Jo Brown

How clinical communication has become a core part of medical education in the UK.

Context  This paper sets out to analyse and interpret the complex events of the last 20 years in order to understand how the teaching and learning of clinical communication has emerged as a core part of the modern undergraduate medical curriculum in most medical schools in the UK.

Transferring Clinical Communication Skills From the Classroom to the Clinical Environment: Perceptions of a Group of Medical Students in the United Kingdom

Purpose To better understand the transfer of classroom-learned clinical communication skills (CCS) to the clinical environment of the hospital ward, where they are practiced and refined by students. Method The author first briefly presents the literature on clinical communication, provides an overview of the debates around the notion of transfer, and presents a sociocultural model of developmental transfer applied to CCS learning. Second, she describes a focus group and nine individual interviews carried out with 17 fourth-year medical students at one medical school in the United Kingdom in 2008. The goal was to elicit their views of CCS teaching, learning, and transfer of CCS to the clinical workplace. Results The findings are presented under the four main themes of transition, where students experienced the transition from the medical school to the hospital ward as a mixture of positive and negative impacts on transferring their CCS skills; the clinical culture, where senior doctors had the greatest impact on student learning and emergent clinical practice; clinical communication as a vehicle for professionalism and being a “good” doctor; and, finally, transfer mechanisms, where simulated practice with actors and the clinical history template were powerful learning tools. Conclusions Findings indicate that more needs to be done to support, develop, and embed CCS into the professional practice of medical students in the clinical workplace. This may be achieved by greater collaboration of educators in the academic and clinical environments. Using the developmental transfer model applied to CCS learning may help foster this relationship.

Applying your clinical skills to students and trainees in academic difficulty.

Background:  When students and trainees in difficulty present late, there are often signs in their history that suggest that earlier identification and intervention might have been possible. Clinical supervisors may have been reluctant to explore issues with them, perhaps because they felt that it was not their role to do so, or that they may not have the necessary skills or perhaps because of the concern of ‘opening a can of worms’ that they would not be able to address.

Perspective: clinical communication education in the United Kingdom: some fresh insights.

Clinical communication education is now part of the core curriculum of every medical school in the United Kingdom and the United States. It has emerged over 30 years because of various societal, political, and policy drivers and is supported by an impressive evidence base.For a variety of reasons, however, clinical communication has become separated from other parts of medical education and tends to be positioned in the early years of the curriculum, when students have limited experience of being in the clinical workplace and working with patients. The teachers of clinical communication, whether medical-school-based or clinically based, may not share learning goals for the subject and this may, therefore, provide a disintegrated learning experience for students.Clinical communication teachers need to inject fresh thinking into the teaching and learning of the subject to unite it with clinical practice in the authentic clinical workplace. Engaging with theories of workplace learning, which aim to overcome the theory/practice gap in vocational education, may be the way forward. The author suggests various ways that this might be achieved-for example, by situating clinical communication education throughout the whole undergraduate curriculum, by integrating the topic of clinical communication with other areas of medical education, by developing coteaching and curriculum design partnerships between medical school and clinical workplace, and by developing a greater range of postgraduate education that offers opportunities for professional development in clinical communication for qualified doctors that is complementary with what is taught in undergraduate education.

Helping students to gain confidence in personal performance

to be identified. Using predictors that are more appropriate and addressing possible obstacles to student success in our curriculum should assist our school in its mission to select and retain more students from disadvantaged communities. What was done Artificial neural network analysis (ANNA) was applied to identify the predictors of success using input and output data for students admitted into our undergraduate medical programme since 1999. A total of 99 input variables in 3 categories were used: demographic (3); quantitative (16), and qualitative (80). Student demographics included gender, ethnic group and home language. Quantitative variables were academic performance in high school and the results of the national health sciences placement tests (HSPTs), which assess potential to succeed at tertiary education level. A set of 80 qualitative variables, related to generic skills, life views and attitudes, were obtained using a questionnaire completed by the students on admission to the programme. Success was measured by academic performance during the first study year according to whether a student passed, passed with distinction or failed. Evaluation of results and impact The study population comprised 171 students for whom complete datasets were available. Ten (6%) of these students failed the first year. ANNA showed that, when using all the input variables, student performance could be predicted with close to 100% accuracy. The most powerful predictors were the results of the HSPTs. Using only these, the 10 failures could be predicted with 90% accuracy. A similar result was found using the 80 qualitative variables in isolation. The results also showed that the average mark achieved during the first year was significantly related to the student s home language and ethnicity. Although future work will need to validate these findings against more data, especially for more unsuccessful students, they already have an impact on our selection process, particularly in helping to identify high-risk students. The study will be expanded to include all years of training, other university programmes, and other health sciences programmes in the country.

A student-led programme to raise awareness of organ donation

O rgan transplantation is described as ‘medicine of the twenty-first century’ and remains the most effective long-term treatment for end-stage kidney, liver, heart and lung failure. As the demand for solid organ transplants increases on an annual basis, the number of potential donors has failed to keep up with demand and has remained constant over the last decade. Moreover, 400 people die every year in the UK while waiting for a kidney transplantation because of the shortage of donor organs.

Learning and teaching clinical communication in the clinical workplace

Clinical communication teaching and learning has become increasingly separate from the clinical workplace over the last 20 years in the UK, and in many medical schools is front‐loaded to the early years of the curriculum. Many reasons exist to explain this separation, including the increasing use of simulation. However, learning by simulation alone is not ideal, and the literature now points towards a new direction that blends simulation with authentic experiences in the clinical workplace to aid the transition to clinical life.