(Re)Teaching Professional Communication

Communication is ‘an essential duty’ of a pharmacist and the cornerstone of quality patient care. And yet, it continues to be one of the most common frustrations reported by preceptors when working with students and residents. Many factors may be at play, including a pandemic, as well as a digital society where so much communication happens in quick, abbreviated bytes.

On this episode, guest Christine Klein reminds us of the many facets of communication, the complex range of reasons some students and residents may struggle, and how we as mentors and teachers can support their development in this area effectively.

Host
Kathy Schott, PhD
Vice President, Education & Operations
CEimpact

Guest
Dr. Christine Klein, PharmD
Vice-Chair for Experiential Education
Clinical Associate Professor
Mercer University College of Pharmacy

Get CE: CLICK HERE TO CPE CREDIT FOR THE COURSE!

CPE Information
 
Learning Objectives
At the end of this course, preceptors will be able to:
1. Discuss the importance of strong communication skills for students and residents
2. Describe the preceptor's role in fostering professional communication

0.05 CEU/0.5 Hr
UAN: 0107-0000-24-041-H99-P
Initial release date: 1/17/2024
Expiration date: 1/17/2025
Additional CPE details can be found here.

The speakers have no relevant financial relationships with ineligible companies to disclose.

This program has been:
Approved by the Minnesota Board of Pharmacy as education for Minnesota pharmacy preceptors.

Reviewed by the Texas Consortium on Experiential Programs and has been designated as preceptor education and training for Texas preceptors.

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Transcript

Speaker 1: 0:08

Hello, if you are a regular listener, welcome back. If you are new to Preceptor Practice, then welcome. We're glad you're here. Preceptor Practice is CMPAC's podcast, created specifically for pharmacy preceptors. Each month, we cover a topic that is focused on helping you connect to resources and ideas that can help you improve your precepting practice, become a more effective teacher and mentor and balance your work with these additional but important responsibilities.

Speaker 1: 0:35

Communication is an essential duty of a pharmacist and the cornerstone of quality patient care, and yet it continues to be one of the most common frustrations reported by preceptors when working with residents and students. Many factors may be at play, including a pandemic, as well as a digital society where so much communication happens in quick, abbreviated bites. On this episode, my guest, christine Klein, reminded me of the many facets of communication, the complex range of reasons some students and residents may struggle, and how we, as mentors and teachers, can support their development in this area effectively. As always, I learned many new things and gained some fresh perspective, and I hope you do too. Well, hi, chris. Thank you so much for joining me today. I'm so glad that my colleague was able to make a connection with you, and I'm excited to talk about professional communication today. So if we could just get started, share with us a little bit about your background and why this has become an important topic for you.

Speaker 2: 1:37

Hi Kathy. Thank you so much for inviting me to chat with you today. I really appreciate having the opportunity. I'm Chris Klein. I've been on faculty at Mercer University College of Pharmacy since 2008. I have been the vice chair of the Department of Pharmacy Practice for experiential education since 2017. And so you know I'm sort of in the front line, so I hear concerns from both faculty members and preceptors about some of our challenges that we're facing right now with students in both professionalism and their professional communication.

Speaker 1: 2:14

And that's kind of where I want to start our conversation today. I know, you know, from my years in experiential education, I still follow a lot of chats and discussion boards, you know, in that space and it just seems like professionalism and maybe even more specifically, professional communication, just keeps coming up more and more, and more, maybe, than it ever has before. What do you think the reason is for this? And, you know, has something changed over the years as the professional evolves? Or, you know, why are we continuing to see more and more of this as a challenge?

Speaker 2: 2:49

I think that's a great question and I think it's really multifactorial. I think certainly some of this is post COVID fallout. You know, we have moved from a, from an environment where everything was done on Zoom and in a Zoom meeting you can try your best to have, you know, good communication and engage and, you know, make eye contact, but it's really a little bit of a challenge. So we we noticed that our students that were coming in, that we had done Zoom interviews, we missed some of those soft skills that we so rely upon in professional communication. I've spoken with residency program directors who indicated that their Zoom interviews for residents were just not the same as in-person interviews and again, it was just difficult for those individuals to maybe engage with someone else, to make eye contact. I mean, we've had students who their whole undergraduate career was done online and remotely and so then we're throwing them into a classroom environment where we're wanting them to work in teams and they really have a struggle with that.

