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“I’ll Never Forget This”: evaluating a pilot workshop in effective communication for dental students
Malmö högskola, Faculty of Technology and Society (TS), Department of Computer Science (DV).ORCID iD: 0000-0002-7480-201X
Malmö högskola, Faculty of Odontology (OD).
Malmö högskola, Faculty of Odontology (OD).
Malmö högskola, Faculty of Education and Society (LS).
2012 (English)In: Journal of Dental Education, ISSN 0022-0337, E-ISSN 1930-7837, Vol. 76, no 10, p. 1311-1316Article in journal (Refereed) Published
Abstract [en]

This study evaluated a pilot workshop for teaching communication skills to dental students. The methodology is based on an experiential learning approach, the use of realistic clinical scenarios, simulated patients, and an integrated teaching team of both educational researchers and dentists. Furthermore, the methodology was adapted for short workshops, which is thought to offer better possibilities for frequent and effective training of communication skills throughout the curriculum. The workshop was piloted with groups of six to ten students from the sixth and tenth semesters (n=94). Results show that the majority of students found the tasks meaningful and well aligned with how they perceived their future profession as dentists. Most students also thought that they learned from the task. An interesting finding is that students not only found it instructive to practice how to communicate in authentic situations, but that they generally found the workshop to be thought-provoking while at the same time providing structure and intellectual tools for the future. A possible explanation for this finding is the sharing of explicit criteria for high-quality communication.

Place, publisher, year, edition, pages
American Dental Education Association , 2012. Vol. 76, no 10, p. 1311-1316
Keywords [en]
communication, dental education, dental students, dentist-patient relations, program evaluation, patient-simulation
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-15991DOI: 10.1002/j.0022-0337.2012.76.10.tb05385.xISI: 000309569700004PubMedID: 23066129Local ID: 15139OAI: oai:DiVA.org:mau-15991DiVA, id: diva2:1419513
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-05-07Bibliographically approved
In thesis
1. Bedömning av professionella samtal: en studie av undervisning och bedömning av tandläkarstudenters patientsamtal
Open this publication in new window or tab >>Bedömning av professionella samtal: en studie av undervisning och bedömning av tandläkarstudenters patientsamtal
2019 (Swedish)Licentiate thesis, comprehensive summary (Other academic)
Abstract [sv]

Denna licentiatuppsats bidrar med ett förslag till ett systematiskt upplägg av undervisning och bedömning av tandläkarstudenters professionella samtal med patient. Det systematiska upplägget baseras på fem delar:struktur för kommunikationsövning: identifiera, analysera, kommunicera och reflektera.Bedömning som stödjer utvecklandet av förmåga att ge informerade omdömenDPCSI-instrumentet, vilket utgör en sammanställning av kriterier och indikatorer för tandvårdssamtalet.Struktur för progression, baserat på DPCSI-instrumentet och resonemang utifrån Hardens (2007) modell för pro-gression för lärandemålBred förankring av undervisning i kommunikationskompe-tens i tandläkarutbildningen

Abstract [en]

This licentiate thesis studies higher education in the intersection of professional competence and pedagogy in higher education. The focus is on knowledge and reflective understanding of teaching and assessment of dental students’ capability to com-municate orally with patients.Dentists’ capability to communicate orally with patients is considered a clinical core competence (Manogue et al., 2001). The Association for Dental Education in Europe have defined seven domains crucial for professional practice. One of these domains is: Interpersonal communication and social skills (Cowpe et al., 2010). Within this domain, the following skills have been identified: establishing a patient–dentist relationship that allows the effective delivery of dental treatment, identify-ing patient expectations, desires and attitudes, sharing infor-mation and professional knowledge with the patient and being able to negotiate. Communicative capability is essential as it is a requisite for efficient clinical practice in dentistry (Hannah et al., 2004). Good communication leads to improved results of care (Carey et al., 2010; Hagihara & Tarumi, 2006; Street et al., 2009), in-creased patient satisfaction (Hurst et al., 2004), as well as re-duced patient anxiety (Hottel & Hardigan, 2005).Although there are guidelines as well as many good reasons for developing dental students’ communicative competence, a need for a more systematic approach to teaching and assessing these skills has been identified (Carey et al., 2010). In addition, the teaching activities and assessment forms have been found to be in need of further development (Yoshida et al., 2002).McKenzie (2014) studied dental students’ attitudes to learn-ing communication skills and found that their attitude was more positive at the beginning than at the end of the educa-tional programme, which is consistent with previous studies of medical students’ attitude (Cleland et al., 2005). McKenzie (2014) discusses that it may be due to socialization into the dental profession where focus is mainly on technical skills and where communication skills are not a priority, or not perceived as a priority by the students. It is important to remember that dental students are responsible, in some schools from a very ear-ly stage in their education, and always from the third year on-wards, for the provision of invasive, irrevocable treatment of patients in