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Communication skills is a core competency for critical care fellowship training. The coronavirus disease (COVID-19) pandemic has made it increasingly difficult to teach these skills in graduate medical education. We developed and implemented a novel, hybrid version of the Critical Care Communication (C3) skills with virtual and in-person components for pulmonary and critical care fellows.To develop and implement a new hybrid virtual/in-person version of the traditional C3 serious illness communication skills course and to compare learner outcomes to prior courses.We modified the C3 course in 2020 in response to the COVID-19 pandemic by adapting large-group didactic content to an online format that included both virtual asynchronous and virtual live content. Small-group skills training remained in person with trained actors and facilitators. We administered self-assessments to the participants and compared with historical data from the traditional in-person courses beginning in 2012. After the 2020 course, we collected informal feedback from a portion of the learners.Like the traditional in-person version, participants rated the hybrid version highly. Learners reported feeling well prepared or very well prepared over 90% of the time in most communication skills after both versions of the course. Over 90% of participants in both versions of the course rated the specific course components as effective or very effective. Feedback from the learners indicates that they prefer the virtual didactics over traditional in-person didactics.Pulmonary and critical care fellows rated a hybrid version of a communication skills training similarly to the traditional in-person version of the course. We have provided a scaffolding on how to implement such a course. We anticipate some of the virtual components of this training will outlive the current pandemic based on learner feedback.

Background: VitalTalk is an established training program for serious illness conversations in the US. Previously, this training course has been provided in-person in Japanese, but never virtually. Objectives: To evaluate the feasibility of a virtually administered VitalTalk workshop in Japanese. Setting/Subjects: We conducted a virtual workshop which consisted of 2 days (3 hours per day) of synchronous sessions and preceding asynchronous modules. Five VitalTalk faculty members in the US facilitated 4 workshops for 48 physicians from 33 institutions across Japan. Learners completed surveys before and after the workshop. Measurements: To evaluate the feasibility, learners were asked for their satisfaction with the workshop and the virtual format as primary outcomes and their self-assessed preparedness in serious illness communication as the secondary outcome. Each question employed a 5-point Likert scale. Results: All learners (n = 48, male 79%) participated in the survey. The mean score of the learners’ satisfaction was 4.69 or higher in all questions. The mean score of the virtual format’s satisfaction was 4.33 or higher in all questions. The mean score of self-reported preparedness on the 11 questions were between 2.30 and 3.34 before the workshop, all of which significantly increased to 3.08 through 3.96 after the workshop (p < 0.01 in all questions). Conclusion: Learners in Japan perceived the virtual format of our VitalTalk workshop as satisfactory, and their self-reported preparedness improved significantly after the workshop. VitalTalk faculty members in the US were able to provide virtual communication training to physicians in Japan.

Background: Nurses are the most precious assets of any health-care institution, thus it's critical to understand their behavior. In this regard, the present study was carried out in order to examine the effect of communication skills training program for head nurses on interpersonal relations and nurses' organizational commitment. This study was carried out at Zagazig University Hospitals, using quasi experimental design. A convenience sample of 50 head nurses and simple random sample of 221 staff nurse from the previously mentioned setting. Tools: A questionnaire sheet was used to collect data for this study that was composed of three parts; Organization Communication Questionnaire, Fundamental interpersonal relation orientation - behavior questionnaires and organizational commitment scale. Results revealed that there was significant improvement in head nurses' communication skills mean score after the program implementation (P < 0.01). As well, there was statistically significant enhancement in their interpersonal relations with nurses mean score (P < 0.01). Additionally, there was a statistically significant improvement in nurses' organizational commitment after the program implementation (P < 0.01). Conclusion: communication skills training program for head nurses is effective in improving interpersonal relations and commitment of their nurses. Recommendation: hospital administration should establish training activities to offer nurses with key skills such as active listening, accurate feedback, and problem-solving techniques.

Although multiple consensus statements have called for large-scale efforts to improve clinicians' communication skills regarding a variety of difficult conversations in medicine, this goal will be difficult to attain because there are no readily scalable, validated communication skills training programs for clinicians. However, novel applications of existing technologies and approaches grounded in learning science can overcome the scalability barriers. Moreover, future advances in virtual reality and artificial intelligence are likely to greatly enhance the possibilities for communication skills training programs. The purpose of this paper is to propose a scalable, theoretically grounded method to train clinicians in advanced communication skills in medicine. First, we summarize four key principles of adult learning relevant to communication skills training in medicine. Second, we discuss recommended practices to design effective technology-enhanced educational interventions, with an emphasis on achieving high amounts of user engagement. Third, we synthesize these principles into a framework for a web- and videoconference-based platform for teaching advanced communication skills in medicine. Once developed, this low-cost, scalable training platform has the potential to allow thousands of clinicians to acquire the advanced communication skills needed for difficult conversations in medicine.

CONTEXT: High quality communication is essential to older adults’ medical decision-making, quality of life, and adjustment to serious illness. Studies have demonstrated that Geritalk, a two day (16 hours total) in-person communication skills training improves self-assessed preparedness, skill acquisition, and sustained practice of communication skills. Due to the COVID-19 pandemic, Geritalk was adapted to a virtual format (4 days, 10 hours total). OBJECTIVES: Our study evaluated the change in participants’ self-assessed preparedness for serious illness communication before and after the virtual course and satisfaction with the course, and compared these findings to responses from a prior in-person Geritalk course. METHODS: Geriatrics and Palliative Medicine fellows at three urban academic medical centers completed surveys, which employed 5-point Likert scales, before and after the virtual course to assess satisfaction with the course and preparedness for serious illness communication. RESULTS: Of the 20 virtual Geritalk participants, 17 (85%) completed the pre-course assessment, and 14 (70%) completed the post-course assessment. Overall, satisfaction with the course was high (mean 4.9 on a 5‐point scale). Compared to in-person Geritalk participants, virtual course participants reported comparable and significant (p

Objective: Communication Skills via Health Literacy (CSvHL) was a pilot elective communication skills training (CST) course, which allowed preclinical medical students to gain communication competence through the experience of being a health educator for high school students (HSSs). The efficacy of CSvHL was explored. Materials and Methods: All 10 medical students were prepared for their HSS-health-educator roles by participating in several observation sessions at an outpatient department and via communication workshops. In-field health education courses were subsequently delivered to HSSs by the medical students. Developments of the medical students’ communication skills were fostered through loops of learning activities and regular feedbacks. Assessments of the pre- and post-CSvHL communication skill levels by means of an OSCE, with adapted ComON Check were evaluated by each medical student, a standardized patient, and three medical instructors. Results: In general, the overall and category-specific average ComON Check scores of the whole class were significantly improved after the CSvHL course. The 3 communication defects with the lowest scores in the pre-CSvHL assessments were subsection division, summarization, and comprehension-check while counseling. Conclusion: CSvHL was successfully established as a preclinical-year CST course. The improvements in the ComON Check scores reflected the transformative learning gained from the hands-on experience, individualized CST, and 360° feedback OSCE for communication skill assessment.

