PCC - teaching Flashcards
(10 cards)
Intro
Epstein et al (2005) - four domains of communication - patients perspective, reaching shared understanding, psychosocial context, sharing power and responisbility
- recommended clearer theory-based operational definitions, clarity on measurement, measures should account for individuals, more longitudinal studies, complexity of PC should be addressed
- poor communication associated with medical errors and negative patient experiences (Levinson & Pizzo, 2011)
- advancements improved outcomes but distanced physicians from patient (Barry & Edgman-Levitan, 2012)
Teaching
- 1992 only 7 schools taught communication skills, now embedded in UK curiculum
- but teaching vague, teacher-dependent, non-reproducible, students want communication script and need consensus on framework of appropriate communication (Headly, 2007)
- best way to teach remains unclear (Clever et al., 2011)
- clinical years have less devotion to cs training, barriers of lack of time, incentives, misconceptions, hard to assess improvements long-term (Levinson et al., 2010)
Sim patients
- used extensively in high income and increasingly in low-income countries (Kwan et al., 2019)
+ scenarios are adaptable, can simulate difficult cases (Isaksson et al., 2022) - expensive, requires training, time consuming, relies on script, aware of sim, may just learn to impress examiner (Krahn et al., 2022)
- ethical/practical issues with pediatric sims, need accurate/consistent way of assessing, differences in study design make it hard to assess
- some students prefer real patients (Clever et al., 2011)
+ valued in student satisfaction and exam scores (May et al., 2009), valued in training and adds element to learning process (Isaksson et al., 2022) - leads to improved communication but methodological issues in studies - baseline skills not measured, outcome measures lack validity/reliability, trainee perceptions mostly ignored (Lane & Rollnick, 2007)
Role play
+ cost saving, experience of patient role, descriptive feedback, reviewing own practice
- leads to improvements but same issues as above (Lane & Rollnick, 2007)
Berkhof et al (2011)
- review of systematic reviews - role play, feedback and small group discussion improved communication but need general agreement on outcome measures
- limitations - publication bias, mix of practitioners and previous training
- students seem to prefer experiential to instructional but have mixed views (Rees et al., 2004)
Word ‘training’ Bylund (2017)
- suggests learner doesn’t know communication skills but likely have interpersonal skills
- suggests only one right way to communicate - more complicated and nuanced than that
- suggests discrete event with beginning/end but requires constant daily process of skills practice and reflection
- instead encourage building skills already have through reflection, experiential work and self direction learning
Comskil model - Brown & Bylund (2008)
- makes skills taught more explicit as training shown effectiveness but not clear what they’re teaching
- ‘communication skills’ often used inconsistently across studies and ambiguous within studies
- grounded in goals, plans and actions (GPA) theories and sociolinguistic theory
- offers potential strategies and skills, adaptable to variety of challenging situations
- more flexible than PCC script
- communication should increase not reduce flexibility by expanding reportiore of skills
- 26 discrete skills in 6 groups - more measurable, better feedback, reliable assessment process
Dementia (O’Brien, 2019)
- patients likely experience increased communication barriers
- HCPs report stress, reduced job satisfaction with difficulty communicating with these patients
- CST effective at improving confidence, knowledge and skills with dementia
- but evidence not clear what content should be
- developed VOICE for dementia - two day training course including conversation video analysis and use of specifically trained sim patients - clearer methods to support PCC
- suggest more training for HCPs and tailoring to specific patients
- supports comskil model as flexibility of communication to adapt to patients
Patient participation
- PCC not beneficial for all, some may prefer more direct approach
- in cancer imposing choice found as harmful as imposing advice (Gattallari et al., 2001)
- women in breast cancer viewed expertise as important (Wright et al., 2004)
- shared decision making seen as gold standard (Boissy, 2020) but some don’t want to be involved so challenge in implementing (Joseph-Williams et al., 2017)
- active participation beneficial but in practice patient contributes litte
- difference between desire to participate less and lack of knowledge (Cegala, 2003) - patient should be educated
Culture
- global shift to PCC
- most research in Western countries - forcing other countries ignores cultural differences
- not all countries teach communication skills in undergrad (Iran - Moezzi et al., 2024)
- China (Buchanan) - traditionally more doctor centred, family told diagnosis not patient, PCC increasingly included in training but contradicts traditions
- if patient not told diagnosis - question ability to practice PCC
- patient not actively involved in decisions, doctors conflicted on best practice vs what they have to do
- laws moving emphasis from ‘protecting’ to informing patient (Hahne et al., 2019)
Gelis et al (2020) - review of PRP
- not trained Pp so less structure and increased between-group variability
- playing patient develops empathy, students consider it valuable and effective
- PRP considered acceptable but not different to other sim training
- PRP globally effective for changing healthcare knowledge and role-play attitudes but only one study considered persistence of change at 6 months
- more research needed to examine effects of student playing/not playing role of patient
- research lacks assessment in real life
- less costly than other sim training
- limitations - high variability in PRP programs, lack of consensus on definition of communication skills
- future research should compare to other sim programs