Speaker 2: 3:56

I think also, you know technology is a little bit of a double-sided sword. You know we've, we've gotten, we've seen that there are challenges, particularly in written communication. You know, with with texting. You know texting and abbreviations, kind of casual language. Sometimes it can be difficult to flip into a little bit more formal writing that that is required in written communication and kind of one of my pet peeves is really, you know, not adhering to to grammar. So a lot of my students know that I'm kind of the grammar queen.

Speaker 2: 4:30

They can come to me if they have a letter or they have a CV, that I'll do it once over for that and I think, moving forward, we're going to see more and more challenges when it comes to artificial intelligence.

Speaker 2: 4:41

You know, that's a huge topic within within education, but it's also a concern within pharmacy education as well. So we've got to figure out a way to balance utilizing artificial intelligence and, you know, not as a, not as a crutch for students, but how, how can we? How can we see the pros and the cons of that? So, so that's that. One's probably a whole another topic of conversation, but but yeah, with with professional communication, I do think it's. There are a couple of reasons why, you know we're seeing problems.

Speaker 2: 5:16

I guess the other issue that we're seeing is that our students, our learners, are having difficulty receiving feedback. Again, when the preceptor and this is really more so when this the preceptor identifies problems or issues or knowledge gaps and I've had some conversations with students that they feel that the preceptor is being rude and disrespectful we try to reframe that conversation and say you know, the preceptor's primary responsibility is patient care and you are the least important person in this, in, in this you know scenario that we have to think about patient care and if your knowledge gaps or your behavior is impairing patient care, then they have a duty to speak up. They have a duty to to to bring that to the student's attention. So we got a lot of big issues. That's a pretty big range.

Speaker 1: 6:14

You'll get all that solved in 30 minutes. I love that you brought up AI. I actually have a conversation scheduled later this week to talk about AI and what that means for experiential education. So I totally agree with you. There's just lots of opportunity there, but we are going to have to navigate that pretty intentionally. Also, difficulty receiving feedback I hadn't thought about that, but certainly if we have a generation of students that maybe aren't accustomed to that, we're going to have some challenges and how do we react to that professionally? Yeah, there's actually a really good book and I can't think of the title of it right now, but I'll put it in the show notes. But it would be a great read for students who are struggling with that and it's all about how to receive feedback effectively and breaking down how we react emotionally to feedback and why that might be and how to overcome some of those things. So I'll make sure I put some of that in the show notes.

Speaker 1: 7:11

I also appreciate your comments, chris, about being in a virtual environment and then having to make that transition to teamwork, and I can actually speak to this pretty personally because we are a fully remote office. There's about a dozen of us sprinkled across the country and we just were together for full in-person meetings this past week and it's game-changing what that does for a team to actually have folks face to face, the things that you don't know about each other, the way the trust just explodes, because it's so much easier to develop trust when you're face to face and assume the best instead of assume the worst and all those kinds of things. So, yeah, I can really see how being virtual and then trying to make that transition can be really challenging for our students who experienced COVID. So how would you? Professional communication is a pretty big concept, I think covers a lot of things. So how would you describe that as succinctly as possible and why is it more important than ever for our students and residents and for our pharmacists and preceptors?

Speaker 2: 8:28

Sure well, for me I mean communication. We think about verbal and we think about written communication, but it's really that exchange of information between individuals. So it might be between patients, it might be between members of the health care team, and it's not just speaking and writing, it's really some of those softer skills. It's active listening, listening to the viewpoints and the opinions of others. It is both exhibiting nonverbal communication and observing and interpreting nonverbal communication.

Speaker 2: 9:04

Again, I touched on the giving and receiving feedback and I think empathy is also a really big piece of good communication. And when we think about why, why is this important? When we look at our cornerstone of what we do, that's going to be good professional communication skills. The Agency for Healthcare Research and Quality says that communication is an essential duty of a provider, which I love the way that that's phrased. It's like that is one of the core elements of things that you should be able to do. And when we look at items and documents like the JCCP's pharmacist patient care process kind of sometimes we abbreviate that the wheel communication and collaboration are literally in the center of the pharmacist patient care process.

