Communication Skills Week 6 PDF

Experiential Learning  Communication was not recognized as a field in which improvement was needed. Medical students as well as physicians were supposed to know how to communicate, just like physicians were supposed to know how to teach. They revealed dissatisfaction with the quality of...

Experiential Learning  Communication was not recognized as a field in which improvement was needed. Medical students as well as physicians were supposed to know how to communicate, just like physicians were supposed to know how to teach. They revealed dissatisfaction with the quality of communication in healthcare, and increasingly patients and the public became aware that there was a strong need for improvement. Elaboration refers to the linking of new knowledge and skills to what we already know. This has been found to anchor the new knowledge and skills better in memory. Context adds relevance to the learning; learners will realise they need the new knowledge and skills in order to address patient Learning preferably occurs in a surrounding that resembles the environment where the new knowledge and skills are needed. This facilitates retrieval when we need it. Collaboration allows the learner to weigh arguments and balance  The best driving force for effective and deep learning is the learner’s motivation when learners have a lack of insight into the need to improve their communication, we cannot count on their motivation. This can be solved in several ways. One solution would be to wait until they actually run into communication difficulties and then help them recognize this, analyse and reflect on the difficulty and then practice with a remedy. learning cycle’ he describes how concrete experiences (inductively) lead to potential theories, which are (deductively) tested in new situations. This process is repeated regularly. It presupposes that the learner is actively involved in an experience, reflects on the experience, analyses the experience and uses the new ideas gained from the experience. It is this cyclical characteristic that helps any new information and skills to be stored in the memory and be retrieved when needed.  communication learning it is not enough to practise just once, even when the learners are observed and receive feedback on their skills. This confrontation is instructive, but it also reinforces what learners do not do well. As suggested by Salmon and Young (2011), reflection should be included, and alternatives should be generated applying new behaviour’ to a process of internalisation and personalisation, in which the alternative communication becomes more authentic. To allow this to happen, alternatives for the early, intuitive approach Learners should receive feedback about how well they do in a given situation, in comparison to what is expected of them an OSCE, we see them behave in quite artificial ways, in order to meet what they interpret as the demands of the instrument  The fourth problem can be seen by teachers in medical schools who teach across different phases of the curriculum Empathy tends to decline across the duration of the medical course (Neumann et al. 2011). Students who were able to communicate in a patient‐centered way in preclinical training demonstrate less of that ability during the clinical phase of their study  Transformative Learning and High‐Fidelity Simulation Transformative and reflective learning are closely aligned in their historical development, combining fundamental ideas within educational theory. When expressed through a variety of simulated learning activities these theories enable us to challenge underlying ideas about clinical practice, creating a reflective discourse that enables reconstruction of various experiences to guide future practice, placing constructivism at the centre of this process – that is, that learners ‘construe, validate, and reformulate the meaning of their experience’  The educational theories providing the foundation for the spectrum of simulation activities include the concepts of behaviourism and constructivism. The concepts of cognitivism and social constructivism are crucial in formulating ideas and learning from simulation, specifically how new experiences are assimilated and accommodated into new knowledge and social understanding. These notions illustrate a more complex understanding of various concepts and how they can be integrated into current thoughts that advance the learner’s professional expertise  Simulation‐based medical education Simulation‐based activities provide the setting for learning specific technical skills, assessing competencies and analysing tasks that may entail any combination of cognitive, psychomotor or attitudinal domains Simulation is gradually being used to explore the complexities of clinical reasoning from the twin paradigms of information processing and judgement theory recognised under the term ‘Dual Process Theory’ This theory proposes that clinical reasoning is a combination of analytic and non analytic reasoning within multiple levels in the decision‐making space, dictated by the context of the problem and the experience of the clinician.  