Teaching and Learning Forum 99 [ Contents ]

Teaching dilemma: How to effectively teach professional (Veterinary) students to improve their communication skills in a practice situation

J. N. Mills and B. Fretz*
Division of Applied Veterinary Medicine
Murdoch University
* Guest lecturer
In order to learn effectively, it has been shown that it is desirable to learn in context. Good communication skills are essential for professional graduates to ensure success and satisfaction in their chosen career. In offering our students the opportunity to explore aspects of good communication, we provided several workshops on Effective Communication in 1998 to final year veterinary students. Topics included investigating individual communication styles, assertiveness, non-verbal communication and dealing with criticism. The workshops used examples drawn directly from veterinary practice, and included video dramas, group discussions and role plays. Students were asked to provide their own examples of communication dilemmas in some instances, for reworking and discussion. By providing contrived, but realistic situations, experiential learning was possible, and debriefing followed each scenario, which helped students reflect more deeply on their experiences. The students expressed a high level of satisfaction with the workshops and requested more. Options for the optimal learning of such skills will be discussed.

Introduction

Good communication skills are essential for graduates from professional disciplines. Communication skills which will enhance their role in a clinical workplace include a 'professional attitude', empathy and caring, active listening, effective speaking and the ability to both give and receive criticism constructively. Indeed, many veterinary employers rank good oral communication skills more highly than academic record when employing new graduates (Duffy, pers comm).

There has been little formal instruction in these skills at our institution (Mills 1997) or in most veterinary colleges (Heath 1996). In contrast, medical, dental and nursing students now have exposure to professional communication and personal development courses (Greenberg and Jewett 1987, Morton 1995, Denny 1996), including formal evaluation of these skills (Farmer 1994, Bolton et al 1995).

The development of professional oral communication skills is enhanced with experience in clinical practice, and in fact, is an on-going lifelong process. However, it is evident that guided instruction at the beginning of their career will focus the awareness of students on effective communication techniques which may speed the learning process. Experiential learning in a controlled setting provides an appropriate forum for developing such skills.

Experiential education is defined as a process through which a learner constructs knowledge, skill and value from direct experiences (Association of Experiential Education, www.aee.org). Experiential education encompasses a wide range of teaching and learning methods which engage the learner actively in whatever is being learned. As a philosophy, experiential education asserts that the development of knowledge and the acquisition of skills belong as partners in education, where each can transform the other (National Society of Experiential Education, www.nsee.org; Kolb 1984).

In this paper, several workshops are described in which some of the issues of professional communication were addressed using examples drawn directly from veterinary practice, and using a combination of role plays, video scenarios and group discussion with some theoretical information. By providing contrived, but realistic situations, experiential learning was possible.

Materials and methods

In addressing the teaching dilemma "How to effectively teach professional veterinary students to improve their oral communication skills in a practice situation", we undertook the following steps:
  1. define the communication needs of veterinarians
  2. determine the skills needed to address the communication needs
  3. determine 'best practise' for delivering the necessary skills: ie experiential model
  4. assign appropriate tools to use to implement the experiential model: role play, videotaped case studies, awareness activities followed by analysis and reflection (debriefing)
  5. evaluate student responses and assess feedback
Communication issues for graduates in veterinary medicine were identified as involving primarily either client or co-worker interactions. Skills such as assertiveness and conveying a professional "attitude" were included as general communication skills. The oral communication needs for veterinary students were summarised and organised into the following groups, which became the focus of the workshops: The workshops each lasted two to three hours. Topics included investigating individual communication styles, assertiveness, non-verbal communication, active listening, client consultations and giving and receiving criticism in the workplace. In each workshop examples were drawn from veterinary practice and presented in a variety of ways for discussion. In some instances students were asked to provide their own examples of communication dilemmas for reworking and discussion.

