This my assignment. I attached the article in the file you can read it to understand every thing. My teacher, gave us 1 question. I write the questions in below you can answer 250 word. Also, I attached 2 participate of these students to you below . You have to reply for 2 students at least 100 word.1- what are the advantages and disadvantages of the blended learning method ?
screen_shot_2016_10_07_at_1.31.35_am.png
screen_shot_2016_10_07_at_1.32.52_am.png
teaching_communications_skills.pdf
Unformatted Attachment Preview
American Journal of Pharmaceutical Education 2016; 80 (4) Article 64.
RESEARCH
Teaching Communication Skills to Medical and Pharmacy Students
Through a Blended Learning Course
Rick Hess, PharmD,a Nicholas E. Hagemeier, PharmD, PhD,a Reid Blackwelder, MD,b Daniel Rose, BS,a
Nasar Ansari, BS,a Tandy Branhama
a
b
East Tennessee State University Bill Gatton College of Pharmacy, Johnson City, Tennessee
East Tennessee State University Quillen College of Medicine, Johnson City, Tennessee
Submitted April 2, 2015; accepted July 23, 2015; published May 25, 2016.
Objective. To evaluate the impact of an interprofessional blended learning course on medical and
pharmacy students’ patient-centered interpersonal communication skills and to compare precourse
and postcourse communication skills across first-year medical and second-year pharmacy student
cohorts.
Methods. Students completed ten 1-hour online modules and participated in five 3-hour group
sessions over one semester. Objective structured clinical examinations (OSCEs) were administered
before and after the course and were evaluated using the validated Common Ground Instrument.
Nonparametric statistical tests were used to examine pre/postcourse domain scores within and
across professions.
Results. Performance in all communication skill domains increased significantly for all students.
No additional significant pre/postcourse differences were noted across disciplines.
Conclusion. Students’ patient-centered interpersonal communication skills improved across multiple domains using a blended learning educational platform. Interview abilities were embodied
similarly between medical and pharmacy students postcourse, suggesting both groups respond well
to this form of instruction.
Keywords: blended learning, communication skills, objective structured clinical examinations
patient-centeredness, and the emphasis of the course is to
truly help students of all disciplines begin to focus on the
issues of the patient primarily. Yet, learning to balance
clinician-centered aspects (ie, diagnosis, medications) of
communication with patient-centered aspects (ie, fears,
concerns, expectations) and performing them at a competent level requires instruction and regular practice for the
student learner.
Suggested pedagogical methods to teach communication skills are varied and can involve observation (real
time or recorded), self-assessment, role-playing, and role
modeling.4 Experiential-based instruction with feedback
improves student communication competencies over traditional or instructional-based formats.5 Yet, few studies
have been conducted comparing two or more experiential
methods in communication training. One study evaluating
standardized patients (SP) and peer role-playing concluded
both methods improved self-efficacy and objective structured clinical examination (OSCE) scores, however the
role-play technique led to higher empathic responses.6
Many training institutions have employed SP interactions for experiential learning.7-10 This type of interaction is preferred over actual patients because a SP can be
INTRODUCTION
Effective communication is paramount to practicing
patient-centered care, and cultivating this skill is a vital
component in the training of all health care students. Medical and pharmacy school accreditation bodies recognize
the importance of this competency in the training of future
clinicians as programmatic curricula incorporating the
formalized instruction of interpersonal communication
skills are mandatory.1,2 From a physician’s perspective,
patient-centered care “seeks to focus medical attention on
the individual patient’s needs and concerns, rather than
the doctor’s.”3
This general definition could easily apply to pharmacists and other health professionals as well. The concept
of delivering patient-centered care is at the heart of health
care reform, and cultivating a clinician-patient relationship is a foundation for its successful deployment.
Exemplary communication skills are the ultimate in
Corresponding Author: Rick Hess, Department of Pharmacy
Practice, Bill Gatton College of Pharmacy, Box 70657,
Johnson City, TN 37614-1704. Tel: 423-439-6784. Fax: 423439-2075. E-mail: hessr@etsu.edu
1
American Journal of Pharmaceutical Education 2016; 80 (4) Article 64.
a helpful ally in teaching and assessment.11 However,
early learners also need exposure to traditional instructional
methods to introduce desirable and effective core communication concepts. One approach to delivery is using a
blended learning format whereby students first learn and
observe basic communication skills on their own time and
follow that with an experiential component. With this approach, students come prepared to practice learned patientcentered communication techniques and receive feedback,
which uses the training time more efficiently.
