Project description:PurposeTo evaluate the current communication skills of resident physicians and identify areas for improvement.Study designUsing a cross-sectional design, data from medical students, residents, fellows, and faculty were assimilated at one of the largest academic medical centers in a low-and-middle-income country via a self-administered, validated survey with a 5-point LIKERT scale. One-way ANOVA was used to compare intra-group means, followed by the Bonferroni test, with a p-value <0.05 considered significant. Heat maps using means were generated and color-coded to signify the level of communication skills expertise.ResultsA total of 320 participants (119 residents, 34 fellows, 78 medical students and 89 attendings) completed the survey. Most residents (58%) reported not having received formal communication skills training. Major barriers impeding effective patient-resident communication were long working hours, inadequate time, and difficulty understanding patients' language (p < 0.001). Residents' self-evaluation of communication skills was significantly higher than observer evaluations from faculty, fellows, and students, reflecting a lack of self-awareness and overestimation of communication expertise. Observer cohorts rated residents moderately on para-verbal communication skills while giving the lowest ratings for breaking bad news (mean 2.8, p-value <0.001) and residents' experience in dealing with workplace conflicts (mean 2.8, p-value = 0.023).ConclusionsOur study identified a clear and critical need for a structured, longitudinal, competency-based communication skills program for residents. Targeted efforts towards bridging the gaps in communication skills identified in this study can improve trainee communication skills expertise and augment patient satisfaction rates to improve the quality of care in developing countries.
Project description:Effective communication with children is a skill, the importance of which is especially highlighted by the COVID-19 pandemic and the ubiquitous wearing of face masks. Anaesthesiology consultants have been shown to display excellent communication skills that facilitate the development of rapid rapport and patient cooperation. Good communication results in positive interactions for hospitalised children, which correlates with improved healthcare outcomes. However, interactions with a child aren't always straightforward, particularly for trainees unfamiliar with certain communication techniques, which are important to use at a time when when the wearing of face masks is commonplace.
Project description:Failures in non-technical skills (NTS) contribute to adverse events in healthcare. Previous research has explored the assessment and training of these skills, and yet there is a lack of evidence for their impact on clinical outcomes. Gastrointestinal endoscopy is a high-pressure specialty, but to date there is little on the role of NTS in this area, or a method for their assessment.
This MD project aims to measure NTS in endoscopy, explore their relationship with clinical outcomes, and identify those specific to this area of healthcare.
Methods An observational study of endoscopy teams in real time, using the Oxford NOTECHS II assessment tool. Comparison of NTS performance with procedure outcomes and patient satisfaction.
A qualitative interview study with staff members to establish the NTS specifically relevant to working in gastrointestinal endoscopy.
Project description:BackgroundAs the aging population is increasing significantly, the communication skills training (CST) on transitional care (TC) is insufficient.AimsThis study aimed to test the effectiveness of an intervention (the online TC CST [OTCCST] and TC) through the perspectives of healthcare providers (HCPs), older patients, and family members.MethodsA total of 38 HCPs caring for older patients were randomized to the experimental (n = 18) or control groups (n = 20), and 84 pairs of patients and family members were enrolled (experimental: n = 42 vs. control: n = 42). The primary outcome was HCP communication confidence; while secondary outcomes included patient quality of life (QoL), activities of daily living (ADL), rehospitalization counts, and family caregiving burden. Data were collected from HCPs using a scale measuring confidence in communicating with patients. Patient outcomes were assessed using the McGill QoL Questionnaire-Revised and Barthel Index. Family members were assessed with the Caregiver Burden Inventory. Rehospitalization counts were tracked for 3 months post-discharge. Data were analyzed using multiple regression analysis.ResultsExperimental group HCPs showed a significant improvement in communication confidence over the control group (p = 0.0006). Furthermore, experimental group patients had significantly fewer rehospitalization counts within 3-month post-discharge (p < 0.05). However, no significant group differences were found in patient QoL and ADL nor in family caregiver burden.ConclusionThe OTCCST can effectively improve HCP communication confidence, and the combination of OTCCST and TC can reduce rehospitalization counts for older patients. The OTCCST allows HCPs to learn asynchronously at their convenience, ideal for continuing education, especially during the COVID-19 pandemic.
Project description:BackgroundSkilled physician communication is a key component of patient experience. Large-scale studies of exposure to communication skills training and its impact on patient satisfaction have not been conducted.ObjectiveWe aimed to examine the impact of experiential relationship-centered physician communication skills training on patient satisfaction and physician experience.DesignThis was an observational study.SettingThe study was conducted at a large, multispecialty academic medical center.ParticipantsParticipants included 1537 attending physicians who participated in, and 1951 physicians who did not participate in, communication skills training between 1 August 2013 and 30 April 2014.InterventionAn 8-h block of interactive didactics, live or video skill demonstrations, and small group and large group skills practice sessions using a relationship-centered model.Main measuresHospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS), Jefferson Scale of Empathy (JSE), Maslach Burnout Inventory (MBI), self-efficacy, and post course satisfaction.Key resultsFollowing the course, adjusted overall CGCAHPS scores for physician communication were higher for intervention physicians than for controls (92.09 vs. 91.09, p < 0.03). No significant interactions were noted between physician specialty or baseline CGCAHPS and improvement following the course. Significant improvement in the post-course HCAHPS Respect domain adjusted mean was seen in intervention versus control groups (91.08 vs. 88.79, p = 0.02) and smaller, non-statistically significant improvements were also seen for adjusted HCAHPS communication scores (83.95 vs. 82.73, p = 0.22). Physicians reported high course satisfaction and showed significant improvement in empathy (116.4 ± 12.7 vs. 124 ± 11.9, p < 0.001) and burnout, including all measures of emotional exhaustion, depersonalization, and personal accomplishment. Less depersonalization and greater personal accomplishment were sustained for at least 3 months.ConclusionsSystem-wide relationship-centered communication skills training improved patient satisfaction scores, improved physician empathy, self-efficacy, and reduced physician burnout. Further research is necessary to examine longer-term sustainability of such interventions.