Introduction: Little is known about Australian podiatry students’ preparedness for clinical placement and graduates’ preparedness for clinical practice. This qualitative study explored clinical supervisors’ perceptions of podiatry students’ and graduates’ preparedness-related challenges and their recommendations for improvement. Methods: Eleven registered podiatrists who had supervised or were still supervising students were interviewed. Transcribed interviews were thematically analysed. Benner’s (1984) stages of clinical competence from novice to expert informed the study. Results: Clinical supervisors were divided about students’ preparedness for clinical placements, with their perceptions ranging from generally prepared (n = 2) to unsure (n = 5) to unprepared (n = 4). They commented on junior versus senior students, institutional differences and specific clinical skill deficiencies, e.g., scalpel debridement and patient communication skills. Perceived challenges for students on placement included poorly developed clinical skills and low self-efficacy, both stemming primarily from insufficient hands-on experience. Participants suggested that for improved placement preparedness, students required better quality clinical experiences and communication skills training. Being work-ready, which most graduating Australian podiatrists were reported to be, involved being safe and self-efficacious. Participants also suggested that a supportive clinical environment, an internship and more advanced interpersonal skills would facilitate preparedness. Conclusion: In terms of Benner’s (1984) framework, during training, podiatry students should be considered novices, and they should be considered advanced beginners on graduation. An entry-level graduate should not be expected to be competent across all areas of clinical practice. Hands-on clinical practice during placements was needed for moving successfully through Benner’s (1984) stages of clinical competence. While clinical supervisors believed that podiatry training generally prepared students for clinical practice immediately following graduation, they asserted that manual clinical and communication skills improvement is required for clinical placements.

Background Advance care planning (ACP) is an important factor that affects the quality of end-oflife. However, health care providers are not able to sufficiently support patients' ACP due to their lack of knowledge and psychological burden. This study investigated how the knowledge, attitudes, and practices of health care providers who completed a communication skills training (CST) program for ACP discussion changed before and after the course. Methods Health care providers who participated in the Education for Implementing End of Life Discussion (E-FIELD) CST training program in Japan were surveyed at three time points: before, immediately after, and 6 months after training. The number of participants who completed all three surveys was 306. Knowledge, confidence, communication difficulties, number of discussions and completions of ACP were measured using a questionnaire. Results Participants' knowledge and confidence increased right after training compared with before training. The number of ACP discussions and completions increased significantly 6 months after training compared with before training and difficulties tended to decrease. Physicians maintained their confidence, which increased immediately after training until 6 months after training and their number of ACP discussions and completions also increased significantly 6 months after training compared with before training. Conclusions The CST program for ACP, E-FIELD, has the potential to increase the knowledge, confidence, and number of ACP discussions and completions used by physicians, nurses, and social workers, and also lower their difficulties.

Medical students who are given opportunities to teach and communicate complex information in an understandable manner will be more effective in educating patients in the future. We provided faculty and near-peer training to medical student facilitators of a community outreach program for middle school students to assess which type of training resulted in better teaching preparedness and confidence. Near-peer–trained students were more confident in their teaching compared to faculty trained counterparts; therefore, there may be some added benefit to peer-delivered/faculty-supervised training for community outreach programs.

The aim of this study was to investigate the effect of emotional communication skills training on emotion regulation, parental self-efficacy and child acceptance in mothers of children with special learning disabilities. The statistical population of this study consisted of all mothers of students with special learning disabilities. Sampling method was accessible in that the participants were selected from mothers of children with learning disabilities who referred to clinics under the supervision of education in Shiraz. Of the 32 selected participants, 15 were assigned to the experimental group and 17 to the control group, randomly. After the pretest, the experimental group was trained in emotional communication skills in ten sessions, while the control group did not receive any specific intervention. Then, post-test was performed for both groups. Garnefski Cognitive Emotion Regulation Questionnaire (CERQ), Dumka Parental Self Agency Measure (PSAM) and Parental Acceptance Questionnaire (PAQ) were used to collect data. The results indicated that the experimental and control groups had significant differences in the variables of cognitive emotion regulation, parental self-efficacy and parental acceptance. In general, the findings supported the effectiveness of emotional-communication regulation skills training on parental characteristics and personality of parents.

Objective (s): The association between self-esteem and the process of mental development of individuals and mental health is well established. In adolescence, the role of parents and their skills in communicating is very sensitive and vital. The purpose of this study was to assess the effect of parentschr('39') communication skills training on the self-esteem of adolescent female students. Methods: This was a quasi-experimental study that conducted in one of the state high schools in Damavand, Iran in 2019. The sample consisted of 77 adolescent girls and their parents who were assigned to two groups: intervention and control. Parents in the intervention group received 16 training sessions in a group pf 10 participants. The control group received nothing. In both groups students completed a self-esteem questionnaire (Cooper-Smith questionnaire) at two points in time: before intervention and three months after the intervention. The data were analyzed by Wilcoxon, Mann-Whitney and analysis of covariance using SPSS22 software. Results: Both groups were similar in most characteristics and at baseline self-esteem score did not differ significantly between two groups (p=0.49). However, after the intervention, there was a significant difference between the experimental and control groups according to analysis of covariance (p=0.001). Conclusion The findings suggest parentschr('39') communication skills training could be effective in improving adolescents’ self-esteem.

Introduction Globally, pharmacy undergraduate programs are evolving to reflect a more patient-centered approach to clinical practice. The importance of teaching communication skills in any undergraduate pharmacy curriculum cannot be overstated. This article compares current literature and practices related to pharmacy services and communication skills training (CST) in pharmacy undergraduate education in the United Kingdom (UK) and Turkey and discusses the need for an urgent change in the CST curriculum in Turkey. Additionally, the article provides potential strategies for improving the quality of CST and for expanding pharmacy practice to ensure students and graduates are motivated to use communication skills. Commentary The traditionally structured curriculum in Turkey, where the basic sciences components are in the early years and clinical experiences in the later years, should be changed into an integrated environment so that CST could be more effectively incorporated. The CST offered at the University of Nottingham could be considered as a framework. Implications To meet patient care and educational needs, the authors have identified three key strategies to develop a change in CST for curriculum planners and policy makers in Turkey.

Background: Effective communications skills are necessary in each area of life, but of particular importance in the field of nursing. Communication is the process of transmitting thoughts, feelings, and facts It is an essential element of the nurse-patient relationship. Nurses are core in strengthening the health system through effective communication with women which affects their level satisfaction. Aim: to evaluate the effect of infertility clinic nurse communication skills training on women satisfaction. Methods: Research Design: quasi experimental design (pre-post training). Setting: Private infertility center (Elbasma center). Sample: A purposive sample of all nurses working in the previously mentioned center; 20 nurses evaluated by 200 women were recruited for the study. Instruments: Four instruments were used for data collection a) Two interviewing questionnaires b) Communication skills assessment instrument c) Satisfaction assessment instrument. Results: This study revealed that there was a high significant difference at nurses communication skills and women satisfaction scores pre and post the training program. Conclusion: Communication skills training program had high significant effect on improving total communication skills of nurses and women satisfaction scores. Recommendations: On- going education for infertility clinic nurses regarding communication skills and its positive effect on women satisfaction and replication of the study with large sample size to further settings.

