Exploring Residents’ Communication Learning Process in the Workplace: A Five-Phase Model

Abstract

ContextCompetency-based education is a resurgent paradigm in professional medical education. However, more specific knowledge is needed about the learning process of such competencies, since they consist of complex skills. We chose to focus on the competency of skilled communication and want to further explore its learning process, since it is regarded as a main competency in medical education.ObjectiveThis study aims to explore in more detail the learning process that residents in general practice go through during workplace-based learning in order to become skilled communicators.MethodsA qualitative study was conducted in which twelve GP residents were observed during their regular consultations, and were interviewed in-depth afterwards.ResultsAnalysis of the data resulted in the construction of five phases and two overall conditions to describe the development towards becoming a skilled communicator: Confrontation with (un)desired behaviour or clinical outcomes was the first phase. Becoming conscious of one’s own behaviour and changing the underlying frame of reference formed the second phase. The third phase consisted of the search for alternative behaviour. In the fourth phase, personalization of the alternative behaviour had to occur, this was perceived as difficult and required much time. Finally, the fifth phase concerned full internalization of the new behaviour, which by then had become an integrated part of the residents’ clinical repertoire. Safety and cognitive & emotional space were labelled as overall conditions influencing this learning process.ConclusionsKnowledge and awareness of these five phases can be used to adjust medical working and learning environments in such a way that development of skilled medical communication can come to full fruition and its benefits are more fully reaped.

Competency-based education is beneficial for professional development

“…They are learned by doing, by experiencing, by getting feedback, by new experimentation, etc. In recent studies on communication [ 11 , 12 ], residents learned communication by first using ‘learned’ and somewhat artificial techniques in actual practice, then with ample feedback on authentic clinical actions (video assessment, peer feedback, supervisor interactions); under safe conditions, communication behaviours become personalized and internalized. Finally, communication behaviours become part of the personal clinical repertoire and can be used flexibly, all depending on the context and the purpose of the encounter.…”

Intercultural doctor-patient communication in daily outpatient care: relevant communication skills

“…It was striking that the doctors all said they were satisfied with their conversation, while the observers concluded that doctors did not practice the relevant ICC skills. An explanation could be that the doctors need to be confronted with their communication behaviour before they can improve their communication skills [ 15 ]. Finally, we need to say that the complexity of ICC cannot be grasped in a list of do’s and don’ts.…”

“…While the theoretical knowledge on ICC skills and the necessity of using these skills have been established [ 6 , 8 , 13 ], several researchers argue that the scientific field of ICC between doctors and patients in real practice is still too small to develop focused training in ICC [ 7 , 14 ] and that just giving feedback does not cover the full picture of skilled medical communication [ 15 ]. It is, for example, unknown which ICC skills are already used by doctors and how they are used.…”

De toetsing van medische competentie

“…Een recente studie vergeleek een vervolgopleiding waarin veel aandacht wordt besteed aan communicatie (huisartsopleiding) met een opleiding waar minder aandacht aan communicatie wordt besteed (chirurgie) [37]. Interessant is dat door deze communicatieaandacht communicatievaardigheden internaliseren en personaliseren [38]. Dat gebeurt door een proces van confrontatie (o. a. door feedback), reflectie, veilige oefening, nieuwe feedback en rolmodellen.…”