Interprofessional communication skills are an essential competency for medical students training to be physicians. Nevertheless, interprofessional education (IPE) is relatively rare in Korean medical schools compared with those overseas. We attempted to evaluate the effectiveness of the first IPE program in our school.
In the first semester of the school year 2018, third-grade medical students (N=149) at the Seoul National University College of Medicine participated in ‘communication between healthcare professionals in the clinical field’ training, which consisted of small group discussions and role-play. To evaluate the effectiveness of this training, we conducted pre- and post-training questionnaire surveys. Comparing paired t-tests, we evaluated the students’ competency in interpersonal communication and their attitude towards the importance of IPE before and after the training. The Global Interpersonal Communication Competence Scale (GICC-15) was used to evaluate competency in interpersonal communication.
Out of 149 students, 144 completed the pre- and post-training questionnaires. The total GICC-15 scores before and after training were 55.60±6.94 (mean±standard deviation) and 58.89±7.34, respectively (p=0.000). All subcategory scores of GICC-15 after training were higher after training and were statistically significant (p<0.05), except for two subcategories. The importance of IPE score also improved after training but was not significant (p=0.159). The appropriateness of content and training method scores were 3.99±0.92 and 3.94±1.00, respectively.
From the results, our school’s IPE program demonstrated a positive overall educational effect. Deployment of systematic and varied IPE courses is expected in the future, with more longitudinal evaluation of educational effect.
Cooperation and effective communication between physicians, nurses, and other health care workers in a clinical setting is essential to ensure patient safety and restore health [
According to the United Kingdom Center for Advancement in Interprofessional Education, IPE occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of patient care [
This study examined 149 students in the third grade of Seoul National University College of Medicine in the school year 2018. Interprofessional communication training was conducted as a part of the ‘human-society-medicine 5’ class in the first semester. The students were just 3 months into clinical rotation program at the time of this training. The title of the training session was ‘communication between healthcare professionals in the clinical field.’ The educational goals of this training were to enable our students to identify the characteristics and problems of the conversational style of themselves and acquire various communication skills which lead to positive interpersonal relationships with other healthcare providers by experiencing the interpersonal conflict situations. The training was conducted for a total of 3 hours and consisted of small group role-play, small group discussions and presentations, and an overall presentation and discussion for the whole class. One hundred and forty-nine students were randomly assigned to 12 small groups of 12–13 students. Six group discussion rooms were arranged for students, with two groups sharing each room for their small group discussions. We presented two cases of conflicts between healthcare professionals to the students. One case was a conflict between an intern and a resident, and the other was a conflict between a resident and a nurse (
We used Kirkpatrick’s 4-level evaluation model to evaluate the effectiveness of our interprofessional communication training program. Kirkpatrick’s 4-level model consists of reaction, learning, behavior, and results. Our evaluation was limited to the reaction and learning stages, which can be evaluated immediately after the training. First, the evaluation of the reaction stage was conducted through questionnaires in order to determine whether the contents and methods of the training program were appropriate. Then, in the evaluation of the learning stage, we compared the change in attitude and overall communication competency of students before and after the training. The questionnaire used to evaluate the attitude change in students asked the importance of interprofessional communication training for future clinical doctors. The evaluation of students’ competency in interprofessional communication before and after practice was conducted using the Global Interpersonal Communication Competence Scale (GICC-15). GICC-15 is a translated and modified version of Interpersonal Communication Competence Scale of Rubin and Martin [
The pre- and post-practice questionnaires were computerized using Google Forms (Google Inc., Mountain View, USA). In order to compare the students’ communication skills and perceptions before and after practice, the total mean score and the mean scores by subcategory were compared by paired t-test. All statistical analysis was performed using STATA ver. 14.0 (Stata Corp., College Station, USA), and a p-value of 0.05 or less was defined as statistically significant.
