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Lin J, Cook M, Siegel T, Marterre B, Chapman AC. Time is Short: Tools to Integrate Palliative Care and Communication Skills Education into Your Surgical Residency. JOURNAL OF SURGICAL EDUCATION 2023; 80:1669-1674. [PMID: 37385930 DOI: 10.1016/j.jsurg.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 07/01/2023]
Abstract
The need to integrate palliative care (PC) training into surgical education has been increasingly recognized. Our aim is to describe a set of PC educational strategies, with a range of requisite resources, time, and prior expertise, to provide options that surgical educators can tailor for different programs. Each of these strategies has been successfully employed individually or in some combination at our institutions, and components can be generalized to other training programs. Asynchronous and individually paced PC training can be provided using existing resources published by the American College of Surgeons and upcoming SCORE curriculum modules. A multiyear PC curriculum, with didactic components of increasing complexity for more advanced residents, can be applied based on available time in the didactic schedule and local expertise. Simulation-based training in PC skills can be developed to provide objective competency-based training. Finally, a dedicated rotation on a surgical palliative care service can provide the most immersive experience with steps toward clinical entrustment of PC skills for trainees.
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Affiliation(s)
- Joseph Lin
- Department of Surgery, University of California San Francisco, San Francisco, California; Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Mackenzie Cook
- Department of Surgery, Oregon Health & Science University, Portland, Oregon
| | - Timothy Siegel
- Department of Surgery, Oregon Health & Science University, Portland, Oregon; Division of Hematology/Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Buddy Marterre
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina; Section of Gerontology and Geriatric Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Allyson Cook Chapman
- Department of Surgery, University of California San Francisco, San Francisco, California; Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, California.
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Schultz K, Howard S, Moreno K, Siegel T, Zonies D, Brasel K, Cook M. What Should the Surgeons Do at the Family Meeting: A Multi-Disciplinary Qualitative Description of Surgeon Participation in Palliative Care Discussions. JOURNAL OF SURGICAL EDUCATION 2023; 80:110-118. [PMID: 36089480 DOI: 10.1016/j.jsurg.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/12/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE National guidelines have suggested that quality surgical care should incorporate effective palliative care (PC). Numerous barriers to surgeon participation remain and the domains of optimal surgeon participation are unclear. DESIGN Eight semi-structured and multi-professional focus groups with 34 total participants. Discussion was transcribed, and qualitative approaches were used to encode, identify, and categorize emergent themes. SETTING Oregon Health & Science University, Portland Oregon. A tertiary care teaching hospital. PARTICIPANTS 34 multi-disciplinary participants in eight focus groups, identified on a volunteer basis. RESULTS Key themes defining domains of optimal surgeon/palliative practice include: (1) "primary/secondary PC" which detailed conflict between the surgeon's desire to be part of palliative discussions and competing clinical/time demands. (2) "role/responsibility" described the tension surgeons feel around a desire to provide honest and goal concordant care (3) "teamwork/conflict" detailed the approach to disagreement among multidisciplinary teams. CONCLUSIONS In this qualitative analysis, emergent themes suggest that surgeons want to be involved in the PC of their patients but are limited by available time and competing for ethical obligations. Tension between competing communication and care obligations and PC goals is common, and discord around patient goals remains an issue. This work highlights the need for a standardized curriculum to improve the PC of surgical patients.
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Affiliation(s)
- Kristen Schultz
- Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, Oregon
| | - Shannon Howard
- Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, Oregon
| | - Kirstin Moreno
- Office of Educational Improvement Innovation, Oregon Health & Science University, Portland, Oregon
| | - Timothy Siegel
- Department of Medicine, Division of Hematology/Medical Oncology, Oregon Health & Science University, Portland, Oregon
| | - David Zonies
- Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, Oregon
| | - Karen Brasel
- Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, Oregon
| | - Mackenzie Cook
- Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, Oregon.
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Baloul MS, Lund S, D’Angelo J, Yeh VJH, Shaikh N, Rivera M. LEGO ®-based communication assessment in virtual general surgery residency interviews. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2022; 1:22. [PMID: 38013704 PMCID: PMC9171471 DOI: 10.1007/s44186-022-00021-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/03/2022] [Accepted: 05/11/2022] [Indexed: 10/27/2022]
Abstract
Purpose Effective communication skills are a critical quality and skill that is highly sought after for surgeons which largely impacts patient outcomes. Residency programs design their interview processes to select the best candidates. LEGO®-based activities have been frequently used to enhance communication skills and team building. This study investigates the effectiveness and reliability of a novel LEGO®-based communication assessment in interviews for surgical residencies and the feasibility of implementing it in a virtual setting. Methods This study conducted a retrospective analysis of a LEGO®-based communication assessment at the program's 2020/2021 residency interviews. Each applicant was assessed on a different model. The total scores were analyzed for consistency among raters and correlated to faculty interviews. Furthermore, the impact of the assessment structure, scoring criteria, and range of models' difficulties on the total scores were explored. Results A total of 54 categorical and 55 preliminary applicants interviewed on 2 days. The assessment on different models and had no impact on applicants' total scores for either categorical and preliminary groups (p = 0.791 and 0.709, respectively). The communication components of the assessment showed high consistency between the raters. The two applicant groups displayed a statistically significant difference (p = 0.004) in the communication evaluation and model accuracy components. Total scores did not correlate with the faculty interviews of standardized questions in either group. Conclusion This novel LEGO®-based communication assessment showed high reliability and promising results as a tool to assess communication and problem solving for residency interviews that can be readily implemented in a virtual setting. Supplementary Information The online version contains supplementary material available at 10.1007/s44186-022-00021-4.
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Affiliation(s)
| | - Sarah Lund
- Department of Surgery, Mayo Clinic, Rochester, MN USA
- Mayo Clinic Multidisciplinary Simulation Center, Rochester, MN USA
| | - Jonathan D’Angelo
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN USA
| | | | | | - Mariela Rivera
- Division of Trauma, Critical Care, and General Surgery, Department of Surgery, Mayo Clinic, 200 1st ST SW, Rochester, MN 55905 USA
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4
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Optimizing surgical education through the implementation of a feedback curriculum. Am J Surg 2022; 224:893-899. [DOI: 10.1016/j.amjsurg.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 11/21/2022]
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Schultz K, Howard S, Siegel T, Zonies D, Brasel K, Cook M, Moreno K. Supporting surgical residents learning clinical palliative care: Insights from multi-disciplinary focus groups. Am J Surg 2022; 224:676-680. [DOI: 10.1016/j.amjsurg.2022.02.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/26/2022] [Accepted: 02/25/2022] [Indexed: 12/18/2022]
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Topoll AB, Wagner JK, Salem KM, Levenson JE, Makaroun MS, Arnold RM. Improving Code Status Documentation Rates Using Communication Skills Training in Vascular Surgery: A Quality Improvement Initiative. J Palliat Med 2022; 25:628-635. [PMID: 34990280 DOI: 10.1089/jpm.2021.0364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Code status discussions are poorly understood by patients and variably performed by admitting providers, yet they are used as a quality metric. Surgical specialties, such as Vascular Surgery, admit patients with urgent and life-threatening illness. Surgical trainees are less likely to receive communication skills interventions when compared with nonsurgical specialties. Without a documented code status, nurses and physicians lack guidance on patient preference in the case of cardiopulmonary arrest and may deliver unwanted measures, which may also result in poor outcomes. Methods: We conducted a before-after Plan-Do-Study-Act quality improvement project between May 2018 and May 2019. A needs assessment included baseline code status documentation rates for the Vascular Surgery department admissions. A communication skills training (CST) and documentation intervention was provided to all Vascular Surgery trainees and advance practice providers (APPs). Departmental e-mails were sent over the 12-month intervention period, which demonstrated the code status documentation rates and served as reminders to document code status. Results: A total of 29 vascular surgery trainees and APPs received the intervention. At completion of the intervention, learners reported increased comfort initiating a code status discussion, making a recommendation for cardiopulmonary resuscitation (CPR) status, and having a strategy to discuss code status. A total of 2762 patient admissions were reviewed, with 1562 patient admissions occurring during the 12-month intervention period. The average code status documentation rate for the three months before the intervention was 7.8%. At the end of the 12-month intervention, documentation rates were 44.9% and 6 months after completion of the study period, average rates remained 45.2%. There was no change in admission rates during the study period. Discussion: CST and regular reminders increased vascular surgery residents' and APPs' comfort in engaging in code status discussions. After intervention, documentation of code status discussions increased with persistence up to six months after the intervention.
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Affiliation(s)
- Alicia B Topoll
- Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jason K Wagner
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Karim M Salem
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Joshua E Levenson
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michel S Makaroun
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Bader A. The Value of Preoperative Assessment. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00004-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Rock LK. Communication as a High-Stakes Clinical Skill: "Just-in-Time" Simulation and Vicarious Observational Learning to Promote Patient- and Family-Centered Care and to Improve Trainee Skill. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1534-1539. [PMID: 33769341 PMCID: PMC8541893 DOI: 10.1097/acm.0000000000004077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Patient-provider communication is a hallmark of high-quality care and patient safety; however, the pace and increasingly complex challenges that face overextended teams strain even the most dedicated clinicians. The COVID-19 pandemic has further disrupted communication between clinicians and their patients and families. The dependence on phone communication and the physical barriers of protective gear limit nonverbal communication and diminish clinicians' ability to recognize and respond to emotion. Developing new approaches to teach communication skills to trainees who are often responsible for communicating with patients and their families is challenging, especially during a pandemic or other crisis. "Just-in-time" simulation-simulation-based training immediately before an intervention-provides the scaffolding and support trainees need for conducting difficult conversations, and it enhances patients' and families' experiences. Using a realistic scenario, the author illustrates key steps for effectively using just-in-time simulation-based communication training: assessing the learner's understanding of the situation; determining what aspects of the encounter may prove most challenging; providing a script as a cognitive aid; refreshing or teaching a specific skill; preparing learners emotionally through reflection and mental rehearsal; coaching on the approach, pace, and tone for a delivery that conveys empathy and meaning; and providing specific, honest, and curious feedback to close a performance gap. Additionally, the author acknowledges that clinical conditions sometimes require learning by observing rather than doing and has thus provided guidance for making the most of vicarious observational learning: identify potential challenges in the encounter and explicitly connect them to trainee learning goals, explain why a more advanced member of the team is conducting the conversation, ask the trainee to observe and prepare feedback, choose the location carefully, identify everyone's role at the beginning of the conversation, debrief, share reactions, and thank the trainee for their feedback and observations.
