Strengthening student communication through pediatric simulated patient encounters.
Ontology highlight
ABSTRACT:
SUBMITTER: Whitt R
PROVIDER: S-EPMC4309937 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:Objective: The purpose of this study was to identify whether or not elderspeak was evident in simulated provider-patient encounters in a chiropractic education program. This study was designed to answer the following three research questions (RQs):RQ 1: Is elderspeak present in simulated patient encounters in a chiropractic education program?RQ 2: If elderspeak is present, which categorization of elderspeak is most frequently used during simulated patient encounters?RQ 3: If elderspeak is present, is gender an influencing variable? Method: The presence of elderspeak in simulated chiropractic encounters was studied using a cross-sectional mixed methods observational research design. Results: A total of 331 occurrences of elderspeak were identified in 60 digitized recordings. The most common form of elderspeak was collective pronoun usage. Conclusion: Results indicated that the chiropractic industry is susceptible to elderspeak. Understanding elderspeak is important to prevent future ageist behaviors from affecting older adult patients and to improve their health outcomes.
| S-EPMC7243371 | biostudies-literature
Project description:BackgroundThis study investigates patient-centered mobile health (mHealth) technology in terms of the secondary user experience (UX). Specifically, it examines how personal mobile technology, under patient control, can be used to improve patient-provider communication about the patient's health care during their first visit to a provider. Common ground, a theory about language use, is used as the theoretical basis to examine interactions. A novel concept of this study is that it is one of the first empirical studies to explore the relative meaningfulness of a secondary UX for specific health care tasks.ObjectiveThe objective of this study was to investigate the extent that patient-operated mHealth technology can be designed to improve the communication between the patient and provider during an initial face-to-face encounter.MethodsThe experimental study was conducted in 2 large Midwestern cities from February 2016 to May 2016. A custom-designed smartphone app prototype was used as the study treatment. The experimental design was posttest-only control group and included video-recorded simulated face-to-face clinical encounters in which an actor role-played a patient. Experienced clinicians consisting of doctors (n=4) and nurses (n=8) were the study participants. A thematic analysis of qualitative data was performed. Quantitative data collected from time on task measurements were analyzed using descriptive statistics.ResultsThree themes that represent how grounding manifested during the encounter, what it meant for communication during the encounter, and how it influenced the provider's perception of the patient emerged from the qualitative analysis. The descriptive statistics were important for inferring evidence of efficiency and effectiveness of communication for providers. Overall, encounter and task times averaged slightly faster in almost every instance for the treatment group than that in the control group. Common ground clearly was better in the treatment group, indicating that the idea of designing for the secondary UX to improve provider outcomes has merit.ConclusionsCombining the notions of common ground, human-computer interaction design, and smartphone technology resulted in a prototype that improved the efficiency and effectiveness of face-to-face collaboration for secondary users. The experimental study is one of the first studies to demonstrate that an investment in the secondary UX for high payoff tasks has value but that not all secondary UXs are meaningful for design. This observation is useful for prioritizing how resources should be applied when considering the secondary UX.
| S-EPMC6238098 | biostudies-literature
Project description:This study had three aims: 1) quantify the difference in stress levels between low and high stress roles during simulated critical communication encounters using objective physiologic data (heart rate variability [HRV]) and subjective measures (State-Trait Anxiety Inventory [STAI]), 2) define the relationship between subjective and objective measures of stress, and 3) define the impact of trainee preparedness and reported self-efficacy on stress levels.DesignMixed methods simulation-based study.SettingSingle center.PatientsPediatric critical care fellows and faculty (n = 12).InterventionsSubjects participated in six simulated scenarios in both high stress "hot seat" and low stress "observer" roles.Measurements and main resultsSubjective stress was measured using the STAI at baseline and after each scenario. Objective stress was measured continuously using a wearable biometric device measuring HRV. Previous residency communication training and self-confidence surrounding various communication topics were collected via questionnaire. Significant changes in subjective (STAI) and objective stress (HRV) measurements in the low- versus high-stress roles were observed. STAI scores increased 8 points during low stress and 12 points during high stress role (p = 0.021) compared with baseline. Two specific HRV markers, root mean square of successive differences between normal heartbeats, a marker of parasympathetic tone, and the low frequency/high frequency (LF/HF) ratio, a marker of sympathetic activation, were significantly correlated with STAI levels (-0.032, p = 0.001; 1.030, p = 0.002, respectively). Participants who reported increased confidence in discussing code status had a significant decrease in stress response (measured via LF/HF ratio) during both the observer (p = 0.033) and hot seat roles (p = <0.001).ConclusionsCommunicating life-altering news in a simulated environment is a stressful experience. This stress results in physiologic changes that can be measured continuously using HRV. HRV measurement may serve as a novel method in evaluating the effectiveness of communication training programs and measuring future stress-reduction interventions.