The reliability of the pre- and post-questionnaires used in this study was measured based on their results. The Cronbach’s
A statistical analysis was conducted on 144 of 149 available students who participated in the practice. Five students who did not complete all the questions in the pre- and post-practice questionnaires were excluded from the analysis. The mean age of the subjects was 24.07±1.89 years (mean±standard deviation [SD]). Of the 144 subjects, 91 were men (63.2%) and 53 were women (36.8%). When classified according to admission type, 85 of 144 (59.0%) were admitted by the premedical department, and the other 59 (41%) were admitted via transfer (
We compared the total scores of all 15 questions of GICC-15 for both pre- and post-practice questionnaires for each student. The total mean score of the students before practice was 55.60±6.94 points (mean±SD) out of a potential 75, and the total mean score after practice was 58.89±7.34, showing that students’ overall communication competency was higher after practice. These results were also statistically significant (p=0.000) (
For the question “how important do you think this class is for you when working as clinical doctor in the future,” the mean score before practice was 4.17±0.97 points (mean±SD), and the mean score after practice was 4.27±0.88 points. Although the mean score slightly increased by 0.1 points after practice, it was not statistically significant (p=0.159) (
The results of this study revealed that the average score of all items regarding the competency and perceived importance of communication were improved after the training. The score differences were statistically significant, excepting those of three questions. This suggests that the training had a positive overall educational effect for students. Previous Korean studies assessing educational effect by conducting pre- and post-evaluation of the communication class have found similar results, though not with regard to IPE [
In addition, overseas studies that examined the effects of IPE also confirmed the positive effect of training; however, these studies did not demonstrate pre- and post-evaluation of IPE [
Students in our study had small group discussions about how the person who performed the role-play could improve their communication, and how to solve the conflict between healthcare professionals in the cases they received. A study investigating the relationship between the amount of small group discussion and students’ moral reasoning skills in medical ethics education by Self et al. [
In the post-training questionnaire, our students rated an average of 3.94±1.00 (mean±SD) points for the question regarding the suitability of the teaching-learning methods used, indicating that they were generally satisfied with the teaching methods. Therefore, our results suggest that the adoption of role-play and small group discussion as the main teaching methods in training contributed to maximizing the educational effect.
Moreover, we performed IPE for third-grade medical students who had just started clinical rotation for the study. There have been some controversies over the timing of introducing IPE to students in terms of gaining educational effectiveness. Some emphasize that early learning of IPE for students may reduce not only the stereotypes of their own profession but also professions of others [
Our study is significant because we evaluated the effects of IPE, which has, to this day, rarely been implemented in Korean medical schools, by comparing pre- and post-practice evaluations. Although medical communication education has been actively conducted at medical schools in Korea, the focus of this education is limited to interviews between doctors and patients [
In addition to education time constraints, there were constraints on arranging training space and a workforce to act as facilitators. These constraints forced us to assign a relatively large number of students (12–13) per group. Ultimately, some students in the groups could not perform the role-play themselves, but watched their teammates perform instead. Additionally, each group could address only one of two available conflict cases, and they also could only practice either the good or bad example of conflict solution for the selected case. In order to overcome these limitations, we placed two groups in each group discussion room, and presented different conflict cases to groups in the same room, to enable all groups to experience both cases. Furthermore, after the small group discussions, we gathered all students together to watch and discuss the selected role-play videos from each room, in order to maximize the educational effect in these limited circumstances. Of course, it would have been more effective if all students had been given the opportunity to take part in role-play with various cases and solutions without any constraints. However, considering the fact that these administrative constraints were inevitable and expected for the first time IPE has been applied in our medical school, we believe our research could contribute to provide a basis for the development of a more systematic IPE program in the near future for our school and for other medical schools of Korea.
In the overseas, IPE addresses not only interprofessional communication and conflict resolution, but also collaborative team-working when treating patients in critical situations (e.g., surgery, cardiopulmonary resuscitation). Various training methods are used to this effect, such as direct role-play and simulation exercises, and education is conducted with students taking different majors, including those studying at nursing schools [
In conclusion, our medical school’s trial of ‘communication between healthcare providers in the clinical field’ training for third-grade medical students demonstrated positive educational effects. We expect to expand our IPE program to include effective collaboration among healthcare professionals when a patient is in a critical situation, and to actually learn with students majoring in other healthcare fields just as medical schools overseas include in their IPE. It is necessary to conduct further longitudinal studies on the effect of IPE after its introduction as part of a systematic curriculum organized by grade or semester for students. In addition, it would be useful to examine how IPE experienced at medical school affects the performance of students in their work as clinical doctors in the future.