In designing the workshops a 'process framework' (Table 1) was used whereby the early learning stages focused on building awareness: acquiring cognitive knowledge of effective communication and identifying how one presently communicates. Using veterinary examples, students recognised the style of communication they used most often and discussed the importance of effective communication for professionals. The latter stages dealt with building skills and practising techniques for effective communication.

Table 1: Process framework for development of professional oral communication skills

Cognitive knowledge (types and importance of communication)
arrow graphic
Identification (recognition of styles, preference of communication,
reasons for communicating in this style)
arrow graphic
Practice (in a non-judgemental, safe environment)
arrow graphic
Transfer (skills become natural behaviour)

Interactive learning activities such as group discussion, videotaped scenarios and role play were used as a means of providing experiential learning. Role playing took up the bulk of our syllabi with students viewing videotaped role plays at the outset and later engaging in 'acting out' their own role plays. Videotaped scenarios acted by Murdoch University drama students were also used during the workshops. The short audiovisual vignettes portrayed positive and negative behaviours and were used as 'triggers' to stimulate discussion and analysis of the communication issues. All workshop activities were followed by group feedback and reflection.

Student performance was measured by a pre and post knowledge quiz and a self assessment questionnaire. True and false questions displayed the students cognitive knowledge of the topic (stage one of the Process Framework) while the self assessment questionnaire focused on the second stage of the Process Framework: identification. Both the true and false and self assessments were revisited at the end of the workshop so that students could judge their learning progress. All workshops were evaluated. The evaluation form focused on what the students learned, what they found most beneficial, what they wished to learn more about, and suggestions for changes.

Outcomes

Evaluations revealed that students appreciated the workshops with 70% to 85% stating they were either very or extremely satisfied with the sessions as a learning exercise. The remainder were moderately satisfied.

When asked to define the most significant aspect of the sessions in terms of benefiting their future practice as a new veterinarian, some student responses were:

" Learning how to handle and diffuse heated situations."

" Getting a chance to deal with difficult situations before they arise in practice."

" Assertiveness strategies - they will be useful in all areas of life."

" It made me aware of how specific communication methods are vital when dealing with certain situations."

" Understanding how other people think; a bit more awareness of potential confrontations and different ways to deal with them."

" Insight into our own personal reactions...as it leads to greater insights into our own personalities and ways we can be more receptive."

Many of the benefits of the sessions were in the first two stages of the Process Framework: cognitive knowledge and identification, especially in the areas of non verbal communication and the importance of assertiveness. The initial sessions were considered to present an introduction to very basic level of skills training. The success of the initial sessions was evident by the level of preparedness for more intensive skills training in the latter sessions; sessions involving more complex issues of conflict management and dealing with criticism. The final stages of the Process Framework: practice and transfer was evidenced in the group of students who participated in several workshops. These students displayed a higher cognitive awareness of the importance of effective communication and an eagerness to improve their skills through more role plays.

The videotaped scenarios and role plays were considered helpful by the students as they gave a focus point to stimulate discussion. The format was considered beneficial and facilitated student involvement and interaction. The students asked for more role plays and discussion, more videos of different scenarios and fewer overheads.

Discussion

Experiential learning appears to have been very valuable in assisting our students to develop effective communication skills, by learning in context. It allowed the students to investigate all levels of the Process Framework from raising awareness, acquiring skills and transferring skills to natural behaviour. Using the various activities employed, students were able to develop their skills and get immediate feedback in a safe, non-judgmental environment.

Role plays were used extensively during the workshops on conflict management and dealing with criticism. Role plays have been recommended by O'Donnell & Shaver (1990) to instruct medical students in dealing with dissatisfied clients, to practise active listening and assertive behaviour and in using lay terms to communicate with clients. Therefore, role plays facilitate both building awareness and acquiring skills.