| S-EPMC9249269 | biostudies-literature
Project description:Background: The mandatory communication skills course for fourth-year medical students at the University of Bern Medical School aims to prepare students for challenging communication situations. Students role-play four different scenarios with simulated patients (SPs) and receive feedback from the patient's perspective. The scenarios are video-recorded and uploaded onto the University's virtual learning environment. Students can watch and annotate their own videos and give others access to view them. Project description: Although the course is well liked by students, we identified three areas for improvement: lack of faculty feedback; little active use of the video-recordings;lack of opportunity for students to discuss their experiences with each other. We aimed to address these shortcomings by introducing an additional learning task: students are asked to annotate a section of the video in which they had performed well, and one in which they thought they could have done better, in both their own and a colleague's videos. These video clips and annotations served as the basis of a subsequent two-hour small-group seminar with a physician tutor. The course was evaluated by a mandatory online questionnaire. Results: All 247 students completed the questionnaire. The annotation tool and task were deemed to be comprehensible. Students believed they had learnt more from annotating a peers' video than from their own and most thought being assessed by peers was acceptable. The physician tutors' comments were largely deemed as helpful. The mean mark for the course given by students was 4.6 (median 5) (1=very poor, 6=very good). Conclusion: A communication skills course expanded by video-annotations and group discussions with a physician tutor was shown to be feasible and was well received by students and faculty.
| S-EPMC7994885 | biostudies-literature
Project description:IntroductionManagement reasoning is distinct from diagnostic reasoning and remains incompletely understood. The authors sought to empirically investigate the concept of management scripts.MethodsIn November 2020, 4 investigators each reviewed 10 video clips of simulated outpatient physician-patient encounters, and used a coding form to document observations about management reasoning. The team used constant comparative analysis to integrate empirically-grounded insights with theories related to cognitive scripts and Type 1/Type 2 thinking.ResultsManagement scripts are precompiled conceptual knowledge structures that represent and connect management options and clinician tasks in a temporal or logical sequence. Management scripts appear to differ substantially from illness scripts. Management scripts varied in quality (in content, sequence, flexibility, and fluency) and generality. The authors empirically identified six key features (components) of management scripts: the problem (diagnosis); management options; preferences, values, and constraints; education needs; interactions; and encounter flow. The authors propose a heuristic framework describing script activation, selection, instantiation with case-specific details, and application to guide development of the management plan. They further propose that management reasoning reflects iterative, back-and-forth involvement of both Type 1 (non-analytic, effortless) and Type 2 (analytic, effortful) thinking. Type 1 thinking likely influences initial script activation, selection, and initial instantiation. Type 2 increasingly influences subsequent script revisions, as activation, selection, and instantiation become more deliberate (effortful) and more hypothetical (involving mental simulation).DiscussionManagement scripts constitute a key feature of management reasoning, and could represent a new target for training in clinical reasoning (distinct from illness scripts).
| S-EPMC9391545 | biostudies-literature
Project description:Although previous studies suggest an association between provider burnout and suboptimal self-reported communication, no studies relate physician burnout to observed patient-physician communication behaviors.To investigate the relationship between physician burnout and observed patient-physician communication outcomes in patient-physician encounters.Longitudinal study of enrollment data from a trial of interventions to improve patient adherence to hypertension treatment.Fifteen urban community-based clinics in Baltimore, MD.Forty physicians and 235 of their adult hypertensive patients, with oversampling of ethnic minorities and poor persons. Fifty-three percent of physicians were women, and the average practice experience was 11.2 years. Among the 235 patients, 66% were women, 60% were African-American, and 90% were insured.Audiotape analysis of communication during outpatient encounters (one per patient) using the Roter Interaction Analysis System and patients' ratings of satisfaction with and trust and confidence in the physician.The median time between the physician burnout assessment and the patient encounter was 15.1 months (range 5.6-30). Multivariate analyses revealed no significant differences in physician communication based on physician burnout. However, compared with patients of low-burnout physicians, patients of high-burnout physicians gave twice as many negative rapport-building statements (incident risk ratio 2.06, 95% CI 1.58-2.86, p < 0.001). Physician burnout was not significantly associated with physician or patient affect, patient-centeredness, verbal dominance, or length of the encounter. Physician burnout was also not significantly associated with patients' ratings of their satisfaction, confidence, or trust.Physician burnout was not associated with physician communication behaviors nor with most measures of patient-centered communication. However, patients engaged in more rapport-building behaviors. These findings suggest a complex relationship between physician burnout and patient-physician communication, which should be investigated and linked to patient outcomes in future research.