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Affiliation(s)
- Laura K. Rock
- L.K. Rock is a pulmonologist and critical care doctor and director, Communication and Teamwork, Critical Care Medicine, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, and she is assistant professor of medicine, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0003-1462-1652
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Lin JA, Im CJ, O'Sullivan P, Kirkwood KS, Cook AC. The surgical resident experience in serious illness communication: A qualitative needs assessment with proposed solutions. Am J Surg 2021; 222:1126-1130. [PMID: 34565516 PMCID: PMC9365675 DOI: 10.1016/j.amjsurg.2021.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/04/2021] [Accepted: 09/13/2021] [Indexed: 11/21/2022]
Abstract
Background: Serious illness communication skills are important tools for surgeons, but training in residency is limited. Methods: Thirteen senior surgical residents at an academic center were interviewed about their experiences with serious illness communication. Conventional content analysis was performed using established communication frameworks and inductive development of themes. Results: Residents had frequent conversations and employed known communication strategies. Three themes highlighted challenges they face. Illness severity included factors attributed to the illness that made serious illness communication more challenging: symptoms, poor prognosis, and urgency. Knowledge and feelings included the factual understanding and emotional experience of residents, patients, and families. Academic structure included hierarchy and the residents’ dual role as learners and teachers. On reflection, residents identified needing greater experiential practice, analogous to learning procedural skills. Conclusions: Surgical residents regularly face serious illness conversations with little training beyond observation of role models. Dedicated training may help meet this need.
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Affiliation(s)
- Joseph A Lin
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA; Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Cecilia J Im
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Patricia O'Sullivan
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Kimberly S Kirkwood
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Allyson C Cook
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA; Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
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Kapadia MR, Kieran K. Being Affable, Available, and Able Is Not Enough: Prioritizing Surgeon-Patient Communication. JAMA Surg 2020; 155:277-278. [PMID: 32101264 DOI: 10.1001/jamasurg.2019.5884] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Muneera R Kapadia
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City
| | - Kathleen Kieran
- Division of Urology, Seattle Children's Hospital, Seattle, Washington.,Department of Urology, University of Washington, Seattle
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Kapadia MR, White AV, Peters L, Kreiter C, Koch KE, Rosenbaum ME. Teaching Patient-Related Communication to Surgical Residents in Brief Training Sessions. JOURNAL OF SURGICAL EDUCATION 2020; 77:1496-1502. [PMID: 32534941 DOI: 10.1016/j.jsurg.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Effective provider-patient communication has several benefits; however, few surgical residency programs have communication training and surgical residents have limited time for education. We developed a communication curriculum with limited didactics and emphasis on practice. Our objective was to evaluate whether this time-limited intervention led to changes in surgical resident communication skills. DESIGN A 4-module curriculum was implemented for surgical residents (PGY2-4). Each 30-minute module focused on specific communication micro-skills: empathy, concerns and expectations, chunking information and avoiding jargon, and teach-back. Modules included brief didactics, simulated patient interactions, feedback, and debriefing. Precurriculum, residents completed a 2-station objective structured clinical examination (OSCE) and a survey on communication confidence. Residents evaluated each module and postcurriculum, completed another 2-station OSCE, confidence survey, and overall curriculum evaluation. Using validated rating scales, OSCEs were scored by 2 independent raters. SETTING Tertiary care, academic center with a 5-year surgical residency program. PARTICIPANTS All 17 eligible residents completed both OSCEs and surveys, and 14 attended ≥3 modules. RESULTS Following the curriculum, residents reported increased use of the targeted skills and increased confidence in responding to emotions, information sharing, and bad news telling (p < 0.004). There was no change in history taking. Residents rated the usefulness of each module modestly (2.5-3.1, scale 0-4), however, the likelihood of skill implementation was higher (3.2-3.6). The overall postcurriculum OSCE scores increased (versus precurriculum scores, p < 0.001). Postcurriculum scores increased for empathy, concerns and expectations, and teach-back. Chunking information and avoiding jargon was unchanged. Fifteen residents reported module length as appropriate, and 2 thought they were too short. CONCLUSIONS The brief modules led to increased self-reported use of communication skills and were effective in improving resident communication in OSCEs. This may be a useful curricular model for both surgical and nonsurgical residency programs with limited availability for curricular time.
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Affiliation(s)
- Muneera R Kapadia
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina.
| | - Anna V White
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Lauren Peters
- Communication Studies, University of Iowa, Iowa City, Iowa
| | - Clarence Kreiter
- Department of Family Medicine, University of Iowa, Iowa City,Iowa
| | - Kelsey E Koch
- Department of Surgery, University of Iowa, Iowa City, Iowa
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Walsh D. Falling Into a Trap. MEDICAL SCIENCE EDUCATOR 2020; 30:995-996. [PMID: 34457758 PMCID: PMC8368676 DOI: 10.1007/s40670-020-00968-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- David Walsh
- Medical College of Georgia at Augusta University, Augusta, GA USA
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13
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Suwanabol PA, Vitous CA, Perumalswami CR, Li SH, Raja N, Dillon BR, Lee CW, Forman J, Silveira MJ. Surgery Residents' Experiences With Seriously-Ill and Dying Patients: An Opportunity to Improve Palliative and End-of-Life Care. JOURNAL OF SURGICAL EDUCATION 2020; 77:582-597. [PMID: 32063510 DOI: 10.1016/j.jsurg.2019.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/25/2019] [Accepted: 12/21/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe how and when surgery residents provided primary palliative care and engaged specialty palliative care services. DESIGN Phase I consisted of a previously validated survey instrument supplemented with additional questions. We then conducted semistructured interviews with a subset of the survey respondents (Phase II). Using thematic analysis, we characterized surgery residents' perceptions of palliative care delivery among surgical patients. SETTING General surgery residency programs across the state of Michigan. PARTICIPANTS General surgery residents across the state of Michigan. All residents in participating programs were invited to complete the survey in Phase I. Phase II consisted of a subset of the survey respondents who underwent semistructured interviews. Interview respondents were sampled to reflect the overall surveyed group. RESULTS Among 119 survey respondents (response rate 70%), all had encountered a palliative care specialist but only 58.8% had been taught when to consult or to refer to palliative care. Survey respondents reported on a multitude of barriers within the clinician, patient and family, and systemic domains. Interviews expanded on survey findings and 4 influential factors of palliative care delivery emerged: (1) Resident Education and Training; (2) Resident Attitudes Toward Palliative Care; (3) Knowledge of Palliative Care; and (4) Training within a Surgical Culture. CONCLUSIONS This study reveals how surgery resident training and experiences impact palliative and end-of-life care for surgical patients at teaching institutions. Knowledge of how and when residents are providing primary palliative care and engaging with palliative care services will inform future knowledge and behavioral interventions for trainees who often provide care for patients nearing the end of life.
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Affiliation(s)
- Pasithorn A Suwanabol
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
| | - C Ann Vitous
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Chithra R Perumalswami
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Sylvia H Li
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Nicholas Raja
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Christina W Lee
- Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Jane Forman
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Center for Clinical Management, Ann Arbor Veterans Affairs Health, Ann Arbor, Michigan
| | - Maria J Silveira
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Ruiz Moral R, García de Leonardo C, Cerro Pérez A, Caballero Martínez F, Monge Martín D. Barriers to teaching communication skills in Spanish medical schools: a qualitative study with academic leaders. BMC MEDICAL EDUCATION 2020; 20:41. [PMID: 32041592 PMCID: PMC7011270 DOI: 10.1186/s12909-020-1944-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/23/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND In recent years, Spanish medical schools (MSs) have incorporated training in communication skills (CS), but how this training is being carried out has not yet been evaluated. OBJECTIVE To identify the barriers to the introduction and development of CS teaching in Spanish MSs. METHODS In a previous study, 34 MSs (83% of all MSs in Spain) were invited to participate in a study that explored the factual aspects of teaching CS in these schools. The person responsible for teaching CS at each school was contacted again for this study and asked to respond to a single open-ended question. Two researchers independently conducted a thematic analysis of the responses. RESULTS We received responses from 30 MSs (85.7% of those contacted and 73% of all MSs in Spain). Five main thematic areas were identified, each with different sub-areas: negative attitudes of teachers and academic leaders; organisation, structure and presence of CS training in the curriculum; negative attitudes of students; a lack of trained teachers; and problems linked to teaching methods and necessary educational logistics. CONCLUSIONS The identified barriers and problems indicate that there are areas for improvement in teaching CS in most Spanish MSs. There seems to be a vicious circle based on the dynamic relationship and interdependence of all these problems that should be faced with different strategies and that requires a significant cultural shift as well as decisive institutional support at the local and national levels. The incorporation of CS training into MS curricula represents a major challenge that must be addressed for students to learn CS more effectively and avoid negative attitudes towards learning CS.
