UKCouncil for Clinical Communication Skills in Undergraduate Medical Education (UKCCC):
Survey of Resources
Final Report
March 2014
Michelle Fromage
Contents
Purpose of the Survey
Description of the Survey
Timeline of the Survey Development, Distribution and Data-collection
Summary of Responses
Preliminary Data Analysis
Consensus Statement Theme Summaries
Tasks and Skills
Age Specific Communication: Children:
Age Specific Communication: The Elderly
Cultural and Social Diversity: Ethnicity
Cultural and Social Diversity: Gender and Sexuality
Cultural and Social Diversity: Disability
Handling Emotions
Communication in Specific Contexts
Specific Application and Planning: SDM, informed consent, risk explanation
Specific Application and Planning: Health Promotion and counselling
Sensitive Issues: Uncertainty
Sensitive Issues: BBN/ death/dying
Sensitive Issues: Sexual History taking
Communication Impairment: Sensory Impairment
Communication Impairment: Learning Disability
5 Areas of Media: Telephone
5 Areas of Media: Written
5 Areas of Media: Electronic
5 Areas of Media: Verbal Presentation
Communicating Beyond the patient: With colleagues
Communicating Beyond the patient: With relatives and carers
Current Theory and Evidence
Reflective Practice: N= 13
Professionalism: N= 12
Ethics and Law: N= 11
Evidence-based Practice: N= 8
Add materials on topics not covered: N= 4
Favourite Resource: N= 3
Further contact: N= 10 provided e-mail address
Further Content Analysis: Resources currently used and/or available
Results of Content Analysis of Current Resources
Collaboration
UKCCC
RCGP materials
Health talk online
Other Resources
Areas not covered
Literature
Theme by Theme Wish List of Resources
Strengths and Limitations
Further Research
Appendix 1: The UKCCC Consensus Statement.
Appendix 2: Example of the survey introduction and questions.
Appendix 3: Invitation E- mail
Appendix 4: The Participant Information Sheet
Appendix 5: Example of follow up questions
Appendix 6: Collated list of references received from participants.
Appendix 7: Categories created across questions and respondents.
Purpose of the Survey
The survey was designed with the objective of exploring what resources Medical Schools across the UK are currently using in their clinical communication teaching,for example, websites, video and audio clips, games, exercises, commercial films, DVD’s, professional guidelines, patient materials, voluntary organisation literature, etc. This was with a view to then being able to map resources and share knowledge about those that are in use and/or are known to be available for use for tutors to access in their own teaching practice. In addition, the survey was designed to establish a ‘wish list’ from clinical communication educators which might include resources that were seen as missing from those which are currently used and available. The findings of the survey will be used by the UKCCC to document the availability of such resources to help those involved with the teaching and learning of clinical communication in undergraduate medicine. The UKCCC has the potential to purchase and/or produce materials for members to access and use in their teaching. In order to do this they require knowledge of what is currently used, what might be available and what would be most useful to its members.
Description of the Survey
As the survey was designed to explore the resources available to clinical communication teachers it had to be comprehensive enough to cover all aspects of what medical schools might teach across their curriculum. In order to ensure this was the case, the survey was produced in line with ‘The Consensus Statement’ (VonFragstein et al., 2008: Appendix 1). That is, all the main themes that were included in the statement were covered in the survey, those being: Tasks and skills, age specific communication, cultural and social diversity, handling emotions, communication in specific contexts, specific application and planning, sensitive issues, communication impairment, 5 areas of media and communicating beyond the patient. The more over-arching themes of current theory and evidence, reflective practice, professionalism, ethics and law and evidence-based practice were also explored as part of the survey. Early versions of the survey were peer-reviewed and the final survey was created in SurveyMonkey and contained 72 questions, each followed by a blank space for respondents to complete their answers (Appendix 2). The survey was sent out to 60 clinical leads/deputy leads (list provided by UKCCC) via a link embedded in an invitation e-mail (Appendix 3)with an attachment containing the Participant Information Sheet (Appendix 4).
