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Table 1 Doctor-patient communication programme for surgical residents

From: Effectiveness of a modified doctor–patient communication training Programme designed for surgical residents in China: a prospective, large-volume study at a single Centre

Module Content Duration
Module 1
Theoretical course
• Principles of medical ethics and professionalism in doctor-patient communication.
• Doctor-patient relationship skills: tone of voice, effective nonverbal communication, eye contact, facial expression, head nods, posture.
3 h
Modules 2–10 Skills learned through practice and feedback
• Steps: supporting knowledge (0.5 h) → personal experience exchange (0.5 h) → video review (0.5 h) → checklist (0.5 h) → role play (1 h) → feedback (1 h).
• The presentation in each module is modified to the trainee’s needs and style based on personal experiences.
Module 2
Gathering of information during admission and relationship building
• Purpose: to understand both the disease and the patient.
• Skills: greet the patient, use a formal address (Nice to see you, Mr......) when communicating within the doctor-patient relationship, use the word “we”, use open-ended questions, do not interrupt the patient.
• Checklist: set the stage by asking about the reason for the visit → elicit the patient’s complete story → give information → understand the patient’s perspective → end the encounter → transition to the physical exam.
3 h
Module 3
Interview before surgery and discussion of the treatment plan
• Purpose: to respect the patient’s right to informed consent, explain the disease and agree on a treatment plan with the patient; to explain the cause of a lesion, the possible progress of the disease, and the therapies and surgical procedures that are planned or being conducted.
• Skills: discover what the patient knows and thinks, explain effectively, ensure an understanding of the problem.
• Checklist: elicit an explanation of the problem from the patient → explain the problem to the patient → ensure the patient’s understanding → agree on a treatment plan with the patient.
3 h
Module 4
Management of angry patients
• Chinese press reports frequently target doctors, patients are usually hostile, and there is a tendency for the patient to blame the doctor.
• Skills: show genuine concern and answer all of the patient’s queries.
• Checklist: prepare the setting → tell the truth with empathy → gain support from family members and suggest spiritual or cultural support → offer hope to the patient.
3 h
Module 5
Discharge notification
• Purpose: to discuss the importance of good adherence to a regular follow-up schedule before discharge.
• Skills: discover what the patient knows and thinks, explain effectively, ensure the patient’s understanding.
• Checklist: elicit an explanation of the problem from the patient → explain the problem to the patient → ensure the patient’s understanding → agree on a treatment plan with the patient.
3 h
Module 6
Breaking bad news about a cancer diagnosis and other serious states of illness
• Breaking bad news to patients is a complex and challenging communication task in medical practice; thus, building a good relationship beforehand is especially important.
• Skills: create a private environment by closing the door; do not interrupt the patient; provide chairs for everyone; tell the truth with empathy (“I am sorry, but the results are not what we hoped for”); gain support from family members and suggest spiritual or cultural support (“Is there anyone else that you would like to involve?” “Do you have any spiritual, religious, or other beliefs to help you during difficult times?”); offer hope to the patient (“There are many effective treatment options for this disease”); decision making and follow-up.
• Checklist: climate prepared → tell the truth with empathy → gain support from family members, as well as spiritually or culturally → offer hope to the patient → discuss decision making and follow-up.
3 h
Module 7
Breaking bad news about perioperative death
• The occurrence of death perioperatively is uncommon; although it is more common during emergency surgery, doctors have to face the facts. The reactions of the patient’s relative are usually hostile, and there is a tendency for the patient to blame the doctor.
• Skills: show genuine concern and answer all the queries of relatives.
• Checklist: prepare the setting → tell the truth with empathy → gain support from the family members and suggest spiritual or cultural support → offer hope to the patient → discuss decision making.
3 h
Module 8
End-of-life discussion
• To encourage the patient and relieve feelings of pain, anger, and grief while promoting feelings of optimism, surprise, and happiness.
• Checklist: prepare the setting → asses the patient’s perceptions and information needs → provide knowledge and respond to emotions with empathy → provide a summary and strategy.
3 h
Module 9
Communication with the patient’s relatives
• Multiple-person interviews are more difficult than interviews with two persons, as they involve more stressful interactions.
• To try our best to fulfil the different requirements of family members.
• Checklist: set the stage by asking about the reason for the visit → elicit the relative’s queries → give information → understand the relative’s perspective → end the encounter.
3 h
Module 10
Standardized patient evaluation
• To evaluate the effectiveness of the programme from the perspective of SPs.
• SPs, residents, and supervisors complete a standardized questionnaire before, immediately after, and 1 month after the programme (3 times).
• Each exam lasts 1 h.
3 h
  1. Abbreviations: DPC, doctor-patient communication; SP, standardized patient