"I Don't Trust It": Use of a Routine OSCE to Identify Core Communication Skills Required for Counseling a Vaccine-Hesitant Patient.

BACKGROUND: Vaccine hesitancy is challenging for clinicians and of increasing concern since COVID-19 vaccination rollout began. Standardized patients (SPs) provide an ideal method for assessing resident physicians' current skills, providing opportunity to practice and gain immediate feedback, while also informing evaluation of curriculum and training. As such, we designed and implemented an OSCE station where residents were tasked with engaging and educating a vaccine-hesitant patient. AIM: Describe residents' vaccine counseling practices, core communication and interpersonal skills, and effectiveness in meeting the objectives of the case. Explore how effectiveness in overcoming vaccine hesitancy may be associated with communication and interpersonal skills in order to inform educational efforts. SETTING: Annual OSCE at a simulation center. PARTICIPANTS: 106 internal medicine residents (51% PGY1, 49% PGY2). PROGRAM DESCRIPTION: Residents participated in an annual residency-wide, multi-station OSCE, one of which included a Black, middle-aged, vaccine-hesitant male presenting for a routine video visit. Residents had 10 min to complete the encounter, during which they sought to educate, explore concerns, and make a recommendation. After each encounter, faculty gave residents feedback on their counseling skills and reviewed best practices for effective communication on the topic. SPs completed a behaviorally anchored checklist (30 items across 7 clinical skill domains and 2 measures of trust in the vaccine's safety and resident) which will inform future curriculum. PROGRAM EVALUATION: Fifty-five percent (SD: 43%) of the residents performed well on the vaccine-specific education domain. PGY2 residents scored significantly higher on two of the seven domains compared to PGY1s (patient education/counseling-PGY1: 35% (SD: 36%) vs. PGY2: 52% (SD: 41%), p = 0.044 and activation-PGY1: 37% (SD: 45%) vs. PGY2: 59% (SD: 46%), p = 0.016). In regression analyses, education/counseling and vaccine-specific communication skills were strongly, positively associated with trust in the resident and in the vaccine's safety. A review of qualitative data from the SPs' perspective suggested that low performers did not use patient-centered communication skills. DISCUSSION: This needs assessment suggests that many residents needed in-the-moment feedback, additional education, and vaccine-specific communication practice. Our program plans to reinforce evidence-based practices physicians can implement for vaccine hesitancy through ongoing curriculum, practice, and feedback. This type of needs assessment is replicable at other institutions and can be used, as we have, to ultimately shed light on next steps for programmatic improvement.

Smartphone technology for communications between clinicians - A scoping review.

OBJECTIVES: This scoping review aims to review explore, assess, and map the literature to inform clinical practice regarding communication between clinicians. Specific Apps/channels used were identified and assessed with a focus on data security with key concepts and knowledge gaps identified. DATA: The Joanna Briggs Institute framework is followed, with search results reported as per the PRISMA ScR for scoping reviews guidelines. SOURCES: A systematic search strategy encompassing EBSCO and OneSearch databases was conducted - two identical searches, (June and October 2020) limited to English language articles published 2016-2020. A narrative synthesis was used to integrate and report the findings. STUDY SELECTION: Sixty-six publications were selected. Twelve from EBSCO, thirty-five from OneSearch, nineteen were hand searched. Sixteen of the publications were research studies, nine were literature reviews, twenty-six were editorial, one was a newspaper article and fourteen were grey literature. Instant Messaging (40%, n = 23), image sharing (41%, n = 24), and video conferencing (19%, n = 11) were functions most popular with clinicians. WhatsApp, generic instant messaging, Facebook messenger, ZOOM, and Skype are evidenced as channels for communication between clinicians within the EU. A sizeable proportion of the publications (38%; n = 25) failed to identify or adequately address technical security concerns and requirements around privacy and data protection. CONCLUSIONS: Clinicians use smartphones /Apps to communicate clinical information with each other. The security and privacy issues arising from their communication of sensitive data is absent or only superficially acknowledged within the literature. CLINICAL SIGNIFICANCE: Clinician's need clearer guidance on the use of smartphone technology for clinical communications.

