Interpersonal and Communication Skills Community Faculty Development Center University of Massachusetts Medical School MQ

Objectives Describe the interrelatedness of communication with other competencies Describe a well-established theory of medical communication (3-function approach) Use a straight forward model for curriculum development (GNOME) Apply the curricular model, with a paradigm for learning, to communication MQ

Communication at the Intersection of the Competencies Patient care Systems Practice Communication WF Knowledge Professionalism

The Communication Competency “…demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, families and professional associates.” WF

Components Create and sustain a therapeutic and ethically sound relationship with patients Use effective listening skills and elicit and provide information… Work effectively with others as a member or leader of the a health care team WF

Relationship among competencies Patient Care Professionalism Effective communication Caring and respectful Counsel and educate Respect, compassion Sensitivity to difference Communication Gather information Develop Relationship Inform and develop plan WF System Partner with managers & providers to …

Linking the communication competency to outcomes Professionalism Patient Care WF System

Evidence that the communication competence is needed Quality of Communication Effective communication improves outcomes Training improves effectiveness Does training improve clinical outcomes? WF

Building Curriculum around Competencies Curriculum Development Model Theory of Communication MQ Learning Paradigm

Goals Needs Objectives Methods Evaluation Curriculum Development Model MQ

Benchmarks Objectives (Competencies) Goals (Outcomes) MQ Goals are very broad outcomes that we wish for our learners. Objectives are specific translation of the competencies into measurable parts. The parts can be called benchmarks or standards of behavior. They repesent expected performance or standards. A developmental sequence is implied. Benchmarks are particularly useful because a set of benchmarks implies a sequence of developmental milestones if you will. Benchmarks (Performance Indicators)

Theory of Communication: Three Function Approach Goals Within our curriculum, what are the overarching communication outcomes that we hope to observe in our learners? Theory of Communication: Three Function Approach Relationship Building Data Gathering Educating MQ

Needs Assessment (KSA) Students Residents Faculty/Educators Staff Patient advocates Risk managers Focus groups Paper or web-based survey Literature review Performance (OSCE, Press-Gainey) MQ How do you do needs assessment around competencies? Needs can be defined in many ways by many ‘stakeholders’

‘Framing’ Objectives/Competencies Using the Three-Function Approach Working as Consultant Difficult Personality Using Interpreters Multiple Complaints Giving Bad News Acknowledging Error Informed Consent Relationship Data Gathering Patient Education MQ The theory actually guides your needs assessment and development of objectives

Learning Paradigm: A Metacognitive Framework MQ Competence vs. capability

Learning Paradigm: A Metacognitive Framework ‘Produce capable as well as competent learners’ Learning Paradigm: A Metacognitive Framework Monitoring and managing one’s thinking, including making plans before a thinking episode, regulating during the episode, and reflecting back afterwards to revise and plan future practices. “. . . reorganizes thinking by providing on-line monitoring and re-direction.” Perkins and Grotzer 1997 MQ Competence vs. capability

Objectives Cognitive Metacognitive Ask (Elicit) Demonstrate Use Summarize Respond Metacognitive Anticipate Reflect Plan Monitor Self-question Perspective-take MQ Cognitive objectives or benchmarks refer to knowledge, application of knowledge, or to skills (even many steps in problem-solving). It is operating on information or even feelings. Actions or behaviors typically related to a cognitive activity that depend on knowledge base include . . . . . Metacognitive actions on the other hand relate more to how one thinks about their own or others’ thinking and feeling. consider the video of the student

Objectives By the end of this curriculum module, we expect our 3rd year students to be able to: Demonstrate the use of open to closed-ended questions when eliciting the patient’s concern (cognition) Anticipate the patient’s emotional response to miscommunication of ‘bad news’ (metacognition); and Establish a plan to resolve miscommunication (metacognition) MQ Objectives are the translation of the competency into behavioral terms

Benchmarks By the end of the 2nd year the student will be able to demonstrate the use of open to closed-ended questions when eliciting the patient’s concern (cognition) By the end of the 3rd year the student will be able to establish a plan to resolve miscommunication (metacognition) MQ Hide slide -- not needed

Methods Learning Faculty Development Teaching MQ

Learning Methods (Mnemonics) Listen (actively & without interruption) Empathize & Elicit (patient perspective) Assess priorities, values & supports Recommend (providing sufficient information that is understandable) Negotiate (a plan of action with patient) MQ What are some strategies you’ve used to enhance learning about communication? Mnemonics -- LEARN, PEARLS

Teaching Methods Role-Play Demonstration Modeling Observation/Feedback MQ

Demonstration as a Method: Technique of Modeling Faculty Development P review what will take place before the experience O utline what you are doing, experiencing and thinking during the activity S hare your findings with the learner during the activity (if appropriate) E valuate learning after the experience MQ Have to consider the best methods for helping faculty become better teachers as well. Mnemonics are helpful faculty development strategies as well.

The Angry Patient: Hepatitis WF

Video of a Difficult Interview: The Angry Patient Demonstration as a Method: Video Video of a Difficult Interview: The Angry Patient

Evaluation Techniques Type Setting Participants Direct Observation Hospital, Health Center, Office Attendings (FP & BS) Videotape Review Health Center Attendings, Self, SPs Patient Experience Patients 360 Nurses, administrators, peers, attendings Reflection Balint, Precepting Attendings, Peers, Self

Evaluation How can we measure that our learners are competent? Are we naming and documenting feedback on communication skills? Do our faculty know how? What resources do we have to perform evaluation? WF

Case Study WF and MQ Triads?