Using self and peer video annotations of simulated patient encounters in communication training to facilitate the reflection of communication skills: an implementation study.
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SUBMITTER: Pless A
PROVIDER: S-EPMC7994885 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:As medical students enter the role of physician, clinical outcomes not only rely on their mastery of clinical knowledge, but also on the effectiveness in which they can communicate with patients and family members. While students typically have numerous opportunities to practice clinical communication with adult patients, such practice in pediatric settings is limited. This study examines if simulated patient (SP) encounters strengthen third-year medical students' communication skills during the pediatrics clerkship. During 2011-2013, three SP encounters (comprising 3 pediatric scenarios) were incorporated into a pediatrics clerkship at one United States medical school to give students a safe venue to practice advanced communication with observation and direct feedback. Third-year medical students engaged in the scenarios and received both written and oral feedback from an evaluator observing the encounter. With IRB approval, students' self-perceived confidence and abilities at performing the advanced communication skills were measured using an eightitem, Likert scale questionnaire administered pre and post the SP encounter. Pre- and post-questionnaires (n=215; response rate, 96%) analyzed using a Wilcoxon-matched pairs signed-rank test demonstrated statistically significant increases in students' perception of their confidence and abilities regarding their performance (P<0.05; Bonferroni correction, P<0.006). There was an increases in student confidence and self-perceived ability in: first, communicating with children and family members of young patients; second, managing confrontational situations involving parents; third, performing a thorough psychosocial history with an adolescent; and fourth, using Evidence Based Medicine to motivate parents.
| S-EPMC4309937 | 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:IntroductionVerbal communication is a vital skill for pharmacists and essential for improving patient care. The aim of this study was to explore students' perception of the impact of self-reflection and self- and peer-assessment on simulated patient counselling sessions.MethodsFocus groups explored student perceptions of how this course and way of learning has impacted their performance at counselling patients. Data were analysed using iterative inductive thematic analysis procedures and mapped to the self-determination theory.ResultsNine focus groups with 47 pharmacy students. We identified three main themes and ten associated subthemes. These were learning style (sub-themes gradual introduction to assessment, learning through self-reflection videos, authentic assessment, individual learning compared to group learning, and learning through observation of best practice), feedback (sub-themes inconsistent feedback, summative feedback, perception of self and relationship with peers informing peer assessment) and benefits in real life practice. These themes mapped well to self-determination theory and highlighted that additional focus may be required for benefits in real-life practice.ConclusionStudents' perceptions of self-reflection and self- and peer-assessment centred on learning style, feedback, and benefits in real-life practice. Additional focus on benefits of this unit of study in real-life practice and work integrated learning on placements may further strengthen the impact of these learning activities.
| S-EPMC9844287 | 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:BackgroundCommunication and interpersonal skills are important for effective patient care but are difficult to measure. Unannounced standardized patient encounters (USPEs) have the benefit of providing a standardized situation and provide a representation of usual care rather than best behavior, while also allowing for video recording without violating patient privacy. We conducted a feasibility pilot study to examine the use of videotaped USPEs in resident education of interpersonal and communication skills and specifically empathy.MethodsThis was a pilot study conducted at an urban community teaching hospital. About 16 first-year emergency medicine engaged in four videotaped USPEs during their normal clinical shifts during 1 academic year. All visible recording equipment was concealed from the residents. The standardized patients completed two assessment forms after each encounter to measure empathy.ResultsAll 16 residents engaged in four videotaped USPEs for a total of 64 encounters.ConclusionsWe were able to successfully demonstrate the feasibility of using USPEs for assessment of resident interpersonal and communication skills.
