What interventions or training methods improve observable communication skills among physicians?

Effective Interventions for Improving Physician Communication Skills

Intensive, practice-oriented communication training programs lasting at least one day that focus on active learning strategies such as role-play, feedback, and small group discussions are the most effective interventions for improving observable communication skills among physicians. 1

Evidence-Based Communication Training Approaches

Duration and Format Requirements

• Communication skills training programs are most effective when they last for at least one day, are learner-centered, and focus on practicing skills rather than just theoretical knowledge 1
• Longer training programs (1-12 months) show more sustainable improvements in communication quality compared to brief interventions such as 1-hour workshops or 1-day training sessions 2
• Improvements in communication skills may diminish over time, with one study showing loss of improvement at 6-month follow-up, suggesting the need for ongoing reinforcement 2

Most Effective Training Methods

• Active, practice-oriented strategies should form the core of communication training programs 1
• The most effective training strategies include:
  • Role-play exercises with feedback 1, 3
  • Small group discussions to process experiences 1
  • Coaching with standardized patients 3
  • Video recording of encounters with subsequent review 3
• Supportive strategies that should only supplement active practice include oral presentations, modeling, and written information 1

Simulation-Based Training

• Brief, intensive coaching using simulated patient encounters has shown significant improvement in physician communication competence and self-efficacy 3
• The combination of self-assessment and skills teaching from experienced coaches following simulated encounters is particularly effective 3
• Improvements in self-efficacy for physician-patient communication can be sustained for at least 6 months after simulation-based training 3

Specific Communication Skills to Target

Patient-Centered Communication Techniques

• Training should focus on five key recommended practices to foster meaningful connections with patients 2:
  1. Preparation with intent before seeing the patient
  2. Listening intently and completely while sitting down
  3. Formulating an agreed agenda with the patient about what matters most
  4. Connecting with the patient's story
  5. Exploring emotional cues by naming and validating the patient's feelings

Active Listening and Emotional Engagement

• Physicians should be trained in active listening techniques and allowing patients adequate time to speak without interruption 2, 4
• Training should emphasize empathic addressing of emotions, as studies show physicians often respond to only 28% of emotional cues compared to 72% of informational cues 2
• The NURSE mnemonic (Naming, Understanding, Respecting, Supporting, Exploring) can be taught as a framework for addressing patients' emotions 2

Structured Information Exchange

• Implementing standardized information checklists can refine communication between healthcare professionals 5
• The "ask-tell-ask" approach should be taught to avoid overwhelming patients with medical information 4
• Training should include techniques for eliciting the patient's agenda with open-ended questions, especially early in the encounter 4

Implementation Considerations

Organizational Support

• Communication skills programs should be embedded as 'core business' within healthcare organizations rather than relying on provisional funding 6
• Communication training should be part of the organizational quality assurance framework, such as including communication skills in clinical audits 6
• Clear protocols should be established for communication during key transition points in care 5

Trainer Qualifications

• Programs should be delivered by trainers who understand communication micro-skills and have the confidence to observe interactions and coach learners 6
• Experienced clinicians who can provide meaningful feedback on realistic clinical scenarios are most effective as communication skills trainers 3, 6

Common Pitfalls to Avoid

• Relying solely on didactic teaching without practice components 1
• Short, one-time interventions without follow-up reinforcement 2
• Failing to adapt communication training to individual learners and local needs 6
• Neglecting to measure outcomes of communication training with validated tools 2

Impact on Patient Outcomes

• While communication training consistently improves clinician self-reported communication skills and comfort, evidence for improvement in patient-reported outcomes remains limited 2
• Some studies have shown potential improvements in aspects of family satisfaction with communication, including frequency and honesty of communication 2
• Poor communication can lead to patient dissatisfaction, anxiety, depression, PTSD, and complicated grief, highlighting the importance of effective communication training despite limited evidence on patient outcomes 2