After two reminders were sent o participants the survey closed (see timeline below). The data was explored and follow up questions were sent to those who had agreed to provide an e-mail address for further contact. The questions varied in terms of their content and the number of them that were asked. This was because the follow up questions were designed to clarify or elaborate on the specific responses provided by the participants. An example of these questions can be found in Appendix 5.
Timeline of the Survey Development, Distribution and Data-collection
Survey developed via SurveyMonkey August/September 2013.
The Survey was distributed on 26th September via e-mail (with embedded link) to 60 clinical communication leads and deputy leads across 33 medical schools. Participant Information Sheet attached.
Reminders sent 14th October and 13th December 2013.
Survey closed 20thDecember.
Follow up questions were sent via e-mail to 10 schools in February 2014.
Summary of Responses
26 surveys were originally submitted from 21 Medical Schools out of a possible 33.
Medical schools: Aberdeen, Barts, Belfast,Birmingham, Bristol, Cambridge, Cardiff, Dundee, Durham. Glasgow, Keele, Kings, Leeds, Manchester, Nottingham, Oxford, Peninsula, St Andrews, St Georges, UCL, UEA.
Following data cleaning: 2 Duplicate surveys were deleted that came from the same IP address with the most complete version being kept for analysis.
2 other surveys were deleted dues to only providing the name of the medical school and no other data.
3 Medical schools submitted 2 separate surveys (presumably from a lead and deputy lead).
The final sample used for analysis was 22 surveys submitted from 19 medical schools. 58% response rate.
Time taken to complete surveys was between 7mins and 2hrs 16 mins. With some respondents taking over a week to complete the survey.
Received 5 E-mail/ telephone responses to follow up questions
Preliminary Data Analysis
The 22 remaining surveys were saved as separate PDF files and were kept securely as a full record of each schools response to the survey. In addition to this, question summaries were also produced as PDF files and saved securely. The question summaries were a full record of all responses for each question across the 22 surveys. The question by question data is summarised below including the numbers of responses. Where possible, the references noted here have been listed more fully in Appendix 6.
Consensus Statement Theme Summaries
Tasks and Skills
Resourcesin current use: N=22, Others: N=9, Wish list: N=16
Summary:Currently used:
UKCCC learning package currently used by 9 schools. 7 used in house DVD/materials. 4 used RCGP materials. 3 used YouTube and 2 used Deanery produced material. Patientstories.org,uk and ‘Shut up and Listen’ by Cathy Jackson were also mentioned.
Age Specific Communication: Children:
Resourcesin current use: N= 17, Others: N= 5
Summary: Currently used:Hear DVD. In-house DVD’s (some out-dated).Taught by Paediatricians, on placement, and with real children and their parents.
Age Specific Communication: The Elderly
Resourcesin current use: N= 15, Others: N= 4, Wish list: N= 12
Summary:Currently used:Dipex DVD. Healthtalkonline. CKS. NHS.uk, NICE.org, Dementia UK and Alzheimers Society materials. Elderly patients from a community group. Real patient with a hearing impairment.
Cultural and Social Diversity: Ethnicity
Resourcesin current use: N= 21, Others: N= 4, Wish list: N= 8
Summary:Currently used:‘Valuing Diversity’ Joe Kai (Ed) used by 2 schools. Two other schools made use of the RCGP material. Other approaches mentioned were; workshops with community groups, in-house video about working with interpreters and the PROCEED video.
Cultural and Social Diversity: Gender and Sexuality
Resourcesin current use: N= 13, Others: N= 2, Wish list: N= 2
Summary:Currently used: Video created by local GUM doctors. One schools made use of consented photos (that may or may not challenge assumptions).Other approaches taken were workshops with community members and the presenting of case histories.
Cultural and Social Diversity: Disability
Resourcesin current use: N= 16, Others: N= 1, Wish list: N= 3
Summary:Currently used: Workshop on complex communication needs- use of AAC in cerebral palsy. Various YouTube clips. The Shropshire CCG film called ‘ask the question’.Real patient with severe language impairment used in workshops. The inclusion of a disability studies module. A lecturer with language impairment used to carry out teaching.The use of real visually impaired/learning disabled patients was adopted in some schools.
