Evaluation of a Communication Survey and Interprofessional Education Curriculum for Undergraduate Health Professional Students
INTRODUCTION Effective communication is an essential competency for collaborative, interprofessional practice. Listening partnerships (taking turns listening for a specified time) are believed to develop more skillful communication. This pilot study examined the perceived communication abilities among undergraduate health profession students enrolled in a multi section foundational Introduction to the Health Professions course. METHODS The research design employed a control group (using the established communication curriculum) and an intervention group (using repeated practice with listening partnerships throughout the duration of the semester) The study compared student perceptions of their own verbal and non verbal communication abilities before and after enrollment in the course. The study also examined the test retest reliability of the instrumentation: the Froehlich Communication Survey. RESULTS Results revealed students reported improved perceptions of their communication abilities after engagement with both the established curriculum as well as the experimental curriculum. An increase in student perception of their ability to listen with compassion was demonstrated only through the interventional curriculum. Statistical analysis revealed good test retest reliability of the instrument. CONCLUSION Results suggest that student perceptions of their own verbal and non verbal communication abilities can be enhanced through intentionality of curriculum and active teaching and learning activities. Received: 05/27/2015 Accepted: 11/13/2015 (c) 2016 Froehlich et al. This open access article is distributed under a Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. H IP Evaluation of a Communication Survey and Interprofessional Education Curriculum ORIGINAL RESEARCH 2(4):eP1082 2 Introduction Scholars increasingly note the importance of effective communication with patients, family, and interprofessional health care team members in the provision of quality healthcare (Alpert, 2011; Boschma et al. 2010; Institute of Medicine [IOM] 2000; Joint Commission, 2015; Lingard, Regehr, Orser et al. 2008; O'Sullivan, Chao, Russell, Levine, Fabiny, 2008; Reisdorff et al. 2006; Sargeant, MacLeod, Murray, 2011; Sutcliffe, Lewton, Rosenthal, 2004; Taylor, 2008) The Joint Commission (2013) tracks sentinel events or "unexpected occurrences involving death or serious physical or psychological injury, or the risk thereof " and identified breakdowns in communication within health care teams as one of many root causes of medical errors. The Commission's 2015 report showed that 563/887 sentinel events in 2013 were due to communication errors second only to human factors as a root cause of medical errors. In 2014 and by the second quarter of 2015, communication as a root cause of sentinel errors had dropped to 3rd place behind human factors and leadership (Joint Commission, 2015) Studies show communication skills of health professionals do not necessarily improve over time or with clinical experience (Fallowfield, Jenkins, Farewell, Saul, Duffy, Eves, 2002; Fellowes, Wilkinson, Moore, 2004) Although data reported to the Joint Commission is voluntary and not epidemiologic, a review of their data could lead one to speculate on whether the communication skills of health professionals might be improving. Studies do show that communication skills can improve with the proper training. While lectures appear to have limited impact in teaching communication skills, effective active teaching methodologies include the following: small group discussion, role play, coaching, written reflection combined with interviews and field note reports, videotapes, feedback, skill practice, multi disciplinary panels, simulated patients in Objective Structured Clinical Examinations (OSCE) and interactive role play (Berkhof, van Rijssen, Schellart, Anema, van der Beek, 2011; Boschma et al. 2010; Harmsen et al. 2005; Kleiner, Link, Travis Maynard Carpenter, 2014; O'Sullivan, Chao, Russell, Levine Fabiny, 2008; Sargeant, MacLeod, Murray, 2011; Shield, Tong, Tomos, Besdine, 2011; Trad, 2013) Listening Partnerships in an Occupational Therapy Curriculum Harris and Templeton (2001) found clients ranked 'listening' as the most important behavior of health professionals. Although one could argue that Implications for Interprofessional Practice Athough in the development phase, Froehlich's Communication Survey appears to be a viable tool for assisting students across health professions in becoming more aware of communication strengths and areas for improvement in self and others. An intentionally delivered interprofessional curriculum that uses active teaching strategies, including the use of listening partnerships (taking turns listening in pairs or triads) appears to enhance health professional students' perceptions