Learning Through Practice

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Medical residents feel that interacting with patients is key for building communication skills.
Posted On: March 31, 2023
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Drs. Gabriel Burke, Lindsay Melvin and Shiphra Ginsburg.

Effective communication is crucial in the medical profession, but how do internal medicine residents develop their communication skills?

A recent study led by Dr. Shiphra Ginsburg, Clinician Scientist at The Institute for Education Research (TIER) and the Wilson Centre for Research in Education at UHN, found that while formal communication training was valuable, it was limited in scope. Instead, residents found working independently with patients to be the most instructive for developing their skills.

The study was conducted between November 2020 and January 2021, and involved 15 virtual, one-on-one interviews with internal medicine residents. The interviews explored how the residents developed their communication skills and the role of formal training in this development.

“Participants consistently stated that interacting directly with patients contributed most to the development of their communication skills. Through these interactions, residents were able to identify communication techniques that they found effective, enabling them to gradually develop their own unique, natural and authentic style,” says Dr. Gabriel Burke, a resident in respirology and the lead author of the study.

“Residents learned strategies for communication through observing staff physicians, rather than from staff observing their interactions with patients and receiving feedback. Any direct feedback that they did receive was often positive, generic and not very actionable,” adds Dr. Lindsay Melvin, Clinician Investigator at TIER and co-author of the study. “Moreover, when staff were directly observing communication interactions, residents often felt the need to deviate from their authentic practice.”

Many participants also described the pressure to become faster with communication due to workload demands.

The study’s findings suggest that in the inpatient setting, residents developed their communication skills primarily through self-reflection on unobserved interactions with patients, with smaller contributions from formal training and feedback from staff physicians.

“Effective communication in medicine is crucial for building trust with patients, as well as ensuring that patients have a clear understanding of their health and the treatments available to them,” says Dr. Ginsburg.

“Medical educators should consider incorporating patient feedback when working with residents, as well as providing more specific and actionable feedback on communication skills. By doing so, medical educators can help ensure that future physicians are better equipped to communicate effectively with their patients—and ultimately, improve the quality of care.”

This work was supported by the Mount Sinai Hospital Department of Medicine Research Fund. TIER receives support from the UHN Foundation. Dr. Gabriel Burke is a resident in respirology at Mount Sinai Hospital. Dr. Lindsay Melvin is a Clinician Investigator at UHN and an Assistant Professor of Medicine at the University of Toronto. Dr. Shiphra Ginsburg is a Clinician Scientist at TIER and at the Wilson Centre for Research in Education, staff physician at Sinai Health and a Professor of Medicine at the University of Toronto; she holds a Tier 1 Canada Research Chair in Health Professions Education.

Burke G, Melvin L, Ginsburg S. "Patients Are the People Who Teach Me the Most": Exploring the Development of Communication Skills During Internal Medicine Residency. J Grad Med Educ. 2023 Feb. doi: 10.4300/JGME-D-22-00433.1.

Study participants felt that high patient volumes in hospitals often pushed them to prioritize efficiency and care for more patients, rather than the patient-centered communication practices taught in their training.