Group process dynamics, skills practice in either simulated or real situations and feedback are said to be the most appropriate methods for promoting transfer of cognitive knowledge of interpersonal skills to actual performance (Horvatich and Meyer, 1979). Horvatich and Meyer (1978, 1979, 1980) and Reed et al (1974) in their research on communication skills training noted that building awareness is not sufficient; that students will not vicariously become effective communicators from mere observation (i.e., how their clinicians or lecturers communicate) or from general experience. Therefore, building awareness must lead to 'teaching' communication skills just as clinical skills are taught in the curriculum.

Debriefing or reflection is an essential part of experiential learning. Students must be debriefed upon completion of an activity with comments from participants, observers, and facilitators (Richmond and Gorham 1992). Debriefing assists in focusing the students on what they have achieved and reflecting on how they will transfer their new skills to natural behaviour (Richmond and Gorham 1992).

Horvatich and Meyer (1980) highlighted the inherent difficulties of measuring interpersonal skills performance. There is no agreement amongst communication educators on what to measure or how to measure it. Moreover, Horvatich and Meyer (1980) state that formal assessment on the quality of students role plays, for example, is not realistic as interpersonal skills developed throughout one's lifetime. They argue that an emphasis on quantity, for example, types and frequency of responses, would be a more appropriate approach to measuring student performance. In terms of assessing transference of skills, there is a need to undertake follow-up assessment once students are in the workplace to determine any long term gains from these teaching strategies.

As a result of student feedback, future sessions will include more role play practice and more time for more intensive debriefing sessions. Other workshops will be planned on issues raised by students: examples include ethical dilemmas, legal issues, animal welfare issues and counselling clients.

References

Bolton, C. et al (1995). Relationship skills in a clinical performance examination: Reliability and validity of the relationship instrument. ERIC Reproduction Services ED390000.

Denny, V. H. (1996). Communication skills for OMRDD direct care workers: Distance learning study guide. ERIC Reproduction Services ED415397.

Farmer, B. W. (1994). Evaluation of communication training effectiveness in the workplace: A case study. ERIC Reproduction Services ED369120.

Greenberg, L. W. and Jewett, L. S. (1987). The case presentation: teaching medical students writing and communication skills. Medical Teacher, 9, 281-84.

Horvatich, P. K. and Meyer, K. B. (1978). Teaching client relations and communication skills: Part I - a review of the literature. J Vet Med Educ, 5, 152-156.

Horvatich, P. K. and Meyer, K. B. (1979). Teaching client relations and communication skills: Part II - a systemic approach. J Vet Med Educ, 6, 99-104.

Horvatich, P. K. and Meyer, K. B. (1980). Teaching client relations and communication skills: Part III - preliminary evaluation of instructional effectiveness. J Vet Med Educ, 7, 146-150.

Heath, T. J. (1996).Teaching communication skills to veterinary students. J Vet Med Educ, 23, 2-7.

Kolb, D. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs. Prentice Hall.

Mills, J. N. (1997). Use of drama in teaching the human side of veterinary medicine. Aust Vet J, 75, 497-499.

Morton, R. (1995). Communication in medical education: the future for specialist services. J Biocommunic, 22(3), 8-11.

O'Donnell, N. and Shaver, L. (1990). The use of role play to teach communication skills. Presented at the 14th National Conference on Successful College Teaching, Orlando, Florida. ERIC Reproduction Services ED336160.

Reed, C. F., Koski, G. R. and Baker, B. R. (1974). Use of the simulated interview to teach doctor-client communication skills. J Vet Med Educ, 1, 9-10.

Richmond, V. P. and Gorham, J. (1992). Communication, learning and effect in instruction. Edina, MN: Burgess International Group, Inc.

Please cite as: Mills, J. N. and Fretz, B. (1999). Teaching dilemma: How to effectively teach professional (Veterinary) students to improve their communication skills in a practice situation. In K. Martin, N. Stanley and N. Davison (Eds), Teaching in the Disciplines/ Learning in Context, 282-286. Proceedings of the 8th Annual Teaching Learning Forum, The University of Western Australia, February 1999. Perth: UWA. http://lsn.curtin.edu.au/tlf/tlf1999/mills.html


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