Professor Owen Hargie

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• Professor Owen Hargie
• School of Communication
• University of Ulster
• odw.hargie_at_ulster.ac.uk

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• "Training Professional Communication Skills
  Research, Theory and Practice"

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• THEORETICAL BACKGROUND

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Key Sources

• Dickson et al. (1997)
• Hargie (2006)
• Hargie Dickson (2004)

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Models of Skill

• Welfords Model of the Human Sensory-Motor System
• Argyles Motor Skill Model
• Hargies Model of Skilled Communicative
  Performance

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EXTERNAL OBJECT
S E N S E O R G A N S
P E R C E P T I O N
C O N T R O L O F R E S P O N S E
E F F E C T O R S
Translation from perception to action Choice of
response
Short- term store
Long-term store
Welfords Model of the Human Sensory-Motor System
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• Crossman (1960) was the first person to attempt
  to conceive of communication as a form of skill.
• He then liaised with Michael Argyle at Oxford
  University, who proceeded to develop the analogy
  between motor and social skill

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• Argyle noted that
• One of the implications of looking at social
  behaviour as a social skill was the likelihood
  that it could be trained in the way that manual
  skills are trained

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Perception Translation Motor responses
Changes in outside world
Motivation, goal
Argyles Motor Skill Model
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Feedback
Person-situation context
Response Mediating factors Perception
Perception Mediating factors Response
Goal
Goal
Feedback
Hargies Model of Skilled Communicative
Performance
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Five Shared Components of Skill

• FRASK
• Fluent
• Rapid
• Automatic
• Simultaneous
• Knowledgeable

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Social and Motor Skill Differences

• Social interaction, by definition, involves other
  people, whereas many motor skills do not.
• The affective domain plays a more central role in
  social contexts.
• The perceptual process is more complex during
  interpersonal encounters.
• Personal factors relating to those involved in
  social interaction play a central role in the
  responses of participants.

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Microteaching

• Allen Ryan (1963) introduced microteaching at
  Stanford University
• Teaching broken down into constituent parts or
  skills
• Each part/skill taught separately
• Skill practice/acquisition occurred in college
  context (teach/reteach cycle)
• Complexity was reduced (e.g. microlessons were 5
  minutes)

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Microtraining

• Microteaching was shown to be effective (Hargie,
  1977)
• Ivey et al. (1968) adapted the approach in
  counsellor training microcounselling.
• Hargie et al. (1978) developed it more widely in
  the training of a range of professional groups
  microtraining but guided by the skills
  theoretical framework.

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• Microteaching Motor - Social
  Skill Analysis
• Microcounselling
• Social Skills
• Microtraining Training
• Communication Skills Training

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Features of Interpersonal Skill

• Learned/knowledge-based
• Behaviourally circumscribed
• Internally consistent
• Sequentially co-ordinated
• Smooth
• Rapid/automatic
• Goal-directed
• Synchronised with the behaviour of others
• Successful/accurate
• Normative and appropriate to context

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Definition of Interpersonal Skill

• A process in which the individual implements a
  set of goal-directed, inter-related,
  situationally appropriate social behaviours,
  which are learned and controlled.
• (Hargie, 2006)

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Criticisms of the Skills Approach

• Reductionism (- distorts reality)
• Ideological (- CST is a Machiavellian management
  tool it is only common sense and a waste of
  curriculum time)
• Artificiality (- changes behaviour)

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Process of Skill Learning

• Unconscious incompetence
• Conscious incompetence
• Conscious competence
• Unconscious competence

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• PRACTICE

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Ubiquity

• CST is now a widely accepted part of the training
  of most professionals
• Communication skills training ... in
  medicine, once considered a minor subject, is
  now ranked as a core clinical skill
• (Laidlaw et al., 2002)

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• The ubiquity of CST was confirmed in recent UK
  surveys of medicine (Hargie et al., in press) and
  physiotherapy (Parry Brown, in press)

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Some Pedagogical Issues

• Tensions between
• flexibility and effectiveness
• content and process
• isolated versus integrated curriculum
• results and resources
• specific and generic approaches
• designated responsibility versus wide involvement
• mass versus spaced teaching

