Finding common ground: meta-synthesis of communication frameworks found in patient communication, supervision and simulation literature

Abstract

Background: Effective communication between patients-clinicians, supervisors-learners and facilitators-participants within a simulation is a key priority in health profession education. There is a plethora of frameworks and recommendations to guide communication in each of these contexts, and they represent separate discourses with separate communities of practice and literature. Finding common ground within these frameworks has the potential to minimise cognitive load and maximise efficiency, which presents an opportunity to consolidate messages, strategies and skills throughout a communication curriculum and the possibility of expanding the research agenda regarding communication, feedback and debriefing in productive ways.

Methods: A meta-synthesis of the feedback, debriefing and clinical communication literature was conducted to achieve these objectives.

Results: Our analysis revealed that the concepts underlying the framework can be usefully categorised as stages, goals, strategies, micro-skills and meta-skills. Guidelines for conversations typically shared a common structure, and strategies aligned with a stage. Core transferrable communication skills (i.e., micro-skills) were identified across various types of conversation, and the major differences between frameworks were related to the way that power was distributed in the conversation and the evolution of conversations along the along the path of redistributing power. As part of the synthesis, an overarching framework "prepare-EMPOWER enact" was developed to capture these shared principles across discourses.

Conclusions: Adopting frameworks for work-based communication that promote dialogue and empower individuals to contribute may represent an important step towards learner-centred education and person-centred care for patients.

Keywords: Communication; Education; Patient care; Power; Simulation; Skills; Supervision; Training.

Fig. 1

Meta-Synthesis methods. In response to the study question an iterative process of screening (literature search) synthesis into a draft framework and re-evaluation was undertaken. An exemplar was chosen from each of the three conversations studied (Makoul, Johnson and Watterson) to initiate the process. A process of constant comparison between an identified study and the draft framework was used to challenge and improve the existing framework

Fig. 2

Conversation Structure. Each conversation was constituted by a preparation, conversation and action phase. Preparation was supported by a clear purpose and goal setting. Conversation was supported by micro-skills, clear structure and strategies. Action was supported by a coaching model. The process occurs in an environment determined by values (person-centred care and an improvement mindset), the learning culture and the relationship in question