Volume 6

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Physician Communication Skills: Results of a Survey of General/Family Practitioners in Newfoundland

Fredrick D. Ashbury, PhD*, Donald C. Iverson, PhD† Boris Kralj, PhD‡, *Department of Oncology, McGill University

*Faculty of Nursing, University of Manitoba; Centre for Health Promotion, University of Toronto; PICEPS Consultants, Inc.; optx Corporation
† Family Medicine, University of Colorado Health Sciences Center; optx Corporation; PICEPS Consultants, Inc.
‡ Ontario Medical Association; PICEPS Consultants, Inc.

Abstract: Purpose: To describe the attitudes related to communication skills, confidence in using commnication skills, and use of communication skills during the physician-patient encounter among a population-based sample of family physicians.
Procedures: A mailed survey, distributed to all family physicians and general practitioners currently practicing in Newfoundland. The questionnaire was designed to collect data in five general areas participant demographics, physician confidence in using specific communication strategies, perceived adequacy of time spent by physicians with their patients, physician use of specific communication strategies with the adult patients they saw in the prior week, and physician use of specific communication strategies during the closing minutes of the encounters they had with adult patients in the prior week.
Main Findings: A total of 160 completed surveys was received from practicing family physicians/general practitioners in Newfoundland, yielding an adjusted response rate of 43.1%. Most of the respondents (83.8%) indicated their communication skills are as important as technical skills in terms of achieving positive patient outcomes. Between one-third and one-half of the respondents, depending on the educational level queried, rated their communications skills training as being inadequate. Fewer than 20% of the respondents rated the communications skills training they received as being excellent. Physicians indicated a need to improve their use of 8 of 13 specific communication strategies during patient encounters, and reported using few communication strategies during the closing minutes of the encounter. Interactions that occurred during a typical encounter tended to focus on biomedical versus psychosocial issues.
Conclusions: Family physicians/general practitioners recognize a need to improve their commnications skills. Well-designed communications skills training programs should be implemented at multi-levels of physician training in order to improve patient satisfaction with their encounters with family/general practitioners, and to increase the likelihood of positive patient outcomes.

Leslie Sargent Jones, PhD^*, Lance E. Paulman, PhD^* Raj Thadani, MS^†, Louis Terracio, PhD^‡,

^*Department of Developmental Biology and Anatomy, University of South Carolina School of Medicine, ^†The National Board of Medical Examiners, ^‡ School of Dentistry, New York University

Abstract - We have examined whether cadaver dissection by first year medical students (MIs) affected their performance in two test measures: the NBME Gross Anatomy and Embryology Subject Exam (dissection-relevant questions only), and practical exams given at the end of each major section within the course. The dissections for the entire course were divided into 18 regional dissection units and each student was assigned to dissect one third of the regional units; the other two-thirds of the material was learned from the partner-prosected cadavers. Performance for each student on the exams was then assessed as a function of the regions those students actually dissected. While the results indicated a small performance advantage for MIs answering questions on material they had dissected on the NBME Subject Exam questions relevant to dissection (78-88% of total exam), the results were not statistically significant. However, a similar, small performance advantage on the course practical exams was highly significant.

Sybille K Lechner BDS, MDS FRACDS, FPFA, FICD*, Peter Kandlbinder BEd (SCAE), MEd (UTS)†, Shalinie Gonsalkorale BDS (Hons), FRACDS*, Michael Bradshaw‡, Katherine M Harris (Lechner) B Soc Sci, MBA**, Tracey Winning BDSc (Hons) GradDipHEd PhD††

*School of Dental Studies, University of Sydney Australia
†Institute for Teaching and Learning University of Sydney, Australia
‡Multimedia programmer, Click Here Design Sydney, Australia
**The Leading Edge Sydney, Australia
††Dental School, Faculty of Health Sciences, Adelaide University, Australia

