Editorial Director: Dr Abraham Marcus Managing Editor: Anne Patterson Consultant Editor: PtoSessor Michael A. Simpson
Teaching Communication Skills
In this issue we begin an occasional series of articles on the teaching of communication and ‘interview’ skills, one of the newer subjects to enter the curriculum, Research has shown clearly that doctor-patient communication is often faulty and usually suboptimal, and that this has a range of serious effects. Communication failures disturb the therapeutic relationship or do not allow it to develop in the first place; they limit the quantity and quality of data the doctor elicits and Editorial Department: Update Publications Ltd, constrain the value and comprehensiveness of his or her diagnosis and 33/34 Alfred Place, management plan; and they reduce the patient’s capacity to underLondon WC 1 E 7DP, England stand, recollect and follow the advice they receive and hence impair Tel: 01-637 4544 the eficacy of therapeutic plans (however aptly they may have been conceived in theory). Inept communication is implicated in a high Subscription and Circulation Department: proportion of cases that lead to dissatisfied, complaining and even Update Publications Ltd, litigious patients. 2 High Street, Communication skills are too often fundamentally misunderstood Station Road, by curriculum planners, and even by some of those who supposedly Petersfield, Hampshire, teach them. They may be misconstrued in several ways. Some see CU32 2JE, England such teaching as a ‘soft’ and unscientific, trendy topic-decorative, Subscription Rates: but not really necessary; they fail to recognize that these are the most Annual Subscription basic of all clinical skills. If doctors lack the capacity to relate well to UKC €17.00 patients; to gather useful, unambiguous and accurate information; Overseas: €22.00 and to impart advice and instructions comprehensibly, memorably Air Mail: €27.00 and influentially, their ability to reach arcane diagnoses or to propose elegant therapeutic plans will be no more relevant to health care than Single Copies UK: €5.00 an appreciation of the tonic variations in Mahler’s symphonies or the Overseas: €6.00 niceties of macramC. Even when these skills are acknowledged as important, they may be neglected or damaged in two principal ways. They may be relegated to the unreal world of the mythical curriculum, along with other subjects such as medical ethics, management and administration Contributions: skills, which are supposedly taught by all the teachers almost all of the Contributions are invited in the time, by ‘example’ and precept. The problem is that once ‘everyform of‘ original papers, articles body’ is teaching it, nobody bothers to. Because most of the time, of‘ discussion and comment on all aspects of health sciences many of the examples students see in practice are bad examples of education. awkward communiction by untrained and inept role models, this is I’rospective contributors should hardly the way to teach any important subject. Those who reject this write to the Managing Editor, criticism of the ‘they pick it up as they go along’ or the Educational Medical Teacher, Update Osmosis school of teaching (who may regard it as an excellent way of Publications Ltd, 33/34 Alfred conveying other subjects) should agree to see anatomy and cardiology Place, London W C l E 7DP, England, before submitting taught the same way, before their arguments are convincing. manuscripts. A whole body of research now allows us to conclude that there is a distinct and definable set of clinical communication skills; that Medical Teacher is published students are not naturally highly gifted at interviewing and talking quarterly. with patients; that the ordinary curriculum in no way enhances, and @ Update Publications Ltd, 1984 in several ways impairs, even such modest abilities as they may have;
Med Teach Downloaded from informahealthcare.com by Mcgill University on 02/02/15 For personal use only.
Subeditor: Deirdre O’Flaherty
120
Medical Teacher Vol 6 No 4 1984
and that a variety of teaching techniques can effectively teach these skills, which can be assessed with useful accuracy. In this issue, Dr Maguire describes a version of the basic technique many of us have used with established success over a number of years and in various settings. A good deal of very interesting research remains to be done in this field but there can no longer be any excuse for any medical school to fail to offer training of this sort. The need for, and efficacy of, such training is as established as it is for any other part of the traditional medical curriculum-and considerably more firmly than some,
Med Teach Downloaded from informahealthcare.com by Mcgill University on 02/02/15 For personal use only.