Speaker 2: 9:59

So now more than ever it's so very important. Good communication skills allow us to build trust and rapport with not only our patients but other members of the health care team. So I don't think it's any secret why communication is usually one of those foundational pharmacy courses in the first year of pharmacy school.

Speaker 1: 10:26

As far as those attributes that you've mentioned, are there any pieces or components of professional communication that you think students and residents struggle most with when we talk about things like empathy, being open-minded which I would attribute to having a growth mindset exhibiting and interpreting body language, some of those kinds of things?

Speaker 2: 10:52

I think one of the things that student pharmacists struggle with initially is really being able to translate information. So we work with our students. They're building this beautiful vocabulary of all these drug names and medical terminology. They struggle a little bit with being able to translate it back into what I like to call patient friendly terms. Could your grandma understand what you're trying to explain to them? So I think that's one of the things that student pharmacists really struggle with.

Speaker 2: 11:30

They sometimes are Thinking about the information that they need to provide to the patient or the questions they need to ask, but they really don't see it as a holistic conversation and really that it needs to be open communication between the student and the patient or the student and the members of the healthcare team. And so that's where the soft skills I think you know they work on them. They're very important, but it really is active listening and it's not me thinking about the next thing I want to say. It's listening to what you are telling me and then maybe asking the next logical follow up question. So they might have a script of questions but they don't think about OK, based on what they've told me, what's my follow up question to that? So that that is a little bit of that active listening. And then, you know, empathy is one of those things like how, how do you teach empathy? You know, we just naturally have a lot of students that are that that just kind of comes second nature to them, so that one truly a soft skill that's hard to assess, it's hard to teach.

Speaker 2: 12:38

So I think I think what the student pharmacist, those are sort of the things that they struggle with with residents, maybe it's a little bit more of if, particularly if they're in a layered learning model, it's receiving feedback from their preceptor but maybe also giving feedback to students that that are working with them. And you could even say this for for new grads. You know, new grads are now suddenly thrust into this environment. If they're, you know, in a, in a community setting, they're supervising pharmacy technicians, and so now they not only have to apply what they know, they have to interact with patients, they have to interact with their, their pharmacy team, and they have to be able to give feedback on performance like, ok, this is, this is an area of where you need to improve. But that, and that's hard, that's hard for, you know, for brand new graduate to be able to give feedback not only receive it, you know, but but also give it as well.

Speaker 1: 13:33

Yeah Well, that's hard for me and I'm certainly not a new graduate, but you know it's part of what we do every day, so it's it's certainly a skill that has to be learned. It sounds, chris, like you're talking a lot about, you know, the merging of critical thinking and communication skills. If that's the challenge, and you know, we all know, that students, when they're in an experiential learning environment, and residents too, one of the most important things in their mind is to not say something's going to make them sound dumb, you know. So they are thinking about what the next thing is that they need to say, and then missing sort of that exchange component that you talked about earlier. So, yeah, great points. Can you speak specifically to professional communication and impact on patient outcomes? I mean, how do we tell a story to residents, students, that you know makes the importance of this stick with them, you know, helps them understand the true impact that their, their ability to communicate effectively can have on their patients having their colleagues, having their own careers, for that matter.

Speaker 2: 14:42

Sure, and we know that, you know, effective communication really can improve patient care. When we have breakdowns in communication, that is what can lead to medical errors. So things like poor transitions of care can lead to adverse events. It can lead to medication errors. But when we have kind of frequent, structured, effective communication, we can see, you know, we can see improvements in patient safety and I think for it's kind of like that, what's your why, why should you care about this? Not only from a patient standpoint you know that this is the right thing to do to improve patient outcomes but it's going to ensure that they can advance in their career.

