Learning methods to improve communication skills in health professional student: a literature review

Learning methods to improve communication skills in health professional student: a literature review Radiatan Mardiah1, Lisa Musharyanti2* Background: Effective communication is one of patient safety’s foundations that health workers must consider. Poor communication will impact both patients and health professionals. Health profession students have to comprehend communication skills to improve patient safety when providing care for the patient. They have learned effective communication from the education stage through various learning strategies. This study aims to identify multiple learning methods to improve effective communication learning in health professional students. Methods: This study is a literature review by looking for the main article according to the inclusion criteria of effective learning and communication methods for health professional students. The search was conducted on several databases with ScienceDirect 32,322, Ebsco 1,644, ProQuest 48,449, and SpringerNature 4,994 articles. The result was that nine articles were screened with the PRISMA chart guide. Results: The results showed that several learning methods such as simulation with a standardized patient, role play with standardized family, experiential learning, cooperative learning, simulation with virtual reality, peer review method, video recording and standardized patient feedback, and specific feedback used to improved communication skills in the health professional students. Conclusion: These methods can improve the communication skills of health professional students, which is the key to supporting patient safety, and there are many challenges and facilities during communication learning proses.


INTRODUCTION
Patient safety is an essential issue that health workers must consider by implementing six patient safety goals. 1 The six goals are to identify patients correctly, improve effective communication, improve the safety of drugs to watch out for, ensure the correct location, procedure, and patient for surgery, prevent the risk of falls and reduce the risk of infection. 2, 3 One of the fundamental patient safety standards is effective communication, which is critical in improving patient safety, achieving quality care, and establishing good relationships between patients and the health profession. Communication skills need to be possessed to prevent unwanted incidents. 4 Medicine incidents in Finland occurred due to poor communication between nurses with 68.2%, nurse-doctor with 41.6%, nurse-patient with 9.6%, and poor team communication with 39.6%.
Forty-five (65.2%) of the 65 respondents had experienced medical errors in the operating room. One of the leading causes was inadequate communication (59.4%). Medical errors that threatened patient safety in the operating room were errors related to communication and information flow (37.7%), wrong place of surgery (17.4%), improper medication administration (17.4%), leaving equipment at the operating site (14.5%), and incorrectly identified the patient (13%). 5 Poor communication hurts all parties, especially patients, such as cessation of care, patient safety, dissatisfaction, and ineffective use of health workers' working time. 6 The above conditions indicate the REVIEW aims to identify various learning methods to improve effective communication learning in health professional students.

METHODS
The research question for this review is "What is the learning method to improve effective communication skills in health professional students?". We used a literature review approach to describe various learning methods to teach effective communication for health professional students.
The search strategy was carried out by looking for the primary articles related to effective communication learning methods for health professionals. The databases used were ScienceDirect, Ebsco, Proquest, and one publisher, namely Springer Nature, using the keywords learning method, teaching method, effective communication, communication skill, and health professional students.
Articles were determined based on two criteria. The inclusion criteria were the main article with a range of 2010-2020, in English, and the respondents were of health professional students in the first semester to the professional stage. The exclusion criteria were articles with incomplete or unclear research methodology and papers that were only abstract parts. They were checked for duplication to eliminate similarity, selected based on the title and abstract, and filtered to get the full article.
Articles selection followed the PRISMA chart guidelines. Below are the searching strategy and results of the articles.

RESULT
Articles generated from four databases were 87,409 articles. The study took 540 health professional students from the early semester to the professional stage. They had received learning related to effective communication and communication skills. The result showed that nine articles reviewed used various learning methods to teach effective communication skills for health professional students-seven articles in nursing and two articles in medical. Below will describe the theme that authors found in the articles reviewed and a summary of nine articles.

DISCUSSION
The results showed that several learning methods such as cooperative learning, simulation with a standardized patient, simulation with standardized family, video recording and standardized patient feedback, experiential learning, simulation with virtual reality, peer review method, patient feedback, specific feedback, could be improved communication skills in health profession students. 12-18, 20 The above learning methods can enhance communication skills and encourage students to communicate appropriately and correctly. Furthermore, the facility and challenge during communication learning are also explained in the articles.

