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A changing culture in interpersonal and communication skills.

In summary it is essential that we improve our interpersonal and communication skills. We can learn and be taught better skills. We will be evaluated on these skills in the future, and it is important for us to establish ourselves as good role models for the future surgeons who will be entering our profession. It is of benefit to our patients and will give them a better understanding of their disease and elevate their level of healthcare. It is also important to us to help reduce our stress and to eliminate burnout. We can improve our interpersonal and communication skills in many ways. First we must be aware that there is a problem and recognize this as a problem that can be solved and that we do need to improve our current skills. This can be done through multiple educational tools such as lectures, videos, and self-assessments. The responsibility for this culture change ranges from top to bottom, but really begins at the bottom. It is important for all of us especially individuals such as myself, who is not only a practicing surgeon but also a surgeon in a leadership position, a surgeon who teaches medical students and residents, and a chairman who develops the careers of young faculty members. It is important for organizations such as the Southeastern Surgical Congress to recognize this need of our members and to conduct seminars, luncheons, and courses in helping us acquire better skills and also giving us some assessment of the current status of our skills. The American College of Surgeons has already addressed this issue by forming the Task Force on Communication and Educational Skills. Various examining boards have already incorporated this into requirements and expectations of future physicians and surgeons. We must establish ourselves as good role models. Being a good role model cannot be overemphasized. We are very fortunate in being good role models in medical knowledge and mastering phenomenal technical feats; however, this is not enough. It is also important that we also improve our interpersonal and communication skills. We must establish goals and outcomes for ourselves and work on ways of assessing these to ensure that we are effective in improving our skills. We must incorporate interpersonal and communication skills into our training programs, postgraduate courses, and all aspects of lifelong continuing education. Addressing the improvement of our interpersonal and communication skills will have many beneficial effects including improved patient outcomes, a better healthcare status for our patients, and a high level of confidence that patients have in us as physicians and surgeons. We do at times have a less than ideal collegial relationship with other disciplines in medicine. This faulty relationship needs to be rectified. We need to restore and maintain a high collegial relationship with everyone in medicine not only other physicians, but also nurses, paramedical personnel, and others. These changes will require a great deal of effort and will take some considerable time. Initially laparoscopic cholecystectomy and laparoscopic skills were not adequately learned but with recognition of its importance, education, and time, we became master surgeons. We are very fortunate to have residents and practitioners with superb laparoscopic skills that they acquired during their training and in structured postgraduate courses. Likewise it is important to incorporate interpersonal and communication skills into our training programs and our continuing medical educational programs. Finally, this is not just a touchy-feely issue, but it is one of surgical professionalism. It is critical for us to address this as an important issue since it will enhance the good qualities that we already possess. Let's start today. I have enjoyed this year being your President, and wish to thank you for the opportunity of addressing you this morning.

Communication↗

Doctor-patient communications in the Aboriginal community: towards the development of educational programs.

OBJECTIVE: Aboriginal people in Canada have poorer health than the rest of the population. Reasons for health disparities are many and include problems in communication between doctor and patient. The objective of this study was to understand doctor-patient communication in Aboriginal communities in order to design educational interventions for medical students based on the needs and experiences of patients. METHODS: Experiences of good and poor communication were studied by semi-structured interviews or focus groups with 22 Aboriginal community members, 2 community health representatives and 2 Aboriginal trainee physicians. Transcribed data were coded and subjected to thematic analysis. RESULTS: Positive and negative experiences of communicating with physicians fell into three broad and interrelated themes: their histories as First Nations citizens; the extent to which the physician was trusted; time in the medical interview. CONCLUSION: Aboriginal peoples' history affects their communication with physicians; barriers may be overcome when patients feel they have a voice and the time for it to be heard. PRACTICE IMPLICATIONS: Physicians can improve communication with Aboriginal patients by learning about their history, building trust and giving time.

Adult↗

Influencing adolescent life style: the role of mass media.

