The application of the Practitioners in Applied Practice Model during breaking bad news communication training for medical students : a case study

Background and Aims Breaking bad news is a key skill within clinical communication and one which can impact outcomes for both the patient and practitioner. The evidence base for effective clinical communication training in breaking bad news is scarce. Frameworks have been found to assist the practitioner, such as SPIKES, however the pedagogical approach used alongside such frameworks can vary. This study sought to examine the impact of utilising the Practitioners in Applied Practice Model (PAPM) alongside the SPIKES framework for training undergraduate medical students in breaking bad news. Methods and Results A case study approach is used to highlight the impact of training based on the PAPM and SPIKES on patient-centred communication and simulated patient satisfaction with the clinical communication behaviour. Results showed that following training, both patient-centred behaviour and patient satisfaction improved. With detailed communication behaviour changes a balance was established between rapport building behaviour, lifestyle and psychosocial talk alongside biomedical information. Conclusion This case study shows how the PAPM could be utilised alongside the SPIKES framework to improve breaking bad news communication in medical undergraduate students and describes the behavioural basis of the improvement. Further research is required to show the generalisability of this training intervention.PostprintPeer reviewe

“The word that comes to mind is polymath” : medical students’ perceptions of rural post-graduate careers

Peer reviewedPublisher PD

‘Having come to university my care was very much in my hands’:exploration of university students’ perceptions of health care needs and services using the common-sense model of self-regulation

Funding: Partial funding for this study was provided by School of Medicine and Enhancement Theme Fund from University of St Andrews.The health care needs and service experiences of higher education students require more research attention, given the increase in students who have a long-term illness, medical condition, or disability (“condition”). It is also important to consider the experiences of rising numbers of international students. This exploratory qualitative study used face-to-face interviews and the common-sense model of self-regulation to investigate students’ perceptions and coping behaviours, in a higher education institution in the UK. Thematic analysis was used to analyse the data. Twenty students who self-identified as having a condition were interviewed. This study adds depth to the understanding of the connections between students’ health-related experiences and their personal, academic, and post-graduation aspirations and the support needs of students, including international students. To optimise institutional support, innovations in partnerships with local care organisations and within the university, staff training about conditions, peer mentorship, and information outreach especially to international students, should be considered.Publisher PDFPeer reviewe

‘Having come to university my care was very much in my hands’ : exploration of university students’ perceptions of health care needs and services using the common-sense model of self-regulation

Acknowledgements We are grateful for the time that the participants gave to this study as well as the funding by School of Medicine and the Enhancement Theme Fund. Funding Partial funding for this study was provided by School of Medicine and Enhancement Theme Fund from University of St Andrews.Peer reviewedPublisher PD

Understanding undergraduate student perceptions of mental health, mental well-being and help-seeking behaviour

Funding: Medical School, University of St AndrewsDespite relatively high levels of psychological distress, many students in higher education do not seek help for difficulties. This study explored undergraduate student understanding of the concepts of mental health and mental well-being and where undergraduate students would seek help for mental well-being difficulties. Semi-structured interviews were carried out with 20 undergraduate students from 5 different subject areas. Interviews were transcribed and thematically analysed. Results highlighted that the majority of participants viewed mental health and mental well-being as two distinct concepts but their views did not affect where they would seek help for mental well-being difficulties. Medical students reported public stigma relating to help seeking for mental well-being difficulties. Undergraduate students are most likely to seek help for mental well-being difficulties from peers, but whether this experience is useful is less clear. How such an approach impacts upon the individual from whom assistance is sought is also not well understood.PostprintPeer reviewe

Virtual, Augmented and Mixed Reality Simulation for teaching and assessing situational awareness and decision making in health professions education : A scoping review protocol

Funding MC was funded through a University of Aberdeen Student Project bursaryPeer reviewedPublisher PD

“The word that comes to mind is polymath” : medical students’ perceptions of rural post-graduate careers

Introduction : Physician shortages in rural and remote areas challenge accessibility and delivery of care to rural and remote communities, including within Scotland. Medical education is a reform priority to establish a sustainable medical workforce. Whilst there is evidence to support aspects of medical education that enhance the likelihood of practicing rurally, the mechanism by which these educational initiatives work is not clearly understood. This study aims to examine medical students’ perceptions of rural and remote practice, how these perceptions motivate their interest to practice rurally, and what aspects of education are thought to influence these perceptions. Methods : This cross-sectional study utilised semi-structured interviews with ten University of St Andrews medical students enrolled in undergraduate or graduate-entry medical education programmes. Feldman and Ng’s theoretical framework was deductively applied. Interviews informed additional sub-themes, which were integrated into the original framework. The final framework helped examine medical students’ perceptions of rural medicine and mechanisms which shape these perceptions. Results : Structural (countrywide) themes included geographical barriers affecting patients and physicians. Organizational themes included perceptions of inequitable allocation of resources between urban and rural areas, as well as limited staff and support in rural practices. Occupational themes included the perception of rural clinical generalists. Personal life themes included the perception of community in rural areas. Mechanisms shaping medical students’ perceptions most profoundly were their experiences (educational, personal experience, or working). Conclusions : Medical students’ perceptions align with other professionals’ reasons for staying in a particular job. Perceptions regarding rural careers included challenges due to geographical proximity to patients, resource allocation in rural areas, and the potential to sub-specialize as a general rural practitioner. Identified mechanisms, which shape perceptions, can be addressed and strengthened by educators, policy makers and Governments to optimize medical education which promotes rural recruitment and retention.Publisher PDFPeer reviewe

