Paper Summary
Title: Learning Communication Skills in Residency
Source: Journal of Graduate Medical Education
Authors: Gabriel Burke, Lindsay Melvin, Shiphra Ginsburg
Published Date: 2023-02-01
Podcast Transcript
Hello, and welcome to paper-to-podcast. Today, we're diving into a fascinating study that we've read 69 percent of, titled "Learning Communication Skills in Residency," authored by Gabriel Burke, Lindsay Melvin, Shiphra Ginsburg, and published on February 1, 2023.
The study investigates how internal medicine residents develop communication skills, and guess what? They mostly learn how to chat with patients independently and through unsupervised interactions. Surprisingly, attending physicians didn't play a significant role in this process. Residents often change their communication styles when under observation to match what they think will be judged favorably, leading to less patient-centered communication. The study highlights the need to reevaluate current communication training and assessment methods. So buckle up, because we're about to explore this in more detail!
The research used a constructivist grounded theory approach, which emphasizes individuals' perceptions and how they create meaning from their experiences. Fifteen internal medicine residents from the University of Toronto were interviewed via Zoom, and their experiences were analyzed using open and axial coding, constant comparison, and an iterative process.
Now, let's get into the positives and negatives of this study. The most compelling aspects include the focus on residents' perspectives, the use of a constructivist grounded theory approach, and the researchers' reflexivity. The study was well-designed, and the methods employed provided valuable insights into the development of communication skills among internal medicine residents.
However, there are some limitations to consider. First, the study was conducted at only one academic institution and involved residents from one inpatient specialty, which could limit generalizability. Second, the participants were volunteers, possibly introducing selection bias. Third, the study was conducted during the COVID-19 pandemic, which might have influenced residents' perspectives on communication training. Lastly, the study relied on self-reported experiences and perceptions, which might be subject to recall or social desirability bias.
So, where can we apply this research? One potential application is to revise and improve communication training for medical residents. By understanding how residents develop their communication skills, educators can design more effective training programs that better align with the realities of clinical practice. This could involve incorporating time constraints and distractions into training scenarios and emphasizing patient-centered communication.
Another application could involve incorporating patient feedback into residency education, as residents learn a great deal from their interactions with patients. This could provide valuable insights into residents' authentic communication practices and help them refine their skills further.
Lastly, this research could inform assessment methods in medical education, addressing the limitations of direct observation and the tendency for residents to alter their communication styles when observed. Developing alternative assessment approaches that capture residents' true communication behaviors can lead to more accurate evaluations of their skills and ultimately better patient care.
And that concludes our deep dive into "Learning Communication Skills in Residency." You can find this paper and more on the paper2podcast.com website. Thanks for joining us, and happy chatting!
Supporting Analysis
The study found that internal medicine residents believe they mainly develop communication skills independently through unsupervised patient interactions, without much guidance from attending physicians. When they are observed, many residents alter their behavior to reflect communication styles they think will be judged favorably. The perceived need for efficiency sometimes results in less patient-centered communication, which is not in keeping with techniques taught to medical learners. Participants credited 80% of their skills development to trial and error of interacting with patients, while only 20% was attributed to observing staff physicians. Additionally, they felt that communication techniques learned in formal training, like classroom teaching environments or standardized patient interactions, often did not translate well to real inpatient settings. This study highlights the gap between how residents are taught to communicate and how they actually communicate in practice, suggesting a need to reevaluate current communication training and assessment methods.
The research used a constructivist grounded theory approach to explore residents' perspectives on the development of their communication skills. This approach emphasizes individuals' perceptions and how they create meaning from their experiences. The study involved 15 internal medicine residents at the University of Toronto, who were selected to ensure diversity in training levels and gender. Between November 2020 and January 2021, one-on-one semi-structured interviews were conducted virtually via Zoom. The interviews focused on residents' experiences with communication skills development and views on existing training modalities. The research team analyzed the interview transcripts iteratively, using open and axial coding to identify themes and explore relationships between them. Constant comparison was used to refine the coding as more transcripts were added to the dataset. The analysis and data collection occurred simultaneously, allowing identified themes to be better explored in later interviews. After 15 interviews, the researchers determined that they had enough rich data to understand and describe the phenomenon under study, and they constructed a model representing the core themes and their interrelationships.
The most compelling aspects of the research are the focus on understanding residents' perspectives on communication skills development and the use of a constructivist grounded theory approach. This approach allowed the researchers to explore the social phenomena of communication skills development in a deep and meaningful way, emphasizing how individual residents perceive and create meaning from their experiences. The researchers followed best practices by selecting a diverse group of participants from different levels of training and gender to ensure a wide range of perspectives. They conducted one-on-one semi-structured interviews, which allowed for rich, reflective responses from the residents. The iterative process of data collection and analysis enabled the researchers to refine their codes and themes as more data was collected, resulting in a well-developed framework that captured the core themes and their interrelationships. Another best practice was the researchers' reflexivity, openly discussing and reflecting on their own experiences in communication skills training and assessment, ensuring that they did not overinterpret the data. This reflexivity, combined with the constructivist grounded theory approach, contributed to the credibility and trustworthiness of the findings. Overall, the research was well-designed, and the methods employed provided valuable insights into the development of communication skills among internal medicine residents.
Some possible issues with the research include the fact that participants were all residents at one academic institution and from one inpatient specialty, which limits the generalizability of the findings to other settings and specialties. Additionally, the participants came from multiple medical schools, but all were volunteers, so they might be more interested in communication skills than non-participants, introducing potential selection bias. Furthermore, the study was conducted during the COVID-19 pandemic, and the PGY-1 participants had only a few months of residency training, all done during the pandemic, which could influence their perspectives on communication training. Lastly, the study relied on participants' self-reported experiences and perceptions, which might be subject to recall bias or social desirability bias.
Potential applications for this research include revising and improving communication training for medical residents, particularly in inpatient settings. By understanding how residents develop their communication skills, educators can design more effective training programs that better align with the realities of clinical practice. This could involve incorporating time constraints and distractions into training scenarios, as well as emphasizing patient-centered communication in busy clinical environments. Another application could be the incorporation of patient feedback into residency education, given that residents learn a great deal from their interactions with patients. This could provide valuable insights into residents' authentic communication practices and help them refine their skills further. Lastly, the research could inform assessment methods in medical education, addressing the limitations of direct observation and the tendency for residents to alter their communication styles when observed. Developing alternative assessment approaches that capture residents' true communication behaviors can lead to more accurate evaluations of their skills and ultimately better patient care.