Developing communication curricula: a consensus-based or theory-driven approach?

When designing curricula to develop students’ clinical communication, how do you decide what to include? Do you draw on collective professional experience, or do you use theory[1]?

Approaches that draw on practitioner experience are often called ‘consensus-based’. Consensus approaches bring together an expert group of health practitioners from different contexts and with different perspectives to establish a shared understanding of key skills. The Health Professionals Core Communication Curriculum (HPCCC) used in this project is a great example of a consensus approach[2]. Theory driven approaches adopt a theoretical perspective on clinical communication, usually derived from linguistics, and develop certain theoretical constructs on which educational goals will be based.

There are benefits and disadvantages to both of these approaches. The skills identified using a consensus approach are directly informed by the situated, reflective practice and experience of expert practitioners, so they are likely to be readily understood and applied by other clinicians. For robust assessment of learning, however, the skills agreed upon also need to have ‘empirical and theoretical strength’[3]. Practitioner understandings of communication, although highly sophisticated, are usually tacit and not theoretically informed. In practice, this means that while practitioners can identify when clinical communication is inappropriate, they often have difficulty explaining why, or advising a student on how to improve.

Although theory driven approaches have the benefit of an established theoretical base, the skills they advocate do not necessarily correspond well to the diverse contexts and experiences of practitioners or clients. In fact, the term ‘communication skills’ has been challenged by some researchers for eliding the complex, subjective and contingent nature of clinical interactions. For example, ‘communication that is improved from an expert perspective does not necessarily improve patients’ experience’[3]. Additionally, communication that focusses on patient satisfaction risks neglecting the importance of clinical outcomes[4].

Some researchers advocate strongly for approaches incorporating both practice-based experience, and the application of language theory[1],[4],[5]. One way to achieve this is through collaboration between practitioners and language experts in the development and implementation of communication curriculum. Such collaborations can better lead to curricula that reflect the realities and complexities of the clinical environment, while also addressing features of language that – while invisible to non-language-experts – are vital for successful clinical communication.

[1] Street RL, De Haes HCJM. Designing a curriculum for communication skills training from a theory and evidence-based perspective. Patient Education and Counseling. 2013; 93: 27-33.

[2] 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 Education and Counseling. 2013; 93:18-26.

[3] Salmon P, Young B. Core assumptions and research opportunities in clinical communication. Patient Education and Counseling. 2005; 58: 225-234.

[4] Salmon P, Young B. The validity of education and guidance for clinical communication in cancer care: Evidence-based practice will depend on practice-based evidence. Patient Education and Counseling. 2013; 90: 193-199.

[5] Dahm MR, Yates L, Ogden K, Rooney K, Sheldon B. Enhancing international medical graduates’ communication: the contribution of applied linguistics. Medical Education. 2015; 49: 828-837.