Coming of age as communicators: differences in the implementation of common communications skills training in four residency programmes.
OBJECTIVE
To determine thematic similarities and differences in the implementation of common-content communications skills training (CST) in medicine, surgery, paediatrics, and obstetrics and gynaecology residency programmes.


METHODS
Communications skills training based upon the Kalamazoo consensus statement of communication skills in the clinical encounter was implemented in 4 residency programmes. Field notes of the CST sessions in each programme were analysed and coded for themes, considering the domains of Context, Input, Process and Product ('CIPP' methodology). Immediate learning outcomes were quantitatively assessed using retrospective pre/post methodology.


RESULTS
Important differences were noted in the implementation of CST in the 4 disciplines. The 2 surgical disciplines showed relatively less reflective language and greater concentration on straight skill acquisition, whereas the 2 medical disciplines concentrated on the residents' role as teachers of communication skills for buy-in. Thematic similarities between disciplines included similar challenges to being good communicators in practice, as identified by residents (e.g. inadequate time and space), as well as lack of formal training. Quantitative learning outcome data from the educational intervention were significant in all groups (P < 0.05).


CONCLUSIONS
Common material in CST can be adapted to different disciplines. By analysing for thematic similarities and differences in implementation in the 4 disciplines, a picture of different pedagogic 'subcultures' emerged, with different behavioural norms and values related to the doctor's role as communicator. In shared core competency training, it may be useful to consider these differences in planning, so that the training may be both sensitive to the behavioural norms of different disciplines, and effective.
Razack
Saleem
S
Centre for Medical Education, McGill University, Montreal, Quebec, Canada. saleem.razack@muhc.mcgill.ca
Meterissian
Sarkis
S
Morin
Lucie
L
Snell
Linda
L
Steinert
Yvonne
Y
Tabatabai
Diana
D
Maclellan
Anne-Marie
AM
D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D013502:General Surgery / Q000193:education; D006176:Gynecology / Q000193:education; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency / Q000592:standards*; D009774:Obstetrics / Q000193:education; D010372:Pediatrics / Q000193:education; D010817:Physician-Patient Relations; D015397:Program Evaluation; D012381:Role Playing; D011795:Surveys and Questionnaires; D013663:Teaching / Q000379:methods