Simulations with Standardized Patient
Simulations with standardized patients for 15-20 minutes also improved verbal and non-verbal communication skills. Students demonstrated maintaining eye contact, creating comfortable conditions for patients, keeping boundaries therapeutic, ensuring patient safety, performing therapeutic communication techniques, conforming with verbal and non-verbal communication, setting limits for inappropriate behavior, reducing anxiety when meeting patients, summarizing, and ending the interaction well. The standardized patient used has been guided and trained for two months. Thus, the simulation with standardized patients effectively will improve communication skills. 13, 21 Simulation with standardized patients effectively enhanced communication skills in the intervention group with higher post-test scores than the control group. The standardized patients created active learning through knowledge in the laboratory, increased confidence when communicating, helped practice direct communication with real people, provided feedback, improved the communication learning process. They also allowed an opportunity to ask questions and discuss Simulated Patient Feedback and Specific Feedback Feedback as a formative assessment can be integrated into learning methods. The feedback provided can develop selfevaluation, reflect the learning process, help build and actively acquire knowledge and skills of students. 23 Input from the simulated patient showed significant improvement in communication skills than the group that did not receive feedback, such as self-introduction, non-verbal behavior, showing care and empathy, providing information, and asking questions. Specific feedback will be better due to its effectiveness in improving student communication skills, such as communication structure, patient handling skills, non-verbal communication skills including pause and intonation, and conversation ending skills. 19, 20 Information from the health profession and patients will support the safety of providing care for patients. Simulation patients have a role in learning communication skills, such as active facilitators to train general or specific communication skills and evaluate students' communication skills training and feedback. 24

Role Play with Standardized Family
Students of health professions must possess communication skills related to patient safety. Role-play with standardized families effectively improved communication skills by demonstrating behaviors through formal lectures, communication skills, and self-confidence when communicating. Students' communication skills increased after role play by self-introducing skills, gathering information, clarifying goals and expectations. The most prominent ability is gathering information. Role-play with a standardized family is effective for learning communication skills. 25 Other research has shown that with role play, students' oral and written communication skills became compatible with pharmacy practice in various settings and could identify effective interaction with other professionals. 26

Cooperative Learning
Cooperative learning can improve communication skills. It emphasizes cooperation and interaction/ communication between students with several activities such as face-to-face interaction between students, Socrates questions, quizzes in pairs, small group discussions using predetermined cases, exercises to form concept maps in groups, identify concept maps that have been made and make presentations aimed at building therapeutic communication skills and collaboration between students, 14 Purpose: To test the effectiveness of roleplaying with family standards to improve nursing students' communication skills Design: Quasi-experimental two groups posttest design Sample: 41 nursing students Intervention: The control group with a formal lecture approach and the intervention group received a traditional lecture and did roleplay with standardized family members for 60 minutes.

Instrument: Standardized Grading Tool Evaluated
The communication skills of the intervention group were better than the control group in all domains of communication skills, such as introducing themselves, gathering information, conveying information, clarifying goals and expectations. The significant difference lies in the domain of gathering information.
These results indicate that role-play with Standardized Family effectively taught nursing students communication skills.

Experiential Learning
Communication skills can be trained using the SBAR communication technique based on experiential learning by David Kolb. Experiential learning is a learning method that emphasizes student experience as a learning process include four stages: the concrete experience stage, which is the initial stage of scenario-based learning; the second stage is reflection, where students will make observations and reflect on the implementation of SBAR communication; the third stage is the abstract conceptualization stage, where the instructor will help students understand the gap between theory and practice to support their conceptualization, and the final step is an active experience, students will do roleplay to practice communication skills using SBAR techniques directly with patients in clinical settings. This method can improve communication performance skills in nursing students with a high level of communication clarity and confidence when performing operations. 17 In experiential learning, students are involved and positioned as actively engaged in developing skills and higherorder thinking, oriented to doing tasks directly through learning experiences. 29