This report was compiled on behalf of the staff at the Northern General Hospital, Sheffield, the staff at the Royal Hallamshire Hospital, Sheffield, and the many people who helped at the scene. The efforts of hundreds of professionals and volunteers were vital and greatly appreciated. We thank Neil Appleyard, David Edbrooke, David Dawson, Stuart Yates, Ian Winston, John Duncan, G A Baker, Charlie Cooper, Kath Sherry, Tim Shaw, and A Moss for access to the neuropsychological reports on some of the survivors.

https://www.bmj.com/content/bmj/303/6814/1385.full.pdf

Doctor-patient communication: the Toronto consensus statement.

ability Coherence and quality of associations VI. Higher cognitive functioning A. Memory B. Attention and concentration C. General information D. Calculation E. Intelligence F. Abstraction G. Judgment

https://www.springer.com/cda/content/document/productFlyer/productFlyer-WEST_978-1-4612-7559-6.pdf?SGWID=0-0-1297-174561716-bookseller

The Medical Interview

Purpose Humanistic care is regarded as important by patients and professional accrediting agencies, but little is known about how attitudes and behaviors in this domain are taught in clinical settings. To answer this question, the authors studied how excellent clinical teachers impart the behaviors and attitudes consistent with humanistic care to their learners. Method Using an observational, qualitative methodology, the authors studied 12 clinical faculty identified by the medical residents enrolled from 2003 to 2004 as excellent teachers of humanistic care on the inpatient medical services at four medical universities in the United States (University of Minnesota Medical School, Emory University, University of Rochester School of Medicine, and Baylor College of Medicine). Observations were conducted by the authors using standardized field notes. After each encounter, the authors debriefed patients, learners (residents and medical students), and the teaching physicians in semistructured interviews. Results Clinical teachers taught primarily by role modeling. Although they were highly aware of their significance as role models, they did not typically address the human dimensions of care overtly. Despite the common themes of role modeling identified, each clinical teacher exhibited unique teaching strategies. These clinical teachers identified self-reflection as the primary method by which they developed and refined their teaching strategies. Conclusions Role modeling is the primary method by which excellent clinical teachers try to teach medical residents humanistic aspects of medical care. Although clinical teachers develop unique teaching styles and strategies, common themes are shared and could be used for the future development of clinical faculty.

Role modeling humanistic behavior: learning bedside manner from the experts.

Objective. —To assess educational practices, problems, and needs in the teaching of medical interviewing and interpersonal skills. Design. —Questionnaires sent to curricular deans and introductory course leaders at all US medical schools in 1991. Results. —Of 130 programs, 114 deans (88%) and 92 course directors (71%) responded. Respondents indicated some advances since a similar survey in 1977: Virtually all medical schools now offer teaching in medical interviewing and interpersonal skills. More faculty from a greater variety of disciplines are involved in this teaching. Most programs feature observation and feedback of students' interviews with patients, and use a variety of effective teaching methods, including simulated patients and role-playing, both little used in 1977. The majority of schools address students' personal growth through discussion or support groups. However, there are problems. Most schools lack a faculty development process. About half of the introductory courses on medical interviewing take place within physical diagnosis courses, often, it appears, without systematic observation, feedback, and evaluation of student skills. Many programs do not explicitly incorporate certain educational principles into their course designs. As in 1977, there appears to be little coordination or sequencing of teaching interpersonal skills throughout the curriculum in most medical schools. Most deans identified significant barriers to improving teaching. Conclusions. —While a number of educational advances have occurred there is still great variation in the quality and intensity of courses offered in US medical schools. However, the pace of progress bodes well for the future. ( JAMA . 1993;269:2101-2105)

Medical interviewing and interpersonal skills teaching in US medical schools. Progress, problems, and promise.

OBJECTIVE: To determine the prevalence, topics, methods, and intensity of ongoing faculty development (FD) in teaching skills. DESIGN: Mailed survey. PARTICIPANTS: Two hundred and seventy-seven of the 386 (72%) U.S. teaching hospitals with internal medicine residency programs. MEASUREMENTS: Prevalence and characteristics of ongoing FD. RESULTS: One hundred and eight teaching hospitals (39%) reported ongoing FD. Hospitals with a primary medical school affiliation (university hospitals) were more likely to have ongoing FD than nonuniversity hospitals. For nonuniversity hospitals, funding from the Health Resources Services Administration and >50 house staff were associated with ongoing FD. For university hospitals, >100 department of medicine faculty was associated. Ongoing programs included a mean of 10.4 topics (standard deviation, 5.4). Most offered half-day workshops (80%), but 22% offered ≥1-month programs. Evaluations were predominantly limited to postcourse evaluations forms. Only 14% of the hospitals with ongoing FD (5% of all hospitals) had “advanced” programs, defined as offering ≥10 topics, lasting >2 days, and using ≥3 experiential teaching methods. These were significantly more likely to be university hospitals and to offer salary support and/or protected time to their FD instructors. Generalists and hospital-based faculty were more likely to receive training than subspecialist and community-based faulty. Factors facilitating participation in FD activities were supervisor attitudes, FD expertise, and institutional culture. CONCLUSIONS: A minority of U.S. teaching hospitals offer ongoing faculty development in teaching skills. Continued progress will likely require increased institutional commitment, improved evaluations, and adequate resources, particularly FD instructors and funding.

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Teaching the teachers: national survey of faculty development in departments of medicine of U.S. teaching hospitals.

In response to the increasing recognition of the importance of interpersonal skills (IPS) to the physician, there has recently been a rapid growth in the number and variety of medical school teaching programs in IPS. This is a report of a national survey which was part of a study designed to determine the extent and characteristics of IPS-teaching. Most medical schools have specific IPS programs, 80 percent of which are less than five years old. Most teachers in the programs are psychiatrists and psychologists. Most programs teach process (for example, listening, responding), information-gathering, and psychological intervention (for example, demonstrating empathy) skills. Less than one-third teach any specific information-giving/counseling skills. IPS programs are taught mostly in the preclinical years, with a notable lack of formal follow-through into the clinical years. Ninety percent of the programs use videotechnology in teaching or assessing IPS. Only about one-third use any kind of outcome index for evaluation.

The Teaching of Interpersonal Skills in U.S. Medical Schools.

The increasing recognition of the importance of a well-developed set of interpersonal skills to the competent family physician has resulted in a rapid growth in the formal teaching of interpersonal skills within family practice residencies. Of the 168 programs responding to a national survey of family practice residencies, 88 percent indicated that they have formal programs in interpersonal skills. It is estimated that there are well over 500 family practice faculty members who have special responsibilities in teaching interpersonal skills. While most programs address the component skills of the interpersonal process (eg, demonstrating empathy, information gathering, information giving, and psychological intervention), it is of concern that only about half offer explicit training in patient education (53 percent), specific types of counseling (eg, family counseling, 55 percent), or some of the specific interpersonal skills important in team practice and practice management (eg, supervisory skills). One of the most striking findings was that 88 percent of the reporting programs use videotechnology, with 77 percent of these planning to increase their use. Although most programs evaluate their interpersonal skills training using both indirect and direct assessment methods, only 25 percent attempt to use patient outcome as a measure of teaching effectiveness.

G S Kahn

Papers

The Teaching of Interpersonal Skills in U.S. Medical Schools.

Teaching interpersonal skills in family practice: results of a national survey.