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G Makoul

Publications and source records attributed to G Makoul.

15 recordsLinked to original sources
PubMed2001

The SEGUE Framework for teaching and assessing communication skills.

This article examines uses and characteristics of the SEGUE Framework, a research-based checklist of medical communication tasks. A recent survey of US and Canadian medical schools indicates that the SEGUE Framework is the most widely used structure for communication skills teaching and assessment in North America. Student and faculty response to the SEGUE Framework as a teaching tool has been positive. Data drawn from clinical skills assessments with standardized patients provide evidence of concurrent and construct validity. Analysis of visits between general internists and their patients reinforces validity of the SEGUE Framework in an actual practice setting. Interrater reliability is high when standardized patients are recording student performance immediately after a live encounter, and when coders are evaluating videotaped or audiotaped encounters; intrarater reliability is strong as well. The SEGUE Framework has a high degree of acceptability, can be used reliably, has evidence of validity, and is applicable to a variety of contexts. Studies of predictive validity are needed.

Clinical Competence↗
PubMed2001

Essential elements of communication in medical encounters: the Kalamazoo consensus statement.

In May 1999, 21 leaders and representatives from major medical education and professional organizations attended an invitational conference jointly sponsored by the Bayer Institute for Health Care Communication and the Fetzer INSTITUTE: The participants focused on delineating a coherent set of essential elements in physician-patient communication to: (1) facilitate the development, implementation, and evaluation of communication-oriented curricula in medical education and (2) inform the development of specific standards in this domain. Since the group included architects and representatives of five currently used models of doctor-patient communication, participants agreed that the goals might best be achieved through review and synthesis of the models. Presentations about the five models encompassed their research base, overarching views of the medical encounter, and current applications. All attendees participated in discussion of the models and common elements. Written proceedings generated during the conference were posted on an electronic listserv for review and comment by the entire group. A three-person writing committee synthesized suggestions, resolved questions, and posted a succession of drafts on a listserv. The current document was circulated to the entire group for final approval before it was submitted for publication. The group identified seven essential sets of communication tasks: (1) build the doctor-patient relationship; (2) open the discussion; (3) gather information; (4) understand the patient's perspective; (5) share information; (6) reach agreement on problems and plans; and (7) provide closure. These broadly supported elements provide a useful framework for communication-oriented curricula and standards.

Communication↗
PubMed1999

Communication teaching and assessment in medical education: an international consensus statement. Netherlands Institute of Primary Health Care.

The importance of communication between doctors and patients has been well established, and there is growing acceptance of the need to teach and assess communication skills in medical schools. Faculty meeting at a consensus workshop during the International Conference on Teaching Communication in Medicine (Oxford, July 1996) generated a series of recommendations for developing and implementing teaching and assessment programmes. The points were refined in subsequent discussions with other interested groups, and endorsed in their current form by a workshop of teachers attending the Communication in Health Care Conference organized by NIVEL, the Netherlands Institute of Primary Health Care (Amsterdam, June 1998). While focused on medical schools, the eight recommendations highlighted in this consensus statement are also relevant to both graduate and continuing medical education programmes: (1) teaching and assessment should be based on a broad view of communication in medicine; (2) communication skills teaching and clinical teaching should be consistent and complementary; (3) teaching should define, and help students achieve, patient-centred communication tasks; (4) communication teaching and assessment should foster personal and professional growth; (5) there should be a planned and coherent framework for communication skills teaching; (6) students' ability to achieve communication tasks should be assessed directly; (7) communication skills teaching and assessment programmes should be evaluated; (8) faculty development should be supported and adequately resourced.

Clinical Competence↗
PubMed1999

Medical education initiatives in communication skills.

Medical educators at undergraduate, postgraduate and continuing medical education levels acknowledge that communication is a fundamental medical skill. Responding to patient, professional and governmental advocates, as well as to advances in research on patient-physician communication and its teaching, some medical educators are in the process of starting new communication curricula, while others are working at expanding, integrating and further developing already well-established programs. For most people working in this area, the question is no longer whether to teach and assess communication skills and attitudes but, rather, how to do so most efficiently and effectively. In order to enhance the development of communication curricula at all levels, we first provide a brief look at how communication education has become widely encouraged in many parts of the globe, and we set out the underlying assumptions that frame the teaching and learning of communication in medicine. We then summarize critical components common to many established communication curricula and identify a series of specific strategies for teaching communication skills. We include a chart that describes a sample of the wide variety of resources available to assist in the development and teaching of communication curricula in medicine. Finally, we consider gaps in current communication curricula and suggest the next steps and ideas for moving forwards.

Attitude of Health Personnel↗
PubMed1998

The evolution of courses in professional skills and perspectives for medical students.

