orientation Week ◽

Equity And Inclusion

Problem: Medical students often feel unprepared to care for patients whose cultural backgrounds differ from their own. Programs in medical schools have begun to address health: inequities; however, interventions vary in intensity, effectiveness, and student experience. Intervention: The authors describe an intensive 2-day diversity, equity, and inclusion curriculum for medical students in their orientation week prior to starting formal classes. Rather than using solely a knowledge-based “cultural competence” or a reflective “cultural humility” approach, an experiential curriculum was employed that links directly to fundamental communication skills vital to interactions with patients and teams, and critically important to addressing interpersonal disparities. Specifically, personal narratives were incorporated to promote individuation and decrease implicit bias, relationship-centered skills practice to improve communication across differences, and mindfulness skills to help respond to bias when it occurs. Brief didactics highlighting student and faculty narratives of difference were followed by small group sessions run by faculty trained to facilitate sessions on equity and inclusion. Context: Orientation week for matriculating first-year students at a US medical school. Impact: Matriculating students highly regarded an innovative 2-day diversity, equity, and inclusion orientation curriculum that emphasized significant relationship-building with peers, in addition to core concepts and skills in diversity, equity, and inclusion. Lessons learned: This orientation represented an important primer to concepts, skills, and literature that reinforce the necessity of training in diversity, equity, and inclusion. The design team found that intensive faculty development and incorporating diversity concepts into fundamental communication skills training were necessary to perpetuate this learning. Two areas of further work emerged: (1) the emphasis on addressing racism and racial equity as paradigmatic belies further essential understanding of intersectionality, and (2) uncomfortable conversations about privilege and marginalization arose, requiring expert facilitation.

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Effect of Communication Skills Training Program for Oncologists Based on Patient Preferences for Communication When Receiving Bad News: A Randomized Controlled Trial

Journal of Clinical Oncology ◽

10.1200/jco.2013.51.2756 ◽

2014 ◽

Vol 32 (20) ◽

pp. 2166-2172 ◽

Cited By ~ 91

Author(s):

Maiko Fujimori ◽

Yuki Shirai ◽

Mariko Asai ◽

Kaoru Kubota ◽

Noriyuki Katsumata ◽

...

Keyword(s):

Communication Skills ◽

Patient Preferences ◽

Controlled Trial ◽

Intervention Group ◽

Depression Scale ◽

Skills Training ◽

Control Group ◽

Communication Skills Training ◽

Communication Performance

Purpose The aim of this study was to identify the effects of a communication skills training (CST) program for oncologists, developed based on patient preferences regarding oncologists' communication. Participants and Methods Thirty oncologists were randomly assigned to either an intervention group (IG; 2-day CST workshop) or control group (CG). Participants were assessed on their communication performance during simulated consultation and their confidence in communicating with patients at baseline and follow-up. A total of 1,192 patients (response rate, 84.6%) who had consultations with the participating oncologists at baseline and/or follow-up were assessed regarding their distress using the Hospital Anxiety and Depression Scale, satisfaction with the consultation, and trust in their oncologist after the consultation. Results At the follow-up survey, the performance scores of the IG had improved significantly, in terms of their emotional support (P = .011), setting up a supportive environment (P = .002), and ability to deliver information (P = .001), compared with those of the CG. Oncologists in the IG were rated higher at follow-up than those in the CG in terms of their confidence in themselves (P = .001). Patients who met with oncologists after they had undergone the CST were significantly less depressed than those who met with oncologists in the CG (P = .027). However, the CST program did not affect patient satisfaction with oncologists' style of communication. Conclusion A CST program based on patient preferences is effective for both oncologists and patients with cancer. Oncologists should consider CST as an approach to enhancing their communication skills.

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Communication skills training for medical students: is it fashion or urgent need? (Literary review and teaching experience)

Profilakticheskaya meditsina ◽

10.17116/profmed20212404163 ◽

2021 ◽

Vol 24 (4) ◽

pp. 63

Author(s):

L.V. Sakhno ◽

V.I. Orel ◽

I.V. Koltuntseva ◽

A.G. Rykachevskaya ◽

T.V. Mishkina ◽

...

Keyword(s):

Medical Students ◽

Communication Skills ◽

Teaching Experience ◽

Skills Training ◽

Communication Skills Training

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Predicating Attitude Toward Learning Communication Skills in Medical Students of Shahid Beheshti University

International Electronic Journal of Medicine ◽

10.34172/iejm.2020.04 ◽

2020 ◽

Vol 9 (1) ◽

pp. 21-25

Author(s):

Maryam Akbarilakeh ◽

Fahimeh Fargah ◽

Katatyoun Razjouyan ◽

Mitra Rahimzadeh

Keyword(s):

Medical Students ◽

Personality Traits ◽

Communication Skills ◽

Medical Training ◽

Medical Curriculum ◽

Attitude Scale ◽

Negative Attitudes ◽

Five Dimensions ◽

Significant Relationships ◽

Convenience Sampling

Background: The ability of communicating with people is of great importance for physicians. Predicting unknown variables like personality traits is one of the important impressive issues in choosing future medical experts in medical training. Regarding this, medical colleges have training programs all around the world. The present study aimed to investigate the attitude toward learning communication skills based on the personality traits of medical students. Materials and Methods: This correlational study was done in 2019 and the participants were medical students who were selected using a convenience sampling method. Zuckerman-Kuhlman personality questionnaire and communication skills attitude scale (CSAS) were used for data collection. CSAS was used to assess positive and negative attitudes. Results: The results showed that only the sociability dimension among the five dimensions of personality had a significant relationship with attitude toward learning communication skills (P=0.018). Moreover, significant relationships of gender (P=0.022), mother’s education level (P=0.049), and residence (P=0.036) with attitude to learning communication skills were found. Conclusion: According to the results, the dimension of demographic characteristics is effective in improving communication skills of medical students. Therefore, it is recommended that it should be considered in medical curriculum development and revision and modifications.

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

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2018-mariecurie.11 ◽

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]

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