The Impact of Explanations on Layperson Trust in Artificial Intelligence-Driven Symptom Checker Apps: Experimental Study.

BACKGROUND: Artificial intelligence (AI)-driven symptom checkers are available to millions of users globally and are advocated as a tool to deliver health care more efficiently. To achieve the promoted benefits of a symptom checker, laypeople must trust and subsequently follow its instructions. In AI, explanations are seen as a tool to communicate the rationale behind black-box decisions to encourage trust and adoption. However, the effectiveness of the types of explanations used in AI-driven symptom checkers has not yet been studied. Explanations can follow many forms, including why-explanations and how-explanations. Social theories suggest that why-explanations are better at communicating knowledge and cultivating trust among laypeople. OBJECTIVE: The aim of this study is to ascertain whether explanations provided by a symptom checker affect explanatory trust among laypeople and whether this trust is impacted by their existing knowledge of disease. METHODS: A cross-sectional survey of 750 healthy participants was conducted. The participants were shown a video of a chatbot simulation that resulted in the diagnosis of either a migraine or temporal arteritis, chosen for their differing levels of epidemiological prevalence. These diagnoses were accompanied by one of four types of explanations. Each explanation type was selected either because of its current use in symptom checkers or because it was informed by theories of contrastive explanation. Exploratory factor analysis of participants' responses followed by comparison-of-means tests were used to evaluate group differences in trust. RESULTS: Depending on the treatment group, two or three variables were generated, reflecting the prior knowledge and subsequent mental model that the participants held. When varying explanation type by disease, migraine was found to be nonsignificant (P=.65) and temporal arteritis, marginally significant (P=.09). Varying disease by explanation type resulted in statistical significance for input influence (P=.001), social proof (P=.049), and no explanation (P=.006), with counterfactual explanation (P=.053). The results suggest that trust in explanations is significantly affected by the disease being explained. When laypeople have existing knowledge of a disease, explanations have little impact on trust. Where the need for information is greater, different explanation types engender significantly different levels of trust. These results indicate that to be successful, symptom checkers need to tailor explanations to each user's specific question and discount the diseases that they may also be aware of. CONCLUSIONS: System builders developing explanations for symptom-checking apps should consider the recipient's knowledge of a disease and tailor explanations to each user's specific need. Effort should be placed on generating explanations that are personalized to each user of a symptom checker to fully discount the diseases that they may be aware of and to close their information gap.

A questionnaire-based study on quality and adequacy of clinical communication between physician and family members of admitted Covid-19 patients.

OBJECTIVE: To assess adequacy of present means of clinical communication between physicians and (Covid-19) patients' family members, to analyse their perspectives and recommend felicitous practices for virtual conversation during ongoing pandemic. METHODS: Cross-sectional questionnaire-based (20 questions) anonymous online survey was conducted including patient's relatives (Group-1) and treating physicians (Group-2), through Google Forms. RESULTS: Response Rate was 82.5%. Group-1 and Group-2 included 155 and 204 respondents respectively. Group-1 preferred update by resident doctors (39%), twice a day (41.9%), daily case-summaries (80%) and hand-written document/electronic messages (53%,31%) as consent. Whereas Group-2 favored update by senior consultants (63%), daily one appraisal (55.9%) and scanned copies of hand written consent (81%) before high-risk procedures. The groups broadly agreed on the desired duration for a fruitful discussion (5-10 min) and designating one responsible person from the family for daily appraisal. CONCLUSION: Use of modern techniques/technologies of communication (voice/video calls, texts) during the ongoing pandemic is acceptable to majority. PRACTICE IMPLICATIONS: Study proposes a senior physician should communicate to a designated responsible family member at-least once a day for stable and twice a day for critical covid patients (more if patient's health condition changes), either by voice or video calls for 5-10 min.

