Role Play in Teaching Communication Skills in Family Medicine
Communication is an essential skill for establishing physician-patient relationships and effective functioning among health care professionals. Effective communication and collaboration can positively influence patient satisfaction and outcomes.
Most medical trainees learn verbal and nonverbal communication skills by watching their teachers and preceptors [British Medical Journal. 2002;325(7366):697–700]. In Family Medicine settings, learners are expected to be actively coached in communication by their supervising teachers—Family physicians and other members of the health care team. More recently, skills workshops and simulated practice sessions have been used to teach communication skills. Some features of clinical competence (e.g. empathy, compassion, counseling, and showing support to patients) might have to be explicitly discussed with learners, as they are often hidden within the communication process [Medical Education. 2002, 36, 141–147].
Interviewing real patients in real practice has been shown to be valuable for learning communication skills and understanding patient illnesses [Med Teacher. 2005;27(6):539–543]. The patient-centered clinical method is used in family medicine teaching as a model for interacting with patients and as part of the evaluation framework for the Certification Examination in Family Medicine. Patient-centered communication has been validated in terms of improved outcomes for patients [Patient Education and Counseling. 2007;67(3):333–42]. The UK’s General Medical Council (GMC) emphasizes effective communication as fundamental to good medical practice.
A positive relationship is fundamental for trust and confidence in the doctor, and necessary for constructive collaboration and compliance [Academic Medicine. 2008;83(1):37–44]. The most important technique for obtaining a positive relationship with the patient is reassurance and attentive listening by the doctor. Another important technique is to give permission to the patient for expressing his or her complaints, and to be the person they are [Cancer Nursing. Mar–Apr 2008:31(2):E18–E27].
Role play in clinical practice is defined as “someone emulating a patient’s role in a clinical encounter, taking into consideration all possible medical, cultural and behavioral contexts’’ [Journal of Inter profes sionalCare. Jan. 2009;23(23):41–51]. It allows for practicing communication in a safe and controlled environment [BMC Medical Education 2007;7(1):3]. It also gives a space for learners to practice communication and receive feedback from staff and peers. Role play between learner and teacher is most common in family practice, as there is a great deal of opportunity for one-on-one teaching [Medical Teacher. 2006;28(3):225–9]. Such role play can often be done in less than a minute, but can be very effective in equipping a learner with effective communication strategies [Academic Medicine 2002;77(7):593–9]. Role play has been shown to be effective in enhancing communication skills. Time for preparation, volunteers’ anxiety, and difficulties in giving proper feedback are some of the obstacles for engaging in role play [British Medical Journal. 2008;336(7646):718–21].
A standardized or simulated patient, well-trained actors is an alternative way of role playing specific communication skills or solving certain patient problems. Simulations can mirror reality quite closely and are good for improving certain communication skills, such as counseling and breaking bad news [International Journal of Palliative Nursing. 2003;9(1):32–38].
More recently, skills workshops and simulated practice sessions have been used to teach communication skills. Communication is an essential skill for safe, effective, and compassionate health care practice. Moreover, recent research also suggests that effective inter professional communication and collaboration can positively influence patient satisfaction and outcomes [American Journal Medicine. 2007;120(9):820–4].
Despite enormous technological innovation for rapid and accurate diagnosis, therapeutic relationship that involves the patient and physician plays an important part in health care delivery. Regarding the familiar triad of knowledge, attitudes and skills, when it comes to teaching and assessing communication in the context of medical education, the primary emphasis is on skills. The focus on skills, suggests that communication can be taught, learned and improved [BMC Medical Education, 2007, 7, 4.]. However, the work on skills needs to be placed in context. The most useful thing about communication is a transactional process in which messages are filtered through the perceptions, emotions and experiences of those involved [Medical Teacher. 2005, 27, 246–251].
Learners always have to exercise their learning process in a safe and supportive educational climate to achieve their goals [Medical Education 2002, 36, 141–147]. Working and role playing in groups can increase learners’ sense of participation, as they can work together and assess different communication skills in various situations. Small groups help in filling gaps in the knowledge and skills of the group members, and they use a learner-centered process with less didactic teaching [Journal Continuing Education in Health Professions. 2011 Fall;31(4):265-7].
Communication skills are an integral part of clinical teaching in Family Medicine. Students develop knowledge of the implication of cultural, social, economic, and legal contexts for patient care and develop awareness of the unique health care needs of ethnically diverse populations and communities. During the role playing they learn knowledge of basic communication concepts, communication models, direct and indirect messages, types and functions of non-verbal communication, attribution, ability to elicit accurate, comprehensive and focused medical histories. This training improves the ability to provide consultation in a structured way, the ability to educate patients about their health problems and to motivate them to adopt health-promoting behaviors.
About the Author: Dr. Firdous Jahan is currently working as Consultant, Associate Professor, Head of the Department of Family Medicine, Oman Medical College, Sohar, Oman. Dr. Jahan has overall responsibility for conducting the academic and service mandate of the department, consistent with the mission and policies of the Oman Medical College, Sohar, Oman. She has been extensively involved in teaching, research and quality improvement, coordinator under and postgraduate teaching ,Facilitator MRCGP Intl South Asia, Conducted workshops , various scientific presentation nationally and inter nationally, abstract presentation , media appearance for health awareness program. She has conducted health awareness programs for general public. Introduced patient centered approached which has resulted in outstanding patient satisfaction and volume. Moreover, she has been into building clinical skills and competence following ethical guidelines with commitment to excellence in quality in patient care.
She has been the member of several important committees concerning research and curriculum also has been teaching under graduate and post graduate students. Scholarly work consists of publication and articles in news papers. A number peer reviewed publications published in national and international journals.
She can be reached at: [email protected]
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