19: Interpersonal Communication Training in Dental Education

19

Interpersonal Communication Training in Dental Education

Toshiko Yoshida and Kazuhiko Fujisaki


Key points
  • The five main factors that influence the development of communication training are (1) the learner’s level, needs, and readiness; (2) the goal setting for the program; (3) the use of appropriate teaching methods encouraging active learning; (4) the availability of quality resources; and (5) the evaluation of the performance of the students.
  • Role-playing with peers and role-playing with non-computer-simulated patients (SPs) are two major teaching methods to encourage active learning.
  • A successful training program using SPs needs to ensure that the SPs are trained to guarantee quality performance, that robust cases are developed, and that the facilitators are trained for their roles.
  • Assessment methods based on the program’s learning objectives should be used to evaluate communication training programs.

Good communication is a window for understanding patients, and serves as a base for providing better patient care. When patients are interviewed in a way that makes them feel understood, their problems and concerns are alleviated. If dental health professionals can clearly comprehend a patient’s problems and concerns, they become more capable of responding to that patient’s needs. As a result, an accurate diagnosis and an appropriate treatment plan can be achieved. It is therefore important for dental health professionals to gain and use effective interpersonal communication skills. In this chapter, we refer to the development, implementation, and evaluation of successful training programs, particularly those focusing on using simulated patients.

The Benefits of Good Communication between Providers and Patients in Dental Care

Effective interpersonal communication plays an important role in dental care and has positive effects on outcomes. Existing literature suggests that effective dentist–patient communication increases patient satisfaction and compliance, and reduces patient anxiety and the risk of malpractice claims. Imanaka et al. (2007) identified that communication with the dentist was the most important factor for patient satisfaction in a university hospital. A recent study indicated that dentists giving personal attention when listening to a patient’s complaint, and helping the patient and instilling confidence about the treatment, were among the important factors related to perceived patient satisfaction (Dewi, Sudjana, & Oesman, 2011). Sondell, Söderfeldt, and Palmqvist (2002) reported that giving patients the opportunity to talk about their dental health helped improve patient satisfaction with the treatment outcome. Effective communication increases patient satisfaction and tends eventually to impact on patients’ cooperation and compliance. Sinha, Nanda, and McNeil (1996) found that politeness was one of the important predictive factors for patient satisfaction as well as for patient compliance, such as keeping appointments and wearing and maintaining appliances. Establishing sympathy and informal relationships between the dentist and the patient contributes to attendance at follow-up sessions (Sandell, Camner, & Sarhed, 1994).

As well, how to communicate with patients is related to a reduction in dental fear/anxiety and the risk of malpractice complaints. A decrease in negative beliefs in how dentists communicate, for example, how uncomfortable patients were asking the dentist questions and how dentists dismissed patients’ worries, was one of the predictors of successful treatment for dental-fear patients (Abrahamsson et al., 2003). Bernson et al. (2011), in a qualitative study, analyzed interviews with patients with dental fear and concluded that in trusting interactions with dental staff, communication reflecting respect, attention, and empathy were among the core factors making regular dental care possible. Lopez-Nicolas et al. (2007) analyzed dental malpractice cases and observed that frequently there was insufficient, or an absence of, information provided during the course of such cases. They pointed out that there was a need for dentists to develop communication skills along to complement their clinical skills.

As is evident from the literature, good communication, along with the quality of dental technology procedures, is an important factor in the process of dental care. However, patients seemed to be less satisfied with particular aspects of the dentist’s communication, specifically the dentist’s explanations related to the treatment (Al-Mudaf et al., 2003; Dewi et al., 2011). Compared with other doctor–patient encounters, dental consultations allow practitioners a better chance to observe and directly palpate disease sites before any subsequent surgical treatment. As a result, dental practitioners tend to rely less on a patient’s subjective complaints and may not put a strong enough emphasis on their communication with patients compared with relying on their technical skills. Verbal communication with a patient can often be too limited during the dental treatment process. Because of the nature of dental treatment services, there is a need for dental health professionals to have more effective communication skills.

Interpersonal Communication Training in Education

Teaching patient–doctor (dentist) communication, both in medicine and dentistry, has traditionally been incorporated into clinical rounds, where excellent opportunities exist for students to simultaneously learn both communication and clinical skills. Nevertheless, students appear less likely to have their patient interviews monitored and to receive the benefit of feedback from busy faculty. Haak et al. (2008), in a randomized study, compared two groups of students: a study group of students who attended a clinical course as well as a communications course, and a control group of students who attended a clinical course as well as problem-based tutorials. The results demonstrated that unlike the study group, the control group did not improve their communications competence. Both groups spent the same amount of contact time with patients in their clinical course. This study suggested that the mere repetition of task skills, without also receiving appropriate guidance or feedback, did not guarantee improvement.

