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Verheijden M, Giroldi E, Timmerman A. Developing skilled communication: The power of self-monitoring. MEDICAL EDUCATION 2023; 57:782-784. [PMID: 37500543 DOI: 10.1111/medu.15170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023]
Abstract
Because communication is an ongoing process, to become skilled, the author argues it is essential to empower trainees through tailored feedback, activation of self‐monitoring, and awareness of constantly changing context.
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Affiliation(s)
- Michelle Verheijden
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
| | - Esther Giroldi
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
| | - Angelique Timmerman
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
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Verheijden M, Giroldi E, van den Eertwegh V, Luijkx M, van der Weijden T, de Bruin A, Timmerman A. Identifying characteristics of a skilled communicator in the clinical encounter. MEDICAL EDUCATION 2023; 57:418-429. [PMID: 36223270 DOI: 10.1111/medu.14953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/21/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In medical communication research, there has been a shift from 'communication skills' towards 'skilled communication', the latter implying the development of flexibility and creativity to tailor communication to authentic clinical situations. However, a lack of consensus currently exists what skilled communication entails. This study therefore aims to identify characteristics of a skilled communicator, hereby contributing to theory building in communication research and informing medical training. METHOD In 2020, six nominal group technique (NGT) sessions were conducted in the context of the general practitioner (GP) training programme engaging 34 stakeholders (i.e. GPs, GP residents, faculty members and researchers) based on their experience and expertise in doctor-patient communication. Participants in each NGT session rank-ordered a 'Top 7' of characteristics of a skilled communicator. The output of the NGT sessions was analysed using mixed methods, including descriptive statistics and thematic content analysis during an iterative process. RESULTS Rankings of the six sessions consisted of 191 items in total, which were organised into 41 clusters. Thematic content analysis of the identified 41 clusters revealed nine themes describing characteristics of a skilled communicator: (A) being sensitive and adapting to the patient; (B) being proficient in applying interpersonal communication; (C) self-awareness, learning ability and reflective capacity; (D) being genuinely interested; (E) being proficient in applying patient-centred communication; (F) goal-oriented communication; (G) being authentic; (H) active listening; and (I) collaborating with the patient. CONCLUSIONS We conceptualise a skilled communication approach based on the identified characteristics in the present study to support learning in medical training. In a conceptual model, two parallel processes are key in developing adaptive expertise in communication: (1) being sensitive and adapting communication to the patient and (2) monitoring communication performance in terms of self-awareness and reflective capacity. The identified characteristics and the conceptual model provide a base to develop a learner-centred programme, facilitating repeated practice and reflection. Further research should investigate how learners can be optimally supported in becoming skilled communicators during workplace learning.
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Affiliation(s)
- Michelle Verheijden
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
| | - Esther Giroldi
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
| | - Valerie van den Eertwegh
- Skillslab, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Marscha Luijkx
- Department of Family Medicine, School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Anique de Bruin
- Department of Educational Development and Research, School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
| | - Angelique Timmerman
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Timmerman A, Oerlemans M, van der Vleuten C, Pawlikowska T, Ram P, Muris J. Exploring typologies of consultation performance using authentic clinical experiences to support learning and assessment in postgraduate medical training. PATIENT EDUCATION AND COUNSELING 2022; 105:2276-2284. [PMID: 34810057 DOI: 10.1016/j.pec.2021.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To validate and refine typologies of consultation performance from previous research to identify learning needs associated with each typology. METHODS We performed a qualitative study in a General Practice Specialty Training programme, using a two-stage design. First, we selected four exemplars from 80 videotaped consultations of 7 first-year and 6 third-year trainees that reflected the four typologies. We subsequently held individual interviews with clinical supervisors (N = 20) who observed these consultations to identify recurrent trainee behaviours. RESULTS The 'doctor-patient interaction' dimension from previous research was specified to encompass relationship-building, exploring, structuring, and shared decision-making competencies. Medical expertise was a moderating factor. The attitude and consultation behaviours included in the typologies were validated and we formulated directions for learning based on learning needs identified per typology. CONCLUSION Supervisors have a shared frame of reference for the behaviours reflecting proficient consultation performance. Serving as a developmental road map, all learning needs emphasised contextual adaptation, calling for an improved balance between patient-centred relationship building and application of medical expertise. PRACTICE IMPLICATIONS By providing rich and tailored feedback on consultation performance, the refined typologies - albeit subject to additional refinement in future research - may promote the monitoring of individual competence development over time.