Since 1981, the Alberta Alcohol and Drug Abuse Commission has been conducting a primary prevention program intended to alter the development of intoxicant use patterns in adolescents. The program uses an integrated set of approaches involving mass communications, face-to-face program elements, community action and small-scale education activities. Mass media have a unique and powerful role as one element of such a program. Able to introduce broad concepts and convey basic, general information, they can also aid in establishing an atmosphere of acceptance of critical issues. Mass media alone probably cannot alter behavior. However, they can reinforce essential arguments and legitimize the community-based, face-to-face program elements that may be able to achieve lasting behavior change.

Adolescent↗

National program for preventing mother-child HIV transmission in Thailand: successful implementation and lessons learned.

OBJECTIVE: To describe the development, components, and initial uptake of Thailand's national program for preventing mother-child HIV transmission. DESIGN: Historical review, interpretation of experience, national program monitoring. SETTING: Public health system, Thailand. PARTICIPANTS: Policymakers, clinicians, HIV-infected pregnant women. INTERVENTION: Voluntary counseling and HIV testing of pregnant women; short-course zidovudine for HIV-infected women and their infants and formula feeding for infants. MAIN OUTCOME MEASURES: Program components implemented and program uptake. RESULTS: Research, monitoring and evaluation of pilot projects, training, and policy-making provided the information, experience, infrastructure, and guidance to develop a program for preventing mother-child HIV transmission that was implemented in all Ministry of Public Health hospitals in Thailand in 2000. A national system was established to monitor program implementation. Monitoring reports were received from 669 hospitals in 65 provinces for the period October 2000 through July 2001. During this period, 93% of 318 721 women who gave birth were tested for HIV; 69% of 3958 HIV-infected women giving birth received zidovudine; and 86% and 80% of the 3865 children born to HIV-infected women received zidovudine and infant formula, respectively, through the program. CONCLUSIONS: A national program for preventing mother-child HIV transmission was successfully implemented in Thailand. Early monitoring indicates good program uptake. Lessons learned from implementing this program include the importance of paying attention to counseling, communication, and training in the program, and using pilot projects and focused monitoring and evaluation data to guide the program development, expansion, and improvement.

AIDS Serodiagnosis↗

Communication skills training for Japanese oncologists on how to break bad news.

BACKGROUND: Despite significant communication gaps between patients and physicians, there has been little effort to initiate and evaluate teaching programs. We investigated whether a communication skills training (CST) could be effectively conducted for Japanese oncologists. METHODS: Fifty-eight oncologists participated in the CST. We evaluated the program by measuring participant-rated confidence for communication with patients, burnout, and satisfaction of participants. RESULTS: Immediately and at 3 months after CST, confidence in communication increased significantly compared with before. The providers' emotional-exhaustion 3 months after the workshop, however, worsened. The participants' satisfaction level with the program was high. CONCLUSIONS: The CST is feasible for Japanese oncologists, but it needs to be modified to reduce emotional-exhaustion.

Adult↗

Neuroendocrine-immune (NEI) circuitry from neuron-glial interactions to function: Focus on gender and HPA-HPG interactions on early programming of the NEI system.

Bidirectional communication between the neuroendocrine and immune systems during ontogeny plays a pivotal role in programming the development of neuroendocrine and immune responses in adult life. Signals generated by the hypothalamic-pituitary-gonadal axis (i.e. luteinizing hormone-releasing hormone, LHRH, and sex steroids), and by the hypothalamic-pituitary-adrenocortical axis (glucocorticoids (GC)), are major players coordinating the development of immune system function. Conversely, products generated by immune system activation exert a powerful and long-lasting regulation on neuroendocrine axes activity. The neuroendocrine-immune system is very sensitive to preperinatal experiences, including hormonal manipulations and immune challenges, which may influence the future predisposition to several disease entities. We review our work on the ongoing mutual regulation of neuroendocrine and immune cell activities, both at a cellular and molecular level. In the central nervous system, one chief compartment is represented by the astroglial cell and its mediators. Hence, neuron-glial signalling cascades dictate major changes in response to hormonal manipulations and pro-inflammatory triggers. The interplay between LHRH, sex steroids, GC and pro-inflammatory mediators in some physiological and pathological states, together with the potential clinical implications of these findings, are summarized. The overall study highlights the plasticity of this intersystem cross-talk for pharmacological targeting with drugs acting at the neuroendocrine-immune interface.

