Teaching communication skills: a skills-based approach.

OBJECTIVES: The purpose of this project was to design structured training activities to emphasize key points about patient-physician communication. Effective communication has been shown to enhance patient satisfaction, compliance with treatment, and medical decisions and outcomes. Basic communication skills and behavioral-change interview skills are taught. DESCRIPTION: Communication is a core "building block" of a four-semester, two-year Essentials of Clinical Medicine Course (ECM), which is in its second year of existence. Four interactive lab sessions have been designed, each with structured learning exercises. At the beginning of each session, students work in groups of 30 completing activities based on videos developed by the Bayer Institute for HealthCare Communication.(1) Subsequently, two groups of three students each work with a behavioral or physician facilitator. A formal training and administration manual for all activities has been developed and an evaluation system developed and implemented. Session 1, "Initial Interview Skills," teaches opening, mirroring, and encouraging non-interrogation activities. Session 2, "Empathic Responses," includes activities entitled "Cue Detection," "Accurate Empathy," and "Getting the Story Straight." In Session 3, "Obtaining an HPI," students view an exemplary medical interview, then role-play computerized cases(2) and practice the HPI data collection based on clinical facts taken from the computerized cases. During the Session 4, "Putting It All Together," students interview a standardized patient (SP) for five to seven minutes and receive and give feedback from peers, SPs, and facilitators. Subsequent to the communication lab, students conduct six physician-supervised patient interviews practicing their medical interviewing skills and write-ups. Two subsequent small-group sessions include "group" interviews of SPs in which students assess readiness for behavioral change (e.g., quitting smoking, losing weight) and also learn to conduct more "difficult' health-promotion conversations (e.g., sexual behavior, alcohol use). Evaluation methods include the use of a professional behavior evaluation form completed by communication facilitators and small-group leaders. This assessment form consists of ratings on: reliability and responsibility, relationships with others, self-improvement and adaptability, upholding professional standards, and communication skills dimensions. A formal interview-behavior checklist is used during the training and in the feedback sessions. Finally, SP OSCEs of communication and behavioral-change interviewing occur at the end of the first year of training. DISCUSSION: The communication labs have been well received by students. Students have reported increased understanding of their upcoming roles as physicians, have stated they have gained insights about the importance of connecting with patients in order to give them proper medical treatment, and have requested additional training in communication. Students have reported increased confidence in their interviewing skills prior to interactions with "actual" patients, and clinical preceptors have reported increased levels of preparedness among students who have participated in the structured learning experience. Future plans include adding communication training with problem patients, and about end-of-life and other challenging issues.