Annie Cushing

UK consensus statement on the content of communication curricula in undergraduate medical education

Context  The teaching and assessment of clinical communication have become central components of undergraduate medical education in the UK. This paper recommends the key content for an undergraduate communication curriculum. Designed by UK educationalists with UK schools in mind, the recommendations are equally applicable to communication curricula throughout the world.

Peer feedback as an aid to learning – What do we want? Feedback. When do we want it? Now!

Background: With 360° appraisals integral to professional life, learning how to give constructive feedback is an essential generic skill. Aim: To use a formative objective structured clinical examination (OSCE) for skills acquisition and development in giving feedback, whilst facilitating awareness of the importance of communication skills in clinical practice. Methods: Medical and nursing students took part in a formative OSCE. Using actors as simulated patients, a three-station OSCE circuit was repeated three times so that students could rotate through the roles as ‘candidate’, ‘examiner’ and ‘observer’. As ‘candidates’, they received immediate feedback on their consultation from the ‘examiner’/‘observer’. The events were evaluated using a questionnaire and focus groups. Results: Students immensely valued this learning event for considering expectations for a performance (91–100%). Concerns around giving peers feedback were acknowledged, and they were divided on preference for feedback from peers or tutors (48% versus 52%). But training in providing feedback and criteria for assessment were considered helpful, as was instruction by faculty to give corrective feedback to peers. Conclusions: Peer observation and professional accountability for giving constructive feedback enhanced awareness of their skills education and training needs. It also opened the dialogue for identifying opportunities for peer assessment and feedback to support work-based education and skills development.

Good communication in psychiatry – a conceptual review

BACKGROUND The communication between clinician and patient is the basis of psychiatric treatment. However, there has been little practical attention to training in it, and no specific theory of what constitutes good communication in psychiatry has been developed. This review aims to identify principles that guide good communication. METHODS A conceptual review of guiding principles for how clinicians should communicate with patients to achieve clinical objectives in psychiatry. RESULTS Five guiding principles for clinicians were identified: a focus on the patients concerns; positive regard and personal respect; appropriate involvement of patients in decision making; genuineness with a personal touch; and the use of a psychological treatment model. CONCLUSIONS The principles are mostly generic, but their implementation can be particularly challenging in psychiatry. They may guide further empirical research on effective communication in psychiatry and be utilised using different personal skills of clinicians.

Patients’ attitudes towards the presence of medical students during consultations

This study analyses the attitudes of patients towards the presence of medical students during consultations. It was conducted in a very culturally and ethnically diverse part of London. The study aimed to investigate the factors, particularly ethnicity, which influence patients’ attitudes towards medical students. A total of 422 patients participated in the study, which was conducted in general practice and hospital outpatient waiting areas in the London Boroughs of Tower Hamlets and Hackney. In general, the results demonstrate that patients are positive towards medical student participation during consultations. In particular, older patients, patients born in the UK and patients with prior experience of medical students seem to be particularly favourable towards students. However, compared with the White-British population, the non-White-British population appears to be more negative towards medical student participation. This study highlights the need for patient education regarding the importance, for the training of future doctors, of medical student involvement in consultations. Practice points•Patients are in general favourable towards medical student presence during consultations.•Older patients, patients born in the UK and patients with prior experience of medical students seem to be more favourable towards medical student participation.•Compared with the White-British population patients from the non-White-British population are less receptive towards medical students.•Patient education towards the importance of medical student involvement for the training of future doctors is highlighted.•Patient rights of consent and choice should not be compromised.

Assessment of Non-Cognitive Factors

The array of instruments and methods designed to assess communication skills, interpersonal skills and attitudes in undergraduate and postgraduate settings are reviewed. The literature points to an emerging evidence base for those elements in the doctor-patient interaction which should be assessed. Some instruments have undergone psychometric testing, mostly inter-rater reliability, but few have been tested for internal consistency or validity.

Decisions at the end of life: an empirical study on the involvement, legal understanding and ethical views of preregistration house officers

Objectives: To collect information on the involvement, legal understanding and ethical views of preregistration house officers (PRHO) regarding end-of-life decision making in clinical practice. Design: Structured telephone interviews. Participants: 104 PRHO who responded. Main outcome measures: Information on the frequency and quality of involvement of PRHO in end-of-life decision making, their legal understanding and ethical views on do-not-resuscitate (DNR) order and withdrawal of treatment. Results: Most PRHO participated in team discussions on the withdrawal of treatment (n = 95, 91.3%) or a DNR order (n = 99, 95.2%). Of them, 46 (44.2%) participants had themselves discussed the DNR order with patients. In all, it was agreed by 84 (80.8%) respondents that it would be unethical to make a DNR order on any patient who is competent without consulting her or him. With one exception, it was indicated by the participants that patients who are competent may refuse tube feeding (n = 103, 99.0%) and 101 (97.1%) participants thought that patients may refuse intravenous nutrition. The withdrawal of artificial ventilation in incompetent patients with serious and permanent brain damage was considered to be morally appropriate by 95 (91.3%) and 97 (93.3%) thought so about the withdrawal of antibiotics. The withdrawal of intravenous hydration was considered by 67 (64.4%) to be morally appropriate in this case. Conclusions: PRHO are often involved with end-of-life decision making. The results on ethical and legal understanding about the limitations of treatment may be interpreted as a positive outcome of the extensive undergraduate teaching on this subject. Future empirical studies, by a qualitative method, may provide valuable information about the arguments underlying the ethical views of doctors on the limitations of different types of medical treatment.

Informed consent in clinical practice: pre-registration house officers’ knowledge, difficulties and the need for postgraduate training

In clinical practice consent is often obtained by junior doctors. This study investigates the involvement of pre-registration house officers (PRHOs) in the process of obtaining consent, the supervision they receive and their knowledge on the subject. Some 74% of the PRHOs in post completed the questionnaire; 68% had often or sometimes obtained consent during their year as PRHO; 18% stated that on the occasions when they had obtained consent they were always the only person eliciting consent; 62% of the doctors perceived some lack of knowledge with regard to the nature of the procedure as a difficulty. Despite a comprehensive undergraduate programme in ethics, law and communication there is a need for applied education regarding the clinical procedures for which PRHOs are obtaining consent.

Medical students' attitudes and behaviour towards sexual health interviewing: short- and long-term evaluation of designated workshops

Workshops aimed at promoting fourth-year medical students’ attitudes towards and subsequent behaviour in talking to patients about sexual health are reported on. Improvements in attitudes are reported following the workshops in 1999–2000 with students being more likely to see the relevance of sexual health enquiry, feeling more confident and competent about broaching the subject and expressing greater intention to do so. One year on, comparison of the intervention and non-intervention group for attendance at the workshop showed no difference in the proportion who had subsequently asked patients questions about sex. The proportion of students asking patients rose from 47% in the fourth year to 92% by the fifth year. Issues of long-term evaluation and the importance of the informal relative to the formal curriculum are discussed.

Educational effectiveness of gynaecological teaching associates. A multi-centre randomised controlled trial

To evaluate, among medical students learning the female pelvic examination, the added benefits of training by gynaecological teaching associates compared with training involving a manikin only.

The importance of non-verbal behaviour: issues for selection, training and assessment

Although race and health research is conducted in the USA, other countries may more commonly focus on ethnicity and minority groups. However, as the authors point out, the issues are generalisable, relating as they do to cultural differences in body language norms, social relationships and also stereotyping. Hence, this review poses a number of important implications for us as medical educators, ranging from selection through to professional practice.