Teaching Medical Students Skills for Effective Communication With Patients Who Have Communication Disorders

Abstract

Purpose Patients with communication impairments including speech, language, cognition, or hearing disorders face many barriers to communication in health care settings. These patients report loss of autonomy in health care decision making, are at increased risk for medical errors, and are less satisfied with health care than patients without communication disorders. Although medical students receive training in effective patient-provider communication, most of this training assumes patients have intact communication abilities. Medical students and other health care providers are often unprepared to meet the communication needs of patients with communication disorders in health care encounters. The purpose of this study was to assess the impact of a curriculum for training medical students to communicate effectively with patients who have a range of communication disorders. Method Twenty-six 2nd-year medical students volunteered for assessments before and after a required workshop in a class. This workshop included instruction about different types of communication disorders and communication strategies, followed by practice with standardized patients portraying different communication disorders. Outcome measures included a knowledge test, ratings of self-efficacy, and evaluation of students' skills when interviewing standardized patients portraying aphasia and dysarthria. Results Medical students demonstrated significant improvements in knowledge, self-efficacy, and use of recommended communication techniques. Conclusions The curriculum appeared effective in changing medical students' knowledge and skills for working with patients with communication disorders. Equipping medical students to meet the needs of patients with communication disorders is 1 key element for improving the quality of health care for this patient population.

Figure 1.

(a and b) Communication skill levels demonstrated by the medical students in each FRAME skill area when interviewing standardized patients portraying aphasia (a) and dysarthria (b). The original 0–10 rating scale was multiplied by 10 for presentation. On the y-axis, 0 = needs improvement and indicates that participants demonstrated little or no awareness or concern for the communication needs of the patient, and they implemented none or one of the targeted communication strategies. A score of 50 = expected and was used when participants demonstrated awareness of the patient's communication needs and made sustained efforts to implement strategies, but the participant might not be highly facile with strategies. This reflected that, at this level of training, students would not be expected to be highly polished with using communication strategies, but they were at least demonstrating awareness and basic skill levels. A score of 100 = truly exceptional and was used when participants implemented appropriate communication strategies with comfort, success, and efficiency, thus demonstrating genuine ease. Asterisks designate a significant difference between pre- and posttraining at p < .05. The numbers in parentheses above the bars are Cohen's d effect sizes corrected for repeated measures.