Abstract: The module was developed as an elective to give motivated senior dental students an opportunity to expand their horizons in planning oral rehabilitation. It comprised one tutor and 12 students, from five universities world-wide, communicating on the World Wide Web (WWW), to develop oral rehabilitation plans for simulated patients. Trigger material came from one of two Case Profiles and consisted of diagnostic casts and details of the clinical and radiographic examination in WWW/CD-ROM form. No background material was supplied as to the "patient's" age, sex, history or main concern(s). Students worked in groups of three, each student from a different location. Individual students were given a role within the group: "Patient", who developed a "personal background" belonging to the trigger examination material, "Academic" who identified state-of-the-art treatment options available for the dental treatment needs identified by the group and "General Practitioner" who tailored these options to the "patient's" needs and wants. Student feedback focused on their perception of their experience with the program in response to a questionnaire comprising 11 structured and four "open" questions. All students felt that the program increased their confidence in planning oral rehabilitation. Ten students felt that the "best thing about the program" was the interaction with students from other universities and the exposure to different philosophies from the different schools. Eight students mentioned their increased awareness of the importance of patient input into holistic planning. Under the heading "What was the worst thing", students cited some technical hitches and the snowball effect of two sluggish students who were not identified early enough and thus impacted negatively on the working of their groups. Student feedback showed that the module succeeded in its aims but needed modification to improve the logistics of working with an extended campus

Head, Discipline of Removable Prosthodontics, School of Dental Studies, University of Sydney

Abstract - With the growing awareness of the importance of teaching and learning in universities and the need to move towards evidence-based teaching, it behooves the professions to re-examine their educational research methodology. While the what, how and why of student learning have become more explicit, the professions still struggle to find valid methods of evaluating the explosion of new innovation in teaching/learning strategies. This paper discusses the problems inherent in applying traditional experimental design techniques to advances in educational practice.

Assistant Professor and Residency Network Director
Department of Family Practice
Michigan State University

Abstract - The use of an electronic mailing list as a means of communication among faculty in a network of university-affiliated family practice residency programs was evaluated. Faculty were automatically subscribed to the list by the list owner. Messages were tracked for one year and a written evaluation survey was sent. Ninety two messages were sent, with 52% of the messages being posted information. While most (65%) survey respondents reported reading 61% or more of the messages, with only 33% ever actually posted at least one message to the list. Given that faculty were automatically subscribed and that there were only 84 total members, the list may have failed to reach a critical mass of active participants. It is concluded that an email list for network faculty did not function as an online discussion group, although it was extremely beneficial as a way of posting information to affiliated residency faculty.

The Importance of Physicians' Nutrition Literacy in the Management of Diabetes Mellitus

^*Department of Health Services Administration
^†Department of Health Science Education
University of Florida

Abstract - Despite pharmacological advances in diabetes treatment, medical nutrition therapy (MNT) continues to be an essential component of diabetes management. Nonetheless, physicians have missed opportunities to provide nutrition counseling to their patients. This presents a problem because Type 2 diabetes is an epidemic with severe consequences that result from non-adherence to nutrition protocols. The goals of this article are: 1) to explore reasons for the continued paucity of nutrition education in medical training programs, 2) to describe how a power educative approach can be used to improve patient outcomes, and 3) to identify considerations for improving nutrition literacy among physicians. These analyses lead to several recommendations for improving nutrition education for physicians.

*Department of Pediatric
†Office of Institutional Analysis
University of Texas Medical Branch
Galveston, Texas

Objective:To compare the residency selection choices of students who experienced courses resulting from generalist physician initiatives to choices made by students prior to the implementation of those courses and to describe the characteristics of students selecting primary care residencies.
Background:In the fall of 1994 a first year Community ContinuityExperience course was initiated and in the summer of 1995 a third year Multidisciplinary Ambulatory Clerkship was begun at the University of Texas Medical Branch in Galveston. These courses were inserted into the curriculum to enhance and promote primary care education.
Design/Methods:We examined the residency selections of cohorts of graduating medical students before (1992-1996) and after (1997-1999) the implementation of the primary care courses. Survey information on career preferences at matriculation and in the fourth year of medical school were available for students graduating after the programs began. We compared the career preferences and characteristics of those students who selected a primary care residency to those who did not.
Results:Prior to the implementation of the programs, 45%(425/950) of students graduating selected primary care residencies compared to 45% (210/465) of students participating in the programs (p=0.88). At matriculation, 45% of students had listed a primary care discipline as their first career choice. Among the students who had indicated this degree of primary care interest 61% ended up matching in a primary care discipline. At year 4, 31% of students indicated a primary care discipline as their first career choice and 92% of these students matched to a primary care residency. By univariate analysis, minority students (53%) were more likely to select a primary care residency than non-minority students (40%); students in the two lowest grade point average quartiles (55% and 50%) selected primary care residencies compared to 37% and 38% of students in the top 2 quartiles; and students who stated that income potential had little or no impact on their choice were more likely to select a primary care residency (48%) than those who said income potential was important (37%).
Conclusions:We observed no significant trend towards higher proportions of graduating students selecting primary care discipline residencies as a result of implementing courses that emphasized primary care. Those students expressing an interest in a primary care discipline at their entrance into medical school were more likely to select a primary care residency. A more significant impact on graduating students interested in primary care may be made through the medical student selection process than by altering the curriculum.

