Professor Owen Hargie School of Communication University of Ulster odw.hargie@ulster.ac.

uk

"Training Professional Communication Skills: Research, Theory and Practice"

THEORETICAL BACKGROUND

Key Sources Dickson et al. (1997) Hargie (2006) Hargie & Dickson (2004)

Models of Skill
Welfords Model of the Human SensoryMotor System Argyles Motor Skill Model Hargies Model of Skilled Communicative Performance

EXTERNAL OBJECT
S E N S E O R G A N S P E R C E P T I O N
C O N T R O L O F R E S P O N S E

Shortterm store

Translation from perception to action: Choice of response

E F F E C T O R S

Long-term store

Welfords Model of the Human Sensory-Motor System

 Crossman (1960) was the first person to attempt to conceive of communication as a form of skill. He then liaised with Michael Argyle at Oxford University, who proceeded to develop the analogy between motor and social skill

Argyle noted that: One of the implications of looking at social behaviour as a social skill was the likelihood that it could be trained in the way that manual skills are trained

Perception

Motivation, goal

Translation

Changes in outside world

Motor responses

Argyles Motor Skill Model

Feedback Perception Response

Person-situation context

Goal

Mediating factors

Mediating factors

Goal

Response

Perception

Feedback Hargies Model of Skilled Communicative Performance

Five Shared Components of Skill

FRASK Fluent Rapid Automatic Simultaneous Knowledgeable

Social and Motor Skill Differences

Social interaction, by definition, involves other people, whereas many motor skills do not. The affective domain plays a more central role in social contexts. The perceptual process is more complex during interpersonal encounters. Personal factors relating to those involved in social interaction play a central role in the responses of participants.

Microteaching
Allen & Ryan (1963) introduced microteaching at Stanford University: Teaching broken down into constituent parts or skills Each part/skill taught separately Skill practice/acquisition occurred in college context (teach/reteach cycle) Complexity was reduced (e.g. microlessons were 5 minutes)

Microtraining
Microteaching was shown to be effective (Hargie, 1977) Ivey et al. (1968) adapted the approach in counsellor training microcounselling. Hargie et al. (1978) developed it more widely in the training of a range of professional groups microtraining; but guided by the skills theoretical framework.

Microteaching Motor - Social Skill Analysis Microcounselling Social Skills Microtraining Training

Communication Skills Training

Features of Interpersonal Skill

Learned/knowledge-based Behaviourally circumscribed Internally consistent Sequentially co-ordinated Smooth Rapid/automatic Goal-directed Synchronised with the behaviour of others Successful/accurate Normative and appropriate to context

Definition of Interpersonal Skill

A process in which the individual implements a set of goal-directed, interrelated, situationally appropriate social behaviours, which are learned and controlled. (Hargie, 2006)

Criticisms of the Skills Approach

Reductionism (- distorts reality) Ideological (- CST is a Machiavellian management tool; it is only common sense and a waste of curriculum time) Artificiality (- changes behaviour)

Process of Skill Learning

1. 2. 3. 4. Unconscious incompetence Conscious incompetence Conscious competence Unconscious competence

PRACTICE

Ubiquity
CST is now a widely accepted part of the training of most professionals: Communication skills training ... in medicine, once considered a minor subject, is now ranked as a core clinical skill (Laidlaw et al., 2002)

 The ubiquity of CST was confirmed in recent UK surveys of medicine (Hargie et al., in press) and physiotherapy (Parry & Brown, in press)

Some Pedagogical Issues

Tensions between:

flexibility and effectiveness content and process isolated versus integrated curriculum results and resources specific and generic approaches designated responsibility versus wide involvement mass versus spaced teaching

Some Pedagogical Issues

Identification of skill content Programme design Sensitisation Skill practice Feedback Assessment of CST Transfer of training Programme evaluation
(Hargie & Saunders,

1983a,b)

Taking one of these areas:

SKILL IDENTIFICATION

Skills Can Be Identified By:

Academics Practitioners Managers The Managed Clients/Customers Researchers Government

Styles of Approach to Skill Identification

Empirical (systematic observation & analysis) Analytical (theoretical, deductive approach) Intuitive (experiential, reflective, approach) (Ellis & Whittington, 1981)

Skill Identification Methods

Direct Observation Task /Subject Matter Analysis Surveys Interviews Focus Groups Delphi Technique Critical Incident Technique Constitutive Ethnography (Hargie & Tourish, 2009)

Some Issues
Sampling Defining the target population (bandwidth-fidelity problem) Rigour and relevance Recordings (ethics) Time commitment

Factors affecting patient assertive behaviour during medical consultations

Type of illness Reason for this visit First v. repeat visit Home v. surgery location Presence of a companion Duration of interaction Physical examination or not The personality of doctor/patient Gender of patient/doctor The initial behaviour of the doctor (Beisecker, 1990)

RESEARCH

Significant Changes
Clarification of skill Conceptual underpinning for CST Mandatory CST in professions Assessment using simulated clients Designated societies (EACH, AACH) and Communication Divisions Research & publications (6,600 hits on GS for CST; 30,700 for SST; 2,640 for IST)

 Indeed interesting forms of evaluation are now being carried out: e.g. Favre et al. (2007) in a study of psychodynamic aspects of practice, found that CST reduced immature defence mechanisms operant in oncology clinicians facing challenging interviews with patients

Those with higher levels of interpersonal skill tend to:

be more sensitive to the needs of others have more friends be more successful in dating be more satisfied in their close personal relationships handle life crises better cope more readily with stress adapt and adjust better to major life transitions

Those with higher levels of interpersonal skill tend to:

be less likely to suffer from depression, loneliness or anxiety report higher levels of happiness perform better academically be more effective professionals be better entrepreneurs be rated as more effective by clients
(Hargie et al., 2004; Segrin et al., 2007a,b)

Benefits
In the health domain, high levels of practitioner interpersonal skill have been shown to be positively correlated with increases in the quality of care and effective health outcomes, while ineffective skills are associated with decreased patient satisfaction, increased medication errors and malpractice claims.

