scholarly journals 140 Lessons From the Front Line: Communication is Key

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
B Pyrke ◽  
B Abdalla ◽  
G Cartwright ◽  
K Figg ◽  
E Murphy ◽  
...  
Keyword(s):  
Communication Skills ◽  
Skills Training ◽  
University Hospital ◽  
Junior Doctors ◽  
Teaching Programme ◽  
Successful Communication ◽  
Difficult Conversations ◽  
The Family ◽  
Regular Family ◽  
Learning Points

Abstract Introduction As junior doctors, we very rarely receive formal teaching on communication after medical school, with telephone encounters and difficult conversations over technology being a vital yet missing part of our education. The COVID-19 pandemic has required us to adapt how we communicate with patients’ families due to hospital visiting restrictions. In an era where tragically deterioration and death have been much more commonplace, we looked to identify areas where junior doctors felt their communication skills could be improved, and implemented a teaching programme to deliver this. Methods Pre-teaching questionnaires were distributed to a range of grades of junior doctors working in University Hospital of Llandough, Cardiff. The questionnaires were distributed at the beginning of June 2020, after 3 months of working in pandemic conditions. A teaching session on telephone and video communication skills was delivered by a local palliative care consultant. Post-teaching, a repeat questionnaire was undertaken to assess response and identify key learning points. Results Pre-teaching, 100% of the 22 respondents had had to participate in difficult conversations over the phone, 82% had had no formal phone based communication skills training and 81.82% felt some form of formal teaching would be helpful. Post-teaching, 12 junior doctors provided feedback with an average 37% increase in confidence to undertake difficult conversations. Key learning points from the session highlighted the importance of preparation, regularly updating the family to build trust and rapport, and integrating family updates via tele-communication into daily ward life. Conclusions Education around telephone communication skills is critical to enable us to adapt our skills in accordance with the demands of the pandemic, to continue to support relatives and to engage with technology with confidence. Increased preparation is required to navigate difficult conversations via technology, and successful communication requires clinicians to take responsibility for initiating regular family updates.

scholarly journals Education Research: Difficult conversations in neurology

Neurology ◽  
2018 ◽  
Vol 90 (2) ◽  
pp. 93-97 ◽  
Author(s):  
Monica E. Lemmon ◽  
Charlene Gamaldo ◽  
Rachel Marie E. Salas ◽  
Ankita Saxena ◽  
Tiana E. Cruz ◽  
...  
Keyword(s):  
Focus Groups ◽  
Communication Skills ◽  
Poor Prognosis ◽  
Skills Training ◽  
Communication Skills Training ◽  
Cross Sectional ◽  
Difficult Conversations ◽  
Perceived Preparedness ◽  
Terminal Diagnosis ◽  
Prognostic Uncertainty

ObjectiveTo characterize features of medical student exposure to difficult conversations during a neurology core clerkship.MethodsThis was a cross-sectional concurrent nested mixed methods study, and all students rotating through a required neurology clerkship between 2014 and 2015 were enrolled. Data collection included an electronic communication tracker, baseline and end-of-clerkship surveys, and 4 facilitated focus groups. Students were asked to log exposure to patient–clinician conversations about (1) new disability, (2) poor prognosis, (3) prognostic uncertainty (4), terminal diagnosis, and (5) end-of-life care.ResultsA total of 159 students were enrolled and 276 conversations were tracked. Most (70%) students observed at least 1 difficult conversation, and conversations about poor prognosis, new disability, and prognostic uncertainty were most commonly logged. At clerkship end, most students (87%) desired additional bedside training in communication skills. Exposure to one of the predefined conversation types did not improve student perceived preparedness to lead difficult conversations in the future. In focus groups, students noted that the educational value of observation of a difficult conversation could be optimized with preconversation planning and postconversation debriefing.ConclusionsDifficult conversations are common in neurology, and represent a valuable opportunity to provide communication skills training on the wards. Future curricula should consider ways to leverage these existing opportunities to enhance communication skills training.