Introduction As junior doctors, we very rarely receive formal teaching on communication after medical school, with telephone encounters and difficult conversations over technology being a vital yet missing part of our education. The COVID-19 pandemic has required us to adapt how we communicate with patients’ families due to hospital visiting restrictions. In an era where tragically deterioration and death have been much more commonplace, we looked to identify areas where junior doctors felt their communication skills could be improved, and implemented a teaching programme to deliver this. Methods Pre-teaching questionnaires were distributed to a range of grades of junior doctors working in University Hospital of Llandough, Cardiff. The questionnaires were distributed at the beginning of June 2020, after 3 months of working in pandemic conditions. A teaching session on telephone and video communication skills was delivered by a local palliative care consultant. Post-teaching, a repeat questionnaire was undertaken to assess response and identify key learning points. Results Pre-teaching, 100% of the 22 respondents had had to participate in difficult conversations over the phone, 82% had had no formal phone based communication skills training and 81.82% felt some form of formal teaching would be helpful. Post-teaching, 12 junior doctors provided feedback with an average 37% increase in confidence to undertake difficult conversations. Key learning points from the session highlighted the importance of preparation, regularly updating the family to build trust and rapport, and integrating family updates via tele-communication into daily ward life. Conclusions Education around telephone communication skills is critical to enable us to adapt our skills in accordance with the demands of the pandemic, to continue to support relatives and to engage with technology with confidence. Increased preparation is required to navigate difficult conversations via technology, and successful communication requires clinicians to take responsibility for initiating regular family updates.

Background Transvaginal ultrasound (TVUS) training opportunities are limited due to its intimate nature; however, TVUS is an important component of early pregnancy assessment. Simulation can bridge this learning gap. Aim To describe and measure the effect of a transvaginal ultrasound simulation programme for obstetric registrars. Materials and methods The transvaginal ultrasound simulation training (TRUSST) curriculum consisted of supported practice using virtual reality transvaginal simulators (ScanTrainer, Medaphor) and communication skills training to assist obstetric registrars in obtaining required competencies to accurately and holistically care for women with early pregnancy complications. Trainee experience of live transvaginal scanning was evaluated with a questionnaire. Programme evaluation was by pre-post self-reported confidence level and objective pre-post training assessment using Objective Structured Assessment of Ultrasound Skills (OSAUS) and modified Royal Australian and New Zealand College of Obstetrics and Gynaecology assessment scores. Quantitative data was compared using paired t tests. Results Fifteen obstetric registrars completed the programme. Numbers of performed live transvaginal ultrasound by trainees were low. Participants reported an increase in confidence level in performing a TVUS following training: mean pre score 1.6/5, mean post score 3/5. Objective assessments improved significantly across both OSAUS and RANZCOG scores following training; mean improvement scores 7.6 points (95% CI 6.2–8.9, p < 0.05) and 32.5 (95% CI 26.4–38.6, p < 0.05) respectively. It was noted that scores for a systematic approach and documentation were most improved: 1.9 (95% CI 1.4–2.5, p < 0.05) and 2.1 (95% CI 1.5–2.7, p < 0.05) respectively. Conclusion The implementation of a simulation-based training curriculum resulted in improved confidence and ability in TVUS scanning, especially with regard to a systematic approach and documentation.

Background: Nurses have an important role in the process of providing information and helping patients prepare for and receive bad news and understand and cope with the bad news they have been given. This study was conducted to evaluate the effect of communication skills training on the level of skill and participation of nurses in breaking bad news. Materials and Methods: This semiexperimental study was performed on 60 nurses working in educational hospitals of Birjand, Iran in 2019. Convenience sampling was performed and the participants were randomly assigned to the two groups of intervention and control. For the experimental group, an integrated workshop on communication skills was held. Before and after the intervention, the Setting, Patient Perception, Invitation, Knowledge, Empathy, and Strategy (SPIKES) SPIKES questionnaire (breaking bad news skills) and the questionnaire of participation in breaking bad news were completed. The collected data were analyzed using descriptive and inferential statistics (independent t‑test) in SPSS software. Results: The mean (SD) of breaking bad news skills after the intervention was 57.42 (10.13) in the control group and 65.12 (5.68) in the experimental group and the between‑group difference was statistically significant ( t 59,41 = 3.93, p < 0.001). After the intervention, the mean (SD) of nurses’ participation in delivering bad news was 21.17 (5.21) in the control group and 25.77 (4.96) in the experimental group and the between‑group difference was statistically significant ( t 75,48 = 3.94, p < 0.001). Conclusions: It seems that to increase the ability of nurses in the process of breaking bad news, it is necessary to teach them communication skills.

Objective The purpose of this study was to evaluate a Communication Skills Training (CST) module for health care providers (HCPs) applying a shared decision-making approach to a meeting with an older adult with cancer and his/her family. Methods Ninety-nine HCPs from community-based centers, cancer centers, and hospitals in the Northeastern U.S. who worked primarily with older adult patients participated in a CST module entitled Geriatric Shared Decision Making. Participants completed pre- and post-training Standardized Patient Assessments (SPAs) and a survey on their confidence in and intent to utilize skills taught. Results Results indicated high HCP satisfaction with the module, with over 95 % of participants reporting high endorsement to all five evaluation items. HCPs’ self-efficacy in utilizing communication skills related to geriatric shared decision making significantly increased pre- to post-training. In standardized patient assessments among a subset of providers (n = 30), HCPs demonstrated improvements in three shared decision-making skills: declare agenda, invite agenda, and check preference. Conclusion A geriatric shared decision-making CST workshop for HCPs showed feasibility, acceptability, and improvement in self-efficacy as well as skill uptake. Practice implications This Geriatric Shared Decision-Making CST module provides an intervention for improving provider-patient-family member communication in the context of cancer care for older adults.

