Transcript B2-Fri-2-2-1

Fri 30th Aug 2013
Session 2 / Talk 2
10:50 – 11:05
BROOKLYN 2
RADIOTHERAPY
Hazel NESER
Abstract
Introduction During March 2013 it was decided to pilot an innovative approach to develop Year 3 radiation
therapy students’ communication skills via simulated clinical scenarios with the use of actors.
Method Twelve common clinical scenarios from the radiation therapy setting were developed and actors
were employed to deliver these scenarios in a simulated clinical setting. Sixteen Year 3 students agreed to
participate in this pilot. They were presented with one scenario and were then required to manage their
interactions appropriate to its context. Two teaching staff and peers observed each student’s interaction via
a digital screen and rated their observations of the student’s performance in six key skills. Each student
was individually videoed so that they could review their own interaction. Verbal feedback was given to the
student directly after their scenario and then written feedback was provided based on collation of
observations of staff, peers and self-review. Ethical approval was gained from the University of Otago’s
ethics committee.
Results Preliminary findings indicate that this was an effective method for students to evaluate their
communication skills. Students reported they gained insight into their strengths and weaknesses, and what
skills needed further development. They also reflected positively on the advantage of watching how their
peers managed interactions as it gave them a different approach to consider.
Conclusions This was an effective tool to enhance personal awareness about communication skills and
areas to develop further. Review of the process is underway to refine delivery for 2014.
Communication is easy,
isn’t it..??
Hazel Neser and Gay Dungey
University of Otago Wellington
NZIMRT 2013
Background
 Two communication papers in undergraduate RT
degree: one in first year and one in second year
 Undergraduate Radiation Therapy and Oncology
papers
 Third year Professional Development paper
 Mostly theoretical with written assessment
Background
 Challenge of teaching
face-to-face
communication skills in a
digital era
 Use of closed circuit video
and simulated clinical
scenarios to create a safe,
low anxiety, controlled
learning environment
 Would this be useful to
adopt in RT training?
Medical and nursing training have
adopted an integrated approach in
their curricula to teach communication
skills, using actors in simulated clinical
scenarios that range from low to high
fidelity:
 Role play
 Video
 Small group discussion and feedback
 Early exposure to real and simulated
patients
Aims:
To facilitate transfer of learning from
academic papers to simulated clinical
scenarios
To develop Year 3 students’ confidence,
competence and professionalism in their
interactions with patients and clinical staff
Sample
 All Year 3 student radiation therapists
enrolled in the Professional Development
paper participated in the workshop
 To avoid coercion to participate in this
study, students were informed that they
could decline by not signing consent form
 17/23 students consented to participate in an
evaluation
 14 females and 3 males
 Aged between 20-25 years
So what did we do?
 Developed 12 common clinical communication
scenarios with high fidelity in a radiation therapy
department, involving either patient or staff
interactions (6 patient, 5 staff and 1 friend/family
scenarios)
 2 actors employed to deliver scenarios in a
simulated consult room with closed circuit video
 Students videoed during real-time and viewed by
peers and lecturers on screen outside of consult
room. Each interaction lasted approximately 5-10
minutes.
Procedure
Students were rated on a Likert
scale by peers and lecturers on
the following aspects:
1-3
Below
expectations
Initial engagement
Identifies the issue/s
or concern/s
Exploration of issue/s
or concern/s
Building the
relationship
Reaching common
ground
Closing interaction
4-6
Meets
expectations
7-9
Above
expectations
Here’s a sample scenario…
Verbal Self Review
In order to develop students’ reflective skills,
each student was invited to reflect on their
experience immediately after scenario with
their peer group:
 How do you think that went?
 What did you do well?
 What do you want to improve?
Verbal Peer Review
 Peers provided verbal feedback after student’s
verbal self-reflection
 Actor also gave feedback from their
perspective
 Lecturers facilitated feedback process overall
 Each student given their own video to critique
their own performance
Written Feedback
 3 sources of information for written
feedback:
 Written self-review was collected from each
student
 Written peer and lecturer feedback were
collated and then given back to each student
as a written summary of performance
Preliminary Findings: Key Themes
Preparation for the clinical environment
The value of learning from peers
Personal insight on own practice
Student Perceptions
 ‘I feel this is a worthwhile exercise…’
 ‘It was very helpful having this scenario
because it would prepare me if I do ever
come across some situation like this…’
 ‘…is helpful to watch and reflect on
someone else doing the same scenario…’
Student Perceptions…
‘I thought my rapport was quite good. I
seemed to be listening well and gave
advice in reaction to what was being
said. I think I could have been less
awkward during the silences because
sometimes silence is acceptable.’
Student Perceptions…
‘I froze up in the situation as well as
trying to find a solution; found it very
awkward but good practice as it
could happen in the clinic and I feel
more prepared now than I did before
the situation.’
Student Perceptions…
‘It was a challenge and quite
intimidating but I learnt from it. The
KEY thing I learnt was that patients
often just need to be listened to.
As an RT I feel like I have to fix
everything for them when really,
after all, they require someone to
listen and empathise with them.’
What else we found…
Overall – ratings by peer, lecturer and
self-reviews were similar
This congruence suggests that students
know what they are good at and what
they need to improve
Health Professional Education
Our findings are similar to those of other
studies that have used actors in simulated
clinical scenarios to develop
communication skills of health professionals
Value of learning from high fidelity
simulated scenarios
Personal and peer ratings tend to be
congruent
Conclusions
 Sound foundation to develop communication
skills
 Structured approach
 Safe and low anxiety environment
 Value of observing peers
 Important role of self and peer review: value in
learning how to give and receive feedback
Limitations
 Self-report
 Peer evaluations
 Challenge of giving and receiving
feedback
 Selection bias
 Who participated/did not participate
Implications for future
 Refine learning objectives
 Development of standardised scenarios
across the three undergraduate years
 Increasing complexity of scenarios appropriate
to each year level
 Evaluation of transfer from academic to
clinical
References
1.
Baille, L., and Curzio, J. (2009). Students’ and
facilitators’ perceptions of simulation in practice
learning. Nursing Education in Practice, 9, pp 297-306.
2.
Bambini, D., Washburn, J., and Perkins, R. (2009).
Outcomes of clinical simulation for novice nursing
students: communication, confidence, clinical
judgment. Nursing Education Perspectives, 30(2), pp 7982.
3.
Bennett, K., and Lyons, Z. (2011). Communication skills in
medical education: an integrated approach.
Education Research and Perspectives, 38(2), pp 45-56.
4.
Gropper, R., et al. (2010). The path to simulated
learning: developing a valid and reliable tool to
evaluate performance of radiological technology
students in patient interactions. Journal of Allied Health,
39(1), pp 28-33.
Thank you!