Communication skills instruction: an analysis of self, peer-group, student instructors and faculty assessment.

OBJECTIVE: To explore the correlation of student and faculty assessments of, second-year dental students' (D2s) communicative skills during simulated patient interviews. METHODS: Eighty-two D2s, 14 student instructors and 8 faculty used a 5-point scale, (1=poor-5=excellent) to assess 12 specific communicative skills of D2s generating assessment sources of self, peer-group, student instructor, and faculty. Mean scores and comparisons between assessment sources were calculated. Spearman correlations evaluated relationships between specific skills and assessment sources. RESULTS: Mean assessment score and standard error for peer-group (4.14 ± 0.04), was higher than self (3.86 ± 0.06, p<0.05) yet slightly higher than student instructor (4.07 ± 0.04) and faculty (3.93±0.10). Regarding assessment sources, the degree of correlation from highest to lowest was peer-group and student instructor (ρ=0.46, p<0.0001), self and student instructor (ρ=0.35, p<0.002), self and peer-group (ρ=0.28, p<0.02). The correlations between student instructor and faculty, faculty and self, and faculty and peer-group were nonsignificant. CONCLUSION: Student assessments were different from faculty by mean score and correlation index. Future studies are needed to determine the nature of the differences found between student and faculty assessments. PRACTICE IMPLICATIONS: Peer, student instructor and faculty assessments of dental students' communicative skills are not necessarily interchangeable but may offer uniquely different and valuable feedback to students.

Teamwork training improves the clinical care of trauma patients.

OBJECTIVES: We investigated these questions: Does formal team training improve team behaviors in the trauma resuscitation bay? If yes, then does improved teamwork lead to more efficiency in the trauma bay and/or improved clinical outcomes? DESIGN: This intervention study used a pretraining/posttraining design. The intervention was TeamSTEPPS augmented by simulation. The evaluation instrument, which was the Trauma Team Performance Observation Tool (TPOT), was used by trained evaluators to assess teams' performance during trauma resuscitations. From November 2008 to February 2009, a convenience sample (n = 33) of trauma resuscitations was evaluated. From February to April 2009, team training was conducted. From May to July 2009, another sample (n = 40) of resuscitations were evaluated. Clinical data were gathered from our trauma registry. The clinical parameters included time from arrival to computed tomography (CT) scanner, arrival to intubation, arrival to operating room, arrival to Focused Assessment Sonography in Trauma (FAST) examination, time in emergency department (ED), hospital length of stay (LOS), intensive care unit LOS, complications, and mortality. Comparing pretraining and posttraining resuscitations, we calculated means, standard deviations, and p values for teamwork ratings and clinical parameters, and we determined significance using the independent samples t-test. SETTING: Level I Trauma Center. PARTICIPANTS: The trauma team included surgery residents, faculty, and nurses. RESULTS: Our trauma team showed significant improvement in all teamwork domain ratings and overall ratings from pretraining to posttraining-leadership (2.87-3.46, p = 0.003), situation monitoring (3.30-3.91, p = 0.009), mutual support (3.40-3.96, p = 0.004), communication (2.90-3.46, p = 0.001), and overall (3.12-3.70, p < 0.001). The times from arrival to the CT scanner (26.4-22.1 minutes, p = 0.005), endotracheal intubation (10.1-6.6 minutes, p = 0.49) and the operating room (130.1-94.5 minutes, p = 0.021) were decreased significantly after the training. CONCLUSIONS: Structured trauma resuscitation team training augmented by simulation improves team performance, resulting in improved efficiency of patient care in the trauma bay. We propose that formal teamwork training augmented by simulation be included in surgery residency training as well as Advanced Trauma Life Support (ATLS).

Communication skills instruction utilizing interdisciplinary peer teachers: program development and student perceptions.

Lack of curricular time, faculty time, and funding are potential limitations for communication skills training in dentistry. Interdisciplinary collaboration amongst health care faculties could address these limitations. This article describes the development, implementation, and student perceptions of a communication skills program in dentistry. The program has four components: Knowledge, Observation, Simulation, and Experience (KOSE) and spans over the second and third years of dental school. KOSE allows students to obtain knowledge of and observe effective communication skills and practice these skills in the simulated and nonsimulated environment. A key feature of KOSE is the utilization of fourth-year medical and dental students as peer teachers. Evaluation of KOSE was geared toward student perceptions. Cross-sectional data were gathered via written surveys from 143 learners (second- and third-year dental students) in 2006-07. Students perceived the ability to recognize effective communication, demonstrated awareness of their communication strengths and weaknesses, and reported that skills gained were transferable to actual patient care. Interdisciplinary collaboration was a feasible way to address the lack of resources in the development of a communications skills program, which was perceived to be worthwhile by learners.

Use of personal digital assistants (PDAs) in reflection on learning and practice.

INTRODUCTION: As the use of personal digital assistants (PDAs) grows, the value of reflection of learning and practice draws increased attention from policymakers and evaluators. To learn more about the use of PDAs in practice and learning, the present study describes use of (1) PDAs in patient care and (2) a PDA version of the Virginia Board of Medicine Continuing Competency and Assessment Form (CCAF), a learning portfolio intended to encourage documentation of reflection on practice and medical education. METHODS: A purposive sample of 10 practicing physicians (6 male, 7 primary care) was recruited from geographic regions throughout Virginia. Five participants were previous users of a PDA. Three sources of data were analyzed: (1) a questionnaire describing PDA usage, (2) transcripts from telephone interviews, and (3) CCAF written comments. A study team member installed the PDA system and conducted individualized training on the basis of current equipment, software, and skills of the learner. Telephone interviews were completed 4-6 months after training. RESULTS: All physicians accessed the system after training. Use of the PDA was associated with the value of information for making clinical decisions. Information accessed by PDA was used not only for clinical decisions but also for patient education and for teaching medical students. Use of the CCAF prompted physicians to reflect on changes in clinical practice. DISCUSSION: Training on the handheld equipment and applications should include assessment of systems connectivity and integration, access authority, existing skills, and previous use. Proponents of PDA use for clinical decisions should assure access to information that is useful to physicians for reflection on learning and practice.