S50 Workshops /Symposia / Patient Education and Counseling 34 (1998) S43 –S55

tailoring products and services that meet not only imme- 2. To explore methods for enhancing communicationdiate needs but also those that are emerging. with patientsMethods. Colleges of General Practice in three countries, 3. To explore the use of trigger tapes and role-play in theat least, are leading the way in implementing validated development of essential communication skillsinstruments to elicit consumer /patient feedback on inter- 4. To share a written curriculum for use in primary carepersonal skills during consultations. training programsResults. There are multiple uses being made of thisfeedback: first, in alerting general practitioners to the 8 workshopthings that their patients appreciate in their skills; second, COMMUNICATION WITH DEAF AND HARD-in assisting Colleges and those engaged in supervising OF-HEARING PEOPLE: STRATEGIES TO MAIN-trainees / registrars in developing and refining new areas TAIN GOOD PROVIDER-PATIENT COMMUNI-of curriculum; and third, in providing critical evidence to CATIONboth the public and to government that general practition-ers not only value feedback and heed it but also are

Steven Barnett, MD, Clinical Senior Instructor Depart-prepared to commit themselves to improving the part-ment of Family Medicine, University of Rochester Pri-nership with their patients and also the quality of theirmary Care Institute of Highland Hospital 1000 Southservices and care. Furthermore, patients value the oppor-Avenue, Rochester, NY 14620 USAtunity to provide feedback and respond thoughtfully

when completing the survey instrument.Conclusion. Results of the experience in three countries - Hearing loss affects a significant portion of the world’sIreland, New Zealand and Australia - will be presented, population. In the US, the prevalence is 9% and increas-along with factors influencing patient feedback adoption. ing, partly due to the aging population. Hearing loss has

a profound effect on the oral /aural communication that istypical in a provider-patient encounter. The inability to7 workshopuse sound as a communication medium is only one of theTHE DISABILITY EVALUATION PROCESS:potential challenges to maintaining good provider-patientPROVIDER-PATIENT COMMUNICATIONcommunication. Sociocultural factors, language barriersand literacy can also contribute. Beginning to appreciate

Format: small group workshop, 25-30 participant the varied experiences of people with hearing loss canhelp providers develop effective communication strate-gies when working with deaf or hard-of-hearing people.Dr. Jamie E. Kerr, Dr. Ruth Kouides, University ofIn this workshop, background material will be presentedRochester School of Medicine, Highland Hospital, 1000related to the experiences of people with hearing loss.South Avenue, Rochester New York 14620Discussion will focus on the similarities and differencesin the experiences for people with different communica-Primary care providers often encounter situations thattion needs: hard-of-hearing people, deaf people whorequire an assessment of an individual’s ability tocommunicate orally, and deaf people who communicateperform certain work-related tasks. These evaluationsprimarily using sign language. Using examples from therequire not only clinical expertise, but also an under-presenter’s and workshop participants’ experiences work-standing of specific task requirements at work and/oring with people with hearing loss, this backgroundknowledge of pertinent legal or regulatory guidelines.material will be applied to healthcare encounters. Spe-Return to work evaluations, and chronic disability assess-cific strategies will be suggested for communicating withments differ in many ways including their reportingpeople with various communication needs. Facilitatedrequirements; however, they share the task of recogniz-group discussion will include methods to incorporateing and understanding the relationship between thethese strategies in the participants’ own healthcare set-physical and psychological attributes of an individual intings. Lessons from the experiences of healthcare pro-the work environment.As a result, providers are frequent-viders with hearing loss will also be discussed. Ideas only asked to advise patients and complete medical evi-how to teach this material to health professional studentsdence forms regarding issues of disability. Oftentimes,will be discussed.physicians are forced into an adversarial role with their

patients. These experiences leave providers and patientsconfused and frustrated.Much of the discomfort in the Objectivesdisability evaluation process is related to the lack of Workshop participants will have an appreciation for thetraining given to this complex clinical task. varied experiences of people with hearing loss and howObjectives those experiences contribute to provider-patient com-1. To review the impact of disability evaluations on the munication challenges.

provider-patient relationship Participants will learn specific strategies for communicat-

