Clinical and

communication
skills

A resource for teaching

emergency care
communication
Susy Macqueen1, Robyn Woodward-Kron1, Eleanor Flynn1, Katharine Reid1,
Kristine Elliott1 and Diana Slade2,3
1
University of Melbourne, Melbourne, Australia
2
University of Technology, Sydney, Australia
3
Hong Kong Polytechnic University, Hong Kong

The CHEC SUMMARY students with communication scenarios through all stages of
­resource Background: Communication in strategies for addressing these the ED journey, whereas insights
emergency departments (EDs), challenges. The foundation of the from ED medical and nursing staff
­provides
often between several health CHEC resource was the findings provide learning opportunities
­students with professionals and patients and and data from a large research about interprofessional communi-
the opportunity relatives, is a major cause of project conducted at five emer- cation for medical students.
to follow patient complaint and error; gency departments in Australia Evaluation suggests that students
­real-life however, communication-­skills over the period 2006–2009. From find the resource useful, and that
teaching for medical students this, we developed ED scenarios the resource has been success-
­scenarios
largely focuses on individual and teaching vignettes using fully embedded in medical and
through all clinician–patient interactions. authentic communication data. junior doctor training on commu-
stages of the Context: We developed and The project included a nationwide nication and quality and safety.
ED journey implemented an evidence-­ medical curriculum scoping Implications: The CHEC resource
informed online resource, phase, involving interviews with enhances the capacity of busy
Communication for Health in medical students and educators, clinical educators to raise
Emergency Contexts (CHEC; on ED communication curriculum students’ awareness of the
http://www.chec.meu.medicine. needs in order to inform the communication needs of emer-
unimelb.edu.au/resources/) to educational activities. gency health care by focusing on
raise medical students’ awareness Innovation: The CHEC resource communication in high-­stress,
of the challenges of communica- provides students with the time-­pressured settings using a
tion in the ED, and to provide opportunity to follow real-­life web format.

192 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2016; 13: 192–196
INTRODUCTION Table 1. Examples of communication strategies iden- The quality of
the patient’s

T
here are unique communica- tified in a primary research project: Communicating
tion challenges in emergency in hospital emergency departments (adapted from care as well as
health care, including Slade et al.7) how patients
limited contact time, resulting in
Communication Description Example
experience
truncated interactions,1 anxious strategy their care are
and aggressive patients,2 multi- negatively
tasking and multiple interrup-
tions,3 teamwork communication,4
Spell out ­explicitly Provide patients with ‘Alright, but for now affected by
the rationale for clear reasons for the priority is treating
and multiple handovers.5 These management/treat- continuing treatment the infection. Make
two aspects
challenges have the potential to ment options and or management plans. sure there is nothing
compromise patient care and decisions Wherever appropriate, nasty with the biopsy
safety, yet little attention is paid make the reasoning and then we can talk
to specialty communication in process available to about how to get the
communication-­skills teaching in patients. Explain the waterworks better in
medical curricula.6 In addition, sequence and priority the long term.’
of treatments.
resources used to teach health-­
professional patient communica- Recognise the pa- Express a positive ‘No. You’re not going
tion tend to be semi-­scripted tient’s perspective attitude to patients’ crazy. I can appreci-
interactions between two people thoughts and feelings ate how uncomfort-
(the clinician and the patient), about their medical able it must feel. It’s
resulting in exchanges that are conditions or their re- not a very nice test.’
sponses to treatment.
sequential and uninterrupted by
other speakers and background
noise. Such resources show little
of the complexity of communica- five emergency departments in address these factors.7 Examples
tion in emergency departments. Australia, conducted between are shown in Table 1.
2006 and 2009.7 The CHEC team
This article reports on how had access to the research The educational context of
we sought to raise awareness project interview transcripts the project was as follows: in
amongst clinical educators and with emergency department the first phase of the project, we
students about the challenges of (ED) health professionals about undertook a national scoping of
communication in emergency communication activities and communication skills, including
departments, as well as deliver- challenges, and to transcripts emergency communication-­skills
ing an online resource to of patient communication with teaching, in all Australian
address these challenges clinicians at the bedside, from medical schools during 2009–
(http://www.chec.meu.medicine. triage to disposition. One of the 2010. We developed the findings
unimelb.edu.au/resources/index. key findings relevant to the CHEC into a statement of needs, which
html). The project, Communi­ project was that the quality of guided the teaching and
cation for Health in Emergency the patient’s care as well as how learning approach in the
Contexts (CHEC), was a collabo- patients experience their care resource (Box 1).8,9 Scoping of
rative project between the are negatively affected by two communication skills in nursing
University of Technology, aspects: (1) contextual complex- schools was also undertaken,
Sydney, Australia, and the ity – this refers to the complex and is incorporated in the
University of Melbourne, and fragmented nature of clini- resource, but is not reported in
Australia, conducted between cian–patient interactions in the this article.
2009 and 2011. ED, which can result in a loss
of information and inadequate To gather evidence of the
CONTEXT AND RESEARCH explanations to the patient; and effect of CHEC on potential users
PHASE (2) the foregrounding of the of the resource, we invited
medical over the interpersonal – medical students to participate in
This section describes the activi- when clinicians fail to build rap- an evaluation of the CHEC
ties that informed the design, port with patients, the patients’ resource. These students were in
content, implementation and understanding of clinicians’ the final 12 months of their
evaluation of the resource. management plans will be com- medical training, and most were
Authentic content for the de- promised.7 We incorporated com- completing a 3-­week emergency
velopment of the CHEC resource munication strategies identified rotation. We invited students to
was provided by a research in the emergency communication complete one section of the
project on communication in research project into CHEC to resource, followed by an online

© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2016; 13: 192–196 193
The resource is Box 1. Statement of needs for communication-­skills
students, primarily medical and
suitable for nursing students, on the special
teaching in emergency medicine communication demands of
both tutorial working in an ED. The resource
Statement of needs and considerations
and individual is suitable for both tutorial and
Justification: there is substantial justification for incorporating commu-
study for nication skills teaching in medical student emergency medicine training individual study for students at
­students at various stages of their clinical
Opportunities: interprofessional learning, simulation as a learning tool education, as well as provid-
various stages
Barriers: some students’ perspectives that communication skills teaching ing assessment opportunities.
of their clinical is unnecessary; time constraints of clinicians The resource includes recon-
education Gaps: students rarely receive feedback on their communication skills structions of several authentic
with patients, which was confirmed by clinical educators; minimal com- clinician–patient interactions
munication teaching in specialty rotations in the ED environment, and is
structured around four stages
Implications: as a result of concerns about time, money, staffing, course
structure and resources, an emergency communication skills resource of the patient journey: triage,
needs to… admission, assessment and
management. Through engaging
• function independently as part of an existing course, not requiring
with patient–clinician encoun-
onerous staff implementation
ters at each stage, students
• be easy to integrate into the curriculum through (1) accessibility and are exposed to ED processes,
(2) clear linking to research evidence, accreditation requirements, interprofessional perspectives,
stakeholder concerns and graduate capabilities nurse–patient communication,
• be flexible so that it can be implemented and assessed at different doctor–patient communication,
stages of medical courses, building on principles of effective com- and clinician roles and com-
munication established earlier in the course munication strategies, which
arose from the primary research
project. Figure 1 shows the start
survey evaluating the resource. INNOVATION: THE CHEC of Ewan’s journey at triage.
The evaluation survey gathered RESOURCE
students’ views on whether they Students can perform a range
would use the resource again or The teaching and learning of tasks, including interactive
recommend it to other students, resource we developed as a online activities, open-­ended
the degree to which they believed result of the above activities discussions and critical reflec-
that using the CHEC resource is a freely available web-­based tion activities. For those
would benefit their communica- resource that aims to provide undertaking an ED rotation, the
tion skills, and their judgements both background information resource can be used both for
on the usability of CHEC. and practical examples for individual and group access,

Figure 1.  Ewan’s journey in the emergency department

194 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2016; 13: 192–196
and there are suggestions for of Ewan’s journey, where the EVALUATION The resource
more substantial projects for student is asked to review the provides
students who are interested. different responses given by Forty-­two medical students (20
The complex communication Ewan and his wife to the nurse at male and 22 female) partici-
­students with
issues in the ED setting – inter- triage and the doctor taking a pated voluntarily in the evalua- insights into the
cultural communication, formal history. Students are then tion, conducted in August 2011, communication
interruptions, time constraints, encouraged to follow a patient after completion of the project. tasks of
complex patients, patient through their time in the ED and Participating students rated the ­other  health
anxiety, multiple health profes- notice how many times the degree to which they believed the
sionals and the perspectives of patient is asked for his or her CHEC resource would help them
­professionals
family members – are demon- story by different clinicians and improve in nine aspects of ED
strated in the different patient the differences in the responses. communication. There were gen-
stories told through the video The role of the accompanying erally high ratings across all eval-
scenarios. The resource is family member is also noted, with uation items, with most students
accompanied by information for the suggestion that students agreeing that CHEC could improve
educators about the communi- review the responses of family their understanding of the impact
cation research underpinning members as well as those of of communication on quality
the resource, with suggestions patients. Such student observa- of patient care in ED (81.4%),
for tutorial implementation. tions could form the basis for a of factors impacting negatively
thoughtful discussion on why on communication in the ED
In an environment that is patients and their relatives might (83.7%), as well as helping them
often time poor for teaching, respond differently to different to better understand the experi-
students can access the resource clinicians. It also provides ence of ED from the patient’s
independently and then use the students with insights into the perspective (90.7%). Student
information that they gain to communication tasks of other evaluation of the usability of the
assist them with patient interac- health professionals, thus features of CHEC suggested that
tions in the ED, and then discuss providing interprofessional most found the material easy to
the issues with their tutors. An learning opportunities. Figure 2 understand (92.9% agreed or
example occurs in the module presents a sample of an interac- agreed strongly), and the majori-
covering the assessment section tive task. ty agreed that they felt confident

