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Promoting interpersonal skills and cultural sensitivity among dental students.

This study evaluated interpersonal communication skills among third- and fourth-year dental students during two clinical communications training programs. Students participated in two clinical communications (CC) training sessions, each comprised of four encounters with patient instructors (PIs) who were trained to enact standardized patient scenarios. Scenarios in CC1 addressed straightforward patient care situations in dentistry (e.g., bridge adjustment), while CC2 added cultural sensitivity issues to the dental scenarios. After each encounter, patient instructors used the Arizona Clinical Interviewing Rating Scale (ACIR) to rate the students' interpersonal skills and gave the students feedback on their performance. The students also received feedback and coaching from dental school faculty in debriefings after encounters with the PIs. Students anonymously rated the program at the end of each session. To evaluate the program, students' performance was compared within and between the two training sessions. Analysis showed statistically significant increases in interpersonal communication skills within each training session (p<0.05) from unsatisfactory to above satisfactory levels. Performance scores at the start of CC2 were statistically lower than at the end of CC1, suggesting that performance wanes without practice. Student evaluations of the program were very positive. Interpersonal communication skills improved during this patient instructor program.

Analysis of Variance↗

Evaluation of training program for volunteer family planning communicators.

The objectives of the VFPCs training program are to develop the strategy for promotion of sterilization by contraceptive comsumers in the provinces. The program promoted coordination among government and the private sector. The project was planned to cover 12 provinces in Northeastern Thailand. The results indicated that the project had achieved readiness to some degree. Consequently, the significant differences between pre and post tests (p less than 0.01) indicated that the VFPCs had benefited by the training program. For the most part, the objectives of training were achieved.

Communication↗

Cord blood thyrotropin screening for primary hypothyroidism on Caribbean island: a rapid communication.

Screening programs using determinations of serum thyroxine have demonstrated that congenital hypothyroidism occurs in one in 4,000 live births in North America. More than 90 percent of affected infants have primary hypothyroidism with elevated plasma thyrotropin (TSH) levels. Since the feasibility of newborn screening and incidence of congenital hypothyroidism in other less well developed areas of the world is not well defined, a study was undertaken of neonatal primary hypothyroid screening infants born on the Caribbean island of St. Lucia in the Lesser Antilles. Three hundred thirteen cord blood samples were collected on filter paper and transported 3,000 miles to Loyola University of Chicago, Stritch School of Medicine (LUMC). From LUMC, the samples were transported to the Illinois State Metabolic Screening Laboratory for determination of TSH by radioimmunoassay (RIA). In this group of newborns, the mean TSH level in cord blood was 10.23 +/- 0.29 microIU per ml (SEM). It is concluded that screening programs for neonatal primary hypothyroidism can be performed using reference laboratories far removed from the population under observation.

Atlantic Islands↗

Developing national epidemiologic capacity to meet the challenges of emerging infections in Germany.

In January 1996, the Robert Koch Institute, Germany's national public health institute, began strengthening its epidemiologic capacity to respond to emerging and other infectious diseases. Six integrated strategies were initiated: developing employee training, outbreak investigation, and epidemiologic research programs; strengthening surveillance systems; improving communications to program partners and constituents; and building international collaborations. By December 1999, five employees had completed a 2-year applied epidemiology training program, 186 health department personnel had completed a 2-week training course, 27 outbreak investigations had been completed, eight short-term research projects had been initiated, major surveillance and epidemiologic research efforts for foodborne and nosocomial infections had begun, and 16 scientific manuscripts had been published or were in press. The German experience indicates that, with a concerted effort, considerable progress in building a national applied infectious disease program can be achieved in a short time frame.

Communicable Disease Control↗

Examination of the communication practices between state newborn screening programs and the medical home.