Feedback and cognitive processes in simulation Feedback is often viewed as an ‘extrinsic process’ imparted by a trainer or facilitator who has the expertise to deliver constructive feedback using trusted guidelines such as agenda‐led, outcome‐based analysis (‘ALOBA’) or Pendleton’s rules Studies seeking to uncover cognitive attributes through simulation are better served through reflective discussions using generic prompts with the learner; for example, ‘What were you thinking at this point’? or ‘How did this factor affect your d ecision making’? Critical reflection may also be provoked through the intrinsic conversation embedded in the experience; that is, the internal conversation that the participant has with him or herself about what happened and why  This may include reflection upon action, seeing ways of doing things differently, analysis of decision making, changing behaviour and reconsidering attitudes. These all provide impetus towards reconstructing practice for the learner Transformative learning can be facilitated through either form of feedback and/or reflection, using personal experiences or vicarious learning through observation of others. High‐fidelity simulations using standardised patients or human patient simulators with filmed performance for subsequent reflective discussion provide an additional opportunity to ‘mull over’ the consequences of actions and thoughts, sometimes using delayed reflection to maximise learning outcomes Adaptive cognitive processes are employed by learners exposed to simulation activities, particularly those associated with the more significant transitions in the ‘medical continuum’; for example, the transition from ‘preclinical’ or classroom‐based learning to ‘clinical rotations‘ on the wards, which are accompanied by a greater expectation of autonomous learning and ‘stand‐alone practice’  The adaptive processes of assimilation and accommodation of experiences into future practice can be illustrated through reflective discussions following high‐fidelity simulation using simulated patients. The increasing emphasis upon patient safety issues and the avoidance of diagnostic errors in clinical practice has propelled the study of cognition using high‐fidelity simulation studies into the spotlight, with more significance upon exploring cognitive factors in medicine explicitly rather than pure technical competencies. Simulation Based strategies provide the learner with exposure to scenarios of increasing complexity in domains such as prescribing and decision making during ward rounds that could only have been learnt through assimilation ‘on the job’ previously.  Reflective Practice reflective thinking as ‘active, persistent and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it and the further conclusion to which it tends’ highlighted an important distinction between reflection and critical reflection. reflective practitioner (1991): someone who used reflection both to learn knowledge from experience and to resolve the complex and obscure problems of professional practice. Similarly, he identified that reflective learning included the handling of experience in different ways, reflecting both in and on action. Reflection in action refers to stopping, thinking and problem solving in the midst of activity – to a process of knowing in action. Alternatively, reflection on action is reserved for those non routine situations where the professional’s reflection in action is inadequate to frame the problem; knowing through action  of professional knowing and learning by categorising knowledge into two types: technical rationality and professional artistry. Technical rationality refers to the dominant scientific paradigm produced by research and ‘knowing that’ (the facts). Professional artistry is gleaned from knowledge largely emerging from professional practice and described as ‘knowing how’ Emphasising that a critical dimension of learning involves recognising and reassessing the structure of assumptions and expectations that frame our thinking, feeling and acting (Mezirow 2006), Mezirow describes these as a ‘frame of reference’. Frames of reference can be transformed through critical reflection on the assumptions upon which our interpretations, beliefs and habits of mind or points of view are based student may understand knowledge as fact and not believe that he or she is learning knowledge when observing a team. psychic refers to the way individuals view themselves and may involve exploring the autobiographical context of a belief  Each of the three components of reflection (content, process and premise) will result in changes in behaviour that reflect more fundamental changes in attitudes and beliefs. Process reflection involves analysing a range of potential strategies, exploring their suitability to address the situation and identifying alternative strategies that might be useable. However, premise reflection involves questioning the justification of the premise on which our beliefs have been constructed (that is, the taken‐for‐granted beliefs that people hold); this is much more challenging and not easy to achieve.  As we look to the future, do we need to consider how to harness the power of critical reflection more effectively within our teaching? As we look to the future, do we need to consider how to harness the power of critical reflection more effectively within our teaching? The incorporation of critical reflection is one of the great strengths of communication skills teaching, it is powerful and can produce transformational learning; that is learning that is sustained and changes us. The challenge is to ensure it is used systematically and consistently by learners Perhaps when we suspect that the students’ level of reflection is low, focusing only on the content, we may want to question whether our teaching methodologies enable us to highlight this to the learner and if so how we then move the student towards process and premise reflection.  Engaging in critical reflection on the clinical context can begin in the classroom by ensuring we enable students at the end of a simulated teaching session to critically reflect on how they need to adapt what they’ve learnt to the clinical context. Equally, students need to be appropriately prepared to critically reflect on the clinical communication they observe in practice.