Hull York Medical School Podcast
Hull York Medical School Podcast
Ep 6: Mastering communication skills at Medical School
We’re excited to share our latest podcast episode, exploring communication skills development at Hull York Medical School!
Join us as we uncover the journey of our Medicine students toward becoming empathetic and confident practitioners.
In this episode, Medicine students Eka and Dominic, along with simulated patient Hayley and Dr Anna Hammond, Director of Communication Skills, discuss:
- The crucial role of effective communication in patient care
- Simulated patient sessions for honing communication skills
- Clinical reasoning development starting from Year 2
- Ongoing skill refinement during full-time clinical placements in Year 3 and beyond
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You can also find out more about our Medicine degrees on the Hull York Medical School website.
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Hello and welcome to the Hull York Medical School podcast. Today we're going to talk about communication skills, why it's important and what we learn here at Hull York Medical School. So I'd like to introduce myself I'm Dom I'm one of the fourth year medical students at the Hull York Medical School. Hull based. If we go around. Yeah I'm Hayley Mason I'm one of the simulated patients that are used at Hull York Medical School. I'm Eka and I'm also I'm a second year medical student at Hull York Medical School. And I'm Dr Anna Hammond I'm Deputy programme director of the MB BS, but I'm also director of communication skills teaching. Brill, so nice to meet you all. So to start off with we're just going to have a little chat about the importance of why it's important to communicate effectively as a doctor and what we learn here at Hull York Medical School. So why do we feel it's important and effective to be able to communicate well? Well I think I'm quite passionate about about communication on the whole, but I think in terms of patients, communication is really important because I think patients are in a vulnerable place and I think communication is important to build trust with a patient. So that they can hear information but also for that rapport building I think is is paramount really. And like you said for you know it's very important to be able to build a rapport with the patient because as a doctor you then want to be able to diagnose them properly and you can only do that if they feel comfortable enough to speak to you and open up to you which is definitely one of the main reasons why communication is very important. And also I think something I've noticed while I was on placement is it's extremely important to be able to speak to your colleagues and peers and that's again another place where those communication skills are really important. Yes I agree absolutely with all of that and I think that the more information that you gather from a patient the better your diagnoses, and I think it's when times become difficult out in the NHS as a doctor that your communication skills are absolutely key to helping you navigate complex situations with patients, but also with colleagues when it's busy so yeah I agree absolutely. Yeah definitely and I think especially with being on placement as well you do see it is very, very busy especially at the moment being winter as well and having those communication skills locked in is really useful and it speeds up the process as well for you and for the patient as well which improves that doctor patient relationship which is really good. Okay so in terms of, and this might be one for you Dr Hammond, in terms of your experience, in terms of communication, how would you feel it's that the Hull York Medical School really prepares us for going into a role of a doctor? Yes so I think that our course is really unique because our students have so many sessions through year one and year two regularly with the same tutor and all our tutors are up, actual practicing clinicians and then working with simulated patients like Hayley developing a toolkit of communication schools, communication skills to use in different situations before then going out onto full-time placement and it always is lovely for me to hear from clinicians out there when they say that Hull York Medical School graduates are particularly good communicators. And in fact recently I was at a conference and an ex HYMS student came up to me and said it wasn't when he was here he appreciated how important it was but it's been since he qualified that he's so grateful for training here so yeah. No definitely I think is well known as well that Hull York Medical School graduates do have really good clinical communication and also clinical skills, but yeah communicating well is part of what we do here isn't it? And I think it's funny because when you talk about communication skills I think a lot of people talk about how how you say things what you say, but I think being a simulated patient I think the nonverbal communication is really important as well so your eye contact your nodding, your active listing, so all of that as a whole I think is crucial really. Yeah I agree. Yeah and I think you learn what is effective communication because in a session somebody might say to you Eka, wow you're an amazing communicator and you would think oh fantastic but it's only when you know what it is that you're doing so that you learn to give each other specific descriptive non-judgmental feedback that you know what the tools are to use effectively. Definitely and I think it's only after I've come to Hull York Medical School that I've actually realised the importance of communication, because we all just think oh medicine is about prescribing or treating the patient, but it's so much more and once you again build that rapport with the patient you you can effectively treat them really well so yeah. And you're lucky when I trained I had one communication skills session in my entire medical school and I only started to learn to communicate when I graduated, so it's great that you have these five years developing your skills before you very quickly become F1 doctors. No definitely and in terms of our clinical skills session so we start right from first year don't we and have it weekly, well we have clinical skills twice weekly don't we? Which obviously communication comes under. So in terms of first year stuff now Eka your second year aren't you so would you have to tell us a bit about first year clinical skills? Yes, for me personally I think they're the best sessions in the year. I love them very much and we get to interact with patients simulated patients, like. We're not too scary then are we? No you're very very lovely and it's a great session because you get to have a