The challenge of engaging doctors in communication skills

Now more than ever, medical professionals need to be supported with skills training to deal with the most challenging of scenarios

Faced with the findings of the initial national patient experience survey the HSE established the national healthcare communication programme in 2018 to address the issue of poor communication between patients and healthcare staff. The progress of the programme has been commendable given the size of the task involved with extremely promising pilot data published to date.

The subsequent national maternity experience survey demonstrated similar shortcomings and the maternity services leadership are to be commended for engaging the services of the programme as soon as the report was published. The programme recommends that all healthcare workers attend module 1 (Making connections) and all clinical staff also attend modules 2,3 and 4 (Core consultation skills, challenging consultations and teamworking). Demographics from the programme make interesting reading. Although attendees are drawn from all healthcare workers – doctors are the least well represented, and this data predates the impact of the pandemic.

This may not come as any great surprise to those familiar with the literature on communication skills training, as the international evidence demonstrates that doctors are slow to engage in such training. The usual reason given by doctors is the lack of protected time available to participate in six -hour training courses. There has been no acceptance of the importance of communication skills training by employers in the health service until recently.

International experience suggests that time constraints alone may not be the sole reason for poor attendance by doctors at communication skills training. If a culture exists where such training is felt to be unnecessary with doctors believing they already communicate well then attendance suffers. In addition, many doctors believe such training cannot replace ‘innate’ communication skills and that formal training in areas such as demonstrating empathy cannot be taught.

A further factor to be considered is the format by which such skills are taught in workshops. Doctors frequently request any such training programmes be reserved for ‘doctors only’. The format of multidisciplinary training sits uncomfortably with many doctors who feel they have ‘further to fall’ in the company of other disciplines or more junior colleagues.

This welcome concept embraces a culture of ‘equal partnership’ in healthcare and identifies removal of hierarchical structures as a key component in effective teamwork. The team that trains together works better together and simple steps such as using first names rather than titles among team members is a novel approach to promoting cohesion among team members. At the programme we have seen the benefits of ‘team’ training involving different disciplines and recorded positive feedback from those involved acknowledging such benefits.

Operating within a flattened hierarchy allows individuals to gain in confidence and be better able to accept feedback from other team members. The use of role playing and subsequent feedback from trained facilitators is key to the success of such training modules. A culture of psychological safety must exist before participants – particularly doctors – feel at ease with role play and receiving feedback in front of others present. The importance of skilled facilitators cannot be overemphasised in this context – especially if such facilitators are not doctors themselves.

It is remarkable that no assessment of how doctors are communicating with patients and staff currently exists within the Irish healthcare system. Too often the problems are only highlighted as a result of reports commissioned in the wake of serious shortcomings, which invariably make for painful reading. Alternatively, individual doctors may find themselves the subject of multiple complaints which oblige management to become involved.

This is all the more regrettable when we already have a unique national training programme in place designed to address such problems. One of the most striking pieces of evidence comes from a study at the Cleveland Clinic involving over three thousand physicians, which showed conclusively that patient satisfaction scores increased significantly in the group who had received communication skills training in comparison to a matched control group.

We know that patient satisfaction scores equate well with reductions in complaints and subsequent litigation which impinge directly on doctors. Interestingly enrolment in studies involving communication skills training increased after individual physicians were made aware of their patient satisfaction scores.

It’s not just patient satisfaction scores at play here, however. The evidence supports the assertion that doctors benefit by having better communication skills themselves resulting in higher levels of job satisfaction and greater protection against burnout.

We need to move toward a culture where communication skills training is regarded as an essential component of continuous professional development for doctors. The aim of such a programme should not be to add another hoop for doctors to jump through but to ensure competency in an area which is fraught with risk for doctors wishing to avoid the trauma of dealing with complaints and/or litigation.

The Medical Council has previously stated its desire to see such training become mandatory but legislation takes time. While the ideal is to facilitate learning of communication skills rather than dictate it, there is little evidence that such pleas are being heeded by the medical community to date. Now more than ever, during the pandemic doctors need to be supported with skills training to deal with the most challenging of scenarios. The programme deserves our support in facilitating greater involvement by doctors in communication skills training if we are to witness real change.