Audiology and Speech Pathology - Theses
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ItemPatient-centred communication in audiology education: an exploration of perspectives and practice( 2018)Patient-centred communication is recognised as the cornerstone to quality healthcare delivery and is associated with positive patient health outcomes. It is a core component of established healthcare disciplines, such as medicine and physiotherapy and is beginning to gain recognition and curriculum space in younger disciplines such as audiology. While there has been a growth in patient communication education in the audiology curricula, studies have reported that students feel ill-prepared when communicating with patients about their hearing impairment. Research remains sparse in exploring the current gaps in communication skills education in audiology. In addition, little is known about student-patient communication in a naturalistic setting such as clinical placements. Therefore, the overarching aim of the research was to explore patient-centred communication in audiology education in an Australian context. This research contains three studies. The first study aimed to examine the perspectives of audiology educators towards patient-centred communication. Semi-structured interviews were conducted with nine audiology program coordinators and key teaching staff to examine the barriers and facilitators to teaching patient-centred communication. Content analysis of the transcribed interviews revealed four emerging themes: professional culture and values, contextual factors, knowledge and understanding of patient-centred communication and individual factors. The findings shed light onto the competing tension between the teaching staff’s value towards patient-centred communication and the biomedically-driven professional culture that places a priority towards technical skills. The aim of the second study was to explore audiology students’ perception of their own clinical communication and learning in the audiology program. In a semi-structured interview using video reflexivity, fifteen students were asked to co-view their own filmed clinical appointment and discuss areas that were most salient to them. Thematic analysis revealed the themes of striving to be patient-centred, assessment shapes behaviour, and power relations to have the biggest influence on students’ own clinical communication. The final theme of what students want uncovered students’ perception towards different teaching methods. These findings showed students’ motivation to demonstrate patient-centred communication can be hindered by conflicting educational standards. The final study examined two interrelated research questions: i) how do audiology students co-construct the communicative tasks in a supervised hearing assessment appointment?; and ii) how does students’ communication align with the principles of patient-centred communication? Final year audiology students from two Australian universities were video-recorded during one of their university-based clinical placements. Two analytical procedures were performed using genre analysis and the development of The Patient-Centred Analytical Framework for Audiology to map students’ patient-centred communication. Findings showed clear communication patterns in how students structured the appointment in the presence of the clinical educator. Students also demonstrated patient-centred communication skills in fostering the relationship and gathering patient information. However, shared decision-making, enablement and responding to patients’ emotional concerns were rarely observed. A significant relationship was found between the clinical educators’ interjection and students’ patient-centred communication patterns. Collectively, these findings identified strengths and gaps in students’ patient-centred communication, and raised questions about the clinical educator’s role in the provision of learning opportunities during the clinical placement. This body of work demonstrated the complexities in teaching and learning patient-centred communication and highlighted the tension between existing barriers and enablers to the implementation of clinical communication education. Irrespective of external barriers, teaching and learning relies on educators’ knowledge and understanding of patient-centred communication. This may include training educators and providing clear guidelines to strengthen the alignment between educational content required for practice, as well as skills to optimise student feedback. To change the technical and biomedical focus within the audiological culture, the development of a unified teaching framework for communication could inform teaching content and assessment rubrics. Ultimately, communication is a skill that requires the opportunity for development. This can be facilitated by integrating communication education longitudinally into the audiology curriculum. Continual reinforcement of communication skills over the course of the program will sustain students’ communication learning and promote skilled communicators.