| S-EPMC7592816 | biostudies-literature
Project description:IntroductionIn simulation sessions using standardized patients (SPs), it is the instructors, rather than the learners, who traditionally identify learning goals. We describe co-constructive patient simulation (CCPS), an experiential method in which learners address self-identified goals.MethodsIn CCPS, a designated learner creates a case script based on a challenging clinical encounter. The script is then shared with an actor who is experienced working as an SP in medical settings. An instructor with experience in the model is involved in creating, editing, and practicing role play of the case. After co-creation of the case, learners with no prior knowledge of the case (peers or a supervisor) interview the SP. The clinical encounter is followed by a group debriefing session.ResultsWe conducted 6 CCPS sessions with senior trainees in child and adolescent psychiatry. Topics that are difficult to openly talk about may be especially appropriate for the CCPS model-without overt guidance or solicitation, the scripts developed by learners for this series involved: medical errors and error disclosure; racial tensions, including overt racism; interprofessional conflict; transphobia; patient-on-provider violence; sexual health; and the sharing of vulnerability and personal imperfections in the clinical setting.ConclusionsCo-constructive patient simulation provides an alternative multistage and multimodal approach to traditional SP simulation sessions that can adapt iteratively and in real time to new clinical vicissitudes and challenges This learner-centered model holds promise to enrich simulation-based education by fostering autonomous, meaningful, and relevant experiences that are in alignment with trainees' self-identified learning goals.
| S-EPMC8169712 | biostudies-literature
Project description:IntroductionFacilitated communication practice with simulated patients (SPs) is a highly effective form of communication training. Unfortunately, little guidance exists on writing SP cases.MethodsWe created a curriculum composed of a case-development workbook and case-writing session with input from national communication educators. In November 2017, we implemented the curriculum in a Teaching Communication Skills course for medical educators. Educators divided into four groups to write cases. Primary outcome was the number of criteria that cases fulfilled. Secondary outcomes were SP evaluation and educator-reported confidence and satisfaction.ResultsSeventeen medical educators (including 15 fellows) completed the curriculum. Four new cases were analyzed against 24 criteria and compared to eight cases written by educators following a previous curriculum. An SP evaluated ease of portrayal for all 12 cases on a 5-point Likert scale (1 = poor, 5 = excellent). Educators completed precurriculum and postcurriculum surveys. Compared to the previous curriculum, cases based on the new curriculum incorporated 26% more case criteria (70% or 16.8 criteria/case vs. 96% or 23.0 criteria/case, p < .01). Ease-of-portrayal rating improved but did not differ statistically (mean: 2.8 vs. 4.5, p = .11). A moderate correlation was found between number of included case criteria and Likert-scale rating (r s = .61, p = .03). Pre- and postcurriculum, educators reported significant increases in confidence (mean: 1.9 vs. 4.0, p < .01) and high curricular satisfaction (mean: 4.8).DiscussionA case-development workbook and case-writing session increased the quality of newly developed SP cases as assessed by prespecified case criteria.
| S-EPMC7819616 | biostudies-literature
Project description:Doctoral students in science disciplines spend countless hours learning how to conduct cutting-edge research but very little time learning to communicate the nature and significance of their science to people outside their field. To narrow this disparity, we created an unusual course titled Communicating Science for doctoral science trainees at Rutgers University. Our goal was to help students develop an advanced ability to communicate their research clearly and accurately and to emphasize its value and significance to diverse audiences. Course design included classroom instruction supplemented with improvisation, video recordings, and ample opportunity for students to practice and receive immediate, constructive feedback in a supportive environment. A multidisciplinary faculty with expertise in science, education, communication, and theater arts taught this course. PhD students came from diverse scientific disciplines, ranging from biology and chemistry to civil engineering. Students also completed a capstone project in which they worked with a professional in the academic or private sector to explore a possible career aspiration. Assessment was in the form of feedback on students' oral and poster presentations, and written abstracts about their research. Student evaluations and comments about course format and content were mostly positive and also provided input for ways to improve the course. We discovered that the diversity of scientific backgrounds among our students enhanced their ability to learn how to communicate their science to others outside their disciplines. We are leveraging the success of our initial course offering to reach other student and faculty groups at Rutgers.