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Affiliation(s)
- Angelique Timmerman
- Maastricht University, Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands.
| | - Marjolein Oerlemans
- Maastricht University, Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Cees van der Vleuten
- Maastricht University, Department of Educational Development and Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Teresa Pawlikowska
- RCSI University of Medicine and Health Sciences, Health Professions Education Centre, Dublin, Ireland
| | - Paul Ram
- Maastricht University, Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Jean Muris
- Maastricht University, Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
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A qualitative exploration of clinicians' strategies to communicate risks to patients in the complex reality of clinical practice. PLoS One 2020; 15:e0236751. [PMID: 32790675 PMCID: PMC7425874 DOI: 10.1371/journal.pone.0236751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Risk communication, situated in the model of shared decision making (SDM), is an essential element in daily clinical practice. The scientific literature makes a number of generic recommendations. Yet the application of risk communication remains a challenge in patient-clinician encounters. How clinicians actually communicate risk during consultations is not well understood. We aimed to explore the risk communication strategies used by clinicians and extract narratives and visualizations of those strategies to help inform medical education. METHODS In this qualitative descriptive study, we interviewed fifteen purposely sampled clinicians from several medical disciplines, who were familiar with the concept of SDM. Deductive and inductive content analysis was used during an iterative data collection and analyses process. RESULTS Our study identified various strategies reported to be used by clinicians to address the complexities of risk communication such as dealing with uncertainty. These included verbal, numerical and visual risk communication and framing. Clinicians were familiar with recommended risk formats such as natural frequencies and population pictograms. However, it became clear that clinicians' expertise and communication goals also play an important role in the risk talk. Clinicians try to lay a foundation for balanced decision-making and to incorporate patient preferences while faced with several challenges such as the dilemma of raising awareness but triggering anxiety or fan fear in patients. Consequently, they also use communication goals such as influencing mindset and reassuring patients. Additionally, clinicians frequently have to account for the illusion of certainty in the risk talk. CONCLUSION Risk communication is a multi-faceted construct that cannot be dealt with in isolation from the clinical context. For future research we recommend considering a more practical framework within the clinical setting and to take a goal-directed approach into account when investigating and teaching the topic. The patient perspective should also be addressed in further research.
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Understanding General Practitioners' Antibiotic Prescribing Decisions in Out-of-Hours Primary Care: A Video-Elicitation Interview Study. Antibiotics (Basel) 2020; 9:antibiotics9030115. [PMID: 32156082 PMCID: PMC7148451 DOI: 10.3390/antibiotics9030115] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 11/16/2022] Open
Abstract
Infections are the most common reason why patients consult out-of-hours (OOH) primary care. Too often there is an overprescribing of antibiotics for self-limiting infections and general practitioners (GPs) do not always choose the guideline recommended antibiotics. To improve antibiotic prescribing quality, a better understanding is needed of the (non) antibiotic prescribing decisions of GPs. This study sets out to unravel GPs’ (non) antibiotic prescribing decisions in OOH primary care. We video-recorded 160 consultations on infections during OOH primary care by 21 GPs and performed video-elicitation interviews with each GP. GPs reflected on their decision-making process and communication while watching their consultation. A qualitative thematic analysis was used. GPs found that their (non) antibiotic prescribing decision-making was not only based on objective arguments, but also subconsciously influenced by their own interpretation of information. Often GPs made assumptions (about for example the patients’ reason for encounter or expectations for antibiotics) without objectifying or verifying this with the patient. From the beginning of the consultation GPs follow a dichotomous thinking process: urgent versus not urgent, viral versus bacterial, antibiotics versus no antibiotics. Safety-netting is an important but difficult tool in the OOH care context, with no long-term follow-up or relationship with the patient. GPs talk about strategies they use to talk about diagnostic uncertainty, what patients can expect or should do when things do not improve and the difficulties they encounter while doing this. This video- elicitation interview study provides actionable insights in GPs’ (non) antibiotic prescribing decisions during OOH consultations on infections.
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Cox A, Li S. The medical consultation through the lenses of language and social interaction theory. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:241-257. [PMID: 30715620 PMCID: PMC7018671 DOI: 10.1007/s10459-018-09873-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 12/26/2018] [Indexed: 05/20/2023]
Abstract
The well-structured medical communication models that are typically described in textbooks are relevant to practice, but the actual messy interactional realities of consultations are often a far cry away from them. As a result, medical trainees frequently encounter difficulties when applying communication skills acquired during training to medical practice. This paper reflects on how clinical communication research and courses can incorporate the growing need for context-bound communication skills training. This paper illustrates how concepts from the research field of language and social interaction can facilitate the description and analysis of communication in clinical encounters, drawing on a real-life example from an increasingly common clinical scenario: a consultation in the emergency department involving a patient who does not speak the same language as the clinician. The proposed way of looking at clinical communication can enrich clinical skills training as it provides a tool to study, analyze, visualize and discuss communication from a different perspective that simultaneously accounts for interactional and clinical reasoning aspects of medical consultations.
