Connecting with different audiences: The anatomy of communication is essential
In the twenty-first century, communication has become truly global. Advances in technology have opened up a host of ways in which we are able to communicate to retrieve or pass on information and knowledge. In many cases we have moved from a place-based communication approach to one of increasing mobility. With this shift in approach, it is apparent that effective communication skills are perhaps even more important so that we can connect appropriately with diverse audiences. Despite this, relatively little attention has been paid to training our students in different modes of communication and therefore we may not be fully preparing our students to play their part in the global community. Given anatomy's place within many health-care curricula, an ideal avenue is available for anatomists to take the lead in providing communications skills training for students. There are a variety of approaches, some of which are outlined in this article, which can be used to create appropriate opportunities for developing different communication skills and these can be woven into existing practices to ensure courses do not become overburdened. A sustained approach to communication skills training will help equip our students to communicate easily with the many aspects of modern society. Anat Sci Educ 6: 134–137. © 2012 American Association of Anatomists.
CHANGES IN THE COMMUNICATION OF INFORMATION
It is clear that information technology has helped create a truly global community where we are able to interact with others in a variety of ways. The ever advancing technological developments in the last couple of decades have led to distinct and dramatic changes in our behavior. One area that has seen a tremendous amount of change is the way in which we communicate to retrieve or pass on information and knowledge. In days gone by we may have used a book-based encyclopedia or reference books at the local library to find out specific facts or produce a manuscript or write a letter to convey information and new knowledge. However the explosion of the internet, access to mobile communication technologies and the array of digital TV and radio stations have resulted in an almost unlimited access to information and an ability to communicate with a global audience without great obstacles. Social media sites have led the way in demonstrating how quickly audiences can be captured with Facebook© (Facebook, Palo Alto, CA), for example, taking little over a year to add 200 million users, while radio, television, and the Internet took 38, 15, and 4 years respectively to reach audiences of 50 million (Stavridis and Parker, 2012). Such changes have had a variety of downstream effects. For instance, Encyclopedia Britannica, which is the oldest English language encyclopedia having first been published in the 1700s, is no longer to be published in a print volume and instead will, in future, only be available online (Bosman, 2012). Letter writing is reducing and has largely been replaced by e-mail and other forms of technology-based communication such as chat rooms, text messaging, voice-over-internet protocol services, such as Skype (Microsoft Corp., Redmond, WA) and social networking. It is estimated that in global terms the volume of letters sent will likely decline by between 25% and 40% over the next five years (Hooper, 2010). Overall there has been a change from a placed-based approach to communication where we call or send information to a ground location to one where mobility is the key and an individual can pick up the information wherever they might be and at a time convenient to them.
THE NEED FOR EFFECTIVE COMMUNICATION SKILLS
Despite changes in the methods used for communication, it is clear that there is a sustained and perhaps increased need for effective communication skills in order to take advantage of this interconnected community (Pawlina and Drake, 2008). In higher education, there has been major growth in the number of new technologies that have been made available to teachers and educators (Ellaway and Masters, 2008; Sugand et al., 2010). This has provided the opportunity to reach new audiences more easily than before, communicate with larger and more globally disperse audiences and to communicate in a diverse and varied way, usually instantaneously (Wang et al., 2010). Such methodologies have proved popular with students, although this is not surprising as the learners of today are largely derived from the “Millenial” generation and as such already include digital and social technology into their learning and communication (Chu et al., 2012; Jacobsen and Forste, 2012). The desire for these students to be engaged with technological advancements and be constantly connected to others via an array of different social media is extremely strong and therefore presents a challenge to educators when designing or implementing learning opportunities (Chu et al., 2012). It is important, for instance, that there is not a sole focus on technology-based communication training at the expense of face-to-face encounters and other more traditional approaches. Similar recommendations have been made by others looking at the question of technology in medical education (Robin et al., 2012). Effective communication in education usually relies on being able to capture the attention and interest of the audience and providing clarity as to the purpose of the session. Without the necessary skills miscommunication and misunderstanding can result (Resnick, 2001). Therefore, as new methodologies and technologies have been introduced, it has been incumbent on universities to devote increasing amounts of time and resources to providing staff with appropriate training opportunities and support that focuses on changing educational approaches and attempts to avoid the alienation of educators less comfortable with new technologies (Mattheos et al., 2008; Evans, 2011; Robin et al., 2011). Such activities should also incorporate giving advice on developing communication skills to maximize the effects of these varying new teaching approaches and where possible use technology in the staff development activities (McKimm and Swanwick, 2010). Including new digital or social media when establishing specific communicating skills training opportunities does provide a mechanism for involving students in the development and design of opportunities and this may subsequently result in even stronger skills being developed.
