Department of Public Health, Clinicum, Faculty of Medicine and Department of General Practice and Primary Health Care, University of Helsinki, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Public Health, University of Helsinki, Helsinki, PO Box 20, Finland.
BMC Med Educ. 2024 Oct 28;24(1):1225. doi: 10.1186/s12909-024-06184-6.
Communication skills are an essential part of clinical competence that need to be acquired during health professions education. Simulations are extensively used for learning communication skills and have long been integral to medical degree programmes. In this research we use qualitative methodology to explore fourth-year medical students' experiences in simulations aimed at improving versatile doctor-patient communication, focusing on their learning with trained actors.
The data comprises reflective writings from 208 fourth-year medical students, gathered after a communication skills course. These students provided informed consent for their writings to be included in the research. We performed an inductive qualitative content analysis on the textual data, with findings presented as themes, supported by categories, codes, and excerpts from raw data to enhance the trustworthiness of the analysis.
We identified eight key themes capturing students' learning experiences through simulations: practising in a safe learning environment, valuing feedback, gaining new perspectives, finding simulations valuable and enjoyable, boosting confidence and self-knowledge, and viewing simulations as authentic and engaging learning opportunities. Some students offered critical perspectives on simulations. Throughout the course, students learned diverse aspects of patient care, emotional and behavioural communication dynamics, and lessons from medical errors. Some students offered critical perspectives on simulations, and a few indicated they did not learn anything new.
A safe learning environment is vital for encouraging learners to explore, make errors, and absorb feedback to improve their communication with patients. Students predominantly valued the communication skills training with actors and the constructive feedback received and given in the debriefing discussions. However, some students expressed critical views toward simulations. Simulations are not static; they evolve and require continual improvements. Hence, we advocate for the ongoing exploration and enhancement of communication skills learning methods, including simulations, with careful consideration for students' vulnerability and the importance of psychological safety. Additionally, it is critical to address students' perceptions that certain clinical teachers prioritise biomedical knowledge over communication skills. Providing tailored training for teachers regarding the learning methods and the desired outcomes of communication courses is essential.
沟通技巧是临床能力的重要组成部分，需要在医疗保健职业教育中习得。模拟教学被广泛用于学习沟通技巧，并且长期以来一直是医学学位课程的重要组成部分。在这项研究中，我们使用定性方法来探索旨在提高全面医患沟通能力的模拟教学中大四医学生的体验，重点关注他们与经过培训的演员一起学习的经历。
数据包括 208 名大四医学生在沟通技巧课程结束后的反思性写作，这些学生同意将他们的写作纳入研究。我们对文本数据进行了归纳式定性内容分析，研究结果以主题呈现，辅以类别、代码和原始数据摘录，以提高分析的可信度。
我们确定了八个关键主题，这些主题捕捉了学生通过模拟教学获得的学习体验：在安全的学习环境中练习、重视反馈、获得新视角、认为模拟教学有价值和有趣、增强信心和自我认知、将模拟教学视为真实和引人入胜的学习机会。一些学生对模拟教学持批评态度。在整个课程中，学生学习了患者护理、情感和行为沟通动态以及从医疗失误中吸取的经验教训等多个方面。一些学生对模拟教学持批评态度，少数学生表示他们没有学到新东西。
安全的学习环境对于鼓励学习者探索、犯错和吸收反馈以提高与患者的沟通能力至关重要。学生主要重视与演员进行沟通技巧培训以及在讲评讨论中获得和给予的建设性反馈。然而，一些学生对模拟教学持批评态度。模拟教学不是静态的，它们会不断发展和改进。因此，我们倡导不断探索和改进沟通技巧学习方法，包括模拟教学，同时要考虑学生的脆弱性和心理安全的重要性。此外，解决学生对某些临床教师更重视生物医学知识而不是沟通技巧的看法也很重要。为教师提供关于学习方法和沟通课程期望结果的定制培训至关重要。
