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Reflective Teaching Practices: An Approach to Teaching Communication Skills in a Small-Group Setting

Fryer-Edwards, Kelly PhD; Arnold, Robert M. MD; Baile, Walter MD; Tulsky, James A. MD; Petracca, Frances PhD; Back, Anthony MD

doi: 10.1097/01.ACM.0000232414.43142.45
Communication Skills

Small-group teaching is particularly suited for complex skills such as communication. Existing work has identified the basic elements of small-group teaching, but few descriptions of higher-order teaching practices exist in the medical literature. Thus the authors developed an empirically driven and theoretically grounded model for small-group communication-skills teaching. Between 2002 and 2005, teaching observations were collected over 100 hours of direct contact time between four expert facilitators and 120 medical oncology fellows participating in Oncotalk, a semiannual, four-day retreat focused on end-of-life communication skills. The authors conducted small-group teaching observations, semistructured interviews with faculty participants, video or audio recording with transcript review, and evaluation of results by faculty participants.

Teaching skills observed during the retreats included a linked set of reflective, process-oriented teaching practices: identifying a learning edge, proposing and testing hypotheses, and calibrating learner self-assessments. Based on observations and debriefings with facilitators, the authors developed a conceptual model of teaching that illustrates an iterative loop of teaching practices aimed at enhancing learners’ engagement and self-efficacy. Through longitudinal, empirical observations, this project identified a set of specific teaching skills for small-group settings with applicability to other clinical teaching settings. This study extends current theory and teaching practice prescriptions by describing specific teaching practices required for effective teaching. These reflective teaching practices, while developed for communication skills training, may be useful for teaching other challenging topics such as ethics and professionalism.

Dr. Fryer-Edwards is assistant professor, Department of Medical History and Ethics, University of Washington School of Medicine, Seattle, Washington.

Dr. Arnold is Leo H. Criep Professor, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.

Dr. Baile is professor, Section of Psychiatry, University of Texas M.D. Anderson Cancer Center, Houston, Texas.

Dr. Tulsky is professor, Department of Medicine, VA Medical Center and Duke University, Durham, North Carolina.

Dr. Petracca is Evaluation Specialist, International Training and Education Center on HIV/AIDS, Seattle, Washington.

Dr. Back is associate professor, Department of Medicine, University of Washington School of Medicine, Seattle, Washington.

Correspondence should be addressed to Dr. Fryer-Edwards, Department of Medical History and Ethics, University of Washington School of Medicine, Box 357120, Seattle, WA 98195; telephone: (206) 221-6622; e-mail: (

© 2006 Association of American Medical Colleges