BACKGROUND: As outlined in the Newborn Screening Task Force report published in August 2000, the newborn screening system is more than just testing, but also involves follow-up, diagnosis, treatment, and evaluation. As such, multiple professional and public partners need to be adequately involved in the system to help ensure success. In addition, newborn screening programs are state-based; therefore, policies and procedures vary from state to state. Historically, there has been little uniformity between state newborn screening programs. OBJECTIVE: To examine the communication practices of state newborn screening programs in the United States, particularly in relation to the medical home. METHODS: A facsimile survey of program staff in all US newborn screening programs. Survey data were collected in August 2000. RESULTS: All 51 programs participated. States were questioned about whether or not they had a procedure to identify the infant's medical home before the child's birth. Twelve states (24%) indicated that there was a procedure in place, whereas 39 states (76%) indicated that either no procedure existed or that they were unsure. In contrast, all state programs (except 1) indicated they notified the primary care physician about abnormal results and the need for follow-up. In addition, state programs reported that primary care physicians have responsibilities within the newborn screening system, particularly related to communicating with parents about screen-positive results and coordinating the collection of a second specimen. Thirty states reported that they directly notified parents of screen-positive infants of results and the need for follow-up as well. In regard to informing parents about newborn screening, 45% of states indicated that primary care physicians had some responsibility in informing parents about newborn screening. Most often, parents were informed about newborn screening just before specimen collection, and the most commonly used techniques to educate parents were informational brochures and conversation. Thirty-five states reported that they engaged in long-term tracking of infants after diagnosis confirmation. Only about half of these states provided long-term tracking of all of the conditions included in their state's newborn screening test panel. Of these 35 states that engaged in long-term tracking, 25 reported that they requested patient information from the primary care physician and/or subspecialist about ongoing treatment and follow-up. CONCLUSIONS: Newborn screening roles and responsibilities vary tremendously between states. Improvements in communication and better-defined protocols are needed, particularly between state newborn screening programs and the medical home. Many states identified the medical home as having significant responsibilities related to the short-term follow-up of screen-positive infants. Identification of the correct medical home before testing would help to reduce unnecessary time and frustration for state newborn screening programs, especially in the follow-up of infants that are difficult to locate. In addition, primary care physicians (ie, the medical home) need to have appropriate and ongoing involvement, including a mechanism to provide feedback to their state newborn screening program. This is particularly important given the adoption of tandem mass spectrometry by an increasing number of states, and the likely expansion of newborn screening in the future. Recommendations include the following: Primary care physicians should have appropriate and ongoing involvement in the newborn screening system and should be appropriately represented on state newborn screening advisory committees. States should develop protocols to identify the medical home before heelstick screening. States should work with families, primary care physicians, and prenatal health care professionals to develop well-defined systems for pretesting education of parents. All newborn screening results (both positive and negative) should be sent to the infant's medical home. If results are not received by the medical home, efforts should be made to obtain results. Medical homes and subspecialists should submit follow-up information on screen-positive infants and infants with confirmed diagnoses to the state newborn screening program, regardless of the existence of state requirements to do so, and efforts to build enhanced direct communication systems, linking state newborn screening programs to community-based medical homes, should continue.

Communication↗

Physicians' communication with a cancer patient and a relative: a randomized study assessing the efficacy of consolidation workshops.

BACKGROUND: Although patients with cancer are often accompanied by a relative during medical interviews, to the authors' knowledge little is known regarding the efficacy of communication skills training programs on physicians' communication skills in this context. The objective of the current study was to assess the efficacy of 6 consolidation workshops, 3 hours in length, that were conducted after a 2.5-day basic training program. METHODS: After attending the basic training program, physicians were assigned randomly to consolidation workshops or to a waiting list. Training efficacy was assessed through simulated and actual interviews that were recorded on an audio tape at baseline, after consolidation workshops for the consolidation-workshops group, and 5 months after the end of basic training for the waiting-list group. Communication skills were assessed according to the Cancer Research Campaign Workshop Evaluation Manual. Patients' and relatives' perceptions of and satisfaction with physicians' communication performance were assessed using a 15-item questionnaire. RESULTS: Sixty-two physicians completed the training program. Compared with physicians who participated to the basic training program, when addressing the patient, physicians who were randomized to the consolidation workshops used more open, open directive, and screening questions (P = 0.011 in simulated patient interviews and P = 0.005 in actual patient interviews) and elicited and clarified psychologic concerns more often (P = 0.006 in simulated patient interviews and P < 0.001 in actual patient interviews). When they addressed the relative, physicians who were randomized to the consolidation workshops gave less premature information (P = 0.032 in simulated patient interviews and P < 0.001 in actual patient interviews). When they addressed the patient and the relative simultaneously, physicians who were randomized to the consolidation workshops used more empathy, educated guesses, alerting to reality, confronting, negotiating, and summarizing (P = 0.003 in simulated patient interviews and P = 0.024 in actual patient interviews). Patients, but not relatives, who interacted with physicians in the consolidation-workshops group were more satisfied globally with the interviews (P = 0.022). CONCLUSIONS: Six 3-hour consolidation workshops resulted in improved communication skills addressed to patients and to relatives. The current results showed that the transfer of skills addressing relatives' concerns remained limited and that consolidation workshops should focus even more systematically on the practice of three-person interviews.

Communication↗

Residents' perceptions of communication skills in postgraduate medical training programs of Pakistan.

