Our keynote speakers stimulated much conversation throughout the conference and on twitter when presenting their work about clinical conversations. 

Liz Crowe opened the proceedings and discussed the cost of incivility on humans in relation to error, safety, retention and wellbeing. She highlighted how our leaders and teams often do not know what to do about incivility and the impact this has on individuals. She talked about learning to speak the language of responsibility and the need for robust conversations; and the imperative to ensure that destructive conflict has more open communication.

“Conflict has the power to transform. Conflict can only be constructive rather than destructive when conversations occur from a space of shared vulnerability, where language is spoken with responsibility and ownership and when people are less interested in justification and more interested in curiosity and understanding." (Crowe, 2019)

Tanja Manser’s inspiring presentation on ‘team talk’ emphasised communication among healthcare professionals to ensure safe and effective team communication and patient care. She described communication behaviours and meta-communicative strategies including implicit coordination between team members that can occur after extensive training together (Manser, 2019)

Jimmie Leppink challenged the delegates to consider how to measure the process of learning and think of the longitudinal measurement of students. By using control charts, network mapping and other statistical techniques, students in difficulty could be identified and remediated earlier (Leppink, 2019).

Another perspective was presented by Walter Eppich in relation to ‘learning through talk’. His work and body of research has examined ‘talk’ as a joint social activity between conversation partners and as a way of learning for practice. Through simulation and workplace learning he addressed the question of: How does talk contribute to learning in clinical education?  He explored the structured talk of feedback and debriefing in healthcare simulation that attends to both the process and the content of learning conversations. He concluded that:

“Health professions educators should steer the talk of practice in two ways: (a) through formal and informal means, such as structured feedback and debriefings that attend to relevant process and content, and strategies that foster relationships and supportive learning environments, and (b) through simulations designed to sensitise clinicians to the affordances of future workplace talk." (Eppich, 2019)

Finally, Vicki Le Blanc provided the delegates with an insightful presentation on rethinking the role of emotions in learning and clinical skills. She spoke about how emotions can have a significant impact on how we perceive the world around us, what we pay attention to, what we remember, as well as our judgements and decision making. She highlighted the importance for clinicians to recognise how emotional states affect our ability to interpret information, make decisions and remember critical information. 

“This greater understanding will, in turn, shape how we teach, provide feedback and coaching, as we as how we assess our learners." (LeBlanc, 2019)

In keeping with the conference theme, a small number of delegate abstracts and presentations explored the nature and process of clinical conversations. Mcallister, et al. (2019) presented work on preparing students for intentional conversations with older adults by using narrative skills to increase networks of communication with older people. The authors described a concept called ‘Narrative Competence’ – that is the ability to deeply listen to a person’s story and then to communicate that story back so that it becomes life-enhancing (Corbaly and Grant, 2015). It was presented as a novel solution to a very difficult problem. The authors found that Narrative Competence developed nursing student’s intentional conversational skills, emphatic engagement, communication, cultural competence, collaborative goal setting and fostered a sense of community. 

Purcell described an Accelerate Communication Excellence (ACE) programme for health students designed to address issues of poor communication competence (Purcell, 2019). ACE includes a web-based diagnostic program on professional communication and a 4-day immersive program. Outcomes of the evaluation revealed diagnostic accuracy for students with poor professional communication competence and development of listening, reading, writing, reasoning and speaking skills in novice students in the immersive programme. 

One additional innovative presentation was a project conducted by McNeill et al. (2019) that used Lego® as a fun way for midwifery and medical students to get to know each other, initiate conversations and bond as a team prior to working in simulations together. They found that the activity enabled open discussion, laughter and team building.

Six manuscripts were accepted from those submitted. The papers published comprised four research articles, a new education method and a practical tips paper. Authors selected a variety of keywords to portray their papers association with our theme including: non-medical expert roles; clinical skills; CanMEDS intrinsic roles; competency-based medical education, social media, online forum, consultation skills; real patients; video-recordings; Cambridge-Calgary Global Consultation Rating Scale; patient centeredness and empathy.

The most relevant paper that contributed to our theme was the practical tips and/or guidelines paper written by Lafleur, Gagne, Paquin and Michaud-Couture from the Universite Laval (Lafleur, Gagne, Paquin et al., 2019). They provided a matrix of high impact clinical studies exemplifying intrinsic roles of physicians. By intrinsic roles the authors referred to the CanMEDS framework for non-medical roles i.e. communicator, collaborator, manager, scholar, professional and health advocate. In their article, the authors provided practical tips on why and how to use high-impact clinical studies to enlighten supervisors and trainees about the educational and clinical importance of those skills. It was also accompanied by a slide kit for use in clinical settings and a selection of 30 examples of ‘hard’ evidence on intrinsic skills with the aim of reinforcing the fact that intrinsic roles are intertwined with the medical expert role to improve patient care.