Gwyn E. Barley

Faculty development to change the paradigm of communication skills teaching in oncology

Dr B, a faculty oncologist supervising fellows at an outpatient oncology clinic, faces a common teaching quandary. A second-year oncology fellow presents a patient with metastatic lung cancer, which has progressed despite second-line palliative chemotherapy. The fellow concludes his presentation, which was technically impeccable, by saying, “I thought the patient was not getting how bad this is, so it was time to hang crepe. I told him it was a choice between phase I or nothing.” Dr B knows the fellow to be a careful physician who is genuinely concerned about the well-being of his patients. Yet the fellows comment about hanging crepe raises a red flag for Dr B, because in his experience, blunt disclosures of poor prognoses may lead patients to wonder if their physician is still on their side. In addition, Dr B does not like telling patients that there is nothing more to be done. But he is not sure how to get the fellow to understand this. Should he confront the fellow about this, or just let the comment pass?

Teaching foundational physical examination skills: study results comparing lay teaching associates and physician instructors.

Background The purpose of this pilot study was to determine differences in the physical exam skills of first-year medical students learning physical exam exclusively from standardized physical examination teaching associates (SPETAs) or physician faculty. Method In all, 144 first-year medical students were randomized to receive SPETA or physician-led physical examination instruction. Students participated in an OSCE assessment immediately following the end of the curriculum block. Results SPETA-trained students performed equivalently to physician faculty trained students across all stations with a mean of 82.9% versus 81.2% (p = .226). Students taught by SPETAs performed significantly better on the abdominal OSCE with a mean score of 88.8%, while physician faculty taught students had a mean score of 85.4% (p = .03). Conclusion Findings from this study suggest that SPETAs can effectively teach foundational physical examination skills to medical students at a similar and sometimes better performance level as physician faculty.

Use of Patient Encounter Documentation (Log) Systems at Three Medical Schools.

This article describes uses and limitations of patient encounter documentation (log) systems in four programs at three medical schools. Curricular, psychometric, and administrative issues affecting their successful implementation are discussed, and recommendations to facilitate their use in program evaluation are offered.

Personalized remedial intensive training of one medical student in communication and interview skills.

Background: Medical students found to be deficient in communication and interview skills pose a difficult remediation challenge. There is no standard way to address such deficiencies. The authors describe the development and implementation of an intensive remedial curriculum. Description: A 2nd-year student found deficient in communication skills was held back for a year and paired with a clinical preceptor for intensive skills training, including a weekly precepted clinic, structured readings, standardized patient (SP) exercises, communications workshops, and end-of-year standardized clinical evaluations. Evaluation: The students self-assessment and the preceptors assessments of communication skill gradually improved over the year. The student improved through a progression of SP exercises focusing on specific communication skills. The student passed a final evaluation exercise with an excellent rating from the SP and the preceptor. Conclusions: This multistrategy approach to improve communication skills can be applied to other students and in other institutions. Based on the Bayer Institute communication workshops and integrated coaching techniques, the material forms a framework to help deficient students to become proficient in communication and interviewing skills.

Improving medical students' communication with limited-literacy patients: project development and implementation.

BACKGROUND Physicians may not realize that some of their patients have limited reading abilities. The AMC Cancer Research Center and the Primary Care Curriculum at the University of Colorado collaborated to develop and implement a project to teach medical students to identify and effectively communicate with limited-literacy patients regarding cancer screening. METHOD The project incorporated two standardized-patient (SP) cases on cancer screening and literacy into the existing curriculum for second-year students. A small-group, interactive problem-based learning (PBL) case on breast cancer screening and literacy introduced the concept of communicating about cancer screening and literacy issues. A clinical practice examination on colorectal cancer screening and literacy was given at the end of the year. RESULTS The collaborative project proved successful in incorporating literacy and cancer screening into a medical school curriculum. Time spent training SPs to play the role of adults with limited literacy was very important, as was time spent pre-testing the cases. The PBL case effectively promoted group discussion of cancer screening and literacy. CONCLUSION The project succeeded in making students aware of literacy and cancer screening issues. Outcome results are being analyzed.

Medical Student Performance on an Adolescent Medicine Examination

PURPOSE To examine the performance of third-year medical students on an adolescent medicine clinical practice examination. METHODS The participants were third-year medical students (2010 [n = 145] and 2011 [n = 134]) at the University of Colorado School of Medicine. Student performance on adolescent contraceptive management was measured in three domains following Accreditation Council for Graduate Medical Education (ACGME) competencies in professionalism, communication, and history-taking skills. RESULTS With regard to professionalism and communication skills, students performed very well, scoring >95% correct in both years. Students demonstrated relatively poorer performance in history-taking competency in 2010 and 2011 (66% and 67% correct, respectively). CONCLUSION In the adolescent Objective Structured Clinical Examination case, third-year medical students demonstrated extremely high performance in communication and professionalism skills. However, performance was lower for history-taking skill in contraceptive management.