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White D, Kilshaw L, Eng D. Communication skills: simulated patient goals of care workshop for acute care clinicians. BMJ Support Palliat Care 2024; 14:94-102. [PMID: 36347567 DOI: 10.1136/spcare-2022-003773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Appropriate and timely goals of patient care (GoPC) discussions are associated with improved health outcomes near the end-of-life among patients with serious illness, however, acute care clinicians report a lack of training in conducting GoPC conversations. OBJECTIVES A half-day GoPC communication workshop for acute care clinicians was delivered and evaluated. Participants were instructed in the use of communication frameworks and practiced skills in clinical scenarios with a simulated patient. METHOD Expert facilitators guided feedback towards learner identified goals during simulated GoPC discussions. Self-reported confidence in communication skills was measured with a pre-post questionnaire, which was repeated 2 months following the workshop. RESULTS 50 clinicians completed the workshop and questionnaire. A mean improvement in confidence in communication skills of 35% (p<0.001) was identified following participation, which remained elevated at 2 months (p<0.001). All participants responded that they would recommend the workshop to a colleague, and more than two-thirds went on to share their learnings with other clinicians. CONCLUSION The use of a simulated patient, communication frameworks and an expert facilitator were associated with durable improvement in confidence in GoPC communication among acute care clinicians. A half-day workshop was feasible and acceptable to participants.
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Affiliation(s)
- David White
- Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Lucy Kilshaw
- Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Derek Eng
- Palliative Care, Royal Perth Hospital, Perth, Western Australia, Australia
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Frydman JL, Gelfman LP, Farquhar D, Ramaswamy R, Dow LA. Goals, Values, and Priorities of Hospitalized Patients: Using a Structured Communication Tool to Engage Medical Students in Serious Illness Communication. J Palliat Med 2024; 27:99-103. [PMID: 37878370 DOI: 10.1089/jpm.2023.0281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
Background: To build third-year medical students' serious illness communication skills, we implemented a structured communication tool-the VALUES tool-focused on patients' goals, values, and priorities and described students' experiences using this tool. Methods: Medical students participated in a social worker-led VALUES didactic and discussion with a patient on the palliative care consult service and, subsequently, completed an anonymous survey about their comfort with the VALUES tool and its usefulness for learning (5-point Likert scales). Results: Of the 142 medical students who participated in the VALUES didactic, 37 completed the survey (26%). The VALUES tool was rated highly in terms of usefulness (mean 4.5; standard deviation [SD] 0.7) and rated lower in terms of overall comfort (mean 3.7; SD 0.7). Conclusion: Our project explored the integration of a VALUES tool into medical student education, and we show that the tool is well rated by learners in terms of comfort and usefulness.
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Affiliation(s)
- Julia L Frydman
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laura P Gelfman
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Diane Farquhar
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ravishankar Ramaswamy
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lindsay A Dow
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Goldhaber NH, Matson J, Luo W, Thareja N, Lopez N, Clary BM, Mekeel KL. Case Bias Case Basis: Expanding Morbidity and Mortality Conference to Examine the Impact of Disparities in Surgical Care. JOURNAL OF SURGICAL EDUCATION 2023; 80:1755-1761. [PMID: 37978011 DOI: 10.1016/j.jsurg.2023.10.002] [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: 03/31/2023] [Revised: 10/04/2023] [Accepted: 10/07/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Originally designed as a forum to discuss adverse patient events, Surgery Morbidity & Mortality Conference (M&M) has evolved into an integral tool within surgical education where trainees at all levels are taught to critically examine decision-making. Others have expanded the scope of subsets of M&M conferences to include additional factors that influence patient outcomes, such as social determinants of health, implicit bias and structural policies that contribute to health disparities. In this study, we implemented a disparities-based discussion into our surgical department's weekly M&M conference and examined the effect(s) on participants' understanding and perceptions of key disparities in access to surgical care. METHODS An anonymous electronic survey was sent to attendees of the Department of Surgery's M&M conference including faculty, residents and medical students prior to implementation of the intervention. The survey queried perceptions of the presence and impact of disparities in access to surgical care and how these are addressed at the study institution. The standard presenter slide template was updated to include a "Disparities Factors" section within the "Reasons for Complication" slide. After over 1 year, a postintervention survey was sent to conference attendees that included the same questions as the initial survey, as well as new questions related to the intervention. Descriptive statistics were performed on survey results, and comparisons were made for paired pre-post items. RESULTS Eighty conference attendees completed the pre-intervention survey, and 70 completed the postintervention survey (22 [27.5%]; 22 [31.4%] attendings, 24 [30.0%]; 21 [30.0%] residents, 34 [42.5%]; 27 [38.6%] medical students respectively). Socioeconomics and language were most commonly identified both pre- and postintervention as the most important factors contributing to disparities in care experienced by patients at the study institution. Respondents agreed disparities in access significantly impact surgical care, and there was an increase in the number of respondents who reported feeling that disparities are being addressed postintervention. A total of 69% (n = 48) of respondents thought that integrating discussion of disparities in access to surgical care into M&M improved their understanding of the role these disparities play, 66% (n = 46) felt that their own thinking or practice changed regarding patient disparities, 84% (n = 59) reported integrating these discussions of disparities into M&M has been helpful overall. CONCLUSION The inclusion of a disparities discussion in weekly M&M conference has led to positive change at the study institution, fostering a more comprehensive and socially conscious dialogue within the Department of Surgery. Survey respondents agreed that disparities exist in access to surgical care, and that the intervention improved their perceptions of how the study institution addresses disparities. Respondents felt that the integration of a disparities discussion was overall helpful, improved their knowledge of disparities in access to surgical care, and impacted their plans to address disparities in their own practices.
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Affiliation(s)
- Nicole H Goldhaber
- Department of Surgery, University of California, San Diego Health, La Jolla, California.
| | - Jared Matson
- Department of Surgery, University of California, San Diego Health, La Jolla, California
| | - William Luo
- School of Medicine, University of California, San Diego, La Jolla, California
| | - Nikita Thareja
- School of Medicine, University of California, San Diego, La Jolla, California
| | - Nicole Lopez
- Department of Surgery, University of California, San Diego Health, La Jolla, California
| | - Bryan M Clary
- Department of Surgery, University of California, San Diego Health, La Jolla, California
| | - Kristin L Mekeel
- Department of Surgery, University of California, San Diego Health, La Jolla, California
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Sobczak K, Trzciński M, Kotłowska A, Lenkiewicz J, Lenkiewicz O, Przeniosło J, Plenikowski J. Delivering Bad News: Emotional Perspective and Coping Strategies of Medical Students. Psychol Res Behav Manag 2023; 16:3061-3074. [PMID: 37576446 PMCID: PMC10417753 DOI: 10.2147/prbm.s421995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose The aim of our study was to analyze students' emotional experiences and coping mechanisms regarding the situation of delivering bad news (DBN). Patients and Methods 291 fifth- and sixth-year students from 14 medical universities took part in our study. Their responses were analyzed from the perspective of their experience - whether the individuals received bad news, delivered bad news themselves, witnessed bad news being delivered, or had no experience at all. We used content analysis (CA) to examine the responses and analyzed classified variables using χ2 tests, logistic regression, and predictive modeling with multiple correspondence analysis (MCA). Results Students who had experience as a deliverer were more likely to experience failure and guilt (p=0.005). Predictions of anxiety (59.3%), stress (41.9%), and sadness (33.7%) were the highest in the students with no DBN experience. These students were most likely to make statements suggesting lack of methods and strategies for coping with difficult emotions. Students, who were immersed in DBN experiences, more often expressed the need to talk about their emotions with an experienced doctor, a family member or a friend, and used those conversations as a coping strategy. Conclusion The most important aspects that influence the quality of delivering bad news are both communication skills and emotional context. Training regarding DBN should not only contain those two elements, but also consider the development of coping mechanisms.
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Affiliation(s)
- Krzysztof Sobczak
- Department of Sociology of Medicine & Social Pathology, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Trzciński
- Student Scientific Circle of Medical Communication, Medical University of Gdansk, Gdańsk, Poland
| | - Agata Kotłowska
- Student Scientific Circle of Medical Communication, Medical University of Gdansk, Gdańsk, Poland
| | - Julia Lenkiewicz
- Student Scientific Circle of Medical Communication, Medical University of Gdansk, Gdańsk, Poland
| | - Oliwia Lenkiewicz
- Student Scientific Circle of Medical Communication, Medical University of Gdansk, Gdańsk, Poland
| | - Julia Przeniosło
- Student Scientific Circle of Medical Communication, Medical University of Gdansk, Gdańsk, Poland
| | - Jan Plenikowski
- Student Scientific Circle of Medical Communication, Medical University of Gdansk, Gdańsk, Poland
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Frydman JL, Dow LA, Smith CB, Kelley AS, Lindenberger EC, Gelfman LP. Virtual Geritalk: Does Intensive Virtual Communication Skills Training Improve Use of Serious Illness Communication Skills? Am J Hosp Palliat Care 2023; 40:620-623. [PMID: 35857414 PMCID: PMC9979275 DOI: 10.1177/10499091221116078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: The COVID-19 pandemic presented a unique opportunity to adapt in-person communication skills training to a virtual format. Objective: Examine use of serious illness communication skills by learners after participating in an intensive virtual communication skills training. Design: Prospective cohort study. Setting/Subjects: Icahn School of Medicine at Mount Sinai, Clinical Fellows. Measurements: Family Meeting Communication Assessment Tool (FAMCAT) assessed fundamental and advanced communication skills. Results: As compared to a historical benchmark obtained after a prior in-person course, the virtual course showed equivalent or better use of communication skills across fundamental skills and advanced skills. Conclusions: Our findings suggest that a virtual communication skills training is associated with the use of serious illness communication skills in the clinical setting by learners.