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Affiliation(s)
- Roger Ruiz Moral
- Department of Medical Education, School of Medicine, Faculty of Health Sciences, Universidad Francisco de Vitoria (UFV), Edificio E. Ctra M-515 Pozuelo-Majadahonda, 3028 Madrid, Spain
| | | | | | | | - Diana Monge Martín
- Family and Preventive Medicine, Epidemiology and Statistics, School of Health Sciences (UFV), Madrid, Spain
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Schleicher I, van der Mei SH, Mika J, Kreuder JG. [Teaching medical students informed consent]. Unfallchirurg 2019; 121:216-222. [PMID: 28083630 DOI: 10.1007/s00113-016-0298-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Teaching competencies in communication are important for medical education, but implementation in the surgical curriculum is still deficient. Communication during informed consent is one main issue. The aim of the study was to implement a reproducible teaching module for informed consent, which closely represents reality. MATERIAL AND METHODS In the existing practical surgical course we implemented a module for practising communication during surgical informed consent with the help of standardized patients and feedback rounds. The outcome was assessed during a clinical examination and the students evaluated the module. RESULTS The module was evaluated by the students positively and deemed helpful for their later work as a doctor. The outcome at clinical examination was 63% (mean) for content and structure of the informed consent and 92% for competency in communication. CONCLUSION For improving the quality of informed consent, teaching competencies in communication during informed consent should be implemented in the curriculum of medical studies, but legal and content-based aspects should not be ignored.
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Affiliation(s)
- I Schleicher
- Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Agaplesion Evangelisches Krankenhaus Mittelhessen in Gießen, Gießen, Deutschland.
| | - S H van der Mei
- Klinik für Psychosomatik und Psychotherapie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Gießen, Deutschland
| | - J Mika
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, operative Notaufnahme, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Gießen, Deutschland
| | - J G Kreuder
- Studiendekanat des Fachbereichs Humanmedizin, Justus-Liebig-Universität Gießen, Gießen, Deutschland
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Nakagawa S, Fischkoff K, Berlin A, Arnell TD, Blinderman CD. Communication Skills Training for General Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2019; 76:1223-1230. [PMID: 31005480 DOI: 10.1016/j.jsurg.2019.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/19/2019] [Accepted: 04/02/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Although good communication skills are essential for surgeons, there is no formal communication training during general surgery residency. OBJECTIVES To implement a communication skills training program based on evidence-based teaching methods in general surgery residency. DESIGN We developed a 2-hour communication skills training program for general surgery residents, consisting of a small group skill practice session using role play with simulated patients along with real-time feedback from facilitators and observing peer residents. A board-certified palliative care physician and a board-certified surgeon facilitated each session. Outcome measures were self-assessment of preparedness with the session immediately before and after the session and 2 months after the session, resident satisfaction, and self-report frequency of skill practice. Results were compared between junior residents (postgraduate year 1-3) and senior residents (postgraduate year 4-5). SETTING Columbia University Medical Center in New York City, a tertiary care, urban academic center with a 5-year General Surgery Residency program. PARTICIPANTS Thirty-one out of 39 (79.4%) general surgery residents (20 junior and 11 senior) were trained over a 9-month period. All participants completed the immediate pre- and post-session surveys, and twenty residents (64.5%) completed the 2-month postsession follow-up survey. RESULTS Overall, self-assessment of preparedness for specific communication challenges improved significantly for 7 of 11 tasks. At baseline, senior residents felt significantly more prepared than junior residents in all 11 tasks. Junior residents' self-assessment of preparedness improved significantly in 10 of 11 tasks. Overall satisfaction with the session was very high (mean 4.74 on a 5-point scale). Residents reported high frequency of self-directed skill practice in the 2-month follow-up survey. CONCLUSIONS This 2-hour communication skills practice session for general surgery residents was feasible, and it improved resident self-assessment of preparedness in communication and augmented self-directed skill practice.
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Affiliation(s)
- Shunichi Nakagawa
- Department of Medicine, Adult Palliative Care Services, Columbia University Medical Center, New York, New York.
| | - Katherine Fischkoff
- Department of Surgery, Division of General Surgery, Columbia University Medical Center, New York, New York
| | - Ana Berlin
- Department of Medicine, Adult Palliative Care Services, Columbia University Medical Center, New York, New York; Department of Surgery, Division of General Surgery, Columbia University Medical Center, New York, New York
| | - Tracey D Arnell
- Department of Surgery, Division of General Surgery, Columbia University Medical Center, New York, New York
| | - Craig D Blinderman
- Department of Medicine, Adult Palliative Care Services, Columbia University Medical Center, New York, New York
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Sanson-Fisher R, Hobden B, Carey M, Mackenzie L, Hyde L, Shepherd J. Interactional skills training in undergraduate medical education: ten principles for guiding future research. BMC MEDICAL EDUCATION 2019; 19:144. [PMID: 31092235 PMCID: PMC6521390 DOI: 10.1186/s12909-019-1566-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 04/22/2019] [Indexed: 05/10/2023]
Abstract
BACKGROUND High-quality healthcare requires practitioners who have technical competence and communication skills. Medical practitioners need interpersonal skills for gathering and transferring information to their patients, in addition to general consultation skills. Appropriate information gathering increases the likelihood of an accurate diagnosis. Transferring information should be performed in a way that promotes patient understanding and increases the probability of adherence to physician recommendations. This applies to: (i) primary prevention such as smoking cessation; (ii) secondary prevention including preparation for potentially threatening interventions; and (iii) tertiary care, including breaking bad news regarding treatment and prognosis. DISCUSSION This debate paper delineates factors associated with undergraduate medical communication skills training where robust research is needed. Ten key principles are presented and discussed, which are intended to guide future research in this field and ensure high quality studies with methodological rigour are conducted. The literature on communication skills training for medical school undergraduates continues to grow. A considerable portion of this output is represented by commentaries, descriptive studies or poorly designed interventions. As with any field of healthcare, quality research interventions are required to ensure practice is grounded in high-level evidence.
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Affiliation(s)
- Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Breanne Hobden
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Mariko Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Lisa Mackenzie
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Lisa Hyde
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Jan Shepherd
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
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Ruiz-Moral R, Gracia de Leonardo C, Caballero Martínez F, Monge Martín D. Medical students' perceptions towards learning communication skills: a qualitative study following the 2-year training programme. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2019; 10:90-97. [PMID: 31055522 PMCID: PMC6766390 DOI: 10.5116/ijme.5cbd.7e96] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/22/2019] [Indexed: 05/11/2023]
Abstract
OBJECTIVES This study aimed to gain an understanding of the perceptions of 4th-year medical students about a training course in communication skills with 'experiential learning' characteristics, completed over the past two years. METHODS Twenty 4th-year medical students were invited to participate in a qualitative study with focus groups. These students were selected randomly, stratifying by gender, from all 4th-year medical students (106) at the Francisco de Vitoria University (Madrid). The students had just completed their communication skills training taught in small groups, with simulated patient interviews and feedback. The focus-group facilitator used an open-ended discussion guide to explore the students' perceptions. Thematic analysis was used to identify salient themes from these discussions. RESULTS Sixteen students participated in two focus groups. The discussions revealed two contrasting perceptions: while this learning is considered useful, it nevertheless brings about a great deal of stress, especially regarding student exposure to peers in small-group sessions when interviewing standardised patients, and summative assessment. This generates a range of negative feelings in students that could affect perspective and attitude towards the importance of doctor-patient relationships. CONCLUSIONS Experiential learning is effective in improving students' communication skills. However, these results suggest that use of such strategies requires a strong focus on "student-centred" teaching approaches, in order to minimise some sensitive topics that may arise during the learning. Further research is needed to refine these strategies depending on the teaching situation and to identify different ways of implementing these experiential methods.
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Affiliation(s)
- Roger Ruiz-Moral
- Department of Medical Education, School of Medicine, Francisco de Vitoria University, Spain
| | | | | | - Diana Monge Martín
- Department of Statistic and Research, School of Medicine, Francisco de Vitoria University, Spain
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Møller JE, Malling BV. Workplace-based communication skills training in clinical departments: Examining the role of collegial relations through positioning theory. MEDICAL TEACHER 2019; 41:309-317. [PMID: 29703120 DOI: 10.1080/0142159x.2018.1464647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Studies suggest that the workplace is a key to understanding how clinical communication skills learning takes place and that medical communication skills need to be reinforced over time in order not to deteriorate. This study explored the perceptions of doctors in four hospital departments who participated in a workplace-based communication training project. Its specific focus was the relationship between collegial relations and learning communication skills. METHODS The study applied a qualitative design using an ethnographic methodology, i.e. interviews and observations. Positioning theory was used as the theoretical framework. RESULTS Training communication skills with colleagues in the actual workplace setting was valued by the participants who experienced more sharing of communication challenges, previously understood as something private one would not share with colleagues. However, collegial relations were also barriers for providing critical feedback, especially from junior doctors to their seniors. CONCLUSION The position as "colleague" both reinforced the communication skills training and hindered it. The communication skills educational model had a flat, non-hierarchical structure which disturbed the hierarchical structure of the workplace, and its related positions.
