의사환자대화의 창의성 : '의사소통기술'을 넘어 '노련한 의사소통'으로 (2) - 미래 의사소통 교육의 원칙

(출처 : www.cpso.on.ca)

의사소통은 근본적으로 창의적인 것이다. (Communication is inherently creative)

의사소통은 전인적이어야 한다. (Communication is holistic)

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PRINCIPLES FOR FUTURE COMMUNICATION TEACHING

좋은 의사환자대화란 단순한 기술로 분해될 수 없지만 고도로 기술적이어야 한다

Good clinical communication is clearly highly skilled, although it defies reduction into elements that can be called skills. 

의사소통이 직관적이고 창의적이어야 한다고 해서, 이것이 훈련이 필요하지 않다는 것은 아니다. 의사소통기술이 교육과정으로 들어 온 것은 무엇보다도 단순히 의사의 직관에 의존할 경우 환자에게 해를 가할 수 있기 때문이다.

Observing that communication is intuitive and imaginative does not mean that it should be undisciplined by training. After all, communication skills teaching won its place in curricula because communication that depends solely on the intuition of practitioners may be hurtful or damaging,

대신 우리는 의사환자대화를 새롭게 개념화함으로서 교육과 현장을 조화시킬 수 있어야 한다. 두 개의 원칙을 언급하고자 한다.

Instead, we need new ways to conceptualise clinical communication that reconcile pedagogy and practice. These will need to incorporate two principles that the concept of communication skills cannot.

의사소통은 근본적으로 창의적인 것이다.

Communication is inherently creative

매우 일반적인 한 가지 원칙을 지키는 것 만으로도, 의사환자대화에서는 독창성이 항상 존재할 수 밖에 없다. '환자의 이름을 부르며 인사하고' '환자의 독특한 임상상을 설명해주는 것' 만으로도 그 전에 어떤 의사도 하지 않았던 것이 이뤄지는 것이다.

At one level, originality is always present, simply as a result of following general rules. Greeting a patient by his or her name or explaining a unique and complex clinical picture may mean saying something that no practitioner has said before

그러나 여기서 독창성이 '규칙'으로 환원될 수는 없다. 창의성이 중요한 교육분야, 특히 예술 영역에서는 독창성과 연결된 복잡성을 교육 목표로 만들 수 밖에 없었다.

However, we are concerned here with originality that cannot be reduced to rules. Pedagogy concerned with creativity, particularly in the creative arts, has had to confront the complexities associated with originality as an education objective.46,50–52 

의학에서의 창의성은 '불확실성'과 밀접한 관련이 있다.

In this field, it is recognised that creativity is intimately associated with uncertainty.

불확실성은 예술가가 창의력을 발휘하여 즉흥적 작업을 하고, 실험을 할 수 있는 여지를 준다.

This inherent uncertainty creates the space within which creative artists improvise and experiment.

이것이 Reed가 말한 "전문가에 의해서 구성된 간접적인 지식을, 자신의 경험을 통해서 직접 습득한 지식으로 보완하는 것"의 중요성이다. 창의적인 작업은 규칙을 잘 따르는 것이 아니라 어떠한 판단을 내리는가에 달려있다.

This points to the importance of what Reed characterised as the ‘first-hand’ knowledge of learners’ own experience to complement the ‘second-hand’ knowledge shaped and selected by experts;54 that is, creative work depends on judgement rather than on following rules,50,52

의사소통은 전인적이어야 한다.

Communication is holistic

의사소통기술과 관련한 어떤 구체적인 행동도 모든 상황에 들어맞지는 않는다. 의사소통이 이루어지고 있는 상황을 둘러싼 모든 환경에 따라 그 행동의 가치가 달라질 수 있다. 실제로 환자는 세세한 의사소통기술보다는 전반적인 상황에 더 관심을 갖는다.

it is implausible to regard any specific behavioural communication skill as desirable in all possible contexts. Its quality only exists in the context of the whole situation, including the communication surrounding it. Indeed, patients can be more concerned with the whole picture – their impression of the practitioner’s character and caring – than with specific communication skills.27,55

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Med Educ. 2011 Mar;45(3):217-26. doi: 10.1111/j.1365-2923.2010.03801.x.

Creativity in clinical communication: from communication skills to skilled communication.

Salmon P, Young B.

Source

Division of Clinical Psychology, University of Liverpool, Liverpool, UK. psalmon@liv.ac.uk

Abstract

Medical Education 2011: 45: 217-226 Objectives  The view that training in communication skills produces skilled communication is sometimes criticised by those who argue that communication is individual and intuitive. We therefore examine the validity of the concept of communication as a skill and identify alternative principles to underpin future development of this field. Methods  We critically examine research evidence about the nature of clinical communication, and draw from theory and evidence concerning education and evaluation, particularly in creative disciplines. Results Skilled communication cannot be fully described using the concept of communication skills. Attempts to do so risk constraining and distorting pedagogical development in communication. Current education practice often masks the difficulties with the concept by introducing subjectivity into the definition and assessment of skills. As all clinical situations differ to some extent, clinical communication is inherently creative. Because it is rarely possible to attribute specific effects to specific elements of communication, communication needs to be taught and evaluated holistically. Conclusions  For communication teaching to be pedagogically and clinically valid in supporting the inherent creativity of clinical communication, it will need to draw from education theory and practice that have been developed in explicitly creative disciplines.

© Blackwell Publishing Ltd 2011.

Comment in

• Skilled communication: comments further to 'Creativity in clinical communication: from communication skills to skilled communication'. [Med Educ. 2011]
• Unskilled creativity is counterproductive. [Med Educ. 2011]