Funding: This research was funded by Excellent Medical Education Joint ASME/GMC Award 2018 Undergraduate category. Background : Empathy is a cornerstone of patient‐centred care. However, empathy levels among health care professionals and medical students are currently suboptimal. An empathy map is a tool which aids in understanding another person’s perspective. Empathy maps have up until now not been used in a medical education setting. Objective : To assess the attitudes towards, applicability and usefulness of empathy maps as part of medical student’s communication skills training. Methods : Empathy map training was introduced to first‐year medical student communication skills training at two UK‐based medical schools. Twenty‐eight participants in total agreed to be interviewed about their experiences using the empathy map, including sixteen students and twelve patient partners who assisted with communication skills training. Results : Medical students and patient partners perceive value in empathy map training. Medical students stated that the empathy map training impacted on their views of empathy and patient‐centredness by highlighting the importance of patient‐centred care. Medical students and patient partners enjoyed the experience of completing the empathy map and had suggestions for how it could be improved in the future. Conclusions : Empathy maps could provide a cost‐effective way to encourage empathic and patient‐centred care in medical education. Furthermore, there is no reason why empathy maps would not aid in any caring profession. Further research is needed to confirm that empathy maps do increase empathy. Publisher PDF

Background Goals of care (GOC) is a communication and decision-making process that occurs between a clinician and a patient (or surrogate decision-maker) during an episode of care to facilitate a plan of care that is consistent with the patient’s preferences and values. Little is known about patients’ experiences of these discussions. Objective This study explored patients’ perspectives of the GOC discussion in the hospital setting. Design An explorative qualitative design was used within a social constructionist framework. Participants Adult patients were recruited from six Australian hospitals across two states. Eligible patients had had a GOC discussion and they were identified by the senior nurse or their doctor for informed consent and interview. Approach Semi-structured individual or dyadic interviews (with the carer/family member present) were conducted at the bedside or at the patient’s home (for recently discharged patients). Interviews were audio-recorded and transcribed verbatim. Data were analysed for themes. Key Results Thirty-eight patient interviews were completed. The key themes identified were (1) values and expectations, and (2) communication (sub-themes: (i) facilitators of the conversation, (ii) barriers to the conversation, and (iii) influence of the environment). Most patients viewed the conversation as necessary and valued having their preferences heard. Effective communication strategies and a safe, private setting were facilitators of the GOC discussion. Deficits in any of these key elements functioned as a barrier to the process. Conclusions Effective communication, and patients’ values and expectations set the stage for goals of care discussions; however, the environment plays a significant role. Communication skills training and education designed to equip clinicians to negotiate GOC interactions effectively are essential. These interventions must also be accompanied by systemic changes including building a culture supportive of GOC, clear policies and guidelines, and champions who facilitate uptake of GOC discussions. Electronic supplementary material The online version of this article (10.1007/s11606-020-06233-y) contains supplementary material, which is available to authorized users.

Background There is widespread agreement about the importance of communication skills training (CST) for healthcare professionals caring for cancer patients. Communication can be effectively learned and improved through specific CST. Existing CSTs have some limitations with regard to transferring the learning to the workplace. The aim of the study is developing, piloting, and preliminarily assessing a CST programme for hospital physicians caring for advanced cancer patients to improve communication competences. Methods This is a Phase 0-I study that follows the Medical Research Council framework; this paper describes the following sections: a literature review on CST, the development of the Teach to Talk training programme (TtT), the development of a procedure for assessing the quality of the implementation process and assessing the feasibility of the implementation process, and the pilot programme. The study was performed at a 900-bed public hospital. The programme was implemented by the Specialized Palliative Care Service. The programme was proposed to 19 physicians from 2 departments. Results The different components of the training course were identified, and a set of quality indicators was developed. The TtT programme was implemented; all the physicians attended the lesson, videos, and role-playing sessions. Only 25% of the physicians participated in the bedside training. It was more challenging to involve Haematology physicians in the programme. Conclusions The programme was completed as established for one of the two departments in which it was piloted. Thus, in spite of the good feedback from the trainees, a re-piloting of a different training program will be developed, considering in particular the bed side component. The program should be tailored on specific communication attitude and believes, probably different between different specialties.

Despite widespread recommendations for involving patient research partners (PRPs), there is little information about how patients have been involved in research. Our aim was to describe and assess the contributions of four PRPs in a project on communication-skills training funded by Deutsche Rheuma-Liga Bundesverband e. V. (German League Against Rheumatism [GLR] is a patient organisation for people with rheumatic and musculoskeletal diseases). The PRPs' participation was beneficial with regards to content and organisation. Thanks to their participation, we could enlarge our sample by over a third, and they contributed their own ideas to the training. Four PRPs added their perspective of various regional organisations. Outside this project, they were also very active within GLR and experienced in managing their rheumatic disease. To achieve more representativeness, future studies might also employ strategies to engage individuals with less experience in dealing with their disease, e.g. newly diagnosed patients. While the collaboration between PRPs and researchers proved very successful, more regular discussions about tasks and responsibilities would be worthwhile.Obwohl die Einbeziehung von Patient*innen als Forschungspartner*innen (FP) in wissenschaftlichen Forschungsprojekten weithin befürwortet wird, gibt es bisher wenig Erfahrungsberichte über die konkrete Umsetzung partizipativer Forschungsprojekte. Dieser Beitrag beschreibt die Mitarbeit von 4 FP im Rahmen eines von der Deutschen Rheuma-Liga Bundesverband e. V. (DRL) geförderten Projekts zur Entwicklung einer Kommunikationsschulung und bewertet die Mitarbeit systematisch. Die Mitwirkung der FP ging mit inhaltlichen und organisatorischen Vorteilen einher: So konnte die Teilnehmerzahl um über ein Drittel erhöht werden. Außerdem ergänzten die FP die im Projekt entwickelte Schulung um eigene Ideen. Die 4 FP brachten ihre Erfahrungen in Bezug auf verschiedene Landesverbände ein. Sie waren unabhängig vom Projekt sehr engagiert in der DRL und hatten viel Vorerfahrung bezüglich des Umgangs mit ihrer jeweiligen rheumatischen Erkrankung. Zur Erreichung einer besseren Repräsentativität sollten künftige Studien versuchen, auch neu erkrankte und somit in Bezug auf das Krankheitsmanagement unerfahrenere Patient*innen zu beteiligen. Obwohl sich die Zusammenarbeit zwischen den FP und den Forschern als sehr erfolgreich erwies, wird ein regelmäßigerer Austausch über Aufgaben und Verantwortlichkeiten als vorteilhaft angesehen.

Background Early integration of palliative care concurrently to standard cancer care is associated with several benefits for patients and their caregivers. However, communication barriers on part of the caring physicians often impede a timely referral to palliative care. This study describes the protocol of the evaluation of a communication skills training aiming to strengthen the ability of physicians to address palliative care related topics adequately and early during disease trajectory. Methods We will implement a communication skills training and evaluate it within a prospective, multi-centered, two-armed randomized controlled trial (RCT), which will be conducted at four sites in Germany. Eligible subjects are all physicians treating patients with advanced cancer in their daily routine. An intervention group (IG) receiving a group training will be compared to a wait-list control group (CG) receiving the training after completion of data collection. At pre- and post-measurement points, participants will conduct videotaped conversations with standardized simulated patients (SP). Primary outcome will be the external rating of communication skills and consulting competencies addressing palliative care related topics. Secondary outcomes on core concepts of palliative care, basic knowledge, attitudes, confidence and self-efficacy will be assessed by standardized questionnaires and self-developed items. A further external assessment of the quality of physician-patient-interaction will be conducted by the SP. Longitudinal quantitative data will be analyzed using covariate-adjusted linear mixed-models. Discussion If the communication skills training proves to be effective, it will provide a feasible intervention to promote an earlier communication of palliative care related topics in the care of advanced cancer patients. This would help to further establish early integration of palliative care as it is recommended by national and international guidelines. Trial registration German Clinical Trials Register DRKS00017025 (date of registration: 4 June 2019).

