1
|
Walter JM, Smith MM, Einstein N, Cohen ER, Wood GJ, Vermylen JH. Development of a Simulation-Based Mastery Learning Curriculum for Late Goals of Care Discussions. J Pain Symptom Manage 2024; 68:e54-e61. [PMID: 38527655 DOI: 10.1016/j.jpainsymman.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Fellows in critical care medicine (CCM) routinely help patients and families navigate complex decisions near the end of life. These "late goals of care" (LGOC) discussions require rigorous skills training and impact patient care. Innovation is needed to ensure that fellow training in leading these discussions is centered on reproducible competency-based standards. The aims of this study were to (1) describe the development of a simulation-based mastery learning (SBML) curriculum for LGOC discussions and (2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners. INNOVATION We developed an SBML curriculum for CCM fellows structured around REMAP, a mnemonic outlining foundational components of effective communication around serious illness. A multidisciplinary expert panel iteratively created an LGOC discussion assessment tool. Pilot testing was completed to refine the checklist, set the MPS, and assess skill acquisition. OUTCOMES The LGOC discussion assessment tool included an 18-item checklist and 6 scaled items. The tool produced reliable data (k ≥ 0.7 and ICC of ≥ 0.7). Using the Mastery Angoff method, the panel set the MPS at 87%. Ten CCM fellows participated in the pilot study. Performance on the checklist significantly improved from a median score of 52% (IQR 44%-72%) at pretest to 96% (IQR 82%-97%) at post-test (P = 0.005). The number of learners who met the MPS similarly improved from 10% during pre-testing to 70% during post-testing (P = 0.02). COMMENT We describe the development of a LGOC SBML curriculum for CCM fellows which includes a robust communication skills assessment and the delineation of a defensible MPS.
Collapse
Affiliation(s)
- James M Walter
- Department of Medicine (J.M.W., M.M.S., E.R.C., G.J.W., J.H.V.), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Melanie M Smith
- Department of Medicine (J.M.W., M.M.S., E.R.C., G.J.W., J.H.V.), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Noah Einstein
- Department of Emergency Medicine (N.E.), Advocate Health Care, Chicago, Illinois, USA
| | - Elaine R Cohen
- Department of Medicine (J.M.W., M.M.S., E.R.C., G.J.W., J.H.V.), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gordon J Wood
- Department of Medicine (J.M.W., M.M.S., E.R.C., G.J.W., J.H.V.), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Julia H Vermylen
- Department of Medicine (J.M.W., M.M.S., E.R.C., G.J.W., J.H.V.), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
2
|
Lincoln TE, Buddadhumaruk P, Arnold RM, Scheunemann LP, Ernecoff NC, Chang CCH, Carson SS, Hough CL, Curtis JR, Anderson W, Steingrub J, Peterson MW, Lo B, Matthay MA, White DB. Association Between Shared Decision-Making During Family Meetings and Surrogates' Trust in Their ICU Physician. Chest 2023; 163:1214-1224. [PMID: 36336000 PMCID: PMC10258434 DOI: 10.1016/j.chest.2022.10.028] [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] [Received: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although trust is central to successful physician-family relationships in ICUs, little is known about how to promote surrogates' trust of ICU physicians in this setting. RESEARCH QUESTION Does the conduct of family conferences and physicians' use of shared decision-making (SDM) within family conferences impact surrogates' trust in the physician? STUDY DESIGN AND METHODS A mixed-methods secondary analysis was done of a multicenter prospective cohort study of 369 surrogate decision-makers of 204 decisionally incapacitated patients at high risk of death or severe functional impairment within 13 ICUs at six US medical centers between 2008 and 2012. Surrogates completed the Abbreviated Wake Forest Physician Trust Scale (range, 5-25) before and after an audio-recorded family conference conducted within 5 days of ICU admission. We qualitatively coded transcribed conferences to determine physicians' use of five SDM behaviors: discussing surrogate's role, explaining medical condition and prognosis, providing emotional support, assessing understanding, and eliciting patient's values and preferences. Using multivariable linear regression with adjustment for clustering, we assessed whether surrogates' trust in the physician increased after the family meeting; we also examined whether the number of SDM behaviors used by physicians during the family meeting impacted trust scores. RESULTS In adjusted models, conduct of a family meeting was associated with increased trust (average change, pre- to post family meeting: 0.91 point [95% CI, 0.4-1.4; P < .01]). Every additional element of SDM used during the family meeting, including discussing surrogate's role, providing emotional support, assessing understanding, and eliciting patient's values and preferences, was associated with a 0.37-point increase in trust (95% CI, 0.08-0.67; P = .01). If all four elements were used, trust increased by 1.48 points. Explaining medical condition or prognosis was observed in nearly every conference (98.5%) and was excluded from the final model. INTERPRETATION The conduct of family meetings and physicians' use of SDM behaviors during meetings were both associated with increases in surrogates' trust in the treating physician.
