How do surgeons think they learn about communication? A qualitative study

Mendick, Nicola; Young, Bridget; Holcombe, Christopher; Salmon, Peter

doi:10.1111/medu.12648

Cited by 13 publications

(18 citation statements)

References 36 publications

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“…However, there are concerns that expert guidance on communication is often unrealistic, 17-21 and many clinicians and students remain sceptical of it. 11,20,[22][23][24][25][26][27][28][29][30][31] Moreover, social scientists have challenged assumptions on which communication education and guidance in cancer and across health care are based. [32][33][34] In this context, a more radical response to negative findings about the effects of communication education is to reappraise the direction the field has taken.…”

Section: Resultsmentioning

confidence: 99%

“…However, in a recent study breast cancer surgeons described communication goals and strategies that explained why they often did not follow formal guidance, just as previous studies found in primary care physicians . For instance, surgeons avoided detailed prognostic information where their priority was to strengthen patients’ morale . Unsurprisingly, the surgeons described gaining little from communication skills training, preferring to observe experienced colleagues and to reflect on their own practice.…”

Section: Clinicians: Goal‐directed Expertsmentioning

confidence: 90%

“…Researchers have unfortunately not been very concerned with clinicians’ views about how they try to meet patients’ communication needs. However, in a recent study breast cancer surgeons described communication goals and strategies that explained why they often did not follow formal guidance, just as previous studies found in primary care physicians . For instance, surgeons avoided detailed prognostic information where their priority was to strengthen patients’ morale .…”

Section: Clinicians: Goal‐directed Expertsmentioning

confidence: 94%

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A new paradigm for clinical communication: critical review of literature in cancer care

Salmon

Young

2016

Med Educ

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ObjectivesTo: (i) identify key assumptions of the scientific ‘paradigm’ that shapes clinical communication research and education in cancer care; (ii) show that, as general rules, these do not match patients’ own priorities for communication; and (iii) suggest how the paradigm might change to reflect evidence better and thereby serve patients better.MethodsA critical review, focusing on cancer care. We identified assumptions about patients’ and clinicians’ roles in recent position and policy statements. We examined these in light of research evidence, focusing on inductive research that has not itself been constrained by those assumptions, and considering the institutionalised interests that the assumptions might serve.ResultsThe current paradigm constructs patients simultaneously as needy (requiring clinicians’ explicit emotional support) and robust (seeking information and autonomy in decision making). Evidence indicates, however, that patients generally value clinicians who emphasise expert clinical care rather than counselling, and who lead decision making. In denoting communication as a technical skill, the paradigm constructs clinicians as technicians; however, communication cannot be reduced to technical skills, and teaching clinicians ‘communication skills’ has not clearly benefited patients. The current paradigm is therefore defined by assumptions that that have not arisen from evidence. A paradigm for clinical communication that makes its starting point the roles that mortal illness gives patients and clinicians would emphasise patients’ vulnerability and clinicians’ goal‐directed expertise. Attachment theory provides a knowledge base to inform both research and education.ConclusionsResearchers will need to be alert to political interests that seek to mould patients into ‘consumers’, and to professional interests that seek to add explicit psychological dimensions to clinicians’ roles. New approaches to education will be needed to support clinicians’ curiosity and goal‐directed judgement in applying this knowledge. The test for the new paradigm will be whether the research and education it promotes benefit patients.

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Section: Resultsmentioning

confidence: 99%

Section: Clinicians: Goal‐directed Expertsmentioning

confidence: 90%

Section: Clinicians: Goal‐directed Expertsmentioning

confidence: 94%

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A new paradigm for clinical communication: critical review of literature in cancer care

Salmon

Young

2016

Med Educ

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“…Some physicians report favouring monodisciplinary training, feeling that they need to address and discuss their specific tasks and worries with their peers (Stiefel et al, in preparation). In addition to experience being an important factor of communication competencies (Mendick, Young, Holcombe, & Salmon, 2015), tension was observed between participants of different hierarchical positions, mainly due to the higher expectations towards senior staff members . Interestingly, the issue emerged whether participants' professional experience should be a criterion for participating in CST programmes.…”

Section: Discussionmentioning

confidence: 99%

Core components of Communication Skills Training in oncology: A synthesis of the literature contrasted with consensual recommendations

2018

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This systematic review synthesises the literature on Communication Skills Training (CST) programmes for oncology professionals to identify their core components and compare them with the recommendations formulated in a position paper based on a European expert consensus meeting. A systematic literature search was conducted using MEDLINE (OVID and PUBMED), CINAHL, EMBASE, PSYCHINFO, Web of Science and the Cochrane Library. The analytic approach relied on an a priori framework based on the position paper's recommendations, generating several themes. Forty-nine articles were included. The CST programmes reported between 2010 and 2016 were heterogeneous. Some recommendations, especially those regarding content and pedagogic tools, were followed by most providers, while others, such as setting, objectives and participants, were not. This synthesis raises questions on how CST programmes are conceived and how they could or should be conceived in future. While medicine, especially clinical communication, is socially and culturally embedded, some recommendations regarding CST programmes seem to be universally valuable, contributing to ensure quality and enhanced credibility, and thus endorsement and sustained implementation, of CST programmes in the oncology setting.

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“…For instance, expression of empathy is usually reduced to simply saying 'I'm sorry to hear that' or 'It must be difficult for you' and may not be offered at a contextually relevant moment in the conversation. This limits the understanding of what counts as effective communication and restricts the development of students' conversational approach to medical consultations (Mendick et al 2015, van den Eertwegh et al 2013, Wouda and van de Wiel 2013. Dahm and colleagues (2015) reveal that educators are able to rely on their tacit intuition to identify communication breakdowns in simulations and where medical students find it difficult to construct effective communication.…”

Section: Introductionmentioning

confidence: 99%