PERSONAL VIEW

Year : 2008  |  Volume : 21  |  Issue : 3  |  Page : 281

In the News! An Opinion - Teachers Unite

J van Dalen
Associate Editor, Education for Health

Correspondence Address:
J van Dalen
Associate Editor, Education for Health

Source of Support: None, Conflict of Interest: None

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In the November 2008 issue of Medical Education a United Kingdom Consensus Statement on the Content of Communication Curricula in Undergraduate Medical Education was published (von Fragstein et al., 2008). The consensus statement has been developed under the guidance of the UK Council of Clinical Communication Skills Teaching in Undergraduate Medical Education, a group of communication skills leaders from all 33 medical schools in the UK.



The consensus statement describes the many communication issues that can be addressed in undergraduate medical education. The issues are presented in a series of concentric circles, organised from the most basic principle (Respect for others) to supporting principles (reflective practice, evidence-based practice, professionalism and ethical and legal principles). There are five intermediate circles:

• Theory and evidence of communication skills. This includes an awareness of the literature related to:
  
  
  • patient satisfaction;
    
    
  • recall;
    
    
  • adherence and concordance;
    
    
  • well-being;
    
    
  • physical outcome;
    
    
  • psychological outcome;
    
    
  • medico-legal issues; and
    
    
  • patient safety and reduction of errors.
  
  
  
• Tasks and skills of clinical communication:
  
  
  • establishing and building a relationship;
    
    
  • initiating;
    
    
  • establishing;
    
    
  • recognizing and meeting patient needs;
    
    
  • gathering information;
    
    
  • eliciting and considering the patient�s world view;
    
    
  • conducting a physical examination;
    
    
  • formulating and explaining relevant diagnoses;
    
    
  • explaining, planning and negotiating;
    
    
  • structuring, signposting and prioritising; and
    
    
  • closing (each with their appropriate skills).
  
  
  
• Specific issues:
  
  
  • age-specific areas;
    
    
  • cultural and social diversity;
    
    
  • handling emotions and difficult questions;
    
    
  • skills for specific clinical contexts;
    
    
  • specific application of explanation and planning skills;
    
    
  • dealing with uncertainty;
    
    
  • sensitive issues; and
    
    
  • communication impairment.
  
  
  
• Media:
  
  
  • face-to-face;
    
    
  • written;
    
    
  • presentations;
    
    
  • computer; and
    
    
  • telephone.
  
  
  
• Communicating beyond the patient:
  
  
  • relatives and carers;
    
    
  • advocates and interpreters;
    
    
  • intraprofessional; and
    
    
  • interprofessional communication.

These concentric circles should be seen as wheels that can turn independently, so that every possible combination can be dialed. In the example of the authors: how to teach the specific situation of explanation and planning about an elderly patient, to a relative over the phone.



However, how to teach is the one issue that is not addressed by the curriculum wheel. This is underpinned by a comment in the same issue of Medical Education (Kinnersley & Spencer, 2008) which states: the purpose of the statement is not to define the precise method of delivery, but to guide overall content.



In my view the strength of the curriculum wheel is twofold. First, the curriculum wheel of communication skills is a valuable addition to medical education. It gives students as well as curriculum planners a systematic overview of all possible situations in which communication may have its specific demands. The second strength is that the curriculum wheel is the result of work of a nationwide Council with representatives of all medical schools in the United Kingdom. The Council was established in 2005. The members meet at 6-months intervals to advance the teaching of communication skills. Ideas are shared and disseminated, enthusiasm for teaching (re)kindled, assessment processes compared, scholarship and collaborative research encouraged, national awareness increased and the overall quality of education improved (Kinnersley & Spencer, 2008).



It may well be that this second outcome will prove to be of even greater benefit than the curriculum wheel itself.



Because, let's face it: there is still much work to be done. Knowing what to teach does not yet give us many clues about how to teach it. Wouldn't it be a fantastic outcome if the same energetic collaboration of the Council could also contribute to the production of teaching material, toolboxes, assessment instruments and teacher guidelines for adequate teaching and assessment of these important skills?



Some examples show that nationwide collaboration between likeminded professionals across health professions schools can move mountains. In The Netherlands, a similar, modest, collaboration exists between leaders of communication skills training of all eight medical schools. In Vietnam, all eight medical schools collaborate already for six years to establish clinical skills training facilities in each of the schools. They jointly develop teaching material, lesson plans and evaluation instruments for all eight schools, and conduct periodic staff training to professionalise their own teaching.



The collaborative efforts may be new to medical schools in many nations. In view of the colossal improvements that can be made in health professions education, collaborations such as the UK example are major steps in the right direction.

Jan van Dalen

Associate Editor Education for Health

References



Kinnersley, P., & Spencer, J. (2008) Communication skills teaching comes of age. Medical Education 42(11), 1052-1053.



von Fragstein, M., Silverman, J., Cishing, A., Quilligan, S., Salisbury, H., & Wiskin, C. (2008). UK consensus statement on the content of communication curricula in undergraduate medical education. Medical Education 42(11), 1100-1107.