Demonstrate the importance of good communication to your students

This article by Peiris, Taylor and Shields 2012, published in the Journal of Physiotherapy (and made available here in its original form under the Creative Commons licence https://creativecommons.org/licenses/by-nc-nd/3.0/) can help students understand the links between their interactions with their clients and how the client perceives the experience.

Peiris et al 2012

 

A map for introducing aspects of ‘communication in health care teams’ into the curriculum

Further analysis of our survey of clinical educators and academic staff provide insight as to consider introducing specific skills into a curriculum.

Results for Domain 3: Communication in health care teams 

 PRECLINICAL

The student:

 

 C1:  perceives and respects individuality, subjective perception, different points of view of team members and the expertise of the different health professions

C7: understands the principles of team dynamics and how factors both support and inhibit teamwork in practice.

C10: gives clear instructions.

C11: ensures that all relevant information is available.

C13: maintains clear, appropriate records (written or electronic) of clinical encounters and plans.

MID CLINICAL

The student:

C3: uses feedback rules (e.g. first-person-statements) and gives feedback to team-members appropriately.

C9: reflects on the impact of own opinion on others and takes this into account.

 

LATE CLINICAL

The student:

C4: is able to solve conflicts and enables a constructive negotiation in a healthcare team

 INDETERMINATE (PRECLINICAL/MIDCLINICAL) I.E. NO CLEAR DIFFERENCES IN NUMBER OF RESPONSES ACROSS THESE CATEGORIES

The student:

C2: contributes to a positive working atmosphere (e.g. supports and integrates team members, mentions the positive side of unpleasant aspects, values team-success).

C5: takes on, clarifies and reflects on own role and responsibilities in the team (e.g. team vs. team-player, leader) and identifies the role of own profession in an inter-professional team.

C6: specifies and appreciates own potential with regard to the team and is willing and able to work with others.

 

INDETERMINATE (MID CLINICAL/LATE CLINICAL) I.E. NO CLEAR DIFFERENCES IN NUMBER OF RESPONSES ACROSS THESE CATEGORIES

The student:

 C15: identifies and is knowledgeable of how to refer to people/institutions/agencies that can help to solve problems appropriate to the situation.

INDETERMINATE (PRE CLINICAL/LATE CLINICAL) I.E. NO CLEAR DIFFERENCES IN NUMBER OF RESPONSES ACROSS THESE CATEGORIES

The student:

C8: identifies own interests and distinguishes these from the team goals.

C14: presents expert knowledge effectively (e.g. presenting a patient and clinical details to others, speaking in front of a group, presenting scientific data).

A map for introducing aspects of ‘intra-and interpersonal communication’ into the curriculum

Further analysis of our survey of clinical educators and academic staff provide insight as to consider introducing specific skills into a curriculum.

Results for Domain 2: Intra- and interpersonal communication 

PRECLINICAL

The student:

 

 B1: The student recognizes own emotions (e.g. insecurity, sympathy/antipathy, attraction) in relation to others (e.g. patients, colleagues) and is able to work efficiently despite own emotional reactions when the situation requires to do so (e.g. degree of suffering of the patient, demanding patient).
 B2: The student recognizes that effective communication with patients can foster patients’ satisfaction and improved clinical outcomes.
B4: The student identifies, reflects and communicates own strengths, weaknesses, limitations and assesses own wishes, fears, goals, norms and values.
B5: The student assesses own stereotypes and social prejudices and is aware that own actions are influenced by personal experience, the current situation, own knowledge and interests.

B8: The student uses authority and influence responsibly.

B12: The student addresses and deals with own uncertainty appropriate to own level of education.