Background For patients with cancer, being well informed by their oncologist about treatment options and the implications thereof is highly relevant. Communication skills training (CST) programs have shown to be effective in improving clinicians’ communication skills, yet CSTs are time-consuming, inconvenient to schedule, and costly. Online education enables new ways of accessible learning in a safe and personalised environment. Aim and methods We describe the design of a digital CST-tool for information provision skills that meets oncologists’ learning needs. We used the CeHRes Roadmap for user-centred design as a guiding framework. Phase 1 (Contextual Inquiry) involved consultation of the literature and a focus group interview study to uncover the learning needs and training preferences of clinicians’ regarding a digital training for the skill of information-provision. In phase 2 (Value Specification), two multidisciplinary expert panels specified the learning content and format of a digital training. Phase 3 (Design) encompassed an iterative development process, including two user group assessment sessions and 5 individual user sessions in which prototypes were tested. All sessions were recorded and independently analyzed by two researchers. Results Based on literature and consultation of the users in the inquiry phase of the development process, and on expert opinion in the value specification phase, relevant (sub) skills and user requirements were defined to consider for the digital training format. It was decided to develop a conventional e-learning and a chatbot. Personalization and interactivity were integrated in the prototypes by including features that allow for e.g., choosing text, video or animation; to upload video-recorded consultations to receive peer-feedback; and to consult a communication expert. Results revealed that, overall, participants expressed a willingness to use a digital training tool to acquire information-provision skills. Individual user testing (including junior clinicians), indicated a preference for the chatbot over the e-learning. Conclusion We offer a description of extensive development work which was conducted in collaboration with multiple health care professionals to iteratively develop two innovative prototypes of digital tools that would appropriately engage oncologists in learning effective information giving skills. The resulting prototypes were well appreciated and thus provide a solid basis for further development and testing.

Communication is a core component of effective healthcare that impacts many patient and doctor outcomes, yet is complex and challenging to both analyse and teach. Human-based coding and audit systems are time-intensive and costly; thus, there is considerable interest in the application of artificial intelligence to this topic, through machine learning using both supervised and unsupervised learning algorithms. In this article we introduce health communication, its importance for patient and health professional outcomes, and the need for rigorous empirical data to support this field. We then discuss historical interaction coding systems and recent developments in applying artificial intelligence (AI) to automate such coding in the health setting. Finally, we discuss available evidence for the reliability and validity of AI coding, application of AI in training and audit of communication, as well as limitations and future directions in this field. In summary, recent advances in machine learning have allowed accurate textual transcription, and analysis of prosody, pauses, energy, intonation, emotion and communication style. Studies have established moderate to good reliability of machine learning algorithms, comparable with human coding (or better), and have identified some expected and unexpected associations between communication variables and patient satisfaction. Finally, application of artificial intelligence to communication skills training has been attempted, to provide audit and feedback, and through the use of avatars. This looks promising to provide confidential and easily accessible training, but may be best used as an adjunct to human-based training., Highlights • Artificial intelligence (AI) applied to health professional-patient communication enables efficient audit and feedback. • Very recent advances have increased the ability of AI to encode the complexity in human interaction. • AI can now encode words as well as a person does, as well as emotion and non-verbal aspects of communication. • AI coding has been shown to be moderately to substantially reliable. • Translation into the real world has yet to be demonstrated.

Purpose Communication skills education is still relatively new in some non-Western countries. Further, most evaluation research on communication skills education examines only short-term results. In our communication skills program in Qatar, we aimed to: 1) assess the impact of the communication skills course on participant skills application; 2) assess the length of time since course completion associated with participant skills application; and 3) assess participant gender or clinical position associated with participant skills application. Methods Seven hundred and thirty-eight physicians completed a seven-module communication skills course. Participants reflected on what they learned in the course and how the course had impacted their behavior through a nine-item online survey that included a four-item Communication Workshop Impact Scale (CWIS), three open questions, and two demographic questions. To assess the effect of time since workshop on outcomes, we stratified the respondents into five groups based on how long ago they had completed the course. Results Three hundred and thirty-two physicians completed the survey. Participants reported agreement with the items on the CWIS: X=4.45 (range 1-5; SD=0.70). When asked which skill(s) they had been able to implement in their clinical practice, 235 gave a specific response, either a specific communication skill (eg, ask open questions), a higher-order category of skills (eg, questioning skills), or the name of one of the seven modules of the course. Only 28 participants listed the name of a skill or module name that they had not been able to implement. There was no evidence of difference in CWIS score based on time since course completion. There was no gender difference; however, residents had significantly lower CWIS scores than fellows (4.70 vs. 4.29, p Conclusion Participants reported agreement with response items about the impact of the course on their skills application. Participant gender did not play a significant role, but residents had lower scores than did fellows. Furthermore, most physicians (92%) were able to name something specific that they had learned from the course and were currently implementing in their practice. Positive outcomes of the course did not seem to diminish over time. Future research should identify whether observable communication behavior matches the self-reported behavior.

А comprehensive clinical, psychopathological and psychodiagnostic examination of 150 male patients with alcohol-related syndrome was conducted; The main group (the patients of which participated in the psychoeducational program) included 105 people. The control group consisted of 45 patients who received standard regulated therapy in the hospital. It was established that the clinical and psychopathological features of the formation of alcohol dependence in men are specific loss of situational control, dysphoria, affective reactions, anxiety and depression disorders depending on the predominant personally significant motives of alcohol consumption. During the course of work, the psychoeducational program was developed and tested in the system of rehabilitation of patients with alcohol dependence, the main purpose of which is a comprehensive influence on the cognitive, emotional, psycho-physiological, behavioral and social aspects of alcohol dependence. The algorithm of psychoeducation of patients with alcohol dependence is developed, which is aimed at increasing the level of special (narcological) knowledge of the patient and his family; working out of skills of solving life problems; communication skills training; training skills of co-ownership.

