Dear Lisa, what an interesting observation indeed!

We have had discussions going in the same direction in our research group. Indeed, it seems that clinical reality should have a greater role in shaping skills training than currently done. We are at the moment developing a future research on implementing an alternative to "classic" CST. Instead of classical lessons, some "supervision"-like education supported by video or audio examples of the clinicians real encounters will be used. We believe that since we ask the clinicians to have a flexible style adapted to the individual needs of the patient, we should also propose a flexible education adapted to the individual needs of the clinician. Also, we feel that a clinician that is more aware of his/her own reactions to clinical situations, and his/her own needs or limits, might be more in touch with the reality instead of staying in formal communication rules. Does this give an idea of a possible answer to your question?

I am also very interested in hearing what others think about your question. Thank you for bringing this topic up!

Hi Lisa,

At our school of nursing, we have incorporated ommunication skills into our simulation scenarios. In debriefing sessions, the student observer leads. Communication is critiqued and ways to improve this skill is discussed. It really helps students focus on this very important skill as well as the technical skills.

As any other clinical skills its also to be learnt. Actually it has to be made to learn by assesnents only. Assesments and barriers only make some body to think serious and motivate to learn.

Thank you for your answers; very informative.

Another thought: should we continue communication skills training after graduation and in early clinical practice?

The Royal College of physicians (RCP) has given great value to communication skills in their  MRCP PACES ( practical assessment of clinical examination skills) exam. which is a postgraduate entrance exam. which highlight the fact of importance of clinical communication skills training after graduation.

My current capstone project is to research communication best practices for a gap analysis of nurse to nurse communication surrounding consultation of our Vascular Access Team.  So far, it looks as though communication curriculum for nurses has been mostly basic anatomy, I.e., sender-receiver, barriers, cultural sensitivity, and HIPPA compliance.  Yet, most workplace communication is much more complicated and intense.  Furthermore, nursing has a lot to learn still from the business community on professional communications. So I would say, "yes, definitely communication training should be ongoing for not only new grads, but for the professional RN as well."   Early clinical practice is a great time to re-evaluate actual performance in the workplace.  Since communication is environmentally dependent, it would be the perfect time to do a self-assessment and create new strategies if necessary.  I highly recommend incorporating group feedback as in a Nurse Residency Program, or to have group time specific to communication issues on a unit.

The initial step is to agree on the need to review the existing curriculum on the subject. This can be approved as a cross-cutting or a service curriculum for all the existing healthcare disciplines or courses. The key content skills of healthcare communication skills include: reading, writing, speaking/oral (speech or word of mouth), understanding (comprehending), listening. These are in addition to all the human senses such as smelling, touching or feeling, tasting, seeing, or hearing among others. Each of these can be developed into course units. The course should be designed to include the traditional communication skills elements like: source, message, channel, receiver (audience), destination, feedback, and context (specific situation or environment). In addition, the course or programme should be designed or taught using a mix of the following methods: theory and practice based on individual and group activities, action research, field work or community outreach, formative and summative assessments or evaluation (learners are evaluated by teachers and tutors/ lecturers/  teachers are evaluated by their students). Clinical settings are covered in both theory and practice. It is possible to integrate communication skills across-the curriculum in different ways such as: by infusing it into each subject as appropriate, as special projects, as separate subjects or courses, as interactive website postings, and outreach activities.

Hello, Interesting question!  I am currently doing my doctoral work on effective communication in teams specifically related to increasing patient safety.   While my work is adressing practing health care professionals I believe introducing communication skills into an undergraduate curriculum could be very positive.

Effective communication is an essential practice skill..  Lack of effective communication can lead to significant adverse outcomes.  Nurses and physicians communicate differently and those differences can result in conflict creating an envrionment of intimidation and fear.  "Speaking up" is a particularly difficult skill for many nurses; and should be part of assertive communication strategies.  The listerature and reserach around speaking up, voice and organizational silence is very interesting and again speaks to the need to address these issues formally within a curriculum. 

Evidence indicates that communication training is most effective if it occurs in interdisciplinary teams and simulation is a great place to start that skill building.  AHRQ has TeamSTEPPSTM curriculum; the curriculum has excellent vignettes, videos and teaching outlines on teams and communication which can be acquired at no cost.  Building communication into nursing curriculums might help ease transition into practice.