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Lackie K, Miller S, Brown M, Mireault A, Helwig M, Beatty L, Picketts L, Stilwell P, Houk S. Interprofessional collaboration between health professional learners when breaking bad news: a scoping review of teaching approaches. JBI Evid Synth 2024; 22:1071-1102. [PMID: 38328948 DOI: 10.11124/jbies-22-00437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE The objective of this scoping review was to examine teaching approaches used to teach interprofessional health professional learners how to break bad news collaboratively. INTRODUCTION When breaking bad news, health professionals must be equipped to deliver it skillfully and collaboratively; however, the literature shows that this skill receives little attention in program curricula. Consequently, health professionals can feel inadequately prepared to deliver bad news, which may lead to increased burnout, distress, and compassion fatigue. INCLUSION CRITERIA Studies that describe teaching approaches used to teach learners how to break bad news collaboratively were considered for inclusion. Studies must have included 2 or more undergraduate and/or postgraduate learners working toward a professional health or social care qualification/degree at a university or college. Studies including lay, complementary and alternative, or non-health/social care learners were excluded. Due to the primary language of the research team, only English articles were included. METHODS The JBI 3-step process was followed for developing the search. Databases searched included MEDLINE (Ovid), CINAHL (EBSCOhost), Embase, Education Resource Complete (EBSCOhost), and Social Work Abstracts (EBSCOhost). The initial search was conducted on February 11, 2021, and was updated on May 17, 2022. Title and abstract screening and data extraction were completed by 2 independent reviewers. Disagreements were resolved through discussion or with a third reviewer. Results are presented in tabular or diagrammatic format, together with a narrative summary. RESULTS Thirteen studies were included in the scoping review, with a range of methodologies and designs (pre/post surveys, qualitative, feasibility, mixed methods, cross-sectional, quality improvement, and methodological triangulation). The majority of papers were from the United States (n=8; 61.5%). All but 1 study used simulation-enhanced interprofessional education as the preferred method to teach interprofessional cohorts of learners how to break bad news. The bulk of simulations were face-to-face (n=11; 84.6%). Three studies (23.1%) were reported as high fidelity, while the remainder did not disclose fidelity. All studies that used simulation to teach students how to break bad news utilized simulated participants/patients to portray patients and/or family in the simulations. The academic level of participants varied, with the majority noted as undergraduate (n=7; 53.8%); 3 studies (23.1%) indicated a mix of undergraduate and graduate participants, 2 (15.4%) were graduate only, and 1 (7.7%) was not disclosed. There was a range of health professional programs represented by participants, with medicine and nursing equally in the majority (n=10; 76.9%). CONCLUSIONS Simulation-enhanced interprofessional education was the most reported teaching approach to teach interprofessional cohorts of students how to break bad news collaboratively. Inconsistencies were noted in the language used to describe bad news, use of breaking bad news and interprofessional competency frameworks, and integration of interprofessional education and simulation best practices. Further research should focus on other interprofessional approaches to teaching how to break bad news; how best to incorporate interprofessional competencies into interprofessional breaking bad news education; whether interprofessional education is enhancing collaborative breaking bad news; and whether what is learned about breaking bad news is being retained over the long-term and incorporated into practice. Future simulation-specific research should explore whether and how the Healthcare Simulation Standards of Best Practice are being implemented and whether simulation is resulting in student satisfaction and enhanced learning.
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Affiliation(s)
- Kelly Lackie
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Stephen Miller
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Marion Brown
- School of Social Work, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Amy Mireault
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
| | - Melissa Helwig
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
- W.K. Kellogg Health Sciences Library, Dalhousie University, Halifax, NS, Canada
| | - Lorri Beatty
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Leanne Picketts
- Centre for Collaborative Clinical Learning and Research, Dalhousie University, Halifax, NS, Canada
| | - Peter Stilwell
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Shauna Houk
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
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Aluce LM, Cooper JJ, Emlet LL, Cohen ER, Ostrowski SJ, Wood GJ, Vermylen JH. Bringing competency-based communication training to scale: A multi-institutional virtual simulation-based mastery learning curriculum for Emergency Medicine residents. MEDICAL TEACHER 2024:1-8. [PMID: 38803304 DOI: 10.1080/0142159x.2024.2345267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/16/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Serious illness communication skills are essential for physicians, yet competency-based training is lacking. We address scalability barriers to competency-based communication skills training by assessing the feasibility of a multi-center, virtual simulation-based mastery learning (vSBML) curriculum on breaking bad news (BBN). METHODS First-year emergency medicine residents at three academic medical centers participated in the virtual curriculum. Participants completed a pretest with a standardized patient (SP), a workshop with didactics and small group roleplay with SPs, a posttest with an SP, and additional deliberate practice sessions if needed to achieve the minimum passing standard (MPS). Participants were assessed using a previously published BBN assessment tool that included a checklist and scaled items. Authors compared pre- and posttests to evaluate the impact of the curriculum. RESULTS Twenty-eight (90%) of 31 eligible residents completed the curriculum. Eighty-nine percent of participants did not meet the MPS at pretest. Post-intervention, there was a statistically significant improvement in checklist performance (Median= 93% vs. 53%, p < 0.001) and on all scaled items assessing quality of communication. All participants ultimately achieved the MPS. CONCLUSIONS A multi-site vSBML curriculum brought all participants to mastery in the core communication skill of BBN and represents a feasible, scalable model to incorporate competency-based communication skills education in a widespread manner.