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Some Pedagogical Issues

• Identification of skill content
• Programme design
• Sensitisation
• Skill practice
• Feedback
• Assessment of CST
• Transfer of training
• Programme evaluation
• (Hargie Saunders, 1983a,b)

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Taking one of these areas

• SKILL IDENTIFICATION

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Skills Can Be Identified By

• Academics
• Practitioners
• Managers
• The Managed
• Clients/Customers
• Researchers
• Government

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Styles of Approach to Skill Identification

• Empirical
• (systematic observation analysis)
• Analytical
• (theoretical, deductive approach)
• Intuitive
• (experiential, reflective, approach)
• (Ellis Whittington, 1981)

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Skill Identification Methods

• Direct Observation
• Task /Subject Matter Analysis
• Surveys
• Interviews
• Focus Groups
• Delphi Technique
• Critical Incident Technique
• Constitutive Ethnography
• (Hargie
  Tourish, 2009)

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Some Issues

• Sampling
• Defining the target population (bandwidth-fidelit
  y problem)?
• Rigour and relevance
• Recordings (ethics)?
• Time commitment

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Factors affecting patient assertive behaviour
during medical consultations

• Type of illness
• Reason for this visit
• First v. repeat visit
• Home v. surgery location
• Presence of a companion
• Duration of interaction
• Physical examination or not
• The personality of doctor/patient
• Gender of patient/doctor
• The initial behaviour of the doctor
• (Beisecker, 1990)

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• RESEARCH

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Significant Changes

• Clarification of skill
• Conceptual underpinning for CST
• Mandatory CST in professions
• Assessment using simulated clients
• Designated societies (EACH, AACH) and
  Communication Divisions
• Research publications (6,600 hits on GS for
  CST 30,700 for SST 2,640 for IST)

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• Indeed interesting forms of evaluation are now
  being carried out
• e.g. Favre et al. (2007) in a study of
  psychodynamic aspects of practice, found that CST
  reduced immature defence mechanisms operant in
  oncology clinicians facing challenging interviews
  with patients

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Those with higher levels of interpersonal skill
tend to

• be more sensitive to the needs of others
• have more friends
• be more successful in dating
• be more satisfied in their close personal
  relationships
• handle life crises better
• cope more readily with stress
• adapt and adjust better to major life transitions

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Those with higher levels of interpersonal skill
tend to

• be less likely to suffer from depression,
  loneliness or anxiety
• report higher levels of happiness
• perform better academically
• be more effective professionals
• be better entrepreneurs
• be rated as more effective by clients
• (Hargie et al., 2004 Segrin et al., 2007a,b)
• 
  

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Benefits

• In the health domain, high levels of practitioner
  interpersonal skill have been shown to be
  positively correlated with increases in the
  quality of care and effective health outcomes,
  while ineffective skills are associated with
  decreased patient satisfaction, increased
  medication errors and malpractice claims.

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• Communication skills training during medical
  school has been shown to have effects lasting as
  long as five yearsIf the change lasts that long
  it is probably permanent (Roter Hall,
  2006)
• there is overwhelming evidence that, when used
  in a systematic, co-ordinated and informed
  fashion, CST is indeed an effective training
  medium (Hargie, 2006)

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• The programs that have been most successful (a)
  are intensive and delivered over an extended
  period of time, (b) provide opportunities for
  practice and feedback on performance, (c) present
  role models, (d) provide follow-up assessments
  and review, and, importantly, (e) have
  institutional support and incentives promoting
  the value of effective communication.
• (Street, 2003)?

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Some Issues

• Not all programmes are based upon a conceptual
  bedrock.
• Dearth of detailed research into the component
  parts of CST. Many decisions about design and
  delivery are still best guesses.
• Lack of research into integration between CST and
  the rest of the curriculum.

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Some Issues

• Epistemological base lack of knowledge of
  situation-specific skills across most
  professions.
• Disinclination towards evaluation by providers.
• Pedagogical differences across professional
  programmes.
• CST is not a unitary or prescriptive phenomenon.
  In many ways its flexibility is both an advantage
  and a drawback.

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Some Issues

• Differences in programme design and operation
  make comparisons across studies very difficult.
• More research is required into all aspects of the
  training cycle, especially outside of medicine.

