Recall your last patient interaction with a healthcare professional. How satisfied were you with the quality of communication and interpersonal skills?
Do you see any room for improvement?
Numerous studies have shown, at least in some places, overall patient dissatisfaction with communication and other interpersonal skills even when physicians believe their abilities to communicate to be excellent. As such, patient interactions sometimes fail in their duty to facilitate accurate diagnostics, provide appropriate counsel and develop caring physician-patient relationships.
Training students and residents in communication, empathy, and other interpersonal skills could improve the overall quality of patient interactions and patient centered care. Our team of market analysts, of which I am part, have interviewed 64 stakeholders (instructors, trainers. professors, education program managers, etc..) over the last year. The recurring opinion is that, even though a lot of progress has been made, it is not sufficient. As students progress throughout medical education, the intensity of medical training and the focus on technical competencies amongst other things shift focus away from interpersonal skills. Medical educational institutions are seeking to address this problem from the core by inculcating these skills in medical education and training. Leading accreditation bodies like the Accreditation Council for Graduate Medical Education and general practitioner specialization programs in Belgium and the Netherlands have established interpersonal skills as foundation competency requirements for practicing physicians. As such, it is imperative that these skills are taught and evaluated in the best way possible.
What is a Positive Patient Interaction?
Three important and related factors are well-known for their importance to positive patient interactions:
Strong Communication
Patient interactions should leave patients feeling heard, understood and empowered with the information to take the right steps towards solving their health concerns. Clear communication is paramount, requiring health care professionals to listen and speak carefully, in areas of patient care spanning from initial patient interviews, patient counseling, explaining treatment options and associated risks, to taking informed consent. Communication skills can break or make patient interactions and overall care and have been proven to build physician and patient confidence, improve compliance, and reduce malpractice.
Empathy
Empathy, the ability to understand and share another’s feelings and/or personal experiences is known to consist of three dimensions: emotional (care, sincerity and unconditional acceptance of the patient/health care user), cognitive (the ability to objectively understand the patient’s perspective from both verbal and non-verbal cues) and behavioral (concrete actions to relieve the patients’ difficulties, and the pain associated with them). Empathy creates trust, reduces doctor patient disputes and improves patient satisfaction.
Shared Decision Making
Patient interactions are evolving into a more collaborative relationship where shared decision making is necessary for patients and physicians to work together. They decide on a selection of tests, care plans and treatments based on the best available clinical evidence, an understanding of risks and expected outcomes and patient preferences and values. This helps patients to be knowledgeable and prepared for dialogue, encourages patients to follow through with treatment and increases satisfaction for both patients and physicians.
Other factors like trust, knowledge, comfort, acceptance, responsiveness, and open-mindedness contribute to quality patient interactions.
How to Train Medical Students in Patient Interactions?
The most effective way to train students and residents in patient interactions is by exposing them to real life situations. In medical institutions, this is commonly done by using real patients, simulated patients (standardized patients trained to act as actual patients to simulate clinical conditions) and volunteer outpatients (actual patients with clinical symptoms who volunteer to participate in earning opportunities). Human patient simulators (dolls, mannequins, robots) can be used in the place of simulated patients. These techniques help medical students to practice physical examinations, give patient instructions, break bad news and carry out other activities with a patient-centered approach. While simulated patients permits students to build confidence and perfect their techniques before exposure to the real world (reducing potential harm to actual patients), volunteer outpatients provide for an authentic experience with real life patient emotions and responses. Read more about recording real patients here.
In addition to putting students in practical situations, it is important to provide them with regular feedback to reinforce good practice, create awareness for improvement and motivate learners to work towards positive outcomes.
