-
The Cochrane Database of Systematic... Feb 2021Communication is a common element in all medical consultations, affecting a range of outcomes for doctors and patients. The increasing demand for medical students to be... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Communication is a common element in all medical consultations, affecting a range of outcomes for doctors and patients. The increasing demand for medical students to be trained to communicate effectively has seen the emergence of interpersonal communication skills as core graduate competencies in medical training around the world. Medical schools have adopted a range of approaches to develop and evaluate these competencies.
OBJECTIVES
To assess the effects of interventions for medical students that aim to improve interpersonal communication in medical consultations.
SEARCH METHODS
We searched five electronic databases: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and ERIC (Educational Resource Information Centre) in September 2020, with no language, date, or publication status restrictions. We also screened reference lists of relevant articles and contacted authors of included studies.
SELECTION CRITERIA
We included randomised controlled trials (RCTs), cluster-RCTs (C-RCTs), and non-randomised controlled trials (quasi-RCTs) evaluating the effectiveness of interventions delivered to students in undergraduate or graduate-entry medical programmes. We included studies of interventions aiming to improve medical students' interpersonal communication during medical consultations. Included interventions targeted communication skills associated with empathy, relationship building, gathering information, and explanation and planning, as well as specific communication tasks such as listening, appropriate structure, and question style.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed all search results, extracted data, assessed the risk of bias of included studies, and rated the quality of evidence using GRADE.
MAIN RESULTS
We found 91 publications relating to 76 separate studies (involving 10,124 students): 55 RCTs, 9 quasi-RCTs, 7 C-RCTs, and 5 quasi-C-RCTs. We performed meta-analysis according to comparison and outcome. Among both effectiveness and comparative effectiveness analyses, we separated outcomes reporting on overall communication skills, empathy, rapport or relationship building, patient perceptions/satisfaction, information gathering, and explanation and planning. Overall communication skills and empathy were further divided as examiner- or simulated patient-assessed. The overall quality of evidence ranged from moderate to very low, and there was high, unexplained heterogeneity. Overall, interventions had positive effects on most outcomes, but generally small effect sizes and evidence quality limit the conclusions that can be drawn. Communication skills interventions in comparison to usual curricula or control may improve both overall communication skills (standardised mean difference (SMD) 0.92, 95% confidence interval (CI) 0.53 to 1.31; 18 studies, 1356 participants; I² = 90%; low-quality evidence) and empathy (SMD 0.64, 95% CI 0.23 to 1.05; 6 studies, 831 participants; I² = 86%; low-quality evidence) when assessed by experts, but not by simulated patients. Students' skills in information gathering probably also improve with educational intervention (SMD 1.07, 95% CI 0.61 to 1.54; 5 studies, 405 participants; I² = 78%; moderate-quality evidence), but there may be little to no effect on students' rapport (SMD 0.18, 95% CI -0.15 to 0.51; 9 studies, 834 participants; I² = 81%; low-quality evidence), and effects on information giving skills are uncertain (very low-quality evidence). We are uncertain whether experiential interventions improve overall communication skills in comparison to didactic approaches (SMD 0.08, 95% CI -0.02 to 0.19; 4 studies, 1578 participants; I² = 4%; very low-quality evidence). Electronic learning approaches may have little to no effect on students' empathy scores (SMD -0.13, 95% CI -0.68 to 0.43; 3 studies, 421 participants; I² = 82%; low-quality evidence) or on rapport (SMD 0.02, 95% CI -0.33 to 0.38; 3 studies, 176 participants; I² = 19%; moderate-quality evidence) compared to face-to-face approaches. There may be small negative effects of electronic interventions on information giving skills (low-quality evidence), and effects on information gathering skills are uncertain (very low-quality evidence). Personalised/specific feedback probably improves overall communication skills to a small degree in comparison to generic or no feedback (SMD 0.58, 95% CI 0.29 to 0.87; 6 studies, 502 participants; I² = 56%; moderate-quality evidence). There may be small positive effects of personalised feedback on empathy and information gathering skills (low quality), but effects on rapport are uncertain (very low quality), and we found no evidence on information giving skills. We are uncertain whether role-play with simulated patients outperforms peer role-play in improving students' overall communication skills (SMD 0.17, 95% CI -0.33 to 0.67; 4 studies, 637 participants; I² = 87%; very low-quality evidence). There may be little to no difference between effects of simulated patient and peer role-play on students' empathy (low-quality evidence) with no evidence on other outcomes for this comparison. Descriptive syntheses of results that could not be included in meta-analyses across outcomes and comparisons were mixed, as were effects of different interventions and comparisons on specific communication skills assessed by the included trials. Quality of evidence was downgraded due to methodological limitations across several risk of bias domains, high unexplained heterogeneity, and imprecision of results. In general, results remain consistent in sensitivity analysis based on risk of bias and adjustment for clustering. No adverse effects were reported. AUTHORS' CONCLUSIONS: This review represents a substantial body of evidence from which to draw, but further research is needed to strengthen the quality of the evidence base, to consider the long-term effects of interventions on students' behaviour as they progress through training and into practice, and to assess effects of interventions on patient outcomes. Efforts to standardise assessment and evaluation of interpersonal skills will strengthen future research efforts.