 

 

INDETERMINATE (PRECLINICAL/MIDCLINICAL) I.E. NO CLEAR DIFFERENCES IN NUMBER OF RESPONSES ACROSS THESE CATEGORIES

The student:

 B3: The student describes and assesses own communication and behavior critically considering alternatives in both.
 B6: The student reflects on own attitude towards work (e.g. cynicism, satisfaction).
 B7: The student reflects and discusses ethical, inter-cultural and other challenges in own actions as a health care professional (e.g. patient unable to give consent, health/illness concepts in different cultures, translators) and discusses approaches for resolution.
 B10: The student knows about models of the health care professional–patient relationship (e.g. transference/counter transference, reciprocity, inter-subjectivity, expectation/experience, potential imbalance of hierarchy).
 B11: The student addresses own and others errors appropriately (e.g. refrains from personally allocating blame) in order to seek for solutions and assistance and knows about basic principles in the development of errors (e.g. neglecting information or patient’s needs, inadequate communication).

 

INDETERMINATE (MID CLINICAL/LATE CLINICAL) I.E. NO CLEAR DIFFERENCES IN NUMBER OF RESPONSES ACROSS THESE CATEGORIES

The student:

 B9: The student analyses and discusses conversational situations with others (metacommunication in e.g. peer reflection, intra and inter-professional team conferences).

A map for introducing aspects of ‘communicating with patients’ into the curriculum

Further analysis of our survey of clinical educators and academic staff provide insight as to consider introducing specific skills into a curriculum.

Results for Domain 1: Communication with patients

PRECLINICAL

The student:

A1:  adapts own communication to the level of understanding and language of the patient, avoiding jargon.
A2: builds and maintains rapport and an empathetic relationship and ensures that the patient feels attended and listened to.
A3: relates to the patient respectfully including ensuring confidentiality, privacy and autonomy and recognizing the patient as a partner in shaping a relationship.
A7: uses techniques of active listening (e.g. reflection, picking up patient’s cues, paraphrasing, summarizing, verbal and non-verbal techniques)
A8: recognizes difficult situations and communication challenges (e.g. crying, strong emotional feelings, interruptions, aggression, anger, anxiety, embarrassing or sensitive issues, cognitive impairment, delivering bad news) and deals with them sensitively and constructively.
A9: shows awareness of the non-verbal communication of both the patient and the healthcare professional
A15: considers somatic, mental, social, gender, cultural, ethical and spiritual elements in the care and assessment of the Patient and perceives divergences between own values and norms and the patient’s.

A18: provides information in a patient-centered way and shares it with the patient’s consent (e.g. colleagues, family and others.) A25: discusses with the patient the likely advantages, disadvantages and expected outcomes

A26: The student encourages active participation by the patient in decision-making and explains choices or rights to the patient in a patient-centered manner.

A27: clarifies own role in decision-making process.

MID CLINICAL

The student:

A12: identifies patient expectations with respect to the role of health care professional.

A14: elicits the needs and capabilities of the patient (e.g. information, autonomy, truth and responsibility) and adapts the plan/intervention to patient’s resources and strengths.

A17: finds out how much information the patient requires and gives the appropriate amount of information

A23: seeks out and synthesizes relevant information from other sources (e.g. patient’s family, caregivers and other professionals), if necessary and available
A24: ascertains how much involvement and responsibility the patient is willing and able to take for decision-making.
A31: discusses decisions with colleagues, patients and their relatives as appropriate and regularly reassesses own decisions and revises them if necessary.
A32: identifies own opinion clearly to the patient if asked.
LATE CLINICAL

The student:

A33: talks openly to the patient about uncertainty and formulates ways of dealing with it.
A34: explains to the patient which information is needed to minimize uncertainty in the decision-making process.
INDETERMINATE (PRECLINICAL/MIDCLINICAL)I.E. NO CLEAR DIFFERENCES IN NUMBER OF RESPONSES ACROSS THESE CATEGORIES

The student:

