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.

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 The role of standardized patient assessment forms in medical communication skills education

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Grace Peters
Keyword(s):  
United States ◽  
Medical Education ◽  
Communication Skills ◽  
Clinical Skills ◽  
Skills Training ◽  
The United States ◽  
Task Completion ◽  
Routine Practice ◽  
Item Checklist ◽  
Skills Education

Communication skills training is a routine practice in medical education designed to instruct and evaluate future physicians in matters of patient-provider interaction. Based on the United States Medical Licensing Examination Step 2 Clinical Skills (CS), medical schools across the United States hire and train standardized patients (SPs) to act as patients in and evaluators of simulated interactions with medical students (MSs). Using discourse analysis, I examine how a computerized assessment form creates a particularized version of communication skills with implications for future practice. The 39-item checklist is completed by SPs following a simulated interaction designed to prepare third-year MSs for the Step 2 CS. Specifically, I analyze how the form is structured to make recognizable specific communication skills tasks, who should complete said tasks, and what varying degrees of communication skills competency are within the realm of task completion. By analyzing the form, I consider the agency of texts in medical education, the implications of technologizing communication as an institutional skill, and the limitations of enlisting SPs to evaluate communication skills competency under the guise of a patient perspective.

scholarly journals Longitudinal Effects of Medical Students' Communication Skills on Future Performance

2015 ◽  
Vol 180 (suppl_4) ◽  
pp. 24-30 ◽  
Author(s):  
Ting Dong ◽  
Jeffrey S. LaRochelle ◽  
Steven J. Durning ◽  
Aaron Saguil ◽  
Kimberly Swygert ◽  
...  
Keyword(s):  
Medical Education ◽  
Medical Students ◽  
Communication Skills ◽  
Clinical Skills ◽  
Pearson Correlation ◽  
Linear Regression Analysis ◽  
The United States ◽  
Evaluation Tool ◽  
Future Performance ◽  
Medical Educators

ABSTRACT Background: The Essential Elements of Communication (EEC) were developed from the Kalamazoo consensus statement on physician–patient communication. The Uniformed Services University of the Health Sciences (USU) has adopted a longitudinal curriculum to use the EEC both as a learning tool during standardized patient encounters and as an evaluation tool culminating with the end of preclerkship objective-structured clinical examinations (OSCE). Medical educators have recently emphasized the importance of teaching communication skills, as evidenced by the United States Medical Licensing Examination testing both the integrated clinical encounter (ICE) and communication and interpersonal skills (CIS) within the Step 2 Clinical Skills exam (CS). Purpose: To determine the associations between students' EEC OSCE performance at the end of the preclerkship period with later communication skills assessment and evaluation outcomes in the context of a longitudinal curriculum spanning both undergraduate medical education and graduate medical education. Methods: Retrospective data from preclerkship (overall OSCE scores and EEC OSCE scores) and clerkship outcomes (internal medicine [IM] clinical points and average clerkship National Board of Medical Examiners [NBME] scores) were collected from 167 USU medical students from the class of 2011 and compared to individual scores on the CIS and ICE components of Step 2 CS, as well as to the communication skills component of the program directors' evaluation of trainees during their postgraduate year 1 (PGY-1) residency. In addition to bivariate Pearson correlation analysis, we conducted multiple linear regression analysis to examine the predictive power of the EEC score beyond the IM clerkship clinical points and the average NBME Subject Exams score on the outcome measures. Results: The EEC score was a significant predictor of the CIS score and the PGY-1 communication skills score. Beyond the average NBME Subject Exams score and the IM clerkship clinical points, the EEC score explained an additional 13% of the variance in the Step 2 CIS score and an additional 6% of the variance in the PGY-1 communication skills score. In addition, the EEC score was more closely associated with the CIS score than the ICE score. Conclusion: The use of a standardized approach with a communication tool like the EEC can help explain future performance in communication skills independent of other education outcomes. In the context of a longitudinal curriculum, this information may better inform medical educators on learners' communication capabilities and more accurately direct future remediation efforts.

scholarly journals AB0682 RHEUMATOLOGY TEACHING IN TIMES OF COVID-19

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1374.1-1374
Author(s):  
Y. Chang ◽  
J. Nicholls
Keyword(s):  
Medical Education ◽  
Medical Students ◽  
Clinical Skills ◽  
Standardized Patients ◽  
Simulated Patients ◽  
Bedside Teaching ◽  
Multiple Choice Questions ◽  
Educational Method ◽  
Telephone Consultation ◽  
Real Patients