mock consultation with SPs and they respond to you as if they were real patients, and your group your group members or your friends in the other room and your tutor can actually see you speak to them and do that consultation, because there's a live video link so they can basically sit there observe you and actually give feedback to you when you're done with the with this consultation. It's not as scary as it sounds really, but it is a nice way for me to understand where I can improve and also what my strengths are, which is which is lovely. I think what what's great is when your peers observe you and give you feedback because it's not just learning for you that's consulting with a simulated patient but it's learning for your peers at the same time and I find that really quite fascinating that when they do give you that descriptive specific non-judgmental feedback just how much you all learn at the same time. Definitely. Yeah and I think in year one very much the focus at the beginning is around learning the communication skills but also learning to give each other feedback which is about behavior not personality and specific descriptive non-judgmental and we talk about holding up a mirror so if I was to describe to you I noticed and tell you what I noticed I wouldn't say to you it was good or bad you would then reflect so it's the learner the person doing the communication skills who does the reflection. And I think what you were saying then about specific descriptive and non-judgmental feedback, that is in a way drummed into us from right at the start isn't it and we do this all the time, we did this with the simulated patients, we do this with our tutors as well which is really good, because you learn from other people don't you? So you take the good bits and you take the bits that you might want to improve on as well and that makes us all better. Yeah and I think we're all learning all the time I've been here since the beginning of HYMS and I'm still learning. I've been a doctor for 30 years and I'm still learning sometimes I hear phrases from students and I think well I'm going to try that with my patients so we're all reflecting aren't we and improving as we go on our journey as clinicians? Definitely So our clinical skills sessions in phase one which that's year one and two, are shaped to that week's learning outcomes aren't they so we have a PBL, problem based learning session, we have placement as well and we have our clinical skills. So in terms of our clinical skills we make sure that the communication sessions are relevant don't we? Now does that mean that specifically we have every week a specific topic to do? Or do we adapt the learning outcomes for that? That's a really good question so during year one it's about learning specific communication skills to then put together seamlessly and fluidly, so open questions, closed questions summarising what a patient tells you to check understanding, but by year two it moves on a bit more to something that we called clinical reasoning. And so clinical reasoning for a student would be the ability to gather information, with purpose from the patient to try and work out the cause of the patient symptoms. So if you were say doing a block on cardiovascular health you might then discuss chest pain in patients who presented with chest pain but it's not about remembering a list of questions, it's about encouraging a patient to speak and tell you their story. Because we know if you ask a patient a question and leave them to talk and don't interrupt them almost everybody finishes before a minute and a half and you get loads of really rich information that helps you as the doctor or the student try and work out the cause for the symptoms. No definitely I think it's important what you said then as well you want to leave it open at the start don't you and then narrow down, and when you go on to do clinical placement and sort of year two as well you look at the real red flags that you want to make sure you exclude and those diagnosis that can be really harmful and I think that's really key to being a good doctor. Yeah. Yeah I was going to say it's a bit like being a detective it's exciting isn't it, learning to work out what goes on with patients? I think we've just been having a lot of sessions on clinical reasoning and again I absolutely love them because as you said we're the detectives and we're constantly trying to ask questions that can lead us to a diagnosis again, and with medicine it's so broad it sometimes gets a bit difficult to figure out what exactly you need to ask to be able to reach that end point. So these sessions are really good because they you know get your your brain thinking and it's it's a great experience to be able to do that with an SP so. And it's funny because I did one of these sessions last week and I'd describe it as being a detective and when we're in role neutral you're all having a discussion around us and and I'm listening to bits of discussion and I find it actually quite exciting how you are narrowing down your different systems and I don't know all the technical terms, but all of your systems and then when you come back into the the role play you're stopping and starting and trying to get all the information and I think that's great how Hull York Medical School use simulated patients in that where we're there to be real realistic, we're there to support and encourage you as students but using us that way in that stop and starting when you're trying to figure out what's happening we're just a tool for for you to actually pick up and just use again. And I think that's the the main importance of a simulated patient how we support you in your learning and it's and it's funny because you're second year and I've seen students from first year to fifth year, and it's lovely and amazing to see how you develop all these skills. Yeah and that's really interesting what Hayley has just said because we haven't chatted much about simulated patients but their people it's not about their performance as an actor it's about being able to really naturalistically, be a person and present information in the same way as a person would and that's why we need simulated patients of all ages ages because of course in a session if you had a 20-year-old man with chest pain you'd be thinking very differently than if it was a 70 year old and we're always trying aren't we Hayley to recruit more SPs and more diverse SPs to make it more realistic. Yeah. Yeah brilliant, we mentioned before in first year and second year it's very communication based second year more going into clinical reasoning how does that change going through to year three four and five so we have the communication master classes don't we? Which are based on communication stuff but