A5: encourages the patient to express own ideas, concerns, expectations and feelings and accepts legitimacy of patient’s views and feelings.
A6: gives information to the patient (oral, written, electronic and over the phone) in a timely, comprehensive and meaningful manner.
A7: uses techniques of active listening (e.g. reflection, picking up patient’s cues, paraphrasing, summarizing, verbal and non-verbal techniques).
A8: recognizes difficult situations and communication challenges (e.g. crying, strong emotional feelings, interruptions, aggression, anger, anxiety, embarrassing or sensitive issues, cognitive impairment, delivering bad news) and deals with them sensitively and constructively.
A10: shapes a conversation from beginning to end with regard to structure (e.g. introduction, initiating the conversation, gathering and giving information, planning, closing interview, setting up next meeting; time management).
A11: uses different types of questions (e.g. open, closed and focused) according to the situation.
A19: elicits and synthesizes information for patient care.
A20: inquires about the patient’s level of knowledge about the illness
A21: considers different elements of a patient history (history of the illness, history of the health care professional–patient relationship, history of the patient).
A22: knows about the importance of supplementing verbal information with diagrams, models, written information and instructions and applies the information appropriately.
A23: seeks out and synthesizes relevant information from other sources (e.g. patient’s family, caregivers and other professionals), if necessary and available
INDETERMINATE (MID CLINICAL/LATE CLINICAL) I.E. NO CLEAR DIFFERENCES IN NUMBER OF RESPONSES ACROSS THESE CATEGORIES

The student:

A16: responds to the patient’s health beliefs and theories of illness and contrasts and integrates these into own theories of illness as a health care professional.

A28: discusses with patient the spectrum of possible consequences of a decision and explains to the patient the likely consequences of not choosing diagnostic and therapeutic measures.
A29: inquires about the relevant psychological and social resources the patient has available for making a decision.
A30: offers the patient the option to include other people in the decision- making process and clarifies with the patient how and when a decision must be made.
INDETERMINATE (PRE CLINICAL/MID CLINICAL/LATE CLINICAL) I.E. NO CLEAR DIFFERENCES IN NUMBER OF RESPONSES ACROSS THESE CATEGORIES

The student:

A13: uses adequate strategies to solve conflicts (e.g. feedback on perception, impact, wishes).

 

 

Are you an academic in Division Health Sciences and are involved in teaching communication skills for the clinical setting?

If the answer is yes, then consider using the ‘Thomas Hurtle’ video resource.

You can access it from the Division of Health Sciences Teaching and Learning website at https://lo.unisa.edu.au/course/view.php?id=5282

All of the scenes in this video have elements of communication, whether between health professionals or between health professional and patient/client/family. Just hover over the scene number and you will see a summary of the scene; this saves you trolling through the complete video!TH timeline 2

 

Results of Survey: Determining a curriculum to develop clinical communication skills for students of health professions.

We recently undertook a survey of academics and clinical educators in the Health Science professional disciplines. We asked them which of 61 communication learning objectives or skills1 that they thought were most important for student to develop.

 

The three skills that were perceived to be most important related to communication with patients (n=47 respondents). The majority of respondents indicated that they thought these skills should be introduced into the curriculum before they embarked on their first clinical placement.

 

A1: The student adapts own communication to the level of understanding and language of the patient, avoiding jargon.

A2:The student uses techniques to build up and maintain rapport and an empathetic relationship and ensures that the patient feels attended and listened to.

A3:The student relates to the patient respectfully including ensuring confidentiality, privacy and autonomy and recognizes the patient as a partner in shaping a relationship

 

This survey informs the development of preclinical learning resources to develop clinical communication skills in students of health professions.

 

 

Survey undertaken by at the University of South Australia

Associate Professor Kerry Thoirs, Associate Head of School: Academic, School of Health Sciences, Lecturer Medical Sonography Kerry.thoirs@unisa.edu.au School of Health Sciences, Division of Health Sciences
Dr Rowena Harper, (Head: Language and Literacy, Teaching Innovation Unit) rowena.harper@unisa.edu.au Learning and Teaching Services, Learning and Teaching Unit
Dr Giordana Cross, Program Director, Dietetics. giordana.cross@unisa.edu.au School of Pharmacy and Medical Sciences, Division of Health Sciences
Dr Sandra Ullrich, Lecturer Nursing. sandra.ullrich@unisa.edu.au School of Nursing and Midwifery, Division of Health Sciences
Jane Coffee, Lecturer Physiotherapy. jane.cofee@unisa.edu.au School of Health Sciences, Division of Health Sciences

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

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