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Affiliation(s)
- Julia L. Frydman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lindsay A. Dow
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Cardinale B. Smith
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy S. Kelley
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Elizabeth C. Lindenberger
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Geriatric Research, Education & Clinical Center, James J. Peters Veterans’ Affairs Medical Center, Bronx, NY
| | - Laura P. Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Geriatric Research, Education & Clinical Center, James J. Peters Veterans’ Affairs Medical Center, Bronx, NY
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Frey-Vogel AS, Ching K, Dzara K, Mallory L. The Acceptability of Avatar Patients for Teaching and Assessing Pediatric Residents in Communicating Medical Ambiguity. J Grad Med Educ 2022; 14:696-703. [PMID: 36591423 PMCID: PMC9765906 DOI: 10.4300/jgme-d-22-00088.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/08/2022] [Accepted: 09/27/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Simulation offers a means to assess resident competence in communication, but pediatric standardized patient simulation has limitations. A novel educational technology, avatar patients (APs), holds promise, but its acceptability to residents, educational relevance, and perception of realism have not been determined. OBJECTIVE To determine if APs are acceptable, provide a relevant educational experience, and are realistic for teaching and assessment of a complex communication topic. METHODS Pediatric residents at one academic institution participated in an AP experience from 2019 to 2021 consisting of 2 scenarios representing issues of medical ambiguity. After the experience, residents completed a survey on the emotional relevance, realism, and acceptability of the technology for assessment of their communication competence. RESULTS AP actor training required approximately 3 hours. Software and training was provided free of charge. Actors were paid $30/hour; the total estimated curricular cost is $50,000. Sixty-five of 89 (73%) pediatric residents participated in the AP experience; 61 (93.8%) completed the survey. Forty-eight (78.7%) were emotionally invested in the scenarios. The most cited emotions evoked were anxiety, uncertainty, concern, and empathy. The conversations were rated by 49 (80.3%) as realistic. APs were rated as beneficial for learning to communicate about medical ambiguity by 40 (65.5%), and 41 (66.7%) felt comfortable having APs used to assess their competence in this area. CONCLUSIONS Pediatric residents were emotionally invested in the AP experience and found it to be realistic. The experience was rated as beneficial for learning and acceptable to be used for assessment of how to communicate medical ambiguity.
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Affiliation(s)
- Ariel S. Frey-Vogel
- Ariel S. Frey-Vogel, MD, MAT, is Director, Pediatric Education, Innovation and Research Center, and Associate Program Director, Pediatric Residency Program, Harvard Medical School and Mass General for Children
| | - Kevin Ching
- Kevin Ching, MD, is Medical Director, Weill Cornell Medicine New York Presbyterian Simulation Center
| | - Kristina Dzara
- Kristina Dzara, PhD, MMSc, is Assistant Dean for Educator Development and Director, Center for Leadership and Innovation in Medical Education, Department of Biomedical Informatics and Medical Education, and Center for Leadership and Innovation in Medical Education, University of Washington School of Medicine
| | - Leah Mallory
- Leah Mallory, MD, is Medical Director, The Hannaford Center for Safety, Innovation, and Simulation, The Barbara Bush Children's Hospital at Maine Medical Center
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Brown J, Myers H, Eng D, Kilshaw L, Abraham J, Buchanan G, Eggimann L, Kelly M. Evaluation of the 'Talking Together' simulation communication training for 'goals of patient care' conversations: a mixed-methods study in five metropolitan public hospitals in Western Australia. BMJ Open 2022; 12:e060226. [PMID: 35922109 PMCID: PMC9353005 DOI: 10.1136/bmjopen-2021-060226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In partnership with Cancer Council Western Australia (WA), the East Metropolitan Health Service in Perth, WA has developed a clinical simulation training programme 'Talking Together' using role play scenarios with trained actors as patients/carers. The aim of the training is to improve clinicians' communication skills when having challenging conversations with patients, or their carers, in relation to goals of care in the event of clinical deterioration. METHODS AND ANALYSIS A multisite, longitudinal mixed-methods study will be conducted to evaluate the impact of the communication skills training programme on patient, family/carer and clinician outcomes. Methods include online surveys and interviews. The study will assess outcomes in three areas: evaluation of the 'Talking Together' workshops and their effect on satisfaction, confidence and integration of best practice communication skills; quality of goals of patient care conversations from the point of view of clinicians, carers and family/carers; and investigation of the nursing/allied role in goals of patient care. ETHICS AND DISSEMINATION This study has received ethical approval from the Royal Perth Hospital, St John of God and Curtin University Human Research Ethics Committees. The outputs from this project will be a series of research papers and conference presentations.
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Affiliation(s)
- Janie Brown
- Curtin School of Nursing, Curtin University, Perth, Western Australia, Australia
| | - Helen Myers
- Curtin School of Nursing, Curtin University, Perth, Western Australia, Australia
| | - Derek Eng
- Palliative Care, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Lucy Kilshaw
- Aged Care, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jillian Abraham
- East Metropolitan Health Service Executive, East Metropolitan Health Service, Perth, Western Australia, Australia
| | - Grace Buchanan
- Cancer Council Western Australia, Subiaco, Western Australia, Australia
| | - Liz Eggimann
- Cancer Council Western Australia, Subiaco, Western Australia, Australia
| | - Michelle Kelly
- Curtin School of Nursing, Curtin University, Perth, Western Australia, Australia
- Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Weill SR, Layden AJ, Nabozny MJ, Leahy J, Claxton R, Zelenski AB, Zimmermann C, Childers J, Arnold R, Hall DE. Applying VitalTalk TM Techniques to Best Case/Worst Case Training to Increase Scalability and Improve Surgeon Confidence in Shared Decision-making. JOURNAL OF SURGICAL EDUCATION 2022; 79:983-992. [PMID: 35246401 DOI: 10.1016/j.jsurg.2022.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/03/2022] [Accepted: 01/22/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Best Case/Worst Case (BC/WC) is a communication tool designed to promote shared decision-making for high-risk procedures near the end of life. This study aimed to increase scalability of a BC/WC training program and measure its impact on surgeon confidence in and perceived importance of the methodology. DESIGN A prospective cohort pre-post study; December 2018 to January 2019. SETTING Multi-center tertiary care teaching hospital. PARTICIPANTS Forty-eight resident surgeons from general surgery and otolaryngology. RESULTS Learners were 24 to 37 years old with 52% in post graduate year 1 to 2. Although learners encountered high-stakes communication (HSC) frequently (3.6 [0.7] on 5-point Likert scale), most reported no HSC training in medical school (74.5%) or residency (87.5%). BC/WC training was accomplished with an instructor to learner ratio of 1-to-5.3. After training, learner confidence improved on all measured communication skills on a 5-point scale (e.g., exploring patient's values increased from 3.6 [0.8] to 4.1 [0.6], p = <0.0001); average within-person improvement was 0.72 (0.6) points across all skills. Perceived importance improved across all skills (e.g., basing a recommendation on patient's values increased from 4.4 [0.8] to 4.8 [0.5], p = 0.0009); average within-person improvement was 0.46 (0.5) points across all skills. Learners reported this training would likely help them in future interactions (4.4 [0.73] on 5-point scale) and 95.2% recommended it be offered to resident physicians in other residency programs and to attending surgeons. CONCLUSIONS Formal training in BC/WC increases learners' perception of both the importance of HSC skills and their confidence in exercising those skills in clinical practice. VitalTalkTM methodology permitted scaling training to 5.3 learners per instructor and was highly recommended for other surgeons. Ongoing training, such as this, may support more patient-centered decision-making and care.
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Affiliation(s)
- Sydney R Weill
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Alexander J Layden
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Janet Leahy
- Department of General Medicine, Section of Palliative Care and Medical Ethics, UPMC, Pittsburgh, Pennsylvania
| | - Rene Claxton
- Department of General Medicine, Section of Palliative Care and Medical Ethics, UPMC, Pittsburgh, Pennsylvania
| | - Amy B Zelenski
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Chris Zimmermann
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Julie Childers
- Department of General Medicine, Section of Palliative Care and Medical Ethics, UPMC, Pittsburgh, Pennsylvania
| | - Robert Arnold
- Department of General Medicine, Section of Palliative Care and Medical Ethics, UPMC, Pittsburgh, Pennsylvania
| | - Daniel E Hall
- Department of Surgery, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania; The Wolff Center at UPMC, Pittsburgh, Pennsylvania; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Geriatric Research Educational and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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Edwards WF, Malik S, Peters J, Chippendale I, Ravits J. Delivering Bad News in Amyotrophic Lateral Sclerosis: Proposal of Specific Technique ALS ALLOW. Neurol Clin Pract 2022; 11:521-526. [PMID: 34992959 DOI: 10.1212/cpj.0000000000000957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 04/24/2020] [Indexed: 12/13/2022]
Abstract
Purpose of Review Physician communication skills are a critical part of care for amyotrophic lateral sclerosis (ALS) patients and caregivers. They shape the development of autonomy and quality of life, and they mitigate emotional trauma. Communication skills are especially critical at 2 different time points in the course of the disease: early when delivering and establishing the diagnosis, and later when clarifying goals of care. Recent Findings Several techniques for physician communication of difficult information are available, including SPIKES (Setting up the interview, assessing the patient's Perception, obtaining the patient's Invitation, giving Knowledge and information to the patient, addressing the patient's Emotions with Empathetic responses, and Strategy and Summary), ABCDE (Advance preparation, Build a therapeutic environment/relationship, Communicate well, Deal with patient and family reactions, Encourage and validate emotions), and BREAKS (Background, Rapport, Exploring, Announce, Kindling, Summarize). These emphasize the physician's accountability and responsibility for communicating effectively. Formal training in these techniques is limited, and their applicability specifically to ALS is inexact. Summary We propose an ALS-specific technique which we call ALS ALLOW to guide physicians in conducting difficult communications with ALS patients and caregivers to develop their understanding, establish autonomy, set goals, and mitigate emotional trauma. The techniques are useful in discussions both early and late stages in the disease.
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Affiliation(s)
- Wesleigh F Edwards
- University of California San Diego School of Medicine (WFE, SM, JP, IC, JR); Department of Internal Medicine (WFE), Scripps Green Hospital and Clinic, La Jolla, CA; Cooper Medical School of Rowan University (SM), Camden, NJ; Department of Neurosciences (JP, JR), University of California, San Diego; and University of New England College of Osteopathic Medicine (IC), Biddeford, ME
| | - Sahana Malik
- University of California San Diego School of Medicine (WFE, SM, JP, IC, JR); Department of Internal Medicine (WFE), Scripps Green Hospital and Clinic, La Jolla, CA; Cooper Medical School of Rowan University (SM), Camden, NJ; Department of Neurosciences (JP, JR), University of California, San Diego; and University of New England College of Osteopathic Medicine (IC), Biddeford, ME
| | - Jonathan Peters
- University of California San Diego School of Medicine (WFE, SM, JP, IC, JR); Department of Internal Medicine (WFE), Scripps Green Hospital and Clinic, La Jolla, CA; Cooper Medical School of Rowan University (SM), Camden, NJ; Department of Neurosciences (JP, JR), University of California, San Diego; and University of New England College of Osteopathic Medicine (IC), Biddeford, ME
| | - Ivy Chippendale
- University of California San Diego School of Medicine (WFE, SM, JP, IC, JR); Department of Internal Medicine (WFE), Scripps Green Hospital and Clinic, La Jolla, CA; Cooper Medical School of Rowan University (SM), Camden, NJ; Department of Neurosciences (JP, JR), University of California, San Diego; and University of New England College of Osteopathic Medicine (IC), Biddeford, ME
| | - John Ravits
- University of California San Diego School of Medicine (WFE, SM, JP, IC, JR); Department of Internal Medicine (WFE), Scripps Green Hospital and Clinic, La Jolla, CA; Cooper Medical School of Rowan University (SM), Camden, NJ; Department of Neurosciences (JP, JR), University of California, San Diego; and University of New England College of Osteopathic Medicine (IC), Biddeford, ME
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Rattani A, Kaakour AH. Screenplays and Screenwriting as an Innovative Teaching Tool in Medical Ethics Education. THE JOURNAL OF MEDICAL HUMANITIES 2021; 42:679-687. [PMID: 31808024 DOI: 10.1007/s10912-019-09584-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Innovation in ethics pedagogy has continued to evolve and incorporate other forms of storytelling aimed at improving student engagement and learning. The use of bioethics narratives in feature-length films, medical television shows, or short clips in the classroom has a well-established history. In parallel, screenplays present an opportunity for an active approach to ethical engagement. We argue that screenplays and screenwriting provide a rich supplement to current medical ethics teaching and serve as a strong form of reflective learning.
