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 Table of Contents  
INVITED EDITORIAL
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 193-195

Interventions for Improving medical students' interpersonal communication in medical consultations; Considering the evidence in the context of the COVID-19 pandemic


College of Health, Medicine and Wellbeing, School of Medicine and Public Health, Medical Education Research, Innovation and Teaching Network, University of Newcastle, Callaghan, New South Wales, Australia

Date of Submission08-Nov-2021
Date of Acceptance08-Nov-2021
Date of Web Publication29-Dec-2021

Correspondence Address:
Dr. Conor Gilligan
School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales
Australia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_261_21

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How to cite this article:
Gilligan C. Interventions for Improving medical students' interpersonal communication in medical consultations; Considering the evidence in the context of the COVID-19 pandemic. Arch Med Health Sci 2021;9:193-5

How to cite this URL:
Gilligan C. Interventions for Improving medical students' interpersonal communication in medical consultations; Considering the evidence in the context of the COVID-19 pandemic. Arch Med Health Sci [serial online] 2021 [cited 2022 Jan 23];9:193-5. Available from: https://www.amhsjournal.org/text.asp?2021/9/2/193/334015



Our recently published Cochrane review[1] scrutinized evidence for communication training programs in medical education. While the importance of effective communication between clinicians and patients is universally accepted,[2],[3] the effectiveness of interventions for improving medical students' interpersonal communication has not been demonstrated unequivocally, and significant variability exists across medical school curricula and methods used.[4],[5],[6] The review sought to determine: the evidence base for communication interventions for medical students; teaching and learning approaches associated with improvements in medical students' interpersonal communications; the most effective approaches to teaching medical communication in the context of pragmatic limitations of medical curricula; and gaps in knowledge about communication interventions for medical students to guide future teaching and research endeavors. The overall goal was to provide guidance to medical educators and accrediting bodies regarding the most effective communication programs in medical curricula and to identify resources needed for the successful implementation of these programs. Indeed, resource limitations often hinder the widespread implementation of preferred (and evidence-based) approaches in the real world of medical education, so the findings have relevance and great potential value for educators.

The findings of our meta-analysis support educational efforts generally, with evidence, albeit of low certainty, that most interventions can improve medical students' overall communication skills as assessed by experts and may also improve empathy and information gathering scores on observed interactions. The strongest finding arising from the meta-analysis indicates that interventions using tailored or intensive feedback are likely to improve overall communication skills more than those using general or no feedback.

Somewhat surprisingly, the review found that e-learning approaches are likely to have little or no difference in impact on empathy or rapport scores compared with face-to-face interventions. The certainty of evidence was too low to detect any differences between simulated patient and peer role-play.

In keeping with our findings, a 2019 review compared digital education for communication skills with usual curricula or no training in 12 studies with 2101 medical students. The authors of this review also concluded that digital education is as effective as traditional learning in medical students' communication skills training, and that blended learning appears to be at least as effective as, and potentially more effective than traditional learning for communication skills and knowledge.[7]

Since publication of the 91 papers (relating to 76 studies) included in our Cochrane review, the tertiary education sector has been rocked by the global COVID-19 pandemic. Pressure on the clinical workforce, reduced access for international students, and restrictions on face-to-face learning have led to significant financial and workforce pressures in medical education.

Our findings may offer some reassurance for medical educators who, as a result of the pandemic, have been forced to shift large components of medical curricula, including communication skills, to an online mode. Anecdotally, and from the authors' own experience, educators viewed teaching interpersonal skills online as a necessary compromise and inferior alternative to their preferred face-to-face teaching methods but were often surprised by their experiences of online teaching. Students' engagement, sense of safety to participate in role-play, and ability to engage in authentic interactions with simulated patients or peers in role-playing often exceeded expectations. While there are likely to be downsides to communication training that occurs via a screen, with, for example, limitations in the ability to use, view, and respond to nonverbal communication, technology also offers some benefits.

Junod Perron et al. surveyed students and tutors involved in synchronous online teaching of clinical communication skills at a Swiss medical school and found that while both groups preferred the face-to-face format, they valued the online learning opportunities, and around half would consider using it postpandemic.[8] Similarly, faculty involved in teaching communication skills online in a Portuguese Dental Medical Education setting reported that students adapted well to the online format and were able to achieve learning objectives, despite warnings from faculty that the experience “wouldn't be the same.”[9]

A study of 2721 medical students across 39 UK medical schools supports a substantial increase in the use of online learning platforms during the pandemic but highlights that students would generally still prefer face-to-face learning, perceive face-to-face to be more effective, and are relatively ambiguous in terms of feeling that they are being well prepared for their profession.[10] The majority of students felt that online teaching had not successfully replaced clinical teaching received through direct patient contact and that they were unable to learn practical clinical skills online.[10] Others have described the importance of educators taking on the role of curators of online activities and facilitators of learning and connection rather than providers of information.[11] In this way, online education can offer new opportunities to engage students in their learning, but many practical considerations should be made to ensure that these opportunities are realized.[12]

The pandemic also led to a rapid increase in the uptake of telehealth, which was used widely but inconsistently, and in most rural health settings before COVID-19[13] Suddenly, telehealth became an important avenue for the provision of healthcare in mainstream settings, uncovering a gap in health professional training for communication with patients using this platform.[14],[15] Telehealth has offered an opportunity for students to continue clinical learning and is making its way into medical curricula as a recognized core skill. Wijesooriya et al. attest that “the experience of teaching and learning via telehealth has placed renewed emphasis on the importance of a discerning medical history…,”[16]which is often a key focus of communication skills training efforts.

