Medical school teaching on interprofessional relationships between primary and social care to enhance communication and integration of care – a pilot study

Figures & data

Figure 1 Sofia’s interface.

Abbreviation: MBBS, Bachelor of Medicine.

Figure 2 Barriers to communication matched to the learning objectives.

Abbreviations: IT, information technology; MDT, multi-disciplinary team; GPs, General Practitioners.

Figure 3 Learning objectives matched to the case scenarios.

Abbreviations: IT, information technology; MDT, multi-disciplinary team; GPs, General Practitioners.

Figure 4 Example scenario.

Abbreviations: MDT, multi-disciplinary team; GP, General Practitioner; QOF, Quality and Outcome Framework; GPs, General Practitioners.

Figure 5 Medical student survey.

Figure 6 GMC Outcomes for Graduates review.

Table 1 Learning objectives in the Imperial College Curriculum

LO	Year	Specialty
Communication analysis: demonstrate ability to analyze effective and ineffective communication between HCPs and patients, as well as amongst HCPs (verbal in person, verbal over the phone, in writing).	5	General Practice

Abbreviation: HCPs, healthcare professionals.

Table 2 Wilcoxon test results

Wilcoxon Test
N1 Mean (before tutorial)	15.25
N2 Mean (after tutorial)	19.33
p-Value	0.0141

Figure 7 Student survey results.

Figure 8 Student survey results regarding delivery style.Abbreviation: PBL, Problem-based learning.

Table

Learning objective	Year	Specialty
Identify and reflect upon difficult or demanding aspects of professional relationships.	2	Generic

Table

Learning objective	Year	Specialty
MDT working: demonstrate the ability to communicate effectively with patients, health care professionals and radiological teams (incl. different radiology staff groups) in the investigation of disease.	5	Radiology
Communication: critique effective and ineffective communication: face to face and written, between patient and health care professional, and inter-health care professional.	5	Generic Palliative care Oncology
MDT communication: recognize the importance of timely communication between primary and secondary care, particularly when transferring patients between settings	5	Palliative Care

Table

Learning objective	Year	Specialty
Communication analysis: demonstrate ability to analyze effective and ineffective communication between health care professionals and patients, as well as amongst health care professionals (verbal in person, verbal over the phone, in writing).	5	General Practice

Table

Learning objective	Year	Specialty
MDT working: demonstrate awareness of the value and role of multi-disciplinary working between palliative care, oncology and primary care teams in formulating management plans for patients.	5	Palliative Care Oncology