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Some Issues

• 10 year rule means that skill development is a
  long process. Considerable research into changes
  in motor skill over time, little in interpersonal
  domain. How, and in what ways does CST
  short-circuit the learning process? How can this
  be further enhanced?

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Some Issues

• Not all trainers are adequately trained.

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Final Comments

• CST has moved from a suspect innovation to a
  generally accepted reality.
• The diversity across programmes will continue.
• The research potential in this field is well
  recognised and will further develop.

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References

• Allen, D. Ryan, K. (1969). Microteaching.
  Reading, MA Addison-Wesley.
• Argyle, M. (1967). The psychology of
  interpersonal behaviour. Harmondsworth Penguin.
• Crossman, E. (1960). Automation and skill.
  London HMSO.
• Beisecker, A. (1990). .Patient power in doctor
  patient communication What do we know? Health
  Communication, 2, 105-122.
• Dickson, D., Hargie, O. Morrow, N. (1997).
  Communication skills training for health
  professionals 2nd ed. London Chapman and Hall.
• Ellis, R. Whittington, D. (1981). A guide to
  social skill training. Croom Helm London.
• Favre, N., Despland, J., et al. (2007).
  Psychodynamic aspects of communication skills
  training A pilot study. Support Care Cancer, 15,
  333-337.
• Hargie, O. (1977). The effectiveness of
  microteaching A selective review. Educational
  Review, 29, 87-97.
• Hargie, O. (ed.) (2006). The handbook of
  communication skills, 3rd ed. London Routledge.
• Hargie, O. Dickson, D. (2004). Skilled
  interpersonal communication Research, theory and
  practice, 4th ed. London Routledge.
• Hargie, O., Dickson, D. Tourish, D (2004).
  Communication skills for effective management.
  Basingstoke PalgraveMacmillan.
• Hargie, O., Boohan, M., McCoy, M. Murphy, P.
  (in press). Current trends in Communication
  Skills Training in UK Schools of Medicine.
  Medical Teacher.
• Hargie, O. Saunders, C. (1983a). Individual
  differences and SST. In R Ellis and D Whittington
  (eds.) New directions in social skill training.
  London Croom Helm.
• Hargie, O. Saunders, C. (1983b). Training
  professional skills. In P. Dowrick and S. Biggs
  (eds.) Using video. London Wiley.
• Hargie, O., Tittmar, H. Dickson, D. (1978).
  Microtraining A systematic approach to social
  work practice. Social Work Today, 9, 14-16.

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References

• Hargie, O. Tourish, D. (2009). (eds.) Auditing
  organizational communication The handbook of
  research, theory and practice. London Routledge.
  
• Ivey, A., Normington, C., Miller, C., Morrill, W.
  Hasse, R. (1968). Microcounseling and attending
  behavior  An approach to pre-practicum counselor
  training.  Journal of Counseling Psychology, 15,
  Part II, 1-12.
• Laidlaw, T., MacLeod, H., Kaufman, D., Langille,
  D. Sargeant J. (2002). Implementing a
  communication skills programme in medical school
  Needs assessment and programme change. Medical
  Education, 36, 115-124.
• Parry, R. Brown, K. (in press). Teaching and
  learning communication skills in physiotherapy
  What is done and how should it be done?
  Physiotherapy.
• Roter, D. Hall, J. (2006). Doctors Talking With
  Patients/Patients Talking With Doctors Improving
  Communication in Medical Visits, 2nded. Westport,
  CT Preager.
• Segrin, C. Taylor, M. (2007a). Positive
  interpersonal relationships mediate the
  association between social skills and
  psychological well-being. Personality and
  Individual Differences, 43, 637646.
• Segrin, C., Hanzal, A., Donnerstein, C., Taylor,
  M. Domschke, T. (2007b). Social skills,
  psychological well-being, and the mediating role
  of perceived stress. Anxiety, Stress Coping,
  20, 321 - 329.
• Street, R. (2003). Interpersonal communication
  skills in health care contexts. In J. Greene B.
  Burleson (eds.), Handbook of communication and
  social interaction skills. Mahwah, NJ Lawrence
  Erlbaum.