Handling Emotions
Resourcesin current use: N= 16, Others: N= 1, Wish list: N= 7
Summary:Currently used: In-house DVD-palliative care. NHS choices on YouTube.Healthtalkonline was accessed by 2 schools. Videos of simulated patients were used as illustration of handling emotions. Newcastle University Empathy Clips- Patch Adams. Lectures and workshopsusing breaking bad news and domestic violence scenarios were mentioned.
Communication in Specific Contexts
Resourcesin current use: N= 15, Others: N= 1, Wish list: N= 4
Summary:Currently used: Case studies presented in Chapters. CETL-Mental Health resources. Psychiatry videos from YouTube, Healthtalk online, Study guide- keeping safe in the interview, Patient educator sessions for Psychiatry history taking.
Specific Application and Planning: SDM, informed consent, risk explanation
Resourcesin current use: N= 15, Others: N= 3, Wish list: N= 6
Summary:Currently used: UKCCC package was accessed by 2 schools. UKCCC scenario bank was also mentioned. One school ran workshops on calculation and numeracy. Other schools used the NHS child vaccination information.
Specific Application and Planning: Health Promotion and counselling
Resourcesin current use: N= 13, Others: N= 0, Wish list: N= 3
Summary:Currently used: Motivational Interviewing teaching and simulation were cited by 4 schools. ‘Ineffective and effective physician’ was used. Health Scotland adverts were cited as a useful resource along with Prochaska and DiClemete –the stage of change model.
Sensitive Issues: Uncertainty
Resources in current use: N= 11, Others: N= 2, Wish list: N= 4
Summary:A set of resources developed by public health. Uncertainty teaching Yr 4 GP attachments- via real experiences.W. Scott Richardson et al. A new arrival: evidence about differential diagnosis.Simulated clinical scenarios with SPs with theme of dealing with uncertainty.
Sensitive Issues: BBN/ death/dying
Resourcesin current use: N= 17, Others: N= 3, Wish list: N= 4
Summary:Currently used: Dipex- BBN. In-house DVD of a GP settingfollowed by hospital setting. Healthtalkonline was cited by 2 schools as was YouTube. The MS Society and the MS Trust were used as resources. One school ran an integrated study day on the ‘end of life care’. Liverpool care pathway. Other schools used current celebrity stories from the media or personal stories in the BMJ. R Buckman’s (a practical guide) work and online video were cited as useful for teaching consultation skills in Palliative care. Real patient testimonies were also cited here.
Sensitive Issues: Sexual History taking
Resourcesin current use: N= 9, Others: N= 2, Wish list: N= 1
Summary:Currently used: Healthtalkonline was accessed for infertility and sexual history videos. Some in-house materials were cited here. One school stated that this area was covered by their ‘reproduction’ clinical rotation.
Communication Impairment: Sensory Impairment
Resourcesin current use: N= 13, Others: N= 3, Wish list: N= 1
Summary:Currently used: Specialist trainers were used in this teaching as well as deaf volunteers. British sign Language was used as one of the languages in working with interpreters in one school while another had input from a deaf tutor. Materials developed in house by speech and language colleagues were also stated as useful resources in this area.
Communication Impairment: Learning Disability
Resourcesin current use: N= 10, Others: N= 2, Wish list: N= 2
Summary:Currently used: Some schools used the resource of actors with intellectual difficulties. The KeeleToolkit and DVD was cited as useful in this area as well as the GMC Interactive clips section, e.g Downs Syndrome.
5 Areas of Media: Telephone
Resourcesin current use: N= 12, Others: N= 1, Wish list: N= 1
5 Areas of Media: Written
Resourcesin current use: N= 10, Others: N= 3, Wish list: N= 2
5 Areas of Media: Electronic
Resourcesin current use: N= 8, Others: N= 1, Wish list: N= 0
5 Areas of Media: Verbal Presentation
Resourcesin current use: N= 7, Others: N= 1, Wish list: N= 0
Summary:Currently used: Telephone: SBAR online resource, workshop with simulation. Written: Teaching session focussed on written communication and writing up a history practice session. NHS Grampian paperwork was cited as a resource. Real patient records and other examples of writing from a clinical workplace were also cited here. Quiz- MDU guidance. Electronic:Schools guidelines and real clinical encounters were cited here and one school ran an AAC session. Verbal:Case presentation in PBL training and log books were cited as useful practice for verbal presentation as well as practice in SSC blocks. Peer-to-peer teaching skills were also mentioned as practice for verbal communication.
