Peer led training in communication skills

Despite recent changes to the medical curriculum there are still regular reports in the media that criticise the bedside manner and communication skills of doctors and medical students.^{1 2} These shortcomings may also be the reason for official complaints and legal action against doctors.³ So, without looking for someone to blame for this continuing trend, what can be done to improve the communication skills of tomorrow’s doctors? Perhaps a student led scheme at Lewisham Hospital offers an answer.

In 2004 a young psychiatrist, Dr Sarah Stringer, inspired by her undergraduate training in communication skills at Cambridge University’s Anatomy B course, decided to implement an arrangement for informal feedback to her psychiatry teaching, with the intention of improving student doctors’ communication skills as well as preparing them for their upcoming objective structured clinical examinations (OSCEs; box 1).

Three years and three awards for teaching excellence later, the sessions have evolved to include a multidisciplinary team of professional actors, foundation year 1 doctors, nurses, and psychiatrists who support senior students to run the teaching. These “peer facilitators” must go through an audition process to ensure good communication skills, ability to teach, and potential of learning from such experience.

Role play and feedback

The sessions begin with a brief talk on the topic of the day (for example, psychosis), which has previously been covered in a more comprehensive lecture. This ensures that all the students have a basic knowledge of the subject and allows clarification of uncertainties before proceeding to the task at hand, be it participation in a role play or peer feedback, which is equally educating.

The students are split into smaller groups run by a pair of peer facilitators and their multidisciplinary support team. One student volunteers for the role play with an actor playing a patient, while other students take feedback tasks (box 2). The task names are meant to be a little tongue in cheek to encourage a relaxed atmosphere.

A written vignette is then provided to the interviewer, giving the patient’s background information and instructions for the interview. Although the role play is to be completed within the usual time for OSCEs, the students are allowed breaks to gather their thoughts and ask for guidance from the group if stuck.

In the feedback process after the role play, the interviewer first reflects on his or her own performance before receiving the views of the patient. The group then gives feedback, and the facilitators encourage relevant discussion. Similar to Pendleton’s rules of feedback,⁴ which move from positive to more critical feedback, this approach immediately covers the important parts of the interview, making it memorable. It also makes students more comfortable in giving feedback; lets them all learn from each other; and builds confidence in future doctor-patient interactions. Finally, written feedback is given to the interviewer, and the scenario is brought to a close on a positive note by the peer facilitators, giving way to the next role play.

To build the confidence of the group, everything occurring in the sessions is confidential. This is crucial because all participants at one time or another may show vulnerability, and the agreement serves to build respect, trust, and professionalism.

Everybody learns from it

We have learnt much by thoroughly observing and helping our junior peers. Our role as facilitators has improved our confidence as well as our knowledge of psychiatry and has made us more aware of our own way of communicating. We have been privileged to support, help, and watch our peers improve their basic skills and general confidence after role plays, interesting discussions, and the guidance of the facilitating team.

The last group of students who attended this teaching achieved an impressive pass rate in the psychiatry OSCE. So the sessions have grown very popular, to the extent that enthusiastic students hoping to join the session from other hospitals have had to be turned down. Hopefully, other centres can adopt this informal approach as an alternative means of teaching students, increasing patient satisfaction by improving the doctor-patient relationships of the future.

We thank Sarah Stringer and the Lewisham teaching team for all their help and support; Martin Johnson and Penny Henderson for the Anatomy B course (1998-9).

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

For more information and handouts visit www.extremepsychiatry.com.

1. Robinson A. Why medical students are lacking in bedside manners. Independent 2007 Feb 20. http://news.independent.co.uk/health/article2287568.ece
2. Aladesanmi. Medication adherence and physician communication skills. Arch Intern Med 2007;167:859-60.
3. Hickey J. Communication is the key. MPS Casebook 2007;15(2):8-9.
4. Pendleton D, Scofield T, Tate P, Havelock P. The consultation: an approach to learning and teaching. Oxford: Oxford University Press, 1984.

       

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