A new communication skills course for junior doctors

Context and setting‘Needs-based communication’ (NBC) is a new approach to improving doctors’ communication skills. Based on Marshall Rosenberg’s widely recognised system of Nonviolent Communication™, NBC has its roots in international conflict resolution (http://www.lifeatwork.co.uk). Since 2005, over 800 junior doctors in the UK Foundation Programme have received 2 days of NBC training in two deaneries (mainly South Yorkshire and South Humber Deanery). Why the idea was necessary Although junior doctors often evaluate their own communication positively, they frequently receive the opposite feedback. The NBC model has a wider remit than other (usually consultation-based) medical communication models, such as the Calgary–Cambridge model. It aims to tackle generic skills, including those involved in resolving difficulties, building trust (especially across interdisciplinary boundaries), avoiding complaints and defusing anger. Crucially, it also tackles communication with colleagues. These generic skills are key Foundation Programme competencies. What was done The process is unusual in that it focuses not just on patients’ needs, but also on the needs of doctors. Often, but not always, these coincide with the needs of a patient or colleague (e.g. for quality care, efficiency, clarity, completion, keeping agreements). Differences can arise in how people try to meet these needs and it is on this strategic level that conflicts can occur. Conflicts may be prevented or resolved by learning how best to express one’s needs and strategies. The NBC model pinpoints four main principles which, respectively, encourage the user to: distinguish objective observation from subjective evaluation (which others may hear as blame); understand feelings as the expression of information about whether a need is met or unmet, and thus to create a ‘safe’ environment for expressing feelings (rather than suggesting that feelings should always be voiced); know how to express one’s needs or values in a way that is most likely to be heard and understood by others, and suggest a clear strategy to meet one’s own needs, while taking other people’s needs into account. Doctors also learn to listen differently to people who are angry or upset. Instead of focusing on the person’s anger or blame, they learn to hear ‘beneath’ the words for more fundamental information: namely, the unmet needs that the person is (in one way or another) trying to express. Thus, they learn to see a person’s behaviour as an attempt (or strategy) to meet a need. This immediately opens up more creative and empathic ways of dealing with the situation as the listener can understand the needs or values that underpin the behaviour, even if the behaviour itself is not acceptable to them. Once someone’s needs have been identified, doctors can be quick to find ways to meet them, using strategies which are more beneficial and take into account the needs of everyone involved. Evaluation of results and impact A total of 83% (n = 557) of the doctors completed an end-of-course evaluation of their NBC training. Their overall response was strongly positive and included the view that NBC can support interviews for specialty training. The doctors’ self-perceived communication skills ability increased from a median of 4.2 before the course to 8.1 afterwards (on a 10-point scale). Finally, many doctors expressed a desire to have such training made available to nurses and other health care professionals.

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