How can we support students to develop clinical communication skills?

Clinical communication is universally recognised as a core skill in the health and nursing professions. While we concentrate a lot on the development of academic communication where the focus is on writing and presentation of ideas, students are often left to manage the development of their own clinical communication development in their clinical/field placements. Yet, clinical communication is very important and probably deserves more attention before we sent our students in to real life settings.

Some good reasons why we should be looking closely at how we develop know effective clinical communication skills in our students:

  • It is important for safety and quality in health services;
  • poor communication is a leading factor in accidental harm to patients;1
  • communication is a common issue raised in patient complaints;2
  • communication is recognised as an important mechanism in teamwork;3.
  • Clinical placement providers are more willing to provide clinical placements for students if they have developed skills in communication;4
  • it improves student confidence

Clinical placements are fundamental learning experiences, and offer different learning experiences to classroom teaching by presenting real life situations that are often challenging, dynamic and unpredictable. Students are required to interact and communicate with patients/clients, a multidisciplinary team, and clinical educators or supervisors whose primary skills are often as clinicians rather than educators. It can be difficult for educators and students to bridge this gap between theory and practice, resulting in student anxiety and poor performance5. Simulated learning can be used as a bridge to the theory-practice gap by providing authentic learning experiences in a safe environment6.

In our institution, we don’t have a common approach to clinical communication education across different health disciplines, even though there is a considerable overlap of communication process skills across different professional groups. This limits inter-professional and multi-professional education which is important in today’s health environment to prepare students for the collaborative practice models that are recommended today to meet the needs of patients presenting with complex health problems. Multi- and inter- professional education also reduces divergent perceptions between professional groups, and facilitates teamwork and communication by the creation of common models of practice across disciplines1.

Is it a pipe dream to develop a collaborative, inter-professional approach to clinical communication education?

In our setting to achieve an inter-professional and multi-professional communication curriculum:

  • Its components need to be flexible and adaptable, to fit the wide variation in program delivery across the different health disciplines. An example of how this might be achieved is to use multimedia simulations which can be integrated with case based learning. Technology based learning can be used for student self-review of their performance via video to develop and improve their clinical skills7,8,9.
  • Essential and common elements of communication need to be identified.

A way forward?

Anecdotal feedback from academics is that they largely base clinical communication education on their own experiences and are not informed by exploratory enquiry or a learning framework. Recently, 61 communication learning objectives common to a range of health professionals were identified by a multidisciplinary group of communication education experts in Europe 10. These learning objectives are referred to as the Health Professionals Core Communication Curriculum (HPCCC) and refer to 3 main domains; 1) communication with patients, 2) intra- and interpersonal communication and 3) communication in health care teams. The HPCCC provides a good foundation framework from which to develop common clinical communication learning objectives for students across multiple programs. Educational, interactive multimedia learning resources can be developed which align with these learning objectives and which can be adapted for sharing across different clinical programs.  This is an important step in providing a clinical communication education structure for academics, giving students improved communication capabilities using flexible and engaging delivery, and creating confidence amongst placement providers in the communication abilities of our students.

 Watch this blog as we start to gather information and resources in the area of clinical communication!

 References

  1. Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Quality & Safety in Health Care. 2004; Suppl 1: i85–i90.
  2. Reader TW, Gillespie A, Roberts J. Patient complaints in healthcare systems: a systematic review and coding taxonomy. BMJ Qual Saf. 2014 May; 23:678–89.
  3. Salas E, Goodwin GF, Burke CS. Team effectiveness in complex organizations.Cross-disciplinary perspectives and approaches. New York: Routledge/Taylor & Francis Group; 2009. Chapter 3, The wisdom of collectives in organizations: An update of the teamwork competencies; p. 39-79.
  4. Sealey RM, Raymond JG, Herb R, Rooney K, Crabb M, Watt K. Supporting placement supervision in clinical exercise physiology. Asia-Pacific Journal of Cooperative Education. 2015; 16(1): 53-69.
  5. Sellek T. Satisfying and anxiety creating incidents for nursing students. Nurs Times.1982 Dec;78 (48): suppl 35: 137–40.
  6. Mayne W, Jootun D, Young B, Marland G, Harris M, Lyttle CP. Enabling students to develop confidence in basic clinical skills. Nurs Times. 2004 June; 100 (24): 36–39.
  7. Issenberg SB, McGaghie WC, Hart IR, Mayer JW, Felner JM, Petrusa ER, Waugh RA, Brown DD, Safford RR, Gessner IH, Gordon DL, Ewy GA. Simulation technology for health care professional skills training and assessment. JAMA. 1999 Sep; 282(9):861-6.
  8. Ravert P. An integrative review of computer-based simulation in the education process. Comput Inform Nurs. 2002 Sep-Oct; 20(5):203-8.
  9. Swan N. Filming medical staff and patients to improve health care in hospitals [internet]. Australian Broadcasting Commission; cited 2015 Nov 6. Available from: http://www.abc.net.au/radionational/programs/healthreport/filming-medical-staff-and-patients-to-improve-health-care-in-ho/4896416
  10. Bachmann C, Abramovitch H, Barbu CG, Cavaco AM, Elorza RD, Haak R, Loureiro E, Ratajska A, Silverman J, Winterburn S, Rosenbaum M. A European consensus on learning objectives for a core communication curriculum in health care professions. Patient Educ Couns. 2013 Oct; 93(1):18-26.