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Communication Skill Development for Dental and Dental Hygiene Students

Sharon K. Lanning, DDS

Overview of Project

A series of exercises were offered to second year dental (D2) and third year dental hygiene (DH3) students on communication skill development. D2 and DH3 students received information on the fundamentals of communication protocol, observed faculty modeling of effective communication in the dental setting and were given the opportunity to practice their communication skills with simulated patients. Simulated patients were played by fourth year medical (M4) students. M4 students and fourth year dental (D4) students gave feedback to the D2 and DH3 students on their communication skills immediately following their interaction with the simulated patient.

Objectives

The objectives of this project were to (1) provide D2 and DH3 students with information on effective communication, (2) model effective patient-clinician communication (3) have D2 and DH3 students practice their communication skills with simulated patients, (4) have D2 and DH students assess their own communication skills and (5) have D4 and M4 students provide feedback to D2 and DH3 students regarding their communication skills.

Description of Teaching Activities 2006

This project added 9 curricular hours of formal teaching and assessment of students’ communication skills to VCU’s School of Dentistry curriculum. Descriptions of the exercises are described below:

  • Lecture
    Features of more and less effective clinician-patient communication relating to how clinicians communicate with patients and what clinicians communicate to patients were presented.
  • Laboratory
    Role-playing amongst faculty members modeled more and less effective communication between clinician and patient. Students used checklists to identify features of effective communication and assessed the clinician’s skills before engaging in their own role-playing exercises.
  • Simulated Clinic Session
    D2 and DH3 students were divided into small groups to portray clinicians in a role-playing exercise with simulated patients played by M4 students. Each D2 and DH3 student had the opportunity to explain the dental findings and treatment plan to one of three simulated patient personas while their group mates observed. D2 and DH3 students assessed their own communication skills and then received immediate feedback from their group mates on their skills. D4 and M4 students facilitated this feedback session. M4 students were utilized for their extensive degree of formal communication training while D4 students have greater direct clinical experience. An interdisciplinary team of faculty from VCU’s Schools of Dentistry and Medicine oversaw the instruction provided. Prior to these exercises, D4 and M4 students participated in a two-hour training session where instruction on role-playing and facilitating constructive feedback were provided. Again, an interdisciplinary team of faculty from VCU’s Schools of Dentistry and Medicine participated in this training session.

Project Assessments and Results

Data were collected to assess the D2 and DH3 students learning of communication protocol and their perceptions of the exercises. Project assessment and results are described below:

  • Learning of Communication Protocol:
    Objective: To test students’ knowledge of communication protocol before and after a series of interactive exercises (as described above).
  • Methods:
    Upon completion of the exercises, eleven multiple choice questions were administered to D2 students immediately prior to (pre-test) and six weeks after (post-test) the exercises focusing on communications skills.    Data were analyzed using a paired samples t-test (α =.05) and Cohen’s d measure of effect size.
  • Results:
    Eighty-eight percent (84/95) of  D2 students completed both the pre-test and post-test. There was a statistically significant difference between the pre-test (X=55.7; SD=12.3) and post-test (X=60.8; SD=18.0) scores (t=-2.345; p=0.21).  However, the Cohen’s d measure of effect size demonstrates little practical significance between these scores (d=0.33).
  • Discussion:
    Although students ’ scores improved from pre-test to post-test, a greater gain was anticipated.  It may be that the multiple choice questionnaire did not allow for evaluation of the subjective aspects of communication protocol.  Further study is needed to determine the exact gains in knowledge of communication protocol since it is a fundamental component of effective communication in the health care setting.
    ***  Data analysis and results prepared by Jonathan Gorman, Sonya Lawson, PhD, and Sharon Lanning, DDS

Students’ Perceptions of Laboratory

  • Objective:
    To consider students’ perceptions of an exercise that included faculty modeling of more and less effective clinician-patient communication.
  • Methods:
    Upon completion of the exercise, a 15-item survey using a 5-point Likert scale was administered to analyze students’ perceptions of the efficacy of this training.  Chi-square analyses were used to determine the effects of variables (student type, age, gender, race, native language) on survey items.
  • Results:
    Response rate was 90% (105/116).  Ninety-two percent of students felt that the exercise was worthwhile and that they were better prepared to distinguish effective from non-effective communication. Ninety-seven percent of students reported learning skills that will help them in the future. However, only 55% of students expressed feeling more comfortable communicating with patients after the training. Seventy-five percent of DH3 students, compared with 51% of D2 students, expressed that the exercise helped them feel more comfortable communicating with patients.  Students commonly reported learning the importance of listening to patient concerns, reducing medical and dental jargon, and being conscious of non-verbal cues.
  • Conclusion:
    The comfort level communicating with patients trended higher for DH3 versus D2 students. This variation may be a result of DH3 students having a reference for their comfort in communicating with patients because they were the only student group treating patients at the time of the survey.  There were no significant differences for any of the variables under investigation, which may be due to small sample size.  Students perceived the classroom exercise as an effective use of time and felt that they were better prepared to identify effective communicate as a result of their experience.
    ***  Data analysis and results prepared by Ryan Edmunds, Sonya Lawson, PhD, Maria Victoria Throckmorton, DDS and Sharon Lanning, DDS

Students’ Perceptions of Simulated Clinic Session (immediately after the session)