their care (General Dental Council, 1997). This could affect the perception of the importance of technical skills. Hannah et al. (2004) suggest that it is important to obtain a wider support of communication skills training within dental faculties in order to promote a positive attitude to communica-tion from dental students. Broder and Janal (2006) found that the dental students’ communicative competence declines during the education and that these skills are not satisfactorily rein-forced and focused in order to maintain a high level of quality. Thus, it can be concluded that teaching communication should be carried out in a way that 1) enables communication to be practiced throughout the entire education and 2) creates a more positive attitude to the importance of communicational skills among the students as well as the teaching staff.AimThe aim of this licentiate thesis is to make a contribution of knowledge and reflective understanding of teaching and as-sessment of dental students’ capability to communicate orally with patients. The following research questions were posed: How does the methodology consisting of: short workshops with role-plays in combination with the Structure for train-ing communication skills and the Criteria for efficient communication work as a means to practice and reflect on communicative competence? What is the students’ experience of the above-mentioned methodology?What characterizes an assessment instrument for formative and summative assessment of dental students’ capability to share decision-making with the patient?What is the reliability and validity of the assessment in-strument?This thesis has a didactic approach, as it relates to the study of what should be taught and assessed, as well as how educa-tion can be designed and assessment performed reliably. The content of teaching relates to interpersonal communication with patients, thus the relevant theory is retrieved from this ar-ea.BackgroundInterpersonal communication is a complex process where at least two persons talk together. The purpose of communicating is to share views and opinions in a process used to create mean-ing with the ultimate goal of both parties understanding the perspective and knowledge of the other communicating party. Interpersonal communication is a complex situated social process in which people who have established a communi-cative relationship exchange messages in an effort to gener-ate shared meanings and accomplish social goals. (Burleson, 2010, s. 151)Interpersonal communication between a dental student and a patient constitutes a complex professional interaction which is difficult to assess (Wiskin et al., 2003). The complexity consists of several layers: Firstly, oral communication entails several types of skills, such as being able to express yourself clearly, lis-ten and interpret what is being said and be able to adapt the communication to the person with whom you communicate (Hargie, 2011). Secondly, communication is not linear. The in-formation given is interpreted by the receiver, based on his/her knowledge, goals and attitudes. This may lead to another inter-pretation than the sender of information intended. Furthermore, the dentist has expert knowledge that the patient may have dif-ficulty to understand. Thirdly, the relationship between the communicating parties, as well as the situation and the context will affect the communication. Lastly, the communicating par-ties will affect each other. These layers of complexity could en-tail difficulties to assess student capability in an equivalent way.Although defined slightly differently in different studies, communicative competence for professional dentists include the capability: to express themselves clearly, to use language that patients can understand, to listen to their patients, and to in-volve patients in treatment decisions (Hobgood et al., 2002). A problem, however, is that while it may be quite easy to com-prehend criteria for successful communication, actually using communication skills in clinical situations may be much more difficult. Theaker et al. (2000) performed process-tracking of interac-tions between experienced dental practitioners and patients, and found that the dental consultation consists of six stages: 1) Greetings and introduction, 2) Determine purpose of visit, 3) Gather information, 4) Clinical examination, 5) Agree on treatment and 6) Closure. These six stages can be used as a way to identify communication skills relevant for each stage, there-by reducing the complexity of teaching and assessment of communicative competence.In this thesis, the main focus is on the two final stages: 5) Agree on treatment and 6) Closure. Evidence suggests that in-volving patients in healthcare decisions have a positive impact on healthcare outcomes as well as patients’ perception of quali-ty. However, the extent to which dental students are trained in communication and Shared Decision Making (SDM) differs and studies have identified a need for intensified learning and assessment of this competence.According to Aspegren (1999), who conducted a review of research about teaching and learning communication skills, the teaching of such skills should be experiential as it has been shown conclusively that instructional methods do not give the desired results. Attempts to use clinical skills assessments such as objective structured clinical examinations (OSCEs) for this pur-pose in dental education have not necessarily led to desirable results. The brief communication skills training described by one group of researchers as “one-shot faculty-facilitated” was not sufficient to improve dental students’ communication skills; in-stead, those authors suggested that a comprehensive training course would likely be