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Affiliation(s)
- Jane Ege Møller
- a Centre for Health Sciences Education , Aarhus University , Aarhus , Denmark
| | - Bente Vigh Malling
- a Centre for Health Sciences Education , Aarhus University , Aarhus , Denmark
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Chaudhry Z, Campagna-Vaillancourt M, Husein M, Varshney R, Roth K, Gooi A, Nguyen L. Perioperative Teaching and Feedback: How are we doing in Canadian OTL-HNS programs? J Otolaryngol Head Neck Surg 2019; 48:6. [PMID: 30654839 PMCID: PMC6337761 DOI: 10.1186/s40463-019-0330-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/08/2019] [Indexed: 11/10/2022] Open
Abstract
Background Discrepancies between resident and faculty perceptions regarding optimal teaching and feedback during surgery are well known but these differences have not yet been described in Otolaryngology - Head and Neck Surgery (OTL-HNS). The objectives were thus to compare faculty and resident perceptions of perioperative teaching and feedback in OTL-HNS residency programs across Canada with the aim of highlighting potential areas for improvement. Methods An anonymous electronic questionnaire was distributed to residents and teaching faculty in OTL-HNS across Canada with additional paper copies distributed at four institutions. Surveys consisted of ratings on a 5-point Likert scale and open-ended questions. Responses among groups were analysed with the Wilcoxon-Mann Whitney test, while thematic analysis was used for the open-ended questions. Results A total of 143 teaching faculty and residents responded with statistically significant differences on 11 out of 25 variables. Namely, faculty reported higher rates of pre and intra-operative teaching compared to resident reports. Faculty also felt they gave adequate feedback on residents’ strengths and technical skills contrary to what the residents thought. Both groups did agree however that pre-operative discussion is not consistently done, nor is feedback consistently given or sought. Conclusion Faculty and residents in OTL-HNS residency programs disagree on the frequency and optimal timing of peri-operative teaching and feedback. This difference in perception emphasizes the need for a more structured approach to feedback delivery including explicitly stating when feedback is being given, and the overall need for better communication between residents and staff.
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Affiliation(s)
- Z Chaudhry
- Department of Medicine, McGill University, Montreal, Canada
| | - M Campagna-Vaillancourt
- Department of Otolaryngology - Head and Neck Surgery, McGill University, 1001 Decarie Boulevard, Room A02-3015, Montreal, Quebec, H4A 3J1, Canada
| | - M Husein
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Canada
| | - R Varshney
- Department of Otolaryngology - Head and Neck Surgery, McGill University, 1001 Decarie Boulevard, Room A02-3015, Montreal, Quebec, H4A 3J1, Canada
| | - K Roth
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Canada
| | - A Gooi
- Department of Otolaryngology - Head and Neck Surgery, University of Manitoba, Winnipeg, Canada
| | - Lhp Nguyen
- Department of Otolaryngology - Head and Neck Surgery, McGill University, 1001 Decarie Boulevard, Room A02-3015, Montreal, Quebec, H4A 3J1, Canada. .,Centre for Medical Education, McGill University, Montreal, Canada.
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Affiliation(s)
- Mary Lou Jackson
- Vision Rehabilitation, Department of Opththalmology, Massachusetts Eye and Ear Infirmary, Harvard Department of Ophthalmology, 243 Charles Street, Boston, MA, 02114
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Bakke KE, Miranda SP, Castillo-Angeles M, Cauley CE, Lilley EJ, Bernacki R, Bader AM, Urman RD, Cooper Z. Training Surgeons and Anesthesiologists to Facilitate End-of-Life Conversations With Patients and Families: A Systematic Review of Existing Educational Models. JOURNAL OF SURGICAL EDUCATION 2018; 75:702-721. [PMID: 28939306 DOI: 10.1016/j.jsurg.2017.08.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/17/2017] [Accepted: 08/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Despite caring for patients near the end-of-life (EOL), surgeons and anesthesiologists report low confidence in their ability to facilitate EOL conversations. This discrepancy exists despite competency requirements and professional medical society recommendations. The objective of this systematic review is to identify articles describing EOL communication training available to surgeons and anesthesiologists, and to assess their methodological rigor to inform future curricular design and evaluation. METHODS This PRISMA-concordant systematic review identified English-language articles from PubMed, EMBASE, and manual review. Eligible articles included viewpoint pieces, and observational, qualitative, or case studies that featured an educational intervention for surgeons or anesthesiologists on EOL communication skills. Data on the study objective, setting, design, participants, intervention, and results were extracted and analyzed. The Newcastle-Ottawa Scale was used to assess methodological quality. RESULTS Database and manual search returned 2710 articles. A total of 2268 studies were screened by title and abstract, 46 reviewed in full-text, and 16 included in the final analysis. Fifteen studies were conducted exclusively in academic hospitals. Two studies included attending surgeons as participants; all others featured residents, fellows, or a mix thereof. Fifteen studies used simulated role-playing to teach and assess EOL communication skills. Measured outcomes included knowledge, attitudes, confidence, self-rated or observer-rated communication skills, and curriculum feedback; significance of results varied widely. Most studies lacked adequate methodological quality and appropriate control groups to be confident about the significance and applicability of their results. CONCLUSIONS There are few quality studies evaluating EOL communication training for surgeons and anesthesiologists. These programs frequently use role-playing to teach and assess EOL communication skills. More studies are needed to evaluate the effect of these interventions on patient outcomes. However, evaluating the effectiveness of these initiatives poses methodological challenges.
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Affiliation(s)
- Katherine E Bakke
- Department of Surgery, University of Massachusetts Medical School, Massachusetts, USA
| | - Stephen P Miranda
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Manuel Castillo-Angeles
- Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christy E Cauley
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Elizabeth J Lilley
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Rachelle Bernacki
- Department of Palliative Care and Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Angela M Bader
- Department of Surgery, University of Massachusetts Medical School, Massachusetts, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Center for Perioperative Research, Brigham and Women's Hospital, Boston, Massachusetts
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
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Newcomb A, Trickey AW, Lita E, Dort J. Evaluating Surgical Residents' Patient-Centered Communication Skills: Practical Alternatives to the "Apprenticeship Model". JOURNAL OF SURGICAL EDUCATION 2018; 75:613-621. [PMID: 28993121 DOI: 10.1016/j.jsurg.2017.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/24/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to assess communication skills and provide feedback to residents. We aimed to develop a feasible data collection process that generates objective clinical performance information to guide training activities, inform ACGME milestone evaluations, and validate assessment instruments. DESIGN Residents care for patients in the surgical clinic and in the hospital, and participate in a communication curriculum providing practice with standardized patients (SPs). We measured perception of resident communication using the 14-item Communication Assessment Tool (CAT), collecting data from patients at the surgery clinic and surgical wards in the hospital, and from SP encounters during simulated training scenarios. We developed a handout of CAT example behaviors to guide patients completing the communication assessment. SETTING Independent academic medical center. PARTICIPANTS General surgery residents. RESULTS The primary outcome is the percentage of total items patients rated "excellent;" we collected data on 24 of 25 residents. Outpatient evaluations resulted in significantly higher scores (mean 84.5% vs. 68.6%, p < 0.001), and female patients provided nearly statistically significantly higher ratings (mean 85.2% vs. 76.7%, p = 0.084). In multivariate analysis, after controlling for patient gender, visit reason, and race, (1) residents' CAT scores from SPs in simulation were independently associated with communication assessments in their concurrent patient population (p = 0.017), and (2) receiving CAT example instructions was associated with a lower percentage of excellent ratings by 9.3% (p = 0.047). CONCLUSIONS Our data collection process provides a model for obtaining meaningful information about resident communication proficiency. CAT evaluations of surgical residents by the inpatient population had not previously been described in the literature; our results provide important insight into relationships between the evaluations provided by inpatients, clinic patients, and SPs in simulation. Our example behaviors guide shows promise for addressing a common concern, minimizing ceiling effects when measuring physician-patient communication.
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Affiliation(s)
- Anna Newcomb
- Division of Trauma, Department of Surgery, Inova Fairfax Hospital, Falls Church, Virginia.
| | - Amber W Trickey
- Department of Surgery, Advanced Surgical Technology and Education Center, Inova Fairfax Hospital, Falls Church, Virginia; Department of Surgery, Stanford-Surgery Policy Improvement Research and Education Center, Stanford University, Stanford, California
| | - Elena Lita
- Division of Trauma, Department of Surgery, Inova Fairfax Hospital, Falls Church, Virginia
| | - Jonathan Dort
- Department of Surgery, Advanced Surgical Technology and Education Center, Inova Fairfax Hospital, Falls Church, Virginia
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See, Do, Teach? A Review of Contemporary Literature and Call to Action for Communication Skills Teaching in Urology. Urology 2018; 114:33-40. [DOI: 10.1016/j.urology.2017.10.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 09/22/2017] [Accepted: 10/24/2017] [Indexed: 11/30/2022]
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Lee JH, Quek BH, Hornik CP, Shahdadpuri R, Turner DA. Trainees’ perception of education in communication and professionalism across two programs in two countries. PROCEEDINGS OF SINGAPORE HEALTHCARE 2018. [DOI: 10.1177/2010105817715270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Different health care systems impact on medical education. Objective: We aim to describe the differences and similarities in the perceptions of pediatric residents on education in professionalism and communication skills across two countries. Methods: We conducted a cross-sectional survey of pediatric residents in the United States and Singapore. A 108-item written questionnaire on perceptions regarding education in communication/professionalism was administered. A five-point Likert scale was used for each attribute in the survey. Quantitative analysis was performed using chi-square test. Results: Response rate was 65.9% (89/135). In the domain of professionalism, residents from both countries ranked shared decision making as the most important attribute (Singapore vs. USA: 26/50 (52.0%) vs. 19/39 (48.7%), p = 0.76). In contrast, there was a difference in ranking of the most important attribute in communication between the two countries, with dealing with difficult family and patient being most important for Singapore trainees (30/50(60.0%) vs. 8/39 (20.5%), p < 0.001). Direct observation and feedback and role modeling by seniors were the most common teaching methods in both centers. Main barriers in learning were high workload (55/89 (61.8%)) and time constraints (53/89 (59.6%)) in both countries. Promoters of teaching these competencies were similar, with role modeling by senior staff rated as most important. Conclusions: This investigation demonstrates more differences in the perception of how communication is taught compared to professionalism across two countries. Barriers and promoters to teaching were similar across these two countries, with role modeling being an important approach to teaching communication and professionalism across both countries.