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Affiliation(s)
- Antoon Cox
- Research Group Interpreting Studies, Faculty of Arts, KU Leuven, Louvain, Belgium
- Brussels Institute of Applied Linguistics and Linguistics and Literary Studies, Faculty of Arts and Philosophy, Vrije Universiteit Brussel, Brussels, Belgium
- Centre for Medical Education, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Shuangyu Li
- Centre for Medical Education, Faculty of Life Sciences and Medicine, King’s College London, London, UK
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Giroldi E, Timmerman A, Veldhuijzen W, Muris J, van der Vleuten C, van der Weijden T. How doctors recognise that their patients are worried: A qualitative study of patient cues. PATIENT EDUCATION AND COUNSELING 2020; 103:220-225. [PMID: 31585821 DOI: 10.1016/j.pec.2019.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/28/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Recognising patient cues indicating worry is essential for successful reassurance. To obtain more insight into the variety and nature of patient cues that may arise in practice, this study explores doctors' reflections on patient cues they recognise during consultations. METHODS We performed a qualitative study during which GPs participated in stimulated recall interviews, using their own video-recorded consultations to enhance reflection. First, we reanalysed an existing dataset of 15 interviews during which GPs elaborated on the doctor-patient interaction. Additionally, 12 GPs were interviewed specifically about recognising patients' cues. RESULTS GPs described four categories of patient cues that indicate worry. GPs recognised worry based on non-verbal cues such as visible bodily reactions, and verbal cues that can be further categorised by type of worry (e.g. about serious disease). Moreover, GPs described behavioural cues, e.g. the patient bringing a list of symptoms. Lastly, GPs recognise worry based on prior knowledge about the patient. CONCLUSIONS GPs reflections have given insight into a wide variety of non-verbal -, verbal -, behavioural- and foreknowledge-based cues. PRACTICE IMPLICATIONS The identified cues can guide other clinicians in recognising worries and inform medical communication training and future research on the effectiveness of recognising cues and patient reassurance.
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Affiliation(s)
- Esther Giroldi
- Department of Family Medicine, Care and Public Health Research Institute CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands.
| | - Angelique Timmerman
- Department of Family Medicine, Care and Public Health Research Institute CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Wemke Veldhuijzen
- Department of Family Medicine, Care and Public Health Research Institute CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands.
| | - Jean Muris
- Department of Family Medicine, Care and Public Health Research Institute CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Cees van der Vleuten
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands.
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute CAPHRI), Maastricht University, Maastricht, the Netherlands.
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van der Vleuten C, van den Eertwegh V, Giroldi E. Assessment of communication skills. PATIENT EDUCATION AND COUNSELING 2019; 102:2110-2113. [PMID: 31351785 DOI: 10.1016/j.pec.2019.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/06/2019] [Indexed: 05/26/2023]
Abstract
OBJECTIVE This paper addresses how communication skills can best be assessed. Since assessment and learning are strongly connected, the way communication skills are best learned is also described. RESULTS Communication skills are best learned in a longitudinal fashion with ample practice in an authentic setting. Confrontation of behavior initiates the learning process and should be supported by meaningful feedback through direct observation. When done appropriately a set of (learned) communication skills become integrated skilled communication, being versatilely used in purposeful goal-oriented clinical communication. The assessment of communication skills should follow a modern approach to assessment where the learning function of assessment is considered a priority. Individual assessments are feedback-oriented to promote further learning and development. The resulting rich information may be used to make progression decisions, usually in a group or committee decision. CONCLUSION This modern programmatic approach to assessment fits the learning of skilled communication well. PRACTICE IMPLICATIONS Implementation of a programmatic assessment approach to communication will entail a major innovation to education.
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Affiliation(s)
- Cees van der Vleuten
- Maastricht University, Department of Educational Development and Research, School of Health Professions Education(SHE), Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands.
| | - Valerie van den Eertwegh
- Maastricht University, Skillslab, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands
| | - Esther Giroldi
- Maastricht University, Department of Educational Development and Research, School of Health Professions Education(SHE), Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands; Maastricht University, Department of Family Medicine, Care and Public, Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands
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van Braak M, de Groot E, Veen M, Welink L, Giroldi E. Eliciting tacit knowledge: The potential of a reflective approach to video-stimulated interviewing. PERSPECTIVES ON MEDICAL EDUCATION 2018; 7:386-393. [PMID: 30446951 PMCID: PMC6283779 DOI: 10.1007/s40037-018-0487-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
| | | | - Mario Veen
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lisanne Welink
- University Medical Center Utrecht, Utrecht, The Netherlands
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Giroldi E, Veldhuijzen W, Geelen K, Muris J, Bareman F, Bueving H, van der Weijden T, van der Vleuten C. Developing skilled doctor-patient communication in the workplace: a qualitative study of the experiences of trainees and clinical supervisors. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:1263-1278. [PMID: 28220333 PMCID: PMC5663797 DOI: 10.1007/s10459-017-9765-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 02/14/2017] [Indexed: 05/16/2023]
Abstract
To inform the development of recommendations to facilitate learning of skilled doctor-patient communication in the workplace, this qualitative study explores experiences of trainees and supervisors regarding how trainees learn communication and how supervisors support trainees' learning in the workplace. We conducted a qualitative study in a general practice training setting, triangulating various sources of data to obtain a rich understanding of trainees and supervisors' experiences: three focus group discussions, five discussions during training sessions and five individual interviews. Thematic network analysis was performed during an iterative process of data collection and analysis. We identified a communication learning cycle consisting of six phases: impactful experience, change in frame of reference, identification of communication strategies, experimentation with strategies, evaluation of strategies and incorporation into personal repertoire. Supervisors supported trainees throughout this process by creating challenges, confronting trainees with their behaviour and helping them reflect on its underlying mechanisms, exploring and demonstrating communication strategies, giving concrete practice assignments, creating safety, exploring the effect of strategies and facilitating repeated practice and reflection. Based on the experiences of trainees and supervisors, we conclude that skilled communication involves the development of a personal communication repertoire from which learners are able to apply strategies that fit the context and their personal style. After further validation of our findings, it may be recommended to give learners concrete examples, opportunities for repeated practise and reflection on personal frames of reference and the effect of strategies, as well as space for authenticity and flexibility. In the workplace, the clinical supervisor is able to facilitate all these essential conditions to support his/her trainee in becoming a skilled communicator.