Table

Learning objective	Relevance	Notes
Year 1: Clincal communication
Introduction to clinical communication: recognize the fundamental principles of communicating with patients and identify key skills that can used in a clinical consultation	None
Patient centered communication: define patient-centred communication	None
Learning objective	Relevance	Notes
Year 1: ClinicalcCommunication
Introduction to clinical communication: recognize the fundamental principles of communicating with patients and identify key skills that can used in a clinical consultation	None
Patient centered communication: define patient-centred communication	None
Content and process: recognize the basic relation between content and process	None
Non-verbal communication: recognize the sources of non-verbal communication (NVC), how NVC conveys emotion, and summarize the importance of NVC in consultations	None
Reflection: demonstrate the ability to reflect on patient interviews and identify key communication and professional skills used effectively and explain the rationale behind using these techniques	None
Feedback: demonstrate the ability to reflect upon feedback received on communication skills	None
Personal strengths: demonstrate awareness of personal strengths in communicating and identify strategies to maintain these	None
Personal weaknesses: demonstrate awareness of personal weaknesses in communication and identify strategies to improve these	None
Year 2: Clincal communication
Medical history: identify the key content of a medical history, and identify the skills necessary to elicit a full clinical history from a patient	None
Social history: recall questions to explore drug, alcohol and tobacco use and identify skills necessary for an effective assessment	None
Nutritional history: list examples of key screening questions when taking a nutritional history, explain the difficulties in establishing a patient’s eating habits and list examples of the clinical complications of poor dietary habits	None
Sensitive information: recognize methods to elicit more sensitive information in the clinical history and when it is appropriate to ask such questions	None
Reflection: demonstrate the ability to reflect on feedback on communication skills, identify skills that require development and ways in which communication skills may be improved/maintained	None
Cross cultural communication: demonstrate awareness of different cultural backgrounds, identify cultural groups to which people belong, explain how cultural issues may affect communication and identify potential solutions for dealing with these problems	None
Interpreters: explain the skills required by health professionals when working with interpreters, and identify the difficulties that may arise with the use of family members as interpreters	None
Year 2: Personal and professional development: the self-aware doctor - teamwork and professional relationships
Identify and reflect upon difficult or demanding aspects of professional relationships.	Partially	Not relevant within the experience of clinical practice of Year 2
Identify effective coping strategies to deal with difficult situations.	Partially	Not relevant within the experience of clinical practice of Year 2
Define the professional view of team work and describe how this applies in practice.	Partially	Not relevant within the experience of clinical practice of Year 2
Summarize your obligations as a team member to colleagues and to patients and be able to apply this understanding to your work-related experiences (academic and clinical).	Partially	Not relevant within the experience of clinical practice of Year 2
Recognize your own strengths and areas for improvement as a team member.	Partially	Not relevant within the experience of clinical practice of Year 2
Critique how your own professional life is maturing and how you deepen your knowledge, challenge your attitudes and broaden your experience through the humanities.	None
Year 3: Communcation skills
Communication principles: demonstrate clear, sensitive and effective communication when interacting with patients, recognize and implement non-verbal communication, and identify key principles for effective information exchange with patients	None	Between health care professionals and patients
Bias and prejudice: demonstrate clear communication regardless of age, social, cultural or ethnic background or disability	None
Multimedia communication: demonstrate clear communication by spoken, telephone, written and electronic means	None
Difficult circumstances: demonstrate clear communication in difficult circumstances and when discussing sensitive issues	None
Impact: demonstrate the ability to assess how a condition affects the quality of life of the patient and their relatives	None
Comprehension: demonstrate the ability to elicit the patient’s understanding of their condition and treatment options, and explain the principles of shared understanding and the skills designed to achieve this aim	None
Consent: demonstrate the ability to obtain informed consent where appropriate and explain the difference between informing a patient and ensuring a patient is informed	None
Formulating plans: demonstrate the ability to formulate a plan for treatment and management in partnership with the patient and their carers and recognize that patients have a right to refuse or limit treatment	None
Limitations and restrictions: demonstrate an understanding of the impact of impairments, activity limitations and participation restrictions on the individual and their carers and family	None
Explain treatment regimes and procedures layman terms (including endoscopy (bronchoscopy and cystoscopy), chest x-ray, contrast enema/meal, intravenous urogram (IVU), computed tomography (CT), ultrasound scan (USS) abdomen/pelvis, echocardiography, Doppler, Magnetic resonance imaging (MRI), Isotope scan (bone, lung, thyroid))	None
GMC guidance: recall the GMC specified communication and patient safety guidance	None
Sociological and psychological factors: demonstrate the ability to assess and respond to patient problems appreciating the impact of clinical, psychological, social, religious and cultural factors	None
Ideas, concerns and expectations: demonstrate the ability to elicit and respond to patient ideas, concerns and expectations	None
Year 3: Good medical practice: professional behavior
Demonstrate professional behaviour paying particular attention to acting with integrity and courtesy, respecting patients’ dignity and privacy, communication skills, and hygiene	None
Demonstrate the ability to work without bias, respecting all patients, colleagues and others	Partially	Not specific to interprofessional relationships
Recognize the framework in which medicine is practised in the UK, including the organization and management of health care provision	None
Demonstrate the ability to work in a multi-disciplinary team	Partially	Not specific to social care or general practice
Year 4
-
Year 5: General practice - professionalism
Communication analysis: demonstrate the ability to analyse verbal (eg, tone of voice, volume), visible (eg, facial expression) and physical (eg, body language) cues in communication between health care professionals and patients	None	Between health care professionals and patients
Communication analysis: demonstrate ability to analyse effective and ineffective communication between health care professionals and patients, as well as amongst health care professionals (verbal in person, verbal over the phone, in writing)	Yes	Identified previously
Communication & Consultation: demonstrate your communication and consultation skills with real and simulated patients to develop experience in patient-centred care	None
Continuity of care: demonstrate awareness of the role of continuity of care between a patient and their GP when managing current and on-going problems (incl. medication reviews, protocol checks eg, asthma review, lifestyle advice eg, smoking and alcohol, deeper awareness and consideration of psycho-social factors)	None
Breaking bad news: explain the principles of sharing difficult news and practice sharing difficult news	None
MDT working & Team roles: explain the roles and responsibilities of members of the primary health care team and demonstrate an understanding of the importance of the multi-disciplinary team in the delivery of effective health care	Partially	Only identifies primary care and does not identify social care
Primary & Secondary care interface: explain the interface between primary and secondary care, incl. referral pathways and communication issues	None
Patient journey & Cancer care: summarize the patient journey and the different disciplines involved in cancer care	None
Relationships & Illness: summarize the ways in which family/personal relationships affect the presentation, course and management of illness	None
Significant event reflection: identify personally significant events and reflect, analyse and critically appraise them through tutor and colleague discussion	None
Reflection, Ethics & Personal experience: identify and critically reflect on the impact of ethical issues and personal experience on patient care, incl. shared decision making and confidentiality	None
Year 6
-

Table

Wilcoxon Test
N1	12
N2	12
Sum (S2)	188
Expectation (E)	150
Std. Error	17.321
Stat	2.194
p-Value	0.0141