Workshops /Symposia / Patient Education and Counseling 34 (1998) S43 –S55 S51

ing with people with different types of hearing loss. ObjectivesParticipants engaged in teaching provider-patient com- The following objectives will be addressed using pre-munication will have material to share with their students dominantly experiential approaches. Attendees’ interestsrelated to communication with people with hearing loss. will guide the specific direction of the session. FollowingPresenter. the workshop, attendees will be able to:Steven Barnett is a family physician with a clinical, 1. Understand the new patient-centered model of theresearch and teaching focus related to cross-cultural interview.healthcare and healthcare for people with hearing loss. 2. Experience using the Integrated Patient-Doctor Inter-He completed an family systems medicine fellowship viewing Model in some of the following situations:which emphasized issues of provider-patient communica- new patient with many biomedical issues, a talkativetion. He has presented nationally and internationally on patient with many complaints, a reticent patient, and aissues related to healthcare and people with hearing loss, psychiatric patient.sociocultural aspects of deafness, disability, and medical 3. Experience using the Integrated Patient-Doctor Inter-education. viewing Model efficiently, in a way that most can

complete the patient-centered process in 3–5 minuteswith most patients.9 workshop

THE PATIENT’S STORY: INTEGRATED PA- Outline of WorkshopTIENT-DOCTOR INTERVIEW - A DATA-BASED, 1. Orientation and IntroductionsSYSTEMATIC APPROACH TO INTERVIEWING 2. Presentation of the Integrated Patient-Doctor Inter-

viewing Model using slides, discussion, hand-outs,Robert C. Smith, B306 Clinical Center, Michigan State and role playUniversity, East Lansing, MI 48824, USA. 3. Divide large group into several groups of 3-5 each.

Small groups will then develop role plays showinghow to use the interviewing model in one of the abovePhysician-patient communication, including the relation-situationsship, is the most important clinical skill physicians need

4. Small groups present role plays to entire group.to acquire.Problems and solutions, especially efficient use, willCommunication skills allow physicians, students, andbe highlighted in discussion and recorded on a flipothers to operationalize the biopsychosocial model. Un-chartfortunately, interviewing is very complex and still not

taught in all medical schools; most residencies and CME10 workshopprograms never address it.

TEACHING AND ASSESSING COMMUNICA-When teachers do instruct students and residents inTION SKILLS IN MEDICAL EDUCATIONinterviewing and the physician-patient relationship, they

are faced with a double problem:Gregory Makoul, PhD, Director, Program in Communi-1. There are no research-based guidelines describingcation & Medicine,Northwestern University Medicalexactly what they should teach, much less how, andSchool, 303 East Chicago Avenue ( W117),Chicago,2. Existing patient-centered interviewing recommenda-Illinois 60611 USA, , makoul@nwu.edu .tions often are vague and general, do not specify the

steps one takes through an entire interview, andThe idea that communication is an essential aspect ofdifferent teachers often emphasize quite differentmedicine is not new, it just seems that way becausethings. Students, physicians, and other learners arecommunication skills training has become more visible inunderstandably confused and uneven in their skillsmany medical schools, residency programs, continuingfollowing courses teaching interviewing.medical education courses and managed care organiza-With a new patient-centered interviewing model as thetions. Attention to communication skills in North Ameri-centerpiece, we intensively trained first year primary carecan medical schools is likely to increase, given aresidents in interviewing and other aspects of psycho-resolution adopted in 1995 by the Liaison Committee onsocial medicine. The interviewing model contains fiveMedical Education (LCME) and the Committee onsteps, each with several behaviorally-defined subsets, thatAccreditation of Canadian Medical Schools (CACMS):performed in order; the model builds upon recent ad-‘‘Communication skills are integral to the education andvances and incorporates previous models (e.g., structuraleffective function of physicians. There must be specificmodel, 3-function model). The interview (and otherinstruction and evaluation of these skills as they relate toaspects of training) was evaluated using a randomized,physician responsibilities, including communication withcontrolled design. The results were very positive, so thatpatients, families, colleagues and other health profession-we are able to recommend the interview as ‘‘data-based.’’als.’’ This resolution suggests not simply an opportunity,The interview is the subject of the workshop.