BACKGROUND: The importance of communication skills in postgraduate medical training is likely to be highlighted given the convergence of research and educational forces. Assessment of these skills in residency training is vital since it can provide basis for policy undertaking among Pakistani medical academia for improving postgraduate training programs. AIM: To assess the perceived status of communication skills of residents in different specialties. MATERIALS AND METHODS: A cross sectional survey was conducted in four teaching hospitals of Karachi between July 1999 and January 2001. A total of 455 residents in different residency programs were contacted. Residents registered both with College of Physicians and Surgeons of Pakistan and Postgraduate Medical Education office of selected hospitals were included in this study. Responses of residents were obtained on 5-point Likert scale. Indices were formed for three components of communication skills: informative, affective and professional communication. STATISTICAL ANALYSIS: Differences between residents' groups were assessed through analysis of variance. RESULTS: Total informative communication index was lowest for multi-disciplinary (12.05, SD = 4.87) and highest for surgical (15.27, SD = 2.51) residents. Total affective index was lowest for multi-disciplinary (12.58, SD = 5.68) and highest for medical (15.74, SD = 3.59) residents. The group differences for four groups of residency programs were not statistically significant for either professional attributes separately or for the total professional index. CONCLUSIONS: The residency programs must establish goals, process and outcomes to incorporate communication skills in postgraduate medical training since this can enhance residents' performance as effective health care providers. Accomplishment of better communication skills can be achieved if the importance of its teaching and training is valued by residency program coordinators.

Adult↗

Evaluation and communication: using a communication audit to evaluate organizational communication.

This article identifies a surprising dearth of studies that explicitly link communication and evaluation at substantive, theoretical, and methodological levels. A three-fold typology of evaluation studies referring to communication is proposed and examples given. The importance of organizational communication in program delivery is stressed and illustrative studies reviewed. It is proposed that organizational communication should be considered in all program evaluations and that this should be approached through communication audit. Communication audits are described with particular reference to established survey questionnaire instruments. Two case studies exemplify the use of such instruments in the evaluation of educational and social programs.

Communication↗

Micro-mainframe-like personal clinical research system.

We constructed a micro-mainframe-link clinical research system for personal use (Personal Clinical Research System). This system was developed with both a mainframe computer and a personal computer (PC). The prepared programs included a database manager (on the mainframe computer), a user interface program (on the PC), and a communication control program that connected the mainframe computer with the PC. The database on the mainframe computer was constructed by two methods. The first method was to transmit data from the PC to the mainframe computer. The second method was to extract data from the patient information database. Using this system, a physician is able to construct a personal research database that contains interesting data for the physician. In addition, the physician is able to accumulate data on a special field using this system. A discharge summary system is now in operation as an example of this system.

Computers, Mainframe↗

A visual data flow environment for macromolecular crystallographic computing.

This article describes the integration of programs from the widely used CCP4 macromolecular crystallography package into a modern data flow visualization environment (application visualization system [AVS]), which provides a simple graphical user interface, a visual programming paradigm, and a variety of 1-, 2-, and 3-D data visualization tools for the display of graphical information and the results of crystallographic calculations, such as electron density and Patterson maps. The CCP4 suite comprises a number of separate Fortran 77 programs, which communicate via common file formats. Each program is encapsulated into an AVS macro module, and may be linked to others in a data flow network, reflecting the nature of many crystallographic calculations. Named pipes are used to pass input parameters from a graphical user interface to the program module, and also to intercept line printer output, which can be filtered to extract graphical information and significant numerical parameters. These may be passed to downstream modules, permitting calculations to be automated if no user interaction is required, or giving the user the opportunity to make selections in an interactive manner.

Base Sequence↗

Marrying content and process in clinical method teaching: enhancing the Calgary-Cambridge guides.

Communication skills training is now internationally accepted as an essential component of medical education. However, learners and teachers in communication skills programs continue to experience problems integrating communication with other clinical skills, ensuring that clinical faculty support and teach communication beyond the formal communication course, extending communication training coherently into clerkship and residency, and applying communication skills in medical practice at a professional level of competence. One factor contributing to these problems is that learners confront two apparently conflicting models of the medical interview: a communication model describing the process of the interview and the "traditional medical history" describing the content of the interview. The resulting confusion exacerbates the above dilemmas and interferes with learners using communication skills training to advantage in real-life practice. The authors propose a comprehensive clinical method that explicitly integrates traditional clinical method with effective communication skills. To implement this more comprehensive approach, they have modified their own Calgary-Cambridge guides to the medical interview by developing three diagrams that visually and conceptually improve the way communication skills teaching is introduced and that place communication process skills within a comprehensive clinical method; devising a content guide for medical interviewing that is more closely aligned with the structure and process skills used in communication skills training; and incorporating patient-centered medicine into both process and content aspects of the medical interview. These enhancements help resolve ongoing difficulties associated with both teaching communication skills and applying them effectively in medical practice.

Clinical Medicine↗

"Unselling" drugs: the marketing of prevention.

By borrowing from the field of social marketing, the examination and execution of drug prevention strategies should be more rigorous and disciplined by the year 2000. This article briefly describes marketing strategies and techniques which can assist in the maximization of drug prevention communications and programs.

Adolescent↗