11 Filling the void: preparing future junior doctors for challenging conversations

2018 ◽  
Vol 8 (3) ◽  
pp. 363.3-364
Author(s):  
Hannah Costelloe ◽  
Alice Copley ◽  
Andrew Greenhalgh ◽  
Andrew Foster ◽  
Pratik Solanki
Keyword(s):  
Palliative Care ◽  
Medical Education ◽  
Medical Students ◽  
Small Group ◽  
End Of Life ◽  
Communication Skills ◽  
Skills Training ◽  
Junior Doctors ◽  
List Type ◽  
The Impact

Evidence demonstrates that medical students have limited experience in developing ‘higher-order communication skills’ (Kaufman et al. 2000). Anecdotally many do not feel confident in their ability to conduct difficult conversations often due to a lack of exposure to such scenarios in practice or a pervasive notion that these scenarios are inappropriate for students and beyond the scope of a junior doctor’s role and thus not a focus of curriculums (Noble et al. 2007). There is however a correlation between level of clinical experience and improved confidence for medical students (Morgan and Cleave-Hogg 2002).We surveyed a group of final year medical students to assess their confidence using a 10-point Likert scale in tackling common palliative and end of life care scenarios. Our intervention comprised a study day of 10 practical small-group teaching simulation and OSCE-style stations designed to provide exposure to common experiences in a controlled setting. We reassessed the confidence of students after delivery and objectively explored the impact of the day by asking participants to complete a validated assessment before and after the course. All results showed significant improvement on t-testing: confidence in end of life communication in an OSCE setting improved by 42.2% and assessment marks improved by 24.7% (p=0.039).Palliative care is an area in which students approaching the end of undergraduate training feel underprepared. Our findings demonstrate that small group sessions improve confidence by facilitating communication practice in a controlled environment and providing crucial exposure to common palliative care scenarios they will face as doctors.References. Kaufman D, Laidlaw T, Macleod H. Communication skills in medical school: Exposure confidence and performance. Academic Medicine [online] 2000;75(10):S90–S92. Available at https://journals.lww.com/academicmedicine/Fulltext/2000/10001/Communication_Skills_in_Medical_School__Exposure.29.aspx [Accessed: 30 May 2018]. Morgan P, Cleave-Hogg D. Comparison between medical students’ experience confidence and competence. Medical Education [online] 2002;36(6):534–539. Available at https://doi.org/10.1046/j.1365-2923.2002.01228.x [Accessed: 30 May 2018]. Noble L, Kubacki A, Martin J, Lloyd M. The effect of professional skills training on patient-centredness and confidence in communicating with patients. Medical Education [online] 2007;41(5):432–440. Available at https://doi.org/10.1111/j.1365-2929.2007.02704.x [Accessed: 30 May 2018]

scholarly journals A Near-Peer Surgical Teaching Programme for Junior Doctors

2020 ◽  
Author(s):  
Shoaib Fahad Hussain ◽  
Teri Hsiao Hsui Toi ◽  
Edward Peter Laurent ◽  
Shaikh Sanjid Seraj ◽  
Samer-ul-Haque
Keyword(s):  
Clinical Education ◽  
Education Programme ◽  
Peer Teaching ◽  
University Hospital ◽  
Junior Doctors ◽  
Free Text ◽  
Teaching Programme ◽  
Surgical Teaching ◽  
The Uk

Abstract Background: Surgical departments across the UK are having to mitigate increasing service demands, budget constraints and changes to work patterns, with their statutory duty to provide high-quality training and education. In an overstretched NHS, securing consultant-led teaching for junior doctors has become increasingly difficult leading to the rise of near-peer teaching. We evaluate the long-term effectiveness of a near-peer surgical teaching programme for junior doctors. Methods: We developed a rolling 12-week trainee-led, didactic surgical education programme for junior doctors and incorporated a three-tiered leadership and handover mechanism involving lead junior doctors, registrars and a lead consultant to ensure consistency and programme continuity. Junior doctors delivered presentations to their peers with close supervision and input from registrars. Participants provided session and supervision feedback using 5-point scales and free-text responses. Data was collected using Google Forms™ and analysed using student’s t-test on Microsoft Excel®. Results: 42 junior doctors responded to our end-of-programme feedback surveys covering December 2018 to April 2020. The overall programme (8.83±1.08/10), topic relevance (4.62±0.58/5), presentation quality (4.60±0.50/5) and supervisor knowledge (4.81±0.40/5) were rated highly by respondents. 95.2% (n=40) of respondents had attended more than 3 sessions and 71.4 % (n=30) had delivered teaching. Respondents also reported significant improvements in subject knowledge (3.72±0.92/5 to 4.50±0.56/5, P<0.0001), clinical confidence, presentation and teaching skills following each session. Conclusions: This long-term near-peer teaching programme addressed the educational needs of junior doctors and developed their presentation and organisational skills. Supervision and input from registrars facilitated discussion and reinforced key concepts. Our strategy also facilitated workplace-based assessments and familiarisation with local management protocols for new cohorts of doctors rotating in Surgery at Basildon University Hospital. We also recently adapted this into a virtual programme in response to the COVID-19 pandemic, maintaining clinical education and expanding our audience. The success of this programme highlights the role that trainees can play in designing, developing and coordinating an effective surgical teaching programme.