Figure 2.  Sample interactive task

© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2016; 13: 192–196 195
The CHEC online using CHEC (78.6%). Components Whereas the project’s firm 3. Coiera E, Jayasuryia R, Hardy J.
resource is of the resource, including video grounding in authentic emergency Communication loads on clinical
segments and tasks, are embed- department communication staff in the emergency department.
firmly based on ded in the communication skills provides a valuable snapshot of the Med J Aust 2002;176:415–418.
health care modules that are part of the final ED experience for students, the 4. Wright MC, Phillips-Bute BG,
communication year Transition to Practice term research focused almost exclusively Petrusa ER, Griffin KL, Hobbs GW,
of the University of Melbourne on patient–clinician interactions. Taekman JM. Assessing teamwork
research in medical education and practice:
medical course, which is de- As a result, there is limited
Relating behavioural teamwork rat-
livered to approximately 320 intra-­or interprofessional commu- ings and clinical performance.
students annually; in the 2014 nication represented in the Med Teach 2009;31:30–38.
evaluation of the communication teaching resource. This could be 5. Ye K, Taylor D, Knott J, Dent
component of the Transition to added to future iterations of the A, MacBean C. Handover in the
Practice term, the communication resource, or taken into account by emergency department: Deficiencies
modules were rated positively. other resource developers, or raised and adverse effects. Emerg Med
The CHEC resource is also used in by clinical teachers with students Australas 2007;19:433–441.
communication skills training for in tutorial settings. This article 6. Silverman J. Teaching clinical com-
interns at two Victorian hospitals, reports primarily on a medical munication: A mainstream activity
or just a minority sport? Patient
in particular, as part of a quality education setting; however, the
Educ Couns 2009;76:361–367.
and safety module on reducing resource includes nursing commu-
complaints about communica- nication, thus providing learning 7. Slade D, Manidis M, McGregor
J, Scheeres H, Stein-Parbury J,
tion in the ED. Approximately 50 opportunities for nursing and Dunston R, Stanton N, Chandler
interns complete this module an- medical students about communi- E, Matthiessen C, Herke M.
nually. CHEC is made available for cation in the ED by other health Communicating in hospital emer-
International Medical Graduate professionals. Therefore, the gency departments. Final Report.
orientation training through the resource can be used in interpro- University of Technology: Sydney;
2011. Available at http://www.
Postgraduate Medical Council of fessional education settings, uts.edu.au/sites/default/files/
Victoria. providing potential for rich EDCOM-maiin-report-interactive.
interprofessional exchange about pdf. Accessed on 27 January 2015.
emergency department interac-
IMPLICATIONS 8. Slade D, Woodward-Kron R, Stein-
tions, which may lead to positive Parbury J, Scheeres H, Widin J,
Built in response to an education- effects on health outcomes. Smith V, Townsend L, Flynn E,
Macqueen S. CHEC: Communication
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Corresponding author’s contact details: Robyn Woodward-Kron, Department of Medical Education, University of Melbourne, 202 Berkeley Street,
Parkville Victoria, 3010, Australia. E-mail: [email protected]

Funding: Support for the CHEC project was provided by the Australian Learning and Teaching Council Ltd, an initiative of the Australian
Government.

Conflict of interest: None.

Acknowledgements: The authors wish to acknowledge the contributions of all members of the CHEC project team: Professor Jane Stein-
Parbury, Associate Professor Hermine Scheeres, Dr Jacquie Widin, Ms Victoria Smith and Ms Lisa Townsend (UTS), and Associate Professor
Gillian Webb (University of Melbourne). We also gratefully acknowledge the contributions from staff and students of the University of
Melbourne Medical School, in particular. We are indebted to the actors and students who helped us to bring the emergency department to life.

Ethical approval: Ethics approval was given by the Medical Education Human Ethics Advisory Group of the University of Melbourne for
the scoping component of the CHEC project (ID 0932365) and for the student evaluation of the CHEC web resource (ID 1136585.1).

doi: 10.1111/tct.12423

196 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2016; 13: 192–196
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