The study research team included, (L to R), Drs. Gabriel Burke, Lindsay Melvin and Shiphra Ginsburg. (Photo: UHN StRIDe Team)

Effective communication is crucial in the medical profession, but how do internal medicine residents develop their communication skills?

A recent study led by Dr. Shiphra Ginsburg, a clinician-scientist at The Institute for Education Research (TIER) at UHN and the Wilson Centre for Research in Education at UHN, found that while formal communication training was valuable, it was limited in scope.

Instead, residents found working independently with patients to be the most instructive for developing their skills.

The study was conducted between November 2020 and January 2021, and involved 15 virtual, one-on-one interviews with internal medicine residents. The interviews explored how the residents developed their communication skills and the role of formal training in this development.

"Participants consistently stated that interacting directly with patients contributed most to the development of their communication skills," says Dr. Gabriel Burke, a resident in respirology at Mount Sinai Hospital and the lead author of the study. "Through these interactions, residents were able to identify communication techniques that they found effective, enabling them to gradually develop their own unique, natural and authentic style."

Study participants felt that high patient volumes in hospitals often pushed them to prioritize efficiency and care for more patients, rather than the patient-centered communication practices taught in their training. (Photo: Getty Images)

"Residents learned strategies for communication through observing staff physicians, rather than from staff observing their interactions with patients and receiving feedback," adds Dr. Lindsay Melvin, a clinician-investigator at TIER and co-author of the study. "Any direct feedback that they did receive was often positive, generic and not very actionable.

"Moreover, when staff were directly observing communication interactions, residents often felt the need to deviate from their authentic practice," adds Dr. Melvin, who is also an assistant professor in the Department of Medicine at the University of Toronto (U of T).

Many participants also described the pressure to become faster with communication due to workload demands.

The study's findings suggest that in the inpatient setting, residents developed their communication skills primarily through self-reflection on unobserved interactions with patients, with smaller contributions from formal training and feedback from staff physicians.

"Effective communication in medicine is crucial for building trust with patients, as well as ensuring that patients have a clear understanding of their health and the treatments available to them," says Dr. Ginsburg, who is also a staff physician at Sinai Health and a professor in the Department of Medicine at U of T. "Medical educators should consider incorporating patient feedback when working with residents, as well as providing more specific and actionable feedback on communication skills.

“By doing so, medical educators can help ensure that future physicians are better equipped to communicate effectively with their patients – and ultimately, improve the quality of care."

This work was supported by the Mount Sinai Hospital Department of Medicine Research Fund. TIER receives support from UHN Foundation. Dr. Shiphra Ginsburg holds a Tier 1 Canada Research Chair in Health Professions Education.

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