The 7 Elements Communication Rating Form for Teaching and Assessing Medical Communication Competency.

INTRODUCTION: Medical communication skills are a critical component of clinical medicine and patient satisfaction. Communication skills are difficult to teach and evaluate, necessitating tools that are effective and efficient. This study presents and validates the 7 Elements Communication Rating Form (7E-CRF), a streamlined, dual-purpose, evidence-based medical communication checklist that functions as a teaching and assessment tool. METHOD: A 14-item teaching and assessment tool is described and validated using face, concurrent, and predictive validity indices. The study was conducted with 661 medical students from the West Virginia School of Osteopathic Medicine (WVSOM). Student performance was assessed in year 1 labs, year 2 labs, and year 2 and year 3 objective structured clinical examination (OSCE). These internal indices were compared with student performance on the Humanistic Domain of the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 2-Performance Evaluation (PE), a licensure exam previously taken in years 3 or 4 of osteopathic medical schools. RESULTS: The evidence of interrater reliability and predictive validity is strong. Data from the 7E-CRF is compared to performance on the COMLEX Level 2-PE, Humanistic Domain. The 7E-CRF can identify students who are at a 10-fold increased risk of failure on the COMLEX Level 2-PE Humanistic Domain.  Conclusions: The 7E-CRF integrates instruction and assessment, based on a national and international model. The simplicity, foundation in professional consensus, ease of use, and predictive efficacy make the 7E-CRF a highly valuable instrument for medical schools in teaching and evaluating competency in medical communication skills.

The hidden curriculum of breaking bad news: Identification of three dimensions and four communication patterns.

OBJECTIVES: To explore students' observations in the hidden curriculum of physicians' breaking bad news interactions and identify dimensions and patterns within them. METHODS: We qualitatively analyzed 156 written narrative descriptions of bad news encounters in the clinics written by senior medical students. RESULTS: The analysis identified three dimensions within the encounters: providing information, dealing with emotions, and discussing treatment plans. These dimensions were observed in different proportions, identifying four communication patterns. Half of the encounters focused solely on presenting a treatment plan. Within them, the news was communicated abruptly while neglecting to share information or address emotions. CONCLUSIONS: Compared to the main literature on breaking bad news that focuses on two dimensions-the present study identified a third, prominent dimension-discussing the treatment plan. Half of the hidden curriculum experiences contradict the taught protocol, paying little/no attention to emotion and information. PRACTICE IMPLICATIONS: When teaching breaking bad news, it is essential to address the day-to-day practices students' observe. Students exposed to these encounters might misinterpret the physician's reliance on a single dimension as best practice. To mitigate this and help recognize their and others' tendency to focus primarily or solely on one dimension, we suggest a simple reflective prompt.

Position paper: Teaching breaking bad news (BBN) to undergraduate medical students.

Sharing new medical information that is perceived as seriously effecting people's lives, i.e., breaking bad news (BBN) is important in caring for patients and relatives and is challenging for healthcare professionals. Optimal BBN requires incorporation and implementation of multiple professional competencies acquired gradually throughout years of training. The BBN encounter has implications for all participants: the patient, family members, their close social environments, and the deliverer of the news. Due to these implications and the accountability involved, medical schools invest educational resources in helping medical students develop this competency. The current paper summarizes literature, research, and teaching experiences while suggesting practical guidelines for designing and teaching a BBN course to undergraduate students. The following principles lie behind the recommendations: stepwise spiral continuity of exposure to and teaching of communication skills in various contexts while focusing on BBN in the advanced clinical years; relating the developing skills to broader humanistic studies; enhancing awareness of self-perspectives and beliefs regarding BBN; connecting to patients' and family members experiences and needs; providing a BBN protocol and opportunities for structured experiential learning followed by reflection and feedback; using observation and reflection to address gaps between theory and real-life practice; and creating continuity of learning about BBN through undergraduate, graduate, and continuing medical education. Applying this learning process can help enhance the management of these difficult conversations to improve patients' care during these difficult, life-changing encounters, and physicians' well-being.

