- Communication is a clinical skill: a basic skill more important than physical examination. It is a series of learned skills: not just a personality trait
- Experience is a poor teacher: often an excellent reinforcer of bad habits.
Research shows the elements needed to learn these skills effectively are:
- Observation (with audio or video)
- plus well-intentioned detailed descriptive feedback
- plus rehearsal to obtain change (labelling skills is not enough – need to try out, discover exact phrasing that works for us and incorporate into our own personality)
We know that
- Communication skills can be taught
- This does make a difference
- The difference is retained
- Effectiveness diminishes as medical students progress unless taught specifically
For a change in learners behaviour, learners need to know how not just know
Problems from our own experience
Many of us will have experienced previous negative even humiliating teaching in education e.g. ward rounds (standing at the back, hoping not to be seen, is not conducive to exposing learning needs). Our experience has often been threatening, humiliating and judgmental. There is in medical culture an apparent reluctance to give or receive praise, and feedback after observation has often been perceived as negative. Giving feedback is a technique which needs experience and training. It involves preparation, structure, explanation and choice of an appropriate setting.
Observation needs:
- A teacher who is keen to help well-motivated and knowledgeable.
- Provision of small safe groups with supportive intent to teach. Optimisation of anxiety levels
- The teacher ensures an environment where the learner understands why he should expose learning areas it than hide them, and that this will not be to his detriment
- The teacher accepts students starting point
- There is good preparation of the student prior to observation.
- A positive and constructive endpoint is reached.
- An ongoing relationship helps.
- Quality feedback and teaching with positive encouragement is provided.
Why do it?
Because experience alone is a poor teacher – observation, feedback and rehearsal have been shown to work here as with all skills teaching (e.g. tennis). Also allows a unique opportunity for looking at oneself. Without observation, a teacher only gets filtered second-hand reporting of what happened, often far from reality (Chinese whispers). Notice the link here with formative assessment and exposure of weaknesses. Thus the need to create an appropriate environment.
Video recording of consultations needs to be done often, with equipment which is easy to use and with effective arrangements for achieving consent of patients. A culture where the trainer and trainee alike video frequently, and provide readily available material, is ideal.