Coming of age as communicators: differences in the implementation of common communications skills training in four residency programmes.

OBJECTIVES: To determine thematic similarities and differences in the implementation of common-content communications skills training (CST) in medicine, surgery, paediatrics, and obstetrics and gynaecology residency programmes. METHODS: Communications skills training based upon the Kalamazoo consensus statement of communication skills in the clinical encounter was implemented in 4 residency programmes. Field notes of the CST sessions in each programme were analysed and coded for themes, considering the domains of Context, Input, Process and Product ('CIPP' methodology). Immediate learning outcomes were quantitatively assessed using retrospective pre/post methodology. RESULTS: Important differences were noted in the implementation of CST in the 4 disciplines. The 2 surgical disciplines showed relatively less reflective language and greater concentration on straight skill acquisition, whereas the 2 medical disciplines concentrated on the residents' role as teachers of communication skills for buy-in. Thematic similarities between disciplines included similar challenges to being good communicators in practice, as identified by residents (e.g. inadequate time and space), as well as lack of formal training. Quantitative learning outcome data from the educational intervention were significant in all groups (P < 0.05). CONCLUSIONS: Common material in CST can be adapted to different disciplines. By analysing for thematic similarities and differences in implementation in the 4 disciplines, a picture of different pedagogic 'subcultures' emerged, with different behavioural norms and values related to the doctor's role as communicator. In shared core competency training, it may be useful to consider these differences in planning, so that the training may be both sensitive to the behavioural norms of different disciplines, and effective.

Learning while evaluating: the use of an electronic evaluation portfolio in a geriatric medicine clerkship.

BACKGROUND: Electronic evaluation portfolios may play a role in learning and evaluation in clinical settings and may complement other traditional evaluation methods (bedside evaluations, written exams and tutor-led evaluations). METHODS: 133 third-year medical students used the McGill Electronic Evaluation Portfolio (MEEP) during their one-month clerkship rotation in Geriatric Medicine between September 2002 and September 2003. Students were divided into two groups, one who received an introductory hands-on session about the electronic evaluation portfolio and one who did not. Students' marks in their portfolios were compared between both groups. Additionally, students self-evaluated their performance and received feedback using the electronic portfolio during their mandatory clerkship rotation. Students were surveyed immediately after the rotation and at the end of the clerkship year. Tutors' opinions about this method were surveyed once. Finally, the number of evaluations/month was quantified. In all surveys, Likert scales were used and were analyzed using Chi-square tests and t-tests to assess significant differences in the responses from surveyed subjects. RESULTS: The introductory session had a significant effect on students' portfolio marks as well as on their comfort using the system. Both tutors and students reported positive notions about the method. Remarkably, an average (+/- SD) of 520 (+/- 70) evaluations/month was recorded with 30 (+/- 5) evaluations per student/month. CONCLUSION: The MEEP showed a significant and positive effect on both students' self-evaluations and tutors' evaluations involving an important amount of self-reflection and feedback which may complement the more traditional evaluation methods.