Topics: Communication; Education, Medical; Empathy; Humans; Information Management; Interpersonal Relations; Medical History Taking; Non-Randomized Controlled Trials as Topic; Patient Satisfaction; Patient Simulation; Randomized Controlled Trials as Topic; Role Playing; Students, Medical
PubMed: 33559127
DOI: 10.1002/14651858.CD012418.pub2 -
Neuro Endocrinology Letters Apr 2023Role-play helps the supervisor present a moment of therapy, and reflect on what has happened to the therapist to the patient and further model the therapeutic skills.... (Review)
Review
Role-play helps the supervisor present a moment of therapy, and reflect on what has happened to the therapist to the patient and further model the therapeutic skills. Usually, the supervisor or other supervisees (in group supervision) play the patient, and the therapist plays a significant moment in the psychotherapeutic session. Supervisors or supervisees in group supervision can play the patient in different situations, and can also reverse roles when the therapist plays their patient, and the supervisor plays the therapist. Before role-playing, there is a need to set a specific goal. Playing roles in supervision can focus on (a) conceptualizing the case; (b) assessing and optimizing therapeutic strategies; (c) a better understanding of the therapeutic relationship. A specific goal needs to be set before role-playing. The technique can focus on (a) case conceptualization; (b) assessment and optimization therapeutic strategies; (c) a better understanding of the therapeutic relationship. A variety of approaches can be used for role-playings, such as pattern learning, modelling, chaining, encouragement and feedback, or psychodrama techniques such as monologue, an empty chair, role change, alter-ego, using multiple chairs or toys.
Topics: Humans; Learning; Motivation; Cognition
PubMed: 37182229
DOI: No ID Found -
Frontiers in Psychiatry 2022
PubMed: 35463488
DOI: 10.3389/fpsyt.2022.890889 -
Cureus Feb 2021Depression is one of the highest prevalent mental illnesses and is one of the common illnesses that can have its onset during childhood or adolescence. It is estimated... (Review)
Review
Depression is one of the highest prevalent mental illnesses and is one of the common illnesses that can have its onset during childhood or adolescence. It is estimated that up to 20% of children experience mental illness worldwide. Preventing the onset of depression in children and adolescents should be a vital public health goal that will improve public health and decrease health care costs. We reviewed literature that described school-based interventions to prevent the onset of depression, reduce the severity of depressive symptoms, and enhance global functioning in adolescents. Our research also provides strategies for school-based intervention programs that are mainly categorized into three main subtypes. We also discussed each subtype and its advantages and limitations. The goal is to bring the readers an understanding of the importance of preventing depression on a community level, beginning at schools.