Communicating Beyond the patient: With colleagues
Resourcesin current use: N= 13, Others: N= 2, Wish list: N= 2
Summary:Currently used: Schools expressed that this subject might be covered in other parts of the medical curriculum, such as specific Inter-professional learning. This teaching was also said to overlap with community and primary care as well as patient safety and human factors teaching. Some schools used in-house DVDs- how to and not to present a patient. Others ran simulated sessions and workshopswhile others demonstrated using videos of junior doctor’s consultations with patients including giving and receiving feedback.
Communicating Beyond the patient: With relatives and carers
Resourcesin current use: N= 11,Others: N=1, Wish list: N= 2
Summary:Currently used:This type of communication was built in to a number of the scenarios used for clinical communication teaching for some schools. Other material cited were: Dipex, the use of the AMPLE criteria and materials based on feedback from carers.
Current Theory and Evidence
Resourcesin current use: N= 12, Others: N= 1, Wish list: N= 2
Summary:Currently used: Some schools provided lists of texts here (See Appendix6) and cited that they presented and signposted current and past research on clinical communication. Another school ran monthly library literature searches with their students.
Reflective Practice: N= 13
Summary:Currently used: Schools cited; case-based study, in-house guidelines and formative written reflections as useful in their teaching in this area. One school used a video byMedical Illustrations(Royal Free campus) on ‘reflecting on communication’. Other resources cited were; reflective diaries, reflective conversations with tutors, Kohlb’s reflective cycle and reflective assignments.J. Lee Moon materials were mentioned as being used by 2 schools.
Professionalism: N= 12
Summary:Currently used: Most schools cited various GMC guideline documents here including; GMC Duties of a Doctor, Tomorrow’s Doctors and Maintaining Boundaries-intimate and sensitive.
Ethics and Law: N= 11
Summary:Most participants expressed that this was taught separately from clinical communication. Those that did teach in this area cited the GMC ethical case scenario and the GMC waiting room.
Evidence-based Practice: N= 8
Summary:Currently used: IT suite practical session on the use of evidence. One school expressed that Evidence-based practice underpins all areas of the curriculum and suggested that the term ‘evidence informed care’ might be more useful in teaching.
Add materials on topics not covered: N= 4
Feedback DVD- freely available for tutor training, deep-end materials- Health Inequalities, Public Protection, integration of health and social care- understanding different communication challenges, medical error and giving apology- Scottish public services Ombudsman Guidance in apology. Health Psychology overlaps with consultation skills so many materials overlap too.
Favourite Resource: N= 3
Feedback skills DVD for tutor training
Healthtalkonline
Further contact: N= 10 provided e-mail address
Further Content Analysis: Resources currently used and/or available
In addition to exploring the data question by question, it was decided that it would be useful to look across the questions and respondents to illustrate any overlaps in terms of resources already used and suggestions made. In order to do this, each of the question summaries was imported into NVivo (Version 8) for further analysis. The data in response to what resources were currently used and available for use by clinical communication teachers across all the themes were explored by using content analysis (grouping the responses into relevant categories). The categories were created as nodes in NVivo and each reference that referred to that category was coded at the nodes. The list of categories created from the data can be found in Appendix 7.
Results of Content Analysis of Current Resources
The most prominent categories found across the survey questions and responses are explained below under each category heading, with examples of quotes from the data provided.
Collaboration
Under several of the themes (from those created in the survey) there was much talk about a collaborative teaching approach that was being adopted by some medical schools. This included both working collaboratively with other university departments as well as making links into the wider community and voluntary groups. Some examples of such teaching were as follows:
“Teaching sessions with a theatre company with actors who have intellectual disabilities”.
“We have a session involving deaf volunteers in Y2 and have now incorporated British Sign Language as one of the languages in the Use of Interpreter session”.