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Affiliation(s)
- Esther Giroldi
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - Wemke Veldhuijzen
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Kristel Geelen
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jean Muris
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Frits Bareman
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Herman Bueving
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Cees van der Vleuten
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
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Salmon P, Young B. A new paradigm for clinical communication: critical review of literature in cancer care. MEDICAL EDUCATION 2017; 51:258-268. [PMID: 27995660 PMCID: PMC5324633 DOI: 10.1111/medu.13204] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/18/2016] [Accepted: 08/15/2016] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To: (i) identify key assumptions of the scientific 'paradigm' that shapes clinical communication research and education in cancer care; (ii) show that, as general rules, these do not match patients' own priorities for communication; and (iii) suggest how the paradigm might change to reflect evidence better and thereby serve patients better. METHODS A critical review, focusing on cancer care. We identified assumptions about patients' and clinicians' roles in recent position and policy statements. We examined these in light of research evidence, focusing on inductive research that has not itself been constrained by those assumptions, and considering the institutionalised interests that the assumptions might serve. RESULTS The current paradigm constructs patients simultaneously as needy (requiring clinicians' explicit emotional support) and robust (seeking information and autonomy in decision making). Evidence indicates, however, that patients generally value clinicians who emphasise expert clinical care rather than counselling, and who lead decision making. In denoting communication as a technical skill, the paradigm constructs clinicians as technicians; however, communication cannot be reduced to technical skills, and teaching clinicians 'communication skills' has not clearly benefited patients. The current paradigm is therefore defined by assumptions that that have not arisen from evidence. A paradigm for clinical communication that makes its starting point the roles that mortal illness gives patients and clinicians would emphasise patients' vulnerability and clinicians' goal-directed expertise. Attachment theory provides a knowledge base to inform both research and education. CONCLUSIONS Researchers will need to be alert to political interests that seek to mould patients into 'consumers', and to professional interests that seek to add explicit psychological dimensions to clinicians' roles. New approaches to education will be needed to support clinicians' curiosity and goal-directed judgement in applying this knowledge. The test for the new paradigm will be whether the research and education it promotes benefit patients.
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Affiliation(s)
- Peter Salmon
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolUK
| | - Bridget Young
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolUK
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Scharitzer M, Pokieser P, Wagner-Menghin M, Otto F, Ekberg O. Taking the history in patients with swallowing disorders: an international multidisciplinary survey. Abdom Radiol (NY) 2017; 42:786-793. [PMID: 27730327 PMCID: PMC5355505 DOI: 10.1007/s00261-016-0931-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Purpose Clinical assessment of swallowing disorders (dysphagia) requires accurate and comprehensive medical history-taking to further tailor the diagnostic work-up, but functional health care questionnaires show a large variability and various limitations. The aim of this study was to assess the way in which international swallowing experts from various disciplines asses swallowing problems in order to improve the radiologist´s ability to take a thorough medical history in this specific patient group. Methods A two-step Delphi method was used to collect swallowing experts’ ways of taking the medical history in patients with swallowing disorders. The questions obtained in a first interview round were pooled and structured by dividing them into general and specific questions, including several subcategories, and these were scored by the experts in a second step based on to their clinical relevance. Results Eighteen experts provided 25 different questions categorized as general questions and 34 dimension-specific questions (eight attributed to ‘suspicion of aspiration,’ 13 to ‘dysphagia,’ six to ‘globus sensation,’ four to ‘non-cardiac chest pain,’ and three to ‘effect of life.’) In the second interview round, the experts´ average predictive values attributed to those questions showed the varying importance of the presented items. Seven general and 13 specific questions (six of them attributed to ‘effect on life’ and seven ‘others’) were also added. Conclusions This collection of questions reflects the fact that a multidisciplinary approach when obtaining the medical history in patients with swallowing disorders may contribute to an improved technique for performing a symptom-oriented medical history-taking for radiologists of all training levels.