Blended learning, a form of e-learning using electronic media, is defined as “the thoughtful integration of
classroom face-to-face learning experiences with online
learning experiences.”12 The online component may be
classified as either synchronous (eg, videoconferencing,
instant messaging, chat) or asynchronous (eg, web-based
presentations, lectures or modules, e-mail, blogs). Advantages of blended learning formats compared to traditional
learning formats are that they are valued by self-directed
adult learners, help overcome the limitations of meeting
time and space, reach a larger number of students, support
instructional methods hard to achieve using textbooks,
save training costs, produce high student ratings, increase
student perceptions of achieving course objectives, and
achieve academic results equivalent to strict face-to-face
teaching.13-16
Blended learning is used in health education to teach
a broad scope of subject matter such as acute care, pediatrics, otolaryngology, cardiovascular pharmacotherapy,
oral radiology, orthodontics, respiratory care, research
ethics, and interprofessional team development.14,16-23
There is also “rudimentary” evidence that blended learning strategies can help students improve their clinical
competencies.24 Health professions students express acceptance using e-learning methods and view its role as
complementary to, but not entirely substitutionary for,
traditional face-to-face faculty-led instruction.25-27
Communication Skills for Health Professionals is
a 2-credit hour course at East Tennessee State University’s (ETSU) Academic Health Science Center (AHSC)
and has been previously described in the Journal.28
Briefly, course enrollment is interdisciplinary and consists of medical, nursing, pharmacy, and psychology students divided into small groups (6-7 students per group)
containing representation from at least three colleges. The
small groups are led by a diverse group of faculty members with appointments at one or more of the participating
colleges.
The biweekly format employs asynchronous, online,
self-directed learning modules to teach core communication skills alternating with a live, 3-hour small group session. This schedule makes available most of the class time
for student learners to interview SPs. An objective assessment of each student’s communication skills is measured
by trained faculty members during mid-point and end-ofcourse OSCEs. Our research objective was to determine
the effectiveness of this blended course design in teaching
medical and pharmacy student patient-centered interpersonal communication skills and compare the results
across disciplines. To our knowledge, this is the first study
to measure the effectiveness of a blended learning format
to teach patient-centered communication.
METHODS
An e-mail was sent to all enrolled incoming first-year
medical and second-year pharmacy students about three
weeks before the start of the course inviting them to participate in the study. The e-mail contained a description of
the study objectives along with a disclaimer that the interviews would be timed and recorded in a format identical to the final OSCE examination, but not viewed until
course completion to avoid potential biasing of faculty
members toward any participant based on precourse
OSCE performance. In addition, students were instructed
that their precourse OSCE scores would not affect their
grade. No rewards or incentives were given to participants.
Nursing and psychology students were not included because their academic calendars began later and did not allow sufficient time for precourse research activities.
Two discipline-specific, precourse recording schedules were held in August 2012. On the day of their scheduled interview, students were given eight minutes to
interview an SP without interruptions. A “door chart”
provided the reason for the patient visit (to talk about
quitting smoking) and was the only information shared
with the student prior to the start of the interview. No
instructional feedback was given when finished.
The SPs were recruited from the ETSU Standardized
Patient Program and were given a smoking cessation case
scenario that included instructions on how to portray the
scene emotionally and how to divulge scripted “clues”
reflecting the patient’s perspective of the situation. The
case was written by course faculty members and has been
used as part of the course’s final OSCE for several years.
The subject of smoking cessation was chosen because it is
a common health topic relevant to all health professions.
The course is designed to ensure the patient-centered
emotions, perspectives, and concerns are the focus rather
than the student’s clinical knowledge base.
Prior to evaluating students, all evaluators completed
a training session conducted by course coordinators that
provided opportunities to use the validated Common
Ground Rating Scale OSCE assessment tool.29 Evaluators
2
American Journal of Pharmaceutical Education 2016; 80 (4) Article 64.
watched a recorded interview and assessed six communication skill constructs (rapport building, agenda setting,
information management, active listening, addressing
feelings, and establishing common ground) as well as
global interview performance using the Common Ground
Rating Scale rubric (Table 1). Scores from the practice
assessment training were compared to scores from communication experts to ensure inter-rater reliability.