Animals↗

Developing Membership in the Education of Deaf and Hard-of-Hearing Students in Inclusive Settings.

This article discusses the importance of membership in the inclusive education of deaf/hard-of-hearing (D/HH) students. Membership refers to being an integral part of the classroom and school communities. Membership is a key philosophical concept in inclusion that may influence how classroom teachers and teachers of D/HH students share their expertise and how they work with students and each other. Membership can be contrasted with "visitorship." When programs treat D/HH students as visitors, these students face greater barriers to obtaining a quality education in classes with hearing students. A social constructivist perspective of learning and teaching that requires students in the classroom to interact with one another and the teacher may best promote learning and is consistent with a focus on membership. We suggest that inclusion is possible, but to sustain students as full members of their classes and school, programs must go beyond placement and communication access issues. To facilitate membership, inclusive programs must carefully address teacher attitudes, teacher roles and relationships, student knowledge and curriculum, structural barriers, extracurricular activities, community relationships, and parental support.

Journal Article↗

Implementation of mass media community health education: the Forsyth County Cervical Cancer Prevention Project.

The Forsyth County Cervical Cancer Prevention Project (FCP) is a community-based health education project funded by the National Cancer Institute. The target population includes around 25 000 black women age 18 and older who reside in Forsyth County, North Carolina. The overall goal of the program is to prevent mortality from cervical cancer by promoting Pap smears and return for follow-up care when needed. Based on the principles of social marketing, a plan to reach the target population with mass media educational messages through electronic and print channels was developed. Guided by marketing objectives, the target population was divided into relatively discrete segments. The segments included church attenders, patients in waiting rooms of public and selected health providers, female students at local colleges, shoppers, viewers of radio and television, newspaper readers, and business owners and managers. Introduction of the program was based on strategies developed for reaching the target population in each segment with television, radio and print mass media messages. Qualitative assessment of the mass media developed by the program indicated that all forms of communication helped to increase awareness of the program.

Adolescent↗

Self-study program on HTML browser--application to Clinical Nursing General Remarks Course.

We created a self-study program using HTML browser on the Clinical Nursing General Remarks Course, Eighty-three students each selected a published book on a personal history (written personal reflections from individuals who had undergone medical treatment and hospitalization), read it and submitted reports of their impressions of the histories. Their reports were arranged from a nursing perspective and entered on the home page of our college using HTML browser. We intended that the students would become more interested in reading of the personal histories, and that they would acquire new self-study skills and increase their interest in Internet through use of our program. In addition, we hoped that this program would encourage positive communication and mutual sharing of information. The students were able to easily refer to a personal history according to their interest from a nursing perspective. Therefore this program realized the mutual learning among students and other users.

Computer Communication Networks↗

Advancing the role of participatory communication in the diffusion of cancer screening among Hispanics.

Based on previously demonstrated methods, a cancer prevention program combining media and interpersonal communication was conducted in a Texas border city (Brownsville) in 1995-1996. To evaluate the program a quasi-experimental panel design study followed 107 women in a program site and 105 women in a comparison site from 1994 to 1996. Women in the program site reported an increase in levels of Pap screening adherence.

Adult↗

How we teach and how they learn.

Residents need to learn how to assess and accommodate to a variety of behaviors and affective styles presented by patients and their families. This requires those skills which enable them to facilitate interactions with people in a positive, effective, and efficient manner. The teaching of these interpersonal and communication skills should incorporate a multi-disciplinary model. The development and implementation of a successful resident training program requires careful attention to the establishment of goals and objectives, learning activities and evaluation strategies that will meet the needs of the resident. The utilization of a multi-teaching, multi-media, and collaborative team approach intensifies the effectiveness of the overall training program. This article describes a training program that focuses on communication skills while being mindful of the various settings in which residency training occurs. These include the use of video-tape of physician/patient interaction in continuing care clinic, communication with children in non-medical settings and audio-tape reviews of physicians telephone management in a pediatric emergency care setting. The evaluation instruments developed to assess interpersonal and communications skills are reviewed and discussed as an integral component of this educational and training model.

Communication↗

Hearing impaired families: the social ecology of hearing loss.