Speaker 2: 15:27

Every single job posting has that requirement of strong communication skills. Really, knowing how to communicate in the right manner to your audience, whether that audience is patients or providers or other members of the team, is going to impact their ability to be successful, their ability in all areas of pharmacy practice. So their why is it's the right thing to do to improve patient safety, but it's also in their best interest. It's going to help with their career advancement. If they struggle with communication or struggle with giving or receiving feedback, then maybe that's something that they need to work on, set some goals, setting on how to incorporate that. It's only going to benefit them. It's only going to benefit them.

Speaker 1: 16:24

Yeah, well, you and I both can think of learners we've had in the past who were clinically competent, knew their stuff, top students but because they struggled with communication and some of those other softer skills, didn't land the residency or didn't land the job or struggled professionally beyond that. So I know we can probably both identify some of those.

Speaker 2: 16:47

Yeah, so many stories, yep, Yep.

Speaker 1: 16:50

Yep, we always say in experiential occasion we don't have to make these things up, right, because they just come to us From a preceptor's perspective, whether they're, you know, interacting with students or residents. What do you think are some of the most common challenges preceptors have in fostering professional communication and maybe even backing that up? I mean, what's the preceptor's role in fostering that professional communication?

Speaker 2: 17:18

Well, I think you know it's certainly part of the preceptor's role because you know we can in the classroom and in the lab setting we can try to model communication. You know most colleges of pharmacy will bring in standardized patients so we can practice counseling. But really, you know, for those students being able to perform it day in, day out in a practice environment, that's really going to ensure that they do have those skills and abilities. And certainly I know preceptors are, they're strapped for time. So you know, if they have a student that has again deficits in knowledge or communication or whatever else that can be difficult for them, I will tell you that every college of pharmacies Office of Experiential Education is there to help be a team member with the preceptor. So we don't want preceptors to everything that they're doing they're going alone.

Speaker 2: 18:18

But you know, the kind of the things that we encourage when we see that students are struggling in their professional communication is really practice, practice, practice. So it might be doing mock patient, a mock patient interview with the preceptor and then the preceptor can fine tune the questions that the student is asking. It can be mock patient counseling and even really, I think, before the preceptor says, oh wait, no, you shouldn't do this debrief with a student, ask them to sort of think about identify well, what do you think you did well? And allow them to focus on what they did well and then ask them to identify you know well, where do you think you struggled? How do you think you can improve on your communication skills? So I think again, you know we've talked about receiving feedback, but that debrief a lot of times when, given that opportunity, students sometimes are a little bit harder on themselves than the preceptors might even be.

Speaker 2: 19:21

But again, I think a debrief is really important and then from there the preceptor can provide some feedback on little you know, tweaks like how can we improve this? You know, maybe it's more open-ended questions, maybe it's listening, making a note of what the patient said and then thinking about the follow-up question that needs to be asked. And then, you know, I think I mentioned this a little bit earlier but structured communication techniques are really helpful, particularly in a team environment, and again, this kind of gives us a framework for consistent communication. It can really reduce the risk of, you know, of communication breakdown. So things like, you know, sbar, we reinforce this with our students because this is what we kind of see in that team situation.

Speaker 2: 20:11

But there, you know, there are other structured communication techniques, things that we don't necessarily teach but, like I pass, I know that that's done a lot for handoffs with nursing staff or team steps. So those kind of structured communication techniques can really be helpful. And again, I think this sort of goes without saying. But also having that preceptor model, good professional communication as well, is critically important. You know, again, we maybe can all think back to preceptors that we had, that were game changers in our lives and it's like, ooh, I want to be like that person, and then maybe we've had a couple also that have been like, hmm, that's really not the way I want to interact with other members of my team. So so modeling that good professional communication is also equally important.

Speaker 1: 20:55

Yeah Well, anytime we say it goes without saying. I think it probably is something that needs to be said. So I'm glad you brought it up, you know.

Speaker 1: 21:04

I think another way that professional communication issues, you know, raise their kind of their ugly head is in conflict, whether that's conflict between other learners or conflict with you know, between learner and preceptor. And you know something when we were talking earlier about the why I'm, you know, I also, I also wonder if having some intentionality about you know, talking about how I'm going to be giving you feedback on your professional communication as part of this experience, because that is a role that I, you know that I have, and here's why. But also, you know, when there are issues of miscommunication or or you know, maybe on professional communication, bringing that back to what might be meaningful for the learner, how this could impact patient outcomes, how your communication could deter your professional career, how it makes others feel you know things, things along those lines, and most of the time learners want to improve. They don't even know that they're doing things right that are perceived as unprofessional.