Background:The COVID-19 pandemic has affected the delivery of face-to-face teaching especially bedside teaching for medical students in the hospitals. Rheumatology outpatient clinics have mostly become virtual or telephone consultation clinics which prevent medical students from seeing patients in person. Students are deprived of the opportunities to take rheumatology history, examining patients and seeing signs of rheumatologic diseases. New adaptations have to be made to ensure equitability and that students still receive the relevant teaching in line with their learning curriculum and to help them prepare for their examinations.Objectives:Our aims are:1)To adapt bedside teaching in the wards to simulated teaching in the classroom using trained simulated ‘patients’; and2)To create simulation teaching of patient journeys in Objective Structured Clinical Examination (OSCE) format known as Clinically Observed Medical Education Tutorials (COMET) (Nair et al., 2001).Methods:1)For simulated teaching in the classroom, we have trained our teaching colleagues as simulated or standardized patients (SPs). We write up fictitious patient histories which simulate common presentations at rheumatology clinics. We train the SPs to give as accurate a history as possible and to simulate pains in different joints (e.g. pain at the metacarpophalangeal joints and proximal interphalangeal joints in rheumatoid arthritis) on clinical examinations. For clinical presentations that are not easily simulated, we use photographs of the relevant signs. This method is used not only as formative assessments but also as end-of-placement summative assessments.2)COMET comprises 3 OSCE-style stations with a tutor each where the students perform different tasks based on a patient’s clinical problem (e.g. acute hot swollen joint). The first station is initial A-to-E assessment of the patient (using a simulator), followed by investigations and interpretations of lab results and imaging (station 2) and lastly, management (including prescribing medications) and communication skills (e.g. explain arthrocentesis to the patient).Results:The overall feedback from students is very positive. We use Likert scale to assess confidence level before and after the teaching session, and pre-session and post-session multiple choice questions to assess learning and knowledge gained.Conclusion:While simulated teaching cannot replace encounters with real patients, students do enjoy these sessions as they get to ‘experience’ a large variety of rheumatologic cases and practice their clinical skills which at times are limited with real patients due to reluctance and pain of the patients.References:[1]Nair, R., Morrissey, J., Carasco, D., Desilva, S. & Patel, V. (2001) COMET: Clinically Observed Medical Education Tutorial - a novel educational method in clinical skills. International Journal of Clinical Skills[2]Van der Vleuten, C.P.M. & Swanson, D.B. (1990) Assessment of clinical skills with standardized patients: state of the art. Teach Learn Med, 2: 58-76.Disclosure of Interests:None declared

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

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

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 Effectiveness of a communication skills training program for medical students to identify patients communicative clues

2020 ◽  
Vol 103 (11) ◽  
pp. 2384-2387
Author(s):  
Roger Ruiz Moral ◽  
Cristina Andrade-Rosa ◽  
Juan D Molina Martín ◽  
Emilio Cervera Barba ◽  
Luis Pérula de Torres ◽  
...  
Keyword(s):  
Medical Students ◽  
Training Program ◽  
Communication Skills ◽  
Skills Training ◽  
Communication Skills Training

scholarly journals Simulated patient and role play methodologies for communication skills and empathy training of undergraduate medical students

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Cristina Bagacean ◽  
Ianis Cousin ◽  
Anne-Helene Ubertini ◽  
Mohamed El Yacoubi El Idrissi ◽  
Anne Bordron ◽  
...  
Keyword(s):  
Medical Students ◽  
Communication Skills ◽  
Role Play ◽  
Skills Training ◽  
Verbal Communication ◽  
Simulated Patient ◽  
Background Information ◽  
Undergraduate Medical Students ◽  
Verbal Behaviour ◽  
Verbal Messages

Abstract Background Verbal and non-verbal communication, as well as empathy are central to patient-doctor interactions and have been associated with patients’ satisfaction. Non-verbal communication tends to override verbal messages. The aim of this study was to analyze how medical students use verbal and non-verbal communication using two different educational approaches, student role play (SRP) and actor simulated patient (ASP), and whether the non-verbal behaviour is different in the two different poses. Methods Three raters evaluated 20 students playing the doctor role, 10 in the SRP group and 10 in the ASP group. The videos were analyzed with the Calgary-Cambridge Referenced Observation Guide (CCG) and, for a more accurate evaluation of non-verbal communication, we also evaluated signs of nervousness, and posture. Empathy was rated with the CARE questionnaire. Independent Mann Whitney U tests and Qhi square tests were performed for statistical analysis. Results From the 6 main tasks of the CCG score, we obtained higher scores in the ASP group for the task ‘Gathering information’ (p = 0.0008). Concerning the 17 descriptors of the CCG, the ASP group obtained significantly better scores for ‘Exploration of the patients’ problems to discover the biomedical perspective’ (p = 0.007), ‘Exploration of the patients’ problems to discover background information and context’ (p = 0.0004) and for ‘Closing the session – Forward planning’ (p = 0.02). With respect to non-verbal behaviour items, nervousness was significantly higher in the ASP group compared to the SRP group (p < 0.0001). Concerning empathy, no differences were found between the SRP and ASP groups. Conclusions Medical students displayed differentiated verbal and non-verbal communication behaviour during the two communication skills training methodologies. These results show that both methodologies have certain advantages and that more explicit non-verbal communication training might be necessary in order to raise students’ awareness for this type of communication and increase doctor-patient interaction effectiveness.

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