| S-EPMC5969400 | biostudies-literature
Project description:IntroductionTraining Basic Life Support saves lives. However, current BLS training approaches are time-consuming and costly. Alternative cost-efficient and effective training methods are highly needed. The present study evaluated whether a video-feedback supported peer-guided Basic Life Support training approach achieves similar practical performance as a standard instructor-guided training in laypersons.MethodsIn a randomized controlled non-inferiority trial, 288 first-year medical students were randomized to two study arms with different Basic Life Support training methods: 1) Standard Instructor Feedback (SIF) or 2) a Peer Video Feedback (PVF). Outcome parameters were objective data for Basic Life Support performance (compression depth and rate) from a resuscitation manikin with recording software as well as overall Basic Life Support performance and subjective confidence. Non-inferiority margins (Δ) for these outcome parameters and sample size calculation were based on previous studies with Standard Instructor Feedback. Two-sided 95% confidence intervals were employed to determine significance of non-inferiority.ResultsResults confirmed non-inferiority of Peer Video Feedback to Standard Instructor Feedback for compression depth (proportion difference PVF-SIF = 2.9%; 95% CI: -8.2% to 14.1%; Δ = -19%), overall Basic Life Support performance (proportion difference PVF-SIF = 6.7%; 95% CI: 0.0% to 14.3%; Δ = -27%) and subjective confidence for CPR performance (proportion difference PVF-SIF = -0.01; 95% CI: -0.18-0.17; Δ = -0.5) and emergency situations (proportion difference PVF-SIF = -0.02; 95% CI: -0.21-0.18; Δ = -0.5). Results for compression rate were inconclusive.DiscussionPeer Video Feedback achieves comparable results as standard instructor-based training methods. It is an easy-to-apply and cost-efficient alternative to standard Basic Life Support training methods. To improve performance with respect to compression rate, additional implementation of a metronome is recommended.
| S-EPMC8297748 | biostudies-literature
Project description:BACKGROUND:Pre-recorded videotapes have become the standard approach when teaching clinical communication skills (CCS). Furthermore, video-based feedback (VF) has proven to be beneficial in formative assessments. However, VF in CCS with the use of pre-recorded videos from real-life settings is less commonly studied than the use of simulated patients. To explore: 1) perceptions about the potential benefits and challenges in this kind of VF; 2) differences in the CCC scores in first-year medical residents in primary care, before and after a communication program using VF in a curricular formative assessment. METHOD:We conducted a pre/post study with a control group. The intervention consisted of VF sessions regarding CCS, performed in a small group with peers and a facilitator. They reviewed clinical consultations pre-recorded in a primary care setting with real patients. Before and after the intervention, 54 medical residents performed two clinical examinations with simulated patients (SP), answered quantitative scales (Perception of Patient-Centeredness and Jefferson Empathy Scale), and semi-structured qualitative questionnaires. The performances were scored by SP (Perception of Patient-Centeredness and CARE scale) and by two blind raters (SPIKES protocol-based and CCOG-based scale). The quantitative data analysis employed repeated-measures ANOVA. The qualitative analysis used the Braun and Clarke framework for thematic analysis. RESULTS:The quantitative analyses did not reveal any significant differences in the sum scores of the questionnaires, except for the Jefferson Empathy Scale. In the qualitative questionnaires, the main potential benefits that emerged from the thematic analysis of the VF method were self-perception, peer-feedback, patient-centered approach, and incorporation of reflective practices. A challenging aspect that emerged from facilitators was the struggle to relate the VF with theoretical references and the resident's initial stress to record and watch oneself on video. CONCLUSION:VF taken from real-life settings seems to be associated with a significant increase in self-perceived empathy. The study of other quantitative outcomes related to this VF intervention needs larger sample sizes. VF with clinical patients from real healthcare settings appears to be an opportunity for a deeper level of self-assessment, peer-feedback, and reflective practices.
| S-EPMC7041283 | biostudies-literature