The use of digital video media in the teaching of communication skills
The teaching of communication skills is an important element of theundergraduate MPharm programme and is an area that offers manyopportunities for educational innovation. Jon Waterfield, VirginiaAspinall and Sandra Hall explain how, at the Leicester School ofPharmacy, the use of digital media is leading the way as an innovativetool to teach communication skills to undergraduate students
The teaching of communication skills is an important element of the undergraduate MPharm programme and is an area that offers many opportunities for educational innovation. Jon Waterfield, Virginia Aspinall and Sandra Hall explain how, at the Leicester School of Pharmacy, the use of digital media is leading the way as an innovative tool to teach communication skills to undergraduate students
Educators are challenged to enable not just competence, but also capability to ensure that the delivery of healthcare keeps up with its ever changing context.1
Pharmacy education providers must offer learning activities that support individuals to develop sustainable abilities appropriate for a continually evolving clinical environment.
The role of pharmacists is rapidly developing and, increasingly, pharmacists will be expected to be effective communicators. How pharmacists interact with patients, customers and other healthcare professionals is a key factor in determining how effective they are as practitioners.
The satisfaction of the other party at the end of the encounter is directly linked to the effectiveness of the interaction. It is considered essential that good communication and negotiation skills are developed in pharmacy students because without these skills effective healthcare cannot be delivered.2
The ability to communicate and negotiate effectively is not necessarily something that is innate; it is something that needs to be developed.3
The development of verbal skills has been well documented4, but it is equally important to consider the non-verbal elements of behaviour that can prove as important to ensuring the success of a negotiation. We considered various ways in which these necessary interpersonal skills could be developed in pharmacy students.
The use of simulated consultations in the training of medical students is well established. Some work has also already been done using role play videos of consultations to allow pharmacists to explore how poor communication could affect a consultation outcome.5
It was decided the use of role play video clips could be used to demonstrate how poor communication could lead to dissatisfaction and, consequently, lack of co-operation of the other party, such as a prescriber unwilling to change a prescription or a patient unwilling to comply with a medication regimen.
Practical role play is often used with pharmacy undergraduates to simulate an interaction with a prescriber or a patient. The Leicester School of Pharmacy has produced a series of video clips to support students in their preparation for role play exercises with members of the pharmacy practice teaching team.
Role modelling is recognised as a powerful teaching tool for passing on the knowledge, skills and values of the medical profession. A paper that looks at how role modelling could be improved within medical education6 states that a conscious effort should be made to articulate what we are modelling and to make the implicit explicit.
One simple example cited is the importance of introducing yourself to the patient and how this can be overlooked easily.
There is the necessity for a role modelling consciousness within a learning environment. Physicians consciously think about being role models when interacting with medical trainees.7
The literature on medical role modelling appears to have an emphasis on positive role modelling, which would be expected, because most of the role modelling in medical training would be done in real life situations.
However, the aim of this video clip project was to extend this idea to provide examples of poor practice and compare this with the ideal standard. This emphasis was possible because of the role play as opposed to real life setting. The scenario of a pharmacist approaching a prescriber with a prescription query can be a potential minefield for the inexperienced student.
The introduction of both negative and positive scenarios was designed to support the student in the negotiation of this potentially complex process. As with all role modelling exercises, the importance of a reflective approach to learning is vital for success.
The socialisation of healthcare professionals is a key part of their education and training. For example, a principle aim of preregistration nurse education programmes is the process of effective socialisation of students into the professional role.
One study confirmed that the positive influence of high quality role models, from both education and practice establishments, are critical to the professional socialisation of student nurses.8
A small scale study investigated the effects of different role models in teaching final-year nursing students how to communicate bad news to patients.9
The study showed improved student performance in a role play activity that was carried out after a negative model was emphasised by teachers as an example of behaviour to be avoided.
Student perception of educational media tools is always an important consideration when embarking on the development of new teaching resources. A study of the educational value of multimedia tools (ie, DVD/video, CD-ROM, internet resources, including streaming video media) currently available to MPharm students10 examined student perception of different resources.
Overall, pharmacy students perceived that DVD-based resources were able to captivate attention and maintain focus more than other resources. It was noted that students favour a combination of both printed and electronic resources.
Media tools should complement and not replace traditional resources because learning is enhanced by high levels of flexibility and interactivity.
At the Leicester School of Pharmacy, the use of short video clip scenarios in the lecture theatre or seminar group is always supplemented by supporting handout material that relates to the prescription or case being observed.
