5 - 2023 | Associate Clinical Educators

Image showing Meducate Academy teaching consultation skills to a group of pharmacists during their Clinical Pharmaceutical Team Meeting. — Meducate Academy Teaching Consultation Skills to Pharmacists at their Clinical Pharmaceutical Team Meeting

In this article, we explore the role of ACEs in healthcare education and the importance of effective communication skills. We discuss the impact of active listening on building rapport with patients and avoiding miscommunication. Drawing insights from experienced pharmacists, we address the challenges of difficult conversations in healthcare. We also highlight the wisdom of Plutarch and the practicality of Anatol Rapoport’s rules for navigating such conversations. By emphasizing the collaborative nature of communication and its life-saving potential, we stress the significance of effective listening skills. ACEs and healthcare professionals are encouraged to prioritize listening as a foundational skill and utilize tools like the Rappoport Rules for improved communication.

Image of Agenda of Pharmaceutical Team Meeting at Dudley College of Technology — Pharmaceutical Team Meeting at Dudley College of Technology Agenda featuring Meducate Academy

How often do you hear what someone is saying but fail to truly listen? How frequently do you find yourself waiting for the person to finish speaking so that you can assert your own thoughts, often with a prepared speech centered around your own agenda, without genuinely addressing the original question? These are the subjects I intend to explore in my writing this month.

As ACEs (Associate Clinical Educators), it is necessary and important that we provide accurate feedback on students’ technical competencies. The feedback should, of course, be relevant and precise, enabling the students to develop as safe practitioners. Another essential aspect of our role is to assist students in developing effective communication tools to establish rapport and gain the trust of simulated patients. This becomes particularly relevant when students embark on their journey to master the art of effective history-taking, marking their initial exploration of the realm of effective communication.

I always emphasize to students that the essence of communication lies in the response one receives. This is crucial because failing to genuinely listen to the patient can result in miscommunication. Each party brings their own agenda to the conversation – the clinician and the patient have their respective goals. It is no wonder that communication can be seen as something of a dark art. Therefore, the role of the ACE is to carefully guide the students through the process.

Always remember that a conversation is a partnership. It is a collaborative process, led by the patients’ ideas, concerns, and expectations, with the clinician and the patient working together.

This topic emerged during a recent Clinical Pharmaceutical Team Meeting held at Dudley College, where my colleague Mark Reynolds and I were invited to speak about Enhancing Consultation Skills to a group of highly experienced Pharmacists. In addition to discussing generic communication skills, we presented a couple of scenarios illustrating poor and effective communication and engaged in discussions on the points raised.

One of the key themes that emerged from the pharmacists was the common problem of patients demanding specific drugs, such as antibiotics, and how to handle such situations. Another recurrent theme was the instances of angry patients being informed about the cost of prescriptions. In other words, the main focus of the discussion revolved around managing difficult conversations.

Effectively navigating a difficult conversation requires active listening, and most of the attendees were eager to hear our thoughts on this matter. Like any skill, it demands constant practice and simply paying attention to the conversation. However, finding the time to listen is challenging in today’s busy pharmacy or GP surgery, where restrictions are imposed on the duration of patient interactions. Nonetheless, learning this skill is vital.

In order to build rapport and gather important information, we allow the patient to talk and express their needs. This is of utmost importance.

Greek philosopher Plutarch, Greek philosopher philosopher, writer, magistrate and priest — Plutarch, Greek philosopher, writer, magistrate, and priest who lived during AD 46, extensively wrote about the subject of listening

Plutarch, the philosopher, writer, magistrate, and priest who lived during AD 46, extensively wrote about the subject of listening. It might be useful to briefly examine his views, as expressed in one of his letters to a young man about to embark on his studies. He discusses different types of listeners: the Lazy Listener, the Scornful Listener, the Excited Listener, and the overly confident listener.

The lazy listener is someone who only listens for information that interests them and shows no interest in what the speaker is saying. They wait for their turn to expand on their own interests, paying little attention to the speaker’s main topic of conversation. The scornful listener is judgmental of alternative ideas or beliefs, as they adhere strictly to their own set of values and beliefs. Plutarch notes that judgment is, in fact, a distraction of the mind, and these types of listeners tend to develop a distorted view of what is actually being said. It is better to have an open mind, he says – a sentiment with which I wholeheartedly agree. We must not let the speaker’s performance distract us from paying attention. Otherwise, we will quickly forget our purpose and potentially miss valuable information. Finally, Plutarch talks about the Overconfident Listener, who assumes they know what the speaker means right from the start and fails to listen for subtle, sometimes hidden, cues in the conversation. When this happens, it is important to step back and actively listen.

Even Plutarch recognized that a conversation is a collaborative process. The responsibility for the outcome of a conversation rests with the listener and with healthcare professionals. Achieving the correct outcome is crucial, and listening can literally save lives.

