patient education

Learning the Art of Communication: In Defense of the Oral Presentation

Chalanda Jones, MD

The oral presentation has been long understood to the be one of the most effective means by which physicians communicate important patient-related information and care planning among one another. Oral presentations are a noted source of stress for medical students, who are developing their skills of formally presenting patient information. In their recently published study,1 Sox and colleagues sought to compare the effects of 3 approaches to teaching medical students oral presentation skills early in pediatric clerkships. They found that students who participated in detailed feedback sessions about their presentations early in their pediatric clerkship delivered higher-quality oral presentations than did control subjects.

In this randomized, controlled trial, 476 students rotating in their third-year pediatric clerkships at 4 medical schools were randomly assigned into 3 groups based on the level of feedback they would receive from the faculty about their oral presentations. The 3 groups comprised those in the control group receiving no feedback at all (158 students), those receiving feedback based on a simple single-item form (160 students), and those receiving detailed feedback based on a detailed 18-item form (158 students).

Because their clerkship experiences included scheduled feedback sessions, study participants in the simple feedback and detailed feedback groups (groups 2 and 3) were not blinded; however, the faculty members who assessed the primary outcome were blinded to the intervention status. All 3 groups of medical students attended a lecture during the first week of their clerkship reviewing the aspects of delivery in oral presentations. Students in groups 2 and 3 gave a live presentation to a facilitator once in the first 10 days of their clerkship, and then participated in an early feedback session.

The facilitators providing simple feedback rated the performance of each student in group 2 on a 9-part scale on which 1 equaled “needs significant help,” 3 equaled “needs some help,” 5 equaled “mostly on target,” 7 equaled “above expectations,” and 9 equaled “well above expectations.”

The facilitators providing detailed feedback evaluated the quality if performance of each group 3 student using an 18-item form that used the same 9-part scale, along with 17 presentation-specific domains, each rated on 5-point scales. Detailed points about the history, physical examination, diagnostic study results, the summary statement, clinical reasoning/synthesis of information, and general aspects of the presentation’s quality were addressed during the feedback session.

As had been expected, the average presentation quality was significantly higher in the detailed-feedback group than in the control group, but the difference in quality between the simple-feedback group and either the control group or the detailed-feedback group was not statistically significant. In adjusted analyses, participants in the detailed-feedback group had significantly higher odds of reporting improvements in oral presentation quality by the end of their clerkship, but there was no statistical difference between either the simple-feedback and control groups or the detailed- and simple-feedback groups. The study authors note that the 18-item instrument used to offer detailed feedback has not been validated.

The results suggest that a review of the important aspects of oral presentations and expectations early in the clerkship, followed by a detailed feedback session with a facilitator within the first 2 weeks of the clerkship, lead to the largest improvement of a student’s oral presentation skills during the clerkship.

Accurate and understandable communication skills learned during medical education are imperative to quality patient care. A skill that is learned incorrectly or incompletely is hard to correct later. The skill of the oral presentation is best learned during the third-year clerkship, where more time can be dedicated to focused feedback. Developing a structured approach to evaluating a future pediatrician’s oral presentation skills may prove helpful for both the evaluator and the student and have the greatest impact on improving the art of communication.

 

Chalanda Jones, MD, is a pediatrician at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware.

 

Charles A. Pohl, MD—Series Editor, is professor of pediatrics and senior associate dean of student affairs and career counseling at Jefferson College in Philadelphia, Pennsylvania.

References

1. Sox CM, Dell M, Phillipi CA, Cabral HJ, Vargas G, Lewin LO. Feedback on oral presentations during pediatric clerkships: a randomized controlled trial [published online ahead of print October 27, 2014]. Pediatrics. doi:10.1542/peds.2014-1209.