more beneficial (Cannick et al., 2007). Hannah et al. (2004) evaluated such a course, consisting of four two-hour classes. That course made use of simulated patients, case-based scenarios, videotaped interviews, and class role-plays, and the students rated the course very highly. Further-more, the students considered communication skills to be a sig-nificantly more important component of their education after completion of the course. However, communication skills have been found to be easily forgotten if not maintained by practice (Aspegren, 1999; Deveugele et al., 2005). Deveugele et al. (2005) therefore suggests that communication skills need to be practiced throughout the entire curriculum since practice every year seems to lead to better acquisition. As a consequence, smaller but recurring workshops on communication skills might be more effective in a longer perspective. Research in medical education has found that significant improvements in commu-nication (such as reduced verbal dominance, increased use of open-ended questions, and increased use of empathy) can fol-low from short teaching interventions (a total of four hours) based on videotaped interviews with simulated patients and in-dividualized feedback (Roter et al., 2004).TeachingThe first study (presented in paper 1, “I’ll Never Forget This”: Evaluating a Pilot Workshop in Effective Communication for Dental Students) aimed to pilot and evaluate a methodology in which dental students are taught communication skills during a short workshop based on communication events with simulated patients. Through the use of short workshops, as opposed to full cours-es, the methodology may provide better opportunities for fre-quent and effective training of communication skills throughout the curriculum. Such a format also means that students have the possibility of practicing their communication skills in vari-ous subject areas. The methodology was based on an experiential learning ap-proach, the use of realistic clinical scenarios, simulated patients, and an integrated teaching team of both educational research-ers and dental educators/dentists. Furthermore, the methodolo-gy was adapted for short workshops, which is thought to offer better possibilities for frequent and effective training of com-munication skills throughout the curriculum. The workshop was piloted with groups of six to ten students from the sixth and tenth semesters (n=94). Results showed that the majority of students found the tasks meaningful and well aligned with how they perceived their future profession as dentists. Most students also thought that they learned from the task. An interesting finding is that students not only found it instructive to practice how to communicate in authentic situations, but that they gen-erally found the workshop to be thought-provoking while at the same time providing structure and intellectual tools for the future. A possible explanation for this finding is the sharing of explicit criteria for efficient communication. Assessment There is extensive evidence that assessment of student knowledge and abilities guides student learning (Brown et al., 2013; Manogue et al., 2001; Struyven et al., 2003) and that assessment defines what students perceive as the real learning outcomes (Biggs & Tang, 2011; Ramsden, 2003). Assessment can have multiple purposes: 1) to evaluate students’ perfor-mance in relation to the learning outcomes – assessment of learning, 2) to support the learning process – assessment for learning, and 3) to maintain the required standard for future professional practice (Joughin, 2009c). In order to assess the student’s communicative competence, teaching and assessment must enable the student to demon-strate his/her competence. In this licentiate thesis, being compe-tent means to integrate knowledge, skills and abilities to man-age relevant information, relationships and situations (Taconis et al., 2004; Towle & Godolphin, 1999). If we want to know how well somebody can write stories or conduct experiments, it seems natural to ask them to do so and to evaluate their performance. (Kane et al., 1999, s. 5) The major advantage of performance assessment is the fact that assessment is based on the observation of the actual per-formance, thus there is no need for reinterpretation (Kane et al., 1999). Authentic assessment is a concept that is frequently used within professional educations. Authentic indicating that the task and the assessment is in line with what a professional den-tist could meet. The tasks are habitually open, which means that they can be solved in multiple ways, thus replicating pro-fessional practice (Black, 1998). Authentic assessments aim at providing reliable information in order to make valid interpre-tations and assessments of the student’s competence in relation to professional quality in occupational practice (Darling-Hammond & Snyder, 2000). Unlike the assessment of fragmented knowledge and skills, which are relatively straightforward to measure and easy to as-sess equivalently, the assessment of complex competence re-quires the capability to make qualitative judgments based on multiple criteria (Sadler, 1989). Boud (2007) suggests that as-sessment as a concept should be redefined and introduces the concept of informed judgment. Informing judgment that is … the capacity to evaluate evi-dence, appraise situations and circumstances astutely, to draw sound conclusions and act in accordance with this analysis. (Boud, 2007, s. 19)The four parts of informing judgment indicates that it is not only teachers and examiners that should be able to give an in-formed judgment. This is in line with Boud’s (2009) argument that students should develop their capability to give informed judgments in order to be able