Deepening the teaching and learning of clinical communication
The importance of reflection and feedback in health education
DOI:
https://doi.org/10.15448/1980-6108.2021.1.39795Keywords:
medical education, communication skills, medical studentsAbstract
Aims: clinical communication (CC) relates to health professionals’ interaction with patients/families. CC is fundamental for the physicians’ role. This paper aims to contribute to the discussion about reflection and feedback for meaningful teaching and learning of CC.
Methods: the authors provided a short review and conceptual discussion of the history and nature of CC teaching, followed by exploring the role of reflection and feedback in teaching CC.
Results: communicating well can be challenging as it requires medical students and professionals to adapt their communication to each patient/family while obtaining all the needed information, conveying trustworthiness, care, and compassion. The teaching of CC to medical students involves deepening the doctor-patient relationship’s technical, relational, and emotional elements. CC requires teaching that is flexible and tailored to the participants’ needs. Therefore, teaching CC must go beyond asking the appropriate question or applying specific checklist-based behaviours. In teaching CC, it is crucial to give medical students support to discuss personal and institutional barriers and attitudes and explore how to transfer their learning to clinical practice. To that end, reflection should be encouraged to allow students to express difficulties and feelings and enhance their understanding of themselves and others. Within this process, feedback is essential to moving beyond skill-based teaching to reflection-based learning.
Conclusion: the move from skills-based learning requires using reflective processes and feedback to allow students to learn about their communication tendencies and needs to become more flexible and attuned to different patient’s needs in clinical encounters.
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References
Davis MS. Research in medical education. Attitudinal and behavioral aspects of the doctor-patient relationship as expressed and exhibited by medical students and their mentors. Acad Med. 1968;43(3):337-43. https://doi.org/10.1097/00001888-196803000-00002
Röttele N, Schöpf-Lazzarino AC, Becker S, Körner M, Boeker M, Wirtz MA. Agreement of physician and patient ratings of communication in medical encounters: A systematic review and meta-analysis of interrater agreement. Patient Educ Couns. 2020;103(10):1873-82. https://doi.org/10.1016/j.pec.2020.04.002
Kee JWY, Khoo HS, Lim I, Koh MYH. Communication skills in patient-doctor interactions: learning from patient complaints. Heal Prof Educ. 2017;4(2):97-106. https://doi.org/10.1016/j.hpe.2017.03.006
Gilligan C, Brubacher SP, Powell MB. Assessing the training needs of medical students in patient information gathering. BMC Med Educ. 2020;20(1):61. https://doi.org/10.1186/s12909-020-1975-2
King A, Hoppe RB. “Best Practice” for patientcentered communication: a narrative review. J Grad Med Educ. 2013;5(3):385-93. https://doi.org/10.4300/JGME-D-13-00072.1
Balint M, Balint J. The Doctor, his patient and the illness. 2. ed. London: Churchill Livingstone; 2000.
Von Fragstein M, Silverman J, Cushing A, Quilligan S, Salisbury H, Wiskin C. UK consensus statement on the content of communication curricula in undergraduate medical education. Med Educ. 2008;42(11):1100-7. https://doi.org/10.1111/j.1365-2923.2008.03137.x
Salmon P, Young B. Creativity in clinical communication: from communication skills to skilled communication. Med Educ. 2011;45(3):217-26. https://doi.org/10.1111/j.1365-2923.2010.03801.x
Scholl I, Zill JM, Härter M, Dirmaier J. An integrative model of patient-centeredness – a systematic review and concept analysis. PLoS One. 2014;9(9):e107828. https://doi.org/10.1371/journal.pone.0107828
Charon R. At the membranes of care. Acad Med. 2012;87(3):342-7. https://doi.org/10.1097/ACM.0b013e3182446fbb
Donetto S. Medical students and patient-centred clinical practice: The case for more critical work in medical schools. Br J Sociol Educ 2012;33(3):431-49. https://doi.org/10.1080/01425692.2012.662821
Ruiz Moral R, de Leonardo CG, Martínez FC, Monge Martín D, García de Leonardo C, Caballero Martínez F, et al. Medical students’ attitudes toward communication skills learning: comparison between two groups with and without training [Response to letter]. Adv Med Educ Pract. 2019;10:411-2. https://doi.org/10.2147/amep.s212021
Brannick MT, Erol-Korkmaz HT, Prewett M. A systematic review of the reliability of objective structured clinical examination scores. Med Educ. 2011;45(12):1181- 9. https://doi.org/10.1111/j.1365-2923.2011.04075.x
Charon R. Narrative Medicine. JAMA. 2001;286(15):1897. https://doi.org/10.1001/jama.286.15.1897
Schön DA, Schon D. The Reflective Practitioner: How Professionals Think in Action. New York, NY: Basic Books; 1983.
