October 5, 2009

Innovations In Teaching

by Tanya Telegadis, Pharm.D. - PGY2 Pain and Palliative Care Pharmacy Resident, University of Maryland School of Pharmacy

Boesen KP, Herrier RN, Apgar DA et al. Improvisational Exercises to Improve Pharmacy Students’ Professional Communication Skills. Am J Pharm Ed. 2009; 73: 1-8.

This article caught my eye because I have a special place in my heart for effective communication. As pharmacists, we are the most trusted healthcare professional and this is in large part due to our accessibility to the public. Patients rely on us for sound medical advice and as a platform to bounce ideas off of and to vent frustrations. In a community pharmacy setting, we have one, two, maybe three minutes with a patient and in this time, we need to establish a relationship with them. We need to be able to listen to what is said, come up with an appropriate response and then relay the information in an effective and appropriate matter (urgency, emergency, sympathy, empathy, concern, etc). In interactions with pharmacists throughout the years, I have seen those who I try to model and those who, quite frankly, make me thankful I am not the patient. In school, we do an excellent job of training in the necessary sciences and technical evaluation skills. My fear is that communication skills are compromised as students hone in on proficiency in the information they need to know and the technical skills they need to demonstrate. This article looks at improvisation, a very interesting way to incorporate communication skills into the pharmacy school curriculum.

The authors implemented twelve 1-hour improvisational sessions into an existing communication course in order to improve listening, observing and responding. They require a course in interviewing and communication skills for the first year students. In this course, students must pass a mock-patient (instructor) interview assessment by demonstrating minimum competencies in interviewing and counseling techniques as well as be able to adapt these to real world situations. They found that a majority of the student struggled with how to quickly recognize cues that would tell them when to address the patient’s emotional state and new physical symptoms. The students were so focused on gathering the information that they missed the cues, so much so that the mock-patient had to resort to exaggerated cues before students recognized a need to change their interview techniques. With this realization, the instructors decided to implement this improvisation plan into their course. They used standardized patient exams to assess student performance in communication skills (the success of their educational program), and reflective journaling and student evaluations to evaluate student’s perceptions of the improvisational exercises.

The purpose of these exercises was to enable students to: (1) develop additional expertise in the “art” of basic communication skills (2) improve the ability to think on their feet (3)understand the importance of emotion and relation in communication (4) become more comfortable in communicating in large groups (5) recognize basic dynamics of group communication and (6) learn to stay “in the moment” focusing on the patient/healthcare provider while recognizing when to change techniques and avoiding the temptation to anticipate. I think that all of these attributes are extremely important to being an effective patient educator … and even during non-professional interactions. These are life skills that some students already possess but can improve … and other students need to acquire.

The researchers addressed each goal with a specific exercise. In the interest of time, I will not explain each exercise but get at what the exercises were intended to achieve. They used “repeated patterns” as not only an ice-breaker but as a means of teaching students to listen for cues, respond accordingly, and ignore everything else in the environment. This is important because pharmacies are busy places and this should not compromise one’s attention to the patient's needs.

A second exercise involved advancing a conversation with “yes and…” Students were given their relationship to one another, their environment, and a topic to discuss. The goal was to continue to move the conversation forward. This technique was then applied to short scenarios with the goal of stressing the importance of status and emotion in every conversation.

Group communication focused on the dynamics of group communication. The goal was to maintain a single focus verbally and nonverbally.

The exercises that they implemented were very successful. Students improved on their skills (and grades!) significantly. The authors admit that some exercises made some students very uncomfortable. But I suspect that these are the students who most benefited from the exercises. Students who felt uncomfortable improve just as much as those who did not complain of discomfort. It is important for all pharmacy students to have good communication skills when working with patients and other healthcare providers.

In Educational Theory and Practice we talk about learning styles, teaching styles and implementing courses/lectures/classes successfully. It is important to keep in mind that many students are driven by grades and will easily lose sight of the whole-picture. When they lose sight of the whole picture, they are losing sight of the “whole patient”. It is our job, as educators, to emphasize the importance of good communication skills and seeing the details in the big picture. It is also our job to serve as role models of these skills and focus not just on the details but the “whole” student. Improvisation helped these researchers achieve their goals. Improvisation appears to be a innovative and fun way to teach an important but difficult skill.

[Editor's Commentary: Communication is a fundamental skill and, more than any other skill in modern life, closely correlated with one's success in nearly every profession and field. Our ability to communicate as health care professionals is a key ingredient to achieving optimal patient outcomes. As educators, pharmacists must be able to effectuate behavior change in various audiences - peers, patients, and prescribers. However, just as lecturing is not the most effective way of teaching our students, simply conveying information is not the most effective method of communicating with our patients. Both require us to know our audience, to care about them, and to listen (and talk less). Both require us to be attuned to the unspoken, non-verbal clues that our patients (and students) send to us ... and to adapt and respond to their needs. Some people are innately gifted communicators (and teachers). The rest of us can build our skills through guided practice and feedback. Teaching students to become effective communicators is perhaps the greatest gift any teacher could aspire to "give" ... and yet, its something we spend far too little time exploring and developing with our students and trainees. We need not do so in explicit ways (as the authors of this teaching innovation did) but in implicit ways by embedding opportunities to build our communication muscles in every course and learning experience. S.H.]

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