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Affiliation(s)
- Laurie M Aluce
- Instructor of Medicine and Emergency Medicine, Department of Medicine and Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Julie J Cooper
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
- Academic Faculty, Department of Emergency Medicine, ChristianaCare, Newark, DE, USA
| | - Lillian Liang Emlet
- Department of Critical Care Medicine and Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Elaine R Cohen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Simon J Ostrowski
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gordon J Wood
- Department of Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Julia H Vermylen
- Department of Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Gagnerie P, Sanges S, Guerreschi P, Wiel E, Lebuffe G, Sanctorum T, Jourdain M, Morell-Dubois S, Zéphir H. Training first-year medical residents to break bad news using healthcare role-play and trainees as simulated patients: Experience of the "ADIAMED" program from Lille University School of Medicine. Rev Med Interne 2023; 44:632-640. [PMID: 37923588 DOI: 10.1016/j.revmed.2023.10.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Several studies suggest the relevance of healthcare simulation to prepare future doctors to deliver bad news. A such, we designed a role-play workshop to train first-year residents enrolled in Lille University School of Medicine to break bad news. The objective of this work is to report on our experience of this training and to assess its educational value through its capacity to satisfy residents' expectations, to induce a feeling of ease towards bad news disclosure, and to change trainees' preconceptions regarding these situations. METHODS The training consisted of a 45-minute heuristic reflective activity, aimed at identifying residents' preconceptions regarding bad news disclosure, followed by 4 30-min role-plays in which they played the parts of the physician, the patient and/or their relatives. Trainees were asked to answer 2 questionnaires (pre- and post-training), exploring previous experiences, preconceived ideas regarding bad news disclosure and workshop satisfaction. RESULTS Almost all residents felt very satisfied with the workshop, which they regarded as formative (91%) and not too stressful (89%). The majority felt "more capable" (53% vs. 83%) and "more comfortable" (27% vs. 62%) to deliver bad news, especially regarding "finding the right words" (12% vs. 22%). Trainees tended to overestimate their skills before the workshop and lowered their assessment of their performance after attending the training, especially when they played the role of a patient in the simulation. CONCLUSION Healthcare role-play seems an interesting technique for training to breaking bad news. Placing residents in the role of patients or relatives is an active approach that encourages reflexivity.
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Affiliation(s)
- P Gagnerie
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France
| | - S Sanges
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France; Université de Lille, Inserm, CHU de Lille, Département de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France.