A number of medical schools substantially revised their curricula in response to the GPEP Report, issued by the Association of American Medical Colleges in 1984. One of the most important areas of change has been in the way students are introduced to the professional skills and perspectives they will need to practice clinical medicine. A number of schools have recently developed interdisciplinary courses to accomplish this goal. Such courses may differ in scheduling, format, and focus, but they share a commitment to broadening skills and perspectives through experiential learning and small-group work. Most of these courses span the entire first two years of the curriculum, and some extend into the third and fourth years, blurring the line between the "preclinical" and "clinical" years. The near-simultaneous, largely independent introduction of major courses of this type into the curricula of some medical schools has gone largely unreported in the literature. This overview article discusses the origins of these courses and reviews the scope of the curricula now in place. Among the most comprehensive programs are those at Northwestern University, Oregon Health Sciences University, the University of California, Los Angeles, and the University of Nebraska, each of which is described and discussed in the following papers.

Academic Medical Centers↗
PubMed1998

Patient, physician & society: Northwestern University Medical School.

Northwestern University Medical School's Patient, Physician & Society (PPS) course was introduced in 1993 as part of a complete restructuring of the first- and second-year curriculum. The PPS course meets two afternoons per week throughout the first two years, with one afternoon focusing on the relationship between patients and physicians and the other on that between physicians and society. The course is designed to provide a comprehensive, integrated introduction to professional skills and perspectives. Fourteen distinct curricular units address personal and professional ethics, medical humanities, behavioral sciences, physician-patient communication, physical diagnosis and clinical reasoning, health services organization and financing, preventive medicine, and the health of vulnerable groups. Health promotion as a primary goal of medicine is an underlying theme throughout the course. Active and interactive learning formats afford many opportunities for personal reflection and discussion. The overall response to the course has been positive, and survey data indicate that students completing PPS report more progress toward the school's fundamental educational goals than do students who had progressed through the first two years before the new curriculum was introduced. Still, a number of students are clearly uncomfortable with educational strategies that give them responsibility for finding answers on their own. Contrasts between PPS and the basic science courses--in content, presentation, and evaluation--highlight the importance of coordinating and integrating the overall medical school curriculum. Plans for enhancing the course include focusing on faculty development and student evaluation, as well as explicitly extending PPS material into the clerkship years.

Curriculum↗
PubMed1998

The future of medical school courses in professional skills and perspectives.

This article looks toward the future of medical school courses in professional skills and perspectives by addressing the extent to which they are a valid model for educating physicians of the 21st century, highlighting what medical educators can learn from the experiences at a sample of four medical schools, and suggesting ways to strengthen this curricular genre. Each of the four courses described in this special feature strives to provide exposure and experience in behavioral science, medical ethics, physician-patient communication, health promotion and disease prevention, physical examination, clinical reasoning, and health services and financing. It is likely that students who will be practicing medicine in the 21st century would also benefit from more attention to personal awareness and professional growth. Several lessons can be drawn from the experiences with these courses: although complex, they are directed by very small groups of faculty; they require large numbers of teaching faculty; it is difficult to establish equal footing with basic science courses; evaluation of students' progress is a major challenge; it is important to clearly articulate course components; the emphasis must extend beyond the first two years; and ongoing student and faculty input is essential. The authors suggest that conducting outcome assessments, creating a more humane culture of medical education, and supporting course faculty are key to a stable future for these courses and a solid education for the students.

Academic Medical Centers↗
PubMed1996

An active-learning approach to basic clinical skills.

Within the context of comprehensive changes in the preclinical curriculum at Northwestern University Medical School, the authors sought to create an active-learning approach to teaching the basic clinical skills of communication, physical examination, and diagnostic reasoning. This approach is built upon the premise that repetitive practice using a structured database, which is emphasized in traditional curricula, is necessary but not sufficient for students' early development as clinicians, as it marginalizes essential areas of discourse and restricts students' understanding of the scope of the medical encounter. Accordingly, this clinical skills curriculum incorporates small-group, patient-instructor, and peer-observation formats to encourage critical thinking and reflection. The clinical skills units have been among the most popular aspects of Northwestern's new curriculum. Preliminary data suggest that the overall attitudes, knowledge, and clinical proficiency of students completing this curriculum compare favorably with those of students who progressed through the preclinical curriculum before the active-learning approach was introduced.

Clinical Competence↗
PubMed1995

Health promotion in primary care: physician-patient communication and decision making about prescription medications.