to take responsibility for and manage their own learning during education and in the profes-sional occupation. The complexity of communication makes assessment cumber-some. A need to more clearly define and operationalize what it means to be proficient in this area has been identified. The aim of the second study was to operationalize communi-cative and relational skills in a comprehensive assessment in-strument for shared decision making. Relevant skills on information exchange, negotiation, com-munication and relationship building were identified through an extensive review of previous research and instruments for as-sessing communication competence. Indicators for assessing these skills were formulated. The instrument was submitted to a pilot test and evaluated based on test content, internal structure and response processes.The Assessment of Shared Decision Making (ASDM) instru-ment consists of eighteen items addressing different aspects of the construct, as well as three different types of skills (see table 13). Findings suggest that the ASDM represents a valid measure of shared decision making with three major components. The importance of developing the ASDM lies not mainly in the summative assessment of students’ communication with pa-tients, but for formative assessment purposes. By identifying the components essential for shared decision making, these aspects and skills can be woven into the curriculum and shared with the students. Thus, the ASDM provides a structure that can meet the need for intensified learning and assessment of dental stu-dents’ competence in communication and shared decision mak-ing.DiscussionIn the following sections, the results of the two studies are dis-cussed with the purpose of addressing the current problem with dental students risking not to acquire a satisfactory level of communicative competence. Former studies have concluded that:1.Teaching and assessment of communicative competence needs to be developed further (Yoshida et al., 2002).2.There is a need for a more systematic approach to teaching and assessing communication skills (Carey et al., 2010). Students’ capability to communicate declines during the education, probably due to these skills not being satisfacto-rily reinforced and focused in order to maintain a high level of quality (Broder & Janal, 2006).Dental students’ attitudes to learning communication skills has been found to be more positive at the beginning than at the end of the educational programme. This may be caused by socialization into the dental profession where focus on technical skills are great and where communication skills are not a priority, or not perceived as a priority by the stu-dents (McKenzie, 2014).Teaching and assessing communicational skillsAs communication skills have been found to be easily forgotten if not maintained by practice (Aspegren, 1999), Deveugele et al. (2005) suggests that communication skills need to be prac-ticed throughout the entire curriculum since practice every year seems to lead to better acquisition. As a consequence, smaller but recurring workshops on communication skills might be more effective in a longer perspective.The results of the first study show that a learning activity, consisting of short workshops including role-plays with authen-tic cases, was an effective way to simulate practice and support the students to get actively involved and engaged in their learn-ing. Workshops with role-plays requires active participation by students (Billings & Halstead, 2005; Freeman, 2003). Students who see themselves as active, participating and responsible for their learning is a basic requirement for developing the ability to assess and to give informed judgment (Boud & Falchikov, 2007). Short workshops where students can focus on developing their communicative capability based on authentic cases of dif-ferent types, are easily adaptable to different situations and to the communication skills that are to be taught and learned. Thus, they can be used throughout the entire education.The results of the first study show that the students found the role-plays and the cases to be meaningful and relevant for prac-tice. They also found that they had been able to develop their communicative competence. Role-plays have been found to af-fect the attitude of those who participate and to support the development of cognitive skills (L. Cohen et al., 2013). Through involving students in communication learning, where they ac-tively construct and reflect on their competence in authentic, meaningful (O’Donovan et al., 2008) and relevant situations and contexts (Sambell et al., 1997), the students’ capacity to be responsible for their learning is stimulated. Valid interpretations and assessments of the student’s competence in relation to the professional quality in occupational practice can be made pos-sible by using authentic cases (Darling-Hammond & Snyder, 2000; Kramer et al., 2009). Role-plays have been found to be a good way for students to integrate and assimilate knowledge, skills and abilities (Bolton & Heathcote, 1999), which is fa-vourable when addressing the complexity in oral communica-tion.The structure for communication learningThe structure used for communication learning at the workshop consisted of four steps: identify -> analyse -> communicate -> reflect. The structure was based on theories for problem solving (Bransford & Stein, 1993; Koellner et al., 2007). The structure for communication learning for dental students was developed partly in order to be used as scaffolding for the student’s learn-ing and partly to provide knowledge about communication through the criteria for effective communication. The criteria for effective communication was based on assessment instru-ments in medical