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Affiliation(s)
- Abbas Rattani
- Stritch School of Medicine, Loyola University Chicago, 2160 S 1st Ave, Maywood, IL, 60153, USA.
| | - Abdul-Hadi Kaakour
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, 1450 San Pablo St, Los Angeles, CA, 90033, USA
- Institute for Bioethics and Health Policy, Miller School of Medicine, University of Miami, P.O. Box 016960 (M-825), Miami, FL, 33101, USA
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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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Frydman JL, Hauck K, Lowy J, Gelfman LP. Improving the Care of Patients With Serious Illness: What Are the Palliative Care Education Needs of Internal Medicine Residents? Am J Hosp Palliat Care 2021; 38:1218-1224. [PMID: 33478256 PMCID: PMC9979276 DOI: 10.1177/1049909120987207] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Hospitalized patients with serious illness have significant symptom burden and face complex medical decisions that often require goals of care discussions. Given the shortage of specialty palliative care providers, there is a pressing need to improve the palliative care skills of internal medicine (IM) residents, who have a central role in the care of seriously ill patients hospitalized at academic medical centers. METHODS We conducted an anonymous survey of IM residents at a large, urban, academic medical center to identify which aspects of palliative care trainees find most important and their knowledge gaps in palliative care. The survey measured trainees' self-assessed degree of importance and knowledge of core palliative care skills and evaluated frequency of completing advance care planning documentation. RESULTS Overall, 51 (23%) IM residents completed the survey. The majority of trainees considered multiple palliative care skills to be "very important/important": symptom management, prognostication, introducing the palliative care approach, discussing code status, and breaking serious news. Across these same skills, trainees reported variable levels of knowledge. In our sample, trainees reported completing healthcare proxy forms and Medical Orders for Life-Sustaining Treatment infrequently. CONCLUSIONS IM trainees rated core palliative care skills as important to their practice. Yet, they reported knowledge gaps across multiple core palliative care skills that should be addressed given their role as frontline providers for patients with serious illness.
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Affiliation(s)
- Julia L. Frydman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Kevin Hauck
- Department of Medicine, New York University Grossman School of Medicine
| | - Joseph Lowy
- Department of Medicine, New York University Grossman School of Medicine
| | - Laura P. Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
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Affiliation(s)
- Megan L McSherry
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sapna R Kudchadkar
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
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Frydman JL, Gelfman LP, Lindenberger EC, Smith CB, Berns S, Kelley AS, Dow LA. Virtual Geritalk: Improving Serious Illness Communication of Clinicians Who Care for Older Adults. J Pain Symptom Manage 2021; 62:e206-e212. [PMID: 33631324 PMCID: PMC8380266 DOI: 10.1016/j.jpainsymman.2021.02.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 01/27/2023]
Abstract
CONTEXT High quality communication is essential to older adults' medical decision-making, quality of life, and adjustment to serious illness. Studies have demonstrated that Geritalk, a two day (16 hours total) in-person communication skills training improves self-assessed preparedness, skill acquisition, and sustained practice of communication skills. Due to the COVID-19 pandemic, Geritalk was adapted to a virtual format (four days, 10 hours total). OBJECTIVES Our study evaluated the change in participants' self-assessed preparedness for serious illness communication before and after the virtual course and satisfaction with the course, and compared these findings to responses from a prior in-person Geritalk course. METHODS Geriatrics and Palliative Medicine fellows at three urban academic medical centers completed surveys, which employed five-point Likert scales, before and after the virtual course to assess satisfaction with the course and preparedness for serious illness communication. RESULTS Of the 20 virtual Geritalk participants, 17 (85%) completed the pre-course assessment, and 14 (70%) completed the post-course assessment. Overall, satisfaction with the course was high (mean 4.9 on a 5-point scale). Compared to in-person Geritalk participants, virtual course participants reported comparable and significant (P < 0.01) improvements in mean self-reported preparedness across all surveyed communication skills. CONCLUSION We show that a virtual communication skills training is feasible and effective. Our findings suggest that the innovative virtual Geritalk course has the potential to increase access to communication skills training, improve serious illness communication skills, and in improve the quality of care received by older adults with serious illness.
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Affiliation(s)
- Julia L Frydman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Laura P Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Geriatric Research, Education & Clinical Center, James J. Peters Veterans' Affairs Medical Center, Bronx, New York, USA
| | - Elizabeth C Lindenberger
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Geriatric Research, Education & Clinical Center, James J. Peters Veterans' Affairs Medical Center, Bronx, New York, USA
| | - Cardinale B Smith
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stephen Berns
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Amy S Kelley
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lindsay A Dow
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Sleiman J, Savage DJ, Switzer B, Colbert CY, Chevalier C, Neuendorf K, Harris D. Teaching residents how to break bad news: piloting a resident-led curriculum and feedback task force as a proof-of-concept study. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:568-574. [DOI: 10.1136/bmjstel-2021-000897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2021] [Indexed: 11/04/2022]
Abstract
BackgroundBreaking bad news (BBN) is a critically important skill set for residents. Limited formal supervision and unpredictable timing of bad news delivery serve as barriers to the exchange of meaningful feedback.Purpose of studyThe goal of this educational innovation was to improve internal medicine residents’ communication skills during challenging BBN encounters. A formal BBN training programme and innovative on-demand task force were part of this two-phase project.Study designInternal medicine residents at a large academic medical centre participated in an interactive workshop focused on BBN. Workshop survey results served as a needs assessment for the development of a novel resident-led BBN task force. The task force was created to provide observations at the bedside and feedback after BBN encounters. Training of task force members incorporated video triggers and a feedback checklist. Inter-rater reliability was analysed prior to field testing, which provided data on real-world implementation challenges.Results148 residents were trained during the 2-hour communications skills workshop. Based on survey results, 73% (108 of 148) of the residents indicated enhanced confidence in BBN after participation. Field testing of the task force on a hospital ward revealed potential workflow barriers for residents requesting observations and prompted troubleshooting. Solutions were implemented based on field testing results.ConclusionsA trainee-led BBN task force and communication skills workshop is offered as an innovative model for improving residents’ interpersonal and communication skills in BBN. We believe the model is both sustainable and reproducible. Lessons learnt are offered to aid in implementation in other settings.
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Pun J. A study of Chinese medical students' communication pattern in delivering bad news: an ethnographic discourse analysis approach. BMC MEDICAL EDUCATION 2021; 21:286. [PMID: 34011322 PMCID: PMC8132433 DOI: 10.1186/s12909-021-02724-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/15/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Breaking bad news is inevitable for prospective doctors, it is important for medical students to learn how to humanely communicate devastating news to patients. This study explores the discourse strategies used by Chinese medical students when conducting critical conversations via role-play scenarios. METHODS Fifty Year-6 medical students attending the 'Serious Illness Communication Module' were recruited from a local medical school in Hong Kong. They were asked to participate voluntarily in two role-play scenarios requiring them to break bad news to a simulated patient in Cantonese. The verbal interactions were video-recorded and analysed using an ethnographic discourse approach to unpack the quality of the observed interaction sequences and identify the discourse strategies strategically used by the medical students to overcome any communication breakdowns (e.g. linguistic expressions conveying diagnoses) and show empathy to patients. RESULTS Six discourse strategies for delivering bad news were identified in the Chinese context: (1) placing great emphasis on patients' emotional needs; (2) informing patients with a balanced focus on medical and emotional needs; (3) directing patients' attention to treatment options; (4) acknowledging concerns about dying patients' physical discomfort and wishes; (5) directing bad news disclosure to patients; and (6) addressing the family expectations of patients. The majority of the Chinese medical students in this study used a patient-oriented approach to cater to the patients' emotional and physical needs. They also often informed and acknowledged the patients' family members. CONCLUSIONS When delivering bad news, medical students should be equipped with discourse strategies that effectively balance interpersonal communication with the communication of medical expertise, which is integral to ensuring patients' participation, their understanding and satisfaction with their clinicians. This is in accordance with the existing communication frameworks for critical conversation and demonstrates awareness of the needs in the Chinese context. However, some students demonstrated poor sensitivity to non-verbal cues, such as tone, manners and attitude. Thus, more training using a culturally appropriate model of communication for critical conversation should be promoted.
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Affiliation(s)
- Jack Pun
- Department of English, City University of Hong Kong, 83, Tat Chee Avenue, Kowloon, Hong Kong SAR, China.
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Marsh M, Lauden SM, Mahan JD, Schneider L, Saldivar L, Hill N, Diaz C, Abdel-Rasoul M, Reed S. Family-centered communication: A pilot educational intervention using deliberate practice and patient feedback. PATIENT EDUCATION AND COUNSELING 2021; 104:1200-1205. [PMID: 33020005 DOI: 10.1016/j.pec.2020.09.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE There are few opportunities in medical education dedicated to learning skills for effective communication in life altering patient scenarios. We therefore aimed to develop and assess a longitudinal advanced communication curriculum for pediatric residents using patient feedback and deliberate practice. METHODS Pediatric residents at a large academic center were randomized into 2 groups. The intervention group received 6 educational sessions from 2019 to 2020, parent feedback of performance via the Communication Assessment Tool (CAT), and monthly communication tips. Communication skills of both groups were assessed at the end of the intervention. RESULTS We collected 937 CAT assessments on 36 first-year residents. The intervention group demonstrated statistically significant improvement in communication skills from pre to post assessment (p = 0.0063, (odds ratio (OR) 1.76, 95 % confidence interval (CI) [1.17, 2.63]) compared to the control group (p = 0.080, OR 1.41, 95 % CI [0.96, 2.05]). CONCLUSIONS There are patient and self-identified performance gaps in communication skills for pediatric residents, underscoring the need for formalized curricula dedicated to these skills. PRACTICE IMPLICATIONS Our study highlights the value of deliberate practice and the integration of family feedback as an educational tool in communication skills development.
