Medical Education
Vocational trainees’ views and experiences regarding the learning and teaching of communication skills in general practice

https://doi.org/10.1016/j.pec.2009.05.002Get rights and content

Abstract

Objective

To explore the views and experiences of general practice (GP) vocational trainees regarding communication skills (CS) and the teaching and learning of these skills.

Methods

A purposive sample of second and third (final) year GP trainees took part in six focus group (FG) discussions. Transcripts were coded and analysed in accordance with a grounded theory approach by two investigators using Alas-ti software. Finally results were triangulated by means of semi-structured telephone interviews.

Results

The analysis led to three thematic clusters: (1) trainees acknowledge the essential importance of communication skills and identified contextual factors influencing the learning and application of these skills; (2) trainees identified preferences for learning and receiving feedback on their communication skills; and (3) trainees perceived that the assessment of communication skills is subjective. These themes are organised into a framework for a better understanding of trainees’ communication skills as part of their vocational training.

Conclusions

The framework helps in leading to a better understanding of the way in which trainees learn and apply communication skills.

Practice implications

The unique context of vocational training should be taken into account when trainees’ communication skills are assessed. The teaching and learning should be guided by a learner-centred approach. The framework is valuable for informing curricular reform and future research.

Introduction

Competent doctor–patient communication is widely accepted as a major factor in effective general practice (GP). This is also reflected in its incorporation into the European definition of General Practice/Family Medicine [1] and its educational consequences as condensed in the EURACT educational agenda [2]. Similarly CanMeds state that being a competent communicator is one of the essential roles that every physician should master [3]. In recent decades, undergraduate curricular reform has resulted in increasing attention being placed on the teaching of communication skills (CS) to undergraduate medical students and the latter's learning of these skills. Despite these efforts, GP vocational trainees are still performing below expected levels on communication assessments. Furthermore, educational steps aimed at improving communication skills during the vocational training period seem to produce variable results [4]. Nonetheless, it should be emphasised that medical educational research has provided abundant evidence that communication skills can be taught and that communication skills training can result in changes that are retained for several years [5]. Congruent with the patient-centred approach to doctor–patient communication, learner-centred teaching methods have been advocated in communication education [6], [7]. Such a learner-centred approach calls for an exploration of the views and experiences of the learners involved. Whereas earlier research addressed the views of undergraduate medical students [8], there is still a lack of research aimed at exploring specific GP vocational trainees’ views on and experiences with communication within clinical consultation and on the educational methods used. This paper seeks to address this gap in GP medical education literature to provide a framework for a better understanding of trainees’ communication skills and to guide future curricular reform aimed at improving the communication skills of general practitioners.

Section snippets

Methods

Qualitative research methods are particularly suited to exploring individuals’ views and experiences [9], [10]. We chose focus group (FG) discussions to obtain a better understanding of trainees’ views since we expected the interactions between participants to yield dimensions of understanding that other methods fail to attain [11], [12]. We organised one try-out and six focus group discussions among second and third (final) year GP vocational trainees in Flanders, the Dutch speaking part of

Results

A total of 31 trainees took part in the six focus groups from which the data are further discussed. In reviewing the transcripts, data saturation occurred with a total of six focus groups. “Saturation” refers to the point at which further data do not yield any additional themes.

Listening to the audio-taped semi-structured telephone interviews, which were used as a way of triangulating our results, did not yield any new themes that had not previously been mentioned in the FG analysis.

The

Discussion

The major findings of this qualitative study relate to the particular nature of GP vocational trainees’ communication skills and training in communication skills. Notwithstanding our attempts to include participants who were not very interested in communication skills, it seems that our participants greatly value communication skills within GP. In contrast to Rees’ findings [8], we hardly noticed any negative attitudes toward communication skills. While it is true that they are often not a

Conflict of interest

We declare that there are no conflicts of interest.

Acknowledgements

This study was funded by the “Interuniversitair Centrum voor Huisartsen Opleiding” (ICHO) (Interuniversity Centre for General Practitioner Training) and by the Department of General Practice, Catholic University of Leuven.

We would like to thank the vocational trainees for taking part in this study, and Elisabeth De Corte for her assistance.

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