Identifying characteristics of a skilled communicator in the clinical encounter

Abstract

Background In medical communication research, there has been a shift from ‘communication skills’ towards ‘skilled communication’, the latter implying the development of flexibility and creativity to tailor communication to authentic clinical situations. However, a lack of consensus currently exists what skilled communication entails. This study therefore aims to identify characteristics of a skilled communicator, hereby contributing to theory building in communication research and informing medical training. Method In 2020, six nominal group technique (NGT) sessions were conducted in the context of the general practitioner (GP) training programme engaging 34 stakeholders (i.e. GPs, GP residents, faculty members and researchers) based on their experience and expertise in doctor–patient communication. Participants in each NGT session rank‐ordered a ‘Top 7’ of characteristics of a skilled communicator. The output of the NGT sessions was analysed using mixed methods, including descriptive statistics and thematic content analysis during an iterative process. Results Rankings of the six sessions consisted of 191 items in total, which were organised into 41 clusters. Thematic content analysis of the identified 41 clusters revealed nine themes describing characteristics of a skilled communicator: (A) being sensitive and adapting to the patient; (B) being proficient in applying interpersonal communication; (C) self‐awareness, learning ability and reflective capacity; (D) being genuinely interested; (E) being proficient in applying patient‐centred communication; (F) goal‐oriented communication; (G) being authentic; (H) active listening; and (I) collaborating with the patient. Conclusions We conceptualise a skilled communication approach based on the identified characteristics in the present study to support learning in medical training. In a conceptual model, two parallel processes are key in developing adaptive expertise in communication: (1) being sensitive and adapting communication to the patient and (2) monitoring communication performance in terms of self‐awareness and reflective capacity. The identified characteristics and the conceptual model provide a base to develop a learner‐centred programme, facilitating repeated practice and reflection. Further research should investigate how learners can be optimally supported in becoming skilled communicators during workplace learning.

Developing skilled communication: The power of self‐monitoring

“…Moreover, the trainee is running out of time during the clinic hour. How can the trainee create trust and display empathy? 5 In the following paragraphs, we reflect on these kind of challenges in applying self‐monitoring when developing skilled communication.…”

“…In the example of an arterial line placement, the trainee can easily recognise if the placement was successful or not; for example, the line has a good blood flow or is blocked. This outcome can stimulate self‐monitoring for future comparable clinical tasks 1,5 …”

“…It may not be easy for the trainee to recognise these emotions as triggers for self‐monitoring as these are not concrete 6 . Moreover, communication takes place in an interactional sequence, with the trainee adapting to differing patient needs 5,8 . In case of the crying patient, it is unclear what caused the crying 4,7,9 .…”

“…There is no ‘golden standard’ available for evaluating communication, such as in procedural skills 7,8 . Becoming skilled in communication performance is a personalised process of the trainee in which recognising attitudes, feelings and thoughts is essential in self‐monitoring 1,5,10 . This implies that developing skilled communication is a continuous process of adapting communication in interaction 5,8 .…”

Skilled communication on social media—the elephant in the room

“…In this issue, Verheijden et al 1 identify characteristics of competent clinical communicators in the workplace. Here, we ask can we apply these same principles to clinicians interacting on social media?…”