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Affiliation(s)
- Melanie Marsh
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH USA.
| | - Stephanie M Lauden
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH USA
| | - John D Mahan
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH USA; The Ohio State University, College of Medicine Columbus, OH USA
| | - Lydia Schneider
- The Ohio State University, College of Medicine Columbus, OH USA
| | - Laura Saldivar
- The Ohio State University, College of Medicine Columbus, OH USA
| | - Nina Hill
- The Ohio State University, College of Medicine Columbus, OH USA
| | | | - Mahmoud Abdel-Rasoul
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH USA; The Ohio State University, College of Medicine Columbus, OH USA
| | - Suzanne Reed
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH USA
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Amsalem D, Martin A, Mosheva M, Soul O, Korotkin L, Ziv A, Gothelf D, Gross R. Delivering Difficult News: Simulation-Enhanced Training Improves Psychiatry Residents' Clinical Communication Skills. Front Psychiatry 2021; 12:649090. [PMID: 33746804 PMCID: PMC7973022 DOI: 10.3389/fpsyt.2021.649090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Delivering difficult news to individuals diagnosed with mental health disorders and their family members can be challenging. The use of simulated patients (SP) is an effective teaching method to enhance clinical skills, particularly those around communication. We developed, implemented, and evaluated the effectiveness of an SP-based training module to improve psychiatric residents' clinical communication skills in delivering difficult news. Methods: We conducted 5-h workshops consisting of 3 components: (1) a high-fidelity simulation session with a professional actor; (2) a 30-min lecture; and (3) role-playing of 3 short scenarios, during which residents rotated taking on different roles (as psychiatrist, patient, or family member). We observed through a 1-way mirror and videotaped each resident's simulation session and followed it with personalized debriefing. Following the workshop, each resident received the full-length video of their simulated interview, together with a list of questions as a take-home assignment. Two months after the workshop, the residents were invited to a second SP-based session, during which 2 independent evaluators, each a board-certified psychiatrist with expertise in medical simulation, evaluated the participants' communication skills using a previously validated instrument. To avoid observation bias, the 2 evaluators rated the videotapes blind to the timing of the simulation (pre- vs. post-training). Participants completed self-report questionnaires on satisfaction and self-confidence, before, after, and 2 months following the workshop. Findings: Of the 28 psychiatric residents who participated in the training day, 24 (86%) completed the post-workshop evaluation. Mean communication score increased from 24.9 to 27.8 (paired t-test: 5.6, p < 0.001). The mean score for the self-confidence questionnaire, calculated on a 1 to 5 Likert scale, increased from 3.4 to 4.0 after the training day, and remained unchanged (4.2) 2 months later (p < 0.001). Conclusions: An SP-based training module proved useful in improving the objectively measured communication skills of psychiatric residents delivering difficult news. The training further enhanced participants' subjective sense of confidence in those clinical skills.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mariela Mosheva
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Child & Adolescent Psychiatry, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Omer Soul
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Child & Adolescent Psychiatry, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Liran Korotkin
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amitai Ziv
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sheba Medical Center, Integrated Rehabilitation Hospital, Ramat Gan, Israel
| | - Doron Gothelf
- Division of Child & Adolescent Psychiatry, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
- Faculty of Medicine, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Raz Gross
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel
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Breaking Bad News, a Pertinent Yet Still an Overlooked Skill: An International Survey Study. Healthcare (Basel) 2020; 8:healthcare8040501. [PMID: 33233556 PMCID: PMC7711660 DOI: 10.3390/healthcare8040501] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/29/2020] [Accepted: 11/17/2020] [Indexed: 02/05/2023] Open
Abstract
Delivering bad news to patients is a challenging yet impactful everyday task in clinical practice. Ideally, healthcare practitioners should receive formal training in implementing these protocols, practice in simulation environments, and real-time supervision with feedback. We aimed to investigate whether healthcare providers involved in delivering bad news have indeed received formal training to do so. We conducted a cross-sectional survey study that targeted all healthcare providers in the intensive care units of 174 institutions in 40 different countries. Participants included physicians, nurses, medical students, nursing students, pharmacists, respiratory technicians, and others. The survey tool was created, validated, and translated to the primary languages of these countries to overcome language barriers. A total of 10,106 surveys were collected. Only one third of participants indicated that they had received a formal training. Providers who had received formal training were more likely to deliver bad news than those who had not. Younger and less experienced providers tend to deliver bad news more than older, more experienced providers. The percentage of medical students who claimed they deliver bad news was comparable to that of physicians. Medical schools and post-graduate training programs are strongly encouraged to tackle this gap in medical education.
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Whittle A, Bourne S, Segal S, Serwint JR. Teaching Death Disclosure: A Mixed-Method Comparison of Resident Self-Assessment and Standardized Patient Assessment. Acad Pediatr 2020; 20:703-711. [PMID: 32087379 DOI: 10.1016/j.acap.2020.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 02/14/2020] [Accepted: 02/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To characterize how pediatric resident self-evaluation compares to standardized patient evaluations in simulated child death disclosure scenarios. METHODS This was a prospective, observational, mixed-methods study in which 18 second-year pediatric residents delivered the news of a death of a child to a trained standardized patient (SP) couple. The SPs evaluated residents via a quantitative global rating (1-3 scale) and via qualitative comments. Following the training, the residents completed self-assessments consisting of a global rating, qualitative comments, and their confidence related to 5 death disclosure skills. RESULTS Agreement between SPs and resident ratings was poor; resident scores were compared to each of their 2 SP evaluators yielding Kappa coefficients of -0.23 (95% confidence interval = -0.60 to -0.07) and -0.30 (95% confidence interval = -0.70 to -0.04). Residents uniformly rated themselves as less capable in their communication skills than SPs did. Residents reported significant increases in their confidence in discussing autopsy and organ donation. Major themes determined from the qualitative comments from SPs included nonverbal communication, verbal communication, attunement to parents, and management of next steps. Residents' comments mirrored these themes with the exception of the absence of nonverbal communication. CONCLUSIONS Pediatric residents underestimated their abilities in a self-assessment of their performance in a SP death disclosure scenario, demonstrating the importance of external feedback, particularly from SPs themselves. Based on SP feedback, future death disclosure trainings should emphasize nonverbal communication skills and specific behaviors that convey effective attunement to families.
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Affiliation(s)
- Amy Whittle
- Department of Pediatrics, Zuckerberg San Francisco General, University of California San Francisco (A Whittle).
| | - Sarah Bourne
- Warren Alpert Medical School of Brown University (S Bourne), Providence, RI
| | - Summer Segal
- Integrative Pediatric Pain and Palliative Care Program, Department of Pediatrics, University of California San Francisco (S Segal)
| | - Janet R Serwint
- Charlotte Bloomberg Children's Center (JR Serwint), Johns Hopkins, Baltimore, Md
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Campos A, Ernest EV, Cash RE, Rivard MK, Panchal AR, Clemency BM, Swor RA, Crowe RP. The Association of Death Notification and Related Training with Burnout among Emergency Medical Services Professionals. PREHOSP EMERG CARE 2020; 25:539-548. [PMID: 32584686 DOI: 10.1080/10903127.2020.1785599] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Death notification is a difficult task commonly encountered during prehospital care and may lead to burnout among EMS professionals. Lack of training could potentiate the relationship between death notification and burnout. The first objective of this study was to describe EMS professionals' experience with death notification and related training. The secondary objective was to assess the associations between death notification delivery, training, and burnout. Methods: We administered an electronic questionnaire to a random sample of nationally-certified EMS professionals. Work-related burnout was measured using the validated Copenhagen Burnout Inventory. Analysis was stratified by certification level to basic life support (BLS) and advanced life support (ALS). The association between the number of adult (≥18 years) patient death notifications delivered in the prior 12 months and burnout was assessed using multivariable logistic regression to adjust for confounding variables. Multivariable logistic regression modeling was used to assess the adjusted association between training and burnout among those who reported delivering at least one death notification in the prior 12 months. Adjusted odds ratios (aOR) and 95% confidence intervals are reported (95% CI). Results: We received 2,333/19,330 (12%) responses and 1,514 were included in the analysis. Most ALS respondents (77%) and one-third of BLS respondents (33%) reported at least one adult death notification in the past year. Approximately half of respondents reported receiving death notification training as part of their initial EMS education program (51% BLS; 52% ALS) and fewer reported receiving continuing education (30% BLS; 44% ALS). Delivering a greater number of death notifications was associated with increased odds of burnout. Among those who delivered at least one death notification, continuing education was associated with reduced odds of burnout. Conclusion: Many EMS professionals reported delivering at least one death notification within the past year. Yet, fewer than half reported training related to death notification during initial EMS education and even fewer reported receiving continuing education. More of those who delivered death notifications experienced burnout, while continuing education was associated with reduced odds of burnout. Future work is needed to develop and evaluate death notification training specifically for EMS professionals.
