We care, we care! Our failures in teaching communication skills at the GME level

Rachel Lewin lewinr@g.ucla.edu

Abstract

Background

Medicine recognizes the need for trainees with high-quality communication skills, but has not yet succeeded at consistently cultivating these skills in the demanding and fast-paced GME environment. These skills are frequently taught in a UME environment, with formal training ending prior to the transition to GME. Technical skills and “non-technical” skills, like communication, are still perceived as separate skillsets, so training is not integrated to develop these skills simultaneously. Several challenges have been identified to teaching communication skills at the GME level: the hierarchical environment, need for reciprocal communication, and a lack of cues identifying the learning frame and encouraging participation.

Methods

Fifteen observations of Internal Medicine rounds at a large urban hospital were conducted focusing on the development of residents’ communication skills, particularly instances of teaching, modeling behaviors, and feedback. Disagreement, as well as discussions about communication strategies, were of particular interest as well. Additionally, thirty-minute interviews were conducted with each member of the observed teams for a minimum of five interviews at each level of experience (i.e. five intern interviews, five attending interviews, etc.). These interviews focused on the development, teaching, and perceived importance of communication skills. This data was transcribed, coded, and analyzed for themes.

Results

Residents identified communication skills as critical, but felt their skills were innate, not acquired in medical school or residency. Residents failed to identify when modeling was used for teaching. Attendings, however, stated that modeling was an important and effective method for teaching communication skills. Residents stated they would not contact their superiors for assistance with communication, identifying their co-residents as their only resource. However, residents are willing to ask their superiors for help with technical medical concerns and ethical concerns.

Conclusion

These results suggest that current communication training is not impactful, but that residents are aware of the importance of these skills. Residents are infrequently cued into the learning frame, leaving them unaware of teaching or modeling. The hierarchical structure of rounds has few opportunities for reciprocal communication unless specifically encouraged through techniques like flipped rounds or cued discussion of communication techniques being used. Residents need to practice communication skills with skilled practitioners. Rounds provide an excellent time for this, but residents must be cued to the educational moment and encouraged to ask questions and participate in conversation. Additionally, residents are hesitant to contact a superior about a communication concern; developing channels to mitigate this hesitancy would improve resident skills and patient care. 
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