Posts Tagged ‘skills’
Using standardized patients to assess communication skills in medical and nursing students
Background:
A number of recent developments in medical and nursing education have highlighted the importance of communication and consultation skills (CCS). Although such skills are taught in all medical and nursing undergraduate curriculums, there is no comprehensive screening or assessment programme of CCS using professionally trained Standardized Patients Educators (SPE’s) in Ireland. This study was designed to test the content, process and acceptability of a screening programme in CCS with Irish medical and nursing students using trained SPE’s and a previously validated global rating scale for CCS.
Methods:
Eight tutors from the Schools of Nursing and Medicine at University College Cork were trained in the use of a validated communication skills and attitudes holistic assessment tool. A total of forty six medical students (Year 2 of 5) and sixty four nursing students (Year 2/3 of 4) were selected to under go individual CCS assessment by the tutors via an SPE led scenario. Immediate formative feedback was provided by the SPE’s for the students. Students who did not pass the assessment were referred for remediation CCS learning.
Results:
Almost three quarters of medical students (33/46; 72%) and 81% of nursing students (56/64) passed the CCS assessment in both communication and attitudes categories. All nursing students had English as their first language. Nine of thirteen medical students referred for enhanced learning in CCS did not have English as their first language.
Conclusions:
A significant proportion of both medical and nursing students required referral for enhanced training in CCS. Medical students requiring enhanced training were more likely not to have English as a first language.
Developing counseling skills through pre-recorded videos and role play: a pre- and post-intervention study in a Pakistani medical school
Background:Interactive methods like role play, recorded video scenarios and objective structured clinical exam (OSCE) are being regularly used to teach and assess communication skills of medical students in the western world. In developing countries however, they are still in the preliminary phases of execution in most institutes. Our study was conducted in a naive under resourced setup to assess the impact of such teaching methodologies on the counseling skills of medical students.MethodFifty four, fourth year MBBS students were identified to be evaluated for communication skills by trained facilitators in a pre-intervention OSCE. The same group of students was given a demonstration of ideal skill level by means of videos and role playing sessions in addition to real life interaction with patients during hospital and community rotations. A post-intervention evaluation was carried out six months later through OSCE and direct observation through structured checklist (DOS) in hospital and community settings. The combined and individual performance levels of these students were analyzed.Results:There was a statistically significant difference in the communication skills of students when assessed in the post-intervention OSCE (p = 0.000). Individual post-intervention percentages of study participants displayed improvement as well (n=45, p = 0.02). No difference was observed between the scores of male and female students when assessed for two specific competencies of antenatal care and breast feeding counseling (p = 0.11). The mean DOS (%) score of 12 randomly selected students was much lower as compared to the post-intervention (%) score but the difference between them was statistically non significant, a result that may have been affected by the small sample size as well as other factors that may come into play in real clinical settings and were not explored in this study (59.41 +/-7.8 against 82.43 +/-22.08, p = 0.88).Conclusions:Videos and role play in combination with community and clinical exposure are effective modes of teaching counseling skills to medical students. They can be successfully utilized even in a limited resource setup, as demonstrated by our trial.
Training auscultatory skills: computer simulated heart sounds or additional bedside training? A randomized trial on third-year medical students
Background:The present study compares the value of additional use of computer simulated heart sounds, to conventional bedside auscultation training, on the cardiac auscultation skills of 3rd year medical students at Oslo University Medical School.Methods:In addition to their usual curriculum courses, groups of seven students each were randomized to receive four hours of additional auscultation training either employing a computer simulator system or adding on more conventional bedside training. Cardiac auscultation skills were afterwards tested using live patients. Each student gave a written description of the auscultation findings in four selected patients, and was rewarded from 0-10 points for each patient. Differences between the two study groups were evaluated using student’s t-test.Results:At the auscultation test no significant difference in mean score was found between the students who had used additional computer based sound simulation compared to additional bedside training.Conclusions:Students at an early stage of their cardiology training demonstrated equal performance of cardiac auscultation whether they had received an additional short auscultation course based on computer simulated training, or had had additional bedside training.
Combining a leadership course and multi-source feedback has no effect on leadership skills of leaders in postgraduate medical education. An intervention study with a control group.
Background:
Leadership courses and multi-source feedback are widely used developmental tools for leaders in health care. On this background we aimed to study the additional effect of a leadership course following a multi-source feedback procedure compared to multi-source feedback alone especially regarding development of leadership skills over time.
