How we train undergraduate medical students in decoding patients' nonverbal clues

Efficacy of a Standardised Patient Simulation Programme for Chronicity and End-of-Life Care Training in Undergraduate Nursing Students

BACKGROUND

Standardised patient simulations seem to be useful for improving the communication skills of health sciences students. However, it is important to define the effectiveness of these types of interventions in complex scenarios linked to disease chronicity and end-of-life contexts.

METHODS

A quasi-experimental study with pre- and post-intervention measures was carried out in a single group. A total of 161 nursing students completed different assessment instruments to measure their attitudes towards communication (Attitude Toward Communication Scale), self-efficacy (Self-Efficacy of Communication Skills, SE-12), and communication skills (Health Professionals Communication Skills Scale, EHC-PS) before and after simulation training with standardised patients. The objective of the program was to train students in non-technical skills for complex situations involving chronicity and end-of-life care. It comprised eight sessions lasting 2.5 h each.

RESULTS

The results showed notable baseline gender differences in attitudes towards communication and in the informative communication dimension, with women obtaining higher scores. The participants' self-efficacy and communication skills significantly improved after completing the intervention, with no significant differences being found for the attitudes towards communication variable.

CONCLUSION

The standardised patient simulation programme for complex scenarios related to chronicity and end-of-life contexts improved communication self-efficacy and communication skills in these nursing students. In future work it will be important to analyse the influence of gender and attitudes towards communication as variables in the learning of communication skills in nursing students.

Being Vulnerable: A Qualitative Inquiry of Physician Touch in Medical Education

PURPOSE

Effective nonverbal communication is associated with empathic behavior and improved patient outcomes. Touch, as a form of nonverbal communication, is relatively unexplored in medical education. This study sought to gain in-depth insights into physicians' experiences communicating with touch and to examine how these insights could inform communication skills curricula.

METHOD

Collaborative inquiry, a form of action research, was used. Six experienced physician-educators from the University of Calgary met 8 times between 2015 and 2018 to critically reflect on their experiences of touch in clinical practice, teaching, and learning. Data comprised meeting transcripts, individual narrative accounts, and digital recordings of role-plays. Interpretative phenomenology, the study of lived experience, guided analysis.

RESULTS

Two themes were identified-touch as presence and touch as risk. Participants used touch to demonstrate presence and a shared humanity with patients, to express "being with" a patient. Risk was not associated with the physical experience of touch but, rather, with its social meaning, interpreted through gender, culture, relationships, and context. Individual experiences were open to many interpretations. Participants expressed tension between their personal experience communicating with touch to express empathy and formal curricular structures. Reflection, role-modeling, and clinical debriefs were suggested as ways to encourage situational awareness and sensitive use of touch.

CONCLUSIONS

Touch is a powerful means to communicate with patients but is highly subjective. Rather than avoiding touch for fear of misinterpretation, encouraging dialogue about its complexity could promote a more balanced understanding of touch and its potential to convey empathy and help physicians more effectively manage risk when using touch.

Humanism in clinical education: a mixed methods study on the experiences of clinical instructors in Iran

BACKGROUND

Medical education is currently more considerate about the human dimension. The present qualitative study aimed to explain the experiences of clinical professors with regard to humanism in clinical education in Iran.

METHODS

This mixed methods study had two phases, a quanitative phase of scientometrics and a qualitative phase of a content analysis. In the scientometrics phase, Ravar PreMap and VOSviewer software programs were utilized for plotting the conceptual networks. The networks were analyzed at the micro-level based on centrality indices (closeness, degree, and betweenness). The conceptual network was plotted and the prominent topics in clinical education were identified using co-word analysis. In the second qualitative phase on the topic, based on the scientometrics phase, semi-structured interviews were conducted with clinical professors. The interviews were transcribed verbatim and analyzed.

RESULTS

On the basis of the analysis of titles, abstracts, and keywords of the retrieved articles on clinical education from ISI Web of Science, Scopus, and PubMed, 1412 keywords were extracted. After the refining process, 356 keywords with 6741 relations remained. Upon plotting the conceptual network, 19 conceptual clusters related to clinical education were obtained. Then, micro-level network analysis (centrality criteria) indicated that the keyword humanism with the frequency of 137 had the highest rate (97.753), closeness (97.802), and betweenness (13.407). Moreover, from the interview data analysis, two themes of "intertwined nature of the human spirit in clinical education" and "humanistic behavior of professors in clinical education" were extracted.

CONCLUSION

As a part of the educational culture, humanistic values must be intertwined with the medical education curriculum. In this regard, humanism and clinical reasoning are the two major clusters of clinical teaching; moreover, altruism and adherence to humanistic values, and scientific qualification are other main pillars that should be considered as the criteria for the selection of clinical professors and medical students.