Speaker 2: 22:09

No, I agree, I agree and again, again, I agree with you. Taking it back to the why, you know why is this important. You know, as we said, we've, you know, we've got hundreds of stories of both good communication strategies and maybe not so good ones. But and I agree that the majority of our students are there for the right reasons, they want to get better. But they're living in this environment, in this time where you know it wasn't their fault that they were online for three years and undergrad, so Right, yeah, exactly Exactly Now.

Speaker 1: 22:41

They're definitely coming to the table with some, with some challenges. So, yeah, yeah, they are. I think that teases us up to talk a little bit about strategies preceptors can use to develop and strengthen the communication schools, schools, sorry skills in their students and residents. So maybe, if you've got some ideas I know we talked about some of these structured communication techniques, but what are some other? What are some other strategies preceptors can use, you know, to intentionally help foster some of those skills or address issues when they arise.

Speaker 2: 23:14

That's a really great question. I'm going to have to pause and think about that one. I mean outside of the of practicing and debriefing and structure communication. I think maybe thinking about the outcome of what happens when communication goes wrong. I'll give you a recent example we had with a student.

Speaker 2: 23:36

So we had a student who was performing a medication history and they were able to collect correctly collect the information and in this case the patient was taking warfarin, kind of a split dose of warfarin, but ultimately was taken 10 milligrams daily, which is kind of a high dose, and they were achieving this by taking two of the five milligram tablets. Communication was was okay, but unfortunately they documented this information incorrectly. So they went into the health record. They documented that, based on the the med history, the patient was taking warfarin, five milligrams, one PO, bid, and so when the preceptor went into review and verify the med history, you know she looked at the student and said why did you document it this way? What is this what the patient told you? Well, no, no, the patient told me they were taken at 10 milligrams, two tablets in the morning. Why? Why did you document it as BID? Well, I didn't know how to indicate it. I didn't know how to write it in the health record and indicate that they were taking two tablets.

Speaker 2: 24:41

So so again, so kind of thinking ahead, so what would have happened if this went into the medical record? What could have happened to this patient? And the student like was, oh, that that's probably bad. Yeah, that's probably bad that. Yeah, I guess that's a midair, yeah, that's a minute, you know. So again, kind of walking the student through and again that reinforces. Like going back to the why why is this information so critically important? Why is it, you know, so essential that the information is documented correctly? So again, you know, sort of that, what would happen to that patient if we didn't catch this error? So I think that's also an important strategy and hopefully, you know, the majority of our students are well, I know that they're not making catastrophic errors like that, but I mean this really, really truly could have caused a significant medication error in this patient.

Speaker 1: 25:33

Yeah, that is a great example and you know you, just, this is probably ignorance on my part, but you've done a great job throughout this conversation of reminding me of the ultimate goal here, which is taking care of patients, and the role that professional communication and good communication plays, and all of that, I think, in the experiential environment so often we get caught up in, you know, some of the more conflict based or unprofessional communication that gets caught up or that leads to conflict.

Speaker 1: 26:03

And if we can take a step back and, I think, focus, you know, as you've described, on these outcomes, it also helps make the conversation between the preceptor and the learner not personal. It's not personal. This is, this is the, you know, a negative outcome that we're trying to avoid, and appropriate communication, you know, could have mitigated that, because that's that's always the struggle in a, in a situation where the conflict might exist, right is Sure not not having any personal. We just this is a, you know, an issue like any other issue that we need to fix and giving learners tools to do that. So, yeah, this has been very helpful. Other other thoughts are, you know, last, last piece of advice I think, for for a preceptor, listeners who might be struggling to give that feedback or identify opportunities for development with their learners.