Methods:
Study participants were consultants responsible for postgraduate medical education at clinical departments. Study design: pre-post measures with an intervention and control group. The intervention was participation in a seven-day leadership course. Scores of multi-source feedback from the consultants responsible for education and respondents (heads of department, consultants and doctors in specialist training) were collected before and one year after the intervention and analysed using Mann-Whitney’s U-test and Multivariate analysis of variances.
Results:
There were no differences in multi-source feedback scores at one year follow up compared to baseline measurements, either in the intervention or in the control group (p = 0.149).
Conclusions:
The study indicates that a leadership course following a MSF procedure compared to MSF alone does not improve leadership skills of consultants responsible for education in clinical departments. Developing leadership skills takes time and the time frame of one year might have been too short to show improvement in leadership skills of consultants responsible for education. Further studies are needed to investigate if other combination of initiatives to develop leadership might have more impact in the clinical setting.
Involving students in real-world research: a pilot study for teaching public health and research skills
Background:There is some evidence that medical students consider population health issues less important than other domains in the health sciences and attitudes to this field may become more negative as training progresses. A need to improve research skills among medical students has also been suggested. Therefore we piloted an integrative teaching exercise that combined teaching of research skills and public health, with real-world research.Methods:Third year medical students at the University of Otago (Dunedin, New Zealand) filled in a questionnaire on their housing conditions and health. The students were given the results of the survey to discuss in a subsequent class. Student response to this teaching exercise was assessed using a Course Evaluation Questionnaire.Results:Of the 210 students in the class, 136 completed the Course Evaluation Questionnaire (65%). A majority of those who responded (77%) greatly supported or supported the use of the survey and seminar discussion for future third year classes. Most (70%) thought that the session had made them more aware and concerned about societal problems, and 72% felt that they now had an improved understanding of the environmental determinants of health. Students liked the relevance and interaction of the session, but thought it could be improved by the inclusion of small group discussion. The findings of the students’ housing and health were considered by the tutors to be of sufficient value to submit to a scientific journal and are now contributing to community action to improve student housing in the city.Conclusions:In this pilot study it was feasible to integrate medical student teaching with real-world research. A large majority of the students responded favourably to the teaching exercise and this was generally successful in raising the profile of public health and research. This approach to integrated teaching/research should be considered further in health sciences training and continue to be evaluated and refined.
Assessing clinical communication skills in physicians: Are the skills context specific or generalizable?
Background:Communication skills are essential for physicians to practice Medicine. Evidence for the validity and domain specificity of communication skills in physicians is equivocal and requires further research. This research was conducted to adduce evidence for content and context specificity of communication skills and to assess the usefulness of a Generic instrument for assessing communication skills in International Medical Graduates (IMGs).MethodA psychometric design was used for identifying the reliability and validity of the communication skills instruments used for high-stakes exams for IMG’s. Data were collected from 39 IMGs (19 men – 48.7%; 20 women – 51.3%; Mean age = 41 years) assessed at 14 station OSCE and subsequently in supervised clinical practice with several instruments (patient surveys; ITERs; Mini-CEX). Results:All the instruments had adequate reliability (Cronbach’s alpha: .54 – 96). There were significant correlations (r range: 0.37 – 0.70, p < .05) of communication skills assessed by examiner with standardized patients, and of mini-CEX with patient surveys, and ITERs. The intra-item reliability across all cases for the 13 items was low (Cronbach's alpha: .20 - .56). The correlations of communication skills within method (e.g., OSCE OR clinical practice) were significant but were non-significant between methods (e.g., OSCE and clinical practice).Conclusion:The results provide evidence of context specificity of communication skills, as well as convergent and criterion-related validity of communication skills. Both in OSCEs and clinical practice, communication checklists need to be case specific, designed for content validity.