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Affiliation(s)
- Martina Scharitzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Peter Pokieser
- Unified Patient Project, Teaching Center, Medical University of Vienna, Vienna, Austria
| | | | - Ferdinand Otto
- Department of Neurology, University Hospital Salzburg, Salzburg, Austria
| | - Olle Ekberg
- Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Malmö, Sweden
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Paternotte E, Scheele F, van Rossum TR, Seeleman MC, Scherpbier AJJA, van Dulmen AM. How do medical specialists value their own intercultural communication behaviour? A reflective practice study. BMC MEDICAL EDUCATION 2016; 16:222. [PMID: 27558271 PMCID: PMC4997670 DOI: 10.1186/s12909-016-0727-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/06/2016] [Indexed: 05/29/2023]
Abstract
BACKGROUND Intercultural communication behaviour of doctors with patients requires specific intercultural communication skills, which do not seem structurally implemented in medical education. It is unclear what motivates doctors to apply intercultural communication skills. We investigated how purposefully medical specialists think they practise intercultural communication and how they reflect on their own communication behaviour. METHODS Using reflective practice, 17 medical specialists independently watched two fragments of videotapes of their own outpatient consultations: one with a native patient and one with a non-native patient. They were asked to reflect on their own communication and on challenges they experience in intercultural communication. The interviews were open coded and analysed using thematic network analysis. RESULTS The participants experienced only little differences in their communication with native and non-native patients. They mainly mentioned generic communication skills, such as listening and checking if the patient understood. Many participants experienced their communication with non-native patients positively. The participants mentioned critical incidences of intercultural communication: language barriers, cultural differences, the presence of an interpreter, the role of the family and the atmosphere. CONCLUSION Despite extensive experience in intercultural communication, the participants of this study noticed hardly any differences between their own communication behaviour with native and non-native patients. This could mean that they are unaware that consultations with non-native patients might cause them to communicate differently than with native patients. The reason for this could be that medical specialists lack the skills to reflect on the process of the communication. The participants focused on their generic communication skills rather than on specific intercultural communication skills, which could either indicate their lack of awareness, or demonstrate that practicing generic communication is more important than applying specific intercultural communication. They mentioned well-known critical incidences of ICC: language barriers, cultural differences, the presence of an interpreter, the role of the family and the atmosphere. Nevertheless, they showed a remarkably enthusiastic attitude overall was noteworthy. A strategy to make doctors more aware of their intercultural communication behaviour could be a combination of experiential learning and ICC training, for example a module with reflective practice.
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Affiliation(s)
- E. Paternotte
- Department of Healthcare Education, OLVG Hospital, P.O. Box 9243, 1006 AE Amsterdam, The Netherlands
| | - F. Scheele
- Department of Healthcare Education, OLVG Hospital, P.O. Box 9243, 1006 AE Amsterdam, The Netherlands
- Medical School of Sciences, Vu University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - T. R. van Rossum
- Department of Healthcare Education, OLVG Hospital, P.O. Box 9243, 1006 AE Amsterdam, The Netherlands
| | - M. C. Seeleman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - A. J. J. A. Scherpbier
- Institute for Medical Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - A. M. van Dulmen
- NIVEL (Netherlands Institute for health services research), P.O. Box 1568, 3500 BN Utrecht, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Faculty of Health Sciences, University College of Southeast Norway, P.O. Box 235, 3603 Kongsberg, Drammen, Norway
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Giroldi E, Veldhuijzen W, Dijkman A, Rozestraten M, Muris J, van der Vleuten C, van der Weijden T. How to gather information from talkative patients in a respectful and efficient manner: a qualitative study of GPs' communication strategies. Fam Pract 2016; 33:100-6. [PMID: 26601673 DOI: 10.1093/fampra/cmv094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Gathering information from talkative patients presents a challenge to clinicians. Empirical evidence on how to effectively deal with this challenge is scant. OBJECTIVE This study explores communication strategies and their underlying mechanisms that GPs consider effective when gathering information from talkative patients in order to inform the development of best practices. METHODS We conducted a qualitative study with experienced GPs. We held individual stimulated-recall interviews (SRIs) with six GPs using their videotaped consultations as a stimulus. The transcripts that ensued were triangulated with data from three focus-group discussions (FGs). We performed a thematic network analysis during an iterative process of data collection and analysis. RESULTS To deal with talkative patients during consultations, GPs first try to pinpoint the cause of patients' talkativeness before deciding on the approach to take. Moreover, they resort to the familiar communication strategies, however, in doing so adopt take a more directive attitude. To prevent such attitude from damaging the relationship, GPs take a stepped approach in which they try not to be overly directive, make the patient co-responsible for efficient time management and make use of empathic interrupting. CONCLUSIONS In the absence of evidence, this description of GPs' communication strategies can guide clinicians, residents and students in gathering information from talkative patients in an efficient, yet empathic and respectful manner. When developing best practices, heed should be paid to the causes of patients' talkativeness and the tension between taking a directive approach and building a doctor-patient relationship.
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Affiliation(s)
- Esther Giroldi
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI) and Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
| | - Wemke Veldhuijzen
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI) and Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Annika Dijkman
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI) and
| | - Maxime Rozestraten
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI) and
| | - Jean Muris
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI) and
| | - Cees van der Vleuten
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI) and
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15
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Loureiro E, Severo M, Ferreira MA. Attitudes of Portuguese medical residents' towards clinical communication skills. PATIENT EDUCATION AND COUNSELING 2015; 98:1039-1043. [PMID: 25952927 DOI: 10.1016/j.pec.2015.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 03/23/2015] [Accepted: 04/01/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore the attitudes and perceptions of Portuguese residents towards Clinical Communication Skills (CCS) and the need for complementary training. METHODS 78 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). RESULTS Residents 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). CONCLUSION Residents 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 IMPLICATIONS Integration 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.
