Communication skills training for emergency department senior house officers - a qualitative study

Objective-To identify common weaknesses in senior house officer-patient con sultation skills, and evaluate direct observation with feedback and negotia tion of educational contracts, as a teaching tool in an emergency departmen t setting. Method-Common weaknesses were identified through review of feedback charts by three trained observers. Alteration in clinical and learning behaviour, as well as senior house officer and observer perceptions of the teaching we re evaluated qualitatively by a combination of semistructured interviews an d focus groups. Results-Several common weaknesses were identified, notably the use of close d questions, and poor negotiation and explanation of treatment plan and fol low up. The senior house officers perceived improvement in their clinical p ractice, welcomed feedback, and subsequently set, though did not complete e ducational contracts. While comfortable with this style of teaching, the ob servers felt that it did not make efficient use of teaching time. Conclusions-This study identifies common weaknesses in the consultation ski lls of emergency department senior house officers and confirms the need for training in this area. Direct observation is effective in changing behavio ur to this end, though self directed learning is not necessarily stimulated . Video recorded consultations with group feedback may be a more effective teaching tool.