Course coordinators randomly selected and scored 10%
of all pre/postcourse OSCEs to assess inter-rater reliability. Ratings were considered reliable if scores were within
20% for each communication skill construct. One evaluation was completed for each participant.
One week after completion of the precourse OSCE,
192 first-year medical, nursing, clinical psychology, and
second-year pharmacy students began Communication
Skills Health Professionals in the fall 2012 semester. Over
the semester, students completed 10 online modules and
attended five small group sessions (Table 2). Following
the third small group session, all students completed
a midterm OSCE. Faculty member provided feedback
1-2 weeks later to students during 30-minute individual
appointments. The final OSCE consisted of two consecutive SP interviews with the last case identical to the
precourse OSCE. Faculty members graded the interview
performance live, but no postinterview feedback was provided. Again, one evaluation was completed for each participant and none of the pre/postcourse evaluators or SPs
were identical.
Scores on pre/postcourse communication skill constructs and the global rating score were analyzed using
SPSS, v22 (IBM, Armonk, NY). Descriptive statistics
were calculated for all construct scores. All communication skill constructs were scored using the Common
Ground Rating Scale rubric on a 1-5 scale (15needs
improvement; 25marginal; 35competent/adequate;
45effective; 55exemplary), with half-point increments
allowed. Data were treated as interval-level variables.
Means (standard deviations) and medians (interquartile
ranges) were calculated for each communication skill
construct. Nonparametric Mann-Whitney and Wilcoxon
rank sum tests were used to compare paired pre/postcourse
scores and pre/postcourse scores across colleges, respectively. An alpha level of 0.05 was set a priori. The East
Tennessee State University Institutional Review Board
approved the study.
the course, representing 79.4% of all medical and pharmacy students who were enrolled in the course.
Precourse agenda setting, information management,
active listening, addressing feelings, and establishing
common ground construct scores were not significantly
different when comparing medical to pharmacy students
(Table 3). Precourse scores for the rapport building construct were significantly higher for medical students
(median53) compared to pharmacy students (median52)
(p,0.01). Median medical student scores ranged from
2 to 3 across all communication constructs, whereas all
median values for pharmacy students were 2. Median
global rating precource scores were 2 for both medical
and pharmacy students.
Five of six postcourse communication skill construct
scores were similar across medicine and pharmacy as was
the global rating (Table 3). Rapport building scores were
significantly higher for pharmacy students (median55)
compared to medical students (median54, p,0.01). Median medical student postcourse scores were 4 across all
communication constructs and the global rating. Median
values for pharmacy students ranged from 4 to 5 across all
communication constructs and the global rating.
Communication skill construct scores and the global
rating scores significantly increased for both medicine
and pharmacy students postcourse compared to precourse
(p values,0.01). Figure 1 presents pre/postcourse median
scores across disciplines.
DISCUSSION
The blended learning course significantly improved
medical and pharmacy students’ patient-centered communication skills. Similarities in communication domain
scores indicate that this course increased both medical
and pharmacy students’ patient-centered communication
skill competency. In general, both medical and pharmacy
students scored poorly in all communication skill domains at baseline. Medical students’ higher interpersonal
skills coming into the course may be related to significantly better scores than pharmacy students in precourse
rapport building. Pharmacy students, being less equipped
for the patient-centered setting, may have benefited more
from the practice and, therefore, showed significantly
more improvement in that domain.
After the course, a large majority of students in both
professions demonstrated patient-centered communication skills with SPs that were considered effective. Meaningful clinician-patient relationships, which are vital to
fostering patient-centered care, were cultivated by the
effective communication strategies emphasized in this
course. The current project specifically evaluated patient
RESULTS
One hundred twenty-four students (n567 medicine,
66% male and 34% female; n557 pharmacy, 39% male
and 61% female) completed the OSCEs before and after
3
Information
Management
Agenda Setting
Rapport Building
Category
Very Effective (4)
Explores complete agenda at the
beginning (first 2 minutes after
rapport building) until patient
says, “Nothing else.” Explicitly
plans agenda and if several
agenda, prioritizes them.