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Affiliation(s)
- Abraham Campos
- Received May 7, 2020 from Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska (AC, EVE); Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts (REC); South Shore Health, EMS Division, Weymouth, Massachusetts (MKR); National Registry of Emergency Medical Technicians, Columbus, Ohio (ARP); Wexner Medical Center, Department of Emergency Medicine, The Ohio State University, Columbus, Ohio (ARP); Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York (BMC); Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan (RAS); ESO, Austin, Texas (RPC)
| | - Eric V Ernest
- Received May 7, 2020 from Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska (AC, EVE); Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts (REC); South Shore Health, EMS Division, Weymouth, Massachusetts (MKR); National Registry of Emergency Medical Technicians, Columbus, Ohio (ARP); Wexner Medical Center, Department of Emergency Medicine, The Ohio State University, Columbus, Ohio (ARP); Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York (BMC); Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan (RAS); ESO, Austin, Texas (RPC)
| | - Rebecca E Cash
- Received May 7, 2020 from Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska (AC, EVE); Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts (REC); South Shore Health, EMS Division, Weymouth, Massachusetts (MKR); National Registry of Emergency Medical Technicians, Columbus, Ohio (ARP); Wexner Medical Center, Department of Emergency Medicine, The Ohio State University, Columbus, Ohio (ARP); Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York (BMC); Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan (RAS); ESO, Austin, Texas (RPC)
| | - Madison K Rivard
- Received May 7, 2020 from Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska (AC, EVE); Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts (REC); South Shore Health, EMS Division, Weymouth, Massachusetts (MKR); National Registry of Emergency Medical Technicians, Columbus, Ohio (ARP); Wexner Medical Center, Department of Emergency Medicine, The Ohio State University, Columbus, Ohio (ARP); Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York (BMC); Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan (RAS); ESO, Austin, Texas (RPC)
| | - Ashish R Panchal
- Received May 7, 2020 from Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska (AC, EVE); Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts (REC); South Shore Health, EMS Division, Weymouth, Massachusetts (MKR); National Registry of Emergency Medical Technicians, Columbus, Ohio (ARP); Wexner Medical Center, Department of Emergency Medicine, The Ohio State University, Columbus, Ohio (ARP); Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York (BMC); Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan (RAS); ESO, Austin, Texas (RPC)
| | - Brian M Clemency
- Received May 7, 2020 from Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska (AC, EVE); Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts (REC); South Shore Health, EMS Division, Weymouth, Massachusetts (MKR); National Registry of Emergency Medical Technicians, Columbus, Ohio (ARP); Wexner Medical Center, Department of Emergency Medicine, The Ohio State University, Columbus, Ohio (ARP); Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York (BMC); Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan (RAS); ESO, Austin, Texas (RPC)
| | - Robert A Swor
- Received May 7, 2020 from Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska (AC, EVE); Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts (REC); South Shore Health, EMS Division, Weymouth, Massachusetts (MKR); National Registry of Emergency Medical Technicians, Columbus, Ohio (ARP); Wexner Medical Center, Department of Emergency Medicine, The Ohio State University, Columbus, Ohio (ARP); Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York (BMC); Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan (RAS); ESO, Austin, Texas (RPC)
| | - Remle P Crowe
- Received May 7, 2020 from Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska (AC, EVE); Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts (REC); South Shore Health, EMS Division, Weymouth, Massachusetts (MKR); National Registry of Emergency Medical Technicians, Columbus, Ohio (ARP); Wexner Medical Center, Department of Emergency Medicine, The Ohio State University, Columbus, Ohio (ARP); Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York (BMC); Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan (RAS); ESO, Austin, Texas (RPC)
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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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Willis R, Strowd RE, Barks MC, Salas RE, Gamaldo CE, Lemmon ME. Education Research: The medical student perspective on challenging conversations. Neurology 2020; 95:226-230. [PMID: 32273429 DOI: 10.1212/wnl.0000000000009261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Medical students experience difficult conversations with patients during clinical clerkships. This study aimed to characterize barriers to and opportunities for learning in the setting of challenging conversations. METHODS Neurology clerkship medical students were enrolled prospectively in a concurrent nested mixed methods study. Qualitative data were collected using a postclerkship survey and semi-structured focus groups. Students were asked to reflect on challenging conversations they experienced with patients and to identify the top reasons why conversations were challenging. Responses were analyzed using directed content analysis. RESULTS A total of 159 medical students were enrolled (MS2: n = 35 [22%]; MS3: n = 97 [61%]; MS4: n = 27 [17%]). Three themes of difficulty were identified in survey and focus group data: (1) tough clinical realities: how the clinical environment makes conversations challenging; (2) communication skill needs: the difficulty of finding the words to say; and (3) navigating emotions: of patients, clinicians, and students themselves. Tough clinical realities were cited by over two-thirds of students in all years (MS2: n = 30 [86%]; MS3: n = 74 [76%]; MS4: n = 23 [85%]). Communication skills needs were cited most frequently by third-year students (MS2: n = 15 [43%]; MS3: n = 55 [57%]; MS4: n = 10 [37%]). Students early in training were more likely to cite difficulty navigating emotions (MS2: n = 28 [80%]; MS3: n = 71 [73%]; MS4: n = 19 [70%]). CONCLUSIONS Medical students frequently observe and participate in challenging conversations with patients. Here, students identified what makes these conversations most difficult. Communication curricula should leverage clinical communication encounters, prepare students for inherent clinical realities, and help students navigate emotions in the health care setting.
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Affiliation(s)
- Rheaya Willis
- From the Duke University School of Medicine (R.W.), Durham, NC; Department of Neurology (R.E. Strowd, R.E. Salas, C.E.G., M.E.L.), Johns Hopkins Medicine, Baltimore, MD; Department of Neurology (R.E. Strowd), Wake Forest School of Medicine, Winston-Salem, NC; Duke-Margolis Center for Health Policy (M.C.B., M.E.L.), Duke University; and Department of Pediatrics (M.E.L.), Duke University Medical Center, Durham, NC.
| | - Roy E Strowd
- From the Duke University School of Medicine (R.W.), Durham, NC; Department of Neurology (R.E. Strowd, R.E. Salas, C.E.G., M.E.L.), Johns Hopkins Medicine, Baltimore, MD; Department of Neurology (R.E. Strowd), Wake Forest School of Medicine, Winston-Salem, NC; Duke-Margolis Center for Health Policy (M.C.B., M.E.L.), Duke University; and Department of Pediatrics (M.E.L.), Duke University Medical Center, Durham, NC
| | - Mary C Barks
- From the Duke University School of Medicine (R.W.), Durham, NC; Department of Neurology (R.E. Strowd, R.E. Salas, C.E.G., M.E.L.), Johns Hopkins Medicine, Baltimore, MD; Department of Neurology (R.E. Strowd), Wake Forest School of Medicine, Winston-Salem, NC; Duke-Margolis Center for Health Policy (M.C.B., M.E.L.), Duke University; and Department of Pediatrics (M.E.L.), Duke University Medical Center, Durham, NC
| | - Rachel E Salas
- From the Duke University School of Medicine (R.W.), Durham, NC; Department of Neurology (R.E. Strowd, R.E. Salas, C.E.G., M.E.L.), Johns Hopkins Medicine, Baltimore, MD; Department of Neurology (R.E. Strowd), Wake Forest School of Medicine, Winston-Salem, NC; Duke-Margolis Center for Health Policy (M.C.B., M.E.L.), Duke University; and Department of Pediatrics (M.E.L.), Duke University Medical Center, Durham, NC
| | - Charlene E Gamaldo
- From the Duke University School of Medicine (R.W.), Durham, NC; Department of Neurology (R.E. Strowd, R.E. Salas, C.E.G., M.E.L.), Johns Hopkins Medicine, Baltimore, MD; Department of Neurology (R.E. Strowd), Wake Forest School of Medicine, Winston-Salem, NC; Duke-Margolis Center for Health Policy (M.C.B., M.E.L.), Duke University; and Department of Pediatrics (M.E.L.), Duke University Medical Center, Durham, NC
| | - Monica E Lemmon
- From the Duke University School of Medicine (R.W.), Durham, NC; Department of Neurology (R.E. Strowd, R.E. Salas, C.E.G., M.E.L.), Johns Hopkins Medicine, Baltimore, MD; Department of Neurology (R.E. Strowd), Wake Forest School of Medicine, Winston-Salem, NC; Duke-Margolis Center for Health Policy (M.C.B., M.E.L.), Duke University; and Department of Pediatrics (M.E.L.), Duke University Medical Center, Durham, NC
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Choe EK, Duarte ME, Suh H, Pratt W, Kientz JA. Communicating Bad News: Insights for the Design of Consumer Health Technologies. JMIR Hum Factors 2019; 6:e8885. [PMID: 31102374 PMCID: PMC6543800 DOI: 10.2196/humanfactors.8885] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/05/2018] [Accepted: 02/07/2019] [Indexed: 11/25/2022] Open
Abstract
Background As people increasingly receive personal health information through technology, there is increased importance for this information to be communicated with empathy and consideration for the patient’s experience of consuming it. Although technology enables people to have more frequent and faster access to their health information, it could also cause unnecessary anxiety, distress, or confusion because of the sensitive and complex nature of the information and its potential to provide information that could be considered bad news. Objective The aim of this study was to uncover insights for the design of health information technologies that potentially communicate bad news about health such as the result of a diagnosis, increased risk for a chronic or terminal disease, or overall declining health. Methods On the basis of a review of established guidelines for clinicians on communicating bad news, we developed an interview guide and conducted interviews with patients, patients’ family members, and clinicians on their experience of delivering and receiving the diagnosis of a serious disease. We then analyzed the data using a thematic analysis to identify overall themes from a perspective of identifying ways to translate these strategies to technology design. Results We describe qualitative results combining an analysis of the clinical guidelines for sharing bad health news with patients and interviews on clinicians’ specific strategies to communicate bad news and the emotional and informational support that patients and their family members seek. Specific strategies clinicians use included preparing for the patients’ visit, anticipating patients’ feelings, building a partnership of trust with patients, acknowledging patients’ physical and emotional discomfort, setting up a scene where patients can process the information, helping patients build resilience and giving hope, matching the level of information to the patients’ level of understanding, communicating face-to-face, if possible, and using nonverbal means. Patient and family member experiences included internal turmoil and emotional distress when receiving bad news and emotional and informational support that patients and family members seek. Conclusions The results from this study identify specific strategies for health information technologies to better promote empathic communication when they communicate concerning health news. We distill the findings from our study into design hypotheses for ways technologies may be able to help people better cope with the possibility of receiving bad health news, including tailoring the delivery of information to the patients’ individual preferences, supporting interfaces for sharing patients’ context, mitigating emotional stress from self-monitoring data, and identifying clear, actionable steps patients can take next.
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Affiliation(s)
- Eun Kyoung Choe
- College of Information Studies, University of Maryland, College Park, MD, United States
| | - Marisa E Duarte
- School of Social Transformation, Arizona State University, Tempe, AZ, United States
| | - Hyewon Suh
- Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Wanda Pratt
- Information School, University of Washington, Seattle, WA, United States
| | - Julie A Kientz
- Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
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25
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Mostafavian Z, Shaye ZA, Farajpour A. Mothers' preferences toward breaking bad news about their children cancer. J Family Med Prim Care 2018; 7:596-600. [PMID: 30112316 PMCID: PMC6069657 DOI: 10.4103/jfmpc.jfmpc_342_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: The responsibility of breaking bad news (BBN) to patients is one of the most difficult tasks of a medical profession. Aim: The current study aimed to investigate the preferences of mothers of children with cancer about BBN. Materials and Methods: In this cross-sectional study was conducted in Mashhad during years of 2016, 62 mothers of children with cancer at Dr-Sheikh hospital were recruited by convenience sampling and completed a questionnaire including demographic data and 20 questions about the mothers’ preferences to BBN. Data displayed as percent by SPSS V20 software. Results: Mothers preferred that BBN conducted by their child's doctor (93.5%), with an emotional and compassionate way (83.9%), and in a private setting (90.3%). Be told completely about the process of diagnosis (98.4%), meet people with similar conditions (83.9%), receive psychological (85.5%), and religious (79%) support after getting bad news, being in touch with a close relative (82.3%) and applying another term-like malignancy instead of cancer (95.5%). Conclusion: We tried providing helpful information for developing national guidelines about how to breaking news in Iran, by doing this study.
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Affiliation(s)
- Zahra Mostafavian
- Department of Community Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Zahra Abbasi Shaye
- Clinical Research and Development Unit, Akbar Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arezou Farajpour
- School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Educational Development Center, Mashhad Branch, Islamic Azad University, Mashhad, Iran
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Hinkle LJ, Fettig LP, Carlos WG, Bosslet G. Twelve tips for just in time teaching of communication skills for difficult conversations in the clinical setting. MEDICAL TEACHER 2017; 39:920-925. [PMID: 28598711 DOI: 10.1080/0142159x.2017.1333587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The ability to communicate well with patients and other members of the healthcare team is a vital skill for physicians to have, but one that is often not emphasized in medical education. Learners of all levels can obtain and develop good communication skills regardless of their natural ability in this area, and the clinical setting represents an underutilized resource to accomplish this task. With this in mind, we have reviewed the growing body of literature on the subject and organized our findings into twelve tips to help educators capitalize on these missed opportunities. While our emphasis is helping learners with difficult discussions, these tips can be easily adapted to any other clinical encounter requiring clear communication. Teaching effective communication skills in the clinical setting requires some extra time, but the steps outlined should not take more than a few minutes to complete. Taking the time to develop these skills in our learners will make a significant difference not only their lives but also their patients and their families.