| S-EPMC2533387 | biostudies-other
Project description: Not available
| S-EPMC4858371 | biostudies-literature
Project description:IntroductionBreaking bad news and dealing with difficult patient encounters is a skill that medical residents must learn during their curriculum. Many different tools are available to measure communication quality, but their development and validation processes are often missing. In this paper, we present the protocol of a systematic review aiming to identify the validated tools for measuring communication skills or communication effectiveness with parents in a paediatrics setting in general, including for difficult patient encounters.Methods and analysisWe will conduct our systematic review in accordance with the methodology suggested by COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and will report this paper following the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses. We will include the studies in which authors developed and/or validated tools for assessing the quality of communication with families by residents and/or physicians during patient encounters in paediatric settings. Studies assessing communication in telemedicine and studies that use the tool to measure a different outcome than its validation will be excluded. Our search strategy will be developed by a scientific librarian and validated using the Peer Review of Electronic Search Strategy (PRESS) tool. Two reviewers will independently screen the studies for selection, extract data of the ones included and assess their level of risk of bias using the COSMIN Risk of Bias checklist. We will perform a narrative synthesis on the study selection process, the characteristics of studies and study population, the characteristics of tools identified, their process of development and/or validation and their psychometric properties. If sufficient data are available, we will do quantitative analyses for each psychometric property.Ethics and disseminationApproval from an ethics committee is not required, as there is no primary data collection. Our findings will be disseminated through a peer-reviewed publication and at local, national and international conferences.Prospero registration numberCRD42020151642.
| S-EPMC8378350 | biostudies-literature
Project description:BackgroundThe aim of this study was to evaluate exercise physiology students' perceptions of two simulation-based learning modules focused on communication and interpersonal skills during history taking.MethodsA prospective, repeated-measures cohort study was conducted with 15 participants. The study evaluated two simulation-based learning modules in a 1-year Graduate Diploma of Exercise Science program. Surveys were administered at four time points: prior to each module and following each module. Students rated their confidence in communication and history taking, and perception of preparedness for practice, motivation for learning, and benefits of undertaking simulation-based learning. Quantitative data were analyzed descriptively and by using repeated measures tests. Qualitative data underwent thematic analyses.ResultsStudents reported a significant improvement in their confidence in communication (P = 0.043) and in two parameters related to history taking (P = 0.034 and 0.035) following the completion of the two modules. There was 96% agreement that the simulation-based learning better prepared students for practice as an exercise physiologist. Significant changes occurred in all aspects of motivation for learning (P ranging from < 0.001 to 0.036) except for usefulness, where there was a ceiling effect (medians of 7 on a 7-point scale). Qualitative analysis demonstrated benefit to participants around themes of experiential learning, realism, opportunity to develop clinical skills, and debriefing. Students also made suggestions with respect to the activity structure of the simulation-based learning modules.ConclusionsThe results of this study indicated that simulation-based learning employing SPs increased the confidence and preparedness of exercise physiology students for conducting history taking, a requisite exercise physiology skill. Future studies should include behavioral measures of skill attainment and include follow-up evaluation to appraise the application of these skills into clinical practice.
| S-EPMC6923845 | biostudies-literature
Project description:BackgroundWith the increasing adoption of electronic health record (EHR) systems, documentation-related burdens have been increasing for health care providers. Recent estimates indicate that primary care providers spend about one-half of their workdays interacting with the EHR, of which about half is focused on clerical tasks. To reduce documentation burdens associated with the EHR, health care systems and physician practices are increasingly implementing medical scribes to assist providers with real-time documentation. Scribes are typically unlicensed paraprofessionals who assist health care providers by documenting notes electronically under the direction of a licensed practitioner or physician in real time. Despite the promise of scribes, few studies have investigated their effect on clinical encounters, particularly with regard to patient-provider communication.ObjectiveThe purpose of this quasi-experimental pilot study was to understand how scribes affect patient-physician communication in primary care clinical encounters.MethodsWe employed a convergent mixed methods design and included a sample of three physician-scribe pairs and 34 patients. Patients' clinical encounters were randomly assigned to a scribe or nonscribe group. We conducted patient surveys focused on perceptions of patient-provider communication and satisfaction with encounters, video recorded clinical encounters, and conducted physician interviews about their experiences with scribes.ResultsOverall, the survey results revealed that patients across both arms reported very high satisfaction of communication with their physician, their physician's use of the EHR, and their care, with very little variability. Video recording analysis supported patient survey data by demonstrating high measures of communication among physicians in both scribed and nonscribed encounters. Furthermore, video recordings revealed that the presence of scribes had very little effect on the clinical encounter.ConclusionsFrom the patient's perspective, scribes are an acceptable addition to clinical encounters. Although they do not have much impact on patients' perceptions of satisfaction and their impact on the clinical encounter itself was minimal, their potential to reduce documentation-related burden on physicians is valuable. Physicians noted important issues related to scribes, including important considerations for implementing scribe programs, the role of scribes in patient interactions, how physicians work with scribes, characteristics of good scribes, and the role of scribes in physician workflow.
| S-EPMC6657447 | biostudies-literature