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Affiliation(s)
- Jan Hau Lee
- Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Bin Huey Quek
- Duke-NUS Medical School, Singapore, Singapore
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore, Singapore
- SingHealth Pediatrics Residency Program, Singapore Health Services, Singapore
| | - Christoph P Hornik
- Department of Pediatrics, Duke Children’s Hospital, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Raveen Shahdadpuri
- SingHealth Pediatrics Residency Program, Singapore Health Services, Singapore
- Department of Pediatrics, KK Women’s and Children’s Hospital, Singapore
| | - David A Turner
- Department of Pediatrics, Duke Children’s Hospital, Durham, NC, USA
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Schoenfeld EM, Goff SL, Elia TR, Khordipour ER, Poronsky KE, Nault KA, Lindenauer PK, Mazor KM. A Qualitative Analysis of Attending Physicians' Use of Shared Decision-Making: Implications for Resident Education. J Grad Med Educ 2018; 10:43-50. [PMID: 29467972 PMCID: PMC5821016 DOI: 10.4300/jgme-d-17-00318.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/10/2017] [Accepted: 09/24/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Physicians need to rapidly and effectively facilitate patient-centered, shared decision-making (SDM) conversations, but little is known about how residents or attending physicians acquire this skill. OBJECTIVE We explored emergency medicine (EM) attending physicians' use of SDM in the context of their experience as former residents and current educators and assessed the implications of these findings on learning opportunities for residents. METHODS We used semistructured interviews with a purposeful sample of EM physicians. Interviews were transcribed verbatim, and 3 research team members performed iterative, open coding of transcripts, building a provisional codebook as work progressed. We analyzed the data with a focus on participants' acquisition and use of skills required for SDM and their use of SDM in the context of resident education. RESULTS Fifteen EM physicians from academic and community practices were interviewed. All reported using SDM techniques to some degree. Multiple themes noted had negative implications for resident acquisition of this skill: (1) the complex relationships among patients, residents, and attending physicians; (2) residents' skill levels; (3) the setting of busy emergency departments; and (4) individual attending factors. One theme was noted to facilitate resident education: the changing culture-with a cultural shift toward patient-centered care. CONCLUSIONS A constellation of factors may diminish opportunities for residents to acquire and practice SDM skills. Further research should explore residents' perspectives, address the modifiable obstacles identified, and examine whether these issues generalize to other specialties.
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Abstract
OBJECTIVE To describe the existing science of palliative care in surgery within three priority areas and expose specific gaps within the field. BACKGROUND Given the acute and often life-limiting nature of surgical illness, as well as the potential for treatment to induce further suffering, surgical patients have considerable palliative care needs. Yet these patients are less likely to receive palliative care than their medical counterparts and palliative care consultations often occur when death is imminent, reflecting poor quality end-of-life care. METHODS The National Institutes of Health and the National Palliative Care Research Center convened researchers from several medical subspecialties to develop a national agenda for palliative care research. The surgeon work group reviewed the existing surgical literature to identify critical knowledge gaps. RESULTS To date, evidence to support the role of palliative care in surgical practice is sparse and palliative care research in surgery is encumbered by methodological challenges and entrenched cultural norms that impede appropriate provision of palliative care. Priorities for future research on palliative care in surgery include: 1) measuring outcomes that matter to patients, 2) communication and decision making, and 3) delivery of palliative care to surgical patients. CONCLUSIONS Surgical patients would likely benefit from early palliative care delivered alongside surgical treatment to promote goal-concordant decision making and to improve patients' physical, emotional, social and spiritual well-being and quality of life. We propose a research agenda to address major gaps in the literature and provide a road map for future investigation.
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Al Fayyadh MJ, Hassan RA, Tran ZK, Kempenich JW, Bunegin L, Dent DL, Willis RE. Immediate Auditory Feedback is Superior to Other Types of Feedback for Basic Surgical Skills Acquisition. JOURNAL OF SURGICAL EDUCATION 2017; 74:e55-e61. [PMID: 28865902 DOI: 10.1016/j.jsurg.2017.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/15/2017] [Accepted: 08/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We examined the effect of timing and type of feedback on medical students' knot-tying performance using visual versus auditory and immediate versus delayed feedback. We hypothesized that participants who received immediate auditory feedback would outperform those who received delayed and visual feedback. METHODS Sixty-nine first- and second-year medical students were taught to tie 2-handed knots. All participants completed 3 pretest knot-tying trials without feedback. Participants were instructed to tie a knot sufficiently tight to stop the "blood" flow while minimizing the amount of force applied to the vessel. Task completion time was not a criterion. Participants were stratified and randomly assigned to 5 experimental groups based on type (auditory versus visual) and timing (immediate versus delayed) of feedback. The control group did not receive feedback. All groups trained to proficiency. Participants completed 3 posttest trials without feedback. RESULTS There were fewer trials with leak (p < 0.01) and less force applied (p < 0.01) on the posttest compared to the pretest, regardless of study group. The immediate auditory feedback group required fewer trials to achieve proficiency than each of the other groups (p < 0.01) and had fewer leaks than the control, delayed auditory, and delayed visual groups (p < 0.02). CONCLUSIONS In a surgical force feedback simulation model, immediate auditory feedback resulted in fewer training trials to reach proficiency and fewer leaks compared to visual and delayed forms of feedback.
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Affiliation(s)
- Mohammed J Al Fayyadh
- Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas.
| | - Ramy A Hassan
- Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas
| | - Zachary K Tran
- Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas
| | - Jason W Kempenich
- Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas
| | - Leonid Bunegin
- Department of Anesthesiology, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas
| | - Daniel L Dent
- Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas
| | - Ross E Willis
- Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas
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Hickey TR, Cooper Z, Urman RD, Hepner DL, Bader AM. An Agenda for Improving Perioperative Code Status Discussion. ACTA ACUST UNITED AC 2017; 6:411-5. [PMID: 27301059 DOI: 10.1213/xaa.0000000000000327] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Code status discussions (CSDs) clarify patient preferences for cardiopulmonary resuscitation in the event of cardiac or respiratory arrest. CSDs are a key component of perioperative care, particularly at the end of life, and must be both patient-centered and shared. Physicians at all levels of training are insufficiently trained in and inappropriately perform CSD; this may be particularly true of perioperative physicians. In this article, we describe the difficulty of achieving a patient-centered, shared perioperative CSD in the case of a medical professional with a do-not-resuscitate order. We provide a brief background in cardiopulmonary resuscitation, do-not-resuscitate, and CSD before proposing an agenda for improving perioperative CSD.
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Affiliation(s)
- Thomas R Hickey
- From the *Yale University School of Medicine, Department of Anesthesiology, VA Connecticut Healthcare System, West Haven, Connecticut; †Department of Surgery, Division of Trauma, Burns, and Surgical Critical Care, and the Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; ‡Ariadne Labs, Boston, Massachusetts; §Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; and ‖Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Campbell S, Goltz HH, Njue S, Dang BN. Exploring the Reality of Using Patient Experience Data to Provide Resident Feedback: A Qualitative Study of Attending Physician Perspectives. Perm J 2016; 20:15-154. [PMID: 27400180 DOI: 10.7812/tpp/15-154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Little is known about the attitudes of faculty and residents toward the use of patient experience data as a tool for providing resident feedback. The purpose of this study was to explore the attitudes of teaching faculty surrounding patient experience data and how those attitudes may influence the feedback given to trainees. METHODS From July 2013 to August 2013, we conducted in-depth, face-to-face, semistructured interviews with 9 attending physicians who precept residents in internal medicine at 2 continuity clinics (75% of eligible attendings). Interviews were coded using conventional content analysis. RESULTS Content analysis identified six potential barriers in using patient experience survey data to provide feedback to residents: 1) perceived inability of residents to learn or to incorporate feedback, 2) punitive nature of feedback, 3) lack of training in the delivery of actionable feedback, 4) lack of timeliness in the delivery of feedback, 5) unclear benefit of patient experience survey data as a tool for providing resident feedback, and 6) lack of individualized feedback. CONCLUSION Programs may want to conduct an internal review on how patient experience data is incorporated into the resident feedback process and how, if at all, their faculty are trained to provide such feedback.
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Affiliation(s)
- Steffanie Campbell
- Assistant Professor of Medicine and an Associate Director of the Internal Medicine Residency Program at Baylor College of Medicine in Houston, TX.
| | - Heather Honoré Goltz
- Assistant Professor at the University of Houston-Downtown and Adjunct Assistant Professor in the Section of Infectious Diseases at Baylor College of Medicine in Houston, TX.
| | - Sarah Njue
- Research Coordinator in the Section of Infectious Diseases at Baylor College of Medicine in Houston, TX.
| | - Bich Ngoc Dang
- Assistant Professor of Medicine in the Section of Infectious Diseases at Baylor College of Medicine and an Investigator at the Center for Innovations in Quality, Effectiveness and Safety at the Michael E DeBakey VA Medical Center in Houston, TX.
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Lamba S, Tyrie LS, Bryczkowski S, Nagurka R. Teaching Surgery Residents the Skills to Communicate Difficult News to Patient and Family Members: A Literature Review. J Palliat Med 2016; 19:101-7. [DOI: 10.1089/jpm.2015.0292] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sangeeta Lamba
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Leslie S. Tyrie
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Sarah Bryczkowski
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Roxanne Nagurka
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
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Patki A, Puscas L. A Video-Based Module for Teaching Communication Skills to Otolaryngology Residents. JOURNAL OF SURGICAL EDUCATION 2015; 72:1090-4. [PMID: 26610354 DOI: 10.1016/j.jsurg.2015.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/19/2015] [Accepted: 07/13/2015] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To determine whether instructional videos modeling examples of "good" and "bad" patient communication skills are useful as an educational tool for improving resident-patient communication. DESIGN Retrospective study in which resident participants in the module gave survey responses indicating perceived utility of the exercise. SETTING Tertiary academic medical center. PARTICIPANTS A total of 11 otolaryngology trainees from postgraduate year 1-5 who attended the course over 2 separate sessions and provided feedback on the benefits of the module. RESULTS All 11 residents attended both sessions. Of 22 total survey responses, 21 found that the videos were "realistic and engaging" and were a true representation of commonly encountered clinical scenarios. Residents identified multiple themes and behaviors distinguishing "good" vs "bad" communication with patients and felt they could incorporate these into daily practice. A perceived weakness was the lack of opportunity for "role playing" with a video-based module as opposed to standardized patients. CONCLUSIONS Instructional videos, when realistic, are useful for modeling effective patient communication skills for residents. By watching the videos, residents are able to identify specific techniques they can incorporate into their daily practice.
