1. Teaching communication skills in the class room Professor Naser Behbehani Department of Medicine Kuwait University

2. Communication skills what is the fundamental question? Should the class room be the primary venue for teaching, Communications skills?

3. Question

4. What actually happens in the class room? 1) Trying to emphasize the difference between hearing and listening. 2) To teach about empathy.

5. Demonstration Hearing Listening

6. How to enhance your empathy?

7. Eliciting patients concerns

8. The Effect of Physician Behavior on the Collection of Data. Beckman HB, Frankel RM. 1984;101:692–6. 74 doctor-patients encounters in primary care Internal Medicine clinic setting in Wayne state University in Detroit were recorded and analyzed. Results – In only 17 (23%) of the visits was the patient provided the opportunity to complete his or her opening statement – In 51 (69%) of the visits the physician interrupted the patient's statement and asked direct questions toward a specific concern – Of these 51 interrupted patients only 1 completed the opening statement later on.

9. Soliciting the patient’s agenda: have we improved? Marvel MK, Epstein RM, Flowers K, Beckman HB JAMA1999;281:283–7. 264 consecutive encounters By 29 board certified family physicians 9 had fellowship in communication skills and family counselling (TP).

10. Soliciting the patient’s agenda: have we improved? Marvel MK, Epstein RM, Flowers K, Beckman HB JAMA1999;281:283–7. 264 consecutive encounters Results – Patients concerns were solicited in 75% of encounters – Opening statement was completed in only 28% of encounters – Opening statement was interrupted after a mean of 23.1 seconds – TP more likely to elicit patients concerns and allow them to complete their opening statements 44% Vs 22%.

11. Teaching Patient Communication Skills to Medical Students: A Review of Randomized Controlled Trials J. Talib etal Eval Health Prof 2007 30: 3 Systematic review of RCT evaluating the effects of teaching on medical students’ patient communication skills. 24 RCT identified, 13 were pretest/posttest control group design. 15 trials were included in the meta analysis as the other 9 had missing data Student ability to establish rapport and data gathering skills improved The effects are large when the teaching intervention was small group discussion (n = 5) or giving structured feedback on a student-patient interview (n = 6).

12. Teaching Patient Communication Skills to Medical Students: A Review of Randomized Controlled Trials J. Talib etal Eval Health Prof 2007 30: 3 Results

13. Empathy

14. The Devil is in the Third Year: A Longitudinal Study of Erosion of Empathy in Medical School. Mohammad-Reza Hojat et al Acad Med. 2009; 84:1182–1191. a longitudinal cohort study of 456 students at Jefferson medical college in Philadelphia. Physician Empathy scale was completed by the students at 5 different times, at school entry and then at the end of each of the academic year. Matched cohort n = 121: students who identified themselves in all the 5 administrations. Unmatched cohort n = 335: students who did not identify themselves in any of the 5 administrations.

15. The Devil is in the Third Year: A Longitudinal Study of Erosion of Empathy in Medical School. Mohammad Hojat et al Acad Med. 2009; 84:1182–1191. Results – Empathy score declined in year 3 compared to year 0 among 73% of students in the matched cohort – 27 had no decline in empathy

16. The Devil is in the Third Year: A Longitudinal Study of Erosion of Empathy in Medical School. Mohammad Hojat et al Acad Med. 2009; 84:1182–1191. Results:

17. The Devil is in the Third Year: A Longitudinal Study of Erosion of Empathy in Medical School. Mohammad Hojat et al Acad Med. 2009; 84:1182–1191. Results: – The matched cohort – 85 graduates pursued their residency training in “people- oriented specialties e.g., family medicine, internal medicine, pediatrics, emergency medicine, psychiatry, obstetrics– gynecology. – 36: pursued training in “technology-oriented” specialties e.g. anesthesiology, pathology, radiology, surgery, orthopedic surgery, etc.

18. Level of Empathy among Medical Students in Kuwait University, Kuwait S. Hasan L. Thalib et al Med Princ Pract 2013;22:385–389

19. N Engl J med 2012; 367:13 Can this ability be taught? The most boring lecture I ever attended was a lecture on compassion — and I’m passionate about the subject. The lecturer talked about eye contact, leaning forward, touching the patient’s elbow at just the right moment. But these are only outward manifestations, which can easily be faked. So how can we wrap our minds around the problem?

20. How to enhance your empathy?

21. Doctors shadow patients’ experiences for “NHS Change Day” Zosia Kmietowicz, BMJ 2014;348: Jonathan Griffiths, a GP from Cheshire, He pledge to be on a wheelchair for one whole day and writes about his experience “What struck me was how the little things we all take for granted became so much more difficult. Things like getting through doors, driving a car, and climbing stairs. The social isolation was the worst,” he said. “It helps me see them as people instead of medical problems and fosters a better patient-doctor relationship.”

22. Which one do you think will have a more lasting effect on development of empathy? A 50 minute lecture to Students about empathy To spend one morning Shadowing a real patient and write his/her reflection

23. The idea of patient shadowing to enhance empathy among medical students "Patient care is more than just healing -- it's building a connection that encompasses mind, body and soul. If you could stand in someone else's shoes... hear what they hear. See what they see. Feel what they feel. Would you treat them differently? Toby Cosgrove, MD CEO, Cleveland Clinic

24. Question

25. Dedication for Dr. Ebaa

26. Conclusion thank you for being such a lovely audience