Speaker 2: 27:02

I think probably the only other tidbit of information I would share is that I think it's important for preceptors to really clearly communicate expectations and requirements for the rotation. So you know, kind of a general overview of you know, this is, these will be your hours, this is what you you know, this is what you should wear, this is what I expect you to do on a daily basis. These are your deliverables on either a daily or a weekly basis. And then also one strategy that a lot of our preceptors employ and I just love it is feedback Fridays. So every Friday the student and the preceptor sit down and again it's a feedback session, but it's also a little bit of that deep brief session. So you know what went well to that, what went well this week, where do you think you're still struggling? And then the preceptor gives the student feedback.

Speaker 2: 28:03

So again, you know, we've really been focusing on professional communication from students, but also the students. They do crave that feedback. They do crave that from the preceptor. They want to know what they're doing well. They some of them struggle with hearing it, but they do want to know areas for improvement. So so that's just one tool. And again, you know I cannot take credit for that at all. I've learned that for my preceptors. But they but they utilize that feedback Fridays so that they're not the students not getting to the midpoint of the rotation and they're reading the comments and going, oh, I need to work on this or oh, I'm not meeting expectations, so, and again, I get it.

Speaker 2: 28:46

Giving feedback, and especially feedback for improvement, is hard. So giving it and receiving it we've talked about that it's hard and I think that's probably true for preceptors. You know. Again, sometimes it's like oof, you know, I'm real worried about this student, how exactly do I have that conversation? So those feedback Fridays are really effective. Again, we're just kind of level setting every week are we, are we where we need to be? So that that tends to be very helpful Because the students really do they, they, they want to know how they're doing the vast majority, so that's my last nugget.

Speaker 1: 29:22

Yeah, thank you. Now, that's a great. That's a great one. I love the feedback Fridays and I think what that does is it just puts the expectation out here that we're going to have this exchange and again, it's not personal. This is about your learning and development and communication is a part of that, and you know I don't know what the stat is but nine times out of 10, a communication issue or a conflict issue is really related to their poor communication or misaligned expectations. Right, and if we can, you know, do everything that we can on the front end of an experience whether it's with a student or a resident to you know, be super crystal clear about what those expectations are, and you know how we operate and what our culture is and how we interact with each other and with patients, then you know we're setting the learner up for for success.

Speaker 2: 30:05

So yeah for success in that rotation and then also career success. So absolutely.

Speaker 1: 30:10

Yeah Well, thank you so much, chris. This was a great conversation. You know, I think one of the one of the most significant topics we get feedback on from preceptors that they want to know more about is giving feedback and professional communication. So I, you know, I think these obviously go hand in hand and and hopefully everybody is taking away all the great things that I have as well. So thank you so much. I really appreciate your time, kathy.

Speaker 2: 30:36

Thanks so much again for asking me. I had it all, so anytime, awesome, Take care.

Speaker 1: 30:42

Thanks. Well, not surprisingly, chris made me think about professional communication in some new ways. I think I went into this episode with a bit of a negative attitude, projecting some of the frustration I think we can all feel sometimes when a student pharmacist or pharmacy resident doesn't exhibit communication skills. That might seem second nature to us, but after talking to Chris, I came away with a bit more empathy and understanding as to why these gaps exist and what we can do about them. She also broadened my thinking to consider the many ways in which communication impacts a preceptor's ability to be an effective teacher, but also an effective provider of patient care. Recognizing that communication impacts everything from patient safety to a student or resident's ability to receive and use feedback was key for me. If you have other strategies that have worked well to foster communication skills in your learners, reach out to me at Kathy at cmpactcom. I'd love to hear from you and share those ideas with others. Dr Klein highlighted many aspects of pharmacy practice impacted by professional communication skills or the lack thereof.

Speaker 1: 31:46

I've added some links in the show notes to some additional podcast episodes and courses on professional communication and feedback. Be sure to check those out. I've also added a link to the book I referenced. It's called Thanks for the Feedback the Science and Art of Receiving Feedback. Well, this might be a great reading assignment for your students or residents. As always, be sure to check out the full library of preceptor by design courses available for preceptors on the CMPACT website, and be sure to ask your experiential program director or your residency program director if you are a member, so that you can access it all for free. Thanks again for listening and I'll see you next time on Preceptor Practice.