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Affiliation(s)
- Aniruddha Patki
- Department of Surgery, Division of Head & Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina.
| | - Liana Puscas
- Department of Surgery, Division of Head & Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina.
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Wouda JC, van de Wiel HBM. Supervisors' and residents' patient-education competency in challenging outpatient consultations. PATIENT EDUCATION AND COUNSELING 2015; 98:1084-1091. [PMID: 26074498 DOI: 10.1016/j.pec.2015.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/07/2015] [Accepted: 05/11/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES We compared supervisors' and residents' patient-education competency in challenging consultations in order to establish whether supervisors demonstrate sufficient patient-education competency to act credibly as role models and coaches for residents. METHODS All consultations conducted at one, two, or three of the outpatient clinics of each of the participating physicians were videoed. Each participant selected two challenging consultations from each clinic for assessment. We assessed their patient-education competency using the CELI instrument, we calculated net consultation length for all videoed consultations and we measured patient opinion about the patient education received using a questionnaire. RESULTS Forty-four residents and fourteen supervisors participated in the study. They selected 230 consultations for assessment. On average, supervisors and residents demonstrated similar patient-education competency. Net consultation length was longer for supervisors. Patient opinion did not differ between supervisors and residents. CONCLUSIONS Supervising consultants generally do not possess sufficient patient-education competency to fulfill their teaching roles in workplace-based learning that is aimed at improving residents' patient-education competency. PRACTICE IMPLICATIONS Not only residents but also supervising consultants should improve their patient-education competency. Workplace-based learning consisting of self-assessment of and feedback on videoed consultations could be useful in attaining this goal.
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Affiliation(s)
- Jan C Wouda
- University of Groningen, University Medical Center Groningen, The Netherlands.
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Kensinger CD, McMaster WG, Vella MA, Sexton KW, Snyder RA, Terhune KP. Residents as Educators: A Modern Model. JOURNAL OF SURGICAL EDUCATION 2015; 72:949-956. [PMID: 26143515 PMCID: PMC4831619 DOI: 10.1016/j.jsurg.2015.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 03/31/2015] [Accepted: 04/06/2015] [Indexed: 06/01/2023]
Abstract
Education during surgical residency has changed significantly. As part of the shifting landscape, the importance of an organized and structured curriculum has increased. However, establishing this is often difficult secondary to clinical demands and pressure both on faculty and residents. We present a peer-assisted learning model for academic institutions without professional non-clinical educations. The "resident as educator" (RAE) model empowers residents to be the organizers of the education curriculum. RAE is built on a culture of commitment to education, skill development and team building, allowing the upper level residents to develop and execute the curriculum. Several modules designed to address junior level residents and medical students' educational needs have been implemented, including (1) intern boot camp, (2) summer school, (3) technical skill sessions, (4) trauma orientation, (5) weekly teaching conferences, and (4) a fourth year medical student surgical preparation course. Promoting residents as educators leads to an overall benefit for the program by being cost-effective and time-efficient, while simultaneously promoting professional development of residents and a culture of education.
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Affiliation(s)
- Clark D. Kensinger
- Vanderbilt University Medical Center, Department of General Surgery. 1161 21st Avenue South, D4313 MCN. Nashville, TN 37232, United States of America
| | - William G. McMaster
- Vanderbilt University Medical Center, Department of General Surgery. 1161 21st Avenue South, D4313 MCN. Nashville, TN 37232, United States of America
| | - Michael A. Vella
- Vanderbilt University Medical Center, Department of General Surgery. 1161 21st Avenue South, D4313 MCN. Nashville, TN 37232, United States of America
| | - Kevin W. Sexton
- Vanderbilt University Medical Center, Department of General Surgery. 1161 21st Avenue South, D4313 MCN. Nashville, TN 37232, United States of America
| | - Rebecca A. Snyder
- Vanderbilt University Medical Center, Department of General Surgery. 1161 21st Avenue South, D4313 MCN. Nashville, TN 37232, United States of America
| | - Kyla P. Terhune
- Vanderbilt University Medical Center, Department of General Surgery. 1161 21st Avenue South, D4313 MCN. Nashville, TN 37232, United States of America
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Braverman AM, Kunkel EJ, Katz L, Katona A, Heavens T, Miller A, Arfaa JJ. Do I Buy It? How AIDET™ Training Changes Residents' Values about Patient Care. J Patient Exp 2015; 2:13-20. [PMID: 28725811 PMCID: PMC5513607 DOI: 10.1177/237437431500200104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Acquiring communication and interpersonal skills is an important part of providing patient-centered care and improving patient satisfaction. This study explores whether residents' own values about patient communication can be influenced by training. METHODS As part of service excellence, a three-hour communication skills training in AIDET™ (Acknowledge, Introduce, Duration, Explanation, Thank You) was delivered to first and second Post-Graduate Year (PGY) residents (n = 123). A survey was designed to measure the value of patient communication and administered pre/post communication skills training. RESULTS Residents' scores about communication values improved significantly for all areas pre- to post-training for patient communication skills (p<0.04). After training, there was little difference by medical specialty, other than surgical specialties, which showed the greatest increase in valuing requesting permission (p=0.034). Gender was also not associated with differences in values, except men showed a greater increase in valuing sitting down (p=0.021) and introductions (p=0.005) than women who already valued these specific behaviors prior to training. CONCLUSIONS Residents value communication, and AIDET™ training is a useful tool to increase the values of good communication and interpersonal skills to enhance service excellence.
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Affiliation(s)
| | - Elisabeth J Kunkel
- Department of Psychiatry & Human Behavior, Thomas Jefferson University, Philadelphia, PA
| | - Leo Katz
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Austin Katona
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Teresa Heavens
- Director of Service Improvement & Volunteer Services, Jefferson's Methodist Hospital, Philadelphia, PA Associate Chief Medical Officer, Thomas Jefferson University, Philadelphia, PA
| | - Andrew Miller
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Jennifer Jasmine Arfaa
- Chief Patient Experience Officer, Thomas Jefferson University Hospital, Philadelphia, PA
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Ashraf B, Tasnim N, Saaiq M, Zaman KU. An audit of the knowledge and attitudes of doctors towards Surgical Informed Consent (SIC). Int J Health Policy Manag 2014; 3:315-21. [PMID: 25396207 DOI: 10.15171/ijhpm.2014.109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/26/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The Surgical Informed Consent (SIC) is a comprehensive process that establishes an information-based agreement between the patient and his doctor to undertake a clearly outlined medical or surgical intervention. It is neither a casual formality nor a casually signed piece of paper. The present study was designed to audit the current knowledge and attitudes of doctors towards SIC at a tertiary care teaching hospital in Pakistan. METHODS This cross-sectional qualitative investigation was conducted under the auspices of the Department of Medical Education (DME), Pakistan Institute of Medical Sciences (PIMS), Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad over three months period. A 19-item questionnaire was employed for data collection. The participants were selected at random from the list of the surgeons maintained in the hospital and approached face-to-face with the help of a team of junior doctors detailed for questionnaire distribution among them. The target was to cover over 50% of these doctors by convenience sampling. RESULTS Out of 231 respondents, there were 32 seniors while 199 junior doctors, constituting a ratio of 1:6.22. The respondents variably responded to the questions regarding various attributes of the process of SIC. Overall, the junior doctors performed poorer compared to the seniors. CONCLUSION The knowledge and attitudes of our doctors particularly the junior ones, towards the SIC are less than ideal. This results in their failure to avail this golden opportunity of doctor-patient communication to guide their patients through a solidly informative and legally valid SIC. They are often unaware of the essential preconditions of the SIC; provide incomplete information to their patients; and quite often do not ensure direct involvement of their patients in the process. Additionally they lack an understanding of using interactive computer-based programs as well as the concept of nocebo effect of informed consent.
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Affiliation(s)
- Bushra Ashraf
- Department of Obstetrics and Gynecology, Mother and Child Health Centre, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Nasira Tasnim
- Department of Obstetrics and Gynecology, Mother and Child Health Centre, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Muhammad Saaiq
- Department of Plastic Surgery and Burns, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Khaleeq-Uz- Zaman
- Departments of Neurosurgery and Medical Education, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
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Wouda JC, van de Wiel HBM. The effects of self-assessment and supervisor feedback on residents' patient-education competency using videoed outpatient consultations. PATIENT EDUCATION AND COUNSELING 2014; 97:59-66. [PMID: 24993839 DOI: 10.1016/j.pec.2014.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To determine the effects of residents' communication self-assessment and supervisor feedback on residents' communication-competency awareness, on their patient-education competency, and on their patients' opinion. METHODS The program consisted of the implementation of a communication self-assessment and feedback process using videoed outpatient consultations (video-CAF). Residents wrote down communication learning objectives during the instruction and after each video-CAF session. Residents' patient-education competency was assessed by trained raters, using the CELI instrument. Participating patients completed a questionnaire about the contact with their physician. RESULTS Forty-four residents and 21 supervisors participated in 87 video-CAF sessions. After their first video-CAF session, residents wrote down more learning objectives addressing their control and rapport skills and their listening skills. Video-CAF participation improved residents' patient-education competency, but only in their control and rapport skills. Video-CAF participation had no effect on patients' opinion. CONCLUSIONS Video-CAF appears to be a feasible procedure and might be effective in improving residents' patient-education competency in clinical practice. PRACTICE IMPLICATIONS Video-CAF could fill the existing deficiency of communication training in residency programs.