of their verbal and non verbal communication abilities. Repeated practice with listening partnerships appears to enhance student perceptions of their ability to listen with compassion. An important area for future research is examining the correlation between students' perceptions of their communication skills and their actual communication abilities with patients, clients, family, and interprofessional team members. H IP ISSN 2159 1253 Health Interprofessional Practice commons.pacificu.edu/hip 2(4):eP1082 3 speaking up and asserting oneself is just as important as listening, Alpert (2011) stated, "the commonest failure in communicating information is the result of inattentive or inaccurate listening" (p. 381) When working with individuals from cultural groups different from our own, listening can become even more complex and challenging (Black Wells, 2007) To enhance communication skills with diverse clients and colleagues, listening partnerships have been used as a formal training method in small group communication and culture seminars in an occupational therapy curriculum at a the University of New England, Biddeford/Portland, ME (UNE) for over 20 years (Froehlich Nesbit, 2004; Froehlich, 2010; Froehlich, Roy, Augustoni, Arsenault, Eldredge, 2014) Listening partnerships, defined as taking turns listening and speaking with a peer for a mutually agreed upon amount of time, are based on the theory and practice of co counseling, also known as re evaluation counseling (Kauffman New, 2004; Jackins, 1981) Students are initially asked to listen to each other for one minute each way without saying anything as the listener in order to raise awareness of the common communication practice of frequent interruptions. Students then engage in repeated listening partnerships in pairs or small groups where they no longer refrain from speaking as listeners, but refine use of effective verbal and non verbal communication. These techniques include asking open and close ended questions, rapport building, clarification, validation, eye contact, reflection and summarizing. Questions related to gender, race, class, culture, age, sexual orientation, religion, and disability support meaningful dialogues on diversity in listening partnerships. Students report in reflective journals that repeated practice taking turns in class listening for 2 5 minutes each way and a minimum of 10 minutes each way as a weekly homework assignment supports the development of better listening and speaking skills. They also report that this exercise sharpens mental focus and attentiveness during conversations. Communication and Cultural Competence Surveys To improve the assessment of learning outcomes related to effective communication and cultural competence, Froehlich developed effective communication and cultural competence surveys (Froehlich et al. 2014) The surveys contain Likert type scale items allowing participants to indicate their level of agreement with survey statements. Qualitative open ended questions then ask students to identify goals related to improving effective communication and cultural competence. These surveys have been piloted with occupational therapy students in a communication and culture course with favorable reviews (Froehlich et al. 2014) Some students report that their communication skills improve simply by completing the communication survey while others appreciate the awareness they gain regarding their deficits in cultural knowledge from the cultural competence survey. For the purposes of this study, only the communication survey was evaluated. Listening Partnerships in an Interprofessional Course UNE has implemented an innovative undergraduate health profession curriculum (Pardue, 2013) This curriculum is required for all undergraduate health care students including nursing, dental hygiene, athletic training, applied exercise science, and health wellness and occupational studies (pre OT) majors. The program of study involves four courses which address the interprofessional collaborative competencies (values and ethics, roles and responsibilities, interprofessional communication, and interprofessional teamwork and team based care) as advanced by a national expert panel (Interprofessional Education Collaborative [IPEC] 2011) The courses include: Introduction to the Health Professions, Health Care Issues, Methods of Scholarly Inquiry, and Ethics for Interprofessional Practice (Pardue, 2013) Faculty from the described majors developed and continually refine these courses. Interprofessional faculty meetings offer rich opportunities for faculty to learn from, with and about each other in shaping these courses into excellent, interprofessional learning experiences for students. In alignment with competencies identified by the IPEC expert panel report (2011) the Introduction to Health Professions course at UNE focuses on assisting students to learn the various roles and responsibilities of