Review article
Effective training strategies for teaching communication skills to physicians: An overview of systematic reviews

https://doi.org/10.1016/j.pec.2010.06.010Get rights and content

Abstract

Objective

Physicians need good communication skills to communicate effectively with patients. The objective of this review was to identify effective training strategies for teaching communication skills to qualified physicians.

Methods

PubMED, PsycINFO, CINAHL, and COCHRANE were searched in October 2008 and in March 2009. Two authors independently selected relevant reviews and assessed their methodological quality with AMSTAR. Summary tables were constructed for data-synthesis, and results were linked to outcome measures. As a result, conclusions about the effectiveness of communication skills training strategies for physicians could be drawn.

Results

Twelve systematic reviews on communication skills training programmes for physicians were identified. Some focused on specific training strategies, whereas others emphasized a more general approach with mixed strategies. Training programmes were effective if they lasted for at least one day, were learner-centred, and focused on practising skills. The best training strategies within the programmes included role-play, feedback, and small group discussions.

Conclusion

Training programmes should include active, practice-oriented strategies. Oral presentations on communication skills, modelling, and written information should only be used as supportive strategies.

Practice implications

To be able to compare the effectiveness of training programmes more easily in the future, general agreement on outcome measures has to be established.

Introduction

Adequate and effective communication during medical consultations is essential for the provision of good care [1], [2]. It is also complex, because physicians have to gather and process information rapidly, and at the same time they have to reassure patients to make them feel comfortable enough to disclose all the necessary information [2], [3]. Many studies have confirmed the inter-relationships between the communication behaviour and efficiency of the physician, and the satisfaction and compliance of patients. For example, it was found that awareness of patient expectations about the physician–patient communication results in more effective communication [4]. Moreover, several studies have shown that the communication styles of physicians influence patient satisfaction and patient compliance. It was also found [5] that patients were most satisfied with interviews in which the physicians were not dominant, because they then felt comfortable enough to talk freely and to ask questions.

Most qualified physicians have had considerable tuition in physician–patient communication, both as medical students and as post-graduates, and communication skills training is integrated in the medical curricula [6]. Communication training is also organised for qualified physicians who work in various medical specialities, but not all specialities. There are even some specialised communication skills training programmes for qualified physicians working in non-curative medicine, such as insurance medicine, occupational medicine, and sickness certification. However, in contrast to the considerable body of research on the effectiveness of communication skills training in curative medicine, hardly any research has focussed on its effectiveness in non-curative medicine. Therefore, to create a framework for an evidence-based training programme specifically aimed at physician–patient communication in non-curative care, we explored the available literature in curative care.

Because medical professionals often lack the time to follow extensive courses, an effective training approach is important. For example, constraints – such as time restrictions or a limited budget – complicate intensive and recurrent training programmes. Consequently, the aim of the present review was to identify from the literature effective approaches for teaching communication skills to qualified physicians. In this review, communication skills training is defined as the entire training programme that physicians attend. Training strategies are defined as the different approaches that are applied in a training programme to teach communication skills to physicians. Examples are oral presentations and role-play.

Even though most medical professionals have received communication skills training in undergraduate as well as postgraduate courses, communication is based on deeply rooted habits and related habitual patterns [7], which makes it difficult and time-consuming to change existing communication behaviour. Our first hypothesis was therefore that longer training programmes (e.g. several days) are more effective than shorter training programmes (e.g. several hours). Our second hypothesis was that active training strategies are more effective than passive training strategies. Active strategies are defined as practising and discussing skills during the training, and passive strategies are defined as strategies that require far less activity from participants, such as listening to a lecture. The effectiveness of modelling – when a certain skill is demonstrated to the participants – was expected to lie in between these two, since it is a passive strategy, but it closely resembles the real-life consultation [3].

Section snippets

Search strategy

In October 2008 we carried out a systematic search for scientific literature on the effectiveness of communication skills training for physicians (as defined by the included reviews). An update was performed in March 2009. The first two authors [MB and HJvR] checked all references of the included studies for other relevant studies. Because we were aware of the existence of a large number of studies on the effectiveness of communication skills training strategies for medical professionals, we

Number and quality of the reviews

We searched four databases: PubMED (65 reviews), PsycINFO (6 reviews), CINAHL (10 reviews), and COCHRANE (6 reviews), and exported all the identified reviews to Reference Manager 10.0. After duplicates were removed, the result was 79 potentially relevant reviews. We excluded 45 reviews because they did not meet the inclusion criteria. Of the 34 remaining reviews, and 7 other reviews identified in the reference lists, 29 were excluded after screening the full text. Details of the studies that

Main findings

We critically appraised reviews focusing on communication skills training for medical professionals to identify effective communication training strategies for physicians, because many studies have reported heterogeneous results. Our results demonstrated that it is possible to teach physicians communication skills during training programmes lasting for at least one day. Role-play, feedback, and small group discussions seemed to be effective evidence-based training strategies. To maintain skills

Conflict of interest

The authors have no conflict of interest that are directly relevant to the content of this article.

Acknowledgements

The authors thank Janneke Staaks, MSc, information specialist at the VU University Medical Center, for her assistance in developing the search strategy used, and David Bruinvels, MD, PhD, senior researcher at the VU University Medical Center, for his insights and comments on an early version of this review.

For this research project support was obtained from the Dutch Institute of Employee Benefit Schemes (UWV). The project is funded by the Dutch ‘Stichting Instituut Gak’, a foundation that

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