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Affiliation(s)
- Jan C Wouda
- University of Groningen, University Medical Center Groningen, The Netherlands.
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Lorenzen AW, Sherman SK, Rosenbaum M, Kapadia MR. Resident involvement in postoperative conversations: an underused opportunity. J Surg Res 2014; 190:437-44. [PMID: 24927930 DOI: 10.1016/j.jss.2014.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/26/2014] [Accepted: 05/07/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Because of established attending-patient and family relationships and time constraints, residents are often excluded from the immediate postoperative conversation with family. Interpersonal and communication skills are a core competency, and the postoperative conversation is an opportunity to develop these skills. Our objective is to assess attitudes, experience, and comfort regarding resident participation during postoperative conversations with families. MATERIALS AND METHODS Residents and attending surgeons in an academic surgery center were surveyed regarding resident involvement in the postoperative conversation with families. Paper surveys were administered anonymously. Nonparametric statistics compared responses. RESULTS There were 45 survey respondents (23 residents, 22 attendings). All residents rated postoperative conversations with families, as "important" or "very important". Residents reported being "comfortable" or "very comfortable" with postoperative conversations. However, on average, residents reported fewer than 10 postoperative conversation experiences per year. Feedback was received by <30% on postoperative communication skills, but 88% wanted feedback. Most attendings reported it is "important" or "very important" for residents to communicate well with families during postoperative conversations, but rated residents' performance as significantly lower than the residents' self-assessments (P < 0.001). Attendings on average were only "somewhat comfortable" or "moderately comfortable" with residents conducting postoperative conversations with families, and only 68% reported allowing residents to do so. When bad news was involved, only 27% allowed resident participation. Most attendings (86%) believed residents need more opportunities with postoperative conversations. CONCLUSIONS Although most residents reported being comfortable with postoperative conversations, these survey results indicate that they have few opportunities. Developing a workshop on communication skills focused on the postoperative conversations with families may be beneficial.
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Affiliation(s)
- Allison W Lorenzen
- Department of Surgery, University of Iowa, Carver College of Medicine, Iowa City, Iowa
| | - Scott K Sherman
- Department of Surgery, University of Iowa, Carver College of Medicine, Iowa City, Iowa
| | - Marcy Rosenbaum
- Department of Family Medicine, University of Iowa, Carver College of Medicine, Iowa City, Iowa
| | - Muneera R Kapadia
- Department of Surgery, University of Iowa, Carver College of Medicine, Iowa City, Iowa.
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Junod Perron N, Cullati S, Hudelson P, Nendaz M, Dolmans D, van der Vleuten C. Impact of a faculty development programme for teaching communication skills on participants’ practice. Postgrad Med J 2014; 90:245-50. [DOI: 10.1136/postgradmedj-2012-131700] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Regenbogen SE, Veenstra CM, Hawley ST, Hendren S, Ward KC, Kato I, Morris AM. The effect of complications on the patient-surgeon relationship after colorectal cancer surgery. Surgery 2013; 155:841-50. [PMID: 24787111 DOI: 10.1016/j.surg.2013.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 12/10/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Trust in physicians is an essential part of therapeutic relationships. Complications are common after colorectal cancer procedures, but little is known of their effect on patient-surgeon relationships. We hypothesized that unexpected complications impair trust and communication between patients and surgeons. METHODS We performed a population-based survey of surgically diagnosed stage III colorectal cancer patients in the Surveillance Epidemiology and End Results registries for Georgia and Metropolitan Detroit between August 2011 and October 2012. Using published survey instruments, we queried subjects about trust in and communication with their surgeon. The primary predictor was the occurrence of an operative complication. We examined patient factors associated with trust and communication then compared the relationship between operative complications and patient-reported trust and communication with their surgeons. RESULTS Among 622 preliminary respondents (54% response rate), 25% experienced postoperative complications. Those with complications were less likely to report high trust (73% vs 81%, P = .04) and high-quality communication (80% vs 95%, P < .001). Complications reduced trust among only 4% of patient-surgeon dyads with high-quality communication, whereas complications diminished patients' trust in 50% with poorer communication (P < .001). After controlling for communication ratings, we found there was no residual effect of complications on trust (P = .96). CONCLUSION Most respondents described trust in and communication with their surgeons as high. Complications were common and were associated with lower trust and poorer communication. However, the relationship between complications and trust was modified by communication. Trust remained high, even in the presence of complications, among respondents who reported high levels of patient-centered communication with their surgeons.
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Affiliation(s)
- Scott E Regenbogen
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI; Department of Surgery, University of Michigan, Ann Arbor, MI.
| | | | - Sarah T Hawley
- Cancer Surveillance & Outcomes Research Team, University of Michigan, Ann Arbor, MI
| | - Samantha Hendren
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI; Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Kevin C Ward
- Department of Epidemiology and Georgia Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Ikuko Kato
- Departments of Oncology and Pathology, Wayne State University School of Medicine, Detroit, MI
| | - Arden M Morris
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI; Department of Surgery, University of Michigan, Ann Arbor, MI; Cancer Surveillance & Outcomes Research Team, University of Michigan, Ann Arbor, MI
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Abstract
Several factors complicate the attainment of expertise in clinical communication. Medical curricula and postgraduate training insufficiently provide the required learning conditions of deliberate practice to overcome these obstacles. In this paper we provide recommendations for learning objectives and teaching methods for the attainment of professional expertise in patient education. Firstly, we propose to use functional learning objectives derived from the goals and strategies of clinical communication. Secondly, we recommend using teaching and assessment methods which: (1) contain stimulating learning tasks with opportunities for immediate feedback, reflection and corrections, and (2) give ample opportunity for repetition, gradual refinements and practice in challenging situations. Video-on-the-job fits these requirements and can be used to improve the competency in patient education of residents and medical staff in clinical practice. However, video-on-the-job can only be successful if the working environment supports the teaching and learning of communication and if medical staff which supervises the residents, is motivated to improve their own communication and didactic skills.
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Affiliation(s)
- Jan C Wouda
- University of Groningen, University Medical Centre, Groningen, The Netherlands.
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Leclercq WK, Keulers BJ, Houterman S, Veerman M, Legemaate J, Scheltinga MR. A survey of the current practice of the informed consent process in general surgery in the Netherlands. Patient Saf Surg 2013; 7:4. [PMID: 23336609 PMCID: PMC3804026 DOI: 10.1186/1754-9493-7-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 01/15/2013] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED Additional non-English language abstract (in Dutch) BACKGROUND A properly conducted surgical informed consent process (SIC) allows patients to authorize an invasive procedure with full comprehension of relevant information including involved risks. Current practice of SIC may differ from the ideal situation. The aim of this study is to evaluate whether SIC practiced by Dutch general surgeons and residents is adequate with involvement of all required elements. METHODS All members of the Dutch Society of Surgery received an online multiple choice questionnaire evaluating various aspects of SIC. RESULTS A total of 453 questionnaires obtained from surgeons and residents representing >95% of all Dutch hospitals were eligible for analysis (response rate 30%). Knowledge on SIC was limited as only 55% was familiar with all three basic elements ('assessment of preconditions', 'provision of information' and 'stage of consent'). Residents performance was inferior compared to surgeons regarding most aspects of daily practice of SIC. One in 6 surgeons (17%) had faced a SIC-related complaint in the previous five years possibly illustrating suboptimal SIC implementation in daily surgical practice. CONCLUSIONS The quality of the current SIC process is far from optimal in the Netherlands. Surgical residents require training aimed at improving awareness and skills. The SIC process is ideally supported using modern tools including web-based interactive programs. Improvement of the SIC process may enhance patient satisfaction and may possibly reduce the number of complaints. ACHTERGROND Het doel van het preoperatieve informed consent proces (surgical informed consent, SIC) is om patiënten een weloverwogen en welgeïnformeerde keuze te laten maken over hun operatieve ingreep. De hedendaagse praktijk betreffende SIC staat mogelijk ver van de ideale situatie af. Doel van deze studie is om de dagelijkse praktijk van chirurgen en chirurgen in opleiding betreffende SIC te evalueren en te zien of deze voldoet aan de daarvoor gestelde eisen. METHODE: Alle chirurgen en andere leden van de Nederlandse Vereniging voor Heelkunde ontvingen een online multiple-choice vragenlijst betreffende de belangrijkste aspecten van SIC. RESULTATEN: In totaal waren er 453 bruikbare reacties uit meer dan 95% van alle Nederlandse ziekenhuizen (respons 30%). De kennis over SIC blijkt zeer beperkt. Slechts 55% van de chirurgen bleek bekend met de drie basiselementen van SIC ('beoordelen van de competentie van een patiënt', 'verstrekken van informatie' and 'adequaat vastleggen van de toestemming van de patiënt'). De dagelijkse praktijk liet behoorlijke verschillen tussen alle respondenten zien, maar chirurgen in opleiding scoorden significant slechter vergeleken met chirurgen. 17% van alle chirurgen kreeg de afgelopen vijf jaar te maken met een klacht betreffende SIC, wat zou kunnen wijzen op een suboptimale implementatie van SIC in de dagelijkse praktijk. CONCLUSIE De kwaliteit van het preoperatieve informed consent proces is in Nederland verre van goed. Chirurgen in opleiding scoorden minder goed dan chirurgen en dienen beter geschoold te worden. Het hele SIC proces zou geformaliseerd moeten worden in protocollen. Moderne hulpmiddelen zoals interactieve softwareprogramma's kunnen hierbij mogelijk helpen. Door het verbeteren van het SIC proces kan de patiëntentevredenheid verhoogd worden terwijl het aantal klachten mogelijk wordt verminderd.
