COMSEP Journal Club
October 2021
Editors: Amit Pahwa, Karen Forbes and Jon Gold
Practice answering pages
Improving Interprofessional Communication Skills for Senior Medical Students Pursuing Pediatrics.. Rao A, Heidemann L, Morgan H, Fitzgerald J, Allen B, Schiller J, Kempner S.. Acad Pediatr. 2021 Sep-Oct;21(7):1297-1299. https://dx.doi.org/10.1016/j.acap.2021.04.032
Reviewed by Nicole Meyers and Suzanne Friedman
What was the study question?
Does a simulated paging curriculum enhance interprofessional communication (IPC) skills for senior medical students pursuing pediatric residency?. Does case difficulty impact these skills?
How was the study done?
The simulated paging curriculum was part of an intensive 4-week pediatric residency preparation course at the University of Michigan Medical School. 11 senior medical students participated in the course in 2019 and 20 in 2020. Standardized registered nurses paged students weekly about 4 inpatient scenarios of varying difficulty and then evaluated them on their global communication, closed-loop communication and clinical decision making. Nurses provided immediate feedback to the students following each call. Data were subsequently analyzed to assess change in communication scores over time, as well as the relationship between case difficulty and quality of communication.
What were the results?
Global communication skills trended towards significant improvement from case 1 to case 4 among the 2019 cohort, and improved significantly for the 2020 group. There was no significant improvement in closed-loop communication over time and no significant relationship between communication scores and difficulty of the case.
What are the implications?
This study demonstrates the success, albeit among a small sample size, of a simulated paging curriculum in evaluating and improving IPC skills for future pediatric residents. Simulation is a particularly useful educational tool as it can be implemented in a virtual learning environment. IPC is integral to resident success, but often not formally taught or evaluated. Thus, educational leaders must continue to develop novel and effective ways for medical students to hone these types of skills prior to residency.
Editor’s Note: I still remember my first day of internship. I was in the NICU and a pager was going off incessantly. I couldn’t figure out where the noise was coming from. An attending physician gently tapped me on the shoulder and told me it was MY pager. Hopefully curricula like this one make new interns better prepared than I was. 🙂 (JG)
Who do you trust?
Pinilla S, Kyrou A, Maissen N, et al. Entrustment decisions and the clinical team: A case study of early clinical students. Med Educ. 2021;55(3):365-375. https://dx.doi.org/10.1111/medu.14432
Reviewed by Daniel Herchline
What was the study question?
What factors are perceived as relevant by early clinical students for entrustment decisions in clinical workplaces within a formative assessment context?
How was the study done?
Using a social constructivist approach based on the theories of trust formation and entrustment, the authors performed interviews with medical students and healthcare team members involved in ad hoc entrustment decisions. Through an inductive analysis process, main themes and subthemes were generated.
What were the results?
The authors conducted either paired-depth or individual interviews with 28 medical students and 4 healthcare providers involved in entrustment decisions. Several important themes were identified including: 1) medical students perceived residents as the most relevant supervisors with respect to ad hoc entrustment decisions; 2) students reported personal characteristics such as initiative, rotation preparation, and prior clinical experience as playing an important role in entrustment decisions; 3) integration into the interprofessional care team was seen as an important facilitator of entrustment processes; and 4) clinical context and specific task impact entrustment development.
What are the implications?
The concept of entrustment is an important consideration in the path toward competency-based medical education. Leveraging the interprofessional healthcare team at-large may be beneficial in facilitating entrustment opportunities for medical students. Particular attention should be given to more adeptly training residents how to assess students as they are seen as the “educational gatekeepers” to meaningful ad hoc entrustment opportunities for students. Finally, students should be given guidance on how to seek out entrustment opportunities through an informal network of clinical supervisors.
Editor’s Comments: One of the interesting findings of this study was the involvement of other members of the interprofessional team (nurse, clinical psychologist, social worker) in terms of entrustment decisions. Having a “network” of support involved in entrustment decisions may be valuable in providing more opportunities for students to meet their learning goals. (KFo)
More on communication skills
Kerr AM, Thompson CM. A longitudinal study of third-year medical students’ communication competence, communication anxiety, and attitudes toward patient-centered care. Patient Education and Counseling 2021; S0738-3991(21)00613-3. https://dx.doi.org/10.1016/j.pec.2021.09.004
Reviewed by Harisa Spahic
What was the study question?
How does a medical student’s thoughts on patient-centered care relate to the change in their communication competence and anxiety during their year of core clinical clerkships?
How was the study done?
At one large medical school, researchers sent 282 students a repeated measures survey during orientation to clinical clerkships. They sent the same survey every 3 months for the next year while on clinical clerkships. The survey included questions about personal communication competence, communication anxiety, and patient-centered care attitudes. All questions were adapted from the physician version of the medical communication competence scale, the Booth-Butterfield and Gould’s 20-item state-communication anxiety inventory, the patient-practitioner orientation scale, and the attitudes towards medical communication scale. Within the communication competence, students were asked about their competence for (1) asking questions, (2) ensuring patient understanding, (3) providing medical information, and (4) showing compassion. They analyzed the survey data with hierarchical linear modeling with restricted maximum likelihood estimation on SPSS.
What were the results?
Survey response rates ranged from 34.0% to 62.8%, but there were no statistical differences in demographics at each phase.
- Over the year, students reported their communication competence increased while anxiety related to communication decreased.
- Students identifying as female were more likely to report lower communication competence, specifically related to sharing medical information, and higher anxiety.
- Students with positive attitudes for patient-centered communication/care were more likely to report higher communication competence, specifically in asking questions, ensuring patient understanding, and showing compassion. They were also less likely to report anxiety related to communication.
What are the implications?
This study has confirmed an anecdotal thought that students’ perception of communication skills improve and anxiety lessens as they spend more time in a clinical setting. More importantly, it has highlighted specific areas and time points to address student concerns about communication competence and anxiety. For example, during earlier parts of the year of clinical clerkships, instructors cognizant of students’ self-reports of lower competence can highlight great question asking or strong displays of compassion in feedback sessions. Likewise, instructors can emphasize patient-centered communication and care in their clinical interactions to promote a positive attitude in this realm.
Editor’s Comments: We must be cautious that perception does not equate skill and the authors note that in their discussion around the results on students who identify as female. They cite a study where female students’ scores on OSCE are higher than their male counterparts. While the scales are validated there is some debate around the utility of agree-disagree anchors. (AP)