Direct observation of weight-related communication in primary care : a systematic review

Funding: Review was carried out as part of a PhD funded by the University of St Andrews 600th Anniversary Scholarship.Background. Primary care is ideally placed to play an effective role in patient weight management however patient weight is seldom discussed in this context. A synthesis of studies that directly observe weight discussion in primary care is required to more comprehensively understand and improve primary care weight-related communication. Objective. To systematically identify and examine primary care observational research that investigates weight-related communication and its relationship to patient weight outcomes. Methods. A systematic review of literature published up to August 2015, using seven electronic databases (including MEDLINE, Scopus, and PsycINFO), was conducted using search terms such as overweight, obese, doctor patient communication. Results. Twenty papers were included in the final review. Communication analysis focused predominantly on practitioner use of specific patient-centred communication. Practitioner use of motivational interviewing was associated with improved patient weight-related outcomes, including patient weight loss and increased patient readiness to lose weight; however few studies measured patient weight-related outcomes. Conclusion. Studies directly observing weight-related communication in primary care are scarce and limited by a lack of focus on patient communication and patient weight-related outcomes. Future research should measure practitioner and patient communications during weight discussion, and their impact on patient weight-related outcomes. This knowledge may inform the development of a communication intervention to assist practitioners to more effectively discuss weight with their overweight and/or obese patients.PostprintPeer reviewe

An analysis of directly observed weight communication processes between primary care practitioners and overweight patients

This research was funded by a University of St Andrews 600th Anniversary Doctoral Scholarship.Objective To analyse weight-related communication prevalence and processes (content/context) between primary care practitioners (PCPs) and overweight patients within routine primary healthcare consultations. Methods Consultations between 14 PCPs and 218 overweight patients (BMI ≥25 kg/m2) were video recorded. Weight communication was coded using the Roter Interaction Analysis System (RIAS) and the novel St Andrews Issue Response Analysis System (SAIRAS). Communication code frequencies were analysed. Results Weight discussion occurred in 25% of consultations with overweight patients; 26% of these had weight-related consultation outcomes (e.g. weight-related counselling and referrals, stated weight-related intention from patients). Weight discussions were more likely to occur if PCPs provided space to patient attempts to discuss weight (p = 0.013). Longer weight discussions (p < 0.001) and contextualising weight as problematic when PCP/patient-initiated weight discussion (p < 0.001) were associated with weight-related consultation outcomes. Conclusion Weight was rarely discussed with overweight patients, however PCP space provision to patient weight-discussion initiation attempts increased weight discussion. When weight was discussed, increased time and/or contextualising weight as a problem increased the likelihood of weight-related consultation outcomes. Practical implication PCP use of specific communication approaches when discussing, contextualising and responding to patient weight may facilitate weight-related discussion and consultation outcomes and could lead to more effective patient weight management.PostprintPeer reviewe

Predictors of weight discussion in primary care consultations : a multilevel modelling approach

This research was funded by a University of St Andrews 600th Anniversary Doctoral Scholarship.Objective To understand how primary care weight-related communication processes are influenced by individual differences in primary care practitioner (PCP) and patient characteristics and communication use. Methods Two multilevel logistic regression models were calculated to predict the occurrence of 1) weight-related discussion and 2) weight-related consultation outcomes. Coded communication data (Roter Interaction Analysis System) from 218 video-recorded consultations between PCPs and patients with overweight and obesity in Scottish primary care practices were combined with their demographic data to develop the multilevel models. Results Weight-related discussions were more likely to occur when a greater proportion of PCP’s total communication was partnership building and activating communication. More discrete weight discussions during a consultation predicted weight-related consultation outcomes. Patient BMI positively predicted both weight-related discussion and consultation outcomes. Conclusion This work demonstrates that multilevel modelling is a viable approach to investigating coded primary care weight-related communication data and that it can provide insight into the impact that various patient and PCP factors have on these communication processes. Practice Implications Through the increased use of partnership building and activating communications, and by engaging in shorter, but more frequent, discussions about patient weight, PCPs may better facilitate weight-related discussion and weight-related consultation outcomes for their patients.PostprintPeer reviewe