OBJECTIVE: This study examined the impact of a survivorship planning consultation (SPC) for patients with Hodgkin’s lymphoma (HL) and diffuse large B-cell lymphoma (DLBCL) on quality of life (QOL). We specifically assessed two potential moderators, cancer worry and perceived empathy, of the intervention effects on QOL. METHODS: This cluster randomized, four-site trial examined the efficacy of a SPC; physicians received communication skills training and applied these skills in a survivorship-focused office visit using a care plan versus a control arm in which physicians were trained to and subsequently provided a time-controlled, manualized Wellness Rehabilitation Consultation (WRC) focused only on discussion of healthy nutrition and exercise. We examined the effect of the intervention on patients’ QOL and examined potential moderators--cancer worry and perceived physician empathy. RESULTS: Forty-two physicians and 198 patients participated. There was no main effect of the intervention on any of the QOL dimensions (ps > 0.10). However, cancer worry was a significant moderator of the effects of the intervention on three QOL domains (physical p=0.04; social p=0.04; spiritual p=.01) and perceived empathy was a significant moderator of QOL (physical p=0.004; psychological p=0.04; social p=0.01). Specifically, the beneficial effects of the intervention were more pronounced among patients who initially reported higher levels of cancer worry and lower levels of physician empathy. CONCLUSIONS: This study identified two factors, perceived empathy and cancer worry, that were found to impact the QOL of patients who participated in this communication-based survivorship intervention.

PURPOSE It is challenging to add rigorous, competency-based communication skills training to existing clerkship structures. The authors embedded a simulation-based mastery learning (SBML) curriculum into a medicine subinternship to demonstrate feasibility and determine the impact on the foundational skill of breaking bad news (BBN). METHOD All fourth-year students enrolled in a medicine subinternship at Northwestern University Feinberg School of Medicine from September 2017 through August 2018 were expected to complete a BBN SBML curriculum. First, students completed a pretest with a standardized patient using a previously developed BBN assessment tool. Learners then participated in a 4-hour BBN skills workshop with didactic instruction, focused feedback, and deliberate practice with simulated patients. Students were required to meet or exceed a predetermined minimum passing standard (MPS) at posttest. The authors compared pretest and posttest scores to evaluate the effect of the intervention. Participant demographic characteristics and course evaluations were also collected. RESULTS Eighty-five students were eligible for the study, and 79 (93%) completed all components. Although 55/79 (70%) reported having personally delivered serious news to actual patients, baseline performance was poor. Students' overall checklist performance significantly improved from a mean of 65.0% (SD = 16.2%) items correct to 94.2% (SD = 5.9%; P < .001) correct. There was also statistically significant improvement in scaled items assessing quality of communication, and all students achieved the MPS at mastery posttest. All students stated they would recommend the workshop to colleagues. CONCLUSIONS It is feasible to embed SBML into a required clerkship. In the context of this study, rigorous SBML resulted in uniformly high levels of skill acquisition, documented competency, and was positively received by learners.

BackgroundStudies showed that decreased marital satisfaction and increased risk of depression and anxiety were mutually related. Therefore, this study was conducted to evaluate the effect of communication skills training with a couple focused approach on marital satisfaction and psychological symptoms among pregnant women.MethodsThis experimental study was performed on 60 pregnant women with low marital satisfaction who were divided into two groups of intervention and control. The women in the intervention group and their husbands participated in a communication training program based on the couple focused approach. The levels of anxiety, depression, and marital satisfaction were evaluated before and then one and three months after the intervention using valid questionnaires.ResultsThe results indicated that after the intervention, compared to the pre-intervention period, the levels of marital satisfaction increased while the levels of depression and anxiety decreased significantly in the intervention group (p ConclusionsThe research findings indicated that communication skills training program based on the couple focused approach and an emphasis on the needs of pregnant women during the pregnancy can improve the marital satisfaction and psychological health of pregnant women.Trial registrationIranian Registry of Clinical TrialsIRCT2017012932264N2, Date of registration: 2017-06-28 Retrospectively registered.

Background: Communication skills of nurses include two important verbal and non-verbal communication dimensions and have of great importance in hemodialysis patients. This study aimed to investigate the effect of nursing communication skills training on satisfaction of patients undergoing hemodialysis. Methods: This quasi-experimental (pretest and posttest design) was carried out on 64 nurses working in the dialysis ward and 90 hemodialysis patients in the hospitals affiliated with Alborz University of Medical Sciences. In this study, nurses and patients were selected by convenience and randomized sampling methods, respectively. In this regard, subjects were selected from the hemodialysis wards of Bahonar, Rajaei and Shariati hospitals in Karaj. Results: Most nurses were female (76.7%) and the age range of the participants was 23-54 years. Nurses achieved a high score in all dimensions of communication skills and a high total score of communication skills after the intervention, and none of them obtained a low score. There was a significant increase in nurses' communication skills after the intervention, compared to before the intervention (106.98±4.18 and 117.97±3.35) (P

Aims Community Reinforcement Approach and Family Training (CRAFT) is a support program for concerned significant others (CSOs) to identified persons (IPs) with alcohol use disorders, with the purpose of engaging IPs to treatment and to improve CSO functioning. The purpose of the present study was to investigate the efficacy of an internet-based version of CRAFT (iCRAFT). Methods Randomized controlled trial comparing iCRAFT with a wait-list (WL) condition with a nation-wide uptake in Sweden. A total of 94 CSOs to a treatment refusing IP, who described the IP according to DSM-IV criteria for alcohol dependence or abuse, were included in the study. iCRAFT consisted of five weekly administered therapist-guided modules with the following content: (a) improve CSOs’ own mental health, (b) improve the CSOs skills in asking the IP to seek treatment, (c) positive communication skills training, (d) contingency management of IP drinking behavior. Main outcome measure was IPs initiative to seek treatment measured at 24 weeks. Secondary outcomes were IP’s daily alcohol consumption, CSOs mental health, quality of life and relational satisfaction. Results Of 94 participants, 15 CSOs reported IP treatment initiative during the study period. Of these, 10 belonged to the iCRAFT condition and five to the WL condition. The difference between conditions was nonsignificant, and the results were inconclusive. Participants in iCRAFT showed short-term improvements regarding depressive symptoms, quality of life and relational happiness. Conclusion This study was unable to demonstrate substantial changes in the iCRAFT program regarding IP treatment seeking or CSO mental health.

A research-to-practice gap exists in childcare settings, particularly affecting instruction to children with developmental delays (DD) including those with or at risk for autism spectrum disorder (ASD). This study aimed to improve implementation of evidence-based instructional practices by childcare providers in inclusive center-based classrooms; a secondary aim was to examine effects on social and communication outcomes of toddlers with DD and/or ASD. Forty-eight childcare providers from 27 centers and 46 toddlers with social and/or communication delays (mean age = 28.5 months) participated in a cluster-randomized controlled trial. Providers were randomized, at the center level, to Instruction-As-Usual (IAU) or the Early Achievements for Childcare Providers (EA-CP) condition. EA-CP providers received two workshops and weekly, job-embedded coaching. Providers’ use of evidence-based instructional practices delivered within a book sharing activity, and toddlers’ cognitive, language, and social communication skills were assessed prior to and following training. Significantly greater gains from pre- to post-training in implementation of EA-CP instructional practices were observed in the EA-CP than IAU group (p

Supportive care in cancer 30(3), 1957-1966 (2022). doi:10.1007/s00520-021-06610-1, Published by Springer, Berlin