How it is done
Four potential areas were selected for the development of a scenario. These practice-based role plays were chosen because they are commonly encountered in a dispensing session and would provide a visual and aural resource to supplement more traditional teaching methods.
The four scenarios included:
- Handing out a dispensed medicine to a patient
- Approaching a prescriber with a prescription query
- Handling a legal error on a prescription
- Dealing with a disallowed item
Each scenario was carefully scripted by a member of the pharmacy practice team, having carefully reflected on both good and poor practice that could be encountered in the selected scenario. The filming took place with two members of staff, one adopting the role of the prescriber and the other the patient.
Each scenario included a brief introduction of the intended outcome and reference to a numbered prescription exercise. This meant that, when the material was shown, students could access the printed prescription that was being used in the role play.
The first part of the filming demonstrated poor practice; the second part of the process demonstrated good practice. There is a brief summary at the end of the filming to ensure that major teaching points have been highlighted and discussed.
The filming took place over half a day and the editing required about eight hours of input from a member of the pharmacy practice team. The editing suites and Apple Mac programmes in the media department were used for this process.
It is expected that the production process will not be as onerous in the future as more expertise is gained in the editing process. The first “rough cut” was produced in DVD format so that it could be reviewed by other members of the pharmacy practice team. The feedback from the teaching team was extremely positive and few changes had to be made.
In order to make the clips accessible to all relevant teaching staff, it was decided that an electronic library was required. The final video clips, which are approximately five minutes in length, were fully formatted by the media department and now appear in the shared drive for the pharmacy practice team to access as appropriate.
One concern that was expressed at a pharmacy practice team meeting was the issue of downloading of clips by students and the possibility that the material may be posted on a public internet site. This would only be a potential problem if tutors chose to insert the clips into learning material that was then posted on the university virtual learning environment (VLE).
It is not possible to “lock off” the clips to prevent such downloading and streaming the clips would also not prevent this activity. As an additional precaution, the files were made large to act as a deterrent against downloading.
In the shared drive folders there are three versions of the files. These include a small and large Windows Media file depending on the quality of use required and also a Quicktime file in case the user does not have access to Windows Media Player.
All of the clips are also available on a DVD so that tutors can choose to use this format if this is more convenient.
There has been an excellent initial student response to the use of this material. The video clips have been shown as an introduction to practical sessions and also in lecture and tutorial sessions. Comments posted by students on blackboard in response to the DVD project include:Much quicker than having it described to you I’m a visual learner so this will stick with me … it was very effective It would have been better for me with students (actors) The video clips idea was a good way of showing what is expected in year 3. Rather than explaining it, watching it helped me to understand clearly why even the simplest procedures in dispensing are important The role plays highlight exactly where you are going right or wrong It gives us a better understanding of the level of communication skills expected of us
Initial anecdotal feedback from academic members of staff is that the clips have improved student performance in practical sessions where the specific skills demonstrated in the clip are being used.
One of the advantages of using this type of media is that the subtleties of body language can be clearly demonstrated and the dynamics of a discussion between a prescriber and a pharmacist are clear. Work is now progressing on developing and producing further material.
Areas planned for future development include:
- Counselling a patient
- Demonstrating how to use specific products and devices
- Approaching a prescriber with more complex clinical queries
- Responding to symptoms in a problem-based learning case study
There is also some investigation into the possibility of encouraging students to become actors in this process.
The production of this type of media and the clear demonstration of both poor and good practice is resource intensive. However, our initial experience demonstrates that this is a valuable resource to develop within a school of pharmacy.
Jon Waterfield and Virginia Aspinall are senior lecturers in pharmacy practice, and Sandra Hall is head of pharmacy practice and clinical pharmacy, all at the Leicester School of Pharmacy
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4. Maguire T. Barriers to communication — how things go wrong. Pharmaceutical Journal 2002;268:246.
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7. Wright SM, Caresse JA. Excellence in role modelling: insight and perspectives from the pros. Canadian Medical Association Journal 2002;167:638–43.
8. Fitzpatrick JM, While AE, Roberts JD. Key influences on the professional socialisation and practice of students undertaking different preregistration nurse education programmes in the United Kingdom. International Journal of Nursing Studies 1996;33:506–18.
9. Parathian AR, Taylor F. Can we insulate trainee nurses from exposure to bad practice: a study of role play in communicating bad news to patients. Journal of Advanced Nursing 1993;18:801–7.
10. Ingram MJ, Sagoe LA, Sosabowski MH, Long AJ, Moss GP. Pharmacy student perceptions of educational media tools. Pharmacy Education 2007;7:77–82.
Citation: The Pharmaceutical JournalURI: 10048602
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