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Advances in health sciences education : theory and practice
Dec 17, 2024;

Unravelling the art of developing skilled communication: a longitudinal qualitative research study in general practice training.

Michelle Verheijden, Angelique Timmerman, Dorien de Buck, Anique de Bruin, Valerie van den Eertwegh, Sandra van Dulmen, Geurt T J M Essers, Cees van der Vleuten, Esther Giroldi
Author Information
  1. Michelle Verheijden: Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands. m.verheijden@maastrichtuniversity.nl. ORCID
  2. Angelique Timmerman: Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands. ORCID
  3. Dorien de Buck: Department of Primary and Community Care, Radboud University Medical Center, Family, Nijmegen, The Netherlands.
  4. Anique de Bruin: Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands. ORCID
  5. Valerie van den Eertwegh: Department of Skillslab, Faculty of Health, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands. ORCID
  6. Sandra van Dulmen: Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands. ORCID
  7. Geurt T J M Essers: Independent Researcher, Utrecht, The Netherlands.
  8. Cees van der Vleuten: Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands. ORCID
  9. Esther Giroldi: Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands. ORCID
PMID: 39690315 DOI: 10.1007/s10459-024-10403-6

Abstract

Doctor-patient communication is a core competency in medical education, which requires learners to adapt their communication flexibly to each clinical encounter. Although conceptual learning models exist, information about how skilled communication develops over time is scant. This study aims to unpack this process of communication learning and to identify its facilitators. We conducted a longitudinal qualitative study employing a constructivist grounded theory approach in a General Practice training setting. Over a 6-month period, we closely monitored 8 first-year and 5 third-year trainees (n���=���13) by means of clinical observations, stimulated recall interviews and audio diaries. In an iterative process of data collection and analysis, we triangulated these sources across trainees (horizontal analysis) and over time (vertical analysis) to identify how themes evolved. This analysis led us to the construction of a six-stage cyclic conceptual model during which trainees: (1) have an impactful experience; (2) become aware of own communication; (3) look for alternative communication behaviours; (4) experiment with new behaviours; (5) evaluate the effectiveness; and (6) internalise the new communication behaviours. Additionally, conditions were found to support learning and reflection. Becoming a skilled communicator seems to require a continuous approach, with repeated practice and reflection to adapt and internalise communication in the clinical encounter. Consequently, we recommend that trainees be supported with tailored feedback to strengthen their communication repertoire. Ideally, they should be guided by supervisors who serve as coaches in a safe learning environment with regular, planned learning activities.

Keywords

Doctor-patient communication Longitudinal qualitative research Medical training Skilled communication Workplace learning

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  2. 839130013/Netherlands Organization for Health Research and Development (ZonMw)
  3. 839130013/Netherlands Organization for Health Research and Development (ZonMw)
  4. 839130013/Netherlands Organization for Health Research and Development (ZonMw)
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  6. 839130013/Netherlands Organization for Health Research and Development (ZonMw)
  7. 839130013/Netherlands Organization for Health Research and Development (ZonMw)
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Created with Highcharts 10.0.0communicationlearninganalysisclinicalskilledstudyqualitativetrainingtraineesbehavioursDoctor-patientadaptencounterconceptualtimeprocessidentifylongitudinalapproach5newinternalisereflectionpracticeresearchcorecompetencymedicaleducationrequireslearnersflexiblyAlthoughmodelsexistinformationdevelopsscantaimsunpackfacilitatorsconductedemployingconstructivistgroundedtheoryGeneralPracticesetting6-monthperiodcloselymonitored8first-yearthird-yearn���=���13meansobservationsstimulatedrecallinterviewsaudiodiariesiterativedatacollectiontriangulatedsourcesacrosshorizontalverticalthemesevolvedledusconstructionsix-stagecyclicmodeltrainees:1impactfulexperience2becomeaware3lookalternative4experimentevaluateeffectiveness6AdditionallyconditionsfoundsupportBecomingcommunicatorseemsrequirecontinuousrepeatedConsequentlyrecommendsupportedtailored feedbackstrengthenrepertoireIdeallyguidedsupervisorsservecoachessafeenvironmentregularplannedactivitiesUnravellingartdevelopingcommunication:generalLongitudinalMedicalSkilledWorkplace

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