Theme: 9AA Teaching and assessing communication skills
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Challenging patients don't take a young doctor seriously - Medical students self-assessed communication skills at the end of their studies
Authors: Asta Toivonen
Eeva Pyorala
Institutions: University of Helsinki, Faculty of Medicine - Finland
 
Background

Communication skills studies (CCS) were started 20 years ago in the Faculty of Medicine at the University of Helsinki. The CCS studies begin in the first study year and continue throughout the six-year curriculum. Several experiential learning methods are used, such as role plays, simulations with actors, video recorded patient interviews and observation and real patient encounters. Communication skills are formatively assessed along the studies and summatively in an OSCE (Objective Structured Clinical Examination) station. The curriculum of the undergraduate medical education is under reform, thereby also CCS are under scrutiny. This research provides material for evidence based educational development.  

This study aims at finding out:

1. How graduating students assess mastering communication

2. How they learn these skills

3. What challenges they have in communication at the end of their studies

Summary of Work

The data were collected in the final study year at the end of an optional course entitled “Doctor’s good communication skills” during the years 2013 and 2014. The students participating in the course answered an anonymous questionnaire including statements using 5-point Likert scale and open-ended questions. The students were asked an informed consent, and 95 students (97%) gave their consent. The data consist of students’ self-assessments of their communications skills management, their descriptions of learning communication and challenges they face in communication at the end of the studies.

A mixed methods analysis was used in the data analysis. Statements were analyzed quantitatively by descriptive statistics indicating general tendencies (mean) and the spread of scores (standard deviation) 1. Open-ended questions were analyzed inductively with qualitative content analysis 2 and then quantified for frequencies.

Summary of Results

The analysis of quantitative statements showed the students assessed they mastered communication skills relatively well, mean varying from 3.17 to 4.45 (Table 1). The students expressed they understand the value of communication in medical practice.The lowest ratings were found in students' ability to discuss the risks of complications, to reflect the effectiveness of care and to handle malpractices with their patient. The amount of missing values in students’ answers is worth noticing (see Figure 1). Most commonly missing values were found in statements concerning the abilities to handle malpractices (22%) and to break bad news (6%). This might be due to lack of experience in these areas.

 

 

The most preferred way of learning communication was interaction with real patients (Figure 2). Students also considered observing senior physicians as an effective way of learning. The other two most referred ways of learning communication were  everyday interaction and communication skills studies with simulations, role plays and video recorded patient interviews.

 

The four most common challenges the students face in communication according to their answers were encountering challenging patients, being able to convince the patient as a student, managing the haste and using understandable language (Figure 3). Students considered also achieving shared understanding with their patient and breaking bad news challenging.

Conclusion

Students expressed they were prepared for professional communication, but lacked confidence is some areas. The challenges they described in their answers refer to the uncertainty of coping in different encounters, of one’s own feelings and of lacking medical knowledge. These all hinder communication with patients.

Students’ expressions clearly show that they appreciate experience based methods in learning communication skills. Previous research supports this by demonstrating that student-centered and experiential learning methods with constructive feedback are the best practices for learning communication skills 3 4 5 6 7.

Graduating students provide us with valuable insights into what are the areas in need of development. The results show that credibility and uncertainty challenge young doctors.  

Take-home Messages
  • Students’ self-assessment of their command of and challenges in communication skills at graduation is valuable in the development of CCS.
  • Students find experiential learning methods effective in learning communication.
  • Instead of cherishing the ideal of perfect and infallible medical doctors we as educators should encourage students' self-reflection on being both medical doctors and human beings.
References

1 Creswell JW. 2014. Educational Research: Planning, Conducting and Evaluating Quantitative and Qualitative Research (4th Ed. Pearson new international edition). Harlow, Essex: Pearson Education Limited.

2 Elo S & Kyngäs H. 2008. The qualitative content analysis process. Journal of Advanced Nursing 62(1), 107-115.

3 Aspegren K. 1999. BEME Guide No. 2: Teaching and learning communication skills in medicine - a review with quality grading of articles. Medical Teacher, 21; 6: 563–570.

Kurtz S, Silverman J & Draper J. 2005. Teaching and Learning Communication Skills in Medicine (2nd Ed.). Abingdon: Radcliff Publishing.

5 Smith S, Hanson JL, Tewksbury LR, Christy C, Talib NJ, Harris MA, Beck GL & Wolf FM. 2007. Teaching patient communication skills to medical students. A review of randomized controlled trials. Evaluation & the Health Professions 30;1: 3–21.

6 Berkhof M, van Rijssen H J, Schellart AJM, Anema JR. & van der Beek AJ. 2011. Effective training strategies for teaching communication skills to physicians: An overview of systematic reviews. Patient Education and Counceling, 84: 152–162.

7 Koponen J, Pyörälä E & Isotalus P. 2012. Comparing three experiential learning methods and their effect on medical students’ attitudes to learning communication skills. Medical Teacher 34;3:e198-207.

Background
Summary of Work
Summary of Results
Conclusion
Take-home Messages
References
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