  • Objective:
    To investigate whether variables (student type, (dental or dental hygiene), age, gender, ethnicity or primary language) influenced students’ perceptions of an interdisciplinary communication skills exercise.
  • Methods:
    Immediately after the exercise, a 23-item survey using a 5-point Likert scale was administered to D2 and DH3 students assessing their perceptions of skills learned, comfort level, and worth of the exercise. The exercise was completed twice and data from years 2005 and 2006 were combined.
  • Results:
    The response rate was 87% (200/228). Ninety percent of D2 and DH3 students felt that the exercise was worthwhile. Two survey items reached statistical significance. D2 students (79%) were more comfortable practicing communication skills in front of their group members compared to DH3 students (60%) (X2=13.3 P=.004). D2 students (75%) were more willing to participate again compared to DH3 students (48%) (X2=10.1 P=.007). It appears female D2 students were more comfortable with the exercise (80%) and willing to participate again (78%) compared to female DH3 students (59% and 47%, respectively).
  • Discussion:
    Students felt the exercise was worthwhile despite DH3 students being less comfortable and less willing to participate again. Perhaps gender within student type influenced comfort level and willingness to participate.  Also, differences in perception between student type may be due to the complexity of the simulated patient cases, which could favor D2 students’ knowledge base.  Developing cases that are consistent with the training of each student type may enhance this exercise.
    *** Data analysis and results prepared by Aaric Allred, Sonya Lawson, PhD, Lawrence Masters, DDS,  and  Sharon Lanning, DDS

Students’ Perceptions of Simulated Clinic Session (one year after real patient experience)

  • Objective:
    To investigate students’ perceptions of the impact of an innovative communication skills exercise after one year of real patient experience.
  • Methods:
    After one year of clinical experience, the matriculated D2 and DH3 students completed a survey that asked them to rate the value of the exercise immediately before (pre-test) and one year after real patient experience (post-test).  The 20-item survey used a 5 point scale (1=very low, 5=very high) focusing on features of effective clinician-patient communication such as the students’ ability to recognize verbal and non-verbal cues, increase accuracy of history taking, motivate and relate to patients, and  relay information to patients.  Data were analyzed using a paired sample t-test and Cohen’s d measure of effect size.
  • Results:
    The response rate was 73% (69/94).  After one year of real patient experience, students found the exercise to be valuable (X=3.75 – 4.14).  When comparing pre- and post-test values, improvements were seen in all areas with t values that ranged from -3.87 to -5.71 (p=.000).  In addition, the Cohen’s d test demonstrated moderate to high practical significance with a range of d =.55 - .91.
  • Discussion:
    It appears that students felt the skills gained from the simulated exercise were transferred to actual patient care.  It is possible that their perceived improvement was a result of continued clinical experience and not solely related to this exercise.  Further study is needed to discern the extent that this training contributes to patient care since data are based on subjective and not objective assessment. 
    *** Data analysis and results prepared by Benjamin Crowley, Sonya Lawson, PhD, and Sharon Lanning, DDS

Impact on Teaching, Learning and Scholarship

This project enhanced students’ knowledge of effective clinician-patient communication protocol. Students frequently reported that they learned to limit the use of medical and dental jargon, speak with confidence, recognize verbal and non-verbal cues, verify patients’ understanding of clinical decision making and strategies to motivate patients as a result of this project. Students also reported that they were able to transfer what they learned in the simulated environment to the non-simulated. DH3 students appear to be less satisfied with some aspects of the exercises compared to D2 students. It may be that D2 students have less experience with speaking in front of a group or interacting with a diverse group of health care professionals. Additionally, the complexity of the simulated patient cases may have favored D2 students’ knowledge base and their future scope of practice. Student’s perceptions of these exercises may have been influenced by gender; however, a larger sample size is needed to further investigate this potential difference.  Further study will also focus on the impact of these exercises on real patient care using objective measurement. Data will be used to further enhance the communication exercises for all student s involved.

This project added 9 curricular hours of formal teaching and assessment of students’ communication skills to VCU’s School of Dentistry curriculum for dental and dental hygiene students. One hundred and eighteen D2 and DH3 students participated in this project during spring semester 2006. Prior to this project, students received approximately 2 hours of formal training on communication in the dental setting and no formal assessment of their skills. This project has served as a pilot for a new communication skills curriculum being developed for implementation during the 2007-2008 academic year. It will span over the first 5 semesters of the pre-doctoral and dental hygiene programs and add 15 curricular hours of formal communication skills training.

Faculty members representing 3 departments within VCU’s School of Dentistry and 2 departments within the School of Medicine participated in this project’s development and teaching of students’ communication skills. Currently, the School of Medicine has established classroom and clinical exercises devoted to teaching and assessment of students’ communication skills. Faculty members at the School of Dentistry obtained guidance from these experienced academicians, which was essential for the success of this project and the development of the new communication skills curriculum. Resources were shared and collaborative relationships fostered as health sciences faculty members worked together. Collaboration amongst faculty members across disciplines supports VCU’s 2020 Vision.

Four undergraduate dental students are currently working on educational research projects associated with the assessment phase of this project. Two students received A.D. Williams Student Research Fellowships for their proposals. Another student’s work is being supported by the Academic Dental Careers Fellowship Program of the American Dental Education Association (ADEA). Four student abstracts were submitted for presentation to ADEA’s annual session in Louisiana fall 2007. Therefore, this project has provided scholarship opportunities for students and faculty members and has contributed to the dissemination of information on the impact of formal communication skills training in dental education.


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