AAOS Bulletin - April, 2006

Orthopaedists go to the head of the class in communication

Mentors, students both benefit at AAOS Communication Skills Mentoring Workshops

By Kathleen Misovic

As an orthopaedic surgeon committed to improving the quality of the care you provide in your practice, you wouldn’t think twice about taking a course to improve your surgical techniques. But have you ever considered taking a course to improve your communication techniques?

The AAOS has teamed up with the Institute for Healthcare Communication (IHC) to provide a special workshop to help orthopaedists improve their communication skills.

“In the workshop, we present communication techniques as though they were medical procedures,” explained John R. Tongue, MD, chair of the AAOS Communications Skills Mentoring Program and one of the mentors who teaches the workshop. “We give you new techniques to follow when communicating with your patients and tips to help you master the procedure.”

“Think of communication as a procedure you can learn, like learning how to do a hip or knee replacement,” added Richard A. Geline, MD, another workshop mentor.

The history behind the workshop

The idea for the workshop originated in the late 1990s when an AAOS public survey found many people didn’t know much about orthopaedists, or think much of their communication skills.

“The survey found most people didn’t know if orthopaedic surgeons straightened your teeth or fixed your bones,” said S. Terry Canale, MD, a workshop mentor. “They also thought we were less caring than other medical professionals and spent less time with patients.”

“The public saw us as high-tech and low touch,” added John F. Sarwark, MD, another mentor. “We knew if we could improve our communication skills, we’d be pretty powerful as a specialty.”

To combat this unfavorable perception, in June 2001, six orthopaedists spent a week at the IHC headquarters in Connecticut to learn how to teach a communication workshop and become a mentor. Since then, the number of trained mentors has increased to 34.

“We used the IHC’s educational and teaching model and made it specific to orthopaedics,” said Dr. Tongue. “We also partnered with the IHC on developing video vignettes featuring communication skills orthopaedists can use.”

Active learning

The workshop is a 4-hour, interactive course that incorporates videotapes and role-playing to help orthopaedists fine-tune their communication skills. It gives them techniques for conducting new patient interviews as well as follow-up visits. The workshop even offers tips for communicating with your operating room staff.

“Participants can take home techniques they can apply to every patient encounter,” Dr. Tongue said.

“The workshop emphasizes the ‘Four Es’ that physicians can use when interacting with patients: engaging them in conversation, listening to their story with empathy, providing them with education on their condition and treatment and enlisting their assistance in treating them,” Dr. Canale explained.

The interactive aspect of the workshop is the key to its success. For instance, participants watch a video showing a conversation between an orthopaedist and a patient, then offer their opinions on how the conversation went and what they would do differently. Participants also take part in role-playing exercises in which they act as both orthopaedists and patients.

“Anyone can listen to a lecture and get through it; the interactive parts of the workshops really help you think and learn; they’re the most fun, too,” Dr. Geline said.

Mentors learn, too

Mentors who teach the workshop also enjoy the experience because it’s as much of a learning experience for them as it is for their students.

“The more I teach these workshops, the more I learn as well,” said Dr. Geline. “Listening to ideas from the other doctors in the workshops helps me spot areas where I can improve my communication skills.”

“A number of mentors have said that teaching the workshop has helped them improve their relationships with their office staff—even with members of their family,” Dr. Tongue added.

Teaching the workshop, however, doesn’t come without its challenges. “I’m teaching a subject that orthopaedists haven’t had a lot of formal education in until now. This is a large area to get your arms around and feel you have mastered it well enough to teach it,” Dr. Tongue explained. “Also, it’s much easier to give a lecture you have prepared and studied for on a small area of knowledge than teach in an interactive forum where you must respond to different situations during every workshop.”

Who needs this course?

Think you’re already doing a good job of communicating? Keep in mind that you will conduct about 150,000 patient interviews during your career. Chances are they won’t all go smoothly.

Dr. Sawark said one of the most frustrating aspects of being a mentor is realizing that some of the orthopaedists who need the class the most won’t be taking it.

“We’re doing a lot of preaching to the choir. I think a lot of doctors don’t think it applies to them, or simply don’t think about communication,” he said. “We need to get these doctors to realize that improving their communications skills will, in fact, make their practices more enjoyable because it enriches their relationships with their patients. It will also reduce their medical liability risk.”

Dr. Tongue said that when orthopaedic surgeons and residents attended the workshop because it was mandatory, they didn’t regret their participation. “I’ve had many participants tell me how much they appreciated the workshop and how glad they were they had to take it,” he said. “We’ve had a lot of practicing orthopaedists say the information they learned has been extremely valuable to their practice. That kind of feedback keeps everyone involved with the workshops inspired.”

The workshops take place throughout the year and are sponsored by various organizations including the AAOS at the Annual Meeting.

For more information on the Communication Skills Mentoring Program visit online.

Sponsor a communication workshop at your location

Would your state orthopaedic society or large group practice be interested in sponsoring a Communications Skills Mentoring Workshop? Visit online for more information or contact Charmain Rachal at the AAOS at (800) 346-2267 ext. 4101 for more information. Sponsoring organizations are responsible for providing location, catering and audio/visual equipment/support for the workshop; there is a $10 per workbook fee for each participant.

Learn to listen

A vital part of communicating doesn’t include speaking at all—but simply listening. The Communication Skills Mentoring Workshops offer these and other tips to help orthopaedists become better listeners:

• When you interview a patient, lean forward, maintain eye contact, smile and ask: How can I help you today? These are six simple, yet powerful and empowering words.

• Lean forward and wait until the patient finishes speaking. This is hard to do. The average medical doctor interrupts a patient within 18 to 23 seconds.

• Facilitate the patient’s “telling of the story” by nodding, showing sympathetic facial expressions, using voice inflections or just repeating a key phrase.

Take in the information, without trying to organize it. Listen to the patient’s exact phrases and words so you can repeat them later to demonstrate that you were listening.

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