The Pendulum of Progress: Soft Skills in Whole Person Clinical Training

The art of medicine increasingly focuses on holistic patient care including social determinants of health, motivational interviewing, and patient engagement with healthcare.^1-3 Simultaneously, societal and work-related shifts to emphasize work-life balance and holistic employee needs are challenging work paradigms.^4-6 Additional emphasis on teams, including multidisciplinary teams with variable personality proclivities, means clinicians increasingly face the challenge of employing soft skills to enhance holistic and comprehensive patient care.^7-9 It stands to reason that it is therefore imperative for all health professions to integrate soft skills into clinical education. Focusing on whole-person clinical training may lead to more prepared and successful clinicians in practice. Below are examples of soft skills employed in practice and techniques clinical educators can use to support their learners’ soft skill development.

Soft Skills in Practice Example: Communication Modalities

Medicine reflects society’s growing dependency on technology, leading to changes in how we communicate, communication speed, and communication expectations.^10-12 For example, in the past 2 to 3 decades, medical records have transitioned from largely paper to electronic medical records (EMR).^13,14 Instead of writing paper notes or orders to be physically transported to the correct department or record, health professionals often use a combination of electronic orders, email, pages, phone calls, and EMR messaging modalities.^15-17 As a result, in addition to deciding what information is needed and the modality best suited to obtaining that information, today’s clinicians should also consider who they are communicating with, including generational and personal preferences for communication. Table 1 shows how information and generational preferences may present in practice.

In addition to understanding the healthcare team’s communication preferences, it is also essential to communicate expectations for response timeliness to learners and trainees. Some mediums, like email, allow greater flexibility, with expectations for responses typically ranging from 72 hours to a couple of weeks. Although EMR messaging allows for rapid communication, it can also serve as a consistent interruption in task coordination for new practitioners, which may contribute to burnout.²⁴ Triaging this communication modality is a crucial skill that preceptors can role model for trainees. It is helpful for preceptors to establish explicit communication preferences, expectations for timeliness of responses, and necessary boundaries at the start of learning experiences to be modeled throughout the learning experience. For example, a preceptor might establish rounds for patient-related questions unless an immediate answer is needed (eg, when it would impact time to discharge) in which case the preceptor would prefer messaging. In this example, the preceptor can also role model work-life balance by clarifying that they will not be on the EMR after 5:00pm (and thus won’t see EMR messages) unless a text message alerts them to a time-sensitive concern. If communication challenges arise or expectations are not being met, methods such as the 1-minute preceptor, Socratic method, or the agree/build/compare methods lend themselves nicely to realigning the preceptor and learner.^25-27

Soft Skills in Practice Example: Feedback

Soft skills related to providing and receiving feedback are challenging for any professional. Lack of feedback or dishonest feedback is a key dysfunction of any team.²⁸ This is also reflected in the practice of audit and feedback, a core element of antimicrobial stewardship programs.²⁹ Feedback can serve as a tool for growth when feedback is given with sincere interest toward common goals and is well received. But if one or both pieces are missing, it can lead to moral injury, as expertly described by Cutrell and Sanders.³⁰

Preceptors can also model the importance of feedback by indicating how they plan to deliver it (ie, in real-time vs feedback Fridays vs other) at the start of learning experiences. It can be helpful to establish feedback as a dynamic interaction to promote growth rather than judgment on the learner as a person. This explicit approach can help prevent identity and relationship triggers that can affect how the learner receives feedback.³¹ It can also help the learner identify trends in receiving and integrating the information. For example, baby boomers are associated with a strong deference for hierarchical structures that may impede their ability to evaluate feedback critically.^19,20 Conversely, Generation Z may equate feedback with failure or not want to disclose when they don’t know an answer, dampening opportunities for growth discussions.^23,32

Business literature provides many different tips for giving feedback. Table 2 shows examples of applying feedback tactics to practice, such as using a framework to help the feedback giver provide specific and structured information. This can be particularly helpful for preceptors to model as it allows the receiver to develop pattern recognition that transforms the feedback into easily digestible chunks for growth opportunities.^31,33 Several feedback frameworks have been proposed across multiple different disciplines. Some that seem easy to adapt to clinical precepting include the following:

• ADAPT: Ask, Discuss, Ask, Plan Together
• SBI: Situation, Behavior, Impact
• DESC: Describe, Express, Specify, Consequences
• Keep, Start, Stop
• Do, Try, Consider
• Agree, Build, Compare

Feedback is a dynamic growth process, and the clinical preceptor must also be prepared to receive feedback from the learner or trainee.^31,33 It can be helpful for the preceptor to use the following scaffold when receiving feedback from trainees and learners: request, receive, reflect, respond, and resolve.³⁴ By requesting feedback from learners, the preceptor can demonstrate the importance of gaining constructive feedback and help establish psychological safety for the learner. When reflecting on the feedback the preceptor has received, the preceptor should try to avoid identity and truth triggers that make it difficult to process feedback. One way to mitigate this is to use a feedback decision tree, including identifying what is within the preceptor’s control, aligning feedback with the preceptor’s values, and seeking advice from mentors or coaches when unsure how to implement changes. Tips for preceptors to keep in mind when role modeling responding to feedback well is to start your response with appreciation and maintain a growth mindset with genuine curiosity toward specifics and resolution ideas.^31,33,35

Parting Tips and Resources

Communication and feedback are just 2 examples of critical soft skills that are important for whole-person clinical training. There are a variety of other soft skills for preceptors to model and foster in learners in clinical practice, especially related to interpersonal challenges and team dynamics. One skill is to be cognizant of generational preferences, individual personality quirks, and nonverbal cues. A classic example of nonverbal cues for the preceptor to be mindful of is someone with a resting, angry face contemplating feedback but perceived as unwilling to listen to or angry at the feedback content. It’s also helpful to remember that just as there are variations in a person’s risk tolerance in patient care, individuals also vary in their degree of conflict avoidance or engagement, which can impact team communication and growth. When precepting these soft skills or some of the many other skills that influence team effectiveness in medicine, it can be helpful to identify the 6 sources of influences that affect behavior and the degree of relationship currency already established.³⁶

References

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