Creating a culture of communication in undergraduate medical education

Abstract

Quality communication improves outcomes across a wide variety of health care metrics. However, communication training in undergraduate medical education remains heterogeneous, with real-life clinical settings notably underutilized. In this perspective, the authors review the current landscape in communication training and propose the development of communication-intensive rotations (CIRs) as a method of integrating communication training into the everyday clinical environment. Despite its importance, communication training is often relegated to a "parallel curriculum." Through integration, CIRs can provide opportunities for reallife skills training, decrease parallel curriculum burden, and provide specialty-specific training in preparation for residency. Clear, efficient communication and human connection remain central in a physician's practice. CIRs reinforce these crucial principles. Potential benefits of a CIR model include role modeling of expert communication techniques; real-time, specific feedback on communication behaviors; development of relationship-centered communication skills and human connection, thereby decreasing burnout; and the opportunity for quality communication practices to become habits in a medical student's daily routine.

Simulation-Based Education in US Undergraduate Medical Education

“…27 Other communication skills, such as providing family updates, disclosing medical errors, and goals of medical care discussions are other "high-stakes" moments in patient centered care that have profound effects on individuals' and families' healthcare experience, patient outcomes, and patient safety therefore should not be underappreciated. 19,[28][29][30][31][32] Interestingly, another gap seen in findings was the lack of advancement of high-acuity, low-frequency SBE, an area where simulation has shown to be of value, not only to improve patient safety but also to help mitigate medical errors. [17][18][19]33 Variability in exposure to these scenarios in clerkships should be a catalyst for SBE adoption in UME, similar to its use in nursing education.…”

“…33,34 Reasons for the lag in adoption of more advanced communication skills or high-acuity/low-frequency SBE may stem from multiple contributing factors. One reason could be lack of dedicated faculty development and resources, 29 a reflection of the lack of standardization and wide variability between different healthcare systems to incentivize education. This is largely attributable to the lack of national standards to address these gaps.…”

“…28 In addition, there is great variation and lack of consensus in the measured constructs and integrated modalities used to assess communication skills in students given the limited validated tools. 29,31 Despite lack of incentives and challenges in measuring communication, medical educators are responsible for teaching and assessing learners in these important interpersonal skills. Physicians' ability to communicate well with patients is directly related to societal trust in the profession, the ability to improve outcomes, enhanced patient-doctor trust, and improved chronic disease management.…”

“…Physicians' ability to communicate well with patients is directly related to societal trust in the profession, the ability to improve outcomes, enhanced patient-doctor trust, and improved chronic disease management. 29 The absence of strong communication significantly correlates with increased medical errors, higher readmissions, decreased patient management after discharge, and increased cost due to malpractice claims. 26,27,29 Hence, there is an urgent need and a vast opportunity to standardize methods for teaching and assessing advanced communication skills of future doctors using SBE.…”

Family caregivers’ perceived communication self-efficacy with physicians

“…There continues to be a need to develop evidence-based communication skills training programs for physicians (Back et al, 2019). It has been noted that a relationship-centered communication skills curriculum in medical education is needed (England et al, 2020) and the typology offers specific approaches for achieving skills such as "generating rapport" and "eliciting all concerns and summarizing"; the Family Caregiver Communication Typology demonstrates how communication should be tailored to varying communication styles of the caregiver.…”