Fortunately, in recent years, educators and practitioners have begun to realize the importance of interpersonal communicative competence for healthcare providers. A recent survey revealed that dentists, as well as dental students and patients, perceived that communication is a vital aspect of competence in dentistry and supported the inclusion of communication training in dental education (Woelber et al., 2012). Yoshida, Milgrom, and Coldwell (2002) found that the most frequently used educational method was lectures. However, more recent research evaluating communication skills learning or assessment methods in undergraduate dental education found clinical role-playing using simulated/standardized patients (SPs) was being widely adopted in addition to didactic learning. This implies the increased use of more active learning methods (Carey, Madill, & Manogue, 2010).

Factors Influencing the Design of Interpersonal Communication Training

The effect of communication training depends on its quality. A number of factors influence the development of communication training:

1. Learners’ levels (novice to expert) and their needs and readiness affect the design of a training program, which can range from basic to advanced.
2. Goal setting is critical for quality interpersonal communication training to be effective in clinical situations. The training needs to be designed to improve the trainee’s knowledge, attitudes, and skills. Successful training should help the trainee expand their knowledge as well as integrating that knowledge into problem solving to effectively perform tasks. Specific training goals affect the design of the training program. Thus, goals need to be determined and adjusted for a student’s training level and individual proficiency.
3. The specific goal of a given training session will determine the appropriate teaching method. Passive instruction, such as a lecture, is suitable for information transmission, while performance-based methods need to be included if the goal is to improve personal attitudes and behavior.
4. Resources, including computer technology and audiovisual aids such as computer-based simulations and videotapes, can be powerful training tools for problem-based learning. A small room with a one-way mirror helps a trainee to be less apprehensive about being observed, and also enables them to concentrate on performing the simulated task. Manuscripts for case studies and books/handouts for lectures are also invaluable resources for communication training. For appropriate staffing, cooperation from facilitators with behavioral science/communication backgrounds and specific health professionals is recommended (Dickson, Hargie, & Morrow, 1997). While a sufficient number of staff is desirable, for live-patient simulations, the availability of simulated patients is a critical factor.
5. Evaluation of performance, as Dickson et al. (1997) noted, is essential. What needs to be measured as well as how to measure it must be considered. What needs to be measured is linked to learning objectives. If the trainees are expected to improve mainly cognitive aspects, pencil-and-paper type evaluations, such as quizzes, essays, and questionnaires are applicable. Trainees’ problem-solving abilities can be assessed by a written examination requiring an analysis of a videotaped interview or printed dialog, with written responses related to the specific case being considered. However, what trainees think they should do is not necessarily the same as how they actually behave. Therefore, a preference exists for performance-based examinations when the goal is to acquire skills and to improve interpersonal behaviors.

Performance-Based Methodologies: Role Playing and Live-Patient Simulation

Popular teaching methods in active learning appear to be role playing with peers, and role playing with non-computer-simulated patients. There has been a gradual increase in studies investigating the effectiveness of teaching methods, with one study attempting to compare the effectiveness of role-play with the use of SPs (Lane & Rollnick, 2007; Schlegel et al., 2012). Each method has its strengths and weaknesses. Some trainees find role-playing in a simulation difficult, especially when they role-play with colleagues (Lane & Rollnick, 2007). Sometimes they are embarrassed because they consider it artificial and are afraid of exposing their incompetence to others. However, a compensatory benefit of this method is that it encourages the trainees to be critical of their own performance and exposes them to such experiences in a safe environment. Role-playing exercises are particularly valuable as they allow performers to understand a patient’s perspective by putting them in the patient’s position. Besides, if feedback from another person is available, performers will realize and identify their personal shortcomings, enabling them to adjust their behavior to meet the needs at hand. These experiences may prove more appealing to students than a simple lecture.

Although there appear to be a greater number of studies regarding medical education, communication education and training programs using a non-computer-simulated/SP in dentistry have been increasing along with evaluation studies of such programs (Cannick et al., 2007; Wagner et al., 2007; White, Krüger, & Snyman, 2008). Ever since SPs were selected for use for an objective structured clinical examination (OSCE), the SP simulation methodology has gained unexpected and considerable attention. SP appears to be an influential educational tool.

Background History of the SP as a Tool in Medical and Dental Education

An SP is a layperson trained to portray the medical history as well as the psychological and social background of an actual patient. An SP is often distinguished from a simulated patient; the difference between them being whether the acting of the role is standardized or not. An SP is usually used for assessment and is expected to give consistent responses to a trainee’s reactions. Both verbal and behavioral responses are strictly controlled. On the ot/>

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Jan 4, 2015 | Posted by in General Dentistry | Comments Off on 19: Interpersonal Communication Training in Dental Education
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