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Affiliation(s)
- Laura Jean Hinkle
- a Department of Medicine, Division of Pulmonary and Critical Care Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Lyle Patrick Fettig
- b Department of Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
| | - William Graham Carlos
- a Department of Medicine, Division of Pulmonary and Critical Care Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Gabriel Bosslet
- a Department of Medicine, Division of Pulmonary and Critical Care Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
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Guetterman TC, Kron FW, Campbell TC, Scerbo MW, Zelenski AB, Cleary JF, Fetters MD. Initial construct validity evidence of a virtual human application for competency assessment in breaking bad news to a cancer patient. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2017; 8:505-512. [PMID: 28794664 PMCID: PMC5536229 DOI: 10.2147/amep.s138380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Despite interest in using virtual humans (VHs) for assessing health care communication, evidence of validity is limited. We evaluated the validity of a VH application, MPathic-VR, for assessing performance-based competence in breaking bad news (BBN) to a VH patient. METHODS We used a two-group quasi-experimental design, with residents participating in a 3-hour seminar on BBN. Group A (n=15) completed the VH simulation before and after the seminar, and Group B (n=12) completed the VH simulation only after the BBN seminar to avoid the possibility that testing alone affected performance. Pre- and postseminar differences for Group A were analyzed with a paired t-test, and comparisons between Groups A and B were analyzed with an independent t-test. RESULTS Compared to the preseminar result, Group A's postseminar scores improved significantly, indicating that the VH program was sensitive to differences in assessing performance-based competence in BBN. Postseminar scores of Group A and Group B were not significantly different, indicating that both groups performed similarly on the VH program. CONCLUSION Improved pre-post scores demonstrate acquisition of skills in BBN to a VH patient. Pretest sensitization did not appear to influence posttest assessment. These results provide initial construct validity evidence that the VH program is effective for assessing BBN performance-based communication competence.
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Affiliation(s)
| | - Frederick W Kron
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Toby C Campbell
- Department of Medicine, University of Wisconsin–Madison, Madison, WI
| | - Mark W Scerbo
- Department of Psychology, Old Dominion University, Norfolk, VA
| | - Amy B Zelenski
- Department of General Internal Medicine, University of Wisconsin–Madison, University of Wisconsin Medical Foundation
| | - James F Cleary
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison, Clinical Science Center, Madison, WI, USA
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
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28
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Studer RK, Danuser B, Gomez P. Physicians' psychophysiological stress reaction in medical communication of bad news: A critical literature review. Int J Psychophysiol 2017; 120:14-22. [PMID: 28666771 DOI: 10.1016/j.ijpsycho.2017.06.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/18/2017] [Accepted: 06/26/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Stress is a common phenomenon in medical professions. Breaking bad news (BBN) is reported to be a particularly distressing activity for physicians. Traditionally, the stress experienced by physicians when BBN was assessed exclusively using self-reporting. Only recently, the field of difficult physician-patient communication has used physiological assessments to better understand physicians' stress reactions. METHOD This paper's goals are to (a) review current knowledge about the physicians' psychophysiological stress reactions in BBN situations, (b) discuss methodological aspects of these studies and (c) suggest directions for future research. RESULTS The seven studies identified all used scenarios with simulated patients but were heterogeneous with regard to other methodological aspects, such as the psychophysiological parameters, time points and durations assessed, comparative settings, and operationalisation of the communication scenarios. Despite this heterogeneity, all the papers reported increases in psychological and/or physiological activation when breaking bad news in comparison to control conditions, such as history taking or breaking good news. CONCLUSION Taken together, the studies reviewed support the hypothesis that BBN is a psychophysiologically arousing and stressful task for medical professionals. However, much remains to be done. We suggest several future directions to advance the field. These include (a) expanding and refining the conceptual framework, (b) extending assessments to include more diverse physiological parameters, (c) exploring the modulatory effects of physicians' personal characteristics (e.g. level of experience), (d) comparing simulated and real-life physician-patient encounters and (e) combining physiological assessment with a discourse analysis of physician-patient communication.
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Affiliation(s)
- Regina Katharina Studer
- Institut universitaire romand de Santé au Travail (Institute for Work and Health), University of Lausanne & University of Geneva, Route de la Corniche 2, CH-1066 Epalinges, Switzerland.
| | - Brigitta Danuser
- Institut universitaire romand de Santé au Travail (Institute for Work and Health), University of Lausanne & University of Geneva, Route de la Corniche 2, CH-1066 Epalinges, Switzerland.
| | - Patrick Gomez
- Institut universitaire romand de Santé au Travail (Institute for Work and Health), University of Lausanne & University of Geneva, Route de la Corniche 2, CH-1066 Epalinges, Switzerland.
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Vergo MT, Sachs S, MacMartin MA, Kirkland KB, Cullinan AM, Stephens LA. Acceptability and Impact of a Required Palliative Care Rotation with Prerotation and Postrotation Observed Simulated Clinical Experience during Internal Medicine Residency Training on Primary Palliative Communication Skills. J Palliat Med 2017; 20:542-547. [DOI: 10.1089/jpm.2016.0348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Maxwell T. Vergo
- Section of Palliative Medicine, Department of Medicine, Geisel School of Medicine,Lebanon, New Hampshire
| | - Sharona Sachs
- Section of Palliative Medicine, Department of Medicine, Geisel School of Medicine,Lebanon, New Hampshire
| | - Meredith A. MacMartin
- Section of Palliative Medicine, Department of Medicine, Geisel School of Medicine,Lebanon, New Hampshire
| | - Kathryn B. Kirkland
- Section of Palliative Medicine, Department of Medicine, Geisel School of Medicine,Lebanon, New Hampshire
| | - Amelia M. Cullinan
- Section of Palliative Medicine, Department of Medicine, Geisel School of Medicine,Lebanon, New Hampshire
| | - Lisa A. Stephens
- Section of Palliative Medicine, Department of Medicine, Geisel School of Medicine,Lebanon, New Hampshire
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Leff V, Klement A, Galanos A. A Successful Debrief Program for House Staff. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2017; 13:87-90. [PMID: 28426397 DOI: 10.1080/15524256.2017.1314234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Challenging end-of-life encounters can be stressful and may lead to burnout. Monthly debriefing sessions are led by a physician and clinical social worker (LCSW). Sessions focus on experiences and emotional reactions rather than case details. Themes identified included; feeling unsupported after difficult deaths, identifying with patients emotionally, and conceptualizing a "good" versus "bad" death. Debriefing provides opportunities for residency physicians to reflect on the affective side of their work and helps promote resiliency.
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Affiliation(s)
- Victoria Leff
- a Clinical Social Work, Duke Palliative Care , Duke University Hospital , Durham , North Carolina , USA
| | - Adrienne Klement
- b Hospital Medicine , Durham VA Medical Center , Durham , North Carolina , USA
| | - Anthony Galanos
- c Duke Palliative Care , Duke University Hospital , Durham , North Carolina , USA
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31
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Peh TY, Yang GM, Krishna LKR, Yee ACP. Do Doctors Gain More Confidence from a Longer Palliative Medicine Posting? J Palliat Med 2017; 20:141-146. [DOI: 10.1089/jpm.2016.0293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tan Ying Peh
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore
| | - Grace Meijuan Yang
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore
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McConnell MM, Monteiro S, Pottruff MM, Neville A, Norman GR, Eva KW, Kulasegaram K. The Impact of Emotion on Learners' Application of Basic Science Principles to Novel Problems. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:S58-S63. [PMID: 27779511 DOI: 10.1097/acm.0000000000001360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE Training to become a physician is an emotionally laden experience. Research in cognitive psychology indicates that emotions can influence learning and performance, but the materials used in such research (e.g., word lists) rarely reflect the complexity of material presented in medical school. The present study examined whether emotions influence learning of basic science principles. METHOD Fifty-five undergraduate psychology students were randomly assigned to write about positive, negative, or neutral life events for nine minutes. Participants were then taught three physiological concepts, each in the context of a single organ system. Testing consisted of 13 clinical cases, 7 presented with the same concept/organ system pairing used during training ("near transfer") and 6 with novel pairings ("far transfer"). Testing was repeated after one week with 13 additional cases. RESULTS Forty-nine students provided complete data. Higher test scores were found when the concept/organ system pairing was held constant (near transfer = 51% correct vs. far = 33%; P < .001). Emotion condition influenced participants' overall performance, with individuals in the neutral condition (50.1%) performing better than those in the positive (38.2%, P < .05) and negative (37.7%, P < .001) emotion conditions. CONCLUSIONS These data suggest that regardless of whether the emotion is positive or negative, mild affective states can impair learning of basic science concepts by novices. Demands on working memory and subsequent cognitive load provide a potential explanation. Future work will examine the extent to which these findings generalize to medical trainees.
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Affiliation(s)
- Meghan M McConnell
- M.M. McConnell is assistant professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. S. Monteiro is assistant professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. M.M. Pottruff is research assistant, Program for Educational Research and Development, McMaster University, Hamilton, Ontario, Canada. A. Neville is professor, Department of Oncology, McMaster University, Hamilton, Ontario, Canada. G.R. Norman is professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. K.W. Eva is professor, Centre for Health Science Education, University of British Columbia, Vancouver, British Columbia, Canada. K. Kulasegaram is assistant professor, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Aoun SM, Breen LJ, Edis R, Henderson RD, Oliver D, Harris R, Howting D, O'Connor M, Birks C. Breaking the news of a diagnosis of motor neurone disease: A national survey of neurologists' perspectives. J Neurol Sci 2016; 367:368-74. [PMID: 27423623 DOI: 10.1016/j.jns.2016.06.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/21/2016] [Accepted: 06/14/2016] [Indexed: 12/12/2022]
Abstract
Communication of the diagnosis of MND is daunting for patients and neurologists. This study aimed to establish a knowledge base of current Australian practice of breaking the news of an MND diagnosis, to assess the neurologists' educational and training needs and to compare the feedback obtained from neurologists and patients to international practice guidelines. An anonymous survey of neurologists was undertaken in Australia (2014). 73 neurologists responded to this national survey (50.4% response rate). Nearly 70% of neurologists reported finding it "somewhat to very difficult" communicating the MND diagnosis, and 65% reported feeling moderate to high stress and anxiety at the delivery of diagnosis. Compared to international guidelines, areas for improvement include length of consultation, period of follow up and referral to MND associations. Two-thirds of neurologists were interested in further training to respond to patient's emotions and development of best practice guidelines. This is the first national study to provide a comprehensive insight into the process of delivering the MND diagnosis from the neurologists' perspective and to make comparisons with those of patients and the international guidelines. This study forms the basis for developing protocols to improve communication skills and alleviate the emotional burden associated with breaking bad news.
