title: Transfer of communication skills training from workshop to workplace: the impact of clinical supervision.
abstract: OBJECTIVE
  Recent studies have recognised that the communication skills learned in the training environment are not always transferred back into the clinical setting. This paper reports a study which investigated the potential of clinical supervision in enhancing the transfer process.
  
  
  METHODS
  A randomised controlled trial was conducted involving 61 clinical nurse specialists. All attended a 3-day communication skills training workshop. Twenty-nine were then randomised to 4 weeks of clinical supervision, aimed at facilitating transfer of newly acquired skills into practice. Assessments, using real and simulated patients, were carried out before the course, immediately after the supervision period and 3 months later. Interviews were rated objectively using the Medical Interview Aural Rating Scale (MIARS) to assess nurses' ability to use key skills, respond to patient cues and identify patient concerns.
  
  
  RESULTS
  Assessments with simulated patients showed that the training programme was extremely effective in changing competence in all three key areas. However, only those who experienced supervision showed any evidence of transfer. Improvements were found in the supervised groups' use of open questions, negotiation and psychological exploration. Whilst neither group facilitated more disclosure of cues or concerns, those in the experimental group responded more effectively to the cues disclosed, reduced their distancing behaviour and increasing their exploration of cues.
  
  
  CONCLUSIONS
  The study has shown that whilst training enhances skills, without intervention, it may have little effect on clinical practice. The potential role of clinical supervision as one way of enhancing the clinical effectiveness of communication skills training programmes has been demonstrated. PRACTISE IMPLICATIONS: This study raises questions about the effectiveness of training programmes which do not incorporate a transfer element, and provides evidence to support the need for clinical supervision for clinical nurse specialist.
authors.affiliation: Cancer Research UK Psychological Medicine Group, Manchester, UK. cathy.heaven@christie-tr.nwest.nhs.uk
authors.forename: Cathy
authors.initials: C
authors.lastname: Heaven
authors.forename: Jenny
authors.initials: J
authors.lastname: Clegg
authors.forename: Peter
authors.initials: P
authors.lastname: Maguire
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D003463:Cues; D004509:Education, Nursing, Continuing / Q000458:organization & administration*; D004650:Employee Performance Appraisal; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017008:Negotiating; D009720:Nurse Clinicians / Q000193:education* / Q000523:psychology; D009723:Nurse-Patient Relations; D009730:Nursing Assessment; D015402:Nursing Education Research; D009745:Nursing, Supervisory / Q000458:organization & administration*; D016544:Patient Simulation; D015397:Program Evaluation; D012650:Self Disclosure; D014163:Transfer, Psychology; D017132:Workplace / Q000458:organization & administration / Q000523:psychology