Michael Simpson, MB. ES. MRCPaych. Professor of Psychiatry, Faculty of Medicine, University of Natal
Unmet Needs in Continuing Education The European region of the World Health Organization (WHO) often seems to attract less attention than do those regions dealing with the enormous health care problems of the third world. Nevertheless, there are many areas of concern even in relatively f l u e n t Europe, and prominent amongst them are the needs of continuing education, specialty training and educational research. It was in order to address these problems that the directors of WHO participating centres, together with experts in the fields of health education, nursing, pharmacy and childcare were brought together at a small seminar in London in October 1983.' Britain was well represented by advisers from Dundee, Newcastle and the BLAT Centre for Health and Medical Education in London, where the seminar was held. Within the broad field of the conference concerns, three main subject areas were delineated as requiring action: 0 To ensure that the specialties developed meet the real needs of the health services. 0 To increase the amount of research relevant to health manpower development (HMD). 0 To change the characteristics of continuing education with a view to implementing the regional and national strategies for attaining health for all by the year 2,000. It is interesting to note that previous WHO seminars had expressed the view that many people in the European region still have insufficient access to health services and that the development of the concept of teamwork as a basis for universal and effective primary health care should be actively promoted as an ideal. Each major topic area was introduced by a working paper, followed by group discussion, reporting back and further discussion in a plenary session. A preliminary list of the results of these discussions for each major area was prepared and some of these are discussed below. In the session on educational research it was agreed that medical schools in general have paid little attention to this field, probably because of limited funds and lack of expertise. Among the more interesting suggestions for a Medical Tcachcr Vol6 No 4 1984'
research study was the need to investigate methods for matching the curriculum to health service needs. Considerable emphasis was laid on the need to investigate career choice and to discover whether specific postgraduate training for general practitioners alters the way in which they respond to the health needs of the population. The session on specialization gave rise to further discussion on the balance between responding to the results of unhealthy lifestyles and trying to promote healthy living. Emphasis was placed on the need to consider the specialized training needs of all categories of health workers, not just doctors. It was considered that all health workers need special training together, not separately, about environmental factors and lifestyles in relation to health and that no specialized teams are required for prevention. Research in the area of specialization using common protocols would enable useful comparisons to be made between different countries. Continuing education, especially in primary health care, was the next major topic discussed, and it was emphasized that the health personnel concerned already possess considerable professional expertise. The overwhelming need is to reorientate their professional attitudes towards the implications,of primary health care. In this respect the visiting expert can often be more influential than the local reformer. The first priority was seen as exchanging information about what is already happening in different countries, possibly followed by specific research projects. It was agreed that the traditional methods of education used in medical schools are inappropriate for continuing education and may, in fact, be inimical to it, a conclusion shared by most general practice educators. Among the research areas suggested were investigations into the organization and technology required, and the special need for identifying the key issues for primary health care physicians in relation to care of the elderly, a major problem in the European sector. From the principal topics, three research projects were selected as being of particular interest to the seminar participants and in line with the regional strategy for attaining health for all by the year 2,000. These were: 1. Evaluation of continuing education, with particular reference to primary health care. 2. Decision-making in regard to specialization. 3. Systems of specialization. Seminar members examined these three proposed projects and stated their potential interest in participating. It was concluded that common protocols should be prepared so that international comparisons could be made and that the centres themselves should assume the main responsibility for their work. Eric Cambrill, ME, 6s.FRCGP. DRCOG. Associate Adviser in General Practice, S. W. Thames Region
Reference
'WHO. The mk of WHO@orticipllling centres in continuiw eabcath, IpocioUy hcrining and rducoriaol m d . World Health Organization Regional Office for Europe, Copenhagen, October 1983.
121
Teaching Communication Skills
In this issue we begin an occasional series of articles on the teaching of communication and ‘interview’ skills, one of the newer subjects to enter the curriculum, Research has shown clearly that doctor-patient communication is often faulty and usually suboptimal, and that this has a range of serious effects. Communication failures disturb the therapeutic relationship or do not allow it to develop in the first place; they limit the quantity and quality of data the doctor elicits and Editorial Department: Update Publications Ltd, constrain the value and comprehensiveness of his or her diagnosis and 33/34 Alfred Place, management plan; and they reduce the patient’s capacity to underLondon WC 1 E 7DP, England stand, recollect and follow the advice they receive and hence impair Tel: 01-637 4544 the eficacy of therapeutic plans (however aptly they may have been conceived in theory). Inept communication is implicated in a high Subscription and Circulation Department: proportion of cases that lead to dissatisfied, complaining and even Update Publications Ltd, litigious patients. 2 High Street, Communication skills are too often fundamentally misunderstood Station Road, by curriculum planners, and even by some of those who supposedly Petersfield, Hampshire, teach them. They may be misconstrued in several ways. Some see CU32 2JE, England such teaching as a ‘soft’ and unscientific, trendy topic-decorative, Subscription Rates: but not really necessary; they fail to recognize that these are the most Annual Subscription basic of all clinical skills. If doctors lack the capacity to relate well to UKC €17.00 patients; to gather useful, unambiguous and accurate information; Overseas: €22.00 and to impart advice and instructions comprehensibly, memorably Air Mail: €27.00 and influentially, their ability to reach arcane diagnoses or to propose elegant therapeutic plans will be no more relevant to health care than Single Copies UK: €5.00 an appreciation of the tonic variations in Mahler’s symphonies or the Overseas: €6.00 niceties of macramC. Even when these skills are acknowledged as important, they may be neglected or damaged in two principal ways. They may be relegated to the unreal world of the mythical curriculum, along with other subjects such as medical ethics, management and administration Contributions: skills, which are supposedly taught by all the teachers almost all of the Contributions are invited in the time, by ‘example’ and precept. The problem is that once ‘everyform of‘ original papers, articles body’ is teaching it, nobody bothers to. Because most of the time, of‘ discussion and comment on all aspects of health sciences many of the examples students see in practice are bad examples of education. awkward communiction by untrained and inept role models, this is I’rospective contributors should hardly the way to teach any important subject. Those who reject this write to the Managing Editor, criticism of the ‘they pick it up as they go along’ or the Educational Medical Teacher, Update Osmosis school of teaching (who may regard it as an excellent way of Publications Ltd, 33/34 Alfred conveying other subjects) should agree to see anatomy and cardiology Place, London W C l E 7DP, England, before submitting taught the same way, before their arguments are convincing. manuscripts. A whole body of research now allows us to conclude that there is a distinct and definable set of clinical communication skills; that Medical Teacher is published students are not naturally highly gifted at interviewing and talking quarterly. with patients; that the ordinary curriculum in no way enhances, and @ Update Publications Ltd, 1984 in several ways impairs, even such modest abilities as they may have;
Med Teach Downloaded from informahealthcare.com by Mcgill University on 02/02/15 For personal use only.