The services available to parents of children with hearing losses, and the options concerning the modes of communication and the educational programs for their children, have significant effects on family relations and the family's understanding of hearing impairment and deafness. This is particularly true in rural areas of British Columbia, Canada, where the range of programs is limited. This paper examines the programs available, parents' understandings of their options, the decisions they make, and the impact on the family of the selection and availability of programs.

Adult↗

Teaching patients to speak up: past and future trends.

The patient role as discussed in popular and professional literature is in a transitional period, but actual patient behaviors remain predominantly traditional. This article summarizes advice to the public concerning patient-physician communication from the past 25 years of popular periodicals and recent self-help literature. The few extant programs for improving patient communication skills are identified. Recommendations are made for more extensive patient-focused education and research regarding skills development and behavior change.

Canada↗

Impact of the family on the sex lives of adolescents.

This article presents the results of three studies as they relate to the influence of the family on adolescents' sex lives. The first study examined sexual and contraceptive practices among girls aged 12-19 in Mexico City. It was found that both communication with the mother and pregnancy history of close female relatives were predictors of initiation of sexual relations, contraceptive use, and pregnancy. The second study examined differences between young men who had gotten their partner pregnant and young men who had not. Again, communication levels with parents were found to influence behavior. The final study examined levels of communication about sex as perceived by parents and their children. Mothers had higher levels of communication with their children about sex than did fathers, and fathers' perception of what they were communicating differed substantially from their children's perception. As a whole, the three studies' results support the hypothesis that the family has a substantial influence on adolescents' sexual and contraceptive behavior and provides justification for the incorporation of such issues as parent-child communication into sex education programs.

Adolescent↗

Speech, vocabulary, and the education of children using cochlear implants: oral or total communication?

This study examines the relationship between the teaching method, oral or total communication, used at children's schools and children's consonant-production accuracy and vocabulary development over time. Children who participated in the study (N = 147) demonstrated profound sensorineural hearing loss and had used cochlear implants for between 6 months and 10 years. Educational programs that used an oral communication (OC) approach focused on the development of spoken language, whereas educational programs that used a total communication (TC) approach focused on the development of language using both signed and spoken language. Using Hierarchical Linear Modeling (HLM) we compared the consonant-production accuracy, receptive spoken vocabulary, and expressive spoken and/or signed vocabulary skills, over time, of children who were enrolled in schools that used either OC or TC approaches, while controlling for a number of variables. These variables included age at implantation, preoperative aided speech detection thresholds, type of cochlear implant device used, and whether a complete or incomplete active electrode array was implanted. The results of this study indicated that as they used their implants the children demonstrated improved consonant-production accuracy and expressive and receptive vocabulary over time, regardless of whether their school employed a TC or OC teaching method. Furthermore, there appeared to be a complex relationship among children's performance with the cochlear implant, age at implantation, and communication/teaching strategy employed by the school. Controlling for all variables, children in OC programs demonstrated, on average, superior consonant-production accuracy, with significantly greater rates of improvement in consonant-production accuracy scores over time compared to children in TC programs. However, there was no significant difference between OC and TC groups in performance or rate of growth in consonant-production accuracy when children received their implants before the age of 5 years. There was no significant difference between the OC and TC groups in receptive spoken vocabulary scores or in rate of improvement over time. However, children in the TC group achieved significantly higher receptive spoken vocabulary scores than children in the OC group if they received their implant before the age of 5 years. The TC group demonstrated superior scores and rates of growth on the expressive vocabulary measure (spoken and/or signed) when compared to the OC group if they received their implants during their preschool or early elementary school years. There was no significant difference if the children received their implants during middle elementary school. Regardless of whether children were in the OC or TC group, children who received their implants during preschool demonstrated stronger performance, on average, on all measures over time than children who received their implants during their elementary school years. The results of this study suggest that children may benefit from using cochlear implants regardless of the communication strategy/teaching approach employed by their school program and that other considerations, such as the age at which children receive implants, are more important. Implications and future research needs are discussed.

Child Language↗

Communication techniques for HMO physicians.

A program utilizing a council of health professionals found three areas of significant importance in physician/patient communication: inquiry, instruction and empathy. Attention to these three areas can improve patient adherence and decrease patient anxiety. The result can be more satisfied patients.

Communication↗