Supplementary files are available from
Cases of Conflict between Healthcare Professionals.
Timetable of ‘Communication between Healthcare Professionals in the Clinical Field’.
Worksheet of ‘Communication between Healthcare Professionals in the Clinical Field’.
Pre-training Questionnaire Survey of ‘Communication between Healthcare Professionals in the Clinical Field’.
Post-training Questionnaire Survey of ‘Communication between Healthcare Professionals in the Clinical Field’.
None.
No funding was obtained for this study.
No potential conflict of interest relevant to this article was reported.
Conception or design of the work: SJK, JSS, SMP; data collection, data analysis, and interpretation: SJK, ODK; and drafting the article, critical revision of the article, and final approval of the version to be published: SJK, KHK, JEL, SHL, JSS, SMP.
Baseline Characteristics (N=144)
Characteristic | Category | Value |
---|---|---|
Age (yr) | 24.07±1.89 | |
Sex | Men | 91 (63.2) |
Women | 53 (36.8) | |
Admission type | Premedical | 85 (59.0) |
Transfer | 59 (41.0) |
Data are presented as mean±standard deviation or number of subjects (%).
Total GICC Scores Comparison between before and after Training (N=144)
Before | After | T-score | p-value |
|
---|---|---|---|---|
Total GICC-15 score | 55.60±6.94 | 58.89±7.34 | -6.96 | 0.000 |
Data are presented as mean±standard deviation.
GICC: Global Interpersonal Communication Competence Scale.
p-value <0.05 was defined as statistically significant.
GICC Scores Comparison between before and after Training by Subcategory (N=144)
Subcategory | GICC score |
T-score | p-value |
|
---|---|---|---|---|
Before | After | |||
1. Self disclosure | 3.63±0.95 | 3.85±0.85 | -2.98 | 0.003 |
2. Empathy | 4.03±0.69 | 4.22±0.63 | -2.99 | 0.003 |
3. Social relaxation | 3.47±0.97 | 3.76±0.92 | -4.32 | 0.000 |
4. Assertiveness | 3.37±3.60 | 3.60±0.93 | -3.23 | 0.002 |
5. Reflective listening | 4.11±0.71 | 4.22±0.65 | -1.91 | 0.059 |
6. Interaction management | 3.83±0.79 | 3.99±0.75 | -2.54 | 0.012 |
7. Expressiveness | 3.67±1.00 | 3.94±0.92 | -3.33 | 0.001 |
8. Supportiveness | 4.10±0.74 | 4.26±0.71 | -2.61 | 0.010 |
9. Immediacy | 3.68±0.85 | 3.99±0.80 | -4.60 | 0.000 |
10. Efficiency | 3.49±0.82 | 3.95±0.76 | -6.37 | 0.000 |
11. Social appropriateness | 3.90±0.71 | 4.06±0.75 | -2.93 | 0.004 |
12. Conversational coherence | 2.33±0.99 | 2.69±1.19 | -3.80 | 0.000 |
13. Goal detection | 3.90±0.80 | 4.06±0.76 | -2.78 | 0.006 |
14. Responsiveness | 4.27±0.65 | 4.28±0.63 | -0.25 | 0.807 |
15. Noise control | 3.81±0.79 | 4.02±0.75 | -2.94 | 0.004 |
Data are presented as mean±standard deviation.
GICC: Global Interpersonal Communication Competence Scale.
p-value <0.05 was defined as statistically significant.
Importance of Communication Score Comparison between before and after Training (N=144)
Importance of communication education | Mean score±standard deviation | T-score | p-value |
---|---|---|---|
Before | 4.17±0.97 | -1.42 | 0.159 |
After | 4.27±0.88 |
p-value <0.05 was defined as statistically significant.