Teaching communication skills in
the class room
Professor Naser Behbehani
Department of Medicine
Kuwait University
Communication skills
what is the fundamental question?
Should the class room be the primary venue for teaching,
Communications skills?
Question
What actually happens in the class room?
• 1) Trying to emphasize the difference
between hearing and listening.
• 2) To teach about empathy.
Demonstration
Hearing
Listening
How to enhance your empathy?
Eliciting patients concerns
The Effect of Physician Behavior on the Collection
of Data.
Beckman HB, Frankel RM. 1984;101:692–6.
• 74 doctor-patients encounters in primary care Internal
Medicine clinic setting in Wayne state University in Detroit
were recorded and analyzed.
• Results
– In only 17 (23%) of the visits was the patient provided the
opportunity to complete his or her opening statement
– In 51 (69%) of the visits the physician interrupted the patient's
statement and asked direct questions toward a specific concern
– Of these 51 interrupted patients only 1 completed
statement later on.
the opening
Soliciting the patient’s agenda: have we improved?
Marvel MK, Epstein RM, Flowers K, Beckman HB
JAMA1999;281:283–7.
• 264 consecutive encounters
• By 29 board certified family physicians
• 9 had fellowship in communication skills and family
counselling (TP).
Soliciting the patient’s agenda: have we improved?
Marvel MK, Epstein RM, Flowers K, Beckman HB
JAMA1999;281:283–7.
• 264 consecutive encounters
• Results
–
–
–
–
Patients concerns were solicited in 75% of encounters
Opening statement was completed in only 28% of encounters
Opening statement was interrupted after a mean of 23.1 seconds
TP more likely to elicit patients concerns and allow them to
complete their opening statements 44% Vs 22%.
Teaching Patient Communication Skills to Medical
Students: A Review of Randomized Controlled Trials
J. Talib etal Eval Health Prof 2007 30: 3
• Systematic review of RCT evaluating the effects of teaching
on medical students’ patient communication skills.
• 24 RCT identified , 13 were pretest/posttest control group
design.
• 15 trials were included in the meta analysis as the other 9
had missing data
• Student ability to establish rapport and data gathering skills
improved
• The effects are large when the teaching intervention was
small group discussion (n = 5) or giving structured feedback
on a student-patient interview (n = 6).
Teaching Patient Communication Skills to Medical
Students: A Review of Randomized Controlled Trials
• Results
J. Talib etal Eval Health Prof 2007 30: 3
Empathy
The Devil is in the Third Year: A Longitudinal Study of Erosion of
Empathy in Medical School.
Mohammad-Reza Hojat et al Acad Med. 2009; 84:1182–1191.
• a longitudinal cohort study of 456 students at Jefferson
medical college in Philadelphia.
• Physician Empathy scale was completed by the students at 5
different times , at school entry and then at the end of each of
the academic year.
• Matched cohort n = 121: students who identified themselves
in all the 5 administrations.
• Unmatched cohort n = 335: students who did not identify
themselves in any of the 5 administrations.
The Devil is in the Third Year: A Longitudinal Study of Erosion of
Empathy in Medical School.
Mohammad Hojat et al Acad Med. 2009; 84:1182–1191.
• Results
– Empathy score declined in year 3 compared to
year 0 among 73% of students in the matched
cohort
– 27 had no decline in empathy
The Devil is in the Third Year: A Longitudinal Study of Erosion of
Empathy in Medical School.
Mohammad Hojat et al Acad Med. 2009; 84:1182–1191.
• Results:
The Devil is in the Third Year: A Longitudinal Study of Erosion of
Empathy in Medical School.
Mohammad Hojat et al Acad Med. 2009; 84:1182–1191.
• Results:
– The matched cohort
– 85 graduates pursued their residency training in “peopleoriented specialties e.g., family medicine, internal
medicine, pediatrics, emergency medicine, psychiatry,
obstetrics– gynecology.
– 36: pursued training in “technology-oriented” specialties
e.g. anesthesiology, pathology, radiology, surgery,
orthopedic surgery, etc.
Level of Empathy among Medical Students in Kuwait
University, Kuwait
S. Hasan L. Thalib et al Med Princ Pract 2013;22:385–389
N Engl J med 2012; 367:13
• Can this ability be taught? The most boring lecture I ever
attended was a lecture on compassion — and I’m
passionate about the subject. The lecturer talked about eye
contact, leaning forward, touching the patient’s elbow at
just the right moment. But these are only outward
manifestations, which can easily be faked. So how can we
wrap our minds around the problem?
How to enhance your empathy?
Doctors shadow patients’ experiences for “NHS
Change Day”
Zosia Kmietowicz , BMJ 2014;348:
• Jonathan Griffiths, a GP from Cheshire, He pledge to be on a wheelchair
for one whole day and writes about his experience
• “What struck me was how the little things we all take for granted became
so much more difficult. Things like getting through doors, driving a car, and
climbing stairs. The social isolation was the worst,” he said. “It helps me
see them as people instead of medical problems and fosters a better
patient-doctor relationship.”
Which one do you think will have a more
lasting effect on development of empathy?
To spend one morning
Shadowing a real patient
and write his/her reflection
A 50 minute lecture to
Students about empathy
The idea of patient shadowing
to enhance empathy among medical students
• "Patient care is more than just healing -- it's building a
connection that encompasses mind, body and soul. If you
could stand in someone else's shoes . . . hear what they hear.
See what they see. Feel what they feel. Would you treat them
differently?
Toby Cosgrove, MD
CEO , Cleveland Clinic
Question
Dedication for Dr. Ebaa
Conclusion
thank you for being such a lovely audience