Less attention appears to have been devoted to the communication skills training of our students, leaving them unprepared for their chosen profession (Numann, 1998). This is disappointing given that our students are likely to be future experts and advocates in their respective fields and will require an ability to explain and promote awareness and understanding to different audiences including those groups without prior knowledge or understanding (Evans, 2011). In addition, being equipped with the skills of effective communication will enable students to make informed decisions as members of the public and engage in the critical debate that many issues require (Krajcik and Sutherland, 2010). The lack of communication skills training in higher education programs was recognized in the Dearing Report of 1997, which looked at the future of higher education in the United Kingdom (Dearing, 1997). The report highlighted four skills (numeracy skills, use of information technology, learning how to learn, and communication skills) that should be key contributors to the future success of graduates (Dearing, 1997). The report recommended that the four key skills should be incorporated into all higher education programs either by the creation of specific skills based modules or through embedding skills development within existing modules. Despite these recommendations, it is unclear whether universities and colleges have been proactive in their approach to helping all students develop such skills, particularly written and oral communication skills. It is therefore likely that in many cases students are entering the global community less prepared to play their effective part than they should be (Evans, 2011).
One particular exception though has been the healthcare professions where the associated professional bodies have recognized the importance of directed communication skills training within the curriculum. In their document Tomorrow's Doctors, the General Medical Council (GMC) in the United Kingdom states that all medical students should be able to communicate clearly, sensitively, and effectively with patients and colleagues in variety of modes (GMC, 2009). Similar competencies are included in the United States Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties. It has therefore been incumbent on the coordinators of medical and related curricula to adapt programs to include some communications skills training thereby recognizing that such training can have enduring effects that improve patient confidence and compliance (Sherbourne et al., 1992; Teutsch, 2003; Yedidia et al., 2003; Duffy et al., 2004; Roter and Hall, 2006; von Fragstein et al., 2008). While this is to be encouraged, there is a distinct emphasis on oral communication skills, with training abilities in history taking, breaking bad news, and demonstrating empathy being a focus (Hargie et al., 1998; Winefield and Chur-Hansen, 2000; Deveugele et al., 2005; Losh et al., 2005). Less time is unfortunately directed at written communication or developing skills for communicating with different audiences such as when there is a need to explain a specific condition in lay terms, or to involve patients in taking a role in their own treatment plan or to negotiate with different groups of colleagues (Fallowfield and Jenkins, 2006; Nuovo et al., 2006; Evans, 2008). These wider skills are surely just as important and are key components in helping students to be fully prepared for their vocation and to develop appropriate professional attributes (Epstein and Hundert, 2002).
ANATOMY AND COMMUNICATION
Although anatomists have a long history as key scientific communicators, demonstrating the wonders of the human body and the relevance of structure in health and disease, we have in the last several decades been seen as somewhat out of touch when communicating with the public (Evans, 2008). This appears to be at odds with the public's growing fascination with anatomy through fictional and factual television programs and exhibitions of cadaveric material (Wijers-Hasegawa, 2004; Evans, 2008). It is therefore clear that as anatomists we have a key role to play in raising public awareness, making sure misunderstanding is avoided and relevance promoted. In the environment of education, anatomists are also well placed to enthuse future advocates and to provide an arena for students to develop key academic skills including communication skills. Given that the discipline of anatomy is often incorporated in the early parts of healthcare curricula, this provides an unrivalled opportunity for anatomists to take a lead in these areas and promote effective communication in particular (Pawlina and Drake, 2008). Setting the scene at this stage is essential to ensure the building blocks of good communication are embedded in our students and provide a basis for further development.