why does that make us different doing that to other medical schools? Yes so when you've talked about communication master classes they're where in years three and four students are asked to come to a session having identified challenges that they've encountered on placement. So it might be a patient who wanted you to tell them a result and you weren't able to. Or it might be a patient who was really talkative and you didn't know how to direct them in a consultation and so students bring these challenges to sessions and Hayley is a simulated patient in master classes and during those master classes students have the chance to roleplay these challenges so Hayley is so talented that she can improvise a scenario to give you the opportunity as a student to practice it to develop strategies because you can't be prepared for everything but you can have a toolbox of skills that you can use and apply to different challenges that you come across. So those sessions are very student led, we don't know what challenges students will bring, but whatever they are you have an opportunity to practice them. No definitely I've taken part in those sessions myself and I found them really useful, I just think there are times on placement especially when you're out in the hospitals and on the wards when you do come across challenges with communication. Whether that's communicating with them whether that's communicating with other doctors as well, there's always going to be barriers there but I do think these sessions really do help and that's what makes us stand out really with having that extra learning which is really good. Yeah and the year three we're back doing them face to face after covid but the year four sessions we've kept online because of course we've talked about communication face to face but also as doctors we have to be able to communicate remotely with patients so by telephone or by video and that's a slightly different set of skills isn't it? Yeah I think especially in today's world a lot more is done video, via video link isn't it or on the phone and I think it is different especially when you're sat next to a patient you can get a lot more from them so having those skills via video or even on the phone you have to tune them skills don't you to be able to get it what you wouldn't get on face value and I think that's something that in our first year when I started in 2020 which is obviously the year of Corona Virus I think that was really good to have that because that might have been something that's been adapted to the world that we lived in living in at the moment. Yeah it definitely so remote consultations were becoming a thing but actually covid pushed that forward didn't it and we all had to develop our skills quickly with the arrival of the pandemic. Yeah because they are so different so when you are face to face you're able to read the body language and read facial expression so they are a a different set of skills so it is great that there's still a mix of online online learning consultations and face to face so it's good that they do that. No brilliant, so part of our communication skills especially in year two are clinical reasoning, so Dr Hammond clinical reasoning what is it? So clinical reasoning is about gathering information from a patient to try and work out the cause of the symptoms in that particular patient, and so for students it's a mixture of being able to gather information using your communication skills and then work working and learning around epidemiology so common causes for symptoms in patients of different ages and then thinking about how different disease types present. So if you get an infection you become unwell over a few hours, if you have a stroke or a heart attack that comes on very quickly, if you develop cancer your symptoms start more slowly and you gradually get worse. And so all of those things students have to know about and tie together to be able to work out what's going on for students. And only over the last 10 -15 years has clinical reasoning being explicitly taught in undergraduate medical school curricula. And at HYMS we co-founded a national organisation called CReME and that's now got representation from 43 medical schools and there's now a consensus statement about what and how to teach clinical reasoning. So HYMS has been at the forefront of that but yeah it's exciting to teach it's helped me develop my clinical reasoning and it's brilliant to watch students develop their thinking about how to work out what's causing patients symptoms. Brilliant Eka how are you finding clinical reasoning at the moment? I'm honestly I'm loving it and I what you mentioned about being able to do that reasoning properly you need to have background information so you need to kind of be aware of the common diseases or symptoms and stuff like that which I feel Hull York Medical School teaches us very well and because PBL skills, placement they're all aligned you know in the same week, with each other we end up getting to those diagnoses quite quick because everything's linked which is which is lovely. Good good, in terms of so we said before about the communication master classes, in year five we obviously have our final exams how do the communication master classes help us prepare for those final national exams? So what we cover is obviously it's a spiralled curriculum we're always developing our skills but specifically in terms of our communication classes how is that going to prepare us for F1 F2 years? Yeah so that's a really good question and it is spiral and of course the skills you learn in year one you build on as you go through but your year five Master Class there are some specific exemplar scenarios and I think there are around seven. So the SPs come to the sessions prepared to simulate all those roles and if as a year five student you're able to do all of those different roles you will have the skills to be able to be in F1. So what's an example of a scenario can you remember from year five master class Hayley? So one of them might be to do with conflict with colleague or a conversation with a consultant yeah I know that's definitely there so I guess the skills in how to speak to consultants or higher level doctors and the just the phrases that you could perhaps use because sometimes I think a lot of students find that a difficult predicament to be in so that's practiced quite a lot. Yes so that's how to give information succinctly and briefly to a senior. There's a scenario about apologising if you make a mistake. Yes. Duty of candour, so you know I've made mistakes as clinicians we are human and what's really important is when you make a mistake to be honest apologise for that to patients or their relatives. So they're quite challenging the scenarios for