How to Provide Feedback During Training
Self-reflection
Over the years, self-reflection has developed into an effective teaching and learning tool for education, decision making and critical thinking. By evaluating their own patient interactions, students and residents can innovate, problem-solve and be autonomous life long learners in a complex healthcare environment. They can create meaning from previous experiences to inform future patient interactions. Despite these advantages, medical students are in need of structural guidance to benefit from self reflection. To facilitate the implementation of self-reflection in medical students, there exist 12 tips to do so:
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- Define reflection in context
- Decide on learning goals for the reflective process
- Choose an instructional method for reflection
- Decide on a structured or unstructured approach to create a prompt
- Make a plan for dealing with ethical and emotional concerns
- Create a mechanism to follow up on the learner’s plan
- Create a conducive learning environment
- Teach learners about reflection prior to the exercise
- Assess reflection
- Make it part of a larger curriculum
- Reflect on the process of teaching reflection
Peer Feedback
With peer feedback, medical students provide their peers (fellow students) with constructive comments regarding their patient interaction skills. In most cases it is a formative process (ungraded) in which students identify what went well and make suggestions for improvement for their peers. The following strategies can be used to facilitate the implementation of peer feedback:
- Define goals and anticipated outcomes
- Create an optimal environment where peer feedback appears none threatening to students. Students should be encouraged to build relationships based on trust so feedback is known to be genuine, valid and valued.
- Ensure peer feedback programs are timely, frequent and consistent to observe improvements over time.
- Train students on how to provide accurate and actionable feedback.
Good to Know
Self-reflection and peer feedback are used to improve patient interactions because skills like communication and empathy that constitute patient interactions are ill-defined (the goals, given state and operations are not fully defined and there are several equally correct solutions to address them). For example, there are multiple ways of dealing with physician empathy and a correct assessment of what actions are right/wrong will depend on the specific context.
Evaluation of Peer Feedback
This takes the peer feedback process a step further where evaluators (professors, trainers etc) assess peer feedback quality. Trained faculty members and other experts can be relied upon to evaluate peer feedback and ensure that it is informative, effective, professional and aligned with the goals and criteria set at the beginning of the exercise.
Evaluation
Formal evaluation methodologies are used to test trainees against predefined learning outcomes. Many professional skills have well defined evaluation methodologies that are tried and tested, traditionally offline and now more and more also online.
Coaching
With coaching, a faculty member or other person is assigned to help the student achieve his/her fullest potential. A coach will evaluate the learner’s performance in past patient interactions, assist the learner to identify strengths, needs, and weaknesses and create a plan for improvement, helping the learner to remain accountable. Coaching is more likely to benefit learners throughout their careers. Usually, coaching relies on fast feedback and trust based relationships where expectations, responsibilities and boundaries are pre-defined. This includes how (will communication take place) what (will an improvement in patient interactions look like), when (the frequency of coaching sessions) and where (should coaching take place / relaxed and comfortable environment).
Instruction/Exercises/Best Practices
Instructors may also share recordings of interactions with a trainee for them to reflect on the doctor patient communication in the recording and provide feedback as a reflective exercise.
How Can Videolab Help Students Develop Skills in Patient Interactions?
It is now clear that enhancing training in patient interactions requires students to be exposed to practical situations (to give them insights into real life occurrence) and to be provided with regular feedback (in the various ways mentioned above) to inform progress.
With the increasing use of technology in medical education, there is now a debate between video platforms and presential methods for training. Nevertheless, research has proven countless times that video leads to an improvement in communication skills through observation and evaluation, and overall student satisfaction with the learning experience. When compared to direct observations in formative OSCEs, researchers saw greater student engagement during video-based sessions and facilitated discussion on communication and professionalism issues.
Videolab is a GDPR-safe multimedia sharing platform that allows you to record and share patient interactions (in simulations and real life settings).
With Videolab, trainees can safely record and upload videos. Trainees can later review these videos for self-evaluation, securely share these with peers for peer feedback and/or with evaluators and coaches coaches for review. Feedback can be received from multiple different sources. Feedback and evaluations can be done in time specific fragments or for the whole video, with structured evaluations according to your defined evaluations methods. All the measures are out in place for patient interactions training to be easy, efficient and secure.
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