| | - P Guerreschi
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Département de Chirurgie Plastique, Inserm, CHU de Lille, 59000 Lille, France
| | - E Wiel
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Université de Lille, CHU de Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, 59000 Lille, France; Pôle de l'Urgence, CHU de Lille, 59000 Lille, France
| | - G Lebuffe
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France; Pôle d'anesthésie réanimation - ULR 7365-GRITA - groupe de recherche sur les formes injectables et les techniques associées, Université de Lille, CHU de Lille, 59000 Lille, France
| | - T Sanctorum
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France
| | - M Jourdain
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France; Université de Lille, Inserm, CHU de Lille, U1190, Department of Intensive Care Medicine, 59000 Lille, France
| | - S Morell-Dubois
- Université de Lille, Inserm, CHU de Lille, Département de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France
| | - H Zéphir
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Département de Neurologie, CHU de Lille, 59000 Lille, France; Université de Lille, Inserm U 1172, CHU de Lille, 59000 Lille, France
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Connell L, Finn Y, Sixsmith J. Health literacy education programmes developed for qualified health professionals: a scoping review. BMJ Open 2023; 13:e070734. [PMID: 36997248 PMCID: PMC10069593 DOI: 10.1136/bmjopen-2022-070734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES Both literature and policy have identified the need for health literacy education for qualified health professionals. This study aimed to identify and map health literacy competencies and health literacy related communication skills educational interventions for qualified health professionals. The research questions included: Of the qualified health professional education interventions identified, which are focused on diabetes care? What health literacy competencies and health literacy related communication skills are integrated into each programme? What are the characteristics of each education programme? What were the barriers and facilitators to implementation? What methods are used to evaluate intervention effectiveness, if any? DESIGN Scoping review, informed by the Joanna Briggs Institute guidelines. DATA SOURCES The following databases: OVID; CINAHL; Cochrane; EMBASE; ERIC: PsycInfo; RIAN; Pro-Quest; UpToDate were searched. ELIGIBILITY CRITERIA Articles were included if the education programme focused on qualified health professionals, in all clinical settings, treating adult patient populations, of all study types. DATA EXTRACTION AND SYNTHESIS Two authors independently screened titles, abstracts and full text articles that met the inclusion criteria. The third author mediated any discrepancies. The data were extracted and charted in table format. RESULTS In total, 53 articles were identified. One article referred to diabetes care. Twenty-six addressed health literacy education, and 27 addressed health literacy related communication. Thirty-five reported using didactic and experiential methods. The majority of studies did not report barriers (N=45) or facilitators (N=52) to implementation of knowledge and skills into practice. Forty-nine studies evaluated the reported education programmes using outcome measures. CONCLUSIONS This review mapped existing education programmes regarding health literacy and health literacy related communication skills, where programme characteristics were identified to inform future intervention development. An evident gap was identified regarding qualified health professional education in health literacy, specifically in diabetes care.
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Affiliation(s)
- Lauren Connell
- Health Promotion Research Centre (HPRC), University of Galway, Galway, Ireland
- Alliance for Research and Innvoation in Wounds (ARIW), University of Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
| | - Yvonne Finn
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Jane Sixsmith
- Health Promotion Research Centre (HPRC), University of Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
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Lagunas M, Petit SD, Deming J, Horecki P, Brustad R, Manz JW, Okuno SH, Christensen SM. Letter to the Editor: The Effectiveness of Empathic Communication Training on Goals of Care and End-of-Life Conversations. J Palliat Med 2022; 25:1616-1617. [PMID: 36608318 DOI: 10.1089/jpm.2022.0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Meg Lagunas
- College of Nursing and Health Sciences, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | | | - James Deming
- Mayo Clinic College of Medicine and Science, Palliative Medicine, Eau Claire, Wisconsin, USA
| | | | | | - James W Manz
- Mayo Clinic College of Medicine and Science, Palliative Medicine, Eau Claire, Wisconsin, USA
| | - Scott H Okuno
- Mayo Clinic College of Medicine and Science, Palliative Medicine, Eau Claire, Wisconsin, USA
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Vitto C, Del Buono B, Daniel L, Rivet E, Cholyway R, Santen SA. Teaching Toolbox: Breaking Bad News with Virtual Technology in the Time of COVID. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1429-1432. [PMID: 33851370 PMCID: PMC8043776 DOI: 10.1007/s13187-021-01975-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 05/13/2023]
Abstract
Breaking bad news is a key component of the physicians' work. Traditionally, breaking bad news has been encouraged to be performed in person whenever possible (Monden et al. Proc (Bayl Univ Med Cent) 29(1):101-102, 2016; Nickson 2019). The common practice prior to the pandemic can be summarized by "The first rule of breaking bad news is: do not do it over the phone." It is important to be present with the family and provide support through compassion and empathy. Until recently, virtual communication technology for serious medical discussions was rare and primarily used when compelled by circumstances such as distance. The COVID-19 pandemic has transformed our ability to deliver news in person and has required the medical community to increase the utilization of telephone and video conferencing to communicate with patients and their family members. Breaking bad news through virtual media is a new skill in need of further guidance and education regarding how to set up the conversation, provide empathy, and lend support (Wolf et al., Oncologist 25(6):e879-e880, 2020). Therefore, we have created a teaching toolbox to help educate healthcare providers on how to deliver bad news by phone or video.