PubMed: 33758723
DOI: 10.7759/cureus.13443 -
Trends in Molecular Medicine May 2024The autoimmune condition vitiligo, characterized by skin depigmentation, presents challenges for effective treatment design, with Janus kinase (JAK) inhibitors and other... (Review)
Review
The autoimmune condition vitiligo, characterized by skin depigmentation, presents challenges for effective treatment design, with Janus kinase (JAK) inhibitors and other repurposed drugs offering a promising strategy for symptom management. This review explores advantages and shortcomings of current therapies, while presenting the urgent need for further innovative approaches. We emphasize the growing understanding of autoimmune involvement in vitiligo, highlighting several novel treatment avenues including relieving melanocyte stress, preventing dendritic cell activation, halting T cell migration, and suppressing inflammation and autoimmunity. Integrating psychodrama therapy to remediate stress alongside medical interventions marks a holistic approach to enhance patient well-being. The molecular underpinnings of vitiligo care are covered, emphasizing exciting advances revolutionizing vitiligo treatment and improving the quality of life for affected individuals.
PubMed: 38705825
DOI: 10.1016/j.molmed.2024.04.009 -
The Arts in Psychotherapy Sep 2021Italy was severely hit by the COVID-19 pandemic. In early March 2020, a series of legislative decrees have been issued, establishing the restrictions that all Italian...
Italy was severely hit by the COVID-19 pandemic. In early March 2020, a series of legislative decrees have been issued, establishing the restrictions that all Italian citizens are required to respect, according to which it is strictly forbidden to leave the house if not for reasons of necessity, health, or work. This qualitative study investigated which aspects clients find helpful or hindering in shifting to group tele-psychodrama due to the COVID-19 pandemic, after participation in an in-person psychodrama group. Participants were 15 adults who were members of a pre-existing in-person psychodrama group that shifted to a tele-psychodrama group format facilitated by two psychodrama therapists. The Client Change Interview was used at the end of the tele-psychodrama as a post-treatment assessment. All the interviews were transcribed and then underwent a thematic analysis. The analysis yielded six shared themes: the role of tele-psychodrama sessions during COVID-19 pandemic; perceived effectiveness of tele-psychodrama; main advantages of tele-psychodrama; limitations encountered during the online intervention; the termination of tele-psychodrama; and the relationship with the therapist. The findings provide preliminary evidence for the clinical practice of tele-psychodrama and lays the groundwork for further studies that can contribute to the use of electronic platforms in psychodrama interventions.
PubMed: 34305221
DOI: 10.1016/j.aip.2021.101836 -
Frontiers in Psychology 2023In highly diverse psychotherapy practices, psychotherapists with their individual schemas and personalities treat patients who are just as individual, each with his/her...
In highly diverse psychotherapy practices, psychotherapists with their individual schemas and personalities treat patients who are just as individual, each with his/her own partially dysfunctional schema, personality, worldview, and life situation. Intuition gained through experience is often applied, and a wide range of perspectives, techniques, and treatment options appropriate to the specific situation and psychotherapist-patient relationship are required for successful treatment of eco-anxiety manifestations. Several examples will be used to present the approaches of different psychotherapeutic approaches to eco-anxiety such as analytical psychology, logotherapy and existential analysis, psychodrama, and Morita-therapy. The treatment-possibilities-expanding psychotherapy science is presented, which helps psychotherapists to look beyond their original learned approach and learn about new perspectives and treatment methods in a methodologically sound way, which they already do intuitively.
PubMed: 37143597
DOI: 10.3389/fpsyg.2023.1162616 -
European Review For Medical and... Oct 2023Supporting the psychological well-being of pregnant mothers is critical. The purpose of this study was to map the intervention to improve the psychological well-being of... (Review)
Review
OBJECTIVE
Supporting the psychological well-being of pregnant mothers is critical. The purpose of this study was to map the intervention to improve the psychological well-being of pregnant mothers.
MATERIALS AND METHODS
This research method uses a scoping review with five stages, i.e., problem identification, identification of relevant studies, study selection, data mapping, compiling, summarizing, and reporting results. A systematic search strategy was applied to check for relevant papers dated 2011 until 2021, based on Pubmed, Scopus, Web of Science, Cochrane, Science Direct, Google Scholar, and Grey Literature. PRISMA flowchart was used to select and summarize the studies, and the PCC framework was used for the search strategy. Criteria for inclusion were studies with pure experimental or quasi-experimental designs, focusing on improving women's psychological well-being or mental health, utilizing psychological well-being measures, and written in English with full-text availability.