Background: Effective communication between nurses and patients in cancer is central element of care. There is a lack of understanding of the value of interpersonal communication between the cancer patients and the professional. Purposes: this study was conducted to assess the effectiveness of Communication Skills Training Program (CSTP) for undergraduate nursing students in caring for cancer patients. Method: One group pretest and posttest quasi experimental design was used to assess the effectiveness of Communication Skills Training Program for undergraduate nursing students in caring for cancer patients. A sample of thirty three students was participated. Students' knowledge was assessed by using a knowledge test. Students' communication skills were observed and evaluated pre- and post-intervention by using Checklist observation sheet namely communication skills observation checklist (SEGUE). Results: there was a significant difference between the students’ level of knowledge pre-and post-intervention (t=–10.12, p=0.001). A significant difference between the students’ level of communication pre-and post-intervention (t=-4.67, p=0.001) was found. Conclusions and Implications: communication skills among undergraduate nursing students were improved by the training program. Different teaching aid such as role playing, open discussion, and bedside demonstration were effective in increasing the level of knowledge and skills. Findings indicate that having specific communication skills program is effective in increasing nurses’ knowledge and developing communication skills also.

OBJECTIVE To investigate effects of an intensive 2-day practice-level communication skills training program (CSTP) with a 3-month follow-up communication in practice program (CIPP) on veterinary health-care team members' communication confidence, client satisfaction, and practice financial metrics. SAMPLE 5 US companion animal veterinary practices. PROCEDURES Following pilot testing at 1 veterinary practice, communication skills training was performed on-site at 4 practices. The 2-day CSTP focused on veterinary communication–specific content. The CIPP included in-practice training sessions every other week to reinforce and build upon communication skills. Team members' communication skills confidence (before and after the CSTP and after the CIPP) and client satisfaction with veterinary visits (2 months before and 3 months after the CSTP) were assessed with surveys. Practice-level financial metrics were collected for 18 months. Variables of interest were compared among time points. RESULTS Measures of team member communication skills confidence and initiation of client conversations regarding the value of goods and services were significantly greater after the CIPP than before the CSTP. Composite communication skills confidence scores 3 months after the CSTP were positively correlated with the mean practice transaction charge and percentage change in the number of heartworm tests performed in the 3 months after the CSTP, compared with results for the same 3 months in the previous year. Measurements of client satisfaction were high before and after the CSTP. There was no significant change in financial metrics in the 3 months after CSTP, compared with the same 3 months in the previous year. CONCLUSIONS AND CLINICAL RELEVANCE This study highlighted opportunities to increase veterinary health-care team members' communication confidence and identified future considerations for communication training in veterinary workplaces.

Objectives The main purpose of this article is to synthesize qualitative research exploring experiences of the factors that facilitated and hindered adherence among patients with type 2 diabetes mellitus (T2DM). Methods Twenty-six qualitative studies were purposefully included in the final sample. The Critical Appraisal Skills Program criteria for quality assessment of the studies was conducted. A meta-ethnographic approach proposed by Noblit and Hare (1988) was employed to analyze the studies. Using the “reciprocal translation” process, the authors searched for and consolidated the common themes. Results Three major themes were observed: (1) psychological determinants comprising illness beliefs, locus of control, and being forgetful; (2) sociocultural determinants of family and community, culture, and financial aspects; and (3) patients’ relationship with their physicians. Discussion The meta-ethnography underlines the importance of cultural nuances in the subjective experiences of the barriers and enablers of diabetes adherence. The findings support the need to include qualitative research methods to develop and evaluate interventions to improve T2DM adherence in patients. Clinical implications of this meta-ethnography include engaging in psychoeducation sessions for patients and caregivers, helping set reminders for patients, introducing communication skills training for healthcare providers, and including female caregivers/patients actively in diabetes care.

Background Palliative systematic treatment offers uncertain and often limited benefits, and the burden can be high. Hence, treatment decisions require shared decision making (SDM). This trial examined the independent and combined effect of an oncologist training and a patient communication aid on SDM. Methods In this multicenter randomized controlled trial with four parallel arms (2016–2018), oncologists (n = 31) were randomized to receive SDM communication skills training or not. The training consisted of a reader, two group sessions, a booster session, and a consultation room tool (10 hours). Patients (n = 194) with advanced cancer were randomized to receive a patient communication aid or not. The aid consisted of education on SDM, a question prompt list, and a value clarification exercise. The primary outcome was observed SDM as rated by blinded observers from audio‐recorded consultations. Secondary outcomes included patient‐reported SDM, patient and oncologist satisfaction, patients’ decisional conflict, patient quality of life 3 months after consultation, consultation duration, and the decision made. Results The oncologist training had a large positive effect on observed SDM (Cohen's d = 1.12) and on patient‐reported SDM (d = 0.73). The patient communication aid did not improve SDM. The combination of interventions did not add to the effect of training oncologists only. The interventions affected neither patient nor oncologist satisfaction with the consultation nor patients’ decisional conflict, quality of life, consultation duration, or the decision made. Conclusion Training medical oncologists in SDM about palliative systemic treatment improves both observed and patient‐reported SDM. A patient communication aid does not. The incorporation of skills training in (continuing) educational programs for medical oncologists is likely to stimulate the widely advocated uptake of shared decision making in clinical practice. Trial registration. Netherlands Trial Registry NTR 5489. Implications for Practice Treatment for advanced cancer offers uncertain and often small benefits, and the burden can be high. Hence, treatment decisions require shared decision making (SDM). SDM is increasingly advocated for ethical reasons and for its beneficial effect on patient outcomes. Few initiatives to stimulate SDM are evaluated in robust designs. This randomized controlled trial shows that training medical oncologists improves both observed and patient‐reported SDM in clinical encounters (n = 194). A preconsultation communication aid for patients did not add to the effect of training oncologists. SDM training effectively changes oncologists’ practice and should be implemented in (continuing) educational programs., Decisions about treatment for advanced cancer require shared decision making, involving both physician and patient. This trial examined the independent and combined effect of oncologist training and a patient communication aid on shared decision making about palliative chemotherapy.

