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Bylund, CM, Brown RF, diCiccone, BL et al. Assessing Facilitator Competence in a Comprehensive Communication Skills Training Programme. Medical Education 2009;43:342-349

Reviewed by: Margaret Clark Golden MD Children's Medical Center of Brooklyn SUNY Downstate College of Medicine, Brooklyn, NY.

What was the study question? How competent are the facilitators who lead communication skills small groups involving role plays with Standardized Patients?

How was the study done? The facilitator training workshops had been previously described, including a checklist of target behaviors for facilitators. In this study, 32 facilitators who had just completed the 2-3 hour training workshop were audiotaped during one of the first three communication skills workshops they led. The authors used multiple review and coding for the first 15 audiotapes to set the standards for basic, advanced, and expert competence levels. They then applied this standard to all 32 audiotapes, including the 17 previously un-reviewed ones.

What are the results? The basic competence standard included 8 facilitator behaviors out of the 21 presented in the training workshops; an expert was expected to demonstrate all 21. Eighteen out of 32 facilitators demonstrated basic competence or above; 7 were assessed to be "approaching competence" because they demonstrated 7 of the basic behaviors; 7 were scored below that level.

What are the implications of these findings? Measures of faculty behavior after faculty development interventions are rare; although it is labor-intensive to review audiotapes, it provides very good face validity that the faculty are actually doing what the curriculum leaders hope. It is also encouraging that a 2-3 hour workshop is followed by at least basic competence in over half the faculty. The next question is how to identify and work with the group of facilitators who were not quite ready for prime time. Also, one should be cautious about generalizing these results to other settings: this project was done at Memorial Sloan Kettering to help oncology fellows develop skills in very difficult areas such as breaking bad news and discussing DNR orders. It is therefore probable that many of the faculty were not learning the communication skills for the first time as they trained to be trainers. On the other hand, this model should get wide review now that the Obama administration has secured a Medicare regulation so that physicians will be reimbursed for having these difficult discussions with patients. Many of us, and especially our colleagues in adult medicine, will need to augment our skills.

Editor's Note:
The authors recognize that the small group learning experience is highly dependent upon the facilitators' skills. This fascinating study sought to determine if faculty were adequately prepared to facilitate small groups well. The facilitator checklist chart (part of this article) may be of use to COMSEP members who facilitate small groups with standardized patients for it outlines the key things that facilitators should do to enhance learning.

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