Developing skilled doctor–patient communication in the workplace: a qualitative study of the experiences of trainees and clinical supervisors

textabstractTo inform the development of recommendations to facilitate learning of skilled doctor–patient communication in the workplace, this qualitative study explores experiences of trainees and supervisors regarding how trainees learn communication and how supervisors support trainees’ learning in the workplace. We conducted a qualitative study in a general practice training setting, triangulating various sources of data to obtain a rich understanding of trainees and supervisors’ experiences: three focus group discussions, five discussions during training sessions and five individual interviews. Thematic network analysis was performed during an iterative process of data collection and analysis. We identified a communication learning cycle consisting of six phases: impactful experience, change in frame of reference, identification of communication strategies, experimentation with strategies, evaluation of strategies and incorporation into personal repertoire. Supervisors supported trainees throughout this process by creating challenges, confronting trainees with their behaviour and helping them reflect on its underlying mechanisms, exploring and demonstrating communication strategies, giving concrete practice assignments, creating safety, exploring the effect of strategies and facilitating repeated practice and reflection. Based on the experiences of trainees and supervisors, we conclude that skilled communication involves the development of a personal communication repertoire from which learners are able to apply strategies that fit the context and their personal style. After further validation of our findings, it may be recommended to give learners concrete examples, opportunities for repeated practise and reflection on personal frames of reference and the effect of strategies, as well as space for authenticity and flexibility. In the workplace, the clinical supervisor is able to facilitate all these essential conditions to support his/her trainee in becoming a skilled communicator

Phase transitions in diglyceride monolayers studied by computer simulations, pressure-area isotherms and x-ray diffraction

1,2-sn-diglyceride monolayers exhibit unique and complex phase transitions as a function of surface pressure. The dynamical response of the layer on expanding the film has been investigated by computer simulations, (π-A) isotherms and grazing-incidence X-ray diffraction. Good agreement is found between the simulations and experiments. The Langmuir film undergoes two phase transitions occurring at 38.3 and 39.8 Å2/molecule. The transition at low surface density is associated with a tilt of ≈14° in the direction close to nearest neighbour. The first transition is unique for the diglyceride molecules and has not been observed for other amphiphilic molecules. It is driven by a competition of hydrophobic/hydrophilic and intra/intermolecular forces and can be pictured as a «seesaw» mechanism. Due to the close packing of the chains at high surface pressure, the sn-1 ester group aligns with the alkyl chain, and only the sn-2 ester group is favoured to lay at the aqueous interface. Hydrophilic forces attract the sn-1 ester group, but its motion towards the aqueous subphase is hindered by intra- and intermolecular chain interactions. On expansion, the intermolecular interaction decreases, and at the first transition, the intramolecular interaction between the two chains is strong enough to cause a «swelling» of the molecules. The diffraction pattern determined in the different mesophases reveals that the layer maintains its hexagonal structure up to the second phase. Concomitant with the tilt, the structure relaxed from a hexagonal to a distorted hexagonal lattice