Abstract

Presented at: AMEE; Glasgow, Scotland; Sept. 2015

Background:
Communication is a core physician competency. Poor communication generates medical error. Rural and urban physician communication can be particularly difficult. Barriers to effective communication between rural physicians and urban consultants in Newfoundland and Labrador (NL) are examined.

Summary of work:
Rural physicians and urban consultants in NL completed a survey assessing effective communication barriers and exploring how simulation presents a solution. Insights will be used to develop a simulation-based curriculum.

Summary of results:
Pilot data confirmed that both groups experienced communication difficulties with one another; 23.1% rural, 27.8% urban rating the difficulties as frequent (p=0.935); 71.2% rural, 72.2% urban as sometimes (p=0.825); and 5.8% rural, 0% urban acknowledged never experiencing difficulties (p=0.714). Overall, 87.1% of participants indicated that communication difficulties impacted patient care and 59.7% identified a role for simulation in solving communication barriers. Forty-percent of participants classified peer-to-peer role-playing as the preferred type of simulation for both rural and urban contexts. The primary thematic trends that emerged as barriers for rural physicians were lack of time and understanding of site limitations. Urban consultants expressed inadequate patient information and language skills as major barriers to effective communication.

Conclusions:
Barriers to effective communication exist between rural physicians and urban consultants in NL. Simulation – chiefly role-playing – addressing management of time constraints, site limitations, patient care and language skill deficiencies should be developed to mediate barriers to effective communication, subsequently improving patient care.

Take-home message:
Communication barriers, which impact patient care, are prevalent between rural physicians and urban consultants. Role-playing simulation addressing context-specific barriers should be used to teach effective communication in rural and urban contexts