Simulating Patient Communication Strategies In a University of Washington training program, medical and speech-language faculty and students collaborate to prepare future physicians to treat people with communication disorders. Features
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Features  |   March 2016
Simulating Patient Communication Strategies
Author Notes
  • Kathryn M. Yorkston, PhD, CCC-SLP, is a professor and head of the Division of Speech Pathology in the Department of Rehabilitation Medicine at the University of Washington in Seattle. She is an affiliate of ASHA Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders. yorkston@uw.edu
    Kathryn M. Yorkston, PhD, CCC-SLP, is a professor and head of the Division of Speech Pathology in the Department of Rehabilitation Medicine at the University of Washington in Seattle. She is an affiliate of ASHA Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders. yorkston@uw.edu×
  • Carolyn R. Baylor, PhD, CCC-SLP, is an assistant professor in the Department of Rehabilitation Medicine and adjunct assistant professor in the Department of Speech and Hearing Sciences at the University of Washington. cbaylor@uw.edu
    Carolyn R. Baylor, PhD, CCC-SLP, is an assistant professor in the Department of Rehabilitation Medicine and adjunct assistant professor in the Department of Speech and Hearing Sciences at the University of Washington. cbaylor@uw.edu×
  • Michael I. Burns, PhD, CCC-SLP, is a lecturer and researcher in the Department of Speech and Hearing Sciences at the University of Washington in Seattle. He is an affiliate of ASHA Special Interest Group 10, Issues in Higher Education. mburns@uw.edu
    Michael I. Burns, PhD, CCC-SLP, is a lecturer and researcher in the Department of Speech and Hearing Sciences at the University of Washington in Seattle. He is an affiliate of ASHA Special Interest Group 10, Issues in Higher Education. mburns@uw.edu ×
  • © 2016 American Speech-Language-Hearing Association
Article Information
Professional Issues & Training / Language Disorders / Features
Features   |   March 2016
Simulating Patient Communication Strategies
The ASHA Leader, March 2016, Vol. 21, 46-51. doi:10.1044/leader.FTR2.21032016.46
The ASHA Leader, March 2016, Vol. 21, 46-51. doi:10.1044/leader.FTR2.21032016.46
Listening to medical educators quickly convinces you that their field is changing rapidly. They use terms such as “active, contextual learning,” “simulations” and “basic competencies.” One such basic competency that’s seen as ever more persistent and necessary is the ability to communicate effectively with patients and families.
Why? Because it’s linked to improved treatment outcomes, and is thus a key tenet of health care reform.
As speech-language pathology faculty, we teach communication skills to medical students in a variety of interactive formats, including use of standardized patients. Using such approaches, we have developed a training workshop for second-year medical students that targets communication with patients who have a range of communication disorders, including language, speech, cognition and hearing. Here, we walk you through our training approach.

Medical students practice “FRAME” strategies with simulated “standardized” patients—all students in speech-language pathology trained to portray aphasia or dysarthria symptoms in medical encounters.

A guiding FRAME
We start the course by teaching students the mnemonic “FRAME” (see graphic below) to organize their conversations with this group of patients. Using FRAME, they:
  • Familiarize themselves with the communication strategies that the patient prefers or requires. In the case of patients with severe communication problems, this might involve learning about augmentative and alternative communication devices.

  • Reduce speaking rate. They allow the patient time to listen and respond.

  • Assist with communication. They frequently review information to confirm understanding, use multiple choice or yes/no questions, and provide brief written summaries of decisions.

  • Mix communication methods. They use meaningful gestures, whiteboards, simple drawings or pictures to get the message across.

  • Engage the patient. They talk directly to the patient, and if caregivers are present, let the patient indicate when to defer to the caregiver and when to let the patient be the primary communicator.

Following this introduction, medical students practice “FRAME” strategies with simulated “standardized” patients—all students in speech-language pathology trained to portray aphasia or dysarthria symptoms in medical encounters. This exercise enables us to target specific skills we want medical students to learn, expose them to the same learning situation, and consistently evaluate their communication skills (see sources below).
The medical students interview the standardized patients to identify what brought them to the clinic. They can use communication tool kits containing whiteboards, alphabet boards and picture displays, as needed. (You can find downloadable examples labeled “patient-provider communication tools.”) Following each 10-minute interaction, the standardized patients come out of character and debrief the medical students about the strategies used. This provides a powerful interprofessional education experience for medical and speech-language pathology students.

“I’ve been spending the last two years filling my head with information—but what good is it if you can’t communicate with the patient?”

Student experience
What do medical students think of our training approach? Based on their comments on course evaluations, timing of the workshop appears to be important. They would prefer to receive it after basic prepwaration in patient-provider communication but before garnering extensive clinical experience.
To us, the comments indicate the second year of medical school is ideal, because the first year emphasizes basic coursework that includes patient-provider communication. Students value that the workshop goes beyond medical knowledge and basic communication training, saying, for example:
  • I’ve been spending the last two years filling my head with information—but what good is it if you can’t communicate with the patient?

  • My usual tricks for patient interactions (rapport-building, open-ended questions) were not very effective.

Some found the review and demonstration of simple techniques and resources helpful, saying:
  • I was unaware of the tools available to help communication and found these very helpful.