Project description:Medical communication across languages is gaining attention as the multilingual character of local, regional, and national populations across the world continues to grow. Effectively communicating with patients involves not only learning medical terminology, but also understanding the community's linguistic practices, and gaining the ability to explain health concepts in patient-centered language. Language concordance between physicians and patients improves patient outcomes, but methods to teach communication skills for physicians are usually limited to the majority or official language. For example, in U.S. medical schools increased demand for physician skills in other languages, such as Spanish, has resulted in renewed academic discourse about best practices in teaching practical communication skills for physicians. In language education, translanguaging is an approach that integrates and validates multilingual individuals' real use of language, which often includes non-standard words, regionalisms, and mixed influences from multiple languages, such as Spanglish or Chinglish. Efforts to improve medical language concordance by teaching a second language to medical students would benefit from an understanding of patient-centered communication strategies, such as is supported by translanguaging. Teaching effective communication skills to physicians should evolve and engage with the fluid linguistic attributes of culturally and linguistically diverse patient populations. In this eye opener, we first introduce the translanguaging perspective as an approach that can increase attention to patient-centered communication, which often includes spontaneous practices that transcend the traditional boundaries of named languages, and then present examples of how translanguaging can be implemented in medical education in order to sustainably enhance equity-minded patient-accessible medical communication.
Project description:BackgroundEffective communication with patients and their families is a fundamental skill for medical students to cultivate during their undergraduate training. However, communicating with pediatric patients presents unique challenges. This study investigated the perceptions, attitudes, and confidence levels of undergraduate medical students regarding communication skills in pediatrics.MethodsA cross-sectional, quantitative, descriptive, and analytical survey was conducted by applying a validated questionnaire, the Housestaff Communication Survey (HCS), to medical students from two higher education institutions in Minas Gerais, Brazil. Data analysis was conducted using SPSS and Excel, employing descriptive statistical tests and multiple logistic regression analyses to evaluate communication, importance, and confidence.ResultsA total of 520 (52%) students participated in the study, with 422 (81.15%) aged from 20 to 29 years and 365 (68.27%) women. While only 113 (21.73%) students reported receiving training in communication skills with both adults and children during their undergraduate studies, over half (270) reported no such training. Those lacking training exhibited lower confidence levels compared with those trained exclusively with adults. Although most students recognized the importance of communication skills, their confidence levels were generally below 60%. Multiple logistic regression analysis identified gender, institution, academic period, and training as significantly associated variables with communication scores.ConclusionsTraining, gender, and academic period emerged as the most significant variables influencing communication skills. Most students expressed lower confidence in interviewing children. To enhance communication with pediatric patients and their families, comprehensive training in pediatric communication skills during undergraduate studies is imperative.
Project description:OBJECTIVE: We describe a collaboration between the graduate medical education office and the Henry Ford Health System's Office of Clinical Quality and Safety to create an institution-wide communication skills curriculum pertinent to the institution's safety and patient- and family-centered care initiatives. METHODS: A multidisciplinary committee provided oversight for the curriculum design and used sentinel event and other quality and safety data to identify specific target areas. The curriculum consisted of 3 courses: "Informed Consent," "Sharing Bad News," and "Disclosure of Unanticipated Events." Each course included 3 components: a multimedia online module; small group discussions led by the program director that focused on the use of communication scripts; and 2 objective structured clinical examinations (OSCEs) requiring residents to demonstrate use of the communication scripts. All first-year residents (N = 145) and faculty (N = 30) from 20 residency programs participated in this initiative. Evaluation of the residents consisted of a self-assessment; the standardized patients' assessment of the residents' performance; and faculty assessment of resident performance with verbal feedback. RESULTS: Survey data showed that residents found the courses valuable, with residents identifying communication scripts they would use in clinical settings. Focus groups with faculty highlighted that the resident debriefing sessions provided them with insight into a resident's communication skills early in their training. CONCLUSION: Our institutional curriculum was developed in a collaborative manner, and used an evidence-based approach to teach communication skills relevant to institutional safety and quality initiatives. Other institutions 5 wish to adopt our strategy of departmental collaboration and alignment of resident education with institutional initiatives.
Project description:ObjectiveThe main aim of this study was to explore the views and perceptions of dietetic educators on their ability to assess communication skills of undergraduate student dietitians in a telehealth setting. A secondary aim was to provide recommendations to educators when assessing these skills using telehealth.MethodsA descriptive qualitative study design was used. Australian and New-Zealand dietetic educators used a validated global communication rating scale to evaluate three pre-recorded telehealth encounters. Educators then answered a series of open-ended questions on their ability to assessed communication skills in the telehealth environment.AnalysisInductive analysis allowed the emergence of themes and sub-themes independent of a specific framework or theory. Peer debriefing and triangulation increased research rigor.ResultsTwenty-four educators were included in this study with the majority (87.5%) having > 10 years experience as a dietetic educator, and 41.6% (n = 10) with experience in assessing dietetics student using telehealth. Most (76%) educators reported the assessment of non-verbal communication skills were challenging in the telehealth environment. Five themes and 15 subthemes emerged relating to advice for students and educators when assessing communication skills and a checklist was developed from recommendations that students and educators can use when preparing, planning, implementing, and assessing telehealth consultations.ConclusionAssessing student communication skills via telehealth provides a useful opportunity with the growing use of the online environment, however, it also presents challenges that must be taken into consideration. While verbal communication skills are easier to assess than non-verbal, both need to be adapted for the telehealth setting.