Effective communication is essential in both human and veterinary medicine. Christine Magrath and Geoff Little of the Veterinary Defence Society communications team describe an initiative to bring communications training into veterinary practices
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MANY complaints in veterinary practice involve some element of communication breakdown, and the Veterinary Defence Society (VDS) Communications Training Programme was set up to help practices deal with some of these communication issues. ⇓
As the programme developed, it became apparent that veterinary practice shared many common problems with the medical profession, and it was reasonable to assume that the research on communication in medical healthcare, which provides the primary rationale for teaching communication and enhancing skills in the medical profession, was equally valid for vets. This research shows that improving specific communication skills can lead to more effective consultations, with benefits that include enhanced accuracy, efficiency and support between clinicians and patients, as well as reduced conflicts, complaints and malpractice claims. More effective consultations can also lead to improved outcomes in terms of:
■ Improved patient satisfaction;
■ Increased understanding and recall;
■ Increased compliance;
■ Improved physiological outcomes;
■ Reduced costs, including shorter hospital stays; and
■ Greater clinical satisfaction.
Although in its early days, research in the veterinary profession suggests that ‘client’ could easily be substituted for ‘patient’, and that many of the skills needed for an effective consultation can also be used when dealing with other members of the practice team.
To date, most communication skills training programmes in the UK and Ireland have been designed for the undergraduate curriculum, and the framework underpinning these programmes has been developed from the medical profession. A pilot project using experiential techniques was established at Liverpool Veterinary School in 2000 in conjunction with the VDS. Following the success of this pilot, the National Unit for the Advancement of Veterinary Communication Skills (NUVACS, www.nuvacs.co.uk) was created to provide support and share resources to promote, establish and expand communication skills training at all veterinary schools in the UK and Ireland.
Until recently, communication skills training for veterinary practitioners and members of the practice team has lagged behind that for undergraduates.
Since 2000, the VDS has provided recent graduate reunion seminars, which target vets who have been qualified for 15 months, along with one-day seminars for members of the practice team. Both these seminars use educational role-players, vignettes and anonymised VDS cases. Although these methods appear to be stimulating, and promote thinking and understanding of communications, they are unlikely to lead to sustained changes in behaviour when applying these skills in practice.
Research suggests that if individuals are to alter how they communicate, repeated practice and rehearsal of skills is necessary. It is much the same as with tennis coaching. Tennis coaches do not assume that their recommendations will be put into practice the next time their pupil plays a match. It requires repeated practice in a ‘safe’ situation, with feedback to refine techniques and skills. It was this type of experiential learning that stimulated the VDS Communications Team to develop in-practice training. This form of training is best suited to small groups, and the interactive format used at the graduate reunion seminars is also included in the armoury to cater for larger practices.
It is often taken for granted that all members of the practice team know how to communicate; after all, they do it every day. However, often this is not the case, and communication should be regarded as another skill that needs to be acquired. Communication is also linked to self-esteem and individual style. This is the starting point of each session, because there is always something that can be added to the toolbox, and good communication skills have no ceiling in achievement because of the inherent complexity of the subject. Also, effective communication is a series of learned skills that can be taught with the same rigour as other clinical skills. Of course, personality is important, but unless the skills can be delineated, it is difficult for those teaching the subject to ascertain why a consultation or interaction with a member of the practice team has not been effective. The VDS Veterinary Consultation Guide, developed in 2002, based on the medical Calgary-Cambridge Guide, provides a comprehensive, yet manageable, delineation and definition of the skills.⇓
The VDS Communications Team draws heavily from this framework to help learners translate knowledge into competence or performance that can be put into practice in the real world. In addition to the guide, the skills are also divided into three overlapping categories:
■ Content skills (what is said);
■ Process skills (how an individual communicates, structures the interaction, relates to clients and uses non-verbal skills);
■ Perceptual skills (what the individual is thinking and feeling, including clinical reasoning and medical problem-solving; this also includes emotions and how these relate to the client, attitudes, biases, assumptions and interactions).
The small group teaching is carried out with approximately 20 individuals. At the start of the session, the group has an opportunity to brainstorm the necessary skills needed for interacting effectively with clients and other team members. This group is then divided into two groups, each led by a trained facilitator.
One learner undertakes a consultation or interaction with a simulated client or team member. These simulated clients are educational role-players, trained in the art of giving feedback while ensuring delegates feel comfortable and safe. The other delegates observe the process. This approach provides an opportunity to practice skills where there are no adverse consequences of ‘botching’ an attempt at a new skill. The initial learner has an opportunity to give feedback on their own performance, followed by feedback from the rest of the group, the role-player and, finally, the facilitator. The advantage of this kind of training is that it allows the learner to rehearse suggestions, allowing multiple opportunities for trial and error. Each learner is encouraged to develop their own method of accomplishing a skill so that it can become incorporated into their own personality and style. The role and skill of the facilitator is key to the success of these experiential learning sessions, ensuring that the process does not become judgemental and non-constructive.
This type of training can also be video recorded, enabling more detailed analysis of the interaction, allowing the participant to self-reflect without being too critical on their own performance.
Role-players are also used for the larger group sessions, but learners do not engage in one-to-one encounters, nor do they receive individual feedback. These sessions are still interactive, however, providing learners with a stimulating environment on which to build their understanding of communication.
Taking communication skills training into practices can involve as many practice personnel as possible, thereby having maximum impact on the practice team. It also provides an opportunity to enable practices to look at areas such as optimising the consultation, handling complaints, communication within the practice and practice protocols.
As general practice becomes increasingly competitive and client expectations continue to increase, it becomes more important for practices to prevent communication errors occurring in the first place. Bringing the message into the practice so the team as a whole can benefit would seem an effective way of developing necessary skills.
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