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Affiliation(s)
- Elizabete Loureiro
- Department of Medical Education and Simulation, Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - Milton Severo
- Department of Medical Education and Simulation, Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Hygiene and Epidemiology, University of Porto, Porto, Portugal
| | - Maria Amélia Ferreira
- Department of Medical Education and Simulation, Faculty of Medicine of the University of Porto, Porto, Portugal
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Mendick N, Young B, Holcombe C, Salmon P. How do surgeons think they learn about communication? A qualitative study. MEDICAL EDUCATION 2015; 49:408-416. [PMID: 25800301 DOI: 10.1111/medu.12648] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 09/15/2014] [Accepted: 10/22/2014] [Indexed: 06/04/2023]
Abstract
CONTEXT Communication education has become integral to pre- and post-qualification clinical curricula, but it is not informed by research into how practitioners think that good communication arises. OBJECTIVES This study was conducted to explore how surgeons conceptualise their communication with patients with breast cancer in order to inform the design and delivery of communication curricula. METHODS We carried out 19 interviews with eight breast surgeons. Each interview centred on a specific consultation with a different patient. We analysed the transcripts of the surgeons' interviews qualitatively using a constant comparative approach. RESULTS All of the surgeons described communication as central to their role. Communication could be learned to some extent, not from formal training, but by selectively incorporating practices they observed in other practitioners and by being mindful in consultations. Surgeons explained that their own values and character shaped how they communicated and what they wanted to achieve, and constrained what could be learned. CONCLUSIONS These surgeons' understanding of communication is consistent with recent suggestions that communication education: (i) should place practitioners' goals at its centre, and (ii) might be enhanced by approaches that support 'mindful' practice. By contrast, surgeons' understanding diverged markedly from the current emphasis on 'communication skills'. Research that explores practitioners' perspectives might help educators to design communication curricula that engage practitioners by seeking to enhance their own ways of learning about communication.
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Affiliation(s)
- Nicola Mendick
- Division of Clinical Psychology, University of Liverpool, Liverpool, UK
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17
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Setting goal and implementation intentions in consultations between practice nurses and patients with overweight or obesity in general practice. Public Health Nutr 2015; 18:3051-9. [DOI: 10.1017/s1368980015000075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AbstractObjectivePatients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight or obesity, in order to identify points for improvement.DesignAn observational checklist was developed to assess goal and implementation intentions and ‘missed opportunities for lifestyle counselling’. Comparisons were made with overall consultation goals set by practice nurses, as measured in a post-visit questionnaire.SettingDutch general practice.SubjectsOne hundred video-taped consultations (2010/2011) between practice nurses and patients with overweight or obesity.ResultsHalf of the consultations contained a goal intention, of which the majority aimed to change eating behaviour. Only part of these goal intentions could be considered implementation intentions. It appeared that actions (how elements) were not often included here. Lifestyle change was more often perceived as an overall consultation goal than weight change. Regarding patterns of overall consultation goals, the majority addressed only one lifestyle factor at a time. If practice nurses formulated weight change in their overall consultation goal, they also used goal or implementation intentions, especially for weight change. In a quarter of the consultations, practice nurses did not ask any further questions about weight, nutrition or physical activity to gain insight, which is an important ‘missed opportunity for lifestyle counselling’.ConclusionsMatching implementation intentions to the broader overall consultation goals of practice nurses would be meaningful, leading to desired goal-directed behaviours and subsequent goal attainment.
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18
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Aper L, Veldhuijzen W, Dornan T, van de Ridder M, Koole S, Derese A, Reniers J. "Should I prioritize medical problem solving or attentive listening?": the dilemmas and challenges that medical students experience when learning to conduct consultations. PATIENT EDUCATION AND COUNSELING 2015; 98:77-84. [PMID: 25448312 DOI: 10.1016/j.pec.2014.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 09/02/2014] [Accepted: 09/19/2014] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Communication skills can be trained alongside clinical reasoning, history taking or clinical examination skills. This is advocated as a solution to the low transfer of communication skills. Still, students have to integrate the knowledge/skills acquired during different curriculum parts in patient consultations at some point. How do medical students experience these integrated consultations within a simulated environment and in real practice when dealing with responsibility? METHODS Six focus groups were conducted with (pre-)/clerkship students. RESULTS Students were motivated to practice integrated consultations with simulated patients and felt like 'real physicians'. However, their focus on medical problem solving drew attention away from improving their communication skills. Responsibility for real patients triggered students' identity development. This identity formation guided the development of an own consultation style, a process that was hampered by conflicting demands of role models. CONCLUSION Practicing complete consultations results in the dilemma of prioritizing medical problem solving above attention for patient communication. Integrated consultation training advances this dilemma to the pre-clerkship period. During clerkships this dilemma is heightened because real patients trigger empathy and responsibility, which invites students to define their role as doctor. PRACTICE IMPLICATIONS When training integrated consultations, educators should pay attention to students' learning priorities and support the development of students' professional identity.