education (Humphris & Kaney, 2000; Rider & Keefer, 2006) and represent a selection of the criteria identified for the second study. The criteria were adapted to the dental education and validated by discussions with teachers in the den-tal school.In the first step – Identify – the student describes the situation in the current case as objectively as possible. The case material may consist of texts, images or videos. The information that the student has found to be relevant and the interpretation of this information, is presented by the student describing what he/she has read, seen and/or heard. By clarifying the interpretations, they can be discussed in the group. Thus, facilitating the identi-fication of the current problem and its root causes, making it possible to analyse the situation and come to solutions that are relevant.In step two – Analyse – the student analyses the situation in the current case from the perspective of the dentist and of the patient. By analysing the situation from the dentist’s perspec-tive, the student considers relevant dental, as well as psycholog-ical and social factors. The analyses from the patient’s perspec-tive enables the student to try to understand the patient’s expe-rience of the situation. The capability to understand and accept the patient’s perspective is vital when establishing a relationship with the patient (Silverman et al., 2005). By considering the pa-tient’s perspective it is also possible for the dental student to de-tect whether he/she needs any further information from the pa-tient. This analysis should allow the student to frame questions and identify relevant treatment options and their risks and ben-efits.In step three – Communicate – the student participates in the role-play and communicates with the patient. Criteria for effi-cient communication are used as a scaffolding structure. The criteria encompass: being able to give information in an ade-quate way, being able to obtain relevant information from the patient, being able to share the decision of treatment with the patient and being able to close the session. The criteria for ef-fective communication represent a selection of the criteria iden-tified for the second study. It is recommended to focus on some criteria at the time (Kurtz et al., 2005) as too many criteria would make it difficult to apply and develop the performance in relation to all of them simultaneously.In step four – Reflect – the student reflects on the perfor-mances as well as strength and weaknesses. After each role-play performance, the students immediately reflect together on the performance in relation to the criteria for efficient communica-tion. Thus, facilitating the students to: give feedback, develop an understanding of the feedback given, be able to connect feedback to the assessment criteria (Sadler, 1989), identify al-ternative solutions and qualities and discuss the feedback as well as how to close the gap between the actual performance and a desired performance. At the workshops, the students were able to participate in a new role-play for the same situation, thus evaluating a strategy for closing the gap. In order to de-cide whether feedback has had any effect, the student needs to use it to develop his/her performance (Boud, 2007). At the end of the workshop, each student was asked to individually, in writing, reflect on the learning activity in relation to themselves and their own communication skills. Being able to reflect on their skills, identify their strengths and weaknesses and to sug-gest ways to develop their skills is central to being able to take responsibility for their own learning (see e.g. Dewey, 1997; Rogers, 2002). By reflecting on skills in relation to a desired performance level, identifying strengths and weaknesses and then suggesting ways to close the gap, the ability to give an in-formed judgment is developed.Assessment tasks should make it possible to assess students’ competence to act in practical situations (Fastré et al., 2010). When using performance assessment, the assessment is direct without re-interpretation from descriptions of action, thereby creating a higher validity (Kane et al., 1999). Assessment crite-ria, indicators and quality levels should be defined when work-ing with performance assessment (Fastré et al., 2010). These aim to make assessment more transparent (Otter, 1995). Crite-ria were formulated for the workshops in the first study. For the second study criteria and indicators were formulated for skills relevant to stage 5) Agree on treatment and 6) Closure, of the dental consultation. Most of the students, in the first study, found the criteria to be usable and that they clarified what was expected of them, thereby making the assessment more trans-parent. The criteria were found to support the structure of the learning activity. The students also used the criteria as scaffold-ing when communicating.Experience of making qualitative assessments based on mul-tiple criteria is a prerequisite for being able to assess the quality of divergent open-answer tasks (Sadler, 2009). Explicit and de-fined criteria and indicators make it possible to discuss them in relation to each other and in relation to the whole of the per-formance. By discussing criteria and indicators with teachers and students the capability to make assessments based on mul-tiple criteria may be learned and developed, in the same way as other competences (Sadler, 2009). Furthermore, the discussions may lead to further development and clarification of criteria, indicators and quality levels of performance.Above, suggestions have been made in order to address the first problem: the need for further development of teaching and assessment of communicative competence (Yoshida et al., 