1. An Effective Method for Teaching Patient-centered Communication Skills to Second-year Medical Students Rachel Bramson, M.D., M.S. Michelle Jeter, Angela Heads, M.A. Robert Wiprud, M.D., Mark English, M.D. Texas A&M University Systems Health Science Center College of Medicine Department of Family & Community Medicine bramson@medicine.tamhsc.edu

2. Importance of Effective Communication Skills Effective patient/physician communication skills can be instrumental in improving: Effective patient/physician communication skills can be instrumental in improving: –treatment adherence, patient satisfaction, health care outcomes 1991 Toronto and Kalamazoo Consensus Statements outline key elements for effective patient/physician communication 1991 Toronto and Kalamazoo Consensus Statements outline key elements for effective patient/physician communication –Rapport –Agenda Setting –Information Management –Active Listening - Exploring the patient’s perspective –Feelings - Empathy, exploration –Reaching Common Ground *Simpson, Buckman, Stewart et al., 1991. Doctor-patient communication: the Toronto consensus statement. *Acad. Med. 2001; 76:390-393, Essential Elements of Communication in Medical Encounters: The Kalamazoo Consensus Statement.

3. Importance of Effective Communication Skills Accreditation Council for Graduate Medical Education has outlined expectations for medical residents including an evaluation of interpersonal and communication skills. Accreditation Council for Graduate Medical Education has outlined expectations for medical residents including an evaluation of interpersonal and communication skills. The United States Medical Licensing Examination includes an assessment of communications competence. The United States Medical Licensing Examination includes an assessment of communications competence. A time of transition: curricular guidelines are emerging (eg. Family Medicine Curriculum Resource Project) A time of transition: curricular guidelines are emerging (eg. Family Medicine Curriculum Resource Project)

4. Methods in Teaching Communication Skills Approaches to training have included: Approaches to training have included: –Lectures, Workshops, Role-plays, Standardized patients, and Videotaped examples of patient/physician encounters What is helpful and what do students prefer? What is helpful and what do students prefer? –In a study of training in medical students, WORKSHOPS along with lectures lead to greater gains than lecture only (Evans et al., 1989) –Rees, Sheard and McPherson (2004) found that medical students preferred EXPERIENTIAL methods (role playing with SPs, interviewing real patients) over class lectures. –The use of BENCHMARKS for effective communication along with videotaped SPs is helpful for training and evaluation (Losh, Mauksch, Arnold, et al., 2005; Boyle, Dwinnell & Platt, 2005).

5. Methods in Teaching Communication Skills Variability among Institutions Variability among Institutions –Methods, curricular time, position, depth of materials –Depends on resources: time, staff, infrastructure, finances, institutional esteem for communication skills Goals of this study: Goals of this study: –To describe an adaptation of Lang’s Common Ground method for teaching patient-centered interviewing. –Discuss student satisfaction with our method.

6. Common Ground Method Teaching and assessing communication skills Teaching and assessing communication skills Patient-centered interviewing Patient-centered interviewing 15 years of development, validated 15 years of development, validated Detailed and time intensive curriculum Detailed and time intensive curriculum Self-Study Modules Self-Study Modules –PowerPoint –Embedded trigger videos SP Role Plays: SP Role Plays: –Detailed scenarios with patient cues for hidden information Forrest Lang, M.D. and Family Medicine Interview Study Group at Eastern Tennessee State University Fam Med 2004, 36(3): 189-98. Communication Assessment Using the Common Ground Instrument: Psychometric Properties

7. Common Ground Core communication skills in Modules –Rapport Building –Information Management –Agenda Setting –Active listening –Addressing Feelings –Reaching Common Ground

8. Methods Participants were 78 second year medical students in the OC Cooper Preceptorship Program, a required longitudinal ambulatory care course meeting one afternoon a week in community physicians’ offices. Participants were 78 second year medical students in the OC Cooper Preceptorship Program, a required longitudinal ambulatory care course meeting one afternoon a week in community physicians’ offices. Common Ground self-study modules Common Ground self-study modules Faculty-led small group workshop Faculty-led small group workshop Three standardized patient interviews in small group Three standardized patient interviews in small group –Two successive student interviews of each SP Immediate verbal feedback from other students, SP, and faculty facilitator Immediate verbal feedback from other students, SP, and faculty facilitator Written feedback after workshop (Common Ground Feedback Form) Written feedback after workshop (Common Ground Feedback Form)

9. Standardized Patient Training SPs recruited and trained by departmental staff SPs recruited and trained by departmental staff Simplified instructions and scenarios Simplified instructions and scenarios 15 minute telephone training 15 minute telephone training 1-2 hours of independent SP preparation 1-2 hours of independent SP preparation One hour training just before workshop One hour training just before workshop

10. Results 74% (n=58) of the M2 students who participated in the workshop responded to a survey about the usefulness and effectiveness of the training they received. 74% (n=58) of the M2 students who participated in the workshop responded to a survey about the usefulness and effectiveness of the training they received.

11. Results-Modules 1=Strongly Disagree 2=Disagree 3=Somewhat Disagree 4=Somewhat Agree 5=Agree 6=Strongly Agree

12. Results-Small Group Leader 1=Strongly Disagree 2=Disagree 3=Somewhat Disagree 4=Somewhat Agree 5=Agree 6=Strongly Agree

13. Results-Small Group Leader Family Medicine – 4, Psychologist – 3, Psychiatrist – 2, 1 each Internal Med., Pediatrics, ER 1=Strongly Disagree 2=Disagree 3=Somewhat Disagree 4=Somewhat Agree 5=Agree 6=Strongly Agree

14. Results-Feedback 84% of students indicated that they believed the live, in-person feedback they received was balanced. 86% of students indicated that they believed the written feedback they received was balanced.

15. Additional Results 93% of students somewhat agreed, agreed or strongly agreed that the SP interview was a worthwhile experience. 93% of students somewhat agreed, agreed or strongly agreed that the SP interview was a worthwhile experience. 94% of students somewhat agreed, agreed or strongly agreed that the SPs were realistic. 94% of students somewhat agreed, agreed or strongly agreed that the SPs were realistic. However, results were split as to whether students would want to do the SP interview for a formal (graded) evaluation. However, results were split as to whether students would want to do the SP interview for a formal (graded) evaluation. –5% strongly disagreed, 19% disagreed, 26% somewhat disagreed –5% strongly agreed, 22.5% agreed, 22.5% somewhat agreed

16. Summary This presents a low budget, less time- and personnel-intensive option for teaching and evaluating medical student communication skills based on an outstanding curriculum. This presents a low budget, less time- and personnel-intensive option for teaching and evaluating medical student communication skills based on an outstanding curriculum. Limitation – not validated. Limitation – not validated. Positively received – students felt that this adaptation of the Common Ground curriculum improved their patient interview skills. Positively received – students felt that this adaptation of the Common Ground curriculum improved their patient interview skills. Qualitatively, improved interview performance compared to previous years. Qualitatively, improved interview performance compared to previous years.