Standardized training of residents is an important part of medical students' education after graduation in China, which is very important for training high-level clinical physicians and improving the quality of medical care [14]. In China, medical students are required to participate in standardized residency training after graduation, so the average age of residents participating in this study is relatively young. Traditional teaching approach primarily relies on classroom lectures, where the teacher assumes a leading role in imparting information and knowledge to students, who passively receive it [1]. This method lacks immersion and fails to equip students with practical application skills. This study used the BOPPPS teaching model combined with the SBAR communication model to try a new doctor‒patient communication teaching and assessment system for exploring and improving oncology residents' doctor‒patient communication teaching methods, focusing on oncology residents' doctor‒patient communication teaching and ability.
The BOPPPS teaching model emphasizes a closed loop of student engagement and instructional feedback [15], it emphasizes students' all-round active and effective learning methods as well as a good teaching interaction and feedback mechanism that prioritizes communication between teachers and students [16]. This approach fully reflects the scientific educational development concept of "student-oriented and teacher-led" learning. It focuses on guiding teachers to obtain active and effective feedback from students' information in the modern teaching environment and to adjust the modern teaching process and behavior in a timely and reasonable way [17]. This teaching method has incomparable advantages in stimulating students' interest and enthusiasm in learning and improving teaching efficiency [1], which is consistent with the results of this study. The results of this study showed that the residents' scores for set the stage, elicit information, give information, understand the patient's perspective, and end encounter were significantly higher after receiving the new teaching model (Table 2, Fig. 2). In this study, the six teaching activities of BOPPPS were closely linked to each other to form an effective and efficient interactive process in the classroom. Student interest-centered participatory learning and post-assessment were the main core aspects. In the post-course questionnaire, we found that residents were interested in the new teaching model, the satisfaction level for innovation was higher in the experimental group than in the control group, indicating that the residents generally recognized this new teaching mode and were able to gain significant benefits from it. This mode of teaching also stimulated students' own independent learning and interest, allowing most of them to achieve rapid mastery of core knowledge at the classroom level (Table 3).
At present, the standardized residents training in China focuses on clinical and operational skills training for medical students, but not enough attention is given to doctor‒patient communication skills. Residents also focus more on the study of medical professional courses and pay less attention to courses related to doctor‒patient communication [18]. Due to the specificities of cancer, most patients in the oncology department have long hospitalization times, many side effects of treatment and a high level of mental stress, which require special understanding and care from medical and nursing staff. Good doctor‒patient communication is an effective way to resolve various conflicts in oncology treatment. Most of the residents have recently graduated from school, do not have long working hours and lack experience; so, their ability to communicate with patients is often poor, which affects their clinical work. The question of how to improve residents' communication with patients through relevant teaching activities has become an urgent problem to be solved. Previous research showed that the communication skills of physicians were significantly improved after communication skills training [19].
The SBAR communication model is a standardized, evidence-based communication model that ensures the accuracy of information in emergency situations. The SBAR communication model emphasizes the patient's condition and background, assessment of the condition, and recommendations for the condition, and it allows for a highly accurate diagnosis and treatment based on the patient's actual condition [20]. As cancer is high-risk and difficult to treat, many conflicts and disputes occur in the diagnosis and treatment of patients by doctors in the oncology department. The application of the SBAR communication mode in oncology can improve patients' satisfaction with the service attitude of medical and nursing staff through communication between doctors and patients to ensure the accuracy of information transmission. This can in turn generate trust in doctors' medical skills and improve patients' cooperation, which can eventually reduce the incidence of doctor‒patient disputes [21]. Furthermore, related studies have found that the SBAR communication model is well suited to providing timely and correct information to health care professionals and reducing unnecessary confusion, thus improving team efficiency [22]. In clinical use, the S generally refers to the basic information of the patient, including the patient's department, name, age, and problem; B refers to the background factors that guide the existence of the current main diagnosis and problems of the patient, which generally include the patient's main complaint of previous relevant medical history; A refers to the assessment of the patient's current situation, including some positive indicators, abnormal test data, abnormal performance, and vital signs of the patient; and R refers to the assessment based on which professional and reasonable advice is given and a plan is drawn up for the next step of treatment [23]. The SBAR model allows communication to occur quickly and effectively despite differences in rank, literacy, and disciplinary background between healthcare providers and to provide timely feedback and treatment for situations that occur [24]. A study of nursing staff in two hospitals trained in the SBAR model found that the SBAR model not only standardized the communication between health care providers and nurses to help health care workers intervene in a timely manner in some unexpected adverse situations but also facilitated handover by health care workers, as nurses could prejudge and deal with some situations of patients first [25]. Some scholars have investigated the methods, problems and effects of the SBAR communication model in the use of shift handover in ICU intensive care centers through a systematic evaluation method and found that the SBAR communication model can standardize shift handover patterns and ensure patient safety [26]. Many experts have been working on the application of the SBAR communication model in the entire healthcare system, especially in medicine, teaching and research [27–29].
The results of this study showed that the residents' scores for set the stage, elicit information, give information, understand the patient's perspective, and end encounter were significantly higher after receiving the new teaching model. The patient communication scores for set the stage, elicit information, give information, understand the patient's perspective, and end encounter were all higher in the experimental group than in the control group. Therein, the scores for elicit information, give information, understand the patient's perspective, and end encounter were significantly higher in the experimental than in the control group, and the differences were statistically significant (P < 0.05). This indicates that the model of doctor‒patient communication established in this study can improve the teaching of doctor‒patient communication for oncology residents. In addition, the overall satisfaction rating of the patients with the residents was higher in the experimental group than in the control group, and the difference was statistically significant (P < 0.05), indicating that the established doctor‒patient communication model was appreciated by the patients.
There were some limitations to this study. First, this study tested a small group of students in a hospital for a short period of time. In addition, because the BOPPPS teaching model was combined with the SBAR communication model for the first time, the students had more free time and more questions, and the teachers needed to answer more questions before and during class, which increased the teachers' workload. Therefore, more practice is needed to further improve and refine the teaching program, and the quality of teaching patient communication in oncology can be improved by optimizing the teaching program and carrying out individualized teaching.