Embodying empathy: A phenomenological study of physician touch

CONTEXT

Empathic physician behaviour is associated with improved patient outcomes. One way to demonstrate empathy is through the use of non-verbal communication (NVC) including touch. To date, research on NVC, and specifically touch, has been relatively limited in medicine, which is surprising given the central role it plays in conveying affective and empathic messages. To inform curriculum development on NVC, this study aimed to examine physicians' experiences of communicating by touch.

METHODS

We conducted an interpretative phenomenological study. A total of 15 physicians (seven women and eight men) from different specialties, including both recent graduates and experienced doctors, described in detail specific instances of touch drawn from their clinical practices. Interview prompts encouraged participants to recall exact details such as the context, their relationship with the patient they touched and their physical experience of touching. Interviews (45-100 minutes) were analysed with template analysis, followed by a process of dialectic questioning, moving back and forth between the data and researchers' personal reflections on them, drawing on phenomenological literature to synthesise a final interpretation.

RESULTS

Participants described two dimensions of the experience of touch: 'choosing and inviting touch' and 'expressing empathy.' Touch was a personal and fragile process. Participants interpreted non-verbal patient cues in order to determine whether or not touch was appropriate. They interpreted facial expressions and body language in the present to make meaning of patients' experiences. They used touch to share emotions, and to demonstrate empathy and presence. Participants' experiences of touch framed it as a form of embodied empathic communication.

CONCLUSIONS

Touch is a powerful form of NVC that can establish human connection. Phenomenological accounts of empathy, which emphasise its embodied intersubjective nature, can be used to theoretically enrich pedagogical approaches to touch in medical education and to deepen our understanding of empathy.

Drama to promote non-verbal communication skills

BACKGROUND

Non-verbal communication skills (NVCS) help physicians to deliver relationship-centred care, and the effective use of NVCS is associated with improved patient satisfaction, better use of health services and high-quality clinical care. In contrast to verbal communication skills, NVCS training is under developed in communication curricula for the health care professions. One of the challenges teaching NVCS is their tacit nature. In this study, we evaluated drama exercises to raise awareness of NVCS by making familiar activities 'strange'.

METHODS

Workshops based on drama exercises were designed to heighten an awareness of sight, hearing, touch and proxemics in non-verbal communication. These were conducted at eight medical education conferences, held between 2014 and 2016, and were open to all conference participants. Workshops were evaluated by recording narrative data generated during the workshops and an open-ended questionnaire following the workshop. Data were analysed qualitatively, using thematic analysis. Non-verbal communication skills help doctors to deliver relationship-centred care RESULTS: One hundred and twelve participants attended workshops, 73 (65%) of whom completed an evaluation form: 56 physicians, nine medical students and eight non-physician faculty staff. Two themes were described: an increased awareness of NVCS and the importance of NVCS in relationship building. Drama exercises enabled participants to experience NVCS, such as sight, sound, proxemics and touch, in novel ways. Participants reflected on how NCVS contribute to developing trust and building relationships in clinical practice.

DISCUSSION

Drama-based exercises elucidate the tacit nature of NVCS and require further evaluation in formal educational settings.

Twelve tips on teaching and learning humanism in medical education

BACKGROUND

The teaching of humanistic values is recognized as an essential component of medical education and continuing professional development of physicians. The application of humanistic values in medical care can benefit medical students, clinicians and patients.

AIMS

This article presents 12 tips on fostering humanistic values in medical education.

METHOD

The authors reviewed the literature and present 12 practical tips that are relevant to contemporary practices.

RESULTS

The tips can be used in teaching and sustaining humanistic values in medical education.

CONCLUSIONS

Humanistic values can be incorporated in formal preclinical environments, the transition into clinical settings, medical curricula and clinical clerkships. Additionally, steps can be taken so that medical educators and institutions promote and sustain humanistic values.

Ways to improve the patient-physician relationship

PURPOSE OF REVIEW

This article revises the main conclusions from recent reviews and research, about the different dimensions that shape the patient-physician relationship, delineating specific areas of intervention that would reinforce the quality of this interaction.

RECENT FINDINGS

The selected articles reflect the permanent interest that exists about this topic. Within the most promissory findings significant associations were found from statistical as well as clinical standpoints. These associated verbal and non-verbal communication skills, as well as the empathizing ability of the physician, with clinical results of the patients, were measured with subjective parameters (e.g. patient satisfaction) and especially objective ones (e.g. physiological markers). Nevertheless, the results are still not robust and cannot be translatable.

SUMMARY

The implications of these studies are at a conceptual and instrumental level. A better precision of the dimensions and variables that define the patient-physician relationship will permit the design of educational strategies and training that will empower the physician for an interaction with his patients of greater technical and relational efficiency.