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Hunter C, Chew-Graham CA, Langer S, Drinkwater J, Stenhoff A, Guthrie EA, Salmon P. 'I wouldn't push that further because I don't want to lose her': a multiperspective qualitative study of behaviour change for long-term conditions in primary care. Health Expect 2014; 18:1995-2010. [PMID: 25376672 PMCID: PMC5810675 DOI: 10.1111/hex.12304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 01/17/2023] Open
Abstract
Background Health outcomes for long‐term conditions (LTCs) can be improved by lifestyle, dietary and condition management‐related behaviour change. Primary care is an important setting for behaviour change work. Practitioners have identified barriers to this work, but there is little evidence examining practices of behaviour change in primary care consultations and how patients and practitioners perceive these practices. Objective To examine how behaviour change is engaged with in primary care consultations for LTCs and investigate how behaviour change is perceived by patients and practitioners. Design Multiperspective, longitudinal qualitative research involving six primary health‐care practices in England. Consultations between patients with LTCs and health‐care practitioners were audio‐recorded. Semi‐structured interviews were completed with patients and practitioners, using stimulated recall. Patients were re‐interviewed 3 months later. Framework analysis was applied to all data. Participants Thirty‐two people with at least one LTC (chronic obstructive pulmonary disease, diabetes, asthma and coronary heart disease) and 10 practitioners. Results Behaviour change talk in consultations was rare and, when it occurred, was characterized by deflection and diffidence on the part of practitioners. Patient motivation tended to be unaddressed. While practitioners positioned behaviour change work as outside their remit, patients felt uncertain about, yet responsible for, this work. Practitioners raised concerns that this work could damage other aspects of care, particularly the patient–practitioner relationship. Conclusion Behaviour change work is often deflected or deferred by practitioners in consultations, who nevertheless vocalize support for its importance in interviews. This discrepancy between practitioners’ accounts and behaviours needs to be addressed within primary health‐care organizations.
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Affiliation(s)
- Cheryl Hunter
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Carolyn A Chew-Graham
- Research Institute, Primary Care and Health Sciences and National School for Primary Care Research, Keele University, Keele, Staffs, UK
| | - Susanne Langer
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | | | - Alexandra Stenhoff
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Elspeth A Guthrie
- Manchester Mental Health and Social Care Trust, Manchester, UK.,University of Manchester, Manchester, UK
| | - Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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20
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Giroldi E, Veldhuijzen W, Leijten C, Welter D, van der Weijden T, Muris J, van der Vleuten C. 'No need to worry': an exploration of general practitioners' reassuring strategies. BMC FAMILY PRACTICE 2014; 15:133. [PMID: 25001991 PMCID: PMC4118274 DOI: 10.1186/1471-2296-15-133] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/30/2014] [Indexed: 11/10/2022]
Abstract
Background In view of the paucity of evidence regarding effective ways of reassuring worried patients, this study explored reassuring strategies that are considered useful by general practitioners (GPs). Methods In a study using a qualitative observational design, we re-analysed an existing dataset of fifteen stimulated recall interviews in which GPs elaborated on their communication with patients in two videotaped consultations. Additionally we held stimulated recall interviews with twelve GPs about two consultations selected for a strong focus on reassurance. Results To reassure patients, GPs pursued multiple goals: 1. influencing patients’ emotions by promoting trust, safety and comfort, which is considered to be reassuring in itself and supportive of patients’ acceptance of reassuring information and 2. influencing patients’ cognitions by challenging patients’ belief that their symptoms are indicative of serious disease, often followed by promoting patients’ belief that their symptoms are benign. GPs described several actions to activate mechanisms to achieve these goals. Conclusions GPs described a wealth of reassuring strategies, which make a valuable contribution to the current literature on doctor-patient communication. This detailed description may provide practicing GPs with new tools and can inform future studies exploring the effectiveness of reassurance strategies.
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Affiliation(s)
- Esther Giroldi
- Department of Family Medicine, Maastricht University, School of Public Health and Primary Care (CAPHRI), P,O, Box 616, Maastricht, The Netherlands.
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Konopasek L, Kelly KV, Bylund CL, Wenderoth S, Storey-Johnson C. The Group Objective Structured Clinical Experience: building communication skills in the clinical reasoning context. PATIENT EDUCATION AND COUNSELING 2014; 96:79-85. [PMID: 24882085 DOI: 10.1016/j.pec.2014.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 03/27/2014] [Accepted: 04/05/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Students are rarely taught communication skills in the context of clinical reasoning training. The purpose of this project was to combine the teaching of communication skills using SPs with clinical reasoning exercises in a Group Objective Structured Clinical Experience (GOSCE) to study feasibility of the approach, the effect on learners' self-efficacy and attitude toward learning communication skills, and the effect of providing multiple sources of immediate, collaborative feedback. METHODS GOSCE sessions were piloted in Pediatrics and Medicine clerkships with students assessing their own performance and receiving formative feedback on communication skills from peers, standardized patients (SPs), and faculty. The sessions were evaluated using a retrospective pre/post-training questionnaire rating changes in self-efficacy and attitudes, and the value of the feedback. RESULTS Results indicate a positive impact on attitudes toward learning communication skills and self-efficacy regarding communication in the clinical setting. Also, learners considered feedback by peers, SPs, and faculty valuable in each GOSCE. CONCLUSION The GOSCE is an efficient and learner-centered method to attend to multiple goals of teaching communication skills, clinical reasoning, self-assessment, and giving feedback in a formative setting. PRACTICE IMPLICATIONS The GOSCE is a low-resource, feasible strategy for experiential learning in communication skills and clinical reasoning.