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Affiliation(s)
| | | | - Lily Daniel
- Virginia Commonwealth University, Richmond, VA, USA
| | - Emily Rivet
- Virginia Commonwealth University, Richmond, VA, USA
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Kayrouz R, Schofield C, Nielssen O, Karin E, Staples L, Titov N. A Review and Clinical Practice Guideline for Health Professionals Working With Indigenous and Culturally and Linguistically Diverse (CALD) Populations During COVID-19. Front Public Health 2021; 9:584000. [PMID: 34249822 PMCID: PMC8267873 DOI: 10.3389/fpubh.2021.584000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background: As the rates of infection and mortality from COVID-19 have been higher in minority groups, the communication of health information in a way that is understood and accepted is of particular importance. Aims: To provide health professionals with a clinical practice guideline for clear and culturally sensitive communication of health information about COVID-19 to people of Indigenous and culturally and linguistically diverse (CALD) backgrounds. Assessment of Guideline Options: The authors conducted a review of the literature on health communication, and the guidelines were developed with particular reference to the SPIKES protocol of “breaking bad news” in oncology and the use of the DSM-5 Cultural Formulation Interview (CFI). Actionable Recommendations: The guideline combines two approaches, the Cultural Formulation Interview, developed for DSM-5, and the SPIKES protocol used for delivering “bad news” in oncology. The combined CFI-SPIKES protocol is a six-step clinical practice guideline that includes the following: (1) Set up (S) the interview; (2) Determine how the patient perceives the problem (P) using the Cultural Formulation Interview (CFI) to elicit the patient's cultural perception of the problem; (3) Obtain an invitation (I) from the patient to receive a diagnosis; (4) Provide the patient knowledge (K) of diagnosis in a non-technical way; (5) Address the patient's emotional reaction (E) to diagnosis; and (6) Provide the patient a summary (S) of healthcare and treatment. Conclusions and Relevance: This article presents guidelines for assessing the cultural dimensions of patients' understanding of COVID-19 and delivering diagnostic and treatment recommendations in ways that are culturally safe and responsive, such as: (a) suspending the clinician's own cultural biases to understand the explanatory models and cultural values of their CALD or Indigenous patients; (b) encouraging the use of interpreters or cultural brokers to ensure that that the message is delivered in a way that the patient can understand; and (c) encouraging CALD or Indigenous patient to take an active part in the solution and treatment adherence, to minimize transmission of COVID-19 in CALD and Indigenous communities.
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Affiliation(s)
- Rony Kayrouz
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia.,eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | | | - Olav Nielssen
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia
| | - Eyal Karin
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia.,eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Lauren Staples
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia.,eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Nickolai Titov
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia.,eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
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Lehn A, Navaratnam D, Broughton M, Cheah V, Fenton A, Harm K, Owen D, Pun P. Functional neurological disorders: effective teaching for health professionals. BMJ Neurol Open 2020; 2:e000065. [PMID: 33681789 PMCID: PMC7903179 DOI: 10.1136/bmjno-2020-000065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/23/2020] [Accepted: 06/02/2020] [Indexed: 12/21/2022] Open
Abstract
Objectives To provide an outline for the delivery of an educational course or lecture about functional neurological disorders (FND) that is directed towards health professionals with varying clinical knowledge and to highlight the educational efficacy that can be derived from a well-designed educational platform. Method Through multidisciplinary collaboration, a course designed to develop the skills for diagnosis and management of FND was created. Elements essential to the delivery of education are: (A) knowledge creation; (B) facilitating multidisciplinary cross-pollination; (C) listening to patients’ experiences; (D) communication skills practice; (E) case studies; (F) discipline specific mentoring; (G) establishing and addressing participant learning goals and (H) developing collegial and referral networks. Changes in participants’ knowledge and clinical practice were assessed via anonymous questionnaires before and after the course. Results Dramatically improved knowledge and confidence in assessment and management of people with FND has been found both immediately following the course as well as on 6-month follow-up. Conclusion It is possible to make real change in the understanding and management of medical and allied health clinicians working with people with FND with a low-cost intervention. Also, the development of educational networks and multidisciplinary collaboration can lead to the creation of therapeutic platforms for the diagnosis, management and advocacy of this patient group.
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Affiliation(s)
- Alexander Lehn
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,The University of Queensland Princess Alexandra Hospital Clinical School, Woolloongabba, Queensland, Australia
| | | | - Megan Broughton
- Brisbane Clinical Neuroscience Centre, Brisbane, Queensland, Australia
| | - Vince Cheah
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Alison Fenton
- Active Rehabilitation, Brisbane, Queensland, Australia
| | - Karl Harm
- Active Rehabilitation, Brisbane, Queensland, Australia
| | - Diana Owen
- Mater Education Centre, Brisbane, Queensland, Australia
| | - Paul Pun
- Emotional Health Unit, Mater Misericordiae Health Services Brisbane Ltd, Brisbane, Queensland, Australia
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