Communication in medical education

T. Pottecher, T. Pelaccia, B. Ludes, J. Sibilia

Ped. Res. Lab. University of Medicine

Strasbourg

Communication in medical practice

• Paramount importance on a daily basis– With patients and relatives– Within the medical team

• Mandatory for medical teachers– At the bedside– To give a lecture

• No formal teaching in medical curriculum

• State of practice in medical universities

• Tools for communication’s assessments

• Results

Survey of «old » residents in anesthesia

• Training in communication : 21%

– 1/3 : simulated patient– ½ : « osmosis » with senior– 1/6 : lectures

• Needing additional training : 88 %

Prochilo C. SFAR 2O11

• State of practice in medical faculties

• Tools for communication’s assessments• Results

Communication skills checklist (partial)

OSCE : Objective structured clinical examination

Assessment of patient’s problem and situation

Appropriate questionning Asked 1 question at a time

Understanding patient’s beliefs Asked SP views about illness

Accuracy of understanding Summarized SP story

Patient Education and Counseling

Elicits patient’s perspectives Asked SP views of need of action

Provides clear instructions Information in segments smal enough to be absorbed

Assesses patient’s understanding Ascertained what SP understood

Clinical cases for simulated patients

Feedback

Giving feedback : core element in medical education

But : thin evidence base to guide medical educators

Algorithm for giving feedback ?

self-feeling

mini-cex

Thomas JD.Giving feedback. J. Palliat Med 2011 Feb;14(2):233-9

• State of practice in medical faculties

• Tools for communication’s assessments

• Results

Survey of «old » residents in anesthesia

• Training in communication : 21percent

– 1/3 : simulated patient

– ½ : « osmosis » with senior

– 1/6 : lectures

• Needing complementary training : 88 percent

• Comfortable for communication

– 81% if previous training

– 60 % without previous training

Prochilo C. SFAR 2O11

Results

OSCE improves also time management

The Netherlands Institute of Primary Health Care (Amsterdam, June 1998) highlighted

this consensus statement to both graduate and continuing medical education

programmes:

1. teaching and assessment should be based on a broad view of communication in medicine;

2. communication skills and clinical teachings should be consistent and complementary;

3. teaching should define, and help students achieve, patient-centred communication tasks;

4. communication teaching and assessment should foster personal and professional growth;

5. there should be a planned and coherent framework for communication skills teaching;

6. students' ability to achieve communication tasks should be assessed directly

7. communication skills teaching and assessment programmes should be evaluated;

8. faculty development should be supported and adequately resourced.

Patient Educ Couns. 1999 Jun;37(2):191-5.

Do you teach medical communication….

• If yes : How?

• If no : Why?