The effect of training in communication skills on medical doctors’ and nurses’ self-efficacy: A randomized controlled trial
Introduction
Communication between the health provider and the patient is important for the patients’ experience of the healthcare service as well as for the outcome of care [1], [2], [3], [4], [5], [6]. Communication is a necessary precondition for elucidating the patients’ symptoms, problems and concerns and thereby an important clinical skill for ensuring health promotion, diagnostics, treatment, care and rehabilitation. Furthermore, several studies link quality of communication and the patient–provider relation to significant improvements in health outcomes such as symptom reduction and psychological status [4], [7], [8], [9], [10].
Despite the growing awareness of the importance of good communication in healthcare, considerable problems such as misinformation, lack of information and lack of responsiveness are still among the nuisances most often reported in surveys about patient satisfaction [11], [12], [13], and insufficient communication between patients and health professionals is one of the most significant factors for patients deciding to file a complaint [14]; all stressing the need for improving doctors’ and nurses’ communication skills.
Several studies have evaluated the effect of communication skills training for health professionals [3], and a few of these were randomized studies measuring the effect of the courses on patient outcomes. However, lack of evidence of the effects of such interventions on patient health care behaviour and health status [15], [16], [17], [18], [19], [20], [21], [22], [23], [24] has given rise to the assumption that the clinicians’ perception of own skills (in terms of self-efficacy) can reduce the overall effectiveness of a training programme and thereby explain the lack of a direct relationship between communication skills training and patient outcome [25], [26]. Therefore, training courses should address the issue of self-efficacy by challenging clinicians’ attitudes and trust in own communication skills [26] and courses should promote introspection and self-awareness as a necessary condition for self-correction [5].
The concept self-efficacy was introduced by Bandura and refers to a person's estimate of his or her ability to perform a specific task successfully [27]. Self-efficacy is an evaluation of the capability to perform a certain task and the expectation of being able to successfully perform certain behaviour.
Organizational research has shown that self-efficacy can predict the performance of an individual. Self-efficacy can change as a result of learning, experience, and feedback; and the magnitude of self-efficacy changes corresponds closely to changes in performance [27], [28]. However, a variety of internal and external factors such as personal knowledge and skills, physical condition, self-esteem, interpersonal environment, available time, task complexity, stress, etc., can also influence self-efficacy and thereby behaviour. Also major changes in personal characteristics (e.g. skills, knowledge, psychological condition) can influence the judging of self-efficacy [27], [28], for example by changing the perception of the initial level of performance during a course [29].
Maquire et al. have developed an inter-disciplinary training course based on these experiences and on the assumption that health professionals who have adequate skills and reasonable confidence in own abilities are more likely to correctly assess and thereby better respond to patients concerns [30], [31]. The course used in this study was built on Bandura's theory of self-efficacy describing how individuals can learn to determine and to modify their estimate of self-efficacy by using role play and feedback as one of the most effective methods [27]. To evaluate the effect of training courses a questionnaire was developed by Maquire to assess clinicians’ self-efficacy. Although the results of Maquire and co-workers relied upon pre–post-measurements, the participants’ self-efficacy ratings showed that their confidence in communicating with patients increased over time and that significant improvements of the tasks were obtained [31]. Based on the theory of social learning and on the evidence from the studies cited above on self-efficacy, further research is required addressing the following questions: can the effect of communication skills training on clinicians’ self-efficacy be evaluated in a randomized trial? Is the rating of self-efficacy constant, or does it change as a result of the training course? Do other internal or external factors in the clinical situation influence self-efficacy of doctors and nurses? Based on these questions the aims of this study were to investigate:
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The effect of communication skills training on doctors’ and nurses’ self-efficacy.
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How training courses influence the retrospective perception of the initial assessment of self-efficacy.
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The determinants of health professionals’ self-efficacy.
Section snippets
Methods
The study was conducted as a randomized controlled trial in which the intervention group received a 5 day communication course and the control group received no intervention.
The study took place in a paediatric outpatient clinic at a regional and general hospital in Denmark. The clinic provides general medical service for children 0–15 years old and performs approximately 11,000 consultations per year. Apart from the child, most often one or both of the parents participate in the consultation,
Population
Of the 30 health professionals included, 29 answered the pre-course questionnaire and the first and second post-course questionnaire (response rate 97%) and 27 answered the third post-course questionnaire (response rate 90%).
Table 1a, Table 1b show that there were no statistical significant differences in the characteristics of the nurses and the doctors included in the two study groups; only the distribution of age tended to be uneven with 66.7% ≥ 40 years in the control group and only 42.9% ≥ 40
Discussion
In this study we found that training in communication skills based on the method described by Maquire et al. [30] increased clinicians’ assessment of own ability to perform a specific communication task—measured as self-efficacy.
The relatively small number of clinicians is one of the shortcomings of the study. It reduces the possibility that an association found also becomes statistically significant (type 2 error). Also the clinicians’ self-rating of self-efficacy can be considered as a
Conclusion
This study represents a randomized controlled trial measuring the benefit of training in communication skills from the doctors’ and nurses’ point of view. The results show that communication skills training improved doctors’ and nurses’ assessment of own ability to successfully manage some of the communication tasks that they face in daily praxis. Using self-rating assessment can be regarded as a valid and useful instrument for measuring the effect of communication courses from the clinicians’
Acknowledgments
The study was supported by the County of Vejle, by Fredericia and Kolding Hospitals, by the Center for Internal Development & Education, Vejle and by the Danish Nurses Organization. The authors want to thank the staff at the Paediatric outpatient’ clinic for their assistance with the study. Also thanks to all the parents who participated in the study.
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