 Communication skills training during medical school has been shown to have effects lasting as long as five yearsIf the change lasts that long it is probably permanent (Roter & Hall, 2006) there is overwhelming evidence that, when used in a systematic, co-ordinated and informed fashion, CST is indeed an effective training medium (Hargie, 2006)

The programs that have been most successful (a) are intensive and delivered over an extended period of time, (b) provide opportunities for practice and feedback on performance, (c) present role models, (d) provide follow-up assessments and review, and, importantly, (e) have institutional support and incentives promoting the value of effective communication. (Street, 2003)

Some Issues
Not all programmes are based upon a conceptual bedrock. Dearth of detailed research into the component parts of CST. Many decisions about design and delivery are still best guesses. Lack of research into integration between CST and the rest of the curriculum.

Some Issues
Epistemological base: lack of knowledge of situation-specific skills across most professions. Disinclination towards evaluation by providers. Pedagogical differences across professional programmes. CST is not a unitary or prescriptive phenomenon. In many ways its flexibility is both an advantage and a drawback.

Some Issues
Differences in programme design and operation make comparisons across studies very difficult. More research is required into all aspects of the training cycle, especially outside of medicine.

Some Issues
10 year rule means that skill development is a long process. Considerable research into changes in motor skill over time, little in interpersonal domain. How, and in what ways does CST short-circuit the learning process? How can this be further enhanced?

Some Issues
Not all trainers are adequately trained.

Final Comments
CST has moved from a suspect innovation to a generally accepted reality. The diversity across programmes will continue. The research potential in this field is well recognised and will further develop.

References Allen, D. & Ryan, K. (1969). Microteaching. Reading, MA: Addison-Wesley. Argyle, M. (1967). The psychology of interpersonal behaviour. Harmondsworth: Penguin. Crossman, E. (1960). Automation and skill. London: HMSO. Beisecker, A. (1990). .Patient power in doctor patient communication: What do we know? Health Communication, 2, 105-122. Dickson, D., Hargie, O. & Morrow, N. (1997). Communication skills training for health professionals 2nd ed. London: Chapman and Hall. Ellis, R. & Whittington, D. (1981). A guide to social skill training. Croom Helm: London. Favre, N., Despland, J., et al. (2007). Psychodynamic aspects of communication skills training: A pilot study. Support Care Cancer, 15, 333-337. Hargie, O. (1977). The effectiveness of microteaching: A selective review. Educational Review, 29, 87-97. Hargie, O. (ed.) (2006). The handbook of communication skills, 3rd ed. London: Routledge. Hargie, O. & Dickson, D. (2004). Skilled interpersonal communication: Research, theory and practice, 4th ed. London: Routledge. Hargie, O., Dickson, D. & Tourish, D (2004). Communication skills for effective management. Basingstoke: PalgraveMacmillan. Hargie, O., Boohan, M., McCoy, M. & Murphy, P. (in press). Current trends in Communication Skills Training in UK Schools of Medicine. Medical Teacher. Hargie, O. & Saunders, C. (1983a). Individual differences and SST. In R Ellis and D Whittington (eds.) New directions in social skill training. London: Croom Helm. Hargie, O. & Saunders, C. (1983b). Training professional skills. In P. Dowrick and S. Biggs (eds.) Using video. London: Wiley. Hargie, O., Tittmar, H. & Dickson, D. (1978). Microtraining: A systematic approach to social work practice. Social Work Today, 9, 14-16.

References
Hargie, O. & Tourish, D. (2009). (eds.) Auditing organizational communication: The handbook of research, theory and practice. London: Routledge. Ivey, A., Normington, C., Miller, C., Morrill, W. & Hasse, R. (1968). Microcounseling and attending behavior: An approach to pre-practicum counselor training. Journal of Counseling Psychology, 15, Part II, 1-12. Laidlaw, T., MacLeod, H., Kaufman, D., Langille, D. & Sargeant J. (2002). Implementing a communication skills programme in medical school: Needs assessment and programme change. Medical Education, 36, 115124. Parry, R. & Brown, K. (in press). Teaching and learning communication skills in physiotherapy: What is done and how should it be done? Physiotherapy. Roter, D. & Hall, J. (2006). Doctors Talking With Patients/Patients Talking With Doctors: Improving Communication in Medical Visits, 2nded. Westport, CT: Preager. Segrin, C. & Taylor, M. (2007a). Positive interpersonal relationships mediate the association between social skills and psychological well-being. Personality and Individual Differences, 43, 637646. Segrin, C., Hanzal, A., Donnerstein, C., Taylor, M. & Domschke, T. (2007b). Social skills, psychological wellbeing, and the mediating role of perceived stress. Anxiety, Stress & Coping, 20, 321 - 329. Street, R. (2003). Interpersonal communication skills in health care contexts. In J. Greene & B. Burleson (eds.), Handbook of communication and social interaction skills. Mahwah, NJ: Lawrence Erlbaum.