To examine health promotion in a primary-care context, we studied perceived and actual communication in 271 consultations between general practitioners and patients in Oxford (England). Although health promotion is a term usually reserved for public-health or wellness programs, a health promotion perspective enriches the examination of communication in physician-patient interactions by emphasizing issues of empowerment, competence and control. Accordingly, we are interested in how communication during medical encounters can improve patients' abilities to exercise appropriate control over their health. A major factor in enabling patients to increase control over their health involves developing their competencies for making decisions and enacting behaviors that can lead to desired, and attainable, health outcomes. This report focuses on communication and decision making about prescription medications, since whether and how to use medications are among the most common and important decisions in which patients can participate. Five instruments were employed to collect data about physicians, patients and their consultations: a Video Analysis, which allowed assessment of actual communication behavior; a Patient Questionnaire designed to gauge perceptions of the encounter and collect demographic information; a Medical-Record Review, which provided information on utilization, diagnosis and treatment; a Telephone Interview, conducted 14 days after the consultation to obtain follow-up information (e.g. experience with the prescribed medication); and a Doctor Questionnaire that focused on attitudes toward consultations and patients. With respect to communication about prescription medications, physicians most frequently mentioned product name (78.2% of consultations) and instructions for use (86.7% of consultations). Patients were extremely passive, rarely offering their opinion or initiating discussion about any aspect of the treatment. We suggest that improving patients' decision-making competencies may require more discussion of benefits and risks, as well as discussion of patients' opinions about the prescribed medications and their abilities to follow through with the treatment plans. The research design proved useful in highlighting discrepancies between perceived and actual communication. Physicians tended to overestimate the extent to which they discussed patients' ability to follow the treatment plan, elicited patients' opinion about the prescribed medication and discussed risks of the medication. And, 24.3% of the patients left the consultation with an 'illusion of competence', a belief that important topics had been discussed when, in fact, they had not been mentioned at all. The pattern of results illustrates the complexity of health promotion in primary care, and underscores the importance of attending to both perceived and actual communication in medical encounters.

Adolescent↗
PubMedDate not supplied

Perpetuating passivity: reliance and reciprocal determinism in physician-patient interaction.

This study introduces, profiles, and tests the explanatory value of reliance, a construct that emerged from, and is expected to illuminate, consideration of perceived control in medical encounters. The investigation also links communication science with the truly interactive perspective of reciprocal determinism, highlighting the impact of personal relations and the significance of perceived control. Data from 271 encounters between general practitioners and patients in Oxford (England) were collected by means of videotapes, patient questionnaires, medical record reviews, and physician questionnaires. The analysis indicates that physician-reliant patients (i.e., those who rely on physicians to make decisions for them) tend to be older and from a more working-class background than were self-reliant patients (i.e., those more interested in participating in choices about their health care). The physician-reliant patients also had more externally oriented outcome expectations and tended to see physicians more often than did their self-reliant counterparts. In addition to defining reliance at the conceptual and operational levels, this study provides preliminary evidence that reciprocal determinism is operating in medical encounters: Despite their preference for patients who feel in control of their health, physicians tended to adapt to patients' reliance orientation, sharing decisions with self-reliant patients and making decisions for physician-reliant patients. Accommodating the passive orientation of physician-reliant patients is likely to diminish patients' chances for maintaining control in the medical encounter, which has implications for health outcomes, cost, and compliance.

Humans↗
PubMedDate not supplied

The use of electronic medical records: communication patterns in outpatient encounters.

OBJECTIVE: To assess physician-patient communication patterns associated with use of an electronic medical record (EMR) system in an outpatient setting and provide an empirical foundation for larger studies. DESIGN: An exploratory, observational study involving analysis of videotaped physician-patient encounters, questionnaires, and medical-record reviews. SETTING: General internal medicine practice at an academic medical center. PARTICIPANTS: Three physicians who used an EMR system (EMR physicians) and three who used solely a paper record (control physicians). A total of 204 patient visits were included in the analysis (mean, 34 for each physician). MAIN OUTCOME MEASURES: Content analysis of whether physicians accomplished communication tasks during encounters; qualitative analysis of how EMR physicians used the EMR and how control physicians used the paper chart. RESULTS: Compared with the control physicians, EMR physicians adopted a more active role in clarifying information, encouraging questions, and ensuring completeness at the end of a visit. A trend suggested that EMR physicians might be less active than control physicians in three somewhat more patient-centered areas (outlining the patient's agenda, exploring psychosocial/ emotional issues, discussing how health problems affect a patient's life). Physicians in both groups tended to direct their attention to the patient record during the initial portion of the encounter. The relatively fixed position of the computer limited the extent to which EMR physicians could physically orient themselves toward the patient. Although there was no statistically significant difference between the EMR and control physicians in terms of mean time across all visits, a difference did emerge for initial visits: Initial visits with EMR physicians took an average of 37.5 percent longer than those with control physicians. SUMMARY: An EMR system may enhance the ability of physicians to complete information-intensive tasks but can make it more difficult to focus attention on other aspects of patient communication. Further study involving a controlled, pre-/post-intervention design is justified.

Academic Medical Centers↗