Evaluation of a communication skills program for first-year medical students at the University of Toronto
Background:Effective doctor-patient communication has been linked to numerous benefits for both patient and physician. The purpose of this study was to evaluate the effectiveness of the University of Toronto’s Therapeutic Communication Program (TCom) at improving first-year medical students’ communication skills.Methods:Data were collected during the 1996/97, 1997/98, 1998/99 and 1999/00 academic years. The study used a repeated measures design with a waiting list control group: students were randomly assigned to groups starting the educational intervention in either September (N = 38) or February (N = 41), with the latter being used as a control for the former. Communication skills were assessed at the pre- and post-intervention times and at the end of the academic year from the perspectives of student, standardized patient and external rater.Results:Only the external rater, using an instrument designed to assess the students’ empathy based on their written responses, showed a time x group interaction effect (p = 0.039), thereby partially supporting the hypothesis that TCom improved the students’ communication skills. Students rated themselves less positively after participation in the program (p = 0.038), suggesting that self-evaluation was an ineffective measure of actual performance or that the program helped them learn to more accurately assess their abilities.Conclusions:The lack of strong findings may be partly due to the study’s small sample sizes. Further research at other medical or professional schools could assess the effectiveness of similar courses on students’ communication skills and on other capacities that were not measured in this study, such as their understanding of and comfort with patients, the doctor-patient relationship, and their ability to give and receive feedback.
Using television shows to teach communication skills in internal medicine residency
Background:To address evidence-based effective communication skills in the formal academic half day curriculum of our core internal medicine residency program, we designed and delivered an interactive session using excerpts taken from medically-themed television shows. Methods:We selected two excerpts from the television show House, and one from Gray’s Anatomy and featured them in conjunction with a brief didactic presentation of the Kalamazoo consensus statement on doctor-patient communication. To assess the efficacy of this approach a set of standardized questions were given to our residents once at the beginning and once at the completion of the session.Results:Our residents indicated that their understanding of an evidence-based model of effective communication such as the Kalamazoo model, and their comfort levels in applying such model in clinical practice increased significantly. Furthermore, residents’ understanding levels of the seven essential competencies listed in the Kalamazoo model also improved significantly. Finally, the residents reported that their comfort levels in three challenging clinical scenarios presented to them improved significantly. Conclusion:We used popular television shows to teach residents in our core internal medicine residency program about effective communication skills with a focus on the Kalamazoo’s model. The results of the subjective assessment of this approach indicated that it was successful in accomplishing our objectives.
A case study for teaching information literacy skills
Background:The Internet has changed contemporary workplace skills, resulting in a need for proficiency with specific digital, online and web-based technologies within the fields of medicine, dentistry and public health. Although younger students, generally under 30 years of age, may appear inherently comfortable with the use of technology-intensive environments and digital or online search methods, competence in information literacy among these students may be lacking.Methods:This project involved the design and assessment of a research-based assignment to help first-year, graduate-level health science students to develop and integrate information literacy skills with clinical relevance. Results:One cohort of dental students (n=78) was evaluated for this project and the results demonstrate that although all students were able to provide the correct response from the content-specific, or technology-independent, portion of the assignment, more than half (54%) were unable to demonstrate competence with a web-based, technology-dependent section of this assignment. No correlation was found between any demographic variable measured (gender, age, or race).Conclusion:More evidence is emerging that demonstrates the need for developing curricula that integrates new knowledge and current evidence-based practices and technologies, traditionally isolated from graduate and health-care curricula, that can enhance biomedical and clinical training for students. This study provides evidence, critical for the evaluation of new practices, which can promote and facilitate the integration of information literacy into the curriculum.
A tool for self-assessment of communication skills and professionalism in residents
Background:Effective communication skills and professionalism are critical for physicians in order to provide optimum care and achieve better health outcomes. The aims of this study were to evaluate residents’ self-assessment of their communication skills and professionalism in dealing with patients, and to evaluate the psychometric properties of a self-assessment questionnaire. Methods:A modified version of the American Board of Internal Medicine’s (ABIM) Patient Assessment survey was completed by 130 residents in 23 surgical and non-surgical training programs affiliated with a single medical school. Descriptive, regression and factor analyses were performed. Internal consistency, inter-item gamma scores, and discriminative validity of the questionnaire were determined.Results:Factor analysis suggested two groups of items: one group relating to developing interpersonal relationships with patients and one group relating to conveying medical information to patients. Cronbach’s alpha (0.86) indicated internal consistency. Males rated themselves higher than females in items related to explaining things to patients. When compared to graduates of U.S. medical schools, graduates of medical schools outside the U.S. rated themselves higher in items related to listening to the patient, yet lower in using understandable language. Surgical residents rated themselves higher than non-surgical residents in explaining options to patients.Conclusion:This appears to be an internally consistent and reliable tool for residents’ self-assessment of communication skills and professionalism. Some demographic differences in self-perceived communication skills were noted.
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