Subeditor: Deirdre O’Flaherty
120
Medical Teacher Vol 6 No 4 1984
and that a variety of teaching techniques can effectively teach these skills, which can be assessed with useful accuracy. In this issue, Dr Maguire describes a version of the basic technique many of us have used with established success over a number of years and in various settings. A good deal of very interesting research remains to be done in this field but there can no longer be any excuse for any medical school to fail to offer training of this sort. The need for, and efficacy of, such training is as established as it is for any other part of the traditional medical curriculum-and considerably more firmly than some,
Med Teach Downloaded from informahealthcare.com by Mcgill University on 02/02/15 For personal use only.
Michael Simpson, MB. ES. MRCPaych. Professor of Psychiatry, Faculty of Medicine, University of Natal
Unmet Needs in Continuing Education The European region of the World Health Organization (WHO) often seems to attract less attention than do those regions dealing with the enormous health care problems of the third world. Nevertheless, there are many areas of concern even in relatively f l u e n t Europe, and prominent amongst them are the needs of continuing education, specialty training and educational research. It was in order to address these problems that the directors of WHO participating centres, together with experts in the fields of health education, nursing, pharmacy and childcare were brought together at a small seminar in London in October 1983.' Britain was well represented by advisers from Dundee, Newcastle and the BLAT Centre for Health and Medical Education in London, where the seminar was held. Within the broad field of the conference concerns, three main subject areas were delineated as requiring action: 0 To ensure that the specialties developed meet the real needs of the health services. 0 To increase the amount of research relevant to health manpower development (HMD). 0 To change the characteristics of continuing education with a view to implementing the regional and national strategies for attaining health for all by the year 2,000. It is interesting to note that previous WHO seminars had expressed the view that many people in the European region still have insufficient access to health services and that the development of the concept of teamwork as a basis for universal and effective primary health care should be actively promoted as an ideal. Each major topic area was introduced by a working paper, followed by group discussion, reporting back and further discussion in a plenary session. A preliminary list of the results of these discussions for each major area was prepared and some of these are discussed below. In the session on educational research it was agreed that medical schools in general have paid little attention to this field, probably because of limited funds and lack of expertise. Among the more interesting suggestions for a Medical Tcachcr Vol6 No 4 1984'
research study was the need to investigate methods for matching the curriculum to health service needs. Considerable emphasis was laid on the need to investigate career choice and to discover whether specific postgraduate training for general practitioners alters the way in which they respond to the health needs of the population. The session on specialization gave rise to further discussion on the balance between responding to the results of unhealthy lifestyles and trying to promote healthy living. Emphasis was placed on the need to consider the specialized training needs of all categories of health workers, not just doctors. It was considered that all health workers need special training together, not separately, about environmental factors and lifestyles in relation to health and that no specialized teams are required for prevention. Research in the area of specialization using common protocols would enable useful comparisons to be made between different countries. Continuing education, especially in primary health care, was the next major topic discussed, and it was emphasized that the health personnel concerned already possess considerable professional expertise. The overwhelming need is to reorientate their professional attitudes towards the implications,of primary health care. In this respect the visiting expert can often be more influential than the local reformer. The first priority was seen as exchanging information about what is already happening in different countries, possibly followed by specific research projects. It was agreed that the traditional methods of education used in medical schools are inappropriate for continuing education and may, in fact, be inimical to it, a conclusion shared by most general practice educators. Among the research areas suggested were investigations into the organization and technology required, and the special need for identifying the key issues for primary health care physicians in relation to care of the elderly, a major problem in the European sector. From the principal topics, three research projects were selected as being of particular interest to the seminar participants and in line with the regional strategy for attaining health for all by the year 2,000. These were: 1. Evaluation of continuing education, with particular reference to primary health care. 2. Decision-making in regard to specialization. 3. Systems of specialization. Seminar members examined these three proposed projects and stated their potential interest in participating. It was concluded that common protocols should be prepared so that international comparisons could be made and that the centres themselves should assume the main responsibility for their work. Eric Cambrill, ME, 6s.FRCGP. DRCOG. Associate Adviser in General Practice, S. W. Thames Region
Reference
'WHO. The mk of WHO@orticipllling centres in continuiw eabcath, IpocioUy hcrining and rducoriaol m d . World Health Organization Regional Office for Europe, Copenhagen, October 1983.
121