Throughout my experience as an actor, comedian, corporate trainer, NLP trainer, and associate clinical educator, I have employed various methods to teach communication skills to students in different fields of study. From armed response teams to salespeople, from actors to presenters, and more recently to physician associates, pharmacists, nurses, and young doctors, the process remains the same: learning to listen first and foremost.

At the recent Team Meeting in Dudley, I extensively discussed the use of Rapoport Rules as a valuable tool for communication skills. I encountered these rules a few years ago and have always wondered why they are not more widely known. Anatol Rapoport, a Russian-born American game theorist, developed a set of rules for handling difficult conversations:

Clearly re-express your conversation partner’s position, defining your understanding of what they want. This ensures clarity in the conversation and prevents you from straying off course with your own assumptions.
List points of agreement with your partner to develop rapport further.
Always mention something you have learned from the person you are talking with, further building agreement.
Only then can you proceed to disagree or compromise with the person. You can see how these rules can be helpful when patients hold fixed beliefs about vaccines, antibiotic use, or various other treatment-related ideas.

I encourage you to follow and practice these steps each time you engage in a difficult conversation. If you are an ACE, please be aware of these tools and pass these skills on to students during their history-taking sessions. The positive impact will be appreciated by everyone.

Next month, I will be talking about our work with Newcastle University PA program teaching musculoskeletal (MSK) examinations.

If you’re a Pharmacy Clinical Lead and wish to discuss working with Meducate Academy Ltd., we would love to give you a demonstration and a workshop at your institution.

Please contact: bobspour@meducateacademy.com or on 07870 611850

If you’re an Associate Clinical Educator (ACE), you may have wondered what sets you apart from a simulated patient or medical role player. In this article, we will be exploring this question and providing a useful questionnaire that will help you become a better ACE, teacher, and communicator. Our goal is to improve the quality of ACEs by answering important questions and providing helpful training resources.

How well do you really know your role as an Associate Clinical Educator? I have been thinking for a while now about creating a quiz for ACEs. I wanted to find out what makes an ACE more than just a simulated patient or medical role player. I believe the following questionnaire will help us become better Associate Clinical Educators, as well as better teachers and communicators.

Over the past couple of years, Meducate Academy has been putting together training courses to help existing ACEs and simulated patients improve their existing skills and introduce new people to the role of the ACE. We are always striving to improve the quality of our ACEs, and in order to do that, we always listen to what they have to say.

When I was starting out, many of these questions were never answered satisfactorily, and after much discussion with our existing ACEs, they all seemed to ask the same questions.

On the 13th of this month (May 2023), we will be running another one-day training course aimed at potential ACE. These are normally people who have been medical role players or have some experience as simulated patients and wish to take it to the next level.

If you are one of those people, you might find it helpful to ask yourself these questions below. If you are an experienced ACE, you could revisit this questionnaire or add more questions to the list. So, get a sheet of paper and answer these questions now.

1. When did you first start working as a medical role player and why?
2. When did you start working as an ACE, and how easy was the transition?
3. How often do you work as a medical role player or ACE?
4. What types of students have you worked with, and did their needs differ?
5. Have you been involved in OSCEs or any other type of examination?
6. Was the training we gave you adequate, or do you feel it was confusing?
7. What type of training would you find most useful?
8. Which aspect of your previous training (prior to medical roleplay/simulated patient/ACE) has helped you engage with your current role?
9. Where do you find resources that help with your current role?
10. What new resources would you find useful to help you improve the quality of teaching?
11. How much do you think your personality affects the learning outcome, and do you think you should spend more time on that aspect of your training?
12. Do you know how to teach a student how to develop rapport with a difficult patient?
13. What do you get, at a personal level, from teaching as an ACE?
14. How do you structure feedback to the student?
15. Do you always achieve your desired outcome when teaching, and if not, do you reflect on what you could do better next time?

We came up with these initial 15 questions, but we welcome any suggestions. As we ask these types of questions to our new ACEs, it’s essential to understand that none of us are experts or masters of our craft. Acknowledging that there is always room to learn something new helps us stay vigilant. Our honesty fosters implicit trust from our students, and they feel that we are with them on their journey.

The type of people we are looking for are those who say, “C’mon chaps, let’s get stuck in,” not “Go on, chaps, off you go.” Lead from the front. We are there to work with the students, not talk at them. Build rapport with the students, have the flexibility to change your behaviour when you need to, be aware, and you and the students will achieve their desired outcomes.

Have an open mind and question everything! At the end of the day, that is what education should be about. That is how we grow and become better humans.

If you are interested in joining us or want to have a chat about our one-day training course aimed at potential ACEs on 13th May 2023 get in touch. Please contact: bobspour@meducateacademy.com or on 07870 611850

Mastering The Skill of Listening: A Key To Patient-Centred Care

15 Questions to Test Your Skills as an Associate Clinical Educator