year five but that's because we want students to go out into F1 prepared for challenges that they might encounter. Yeah and it's it's done in such a way it's in a supportive way so you might come with challenges that you've had and I'm saying this but I know you've already done some master classes haven't you but the at the end of those master classes students go away feeling relieved, feeling glad that they've practiced and and some people actually when you see them, afterwards they've come up against one of those scenarios later on, the week after, so it's really useful to practice. It's about being prepared as well and it's better to get things wrong in those sessions than in the real thing in on the wards because you're here to learn here and yes we are on the wards too but it's a little bit better when you've got that nicer learning atmosphere and environment isn't it around you and not with a patient. And I think when you're seeing your peers do it as well I mean I've said that with the the other the scenarios that you do in class but it's learning for you all at the same time it's not just for the person that's doing the scenario it's it's group learning. Yes definitely. And I was going to say as well so we said a lot about communication with patients but before we talked about relatives as well and we do have communication skills classes don't we sessions on relatives so and that's important isn't it because as doctors you are going to be talking to relatives of of family. Dr Hammond I've got a question for you. So from clinical practice what feedback do you get about Hull York Medical School students and their communication skills? Yeah that's really interesting so I said at the beginning that I met the Hull York Medical School student themselves who's now a Doctor who reflected, but I do have consultants and GPs who frequently say that actually particularly at the junior doctor stage Hull York Medical School graduates have more developed communication skills and that's I think testament to the fact that our curriculum has lots of sessions, that we spend a lot of time teaching students to reflect on their communication give each other feedback we have this fantastic body of highly trained simulated patients who work with us and are absolutely student centered so they don't come in to act they come in to be a simulated patient to help students develop. And I'd actually say in all of the work that I do as an actor I think this type of work at the medical school here is really rewarding and I think as I mentioned seeing your skills develop and being there to actually advise to I mean I've said encourage but it is really about encouraging your skills in a realistic way. And for Haley and me how privileged are we if you think of all the students that we've helped develop their communication skills who've become doctors and all the patients that those doctors have seen it's huge isn't it? Yeah it is, it's amazing, it's amazing it's a privilege. Yeah. I interrupted you Eka, what were you going to say? No I was just saying that I can we understand how important that interaction with an SP is during our clinical skills sessions because if you look at most of us in year one and where we are now we can see that progression and that's simply because we've had those weekly clinical skills sessions and then we've had the opportunity very early on from the third week of first year to go on placement and actually speak to people and patients and use those skills that we've learned in in skills sessions so I'm we are very lucky to have SPs to come and give their time to help us learn so yeah. I think that's one of the good things as well about the Hull York Medical School is the fact we have really early placements isn't it? And we were able to use them communication skills from the offset. I know from my own placement so last year and this year that I do use these communication skills all the time not only with patients but with doctors, with relatives and it's being able to adapt to the situation. So I've had patients before and there's been language barriers there's been communication barriers through disability and I do think Hull York Medical School really equips you well to be able to deal with something that might put you outside of your comfort zone or to make sure at the end of the day we're here to benefit our patient aren't we? So yeah. Yeah and I think an example of a session is we have a session in I can't remember if it's year one or year two where we have a triadic consultation, so that's where you're there and a husband and wife come or you might have a parent and a teenager or partners come in and they both want the patient wants to tell you something and the partner or the spouse or the parent or the child and actually there's real skill to managing consultations with two people and you have have the opportunity to practice that. Yeah I remember that particular session it was a a few months a week, few weeks ago. Yeah I did a session in York actually. And it was so tricky but then when you finish the consultation the feedback that you get from your tutor from your peers it just makes you that more much more comfortable in the future when you may again interact with you know patients like that so it's a lovely way to learn and yeah. Yeah because often if it's two people that come the person who's come is anxious and worried and they want to butt in and they want to be heard but if you're able to sign post I'll come to you in a minute absolutely I want to hear what you have to say it makes it easier. I think it's making each of the people, each person in front of you feel valued. Because I played the the parent in that situation quite a talkative patient, parent. I remember that one. I think it's important important as well because I've just done my pediatric child's health block and I do think it's important because you well mostly always unless that child's a bit older have the parents in so it's how do you talk to them differently of what you would talk to the child and obviously you want to include that child not every depends how old they are but might not want to talk yeah, so it's being able to talk whilst they can understand what you're saying without feel like you're talking about them so it's being able to sort of judge that and I do think we do do that from the offset which is really good and having that practice like you're saying with the simulated patients and the the groups of people. So thank you very much for listening to this addition of communication skills podcast. I'd like to thank Dr Hammond, Eka and Hayley I hope you've all enjoyed yourselves. Yeah it's been really good. And thank you very much for listening. 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