RESULTS
From 32 articles, 56.24% used randomized control trials (RCT), 28.12% used quasi-experimental, 9.38% used experimental, and 3.13% used a clustered randomized trial and case study methods. 50% of the articles used developed countries, while the remaining 50% used developing countries. 12.50% of the articles used online or web-based for intervention, physical activities, and antenatal education, 9.38% used Cognitive Behavior Therapy (CBT), 21.85% used psychoeducation, 6.25% used mindfulness, Interpersonal Therapy (IPT), training-based, and 3.13% used psychodrama, relaxation, counseling, and happiness therapy. Intervention facilitators were engaged in 25% of the articles, no information regarding facilitators in another 25% of the articles, 21.85% engaged midwives, 12.50% engaged psychologists and physiotherapists, 6.25% engaged health workers, the researchers did 15.63%, and community workers and lectures did the remaining 3.13%.
CONCLUSIONS
Further empirical research to improve the psychological well-being of pregnant mothers needs to be done with a psychoeducational approach considering such communications, the role of the facilitator in intervention, and the research media used.
Topics: Female; Pregnancy; Humans; Psychological Well-Being; Mothers; Cognitive Behavioral Therapy; Mental Health; Evidence-Based Medicine; Randomized Controlled Trials as Topic
PubMed: 37916351
DOI: 10.26355/eurrev_202310_34161 -
Psychology and Psychotherapy Sep 2021To explore the heterogeneity of the literature on psychological interventions for psychological difficulties in people with Parkinson's disease (PD). (Review)
Review
PURPOSE
To explore the heterogeneity of the literature on psychological interventions for psychological difficulties in people with Parkinson's disease (PD).
METHODS
A scoping review was performed across five major databases (MEDLINE Complete, PsycINFO, CINAHL, Academic Search Ultimate, and Cochrane Library) up to June 2020.
RESULTS
From an initial return of 4911 citations, 56 studies were included, of which 21 were RCTs. A relatively wide range of therapeutic models have been adopted with people with PD, from common therapies such as cognitive behavioural therapy (CBT) and mindfulness, to less frequent approaches, for example, acceptance and commitment therapy (ACT) and psychodrama. The clinical implications of the findings are discussed, and suggestions are provided for future research on intervention studies and key psychological outcomes.
CONCLUSIONS
CBT appears to be effective in treating depression and sleep disorders in people with PD, while psychoeducation programmes alone should be avoided. The use of CBT to improve anxiety, quality of life, and impulse control, as well mindfulness-based interventions, should be undertaken with some caution because of insufficient research and inconsistent results. As we enter the new decade, more high-quality evidence is required for psychological interventions in people with PD in general and to corroborate preliminary positive findings on the adoption of less frequent approaches such as ACT.
PRACTITIONER POINTS
Parkinson's disease is a progressive neurodegenerative condition associated with several psychological difficulties which be targeted by psychological interventions. Currently, cognitive behavioural therapy (CBT) can be recommended to treat depression and sleep disorders in people with Parkinson's, while psychoeducation alone should be avoided. Caution is advised regarding the use of CBT and mindfulness-based interventions to improve anxiety, quality of life, and impulse control. Further evidence is required for less common approaches, such as acceptance and commitment therapy, psychodrama, and EMDR.
Topics: Acceptance and Commitment Therapy; Cognitive Behavioral Therapy; Humans; Parkinson Disease; Psychosocial Intervention; Psychotherapy; Quality of Life
PubMed: 33174688
DOI: 10.1111/papt.12321 -
New Directions For Student Leadership Jun 2022This article describes a developmental framework for the application of role-playing games (RPGs) in leadership learning. RPGs relate to leadership learning on a range...
This article describes a developmental framework for the application of role-playing games (RPGs) in leadership learning. RPGs relate to leadership learning on a range of levels from individual development, to team building, to parallel group processes. The variety and depth of learning and development potential in RPGs is very exciting, particularly the potential for collective creativity associated with the need for leadership that transforms communities. Many established learning frameworks used for leadership/adult learning are included and an original framework for adopting a developmental understanding is explained.
Topics: Adult; Group Processes; Humans; Leadership; Learning; Role Playing
PubMed: 35822217
DOI: 10.1002/yd.20501