BROOKLYN 2 RADIOTHERAPY Hazel NESER Fri 30 th Aug 2013 Session 2 / Talk 2 10:50 – 11:05 Abstract Introduction During March 2013 it was decided to pilot an innovative approach to develop Year 3 radiation therapy students’ communication skills via simulated clinical scenarios with the use of actors. Method Twelve common clinical scenarios from the radiation therapy setting were developed and actors were employed to deliver these scenarios in a simulated clinical setting. Sixteen Year 3 students agreed to participate in this pilot. They were presented with one scenario and were then required to manage their interactions appropriate to its context. Two teaching staff and peers observed each student’s interaction via a digital screen and rated their observations of the student’s performance in six key skills. Each student was individually videoed so that they could review their own interaction. Verbal feedback was given to the student directly after their scenario and then written feedback was provided based on collation of observations of staff, peers and self-review. Ethical approval was gained from the University of Otago’s ethics committee. Results Preliminary findings indicate that this was an effective method for students to evaluate their communication skills. Students reported they gained insight into their strengths and weaknesses, and what skills needed further development. They also reflected positively on the advantage of watching how their peers managed interactions as it gave them a different approach to consider. Conclusions This was an effective tool to enhance personal awareness about communication skills and areas to develop further. Review of the process is underway to refine delivery for 2014.

Communication is easy, isn’t it..?? Hazel Neser and Gay Dungey University of Otago Wellington NZIMRT 2013

Background  Two communication papers in undergraduate RT degree: one in first year and one in second year  Undergraduate Radiation Therapy and Oncology papers  Third year Professional Development paper  Mostly theoretical with written assessment

Background  Challenge of teaching face-to-face communication skills in a digital era  Use of closed circuit video and simulated clinical scenarios to create a safe, low anxiety, controlled learning environment  Would this be useful to adopt in RT training?

 Medical and nursing training have adopted an integrated approach in their curricula to teach communication skills, using actors in simulated clinical scenarios that range from low to high fidelity:  Role play  Video  Small group discussion and feedback  Early exposure to real and simulated patients

Aims:  To facilitate transfer of learning from academic papers to simulated clinical scenarios  To develop Year 3 students’ confidence, competence and professionalism in their interactions with patients and clinical staff

Sample  All Year 3 student radiation therapists enrolled in the Professional Development paper participated in the workshop  To avoid coercion to participate in this study, students were informed that they could decline by not signing consent form  17/23 students consented to participate in an evaluation  14 females and 3 males  Aged between years

So what did we do?  Developed 12 common clinical communication scenarios with high fidelity in a radiation therapy department, involving either patient or staff interactions (6 patient, 5 staff and 1 friend/family scenarios)  2 actors employed to deliver scenarios in a simulated consult room with closed circuit video  Students videoed during real-time and viewed by peers and lecturers on screen outside of consult room. Each interaction lasted approximately 5-10 minutes.

Procedure

Students were rated on a Likert scale by peers and lecturers on the following aspects: 1-3 Below expectations 4-6 Meets expectations 7-9 Above expectations Initial engagement Identifies the issue/s or concern/s Exploration of issue/s or concern/s Building the relationship Reaching common ground Closing interaction

Here’s a sample scenario…

Verbal Self Review  In order to develop students’ reflective skills, each student was invited to reflect on their experience immediately after scenario with their peer group:  How do you think that went?  What did you do well?  What do you want to improve?

Verbal Peer Review  Peers provided verbal feedback after student’s verbal self-reflection  Actor also gave feedback from their perspective  Lecturers facilitated feedback process overall  Each student given their own video to critique their own performance

Written Feedback  3 sources of information for written feedback:  Written self-review was collected from each student  Written peer and lecturer feedback were collated and then given back to each student as a written summary of performance

Preliminary Findings: Key Themes  Preparation for the clinical environment  The value of learning from peers  Personal insight on own practice

Student Perceptions  ‘I feel this is a worthwhile exercise…’  ‘It was very helpful having this scenario because it would prepare me if I do ever come across some situation like this…’  ‘…is helpful to watch and reflect on someone else doing the same scenario…’

Student Perceptions…  ‘I thought my rapport was quite good. I seemed to be listening well and gave advice in reaction to what was being said. I think I could have been less awkward during the silences because sometimes silence is acceptable.’

Student Perceptions…  ‘I froze up in the situation as well as trying to find a solution; found it very awkward but good practice as it could happen in the clinic and I feel more prepared now than I did before the situation.’

Student Perceptions…  ‘It was a challenge and quite intimidating but I learnt from it. The KEY thing I learnt was that patients often just need to be listened to. As an RT I feel like I have to fix everything for them when really, after all, they require someone to listen and empathise with them.’

What else we found…  Overall – ratings by peer, lecturer and self-reviews were similar  This congruence suggests that students know what they are good at and what they need to improve

Health Professional Education Our findings are similar to those of other studies that have used actors in simulated clinical scenarios to develop communication skills of health professionals  Value of learning from high fidelity simulated scenarios  Personal and peer ratings tend to be congruent

Conclusions  Sound foundation to develop communication skills  Structured approach  Safe and low anxiety environment  Value of observing peers  Important role of self and peer review: value in learning how to give and receive feedback

Limitations  Self-report  Peer evaluations  Challenge of giving and receiving feedback  Selection bias  Who participated/did not participate

Implications for future  Refine learning objectives  Development of standardised scenarios across the three undergraduate years  Increasing complexity of scenarios appropriate to each year level  Evaluation of transfer from academic to clinical

References 1.Baille, L., and Curzio, J. (2009). Students’ and facilitators’ perceptions of simulation in practice learning. Nursing Education in Practice, 9, pp Bambini, D., Washburn, J., and Perkins, R. (2009). Outcomes of clinical simulation for novice nursing students: communication, confidence, clinical judgment. Nursing Education Perspectives, 30(2), pp Bennett, K., and Lyons, Z. (2011). Communication skills in medical education: an integrated approach. Education Research and Perspectives, 38(2), pp Gropper, R., et al. (2010). The path to simulated learning: developing a valid and reliable tool to evaluate performance of radiological technology students in patient interactions. Journal of Allied Health, 39(1), pp

Thank you!