  • I stumbled and stumbled until I remembered to use a writing board and picture cards. They are very helpful.

  • I was surprised to learn about the diversity and usefulness of multimedia resources like pictures, diagrams, drawing, etc.

Because talking with patients who are difficult to understand was said to be both “humbling” and “frustrating,” many students viewed standardized patients as a “safe” place to practice new skills. One said:
  • It can be hard and awkward. I’m glad I didn’t feel that the first time I worked with a real patient.

Perhaps because of their extensive experience with other types of standardized patients, students appeared to treat the standardized patients as realistic representations of authentic patients. They were often empathetic and able to appreciate the patient’s perspective, saying, for example:
  • They [the patients] get as frustrated as we do.

  • My frustration most likely pales in comparison to theirs [the patient’s].

  • Patients feel bad about “wasting” our time! I felt awful; I didn’t understand them when they were working so hard.

Students also seemed to appreciate the ability to uncover hidden competency in the patients:
  • [It is good to have] the reminder that an inability to communicate doesn’t always indicate any further cognitive disability.

  • I was amazed at how much they could communicate if I was patient and helped them along the way.

Finally, medical students indicated that interviewing patients with communication disorders was challenging but rewarding:
  • [You have to] try different things, be creative. Breakthroughs are satisfying.

  • I think I found it to be challenging but fun when communication was established. I found myself looking forward to the patients in the future.

The interactive training experience increased medical students’ knowledge of communication disorders. And, perhaps more importantly, it changed their attitudes and behaviors when interacting with vulnerable patients.

Lessons learned
In all, the medical students’ comments suggest that the interactive experience increased their knowledge of communication disorders. And, perhaps more importantly, it changed their attitudes and behaviors when interacting with vulnerable patients.
We’ve learned at least three important lessons: First, medical students want to communicate effectively with their patients who have difficulties, but they don’t know how. Second, basic patient-provider communication skills are important, but not sufficient. Training in appropriate communication strategies is critical. Finally, training in a general set of simple tools, strategies or techniques is an excellent place to start.
The fields of speech-language pathology and medical education are uniquely positioned to collaborate with one another on patient-provider communication, particularly when patients with communication vulnerabilities are involved. SLPs can learn from the field of medical education about curricula in patient-centered practice, shared decision-making and training through simulations. SLPs, in turn, can prepare our physician colleagues to better understand the hidden competencies of patients with communication disorders, and how to more effectively include these patients in the health care process.
FRAME-ing Conversations With Patients With Communication Disorders (reprinted with permission from “Patient-Provider Communication,” chapter 3)
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Sources
Burns, M., Baylor, C., Morris, M., McNalley, T., & Yorkston, K. (2012). Training healthcare providers in patient-provider communication: What medical education and speech-language pathology can learn from one another. Aphasiology, 26(5), 673–688. [Article]
Burns, M., Baylor, C., Morris, M., McNalley, T., & Yorkston, K. (2012). Training healthcare providers in patient-provider communication: What medical education and speech-language pathology can learn from one another. Aphasiology, 26(5), 673–688. [Article] ×
Hill, A., Davidson, B., & Theodoros, D. (2010). A review of standardized patients in clinical education: Implications for speech-language pathology programs. International Journal of Speech-Language Pathology, 12(3), 259–270. doi:10.3109/17549500903082445 [Article] [PubMed]
Hill, A., Davidson, B., & Theodoros, D. (2010). A review of standardized patients in clinical education: Implications for speech-language pathology programs. International Journal of Speech-Language Pathology, 12(3), 259–270. doi:10.3109/17549500903082445 [Article] [PubMed]×
Makoul, G. (2001). The SEGUE framework for teaching and assessing communication skills. Patient Education and Counseling, 45(1), 23–34. [Article] [PubMed]
Makoul, G. (2001). The SEGUE framework for teaching and assessing communication skills. Patient Education and Counseling, 45(1), 23–34. [Article] [PubMed]×
Yorkston, K., Baylor, C., Burns, M., Morris, M., & McNalley, T. (2015). Medical education: Preparing professionals to enhance communication access in healthcare setting. In Blackstone, S. W., Beukelman, D. & Yorkston, K. (Eds.), Patient-provider communication: Roles of speech-language pathologists and other health care professionals (pp. 37–72). San Diego: Plural Publishing.
Yorkston, K., Baylor, C., Burns, M., Morris, M., & McNalley, T. (2015). Medical education: Preparing professionals to enhance communication access in healthcare setting. In Blackstone, S. W., Beukelman, D. & Yorkston, K. (Eds.), Patient-provider communication: Roles of speech-language pathologists and other health care professionals (pp. 37–72). San Diego: Plural Publishing.×
Zolnierek, H., Kelly, B., & DiMatteo, M. (2009). Physician communication and patient adherence to treatment: A meta-analysis. Medical Care, 47(8), 826–834. [Article] [PubMed]
Zolnierek, H., Kelly, B., & DiMatteo, M. (2009). Physician communication and patient adherence to treatment: A meta-analysis. Medical Care, 47(8), 826–834. [Article] [PubMed]×
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March 2016
Volume 21, Issue 3