Michael Burns

Training healthcare providers in patient–provider communication: What speech-language pathology and medical education can learn from one another

Background: While the field of speech-language pathology and medical education both provide training to improve the abilities of their students to communicate with patients, these fields rarely interact or collaborate with one another to maximise the effectiveness of this training. With a recent emphasis on the communication needs of patients with aphasia and other communication disorders in healthcare, and barriers these patients often face in accessing healthcare services, it has become increasingly important to review current research regarding patient–provider communication training, as well as what speech-language pathology and medical education can learn from one another in this area. Aims: The purpose of this literature review was (1) to examine the impact of communication disorders on patient–provider communication, (2) to identify gaps in current patient–provider communication training in medical education that speech-language pathology can help fill, and (3) to highlight innovations in medical education that may enhance the clinical training of speech-language pathology students. Main Contributions: There is a significant body of research to demonstrate the effectiveness of patient–provider communication training in medical education. However, research and training in this area often neglects patients with aphasia and other communication disorders, who are more vulnerable to medical errors and poorer health outcomes than patients without communication disorders. Speech-language pathologists (SLPs) are uniquely qualified to train other healthcare providers in communication techniques to use with patients with communication disorders. The field of speech-language pathology can also benefit from using patient–provider communication frameworks and standardised patients to improve student training and service delivery for patients with communication disorders. Conclusions: Collaboration between speech-language pathology and medical education can help to ensure the highest-quality healthcare services are offered to the patients they serve.

Health Care Provider Accommodations for Patients With Communication Disorders

Health care providers can experience increased difficulty communicating with adult patients during medical interactions when the patients have communication disorders. Meeting the communication needs of these patients can also create unique challenges for providers. The authors explore Communication Accommodation Theory (H. Giles, 1979) as a guide for helping providers learn to adapt, or accommodate, their communication style at the appropriate level (neither too much nor too little) when their patients have communication disorders. Using principles of Communication Accommodation Theory, this article navigates case examples of medical interactions involving 2 hypothetical patients, 1 with aphasia and 1 with dysarthria. We use these two patients to illustrate some appropriate accommodations for patients with aphasia or dysarthria. Suggested accommodations stem from the FRAME mnemonic for communicating with patients with communication disorders and are organized using SEGUE, a framework outlining specific steps in a typical medical interaction. This article may also serve as a resource for speech–language pathologists providing in-services to their health care colleagues on this topic and to support interprofessional practices.

Assessing the Believability of Standardized Patients Trained to Portray Communication Disorders

Purpose The purpose of this study was to evaluate the believability of standardized patients portraying individuals with communication disorders as part of a larger study in which standardized patients help train medical and allied health students about communication disorders. Method Two women portrayed persons with aphasia, and 2 men depicted persons with dysarthria associated with Parkinsons disease. Two stakeholder groups rated believability. Speech-language pathologists rated believability of videos online. Persons with aphasia rated aphasia videos during in-person sessions with the researchers. Results Targeted believability was 80 or higher (0-100 scale; 0 = not at all believable, 100 = very believable). For speech-language pathologist raters, average ratings met the target for the portrayals of the aphasia characteristics of word-finding problems, agrammaticism, nonverbal communication, and overall portrayal but not for auditory comprehension problems. Targets for the portrayals were met for the dysarthria characteristics of reduced speech movements, reduced loudness, reduced intonation, flat affect, and overall portrayal but not for speech rate. Ratings for different standardized patients portraying the same case were not significantly different from each other on most characteristics. Ratings from persons with aphasia were highly variable. Conclusion Standardized patients who do not have communication disorders can portray disorder characteristics in a believable manner.

Employer Reactions to Adductor Spasmodic Dysphonia: Exploring the Influence of Symptom Severity and Disclosure of Diagnosis During a Simulated Telephone Interview

Purpose The purpose of this study was to determine the influence of symptom severity and disclosure of adductor spasmodic dysphonia (ADSD) on the perceptions of human resource personnel members (HRPs) during a simulated phone interview. Method One female speaker with ADSD was recorded reading an interview script at two time points: (a) pre-BOTOX injection (severe), and (b) post-BOTOX injection (mild). Thirty-two HRPs evaluated the recording in one of the two conditions via a qualitative structured interview. HRPs gave their recommendations regarding when and how to disclose ADSD. Results In the mild condition, no HRP perceived that the applicant had a voice disorder. Disclosure was not recommended as often, as an impairment was not initially noticed. However, 15/16 HRPs commented on the applicants voice in the severe condition, with most suspecting she was a smoker or had lung/throat cancer. Disclosure in the severe condition was recommended more often, as it clarified symptoms that were noted at the outset. Conclusions Symptom severity in ADSD influences employer perceptions during the phone interview process. Incorrect assumptions may be made about applicants with severe symptoms, and apparentness of symptoms influences whether or not disclosure is recommended. Results have implications for counseling individuals with ADSD who are navigating the job interview process.

Patient-Provider Communication Training for Dysarthria: Lessons Learned from Student Trainees

Patient-provider communication skills training programs rarely include content addressing how health care providers can improve communication with patients exhibiting dysarthria and other communication disorders. Consequently, these patients often struggle to access quality health care services. This article describes a training program focused on giving health care students the opportunity to interact with standardized patients portraying dysarthria and aphasia. A summary of the programs outcome is then provided from the perspective of the students involved as well as lessons students taught us about how to continue improving this type of program and to make it a more universal part of health care education.