Expanding Goals of Care Conversations Across a Health System: The Mapping the Future Program.

CONTEXT: Clinician failure to discuss goals of care (GOC) with seriously ill patients remains prevalent. Small-scale educational interventions have demonstrated improvement in physician communication skills, but it is unknown if these results translate into practice changes. OBJECTIVES: To implement a large-scale educational intervention that would facilitate increased GOC discussions in at-risk patients, increase clinician confidence in having GOC discussions, and prove to be sustainable. METHODS: The Mapping the Future courses were four-to-eight-hour trainings, with brief lectures and demonstrations followed by practice with simulated patient cases. Participants completed precourse and postcourse surveys, including demographic information, self-confidence in a variety of communication tasks, willingness to initiate GOC discussions, barriers to GOC discussions, and self-perceived skill at having GOC conversations. We compared the rate of documentation of GOC discussions with at-risk inpatients in three hospitals for physicians who had taken the course and those who had not. RESULTS: Over a two-year period, we trained 512 clinicians in 42 sessions. After the course, participants felt that they had improved in all the skills that we taught and agreed that they would be more likely to initiate GOC conversations. Trained physicians were more likely than their nontrained colleagues to document a GOC discussion with at-risk patients (30.8% vs. 27.2%; P = 0.0001). CONCLUSION: A large-scale educational intervention involving simulated patient cases increased GOC documentation across a health system. Other programs might consider collaboration with quality improvement specialists to measure the impact of education and situate it within other system changes to support increased GOC discussions.

La comunicación pedagógica en los docentes del nuevo plan de formación en Medicina Integral Comunitaria / Teaching communication in the professors of the new training plan for Community Medicine

Introducción: el Programa Nacional de Formación en Medicina Integral Comunitaria surgió para garantizar la formación del médico que requiere la nueva sociedad venezolana. Los sistemas de actividad y comunicación pedagógica que se desarrollan en el proceso docente educativo son inseparables en los procesos formativos, garantizándose en buena medida el éxito en la formación de la personalidad del educando con un elevado compromiso social, humanista, ético, científico y técnico. Objetivo: determinar cómo los docentes desde la autovaloración, identifican la comunicación pedagógica que establecen con sus alumnos mediante el cumplimiento de las funciones de la comunicación. Método: se realizó un estudio descriptivo, cualitativo, de corte transversal a 31 profesores del Nuevo Plan de Formación de Medicina Integral Comunitaria del Municipio Roscio, estado de Guárico, Venezuela; que participaban como alumnos en un Curso Básico de Pedagogía. Previo consentimiento; se les aplicó un cuestionario estructurado en doce enunciados que debían enumerar de acuerdo al comportamiento comunicacional que presentaban con sus educandos. Los resultados se llevaron a tablas para su análisis en porcentajes y de acuerdo a valoración cualitativa por escala de Likert. Resultados: se encontraron importantes dificultades en la comunicación pedagógica de los docentes en la función afectiva-valorativa y con menor frecuencia en al informativa-pedagógica lo que pone en riesgo exitosos resultados en el proceso docente educativo. Conclusiones: se recomienda atender la superación de los docentes en comunicación pedagógica, en el contexto del entorno social donde se desenvuelven mediante la inclusión de estos temas en los Cursos Básicos de Pedagogía y Diplomado que deben recibir(AU)

