Communication skills

Question 1

Citation for “Beneficial impact of CS on good patient outcomes like satisfaction with care”

Answer 1

Paddison et al., (2013)

Question 2

Citation for “Beneficial impact of CS on good patient outcomes like adherence to treatment plans”

Answer 2

Zolneirek & Di Matteo (2009)

Question 3

Citation for “Beneficial impact of CS on good patient outcomes like likelihood to sue for malpractice”

Answer 3

Levinson et al., (1997)

Question 4

Citation for “Beneficial impact of CS on good doctor outcomes like burnout and increasing job satisfaction”

Answer 4

Bensing et al., (2013)

Question 5

“Therefore the importance of CS training in any medical curriculum cannot be over stated” - Who said that

Answer 5

Bennet & Lyons (2011)

Question 6

What is the current UK GMC (2009) standard for medical graduates?

Answer 6

To engage in patient centred care, which is care that puts the patient first and to use good CS to do this.

Question 7

What is a major framework for teaching CS? and what do they use to teach this guide?

Answer 7

The Calgary-Cambridge Guide (Silverman et al., 1998) and uses simulated patients to practice it

Question 8

Who said a benefit of using simulated patients? and what was it?

Answer 8

Eagles et al., (2007) said that SPs are beneficial as situations can be tweaked to what the student is struggling with and SPs can give feedback

Question 9

Who said a weakness of using SPs and what was it?

Answer 9

Khran et al., (2002) said that using a script with SPs often lacks empathy and that using SPs may just help the students learn skills that impress examiners which are not that helpful practically.

Question 10

What do students prefer as a teaching method for CS? and who found that?

Answer 10

Rees et al (2004) found that students valued experimental methods of teaching like using SPs rather than instructional methods like face to face teaching.

Question 11

What is another challenge of teaching CS that is not about SPs?
2 points of the same thing and 2 citations

Answer 11

Difficult to teach CS at a postgraduate level (Beckman & Frankel, 2003) and there needs to be longitudinal reinforcement of CS for it to be effective.

And Levison, Lesser & Epstein (2010) said that post-grad physicians often have barriers to learning CS including lack of time and lack of incentives.

Question 12

How are CS assessed? and citation?

Answer 12

Via Objective Structured Clinical Examinations (OSCE’s) (Harden & Gleeson, 1979) which are a series of timed stations which have been developed to assess a number of learning outcomes e.g. drawing blood, this includes ‘effective communication’.

Question 13

What do the examiners use to mark the students on their CS?

Answer 13

Either a checklist of specific behaviours or a global rating scale on the OSCE.

Question 14

What is a weakness of using OSCEs to assess CS? and who said it?
and did they say anything positive about OSCEs?

Answer 14

Epstein (2007) said that OSCEs are artificial in their timing and setting. They are also expensive as MS usually go through 20 OSCEs throughout their training.

HOWEVER, he did also say that OSCEs are very reliable and can be tailored to educational goals.

Question 15

What is another weakness of assessing CS? that isn’t about OSCEs? and who said it?

and is there anything being done about it? and is there problems with it already?

Answer 15

Walker (1996) said there is a lack of clarity about the criteria and marking guidelines which are not really standardised across the UK.

Yes, the UK GMC is currently in the process of creating the Medical Licensing Agreement which is coming out in 2024 as a standard of proficiency.
However, this is only for medicine students and there will still be a lack of standardised measures for all HCPs.

Question 16

What is a weakness of assessing CS in terms of the examiner and marking bias? and who said it?

What can we do about this? and who said it?

Finally, can we tailor marking criteria to different examiners? and who said it?

Answer 16

Using a global rating scale is often difficult for examiners to interpret and may be prone to cognitive bias in judgement and decision making (Hardman, 2009)

Ensuring all examiners undergo extensive training can reduce this bias and also reduce the number of examiners needed to produce a reliable score (Kogun et al., 2009)

Yes, Regehr et al (1998) said less experienced examiners should use the checklist and more experienced should use the global rating scale. This is a challenge because assessments need to be tailored to the medical schools faculty rather than being standardised.

Question 17

What is a strength of using OSCEs to assess CS? and who said it? (For conclusion)

Answer 17

Gormley (2011) said that OSCEs have shown to be a RELIABLE tool for assessing CS

Question 18

For conclusion what is the most important point regarding teaching and assessing CS?

Answer 18

Teaching and evaluating CS in HealthCare is only useful if genuinely incorporated into everyday clinical practice, not just in educational/exam settings. Otherwise we run the risk of passing the test but failing the patient.

Question 19

What is one Cochrane review which says that educational programmes have been effective in teaching CS to MS?
Name one problem with the study?

What did they say about getting feedback? What does this mean for implications?

Answer 19

Gilligan et al., (2021) found that CS training programmes had positive effects on interpersonal skills.
However, the effects were often small and the authors suggested low confidence in their results.

Also found that programmes which involved feedback were more effective at bettering CS than those who did not. Future CS training should use feedback to better improve PP communication.

Question 20

Who says that CS training in the US has not been that effective?

Why?

Does this apply to the UK?

Answer 20

Headly (2007) because many of the published approaches to teaching CS suffer from being ‘vague, teacher-dependent and non-reproducible’.

Because there is a lack of a curriculum which outlines the necessary requirements of good PP communication.

Not really because the UK has the GMC (2009) but still relevant.

Question 21

Who says that CS training has been effective but that there are problems with studies that evaluate these training programmes?

And what are 2 of these problems?

Answer 21

Lane and Rollick (2007) -> CS training has improved PP communication but there are many methodological problems with these studies that evaluate training programmes, so it is difficult to draw concrete conclusions about their effectiveness.

Like…

1. Studies did not measure baseline CS of MS, making comparisons tricky
2. Studies did not appear to randomise pps

Question 22

What is a recent study that said using SPs was effective at bettering CS in MS?

What was a problem with this study, who said it?

Answer 22

Geoffroy et al (2020) investigated the effectiveness of using SPs for the acquisition of CS in MS and assessed it with a global rating scale of 17 items based on the CC guide.

They found that using SPs were effective at bettering global rating scale scores for student’s CS.

However, just because it bettered exam results, does not mean it would be this helpful practically, maybe MS are just learning skills to impress examiners which is not helpful in the real world.