Communication in the conversation between preceptors and physicians-in-training during simulation: what is not said

ABSTRACT

Background:

There is an abundance of published communication models, but few explicate how professional conversation may include the communication of some information but exclude the sharing of one’s inner thoughts and feelings. This conceptualization of communication was applied to guide our understanding of how medical learners interact with preceptors at the bedside in a high-fidelity simulation when managing a patient case.

Methods:

A total of 84 medical learners (42 residents and 42 medical students) participated in a high-fidelity simulation. After they interacted with the patient for about 10 min, a preceptor entered and offered an equivocal or questionable recommendation about diagnosis or treatment. This type of recommendation was designed to trigger a difficult conversation that would create an opportunity for the learners to share facts, thoughts, points of view, and feelings about the patient with the preceptor. The preceptor left the room, and the learners completed their assessment once they made a diagnosis and treatment recommendations. Two raters independently coded the communication between the preceptor and learners by independently watching video recordings.

Results:

Of the three types of communication styles identified in the model, the majority of learners (n = 56, 66.70%) engaged in a muted conversation where they shared little or no clarification of facts about the patient’s case, their feelings or thoughts, nor did they explore their preceptor’s point of view.

Conclusions:

Learners may not feel comfortable exploring or expressing thoughts and feelings in front of their preceptors. We recommend that preceptors directly engage learners in conversation.

KEYWORDS:

• Medical students
• simulation
• communication
• medical education

Acknowledgments

The authors wish to thank all the medical learners for taking the risk of learning through simulation.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval statement

This study was reviewed and approved by the University of Calgary Conjoint Health Research Ethics Board (Ref #14-0758, Oct 21/2019).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Tanya N. Beran

Tanya Beran is a Professor in Medical Education in the Department of Community Health Sciences at the University of Calgary. With a research focus of child and adult education and health, she has published over 100 peer review papers and received tri-council funding for many years.

Ghazwan Altabbaa

Ghazwan Altabbaa is an Associate Professor in the Department of Medicine at the University of Calgary. He is a certified healthcare simulation educator with research interest in clinical decision support, communication, and social influence in healthcare and medical education.

Elizabeth Oddone Paolucci

Elizabeth Oddone Paolucci is a Professor in the Cumming School of Medicine with a joint appointment in the Departments of Community Health Sciences and Surgery. She is trained in Educational Psychology and has successfully applied a mixed-methods and social sciences lens to examining teaching and learning practices in medicine. Her research focuses on the measurement and evaluation of learners, educators, and programs to evolve our understanding of how curriculum design, instructional methods, and assessment practices can be optimized to shape competency development, professional practice, and learner well-being in the health professions.