Introduction: The National Program for Training in Community Medicine emerged to guarantee the training of the physicians required by the new Venezuelan society. The systems of teaching and communication activity developed in the educational process are inseparable in the training process, guaranteeing to a great extent the success in the training of the students´ personality of with a high social, humanistic, ethical, scientific and technical commitment. Objective: To determine how teachers, from self-assessment, identify the pedagogical communication that they establish with their students through the fulfillment of the communication functions. Method: A descriptive, qualitative, cross-sectional study was carried out on 31 teachers of the New Plan of Training in Community Medicine of Roscio Municipality, Guárico State, Venezuela, who participated as students in a Basic Course in Pedagogy. Under informed consent, the were applied a questionnaire structured by twelve statements that they were to order according to the communicational behavior they presented with their students. The results were taken to tables for analysis in percentages and according to qualitative assessment by Likert scale. Results: Important difficulties were found in the pedagogical communication of teachers regarding the affective-evaluative function and less frequently in the informative-pedagogical one, which puts at risk successful results in the educational teaching process. Conclusions: It is recommended to attend the improvement of teachers regarding pedagogical communication, in the context of the social environment where they practice, through the inclusion of these subjects in the Basic Courses of Pedagogy and the Diploma Course that they should receive(AU)

La comunicación pedagógica en los docentes del nuevo plan de formación en Medicina Integral Comunitaria / Teaching communication in the professors of the new training plan for Community Medicine

Introducción: el Programa Nacional de Formación en Medicina Integral Comunitaria surgió para garantizar la formación del médico que requiere la nueva sociedad venezolana. Los sistemas de actividad y comunicación pedagógica que se desarrollan en el proceso docente educativo son inseparables en los procesos formativos, garantizándose en buena medida el éxito en la formación de la personalidad del educando con un elevado compromiso social, humanista, ético, científico y técnico. Objetivo: determinar cómo los docentes desde la autovaloración, identifican la comunicación pedagógica que establecen con sus alumnos mediante el cumplimiento de las funciones de la comunicación. Método: se realizó un estudio descriptivo, cualitativo, de corte transversal a 31 profesores del Nuevo Plan de Formación de Medicina Integral Comunitaria del Municipio Roscio, estado de Guárico, Venezuela; que participaban como alumnos en un Curso Básico de Pedagogía. Previo consentimiento; se les aplicó un cuestionario estructurado en doce enunciados que debían enumerar de acuerdo al comportamiento comunicacional que presentaban con sus educandos. Los resultados se llevaron a tablas para su análisis en porcentajes y de acuerdo a valoración cualitativa por escala de Likert. Resultados: se encontraron importantes dificultades en la comunicación pedagógica de los docentes en la función afectiva-valorativa y con menor frecuencia en al informativa-pedagógica lo que pone en riesgo exitosos resultados en el proceso docente educativo. Conclusiones: se recomienda atender la superación de los docentes en comunicación pedagógica, en el contexto del entorno social donde se desenvuelven mediante la inclusión de estos temas en los Cursos Básicos de Pedagogía y Diplomado que deben recibir(AU)

Introduction: The National Program for Training in Community Medicine emerged to guarantee the training of the physicians required by the new Venezuelan society. The systems of teaching and communication activity developed in the educational process are inseparable in the training process, guaranteeing to a great extent the success in the training of the students´ personality of with a high social, humanistic, ethical, scientific and technical commitment. Objective: To determine how teachers, from self-assessment, identify the pedagogical communication that they establish with their students through the fulfillment of the communication functions. Method: A descriptive, qualitative, cross-sectional study was carried out on 31 teachers of the New Plan of Training in Community Medicine of Roscio Municipality, Guárico State, Venezuela, who participated as students in a Basic Course in Pedagogy. Under informed consent, the were applied a questionnaire structured by twelve statements that they were to order according to the communicational behavior they presented with their students. The results were taken to tables for analysis in percentages and according to qualitative assessment by Likert scale. Results: Important difficulties were found in the pedagogical communication of teachers regarding the affective-evaluative function and less frequently in the informative-pedagogical one, which puts at risk successful results in the educational teaching process. Conclusions: It is recommended to attend the improvement of teachers regarding pedagogical communication, in the context of the social environment where they practice, through the inclusion of these subjects in the Basic Courses of Pedagogy and the Diploma Course that they should receive(AU)