Managing the complexity of doing it all : an exploratory study on students' experiences when trained stepwise in conducting consultations

Background: At most medical schools the components required to conduct a consultation, medical knowledge, communication, clinical reasoning and physical examination skills, are trained separately. Afterwards, all the knowledge and skills students acquired must be integrated into complete consultations, an art that lies at the heart of the medical profession. Inevitably, students experience conducting consultations as complex and challenging. Literature emphasizes the importance of three didactic course principles: moving from partial tasks to whole task learning, diminishing supervisors' support and gradually increasing students' responsibility. This study explores students' experiences of an integrated consultation course using these three didactic principles to support them in this difficult task. Methods: Six focus groups were conducted with 20 pre-clerkship and 19 clerkship students in total. Discussions were audiotaped, transcribed and analysed by Nvivo using the constant comparative strategy within a thematic analysis. Results: Conducting complete consultations motivated students in their learning process as future physician. Initially, students were very much focused on medical problem solving. Completing the whole task of a consultation obligated them to transfer their theoretical medical knowledge into applicable clinical knowledge on the spot. Furthermore, diminishing the support of a supervisor triggered students to reflect on their own actions but contrasted with their increased appreciation of critical feedback. Increasing students' responsibility stimulated their active learning but made some students feel overloaded. These students were anxious to miss patient information or not being able to take the right decisions or to answer patients' questions, which sometimes resulted in evasive coping techniques, such as talking faster to prevent the patient asking questions. Conclusion: The complex task of conducting complete consultations should be implemented early within medical curricula because students need time to organize their medical knowledge into applicable clinical knowledge. An integrated consultation course should comprise a step-by-step teaching strategy with a variety of supervisors' feedback modi, adapted to students' competence. Finally, students should be guided in formulating achievable standards to prevent them from feeling overloaded in practicing complete consultations with simulated or real patients

Doctor-patient communication with people with intellectual disability - a qualitative study

<p>Abstract</p> <p>Background</p> <p>People with intellectual disability (ID) expressed dissatisfaction with doctor-patient communication and mentioned certain preferences for this communication (our research). Since many people with ID in the Netherlands have recently moved from residential care facilities to supported accommodations in the community, medical care for them was transferred from ID physicians (IDPs) to general practitioners (GPs) in the vicinity of the new accommodation. We addressed the following research question: 'What are the similarities and differences between the communication preferences of people with ID and the professional criteria for doctor-patient communication by GPs?'</p> <p>Methods</p> <p>A focus group meeting and interviews were used to identify the preferences of 12 persons with ID for good communication with their GP; these were compared with communication criteria used to assess trainee GPs, as described in the MAAS-Global manual.</p> <p>Results</p> <p>Eight preferences for doctor-patient communication were formulated by the people with ID. Six of them matched the criteria used for GPs. Improvements are required as regards the time available for consultation, demonstrating physical examinations before applying them and triadic communication.</p> <p>Conclusions</p> <p>People with ID hold strong views on communication with their doctors during consultations. GPs, people with ID and their support workers can further fine-tune their communication skills.</p

Communication guidelines as a learning tool: An exploration of user preferences in general practice

AbstractObjectiveTo explore characteristics of written communication guidelines that enhance the success of training aimed at the application of the recommendations in the guidelines.MethodsSeven mixed focus groups were held consisting of communication skill teachers and communication skill learners and three groups with only learners. Analysis was done in line with principles of grounded theory.ResultsFive key attributes of guidelines for communication skill training were identified: complexity, level of detail, format and organization, type of information, and trustworthiness/validity. The desired use of these attributes is related to specific educational purposes and learners’ expertise. The low complexity of current communication guidelines is appreciated, but seems ad odds with the wish for more valid communication guidelines.ConclusionsWhich guideline characteristics are preferred by users depends on the expertise of the learners and the educational purpose of the guideline.Practice implicationsCommunication guidelines can be improved by modifying the key attributes in line with specific educational functions and learner expertise. For example: the communication guidelines used in GP training in the Netherlands, seem to offer an oversimplified model of doctor patient communication. This model may be suited for undergraduate learning, but does not meet the validity demands of physicians in training

"Should I prioritize medical problem solving or attentive listening?": the dilemmas and challenges that medical students experience when learning to conduct consultations

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Vaardig communiceren: ervaringen van aios en opleiders

De huisartsopleiding onderschrijft het belang van ‘vaardige arts-patiënt communicatie’ – communicatie die zich voegt naar de situatie – en is bezig het curriculum daaraan aan te passen. In een aantal focusgroepinterviews, onderwijsbijeenkomsten en individuele interviews onderzochten we hoe aios (arts-in-opleiding tot specialist) vaardige communicatie leren en hoe opleiders hen daarbij kunnen ondersteunen. We vonden dat aios via een iteratieve leercyclus een persoonlijk communicatierepertoire ontwikkelen. Opleiders kunnen dit leerproces ondersteunen door aios concrete voorbeeldzinnen aan te reiken die ze kunnen uitproberen, om vervolgens samen te evalueren hoe deze uitgepakt hebben

Interpersonal perception in the context of doctor-patient relationships: A dyadic analysis of doctor-patient communication

Doctor-patient communication is an interpersonal process and essential to relationship-centered care. However, in many studies, doctors and patients are studied as if living in separate worlds. This study assessed whether: 1) doctors' perception of their communication skills is congruent with their patients' perception; and 2) patients of a specific doctor agree with each other about their doctor's communication skills. A cross-sectional study was conducted in three provinces in Canada with 91 doctors and their 1749 patients. Doctors and patients independently completed questions on the doctor's communication skills (content and process) after a consultation. Multilevel modeling provided an estimate of the patient and doctor variance components at both the dyad-level and the doctor-level. We computed correlations between patients' and doctors' perceptions at both levels to assess how congruent they were. Consensus among patients of a specific doctor was assessed using intraclass correlation coefficient (ICC). The mean score of the rating of doctor's skills according to patients was 4.58, and according to doctors was 4.37. The dyad-level variance for the patient was .38 and for the doctor was .06. The doctor-level variance for the patient ratings was .01 and for the doctor ratings, .18. The correlation between both the patients' and the doctors' skills' ratings scores at the dyad-level was weak. At the doctor-level, the correlation was not statistically significant. The ICC for patients' ratings was .03 and for the doctors' ratings .76. Overall, this study suggests that doctors and their patients have a very different perspective of the doctors' communication skills occurring during routine clinical encounters.Shared decision making Relationship-centered care Dyadic data analysis Doctor-patient relationship Doctor-patient communication