The anatomy laboratory, for example, is an ideal environment for growing and assessing early skills and introduces students to the need for communicating effectively with each other and the staff (Pawlina, 2006). The use of peer-assisted learning, team-based learning, and near-peer teaching have been shown as methods that can promote communication skills development as well as the required anatomical knowledge and understanding (Krych et al., 2005; Evans and Cuffe, 2009; Shankar and Roopa, 2009; Vasan et al., 2011). There is however a host of other approaches that can be incorporated into anatomy and related courses that focus on improved communication as a downstream outcome. Obviously it is essential for course leaders not to overburden their courses with too much content or assessment and therefore a careful balance must be struck to ensure students gain the necessary knowledge and understanding whilst developing other essential skills and competencies (Evans, 2011). With this in mind, the inclusion of specific opportunities for communications skills development should ideally be woven into existing practices within a course or theme and used as a way to enhance the learning experience. For instance, providing opportunities for oral presentations is already a part of many courses, but instead of presenting at the level of peers or faculty, why not challenge students to aim their presentation to a different audience such as a patient group, a research grant panel or a local TV news unit. There should still be a major emphasis on the knowledge and understanding (which can also be tested by subsequent questioning) but “changing” the audience will provide a different and useful challenge. A similar approach can used if a course utilizes the creation of student posters or oral-based assessments such oral (viva-voce) examinations or objective structured practical examinations (OSPEs). Once again the focus can be on knowledge, understanding, and interpretation, but the audience to which the information is directed can be more varied than traditionally would be the case. Other ways of incorporating oral communication skills training could be the use of mock-interviews, peer or faculty observation, simulation/role play or the creation of videos, audio casts etc., (Hargie et al., 1998; Van Dalen et al., 2001; Losh et al., 2005; Windish et al., 2005; Nuovo et al., 2006; Green and Hope, 2010; Yoo and Chae, 2011; Koenigsfeld et al., 2012; Pearce and Evans, 2012). In each case the method chosen can have a distinct anatomical flavor as appropriate. Providing students with active opportunities appears to impact positively on communications skills development. Being able to design and produce video on particular topics, for instance, results in students feeling that they are better able to synthesize appropriate knowledge and convey that to particular audiences (Green and Hope, 2010). The use of mock-interviews can make students feel better prepared for “real” interviews and may also lead to better success rates (Koenigsfeld et al., 2012).
There are also opportunities for incorporating written communications skills training although the time factor for such inclusions in a busy and demanding course might make possibilities more restrictive. In our program, for instance, we have incorporated and evaluated the design of newspaper and magazine articles aimed at specific audiences and on a range of anatomically related topics and also the creation of patient-focused information leaflets (Evans, 2007, 2008). There are however a range of other possibilities including the creation of online materials (e.g. a teaching package on an anatomical region), journal and diary writing (e.g. “the first dissection room experience”), creative writing exercises (e.g. a poem) or devising media releases or authoring opinion editorials and commentaries (Poirier et al., 1998; Bergman and Irvine, 2004; Rees and Sheard, 2004; Poronnik and Moni, 2006; Pearce and Evans, 2012; Evans, unpublished). In addition, course leaders can suggest students write mock grant applications or ethics proposals, prepare short review manuscripts or write abstracts for published papers (Reif-Lehrer, 1992; Marusić and Marusić, 2003). Once again the focus of each approach can be anatomical. The use of such methods does appear to impact on student communication abilities with the incorporation of opportunities for students to generate opinion editorials in physiology and pharmacology, for example, resulting in more effective skills being demonstrated (Poronnik and Moni, 2006). Providing students with opportunities to create articles or information for a lay audience also appears to allow them to appreciate the significance of effective communication skills and use a methodology that they feel is relevant (Tierney, 2003; Evans, 2007; Evans, 2008).
Overall there is a variety of approaches to enhance further the opportunities for communication skills training and assessment provided for our students in teaching sessions and these approaches cover both oral and written skills. Providing multiple opportunities for students to learn and practice their communication skills appears to be the key to continued development and success (Orr, 1996, Humphris and Kaney, 2001; Saxena et al., 2009). Incorporating active and experiential learning methods for communication skills training appears to increase the positive attitude students have towards learning communication skills suggesting such approaches help students appreciate the importance of communication skills (Koponen et al., 2012).
It is clear that the need for effective communication skills is crucial in the increasingly globally connected world in which we live. As educators we have a role to play helping our students develop the skills necessary for promoting public awareness of scientific issues, engaging children in the wonders of science, debating issues with the legislature, writing effective grant applications or journal articles, or interacting with patients or colleagues. As anatomists we should be adjusting our courses to incorporate and maximize aspects of communication skills training. The challenge is to devise particular strategies that are appropriate to our courses and which ensure our graduates will be equipped and able to communicate with society in the twenty-first century.
NOTES ON CONTRIBUTOR
DARRELL J.R. EVANS, B.Sc., Ph.D., F.S.B., F.R.M.S., F.H.E.A., is a professor of developmental tissue biology, Head of Anatomy and Associate Dean at Brighton and Sussex Medical School, Brighton, United Kingdom. He leads the anatomy curriculum at BSMS and has taught anatomy and embryology to medical, dental, and science students for over 15 years.