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Affiliation(s)
- Wouter Kg Leclercq
- Department of Surgery, Máxima Medical Centre, de run 4600, Veldhoven, 5504 DB, the Netherlands.
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Wouda JC, van de Wiel HBM. Education in patient-physician communication: how to improve effectiveness? PATIENT EDUCATION AND COUNSELING 2013; 90:46-53. [PMID: 23068910 DOI: 10.1016/j.pec.2012.09.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 08/30/2012] [Accepted: 09/16/2012] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Despite educational efforts expertise in communication as required by the CanMEDS competency framework is not achieved by medical students and residents. Several factors complicate the learning of professional communication. METHODS We adapted the reflective-impulsive model of social behaviour to explain the complexities of learning professional communication behaviour. We formulated recommendations for the learning objectives and teaching methods of communication education. Our recommendations are based on the reflective-impulsive model and on the model of deliberate practice which complements the reflective-impulsive model. Our recommendations are substantiated by those we found in the literature. RESULTS The reflective-impulsive model explains why the results of communication education fall below expectations and how expertise in communication can be attained by deliberate practice. The model of deliberate practice specifies learning conditions which are insufficiently fulfilled in current communication programmes. CONCLUSION The implementation of our recommendations would require a great deal of effort. Therefore we doubt whether expertise in professional communication can be fully attained during medical training. PRACTICE IMPLICATIONS We propose that the CanMEDS communication competencies not be regarded as endpoints in medical education but as guidelines to improve communication competency through deliberate practice throughout a professional career.
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Affiliation(s)
- Jan C Wouda
- Wenckebach Institute, University of Groningen, University Medical Center, Groningen, The Netherlands.
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Taylor D, Luterman A, Richards WO, Gonzalez RP, Rodning CB. Application of the core competencies after unexpected patient death: consolation of the grieved. JOURNAL OF SURGICAL EDUCATION 2013; 70:37-47. [PMID: 23337669 DOI: 10.1016/j.jsurg.2012.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 05/09/2012] [Accepted: 06/22/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To review and assess educational strategies and formats regarding communication with families/survivors in the aftermath of unexpected and untimely patient death. To propose an integrated curriculum designed and intended to foster proficiency, competence, confidence, and composure in relaying catastrophic information in the context of the professional experience of a cohort of seasoned surgeons. BACKGROUND Unexpected and untimely patient death is emotionally and psychologically wrenching for families, surgeons, and healthcare providers. We have previously proffered that 2 distinct, but interactive, phases of response are relevant when communicating with a family before and after the event: a proactive phase intended to establish a positive therapeutic relationship with the family; and a reactive phase intended to respond to the family in a compassionate and respectful manner and to ensure self-care for the physicians and health care providers. STUDY DESIGN Survey of a cohort of senior surgeons (membership of the Southern Surgical Association) and Surgical Residency Program Directors (membership of the Association of Program Directors in Surgery). RESULTS Sixty percent of the senior surgeons surveyed had experienced unexpected patient death. They advised strategies to cope with that clinical situation commensurate with the core competencies of the Accreditation Council for Graduate Medical Education: Medical Knowledge: maximize objective information/data and minimize subjective opinion; Patient Care: critique the events and conduct postmortem analyses; Interpersonal and Communication Skills: honesty, empathy, and patience; Professionalism: provide emotional and psychological support to family and personnel with privacy and in a nonaccusatory manner; Practice-Based Learning and Improvement: preoperative discussion and documentation in the context of informed consent and advanced directives vis-á-vis risk-benefit, effort-yield, and benefit-burden analyses; and Systems-Based Practice: involve chaplains and hospital personnel. Thirty-six percent of the graduate surgical educational programs surveyed allegedly provided educational venues to enable surgical residents to cope with unexpected patient death, although the formats were not specified. CONCLUSIONS Graduate, postgraduate, and continuing educational programs aspire to prepare physicians and surgeons for independent professional practice-scientifically, humanistically, and artistically. Incorporating educational strategies to enable graduates to cope with the emotional and psychological turmoil of unexpected patient death is relevant.
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Affiliation(s)
- Dan Taylor
- Department of Surgery, College of Medicine and Medical Center, University of South Alabama, Mobile, Alabama, USA
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Snyder RA, Tarpley MJ, Tarpley JL, Davidson M, Brophy C, Dattilo JB. Teaching in the operating room: results of a national survey. JOURNAL OF SURGICAL EDUCATION 2012; 69:643-649. [PMID: 22910164 DOI: 10.1016/j.jsurg.2012.06.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 05/30/2012] [Accepted: 06/07/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND With the institution of the work-hour restrictions in 2003, less time may be available for surgical residents to learn operative technique and judgment. While numerous studies have evaluated the use of surgical simulation training to enhance operative skills, little is known about the quality of teaching that takes place in the operating room (OR). The purpose of this study was to assess residents' perception of faculty teaching in the OR in order to target ways to improve operative education. METHODS A request for resident participation in an online survey was sent to the Program Coordinator at all 255 ACGME-accredited general surgery residency programs. RESULTS A total of 148 programs (59%) participated in the survey, and anonymous responses were submitted by 998 of 4926 residents (20%). Most residents reported that attending surgeons verbalize their operative approach (55%), include residents in intraoperative decisions (61%), and offer technical advice (84%). However, few residents reported that faculty help to identify the resident's personal educational operative goals preoperatively (18%) or discuss areas of improvement with residents (37%). Of all cases scrubbed in the past year, most residents feel as though they only actually performed the procedure between 26% and 50% (29%) or between 51% and 75% (32%) of the time. However, more than half of all residents (51%) log these procedures for ACGME as primary surgeon 76%-100% of the time. CONCLUSIONS This study demonstrates that from the residents' perspective, a number of opportunities exist to improve teaching in the OR, such as guiding residents with preoperative preparation and providing them with constructive feedback. These findings also suggest that residents may be logging cases without feeling as though they actually perform the operations.
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Affiliation(s)
- Rebecca A Snyder
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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Lin ML, Huang CT, Chiang HH, Chen CH. Exploring ethical aspects of elective surgery patients' decision-making experiences. Nurs Ethics 2012; 20:672-83. [PMID: 22918058 DOI: 10.1177/0969733012448967] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The practice of respecting patients' autonomy is rooted in the healthcare professionals' empathy for patients' situations, without which appropriate supports to the patients during the informed consent process may be remarkably moderated. The purpose of this study was to explore elective surgery patients' experiences during their decision-making process. This research was conducted using a phenomenological approach, and the data analysis was guided by Colaizzi's method. A total of 17 participants were recruited from a hospital in southern Taiwan. Two major themes emerged from the analyses: (a) a voluntary yet necessary alternative--to undergo a surgery and (b) alternatives compelled by the unalterable decision--the surgery. It was concluded that unless healthcare professionals can empathize with the distressed situation of their patients who are facing elective surgery, the practice of informed consent may become merely a routine. Nurses can be the best advocates for patients and facilitators to enhance communication between patients and healthcare personnel.
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Affiliation(s)
- Mei-Ling Lin
- National Cheng Kung University, Taiwan; National Changhua University of Education, Taiwan
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Peccoralo L, Karani R, Coplit L, Korenstein D. Pocket card and dedicated feedback session to improve feedback to ward residents: a randomized trial. J Hosp Med 2012; 7:35-40. [PMID: 22038842 DOI: 10.1002/jhm.934] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 03/22/2011] [Accepted: 03/28/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND Residents are often dissatisfied with feedback received on the wards, and hospital attendings are often uncomfortable and unskilled at giving feedback. OBJECTIVE Determine the impact of a pocket card and feedback session on Internal Medicine (IM) residents' perceptions of feedback and attendings' comfort giving feedback. DESIGN Prospective randomized trial using chi-square analysis. SETTING Inpatient wards at 1 academic medical center. PARTICIPANTS One hundred eleven IM residents and 36 attendings. INTERVENTION We introduced a pocket feedback card, structured around the Accreditation Council for Graduate Medical Education competencies, and a feedback session to guide mid-rotation feedback. Control group attendings received the usual reminder to provide feedback. MEASUREMENTS Attendings' and residents' survey responses, after the inpatient month, assessing attitudes towards feedback and qualitative interviews with intervention attendings. RESULTS Intervention residents were more likely than controls to report sufficient and useful feedback from attendings. They reported more feedback regarding skills needing improvement and how to improve their skills (51.3% vs 25.5%, P = 0.02), and felt their clinical (61.5% vs 27.8%, P = 0.001) and professionalism/communication (51.3% vs 29.1%, P = 0.03) skills improved based on this feedback. Intervention attendings, as compared to controls, agreed that residents improved their professionalism/communication skills (76.9% vs 31.1%, P = 0.02) based on feedback. Most intervention attendings found the card and session acceptable and would use both in the future. CONCLUSIONS A pocket feedback card and dedicated feedback session improved the quantity and quality of feedback delivered to IM residents by their attendings on the inpatient wards.
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Affiliation(s)
- Lauren Peccoralo
- Division of General Internal Medicine, Samual M. Bronfman Department of Internal Medicine, Mount Sinai School of Medicine, New York, New York.
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Nestel D, Cooper S, Bryant M, Higgins V, Tabak D, Murtagh G, Barraclough B. Communication challenges in surgical oncology. Surg Oncol 2011; 20:155-61. [DOI: 10.1016/j.suronc.2010.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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