Effective teaching of communication to health professional undergraduate and postgraduate students: A Systematic Review

Review Question/Objective The objective is to identify and assess the effectiveness of tools and methods of teaching communication skills to health professional students in undergraduate and postgraduate programs, to facilitate communication in hospitals, nursing homes and mental health institutions. For this review, effective communication will be defined as that which enhances patient satisfaction, safety, symptom resolution, psychological status, or reduces the impact/burden of disease and/or improved communication skills within undergraduate or postgraduate students The review question is: What is the best available evidence on strategies to effectively teach communication skills to undergraduate and postgraduate medical, nursing and allied health students (nutrition and dietetics, occupational therapy, physiotherapy, speech pathology etc)? Background Communication is a two‐way interaction where information, meanings and feelings are shared both verbally and non‐verbally.1 Effective communication is when the message being conveyed is understood as intended.1 Effective communication between the health professional and patient is increasingly being recognised as a core clinical skill.2 Research has identified the far reaching benefits of effective communication skills including enhanced patient satisfaction, patient safety, symptom resolution and improvements in functional and psychological status.3 Poor communication can result in omitted or misinterpretation of information resulting in declining health of the patient.1 Despite the importance of effective communication in ensuring positive outcomes for both the patient and health professional, there is concern that contemporary teaching and learning approaches do not always facilitate the development of a requisite level of communication skills, both verbal and written4 and a difficulty for the current generation of communication skills teachers is that many have not had the experience of being taught communication skills themselves.5 Studies have shown that communication skills can be taught, although proven learning strategies should be the basis of any communication teaching.4 It is reported that the communication skills teachers themselves be trained in communication skills and assessment of communication skills should be an important component of the health professionals' accreditation.6, 7 Not only should the communication skills of the teacher be evaluated but the teaching modules within the program should also be evaluated on a regular basis. In all cases of communication teaching, strong faculty support is required for any communication skills programme to be successful.2 Early introduction of communication skills programmes, which are continued throughout all the years of the curriculum, has been shown to be effective in improving confidence and reducing the number of errors made and establishing a more permanent understanding of communication.8 Throughout the undergraduate degree, increased integration between communication and clinical teaching is important in learning to use the two skill sets together, so as to closely reflect what happens in clinical practice.9, 10 Research suggests that communication training is most effective when longitudinal in nature and coincides with ongoing professional practice education.9, 11 Many studies have shown that communication skills programmes with a strong experimental and/or practical component are more effective than programmes that are solely theory or discussion based.9 Simulations and role‐play are effective instructional methods for developing communication skills including opening and closing consultations, conducting the consultation in a logical manner, improving body language, using language at the level of understanding of the patient and using clear verbal and written communication.9 One particular strategy that has been shown to be effective is the use of videotaped consultations with standardised patients. Although measuring the effectiveness of communication skills training is difficult, there are a few common strategies used in the current literature. It has been suggested that evaluation of the competence of students' verbal communication skills is best assessed during observations of simulated consultations with standardised patients4, 12 followed by constructive feedback.13 The quality of the constructive feedback is crucial, needing to be specific, non‐judgemental and descriptive.13 A number of studies have used objective structured clinical exams (OSCE) where a marking scheme is used to evaluate different components of communication whilst ensuring a more standardised assessment for all students.14 Given the concern with communication skills of contemporary health professionals, and the variability in current communication education programmes,15 it is important that an educational model be developed to foster the development of effective communication. This model should be multi‐faceted, that is, address knowledge, skill and attitude domains and cover both verbal and non‐verbal forms of communication.16 A preliminary search of JBI Library of Systematic Reviews, Cochrane Library of Systematic Reviews, Medline, CINAHL, DARE, PROSPERO has been performed and one existing systematic review was identified.17 The review investigated communication teaching in nurse education in the United Kingdom (UK). The review discusses a number of points including 1) who teaches communication skills; 2) the methods used; 3) time spent on communication skills training; 4) the goals or content of the teaching and; 5) assessment, evaluation and overall effectiveness of communication teaching. From the 17 studies included in this review, it was found that team teaching provides greater depth and more perspectives therefore likely to be more effective. Experiential methods, standardised patients, and group work are commonly used as methods of teaching with course content including empathy, self‐awareness, interviewing skills and critical thinking. The time spent in teaching communication skills is often not reported with information on the methods of assessment of communication skills also limited although the use of standardised patients and OSCEs most commonly used. This review concluded that there was a lack of research in this area and the strength of conclusions from these studies were lessened due to the flaws in methodological design,17 Therefore, the question still remains as to what aspects of teaching communication are effective. Given the poor methodological design of the studies included in the above review, the time since publication of the last review (2002), and the lack of recent research specific to this topic, this review is somewhat exploratory and hopes to further explain effective methods of communication teaching and evaluation.