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Affiliation(s)
- Samar M Aoun
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
| | - Lauren J Breen
- School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
| | - Robert Edis
- Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia.
| | - Robert D Henderson
- Royal Brisbane & Women's Hospital, Butterfield Street, Herston, Queensland 4006, Australia.
| | - David Oliver
- Wisdom Hospice, High Bank, Rochester, Kent ME1 2NU, UK; University of Kent, UK.
| | - Rodney Harris
- MND Victoria, PO Box 23, Canterbury, Victoria 3126, Australia.
| | - Denise Howting
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
| | - Margaret O'Connor
- Faculty of Health, Arts & Design, Swinburne University Melbourne, Victoria 3800, Australia.
| | - Carol Birks
- MND Australia, PO Box 990, Gladesville, NSW 1675, Australia.
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Roze des Ordons A, Ajjawi R, Macdonald J, Sarti A, Lockyer J, Hartwick M. Palliative and end of life care communication as emerging priorities in postgraduate medical education. CANADIAN MEDICAL EDUCATION JOURNAL 2016; 7:e4-e21. [PMID: 27103952 PMCID: PMC4830369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Reliance on surveys and qualitative studies of trainees to guide postgraduate education about palliative and end of life (EOL) communication may lead to gaps in the curriculum. We aimed to develop a deeper understanding of internal medicine trainees' educational needs for a palliative and EOL communication curriculum and how these needs could be met. METHODS Mixed methods, including a survey and focus groups with trainees, and interviews with clinical faculty and medical educators, were applied to develop a broader perspective on current experiences and needs for further education. Quantitative descriptive and thematic analyses were conducted. RESULTS Surveyed trainees were least confident and least satisfied with teaching in counseling about the emotional impact of emergencies and discussing organ donation. Direct observation with feedback, small group discussion, and viewing videos of personal consultations were perceived as effective, yet infrequently identified as instructional methods. Focus groups and interviews identified goals of care conversations as the highest educational priority, with education adapted to learner needs and accompanied by feedback and concurrent clinical and organizational support. CONCLUSIONS Our work expands on previous research describing needs for postgraduate education in palliative and EOL communication to include the importance of support, culture change, and faculty development, and provides insight into why such needs exist.
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Affiliation(s)
| | - Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Australia
| | - John Macdonald
- Division of Critical Care Medicine, University of Ottawa
- Department of Anesthesia, University of Ottawa
| | - Aimee Sarti
- Division of Critical Care Medicine, University of Ottawa
- Division of Palliative Medicine, University of Ottawa
| | - Jocelyn Lockyer
- Department of Community Health Sciences, University of Calgary
| | - Michael Hartwick
- Division of Critical Care Medicine, University of Ottawa
- Division of Palliative Medicine, University of Ottawa
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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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Aminiahidashti H, Mousavi SJ, Darzi MM. Patients' Attitude toward Breaking Bad News; a Brief Report. EMERGENCY (TEHRAN, IRAN) 2016; 4:34-7. [PMID: 26862548 PMCID: PMC4744612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Delivering bad news is a stressful moment for both physicians and patients. The purpose of this investigation was to explore the patients' preferences and attitudes toward being informed about the bad news. METHODS This cross-sectional study was done on patients admitted to Imam Khomeini Hospital, Sari, Iran, from September 2014 to February 2015. Patient attitude regarding breaking bad news was evaluated using a reliable and valid questionnaire. RESULTS 130 patients were evaluated (61.5% male, mean age = 46.21 ± 12.1 years). 118 (90.76%) participants believed that the patient himself/herself should be informed about the disease's condition. 120 (92.30%) preferred to hear the news from a skillful physician and 105 (80.76%) believed that emergency department is not a proper place for breaking bad news. CONCLUSION Based on the results of the present study, most participants believed that the most experienced and skillful physician should inform them completely regarding their medical condition. At the same time they declared that, it is best to hear bad news in a calm and suitable place and time rather than emergency department or hospital corridors during teaching rounds.
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Affiliation(s)
- Hamed Aminiahidashti
- Department of Emergency Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Jaber Mousavi
- Department of community medicine, Faculty of medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Mehdi Darzi
- Faculty of medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Corresponding Author: Mohammad Mehdi Darzi, Student of Medicine, Department of Emergency Medicine, Imam Khomeini Hospital, Amir Mazandarani Bolivar, Sari, Iran. Tel: +989113540546;
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Abstract
When physicians lack proper training, breaking bad news can lead to negative consequences for patients, families, and physicians. A questionnaire was used to determine whether a didactic program on delivering bad news was needed at our institution. Results revealed that 91% of respondents perceived delivering bad news as a very important skill, but only 40% felt they had the training to effectively deliver such news. We provide a brief review of different approaches to delivering bad news and advocate for training physicians in a comprehensive, structured model.
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Affiliation(s)
| | - Lonnie Gentry
- Department of Surgery, Baylor University Medical Center at Dallas
| | - Thomas R Cox
- Department of Surgery, Baylor University Medical Center at Dallas
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Abstract
Objective: In a regional hospital, many patients are newly diagnosed with cancer. Breaking the bad news in these patients and their relatives is a tough task. Many doctors are not experienced in talking to patients about death or death-related diseases. In recent years, there have been great efforts to change the current situation. The aim of this study was to investigate the experience and education of medical personnel in breaking bad news in a secondary hospital. Materials and Methods: 59 doctors from General Hospital of Komotini, Greece were included in the study. All the doctors were in clinical specialties that treated cancer patients. A brief questionnaire was developed based on current guidelines such as Baile/SPIKES framework and the ABCDE mnemonic. Results: Residents are involved in delivering bad news less frequently than specialists. Only 21 doctors (35.59%) had specific training on breaking bad news. 20 doctors (33.90%) were aware of the available techniques and protocols on breaking bad news. 47 doctors (79.66%) had a consistent plan for breaking bad news. 57 (96.61%) delivered bad news in a quiet place, 53 (89.83%) ensured no interruptions and enough time, 53 (89.83%) used simple words and 54 (91.53%) checked for understanding and did not rush through the news. 46 doctors (77.97%) allowed relatives to determine patient's knowledge about the disease. Conclusions: There were low rates of specific training in breaking bad news. However, the selected location, the physician's speech and their plan were according to current guidelines.
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Affiliation(s)
| | - Triada Exiara
- Department of Internal Medicine, General Hospital of Komotini, Komotini, Greece
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Evaluation of the Impact of a Simulation-enhanced Breaking Bad News Workshop in Pediatrics. Simul Healthc 2014; 9:213-9. [DOI: 10.1097/sih.0000000000000031] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aein F, Delaram M. Giving bad news: a qualitative research exploration. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e8197. [PMID: 25068066 PMCID: PMC4102999 DOI: 10.5812/ircmj.8197] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 11/18/2013] [Accepted: 02/15/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The manner in which healthcare professionals deliver bad news affects the way it is received, interpreted, understood, and dealt with. Despite the fact that clinicians are responsible for breaking bad news, it has been shown that they lack skills necessary to perform this task. OBJECTIVES The purpose of this study was to explore Iranian mothers' experiences to receive bad news about their children cancer and to summarize suggestions for improving delivering bad news by healthcare providers. MATERIALS AND METHODS A qualitative approach using content analysis was adopted. Semi-structured interviews were conducted with 14 mothers from two pediatric hospitals in Iran. RESULTS Five major categories emerged from the data analysis, including dumping information, shock and upset, emotional work, burden of delivering bad news to the family members, and a room for multidisciplinary approach. CONCLUSIONS Effective communication of healthcare team with mothers is required during breaking bad news. Using multidisciplinary approaches to prevent harmful reactions and providing appropriate support are recommended.
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Affiliation(s)
- Fereshteh Aein
- Nursing Faculty, Shahrekord University of Medical Sciences, Shahrekord, IR Iran
- Corresponding Author: Fereshteh Aein, Nursing Faculty, Shahrekord University of Medical Sciences, Rahmatieeh, Shahrekord, IR Iran. Tel: +98-9131024581, E-mail:
| | - Masoumeh Delaram
- Nursing Faculty, Shahrekord University of Medical Sciences, Shahrekord, IR Iran
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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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Bays AM, Engelberg RA, Back AL, Ford DW, Downey L, Shannon SE, Doorenbos AZ, Edlund B, Christianson P, Arnold RW, O'Connor K, Kross EK, Reinke LF, Cecere Feemster L, Fryer-Edwards K, Alexander SC, Tulsky JA, Curtis JR. Interprofessional communication skills training for serious illness: evaluation of a small-group, simulated patient intervention. J Palliat Med 2013; 17:159-66. [PMID: 24180700 DOI: 10.1089/jpm.2013.0318] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Communication with patients and families is an essential component of high-quality care in serious illness. Small-group skills training can result in new communication behaviors, but past studies have used facilitators with extensive experience, raising concerns this is not scalable. OBJECTIVE The objective was to investigate the effect of an experiential communication skills building workshop (Codetalk), led by newly trained facilitators, on internal medicine trainees' and nurse practitioner students' ability to communicate bad news and express empathy. DESIGN Trainees participated in Codetalk; skill improvement was evaluated through pre- and post- standardized patient (SP) encounters. SETTING AND SUBJECTS The subjects were internal medicine residents and nurse practitioner students at two universities. INTERVENTION AND MEASUREMENTS The study was carried out in anywhere from five to eight half-day sessions over a month. The first and last sessions included audiotaped trainee SP encounters coded for effective communication behaviors. The primary outcome was change in communication scores from pre-intervention to post-intervention. We also measured trainee characteristics to identify predictors of performance and change in performance over time. RESULTS We enrolled 145 trainees who completed pre- and post-intervention SP interviews-with participation rates of 52% for physicians and 14% for nurse practitioners. Trainees' scores improved in 8 of 11 coded behaviors (p<0.05). The only significant predictors of performance were having participated in the intervention (p<0.001) and study site (p<0.003). The only predictor of improvement in performance over time was participating in the intervention (p<0.001). CONCLUSIONS A communication skills intervention using newly trained facilitators was associated with improvement in trainees' skills in giving bad news and expressing empathy. Improvement in communication skills did not vary by trainee characteristics.