Environmental Considerations for Effective Telehealth Encounters: A Narrative Review and Implications for Best Practice.

Introduction: Due to the reduction in-person visits, the COVID-19 pandemic has led to expansions in the use of telehealth technology to provide patient care, yet clinicians lack evidence-based guidance on how to most effectively use video communication to enhance patient experience and outcomes. Methods: A narrative review was conducted to describe environmental factors derived from research in social psychology and human-computer interaction (HCI) that may guide effective video-based clinician-patient telehealth communication. Results: Factors such as nonverbal cues, spatial proximity, professionalism cues, and ambient features play an important role in patient experience. We present a visual typology of telehealth backgrounds to inform clinical practice and guide future research. Discussion: A growing body of empirical evidence indicates that environmental cues may play an essential role in establishing psychological safety, improving patient experience, and supporting clinical efficacy in these virtual experiences. Conclusion: The expanded use of telehealth visits suggests the need for further research on the relative effects of these environmental factors on patient experience and outcomes.

Trauma-Informed Care in Primary Health Settings-Which Is Even More Needed in Times of COVID-19.

Included in the general practitioner's (GP) core competencies is the ability to adopt a person-centered approach, and the use of the biopsychosocial model in their clinical work. Traumatic events (TEs) are frequently experienced within the population and are known to dysregulate the stress response system and to be associated with psychiatric and physical disorders. GPs may feel reluctant to confront TEs for a variety of reasons, such as a lack of sufficient training in trauma-informed care or a fear of causing harm when discussing a patient's more complicated issues, among others. This perspective paper aims to review the existing studies that support the practice of trauma-informed healthcare and to summarise best practices. Studies have shown that patients appreciate the questions that clinicians ask them about trauma-related issues and that they understand that this can be important for their healthcare. Furthermore, asking about trauma-related issues in a patient-centered and empathic way can result in better doctor-patient relationships, which improves the levels of satisfaction of both the patient and the doctor with the consultation, as well as improved health-related outcomes. As past traumatic experiences increase the risk of developing post-traumatic stress disorder on exposure to a new TE, the onset of the COVID-19 pandemic has led to trauma-informed care becoming even more important if the strategy is to continue to invest in preventive medicine.

Online Synchronous Clinical Communication Training During the Covid-19 Pandemic.

PURPOSE: As the COVID-19 pandemic outbreak occurred, most structured clinical communication training were transformed from in-person to remote seminars. The aim of our study was to evaluate the usefulness and feasibility of online synchronous clinical communication training from both students' and tutors' perspectives. PATIENTS AND METHODS: We conducted a cross-sectional study. Geneva Faculty of Medicine' 3rd year medical students and tutors involved in clinical communication were asked to respond to an online survey. RESULTS: Eighty-five of 149 students and 15/16 tutors responded. Students highly valued both online seminars and reported little technical difficulty. They felt that tutors were well prepared and actively involved them in experiential learning. Tutors globally reported little technical difficulty and felt rather well prepared to do so online. Although both students and tutors preferred the in-person format, half of them could still consider using an online format in the future outside the pandemic but mentioned it required specific rules. CONCLUSION: Our results suggest that clinical communication can be taught and practiced online and that tutors can quickly adapt to such changes.

Clinical Communication Skills Training in Dental Medical Education: The COVID-19 Pandemic Challenge.

It is very important for healthcare professionals to have good clinical communication skills, especially dentists. Patient-centred care results in patient satisfaction, better outcomes, and less complaints from dental patients. Due to the onset of the COVID-19 pandemic, the clinical communications skills programme of the pre-graduate course in dental medicine at the University of Porto had to be transformed to an online format. Based on their role as faculty, the authors aimed to recount their initial reflections and concerns within this perspective, and to share how they adapted to the new reality of teaching clinical communication skills online, as well as the conclusions of our experience, in the hope that this will help others who may have to go through a similar process. The authors acknowledged that the students achieved the pre-established goals of the clinical communications skills programme through the new online format.