2002). The discussion will now continue in regard to the second problem: the identified need for a more methodical approach to teaching and assessing communication skills (Carey et al., 2010). Systematics of teaching and assessing communication capabil-ityOral communication – professional communication with a pa-tient constitutes a complex, situated social process where the participants exchange information in order to create a shared view of the meaning of the communicational content. One way of dealing with the complexity is by using the structure of the dental consultation. The dental consultation consists of six stages: 1) Greetings and introduction, 2) Determine purpose of visit, 3) Gather information, 4) Clinical examination, 5) Agree on treatment and 6) Closure (Theaker et al., 2000). Criteria and indicators relevant to stage 5 and 6 were defined for the second study (the Assessment of Shared Decision-Making instrument, ASDM). In order to cover the entire dental consultation criteria and indicators for the other four stages were identified. This resulted in the Dental-Patient Communica-tion Skills Instrument (DPCSI) (see table 15). Teaching and assessment should be based on the principles of informed judgment: the capacity to evaluate evidence, appraise situations and circumstances astutely, to draw sound conclu-sions and act in accordance with this analysis. By focusing on a limited number of criteria at the time, this can be ensured. Deveugele et al. (2005) has suggested that communication skills need to be practiced throughout the entire curriculum since practice every year seems to lead to better acquisition. Based on the DPCSI-instrument, relevant criteria and indicators can be allocated to various courses throughout the dental edu-cation programme. Each course will ensure that a reasonable number of criteria are taught, trained and assessed. When the allocation of criteria has been made, short workshops based on the structure for communication learning with role-plays using authentic cases can be planned. In order to ensure that dental students’ communicative and relational skills does not decline during the education (Broder & Janal, 2006), a discussion on progression based on a model by Harden will follow. Harden (2007) defines four dimensions of progression: increasing breadth, increasing depth, increasing utility and increasing proficiency.Increased breadth is reached by extending the area of compe-tence to new topics and contexts (Harden, 2007). Within dental education this could involve communicating with different pa-tients with different types of problems.Increased depth entails an increase in depth of study or level of difficulty (Harden, 2007). Within dental education this could involve communicating with patients with complex symptoms and issues.Increased utility means moving from a theoretical under-standing to applying the knowledge to practice (Harden, 2007). Within dental education this could entail increasing the contex-tual authenticity throughout the education.Increased proficiency involves the achievement of higher standards, committing fewer mistakes and acting more inde-pendently (Harden, 2007). Within dental education this could mean increased independence and being able to explain difficult procedures to the patient. The second problem mentioned above, is the identified need for a more methodical approach to teaching and assessing communication skills (Carey et al., 2010). Based on the discus-sion above a methodical structure for teaching and assessing communication skills is suggested. Attitudes to communicative competenceThe third problem mentioned above is the identified change in dental students’ attitude to learning communication skills from positive to more negative during the education. This may be caused by socialization into the dental profession where focus mainly lies on technical skills and where communication skills are not a priority, or not perceived as a priority by the students (McKenzie, 2014). In order to improve the students’ view on the value of communicative competence it is important to reach a wider support for this within a dental faculty (Hannah et al., 2004). One way of accomplishing this could be to involve all staff engaged in the dental education in discussing the evidence for the importance of having good communication skills. This licentiate thesis contributes with a suggestion for a sys-tematic structure for teaching and assessing communication skills. In order to implement the structure there is a need for wide support for the importance of communication skills at the dental faculty. The systematic structure consists of the follow-ing parts:The structure for communication learning – identify – ana-lyse – communicate – reflectAssessment that supports the development of the capability to give informed judgmentsThe Dental-Patient Communication Skills Instrument (DPCSI) with relevant criteria and indicators for the entire dental consultationA structure for progression based on a model by Harden (2007)

Place, publisher, year, edition, pages
Malmö universitet, Fakulteten för lärande och samhälle, 2019. p. 192
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Malmö Studies in Educational Sciences: Licentiate Dissertation Series, ISSN 1653-6037 ; 41
National Category
Social Sciences
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urn:nbn:se:mau:diva-7644 (URN)10.24834/2043/26856 (DOI)26856 (Local ID)9789171045034 (ISBN)9789171045027 (ISBN)26856 (Archive number)26856 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-02-23Bibliographically approved

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Lucander, HenrietteKnutsson, KerstinSalé, HannaJönsson, Anders

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