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Affiliation(s)
- Alison M Bays
- 1 Department of Medicine, University of Washington , Seattle, Washington
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[Breaking bad news--a challenge for every physician]. Med Klin Intensivmed Notfmed 2013; 109:609-13. [PMID: 23712179 DOI: 10.1007/s00063-013-0250-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 04/16/2013] [Accepted: 04/21/2013] [Indexed: 10/26/2022]
Abstract
Breaking bad news is one of the most important and challenging physician's duties in routine daily work. It is not unusual that such dialogues take place at the very beginning of a doctor-patient relationship and positively or negatively influence the further course. In cases of critically ill patients or in emergency situations clinicians mostly interact with family members who have to cope with their own distress and with uncertainties of their loved one's disease. It is well accepted that good communication can significantly improve coping with the disease and promote patient compliance as well as better fulfilling family needs. Particular difficulties are the often minimal or lacking information on the counterpart and the family network, the expectations of patients and their families and the inability to predict their reactions. It is always a challenge to honestly deliver bad news to a patient and relatives without destroying their hope. Despite often limited time resources a bond of trust should be built up and the patient should be empowered to participate in shared decision making.
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Granek L, Krzyzanowska MK, Tozer R, Mazzotta P. Oncologists' strategies and barriers to effective communication about the end of life. J Oncol Pract 2013; 9:e129-35. [PMID: 23942929 DOI: 10.1200/jop.2012.000800] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Communicating about the end of life with patients has been reported as one of the most difficult and stressful part of the work of oncologists. Despite this fact, oncologists receive little training in this area, and many do not communicate effectively with patients. The purpose of this analysis, part of a larger study examining oncologists' experiences of patient loss, was to explore oncologists' communication strategies and communication barriers when discussing end-of-life issues with patients. METHODS Twenty oncologists were interviewed at three hospitals about their communication strategies on end-of-life issues with patients. The data were analyzed using the grounded theory method. RESULTS The findings revealed the strategies to effective communication about the end of life included: being open and honest; having ongoing, early conversations; communicating about modifying treatment goals; and balancing hope and reality. Barriers to implementing these strategies fell broadly into three domains, including physician factors, patient factors, and institutional factors. Physician factors included difficulty with treatment and palliation, personal discomfort with death and dying, diffusion of responsibility among colleagues, using the "death-defying mode," lack of experience, and lack of mentorship. Patient factors included, patients and/or families being reluctant to talk about the end of life, language barriers, and younger age. Institutional factors included stigma around palliative care, lack of protocol about end-of-life issues; and lack of training for oncologists on how to talk with patients about end-of-life issues. CONCLUSION We conclude by drawing implications from our study and suggest that further research and intervention are necessary to aid oncologists in achieving effective communication about end-of-life issues.
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Affiliation(s)
- Leeat Granek
- Ben Gurion University of the Negev, Be'er Sheva, Israel; Princess Margaret Hospital; Sunnybrook Health Sciences Centre; University of Toronto, Toronto; and Juravinski Cancer Centre, Hamilton Ontario, Canada
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Peterson EB, Porter MB, Calhoun AW. A simulation-based curriculum to address relational crises in medicine. J Grad Med Educ 2012; 4:351-6. [PMID: 23997881 PMCID: PMC3444190 DOI: 10.4300/jgme-d-11-00204] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 12/09/2011] [Accepted: 02/05/2012] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Preparing health care professionals for challenging communication tasks such as delivering bad news to patients and families is an area where a need for improved teaching has been identified. OBJECTIVES We developed a simulation-based curriculum to enhance the skills of health care professionals, with an emphasis on the communication of difficult or bad news, which we termed relational crises. METHODS Our approach was based on a review of existing simulation-based curricula, with the addition of unique features, including a learner-focused needs assessment to shape curriculum development, use of 360-degree evaluations, and provision of written feedback. Development and implementation of our curriculum occurred in 3 phases. Phase I involved a multidisciplinary needs assessment, creation of a clinical scenario based on needs assessment results, and training of standardized patients. In Phase II we implemented the curriculum with 36 pediatric and internal medicine-pediatrics residents, 20 nurses, and 1 chaplain. Phase III consisted of the provision of written feedback for learners, created from the 360-degree evaluations compiled from participants, observers, faculty, and standardized patients. RESULTS Participants felt the scenarios were realistic (average rating of 4.7 on a 5-point Likert scale) and improved their practice and preparedness for these situations (average rating, 4.75/5 and 4.18/5, respectively). Our curriculum produced a statistically significant change in participants' pre- and postcurriculum self-reported perceptions of skill (2.42/5 vs. 3.23/5, respectively, P < .001) and level of preparedness (2.91/5 vs. 3.72/5, respectively, P < .001). DISCUSSION A simulation-based curriculum using standardized patients, learner-identified needs, 360-degree evaluations, and written feedback demonstrated a statistically significant change in participants' self-perceived skills and preparedness for communicating difficult news in pediatrics.
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Jacques AP, Adkins EJ, Knepel S, Boulger C, Miller J, Bahner DP. Educating the delivery of bad news in medicine: Preceptorship versus simulation. Int J Crit Illn Inj Sci 2012; 1:121-4. [PMID: 22229135 PMCID: PMC3249843 DOI: 10.4103/2229-5151.84796] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Simulation experiences have begun to replace traditional education models of teaching the skill of bad news delivery in medical education. The tiered apprenticeship model of medical education emphasizes experiential learning. Studies have described a lack of support in bad news delivery and inadequacy of training in this important clinical skill as well as poor familial comprehension and dissatisfaction on the part of physicians in training regarding the resident delivery of bad news. Many residency training programs lacked a formalized training curriculum in the delivery of bad news. Simulation teaching experiences may address these noted clinical deficits in the delivery of bad news to patients and their families. Unique experiences can be role-played with this educational technique to simulate perceived learner deficits. A variety of scenarios can be constructed within the framework of the simulation training method to address specific cultural and religious responses to bad news in the medical setting. Even potentially explosive and violent scenarios can be role-played in order to prepare physicians for these rare and difficult situations. While simulation experiences cannot supplant the model of positive, real-life clinical teaching in the delivery of bad news, simulation of clinical scenarios with scripting, self-reflection, and peer-to-peer feedback can be powerful educational tools. Simulation training can help to develop the skills needed to effectively and empathetically deliver bad news to patients and families in medical practice.
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Affiliation(s)
- Andrew P Jacques
- The Ohio State University, Department of Emergency Medicine, Columbus, Ohio, USA
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Gilmore T. Reflections on giving bad news. Acad Emerg Med 2012; 19:356-8. [PMID: 22360762 DOI: 10.1111/j.1553-2712.2012.01305.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Death in the emergency department (ED) is fairly common. Giving bad news can be difficult, but it is a skill that is vitally important for the emergency physician. In the past it may have been difficult to find good resources on the subject, but now there are many reviews and guidelines; the SPIKES and GRIEV_ING protocols are two such guidelines. Furthermore, giving bad news is now taught in medical school and residency. This reflection is about giving the news of the death of a family member over the telephone. Little literature addresses giving bad news over the telephone.
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Affiliation(s)
- Thomas Gilmore
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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Conn R, Berry PA. The decision to engage in end-of-life discussions: a structured approach for doctors in training. Clin Med (Lond) 2010; 10:468-71. [PMID: 21117379 PMCID: PMC4952408 DOI: 10.7861/clinmedicine.10-5-468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Engaging in end-of-life discussions is a major source of anxiety for doctors in training. The authors propose the use of a decision-making model to assist trainees and their clinical supervisors in such situations. Divided into' 'patient-centred' and 'physician-centred' components, the model ensures that the following aspects are analysed: patient and family safety, patient and family choice, physician competence and physician comfort. A real but historical end-of-life scenario is presented to a foundation year 1 doctor, and the particular risks of engaging in a discussion are subsequently clarified with reference to each of the model's components.
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Murinson BB, Klick B, Haythornthwaite JA, Shochet R, Levine RB, Wright SM. Formative experiences of emerging physicians: gauging the impact of events that occur during medical school. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2010; 85:1331-1337. [PMID: 20671460 DOI: 10.1097/acm.0b013e3181e5d52a] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Emotional development, an important component of nascent professional competence, is likely to be shaped by specific formative experiences. This study sought to identify and gauge the impact of highly evocative experiences occurring during medical school. METHOD A 34-item list of candidate formative experiences was developed through focus group meetings of "colleges program"-affiliated student-advising faculty. The resulting survey instrument was administered to 216 graduating medical students at the Johns Hopkins University School of Medicine in 2007 and 2008 in a cohort study. Primary outcomes were exposure rates for the experiences and students' ratings of impact for those that occurred. RESULTS One hundred eighty-one students (84%) responded. All events were experienced by >25% of students. Two events were described by most as having tremendous impact: "finding an exceptional role model" and "identifying a perfect area of medicine." Other prevalent events with strong impact included "a special patient-care experience," "working well with a team," "seeing a patient whose life was saved," "encountering a negative role model," "seeing a patient die," "seeing a patient experience severe pain," and "a bad clinical experience." Factor analysis revealed three event clusters: "inspiring experiences," "mortality-related experiences," and "negative experiences relating to the learning environment." CONCLUSIONS Specific formative experiences have especially strong impacts on medical students. Whereas the intrinsic value of such experiences should continue to drive educational design, increased awareness of the diversity and range of formative experiences will prepare educators to more effectively guide positive emotional development, enhancing personal and professional growth during medical school.
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Affiliation(s)
- Beth B Murinson
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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50
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Billings ME, Engelberg R, Curtis JR, Block S, Sullivan AM. Determinants of medical students' perceived preparation to perform end-of-life care, quality of end-of-life care education, and attitudes toward end-of-life care. J Palliat Med 2010; 13:319-26. [PMID: 20178433 DOI: 10.1089/jpm.2009.0293] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Medical students' learning about end-of-life care can be categorized into three learning modalities: formal curriculum, taught in lectures; informal curriculum, conveyed through clinical experiences; and "hidden curriculum," inferred from behaviors and implicit in medical culture. In this study, we evaluated associations between survey items assessing these learning modalities and students' perceptions of their preparation, quality of education, and attitudes toward end-of-life care. METHODS Data were collected from a national survey of fourth-year medical students (n = 1455) at 62 medical schools in 2001. Linear regression analyses were performed to assess associations between formal, informal and hidden end-of-life care curricula and students' perceived preparedness to provide end-of-life care, quality of end-of-life care education and attitudes toward end-of-life, controlling for students' demographics and clustered by school. RESULTS Students reporting more exposure to formal and informal curricula felt more prepared and rated their end-of-life care education higher. Students with more exposure to a hidden curriculum that devalued end-of-life care perceived their preparation as poorer and had poorer attitudes toward end-of-life care. Minority students had slightly more negative attitudes but no differences in perceived end-of-life care preparation. CONCLUSIONS Medical students' sense of preparedness for end-of-life care and perceptions of educational quality are greater with more coursework and bedside teaching. By contrast, the hidden curriculum conveying negative messages may impair learning. Our findings suggest that implicit messages as well as intentional teaching have a significant impact on students' professional development. This has implications for designing interventions to train physicians to provide outstanding end-of-life care.
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Affiliation(s)
- Martha E Billings
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington 98104, USA.
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