Objectives:

1. Define interpersonal and communication competency

2.Explain the factors that facilitate effective verbal and nonverbal communication, including reflective listening.

3.Design strategies for teaching and assessing  interpersonal and communication skills.

Physicians must be competent in interpersonal and communication skills to practice medicine effectively. A large evidence-based literature confirms that physician competency with these skills is directly associated with improved health outcomes, including improved symptom resolution, better patient adherence to treatment plans, greater patient and physician satisfaction and fewer behaviors associated with malpractice claims and medical error.

This brief text is to provide the knowledge, values and resources necessary to enable those responsible for medical education at all levels to create an effective program in interpersonal and communication skills, considered to be the heart and soul of medicine.

Communication skills in healthcare---how are we doing?

Communication problems are common and usually concern communication problems, not competency issues. However, they negatively affect patient management and outcomes. The majority of malpractice claims are considered to arise from communication errors. Here are some study results:

Physicians fail to elicit 54% of patients’ complaints and 45% of their concerns

They often pursue a “doctor-centered” approach that discourages patients from telling their story.

They use jargon and language that patients do not understand.

Ineffective communication skills and a lack of focus on the physician-patient relationship, correlate with malpractice claims and suits such that 71% of malpractice depositions are thought to involve these skills. Of these, the following problems were cited (Beckman)

1.    Deserting the patient 32%

2.    Devaluing patient and/or family views:  29%

3.    Delivering information poorly   26%

4.    Failing to understand the patient and/or the family perspective:  13%

Why teach interpersonal and communication skills?

Studies show that good communication and patient-centered care can lead to better health outcomes, correlates directly with improved quality of care, patient satisfaction, and adherence, greater symptom improvement, better management of chronic conditions, and fewer medication errors. Physician caring and openness to communication are significant factors in a patient’s decision to continue a relationship with his or her physician. Positive patient perceptions of communication with their doctors are associated with improved efficiency of care including a significant reduction in diagnostic testing and referrals. These skills can correlate also with greater physician satisfaction and may decrease physician burnout.

Can communication skills be learned?

Numerous studies show that interpersonal and communication competencies involve a series of skills that can be learned and taught. Training produces measurable changes in physicians’ communication skills and the changes are sustained.

The culture of training:

Learners will internalize and perpetuate attitudes and behaviors of their role models. They feel caught between their moral principles and pressures to suppress their moral principles to fit in with team members. Studies indicate that communication skills and empathy decline during medical education.

Noble and Richardson note that communication skills teaching can fail due to lack of continuity of teaching and mixed messages about the value of communication. Here are their suggestions:

1.    Role modeling and good communication skills toward everyone.

2.    Ward-based teaching by clinicians

3.    A positive attitude toward communication and its teaching, including dialogue with learners about their learning and how the acquisition of communication skills enhances their learning.

4.    General professionalism including handling situations fairly with a clear sense f boundaries

5.    Self-reflection in practice, so that ineffective or partially effective communication is acknowledge and discussed to provide insight.

Definitions of interpersonal and communication competencies

The Kalamazoo II Report lists the following important elements of interpersonal skills:

Respect and treat others as one would want to be treated

Pay attention to the patient with open, nonverbal, verbal, and intuitive communication channels

Be present in the moment and mindful of the importance of the relationship

Have a caring intent to relieve suffering and show curiosity and interest in the patient’s ideas, concerns, and values

Have flexibility that enables the practitioner to adjust interpersonal skills as necessary

ACGME Language

1.    Create and sustain a therapeutic and ethically sound relationship with patients

2.    Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills

3.    Work effectively with others as a member or leader of a healthcare team or other professional group

Nonverbal communication:

It is said that 75-80% of our communication is nonverbal. Do you believe it? The following two sites are fascinating illustrations and information about nonverbal communication.

http://www.fhsu.edu/~zhrepic/Teaching/GenEducation/nonverbcom/nonverbcom.htm

http://nonverbal.ucsc.edu/

A website illustrated with photos, videos, and audio files. A fascinating trip through nonverbal communication with face, gesture, voice,  physical space, and body position.

Concordant_Competency_Framework_2007.pdf

Assessing communication competence.pdf

Clinical Skills for Undergraduate med studnets. cfm.pdf  - just uploaded

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