The Brachial Plexus: Development and Assessment of a Computer Based Learning Tool

Abstract - The objective of the present study is to evaluate the use of multimedia technology to simplify study of the brachial plexus. A combination of newly-rendered illustrations, animations, explanatory text, and a set of printable sample questions were combined into a program to provide a tutorial for the brachial plexus. One aspect of the program is an animation showing the development of the brachial plexus from its developmental origins that illustrates limb rotation and the resulting adult anatomy and dermatomal arrangement. The cross-platform program requires Quicktime 3.0 and is packaged on CD-ROM. Student evaluation of the program highlights its ease of use and intuitive navigation. User evaluation provides validation that the use of illustrations and animations is beneficial to user’s understanding and retention of the material. Future plans involve incorporation of pathologic images in order to enhance the clinical relevance of the product.

Survey of Nutrition Education in U.S. Medical Schools – An Instructor-Based Analysis

Frank M. Torti, Jr.^*, Kelly M. Adams, MPH, RD^*, Lloyd J. Edwards, PhD^†, Karen C. Lindell, MS, RD^*, Steven H. Zeisel, MD, PhD^*

^*Department of Nutrition
^†Department of Biostatistics
School of Public Health
School of Medicine
University of North Carolina at Chapel Hill

Abstract - Background: Recent reports on the state of nutrition in U.S. medical schools suggest that these schools are challenged to incorporate nutrition into an already full curriculum.
Objective: The aim of this study was to determine the current state of nutrition education in US medical schools based on information reported by individuals responsible for teaching nutrition to medical students.
Design: Between July 1999 and May 2000, we surveyed 122 U.S. medical and osteopathic schools. The survey was mailed to the nutrition educator at each institution; recipients could return the survey via mail, fax, or the web.
Results: The majority of the 98 medical schools responding to the survey provided nutrition education. In 90% of responding U.S. medical and osteopathic schools (representing 88 of 98 schools and over 65% of all institutions), all students were guaranteed exposure to nutrition. An average of 18 ± 12 hours of nutrition was required, including material integrated into other types of courses.
Conclusions: Our findings indicate that nutrition education is an integral part of the curriculum for the majority of US medical schools surveyed. A number of medical schools have chosen to incorporate nutrition education into already established basic science and clinical courses.

An Integrated Approach for Evaluating Students' Achievement of Clinical Objectives

Patrick D. Bridge, PhD^*, and Kenneth A. Ginsburg, MD^†

^*Department of Family Medicine
^†Department of Obstetrics and Gynecology
Wayne State University
Detroit, MI

Abstract - During the clinical phase of undergraduate medical education (UME) students are often geographically disbursed and assigned to preceptors throughout the community. Monitoring, documenting, and evaluating their clinical experiences and achievement of clinical objectives in this venue becomes a challenge, especially for large UME programs. The purpose of this manuscript is to discuss a method for developing and implementing a school-wide evaluation system for the clinical phase of UME. This type of evaluation system links students' clinical experiential data with the objectives of a clerkship, using technological advances, such as the Personal Digital Assistant (PDA), Internet, and intranet. Clerkship directors are provided real-time reports on student's progress toward achieving clerkship objectives and are able to monitor the clinical activities of the clerkship. Students on the other hand, will be empowered to take more control of their educational experiences by monitoring their own progress.

Clinical Teaching and OSCE in Pediatrics

Professor of Pediatrics
Departments of Pediatrics and Medical Education
Faculty of Medicine, Ankara University, Ankara, Turkey

Abstract - Emphasis is being given to early contact by medical students with patients, and curricula are being designed to address this trend. Although teaching of clinical skills mostly depends on the traditional "apprenticeship" model, there is insufficient supervision of students while they examine the patients. This leads to the lack of acquisition of good clinical skills and some patient-student frustrations during examination by inexperienced students. The problem is greater in pediatric departments. One way to overcome this is to observe the students while they take a history and do a physical examination and to give them feedback. On the other hand, objective structured clinical examinations (OSCEs) should be used more in pediatric examinations to make use of the steering effect such examinations have on student achievement. However, OSCEs should not be the only student assessment tool, but should be complemented by other examination methods.

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Volume 6, 2001