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

2. 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

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

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

5. 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

6. 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 …

7. Linking the communication competency to outcomes
Professionalism
Patient Care WF
System

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

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

10. Goals Needs Objectives Methods Evaluation Curriculum Development ModelMQ

11. 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)

12. 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

13. 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’

14. ‘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

15. Learning Paradigm: A Metacognitive FrameworkMQ
Competence vs. capability

16. 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

17. 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

18. 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

19. 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

20. Methods
Learning
Faculty Development
Teaching MQ

21. 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

22. Teaching Methods Role-Play Demonstration Modeling Observation/FeedbackMQ

23. 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.

24. The Angry Patient: HepatitisWF

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

26. 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

27. 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

28. Case Study
WF and MQ Triads?