The Impact of Communication Skills Training on Cardiology Fellows' and Attending Physicians' Perceived Comfort with Difficult Conversations

2017 ◽  
Vol 20 (7) ◽  
pp. 767-769 ◽  
Author(s):  
Kathryn Berlacher ◽  
Robert M. Arnold ◽  
Eva Reitschuler-Cross ◽  
Jeffrey Teuteberg ◽  
Winifred Teuteberg
Keyword(s):  
Communication Skills ◽  
Skills Training ◽  
Communication Skills Training ◽  
Difficult Conversations ◽  
Attending Physicians ◽  
The Impact

scholarly journals Self-assessment of residents in respect of attitudes to communication

2019 ◽  
Vol 20 ◽  
Author(s):  
Rustu Kaya ◽  
Ali Ramazan Benli ◽  
Aybala Cebecik ◽  
Didem Sunay
Keyword(s):  
Internal Medicine ◽  
Family Medicine ◽  
Communication Skills ◽  
General Surgery ◽  
Skills Training ◽  
Attitude Scale ◽  
University Hospital ◽  
Communication Skills Training ◽  
The Mean ◽  
Family Medicine Residents

AbstractAimAs communication skills are essential for medical practice, many medical schools have added communication skills training to their curricula in recent years. The aim of this study was to determine and compare the attitudes to communication skills of family medicine, internal medicine and general surgery residents.Materials and methodsFamily medicine, internal medicine and general surgery residents of three training and research hospitals and one university hospital in Ankara were included in this cross-sectional study. A questionnaire was used for obtaining information about age, gender, marital status, graduation date and whether receiving any training for communication skills. The Turkish version of the Communication Skills Attitude Scale was used.ResultsIn all, 58 (50%) family medicine, 30 (25.9%) internal medicine, and 28 (24.1%) general surgery residents were accepted to participate in the study. Of the 116 residents, 58 (50%) were female and 58 (50%) were male, with a mean age of 29.47±4.63 years, and 68 (58.6%) of them were married; 59.5% of the participants received training about communication skills and 56.5% of them received it at medical school. The mean positive attitude scale (PAS) score was 3.85±0.58, and the mean negative attitude scale (NAS) score was 2.42±0.52. The PAS scores of female residents were higher than those of males (P=0.01). The PAS scores of residents who received communication skills training were higher than the scores of those who had not (P=0.01). The PAS scores of family medicine residents were higher and the NAS scores were lower than those of internal medicine and general surgery residents.ConclusionThe communication skill attitudes of family medicine residents were better than those of internal medicine and general surgery residents.

Advancing family communication skills in oncology nursing

2017 ◽  
Author(s):  
Talia Zaider ◽  
Shira Hichenberg ◽  
Lauren Latella
Keyword(s):  
Communication Skills ◽  
Skills Training ◽  
Collaborative Problem Solving ◽  
Advanced Practice ◽  
Family Interactions ◽  
Single Session ◽  
Acute Care Nurses ◽  
Practice Nurses ◽  
The Family ◽  
Perceived Relevance

This chapter presents a new communication skills training initiative designed to advance family-centred care in the inpatient oncology setting. Because of their consistent contact with families, oncology nurses are well-positioned to initiate and model supportive care to the family. Two formats of training are presented: (i) a single-session module for acute care nurses focuses on responding to challenging family interactions at the bedside; (ii) a comprehensive, six-month curriculum for advanced practice nurses focuses on conceptualization and intervention skills, as applied to a range of complex family situations that arise during a patient’s admission. The training presented here teaches nurses to effectively partner with families, assess support needs, facilitate collaborative problem-solving, and transition families to psychosocial resources. Both training efforts were piloted at a large, comprehensive cancer centre. Preliminary data supports the feasibility and perceived relevance of training content, as well as gains in nurses’ confidence working effectively with families.

