| Description |
This article describes the results of a theatre-based intervention, Coached Rehearsal Techniques for Interpersonal Communication (CRiTICS), which improved some non-verbal and paraverbal communication skills in medical students during a simulated difficult communication scenario. The goal of this study was to compare the efficacy of CRiTICS to the efficacy of a discussion-based approach to medical student preparation for difficult conversations. To accomplish this, we conducted a double-blind, randomized controlled trial with first-year medical students in 2019. All 123 participants prepared for a simulated disclosure of a newborn screening result significant for Spinal Muscular Atrophy (SMA), a life-threatening genetic disorder. The intervention group rehearsed for the simulation with an acting teacher and an actor playing the role of the newborn's parent. Teachers offered individualized coaching to each learner during the 50-minute rehearsal. The active control group prepared for the simulation in a faculty-facilitated small group discussion, which is a more typical approach. To assess the effectiveness of the two approaches, each participant engaged in the simulated disclosure of an SMA diagnosis to an actor playing a newborn's parent in a clinical simulation center. These assessment encounters were video recorded. Primary outcomes of interest were scores on the Medical Communication Competency Scale (MCCS)-a questionnaire participants answered immediately following the simulation- and observations of participants' non-verbal and paraverbal communication via the video recordings. Participants assigned to the CRiTICS group rated themselves significantly higher on the MCCS in the domains of both information and socioemotional communication competence than the control group did. Research assistants were trained to identify particular behaviors that are considered best practices in difficult heathcare communication scenarios and to score participants on their performance of those behaviors. RAs were not told which group each participant was assigned to. Compared to the control group, intervention group participants were rated as having significantly greater effectiveness in some non-verbal and paraverbal communication behaviors, including attending and adjusting to the communication needs of the actor, sitting at eye-level with the actor right away, and remaining silent while the actor was talking. The CRiTICS intervention showed significant positive effects on the performance of physician trainees in a simulated difficult communication scenario. Future study should examine the longitudinal impacts, optimal duration and frequency, effects at different levels of training (e.g., during medical school v. residency), and its impact on learners in health professions. Improving communication between patients and health care providers can strengthen therapeutic relationships, reduce stress and burnout among providers, and improve outcomes through better, more patient-centered care. |