Explores for additional agenda
later or at the end.
Begins interview with effective
open-ended question and
nondirected facilitation.
Continues in this mode (with
occasional closed-ended points
of clarification) until most/all of
patient’s information about the
condition has been expressed.
Notably effective information
flow with explicit summary(s),
directives, and/or segues. Asks
appropriate focused (closed)
questions towards the end.
Clear, professional,
respectful, and
interested but minimal
or ineffective specific
verbal or nonverbal
efforts to make a more
personal connection.
Competent/
Adequate (3)
Begins with a majority of
effective open-ended
questions/facilitations.
Appropriate mixes of
open and closed-ended
questions. (Required)
Effectively manages info
flow. Uses some form of
summary, directives or
segues.
Uses some open-ended
and closed-ended
questions from the
beginning. Doesn’t use
summaries, directives
or segues. Organization
adequate.
Explores complete agenda
Explores for agenda
early until “Nothing else”
partially with at least
but does not summarize
two efforts at agenda
or prioritize or explore
setting. One can be at
for more agenda at end.
beginning and one at
end.
Notably warm and makes
Demonstrates rapport-building
effective connection via
skills so most patients would
identifiable elements
subsequently go out of their way
of both verbal and
to tell friend or family about this
nonverbal connection.
interviewer with extraordinary
interpersonal skills. Usually
includes two or more elements of
“positive speak” and expressions
of nonverbal interest that are
exceptionally warm.
Exemplary (5)
Table 1. Communication Skills Domain Rating Categories and Observable Descriptions
Needs
Improvement (1)
4
Mostly closed-ended
questions. Info flow
weak, repetitive, or
disorganized.
(Continued)
Mostly closed-ended
questions. Uses
numbers of flawed,
leading, or repeated
questions.
Disorganized,
confusing,
misleading info
flow.
Absent are positive
For the most part,
elements of
professional and
relationship
respectful. Absent of
building. Present
specific effective
are clearly negative
efforts at rapport
comments or
building. Present are
expressions, which
some comments,
would leave many
expressions or
patients with
nonverbal behaviors,
negative feelings
which might have a
about the
negative reception by
interviewer.
a least some patients.
Asks only once at the
Doesn’t explore for
beginning “What
agenda but begins
brings you in today?”
addressing an
or “How can I be of
established problem
help?” or at the end
identical in chart.
“Is there anything
Doesn’t return to
else?”
agenda at any point.
Marginal (2)
American Journal of Pharmaceutical Education 2016; 80 (4) Article 64.
Exemplary (5)
Very Effective (4)
Demonstrates genuine
Active Listening Very effective at identifying the
interest in the PPI by
PPI (ie, what the patient thinks
to Understand
using active listening at
the Patient’s
may be going on; the greatest
least part of the time.
concern about the problem; and
Perspective
Does explore the clues
the expectations for the visit).
on Illness (PPI)
initially, but not always
The PPI is repeatedly explored
fully. Once identified,
using active listening to
PPI will be partially
understand the meaning behind
addressed with some
the patient’s “clues.” Once the
elements of
PPI is disclosed, these elements
acknowledgment,
are acknowledged, normalized,
normalization, and
and used as part of a plan to
building a plan based
address the medical diagnosis
on the PPI.
and the PPI.
Acknowledges feeling
Addressing
Responds to all opportunities to
when expressed. Does
Feelings
address feelings. When feelings
not fully address/
surface, these are effectively
incorporate into
addressed and then incorporated
visit. Does not fully
into the visit. Also effectively
address “potential”
seeks out the “potential feelings”
feeling situations.
when situations with high
likelihood of feelings surface in
the interview.
Plan begins with a
Plan linked explicitly to a
Reaching
considerable
thorough understanding of the
Common
understanding of
patient’s knowledge and
Ground (no
patient’s knowledge and
perspective. Discusses
conflict)
perspective. Explains
feasibility, and decision making
clearly with only
and matches plan to patient’s
occasional use of jargon.
apparent or explicit preference.
Checks for understanding
Explains diagnosis and
and feasibility explicitly.
treatment clearly and concisely,
Supports patient’s
checks effectively for
decision-making
understanding (tell-ba …
Purchase answer to see full
attachment
Recent Comments