Communication Skills in Postgraduate to Established Practice
Communication Skills in Postgraduate to Established Practice
A total of 2514 articles were identified through systematic review, 2292 articles were rejected on initial review (the majority did not involve medical personnel (1156) or communication skills assessment (728)), leaving 222 articles for abstract review. Following abstract review, 160 articles did not meet inclusion criteria, the majority did not include communication skills assessment (122), 9 were excluded for junior postgraduate year (PGY) status and 5 articles were excluded due to undergraduate status. Sixty-two articles remained for full review. Eleven further articles were identified from hand search of references, leaving 73 articles for full review. After full text review, 39 articles were excluded due to lack of communication skills assessment (21), non-medical or other medical personnel (eg, nursing) (3), early and unclear PGY status not meeting criteria (3) or the full paper was not yet published and only available in abstract form (8). Thirty-four articles were available meeting inclusion and exclusion criteria (figure 1).
(Enlarge Image)
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart for article selection. PGY, postgraduate year.
Populations. In total, 22 of the 34 articles were based in the USA, 4 in Canada, 3 in the UK, 3 in Europe (2 Belgium, 1 Netherlands), 1 in Israel and 1 in India. Eleven articles involved family/general practice/internal medicine, 8 articles involved surgical residents (orthopaedic, plastic surgery, general surgery), 5 involved oncology practitioners, 4 articles involved paediatricians, 3 involved sampling from multiple disciplines and 3 articles involved radiology residents, geriatric and palliative care fellows, and critical care fellows, respectively. At total of 1355 participants within these papers fit the inclusion criteria of within 2 years of completion of training programme or were in consultant practice (Table 1).
Communication assessment tools. Twenty-two articles used standardised patients, 9 involved OSCE or objective structured performance evaluation. The majority (n=21) involved self-assessment by questionnaire, usually an author-developed, content-specific questionnaire. Seven articles used self-assessment measures only, while the remaining 27 articles used either objective assessment by faculty/coworker and/or patient/standardised patient exclusively, or used in conjunction with self-assessment (Table 2). Nineteen articles used an educational initiative to teach communication skills. The initiatives varied from lecture-based content, training programmes, to simulated patients' scenarios (Table 3).
The quality of the studies was variable, though the majority (n=26) were grade 3 or above as scored by the BEME quality rating system. Rating of 3 or above (4 or 5) states the conclusions can probably be based on results or likely to be true based on the methodological rigour of the studies. The main weaknesses in the studies were the quality of the assessment tools and the presence of objective assessment. The majority of assessment tools (questionnaires) used were either developed by the author or the institution and were not previously validated within the literature or piloted prior to use. Those studies that scored <3 generally relied upon participants' self-assessment of ability or confidence in ability. The reliability of self-assessment to correlate with actual ability is limited. As the majority of studies had a reasonable BEME rating, the findings can probably be based on the results found (Table 2).
Results
Systematic Review Process
A total of 2514 articles were identified through systematic review, 2292 articles were rejected on initial review (the majority did not involve medical personnel (1156) or communication skills assessment (728)), leaving 222 articles for abstract review. Following abstract review, 160 articles did not meet inclusion criteria, the majority did not include communication skills assessment (122), 9 were excluded for junior postgraduate year (PGY) status and 5 articles were excluded due to undergraduate status. Sixty-two articles remained for full review. Eleven further articles were identified from hand search of references, leaving 73 articles for full review. After full text review, 39 articles were excluded due to lack of communication skills assessment (21), non-medical or other medical personnel (eg, nursing) (3), early and unclear PGY status not meeting criteria (3) or the full paper was not yet published and only available in abstract form (8). Thirty-four articles were available meeting inclusion and exclusion criteria (figure 1).
(Enlarge Image)
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart for article selection. PGY, postgraduate year.
Study Findings
Populations. In total, 22 of the 34 articles were based in the USA, 4 in Canada, 3 in the UK, 3 in Europe (2 Belgium, 1 Netherlands), 1 in Israel and 1 in India. Eleven articles involved family/general practice/internal medicine, 8 articles involved surgical residents (orthopaedic, plastic surgery, general surgery), 5 involved oncology practitioners, 4 articles involved paediatricians, 3 involved sampling from multiple disciplines and 3 articles involved radiology residents, geriatric and palliative care fellows, and critical care fellows, respectively. At total of 1355 participants within these papers fit the inclusion criteria of within 2 years of completion of training programme or were in consultant practice (Table 1).
Communication assessment tools. Twenty-two articles used standardised patients, 9 involved OSCE or objective structured performance evaluation. The majority (n=21) involved self-assessment by questionnaire, usually an author-developed, content-specific questionnaire. Seven articles used self-assessment measures only, while the remaining 27 articles used either objective assessment by faculty/coworker and/or patient/standardised patient exclusively, or used in conjunction with self-assessment (Table 2). Nineteen articles used an educational initiative to teach communication skills. The initiatives varied from lecture-based content, training programmes, to simulated patients' scenarios (Table 3).
Evaluation of Methodological Analysis
The quality of the studies was variable, though the majority (n=26) were grade 3 or above as scored by the BEME quality rating system. Rating of 3 or above (4 or 5) states the conclusions can probably be based on results or likely to be true based on the methodological rigour of the studies. The main weaknesses in the studies were the quality of the assessment tools and the presence of objective assessment. The majority of assessment tools (questionnaires) used were either developed by the author or the institution and were not previously validated within the literature or piloted prior to use. Those studies that scored <3 generally relied upon participants' self-assessment of ability or confidence in ability. The reliability of self-assessment to correlate with actual ability is limited. As the majority of studies had a reasonable BEME rating, the findings can probably be based on the results found (Table 2).
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