ABSTRACT
Poor communication skills can compromise patient care in palliative medicine. As accreditation bodies have only called for mandatory communication skills trainings (CSTs) in recent years, CSTs are new to most hospital departments. This systematic scoping review aims to gather data on existing CSTs to identify key factors in teaching and assessing communication skills in the palliative care setting so that effective evidence- based CSTs applicable to the post-COVID-19 era can be designed. Independent searches across 7 bibliographic databases were carried out. A 'split approach' comprising thematic analysis, directed content analysis and tabulated summaries of included articles was employed. 25,809 abstracts were identified, and 109 articles were included and analysed. Themes revealed include problems with existing CSTs;guiding principles for curriculum design;teaching methods;curriculum content;assessment methods and outcomes measured;integration of curriculum;and resources, facilitators and barriers to effective training. A major flaw in existing CSTs is the lack of curriculum structure, focus and standardisation. The planning and execution of a CST curriculum needs to be stepwise and competency based. Holistic assessment by faculty, simulated patients and peers on the learner's performance plays a key role in consolidating knowledge. The educational institute must clearly define the objectives of the programme, allocate sufficient administrative and financial resources, and ensure the wellbeing of its stakeholders. Beyond medical education, a spiral curriculum with longitudinal assessments will equip learners in palliative care with the necessary skills and confidence to face complex communication scenarios in our healthcare landscape. Good communication skills can improve patient satisfaction, treatment compliance, and reduce physician burnout and the frequency of malpractice claims. This strengthens the overall doctor-patient relationship in palliative care. (Table Presented) .
ABSTRACT
Background: Systematic scoping reviews are a relatively new method of knowledge syntheses that have gained prominence in the field of medical education. Our study evaluates systematic scoping review (SSR) use in Internal Medicine (IM) due to the abundance of prior studies, allowing conclusions to be drawn in parallel to its subspecialty, palliative medicine (PM). PM in particular stands to benefit from our proposed approach, especially with how COVID-19 has forced a change in mentoring structures. It is imperative that the tools used to evaluate mentoring are dynamic and holistic in such turbulent times. Aims: To highlight its features and suitability for the effective study of mentoring, we demonstrate Krishna's Systematic Evidence Based Approach (SEBA) to determine what is known of SSR use in IM. Methods: One team of researchers employed Braun and Clarke's approach to thematic analysis to independently review the articles identified from five bibliographic databases and seven medical education journals on the use of systematic scoping reviews in medical education. A second team of researchers employed Hsieh and Shannon's directed content analysis for concurrent analysis. A third team summarised the included articles. Results: The results of this 'Split Approach' were compared. 3134 abstracts were identified and 62 articles were analysed. Four themes were ascertained from thematic analysis, and one additional category from directed content analysis. These were: characteristics, methodological framework, indications and limitations, use of grey literature, and the structure of systematic scoping reviews. Conclusion: In this paper, we show that the SEBA is more than equipped to fill in the gaps of SSRs in IM education and its subspecialty teachings to allow for its holistic appreciation. In advancing this approach, we also proffer a new tool to assess the quality of grey literature and ensure a balanced perspective in the evaluation of mentoring in PM.
ABSTRACT
Background and aim: The COVID-19 pandemic has had significant ramifications upon clinical medical education. Restrictions on in-person face-to-face meetings and the limited mentoring support from redeployed physicians have compromised mentoring relationships and jeopardised mentoring programs in palliative medicine. The evidenced success of combined novice, peer-, near-peer and electronic-mentoring (CNEP) and interprofessional mentoring (IPM), together with palliative medicine's emphasis on interprofessional teamwork for holistic patient care, suggest that the concurrent application of CNEP and IPM (CNEPIPM) may be effective in addressing the continued geographical and manpower constraints in palliative medicine training amidst the COVID- 19 pandemic. This study thus aims to assess the viability and suitability of a CNEP-IPM mentoring approach in palliative medicine. Methods: With little known about this form of mentoring, a systematic scoping review (SSR) was carried out studying published accounts of CNEP and IPM. The Systematic Evidence Based Approach (SEBA) was adopted to enhance the trustworthiness, transparency and reproducibility of SSRs. Results: A total of 15,121 abstracts were reviewed, 557 full text articles were evaluated, and 92 articles were included. Concurrent content and thematic analysis revealed 4 themes/categories: characteristics of CNEP and IPM, stages of CNEP and IPM, the roles of host organizations and assessment methods and criteria. Conclusions: This SSR evidences the viability of a CNEP-IPM approach and forwards an evidence-based framework for the design, implementation and evaluation of a CNEP-IPM mentoring program in palliative medicine. Further prospective studies and research into the program design, mentoring process, complex CNEP-IPM mentoring relationships, and the validation of robust evaluation tools are still required.