That was a game changer: clinical impact of an emergency department-based palliative care communication skills training workshop

2019 ◽  
pp. emermed-2019-208567
Author(s):  
Rebecca Wright ◽  
Bradley Hayward ◽  
Emmett Kistler ◽  
Victoria Vaughan Dickson ◽  
Corita Grudzen
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Communication Skills ◽  
Skills Training ◽  
Training Workshop ◽  
Feedback Environment ◽  
Goals Of Care ◽  
Difficult Conversations ◽  
Communications Skills ◽  
The Impact

ObjectiveTo explore the impact of an adapted goals-of-care communications skills workshop created for ED physicians from the physicians’ perspective.MethodsSemi-structured, one-on-one audio-recorded interviews lasting 30–60 min were conducted with twelve physicians who had completed the training workshop. Interviews explored the experience of undertaking the workshop, its impact on their clinical practice and their ability to teach new skills to other clinicians using learnt techniques. Descriptive content analysis was performed on interview transcripts.ResultsParticipants reported positive experiences of the workshop. The analysis identified four main themes and ten subthemes dealing with workshop content and its impact on subsequent ED-based clinical practice. There were: 1) value and future improvements for the course; 2) value of the course to practice; 3) value of the course for teaching residents and 4) barriers to application of learning. Specifically recommended components include the use of mnemonics, mechanisms to introduce difficult conversations and a positive feedback environment. Participant-recommended refinements to the workshop included emphasising urgency, replicating the chaotic ED environment and expanding content to include more ED-focused goals-of-care discussions.ConclusionA short, focused training workshop directed at improving palliative care communication skills among ED clinicians appears to be welcomed and useful.

468 IMPROVING ADVANCE CARE PLANNING SKILLS IN JUNIOR DOCTORS

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
S Cohen ◽  
R Singh ◽  
N Khalid ◽  
J Young ◽  
M Aldiwani ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Training Session ◽  
Skills Training ◽  
Junior Doctors ◽  
Care Planning ◽  
Health Care Planning ◽  
Difficult Conversations ◽  
Discharge Letter ◽  
Advance Care ◽  
And Training

Abstract Introduction Junior doctors are increasingly encountering Advance Care Planning (ACP) when they look after frail, older or multi-morbid patients during their hospital rotations. However, there remains a lack of formal training and resources, particularly with DNACPR discussions and when engaging patients and their loved ones with Emergency Health Care Planning (EHCP). We aimed to assess the need for ACP, improve the infrastructure by which ACP is delivered, and better support junior doctors to have these difficult conversations. Method Discharges from the Geriatrics Department at Kettering General Hospital were reviewed initially in May 2019 and again in January 2020 following intervention. We introduced a focused communication skills training session delivered at departmental teaching, which included a combination of simulation training and lectures. We additionally designed and implemented an EHCP template to aid junior doctors’ discussions. This could also be copied to the discharge letter, to facilitate safe transfer of care to primary care. Results In May 2019 of 32 patients, 100% met at least one SPICTTM criterion, with median of 4 criteria, thus indicating a high need for ACP in this cohort. Despite this, only one discharge letter included an EHCP and two had a request for GP colleagues to complete one. Evaluation of discharges again in January of 2020 reconfirmed a similar need for ACP, but following our interventions, the number of EHCP’s performed had increased. Of 22 identified patients 4 had a completed EHCP and 3 were requested for completion by their GP. Qualitative questionnaires demonstrated an improvement in both knowledge and confidence amongst junior doctors following the training session. Conclusion We have shown that there is a necessity for ACP to be considered for Geriatrics inpatients, and that providing structure and training in this challenging area offers benefit to both patients and junior doctors.

Improving Communication Skills in Health Care

2013 ◽  
Vol 20 (3) ◽  
pp. 109-117
Author(s):  
Lynda Katz Wilner ◽  
Marjorie Feinstein-Whittaker
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Communication Skills ◽  
Health Care Professionals ◽  
Skills Training ◽  
International Medical Graduate ◽  
Medical Graduate ◽  
Health Care Environment ◽  
Medical Interpreters ◽  
Accent Modification

Hospital reimbursements are linked to patient satisfaction surveys, which are directly related to interpersonal communication between provider and patient. In today’s health care environment, interactions are challenged by diversity — Limited English proficient (LEP) patients, medical interpreters, International Medical Graduate (IMG) physicians, nurses, and support staff. Accent modification training for health care professionals can improve patient satisfaction and reduce adverse events. Surveys were conducted with medical interpreters and trainers of medical interpreting programs to determine the existence and support for communication skills training, particularly accent modification, for interpreters and non-native English speaking medical professionals. Results of preliminary surveys suggest the need for these comprehensive services. 60.8% believed a heavy accent, poor diction, or a different dialect contributed to medical errors or miscommunication by a moderate to significant degree. Communication programs should also include cultural competency training to optimize patient care outcomes. Examples of strategies for training are included.

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