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Rating: 4.0/5 (1 vote cast)

Authors Institution
Jane Ege Moeller
Dorte Lange Hoest
Aarhus University - Center for Medical Education
Theme
2JJ Communication
Integrating communication skills training in the clinical setting - A qualitative study of four hospital wards
Background

Since 2004 post-graduate medical communications training in Denmark predominantly has taken the form of short courses separated from the clinical work. Theories concerning situated learning, transfer, and communication skills training, however, suggest that this type of skills training will be more effective if it was integrated in everyday clinical practice.

Summary of Work

The aim of this project was twofold:

1) To introduce and  implement a concept for communication skills training situated in a clinical setting.

2) To train facilitators so that the departments on a longer term could run  the training without external support.

The project developed and implemented a communication skills training concept in four different hospital departments (i.e. neurosurgery, gynecology, pediatrics and lung medicine)  in Denmark in 2013- 2014. The concpet built on the Calgary-Cambridge Observation Guide, involving role-play, video supervision, collegial feedback and facilitator training. The training sessions have been distributed over a period of 1-2 years (½ -1 hour sessions for 4-7 weeks at a time). In total, each department has received an estimated 11-17 hours of training per year.

A qualitative study was undertaken applying etnographic methodology. Methods involved were observations and  interviews with participating doctors (n=36). The data was analyzed thematically.

 

 

 

 Collegial feedback

 

Summary of Results

Five central themes were observed.

1. Positive, but varied implementation of the communication skills: All participants implemented the communication skills. However they integrated the skills in very different ways.  Three analytical patterns were observed: the ‘ad hoc’ user, the ‘problem-solving’ user and the 'full-time' user.

2. Communication: a part of the personality or skill to be learned? Two analytically different understandings of communication were observed among the participating doctors:

  1. Communication is seen as a part of the personality. When communication is taught it is somehow artificial.  Constructive criticism thus involves the risk of being a critique of the personality: "How you communicate, has to do with the core of who you are" (physician A)
  2. Communication is a certain kind of skill or technique. Communication skills can be taught and they need maintenance. If the training is not repeated, the use of the tools fades away. “Communication skills are like a muscle that needs training” (physician B)

3. Slow learning, but with few hours and a large audience:  The clinical conditions disturb the training sessions. Due to work responsibilities, shifting working hours, etc., none of the doctors has participated in all sessions. Most participants attended no more than 50 % of the sessions. Thus, the learning progress is slow. At the same time this type of educational concept reaches a wider number of doctors, because it is situated in the hospital setting. "I would never have participated in a two-day communication course, but this works" (physician C)

4. Collegial culture and disturbance of hierarchical structures:  Junior doctors find it challenging to give constrictive criticism to senior colleagues, and sometimes they abstain from doing it. Collegial relations influence how one gives and receives critique: “We have to work together afterwards” (physician D),  and "If the critique is given by a colleague that you don’t like so much, you might feel it harder”.(physician E)

Despite this, participants treasure the learning they get out of watching a colleague’s video. “ I think it has been great to see how my colleagues handle different types of conversations. I have learned a lot about my own way of communicating. And it has been great fun!” (physician F).  In one department the doctors identify that the communication training has led to a “change in our working culture”.

5. Facilitator training: 3 hours of facilitation skills training and supervision support is sufficient for running the video supervision without external persons involved. However, it is reported that on a longer term more external support to the facilitators is needed to ensure a high quality of feedback.

Conclusion

Situating communication skills training in a clinical setting ensures that a large group of physicians is reached, and that participants experience a positive, yet varied outcome. Collegial relations are both barriers and resources for the training. Understandings of ‘what communication is’, play a role for the ways in which participants respond to the training. This kind of training can be characterized as ‘slow learning’, but with the potential of being fully implemented as a part of the working culture.

Take-home Messages

Situating communication skills training in the clinical setting is a highly effective educational strategy, if it is accepted that it is a slow learning proces involving a complex of barriers.

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