Abstract
In this thesis we investigated medical specialists' competency in patient education and how the teaching of patient-education competency in medical-specialist training might be improved.
We developed a reflective-impulsive model of physicians' communication behavior to explain the limited effects of communication education in undergraduate curricula and postgraduate training. The deliberate-practice model, which complements the reflective-impulsive model, provides the learning conditions required to achieve patient-education expertise in clinical practice. Since these learning conditions are not met in undergraduate curricula and postgraduate training, the average performance of residents' and consultants' patient-education is not adequate. Furthermore, their patient-education performance is quite inconsistent, meaning that performance is adequate in some consultations, but inadequate in others.
The deliberate-practice learning conditions inspired us to develop a program for self-assessment of and supervisors' feedback on residents' communication competency using videoed outpatient consultations (video-CAF). We tested the feasibility and effects of video-CAF on residents' communication competency. We demonstrated that video-CAF participation improved residents' communication self-awareness and also slightly improved their patient-education competency. However, we also concluded that supervising consultants did not possess the superior patient-education skills required to act as credible role-models, coaches, and assessors in the video-CAF process. Thus, we recommend improving both residents' and supervising consultants' clinical communication by intervision, meaning mutual and egalitarian assessment of and feedback on communication competency in clinical practice instead of one-sided supervision of residents.
We developed a reflective-impulsive model of physicians' communication behavior to explain the limited effects of communication education in undergraduate curricula and postgraduate training. The deliberate-practice model, which complements the reflective-impulsive model, provides the learning conditions required to achieve patient-education expertise in clinical practice. Since these learning conditions are not met in undergraduate curricula and postgraduate training, the average performance of residents' and consultants' patient-education is not adequate. Furthermore, their patient-education performance is quite inconsistent, meaning that performance is adequate in some consultations, but inadequate in others.
The deliberate-practice learning conditions inspired us to develop a program for self-assessment of and supervisors' feedback on residents' communication competency using videoed outpatient consultations (video-CAF). We tested the feasibility and effects of video-CAF on residents' communication competency. We demonstrated that video-CAF participation improved residents' communication self-awareness and also slightly improved their patient-education competency. However, we also concluded that supervising consultants did not possess the superior patient-education skills required to act as credible role-models, coaches, and assessors in the video-CAF process. Thus, we recommend improving both residents' and supervising consultants' clinical communication by intervision, meaning mutual and egalitarian assessment of and feedback on communication competency in clinical practice instead of one-sided supervision of residents.
| Translated title of the contribution | Patiëntenvoorlichting in de consulten van medisch specialisten |
|---|---|
| Original language | English |
| Qualification | Doctor of Philosophy |
| Awarding Institution |
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| Supervisors/Advisors |
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| Award date | 4-Jun-2014 |
| Place of Publication | [S.l.] |
| Publisher | |
| Print ISBNs | 978-90-367-6937-2 |
| Electronic ISBNs | 978-90-367-6938-9 |
| Publication status | Published - 2014 |