The forced shift to online teaching and learning has had some unexpected positive consequences, with some reports of educators' and students' willingness to integrate online expertise garnered through the pandemic into practice.[17] A report published by the Medical Deans of Australia and New Zealand recognized the need to “balance the benefits of online learning with the need for human connection and immersive, onsite learning.”[18] This notion is supported to some extent by the results of our meta-analysis, but what the statistics are unable to capture is the richness of human connection likely to be nurtured more in face-to-face learning than in remote experiences.

Taken together, the results of our Cochrane review and the subsequent pandemic-related experiences lend weight to the notion that “when taught, students will learn,” regardless of the format or approach taken. Combining the lessons of the review with those of the pandemic, however, we are in a position to offer well-informed guidance to educators and accreditors as per our goal. Communication skills can be taught and learned online, but are likely best taught through blended learning or a combination of modes of delivery, and should prioritize the provision of tailored feedback to students. In the face of stretched resources, peer role-play may be a viable alternative to a reliance on costly simulated patients; however, again, a combination could be more likely to achieve the ideal outcomes in terms of both student performance and satisfaction.

Overall, we should perhaps not view online learning of communication skills as inferior to the in-person alternative but should be working toward ways in which educational approaches can maximize learning in the online environment and use a balance between online and in-person learning to address relevant and important learning objectives such as demonstrating skills in communicating with patients through telehealth.



 
  References Top

1.
Gilligan C, Powell M, Lynagh MC, Ward BM, Lonsdale C, Harvey P, et al. Interventions for improving medical students' interpersonal communication in medical consultations. Cochrane Database Syst Rev 2021;2:CD012418.  Back to cited text no. 1
    
2.
Simpson M, Buckman R, Stewart M, Maguire P, Lipkin M, Novack D, et al. Doctor-patient communication: The Toronto consensus statement. BMJ 1991;303:1385-7.  Back to cited text no. 2
    
3.
Richardson WC, Berwick DM, Bisgard JC, Bristow L, Buck CR, Cassel CK, et al. Crossing the Quality Chasm: A New Health System for the 21st Century. 1st edition. Vol. 1. Washington DC: National Academies Press, 2001.  Back to cited text no. 3
    
4.
Hargie O, Boohan M, McCoy M, Murphy P. Current trends in Communication Skills Training in UK schools of medicine. Med Teach 2010;32:385-91.  Back to cited text no. 4
    
5.
Hoffman M, Ferri J, Sison C, Roter D, Schapira L, Baile W. Teaching communication skills: An AACE survey of oncology training programs. J Cancer Educ 2004;19:220-4.  Back to cited text no. 5
    
6.
Lanken PN, Novack DH, Daetwyler C, Gallop R, Landis JR, Lapin J, et al. Efficacy of an internet-based learning module and small-group debriefing on trainees' attitudes and communication skills toward patients with substance use disorders: results of a cluster randomized controlled trial. Acad Med 2015;90:345-54.  Back to cited text no. 6
    
7.
Kyaw BM, Posadzki P, Paddock S, Car J, Campbell J, Tudor Car L. Effectiveness of digital education on communication skills among medical students: Systematic review and meta-analysis by the digital health education collaboration. J Med Internet Res 2019;21:e12967.  Back to cited text no. 7
    
8.
Junod Perron N, Dominicé Dao M, Rieder A, Sommer J, Audétat MC. Online synchronous clinical communication training during the COVID-19 pandemic. Adv Med Educ Pract 2020;11:1029-36.  Back to cited text no. 8
    
9.
Salgado H, Castro-Vale I. Clinical communication skills training in dental medical education: The COVID-19 pandemic challenge. Healthcare (Basel) 2020;8:E429.  Back to cited text no. 9
    
10.
Dost S, Hossain A, Shehab M, Abdelwahed A, Al-Nusair L. Perceptions of medical students towards online teaching during the COVID-19 pandemic: A national cross-sectional survey of 2721 UK medical students. BMJ Open 2020;10:e042378.  Back to cited text no. 10
    
11.
Phirangee K, Epp CD, Hewitt J. Exploring the relationships between facilitation methods, students' sense of community, and their online behaviors. Online Learn 2016;20:134-54.  Back to cited text no. 11
    
12.
Seymour-Walsh AE, Bell A, Weber A, Smith T. Adapting to a new reality: COVID-19 coronavirus and online education in the health professions. Rural Remote Health 2020;20:6000.  Back to cited text no. 12
    
13.
Cermack M. Monitoring and telemedicine support in remote environments and in human space flight. Br J Anaesth 2006;97:107-14.  Back to cited text no. 13
    
14.
Reay RE, Looi JC, Keightley P. Telehealth mental health services during COVID-19: Summary of evidence and clinical practice. Australas Psychiatry 2020;28:514-6.  Back to cited text no. 14
    
15.
White SJ, Barello S, Cao di San Marco E, Colombo C, Eeckman E, Gilligan C, et al. Critical observations on and suggested ways forward for healthcare communication during COVID-19: pEACH position paper. Patient Educ Couns 2021;104:217-22.  Back to cited text no. 15
    
16.
Wijesooriya NR, Mishra V, Brand PL, Rubin BK. COVID-19 and telehealth, education, and research adaptations. Paediatr Respir Rev 2020;35:38-42.  Back to cited text no. 16
    
17.
Rajab MH, Gazal AM, Alkattan K. Challenges to online medical education during the COVID-19 pandemic. Cureus 2020;12:e8966.  Back to cited text no. 17
    
18.
MDANZ. Changing for Good: What We Learned in 2020. The impact of COVID-19 on Medical Schools in Australia and New Zealand. Medical Deans Australia and New Zealand; 2021. Available from: https://medicaldeans.org.au/. [Last accessed on 2021 Dec 14].  Back to cited text no. 18
    




 

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