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Affiliation(s)
- Lyuba Konopasek
- NewYork-Presbyterian Hospital, Graduate Medical Education, New York, NY, USA; Weill Cornell Medical College, Department of Pediatrics, New York, NY, USA.
| | - Kevin V Kelly
- Weill Cornell Medical College, Department of Psychiatry, New York, NY, USA
| | - Carma L Bylund
- Hamad Medical Corporation, Department of Medical Education, Doha, Qatar; Weill Cornell Medical College-Qatar, Department of Psychiatry, Doha, Qatar
| | - Suzanne Wenderoth
- Reading Health System, Department of Internal Medicine, Reading, PA, USA
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Abraham NS, Alberts JK. Simplifying shared decision-making: physician-patient interactions as negotiations. Clin Gastroenterol Hepatol 2013; 11:1368-9. [PMID: 24051133 DOI: 10.1016/j.cgh.2013.08.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Neena S Abraham
- Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Scottsdale, Arizona
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Street RL, De Haes HCJM. Designing a curriculum for communication skills training from a theory and evidence-based perspective. PATIENT EDUCATION AND COUNSELING 2013; 93:27-33. [PMID: 23890580 DOI: 10.1016/j.pec.2013.06.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/23/2013] [Accepted: 06/08/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Because quality health care delivery requires effective clinician-patient communication, successful training of health professionals requires communication skill curricula of the highest quality. Two approaches for developing medical communication curricula are a consensus approach and a theory driven approach. We propose a theory-driven, communication function framework for identifying important communication skills, one that is focused on the key goals and outcomes that need to be accomplished in clinical encounters. We discuss 7 communication functions important to medical encounters and the types of skills needed to accomplish each. DISCUSSION The functional approach has important pedagogical implications including the importance of distinguishing the performance of a behavior (capacity) from the outcome of that behavior in context (effectiveness) and the recognition that what counts as effective communication depends on perspective (e.g., observer, patient). CONCLUSION Consensus and theory-driven approaches to medical communication curricula are not necessarily contradictory and can be integrated to further enhance ongoing development and improvements in medical communication education. PRACTICE IMPLICATIONS A functional approach should resonate with practicing clinicians and continuing education initiatives in that it is embraces the notion that competent communication is situation-specific as clinicians creatively use communicative skills to accomplish the key goals of the encounter.
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Affiliation(s)
- Richard L Street
- Department of Communication, Texas A&M University, College Station, USA.
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Hulsman RL, Peters JF, Fabriek M. Peer-assessment of medical communication skills: the impact of students' personality, academic and social reputation on behavioural assessment. PATIENT EDUCATION AND COUNSELING 2013; 92:346-54. [PMID: 23916674 DOI: 10.1016/j.pec.2013.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 07/01/2013] [Accepted: 07/02/2013] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Peer-assessment of communication skills may contribute to mastery of assessment criteria. When students develop the capacity to judge their peers' performance, they might improve their capacity to examine their own clinical performance. In this study peer-assessment ratings are compared to teacher-assessment ratings. The aim of this paper is to explore the impact of personality and social reputation as source of bias in assessment of communication skills. METHODS Second year students were trained and assessed history taking communication skills. Peers rated the students' personality and academic and social reputation. RESULTS Peer-assessment ratings were significantly correlated with teacher-ratings in a summative assessment of medical communication. Peers did not provide negative ratings on final scales but did provide negative ratings on subcategories. Peer- and teacher-assessments were both related to the students' personality and academic reputation. CONCLUSION Peer-assessment cannot replace teacher-assessment if the assessment should result in high-stake decisions about students. Our data do not confirm the hypothesis that peers are overly biased by personality and reputation characteristics in peer-assessment of performance. PRACTICE IMPLICATIONS Early introduction of peer-assessment in medical education would facilitate early acceptance of this mode of evaluation and would promote early on the habit of critical evaluation of professional clinical performance and acceptance of being evaluated critically by peers.
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Affiliation(s)
- Robert L Hulsman
- Academic Medical Centre, Department of Medical Psychology, Amsterdam, The Netherlands.
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Hulsman RL, Visser A. Seven challenges in communication training: learning from research. PATIENT EDUCATION AND COUNSELING 2013; 90:145-146. [PMID: 23312421 DOI: 10.1016/j.pec.2012.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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