Introduction The aims of this study were to (1) examine what makes a communication encounter with a diagnostic radiographer effective from the patient's perspective and (2) explore the impact of communication skills on the relationship between a diagnostic radiographer and their patient. Methods Semi-structured interviews were conducted with 10 patients immediately after their imaging examination. Completed interviews were analysed using an inductive approach. Results Five themes were identified in the qualitative data. (1) Introduction and Greeting, (2) Explanation/Instruction, (3) Feeling at ease, (4) Clear communication, and; (5) Gentle manner. Conclusion These results have identified that effective communication promotes the development of rapport and trust between the radiographer and patient. These findings have implications for practitioners, educators and university programs and should be considered in the development of communication skills training programs for diagnostic radiography students

BackgroundCommunication skills learned in the classroom do not transfer easily into clinical practice because they are not reinforced by teachers in the workplace setting and because lack of faculty training restricts the transfer of communication skills in real patient encounters. Trained university-based communication skills teachers often work simultaneously as doctors in clinics. This study explored if and how the skills of these teachers play a role in communication skills training in the clinical workplace.MethodsWe used an exploratory sequential design: a mixed method approach that combined a survey with communication skills teachers, and qualitative individual interviews with these teachers and their educational leaders in clinical departments. The questionnaire was analysed using descriptive statistics. The interviews were analysed using content analysis.ResultsThe response rate was 34 %. A majority (93 %) used their communication skills when communicating with patients and relatives. Less than half taught communication in clinical departments. Approximately half of the respondents stated that encouragement from their leaders or colleagues would inspire them to use their teaching skills in the workplace. However, only 20 % had told their leaders about their competencies in teaching communication. One third thought that they needed further teacher training to teach in the clinical workplace.Qualitative analysis showed that teaching opportunities existed but mainly consisted of random, one-off sessions that came about through the initiative of the communication skills teachers themselves. The teachers described several barriers, such as the challenge of teaching colleagues, as communication relates to identity and hierarchical structures, as well as a lack of requests from colleagues or management, and department culture prioritizing topics relating to medical expertise. None of the educational leaders made use of the teachers’ specific communication skills in a structured way: some saw it as unimportant, while others saw it as a potential resource.ConclusionTransfer of the teaching skills of communication skills teachers trained for university-based clinical communication training happened, but to a limited degree. Although both opportunities and barriers for transferring communication skills existed, barriers seemed to dominate, and opportunities for communication skills training in the workplace setting were not used to their full potential.

The COVID-19 pandemic has once again highlighted the relationship between skilled communication by health professionals and patient outcomes (Moore, Rivera Mercado, Grez Artigues, et al., 2018). However, the pandemic has also introduced challenges in delivering face-to-face communication skills training. To overcome these challenges and meet the ongoing need for communication skills training we used an approach based on Kolb’s (1984) model of experiential learning to adapt our ACST programme for blended learning delivery. Blended learning has been used to train health professionals for many years, but there remains much to be learned about the transition of ‘soft skills’ training to the online environment (Moore, Rivera Mercado, Grez Artigues, et al., 2018;, Kolb, 1984; Hess, Hagemeier, Blackwelder, et al, 2016). We contribute to this literature by evaluating our blended learning course in comparison to our long-running face-to-face equivalent. Our two-day course has been evaluated since inception (2016) using an anonymised, self-reported questionnaire created by Bibila & Rabiee (2013) that measures level of confidence in communication. We analysed trends in pre-/post confidence scores from our final three face-to-face courses and first three blended learning equivalents. We then used thematic analysis of participant feedback to evaluate choices made in the educational design of the blended learning course against evidence from health education literature. Trend analysis showed participants report improvements in confidence that were equivalent between the two courses. Thematic analysis demonstrated clear constructive alignment between learning outcomes, course content and participant learning. Our findings indicate that communications skills training delivered via blended learning can deliver equivalent outcomes to face-to-face learning.

IntroductionAlthough antibiotic use and antimicrobial resistance in the Netherlands is comparatively low, inappropriate prescription of antibiotics is substantial, mainly for respiratory tract infections (RTIs). General practitioners (GPs) experience pressure from patients with an immigration background to prescribe antibiotics and have difficulty communicating in a culturally sensitive way. Multifaceted interventions including communication skills training for GPs are shown to be most effective in reducing antibiotic prescription. The PARCA study aims to reduce the number of antibiotic prescriptions for RTIs through implementing a culturally sensitive communication intervention for GPs and evaluate it in a randomised controlled trial (RCT).Methods and analysisA non-blinded RCT including 58 GPs (29 for each arm). The intervention consists of: (1) An E-learning with 4 modules of 10–15 min each; (2) A face-to-face training session in (intercultural) communication skills including role plays with a training actor and (3) Availability of informative patient-facing materials that use simple words (A2/B1 level) in multiple languages. The primary outcome measure is the number of dispensed antibiotic courses qualifying for RTIs in primary care, per 1000 registered patients. The secondary outcome measure is the number of all dispensed antibiotic courses, per 1000 registered patients. The intervention arm will receive the training in Autumn 2021, followed by an observation period of 6 winter months for which numbers of antibiotics will be collected for both trial arms. The GPs/practices in the control arm can attend the training after the observation period.Ethics and disseminationThe study protocol was approved by the Medical Ethics Review Committee of Erasmus MC, University Medical Center Rotterdam (MEC-2020-0142). The results of the trial will be published in international peer-reviewed scientific journals and will be disseminated through national and international congresses. The project is funded by The Netherlands Organisation for Health Research and Development (ZonMw).Trial registration numberNL9450.

Background: Musculoskeletal pain (MSKP) is an extremely common pain disorder in almost all populations. Self-management (SM) support is a programme to prepare people to self-manage their health condition effectively, while maintaining quality of life. SM is a cost-effective and context-specific strategy to address the global public health burden. Objectives: Self-management needs a change in behaviour from seeking unnecessary medical care to safely self-managing symptoms. As changing individuals’ behaviour is challenging, the objective of my literature review was to identify the characteristics, in both therapist and patient, to successfully engage in SM. Method: A narrative literature review, that could inform evidence-based support programmes for SM of MSKP. Results: Studies on successful implementation of SM of MSKP do not report strong outcomes. However, in more recent years a few positive outcomes were reported, possibly as a result of research evidence for the application of psychosocial skills and contemporary pain neuroscience in the management of persistent MSKP. Conclusion: Psychologically-informed physiotherapy, addressing psychosocial barriers to the maintenance of SM programmes, could facilitate more successful outcomes. Clinical implications: Before engaging in a SM support programme, obstacles to behaviour change must be identified and addressed in a SM support programme, to facilitate individuals towards taking safe responsibility for their healthcare. Therapists working with patients with persistent MSKP, should upskill themselves to be in line with the latest pain and psychosocial research literature. Moreover, communication skills training seems to be a priority for effective SM support programmes.

Background: To investigate the current status of simulated patient (SP) program education in mainland China. Methods: It is a cross sectional surveys to SP program with qualitative research method and statistical analysis. The study was conducted in 79 medical colleges in mainland China. Questionnaires were distributed to 79 medical colleges in mainland China, and 68 were completed and returned. Of those, we selected 64 valid feedback (valid response rate 81.0%). We compared the current status of SP, the origin of SP, SP training course, challenge, and future plan of 79 medical colleges in mainland China. Results: The number of SP program education in medical college with long clinical programs was significantly higher than that in medical colleges with single 5-year clinical program (pConclusions: SP program has advantage of improving doctor-patient relationship. Patient and public involvement will benefit from an increase for resident proportion in SP members. Overcoming the obstacles contributes to expanding the utilization of SP program and further improving student’s communication skills.