Reflective Teaching Practices: An Approach to Teaching Communication Skills in a Small-Group Setting

Abstract

Small-group teaching is particularly suited for complex skills such as communication. Existing work has identified the basic elements of small-group teaching, but few descriptions of higher-order teaching practices exist in the medical literature. Thus the authors developed an empirically driven and theoretically grounded model for small-group communication-skills teaching. Between 2002 and 2005, teaching observations were collected over 100 hours of direct contact time between four expert facilitators and 120 medical oncology fellows participating in Oncotalk, a semiannual, four-day retreat focused on end-of-life communication skills. The authors conducted small-group teaching observations, semistructured interviews with faculty participants, video or audio recording with transcript review, and evaluation of results by faculty participants. Teaching skills observed during the retreats included a linked set of reflective, process-oriented teaching practices: identifying a learning edge, proposing and testing hypotheses, and calibrating learner self-assessments. Based on observations and debriefings with facilitators, the authors developed a conceptual model of teaching that illustrates an iterative loop of teaching practices aimed at enhancing learners' engagement and self-efficacy. Through longitudinal, empirical observations, this project identified a set of specific teaching skills for small-group settings with applicability to other clinical teaching settings. This study extends current theory and teaching practice prescriptions by describing specific teaching practices required for effective teaching. These reflective teaching practices, while developed for communication skills training, may be useful for teaching other challenging topics such as ethics and professionalism.

Interprofessional Communication Skills Training for Serious Illness: Evaluation of a Small-Group, Simulated Patient Intervention

“…The course structure was adapted from a residential four-day workshop that showed efficacy in improving communication skills behaviors for oncology fellows (Oncotalk.) 13,19 Each site's Codetalk workshop was composed of eight four-hour sessions (twice per week for a month) led by two faculty facilitators, one of whom was a physician and the other a nurse or nurse practitioner. A detailed content outline and facilitator guidelines were provided for each session and were structured with the following components: (1) a brief didactic overview that included a demonstration roleplay by the faculty facilitators, (2) skills practice using a simulated patient (or family member), and (3) reflective discussions of how it felt to be in these situations.…”

Confronting Safety Gaps Across Labor and Delivery Teams

“…The skill building should show how to address the tough concerns identified in this paper and include role-plays, simulations, or other forms of deliberate practice. 48,49 5 Build Social Motivation & Ability. The right people need to lead this change or the old norms will reassert themselves.…”

Teaching the Medical Interview: Methods and Key Learning Issues in a Faculty Development Course

“…In contrast to a self-study process, our program emphasized the importance of small group learning and the teacher-learner relationship to ensure learning. The importance of goal-setting, observation, guided reflection, and feedback based on participant goals in the learning process has been described as critical in teaching communication skills 41 and in developing expertise with complex learning tasks. 42 More than half of the participants in this faculty development program had previously attended a similar AACH course.…”

“…This framework parallels the one derived empirically by FryerEdwards who broke down this teaching process into the following steps: 1) identifying a learning edge (setting goals), 2) proposing and testing hypotheses (trying new skills), and 3) calibrating learner's self-assessments (feedback and evaluation). 41 Educators running faculty development programs should consider adapting their methodology to allow individual learners to establish their own learning goals and objectives and choose methods that allow for their achievement during their programs.…”