Karnieli-Miller O. Reflective practice in the teaching of communication skills. Patient Educ Couns. 2020;103(10):2166–72. https://doi.org/10.1016/j.pec.2020.06.021
Kolb, DA. Experiential learning: experience as a source of learning and development. New Jersey: Prentice-Hall; 1984.
Manca A, Gormley GJ, Johnston JL, Hart ND. Honoring medicine’s social contract. Acad Med. 2020;95(6):958- 67. https://doi.org/10.1097/ACM.0000000000003059
Gomes AP, Rego S. Paulo Freire: contribuindo para pensar mudanças de estratégias no ensino de medicina. Rev Bras Educ Med. 2014; 38(3):299-307.
Ellaway RH. Postmodernism and medical education. Acad Med. 2020; 95(6):856-9. https://doi.org/10.1097/ACM.0000000000003136
Meitar D, Karnieli-Miller O, Eidelman S. The impact of senior medical students’ personal difficulties on their communication patterns in breaking bad news. Acad Med 2009; 84(11):1582-94. https://doi.org/10.1097/ACM.0b013e3181bb2b94
Grossman E, Cardoso MHCA. A narrativa como ferramenta na educação médica. Rev Hosp Univ Pedro Ernesto. 2014; 13(4):32-8. https://doi.org/10.12957/rhupe.2014.13945
Greenhalgh T, Hurwitz B. Narrative based medicine: Why study narrative? BMJ. 1999;318(7175):48-50. https://doi.org/10.1136/bmj.318.7175.48
Sternlieb Jeffrey L. A Guide to introducing and integrating reflective practices in medical education. Int J Psychiatry Med. 2015; 49(1):95-105. https://doi.org/10.2190/PM.49.1.g
Chan KDKD, Humphreys L, Mey A, Holland C, Wu C, Rogers GDGDGD. Beyond communication training: The MaRIS model for developing medical students’ human capabilities and personal resilience. Med Teach. 2020;42(2):187-95. https://doi.org/10.1080/0142159X.2019.1670340
de la Croix A, Veen M. The reflective zombie: Problematizing the conceptual framework of reflection in medical education. Perspect Med Educ. 2018; 7(6):394-400. https://doi.org/10.1007/s40037-018-0479-9
Ruiz-Moral R, García de Leonardo C, Cerro Pérez A, Monge Martín D, Caballero Martínez F. How communication skills are being incorporated, taught, and assessed in Spanish Medical Schools. Educ Medica. 2020. Epub 2020 Mar 03 https://doi.org/10.1016/j.edumed.2019.12.003
Ramani S, Könings KD, Ginsburg S, van der Vleuten CP. Feedback redefined: principles and practice. J Gen Intern Med. 2019;34(5):744-9. https://doi.org/10.1007/s11606-019-04874-2
Andolsek K, Padmore J, Hauer K, Edgar L, Holmboe E. Clinical competency committees – a guidebook for programs. Accreditation Council for Graduate Medical Education [Internet] 3. ed. Chicago, Il: Accreditation Council for Graduate Medical Education. [cited 2020 March 15]. Available from: http://www.acgme.org/acgmeweb/Portals/0/ACGMEClinicalCompetencyCommitteeGuidebook.pdf
Rozental L, Meitar D, Karnieli-Miller O. Medical students’ experiences and needs from written reflective journal feedback. Med Educ. 2021;55(4):505-17. https://doi.org/10.1111/medu.14406
Brown J. Transferring clinical communication skills from the classroom to the clinical environment: perceptions of a group of medical students in the United kingdom. Acad Med. 2010; 85(6):1052–9.
Vågan A. Medical students’ perceptions of identity in communication skills training: A qualitative study. Med Educ. 2009;43(3):254–9. https://doi.org/10.1111/j.1365-2923.2008.03278.x
Karnieli-Miller O, Neufeld-Kroszynski G, Karnieli- Miller O, Neufeld-Kroszynski G. Combining machine learning and human reflective process for teaching communication skills. Med Educ. 2020;54(12):1093–5. https://doi.org/10.1111/medu.14391
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