Collapse
Affiliation(s)
- Taylor E Lincoln
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA.
| | - Praewpannarai Buddadhumaruk
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA
| | - Leslie P Scheunemann
- Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, PA; Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Chung-Chou H Chang
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Shannon S Carson
- Division of Pulmonary Disease and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Catherine L Hough
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR
| | - J Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Wendy Anderson
- Department of Medicine and Division of Hospital Medicine and Palliative Care Program, University of California San Francisco, San Francisco, CA
| | - Jay Steingrub
- Division of Pulmonary and Critical Care Medicine, Baystate Medical Center, Springfield, MA and Tufts University School of Medicine, Boston, MA
| | - Michael W Peterson
- Department of Medicine, University of California San Francisco Fresno Medical Education Program, Fresno, CA
| | - Bernard Lo
- Department of Medicine, University of California San Francisco Fresno Medical Education Program, Fresno, CA
| | - Michael A Matthay
- Division of Pulmonary and Critical Care Medicine, University of Massachusetts Chan Medical School, Baystate, MA
| | - Douglas B White
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| |
Collapse
|
3
|
Kobayashi M, Katayama M, Hayashi T, Hashiyama T, Iyanagi T, Une S, Honda M. Effect of multimodal comprehensive communication skills training with video analysis by artificial intelligence for physicians on acute geriatric care: a mixed-methods study. BMJ Open 2023; 13:e065477. [PMID: 36868602 PMCID: PMC9990644 DOI: 10.1136/bmjopen-2022-065477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
OBJECTIVES To quantitatively analyse by artificial intelligence (AI) the communication skills of physicians in an acute care hospital for geriatric care following a multimodal comprehensive care communication skills training programme and to qualitatively explore the educational benefits of this training programme. DESIGN A convergent mixed-methods study, including an intervention trial with a quasi-experimental design, was conducted to quantitatively analyse the communication skills of physicians. Qualitative data were collected via physicians' responses to an open-ended questionnaire administered after the training. SETTING An acute care hospital. PARTICIPANTS A total of 23 physicians. INTERVENTIONS In a 4-week multimodal comprehensive care communication skills training programme, including video lectures and bedside instruction, from May to October 2021, all the participants examined a simulated patient in the same scenario before and after their training. These examinations were video recorded by an eye-tracking camera and two fixed cameras. Then, the videos were analysed for communication skills by AI. MAIN OUTCOME MEASURES The primary outcomes were the physicians' eye contact, verbal expression, physical touch and multimodal communication skills with a simulated patient. The secondary outcomes were the physicians' empathy and burnout scores. RESULTS The proportion of the duration of the participants' single and multimodal types of communication significantly increased (p<0.001). The mean empathy scores and the personal accomplishment burnout scores also significantly increased after training. We developed a learning cycle model based on the six categories that changed after training from the physicians' perspective: multimodal comprehensive care communication skills training; increasing awareness of and sensitivity to changes to geriatric patients' condition; changes in clinical management; professionalism; team building and personal accomplishments. CONCLUSIONS Our study showed that multimodal comprehensive care communication skills training for physicians increased the proportions of time spent performing single and multimodal communication skills by video analysis through AI. TRIAL REGISTRATION NUMBER UMIN Clinical Trials Registry (UMIN000044288; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000050586).
Collapse
Affiliation(s)
- Masaki Kobayashi
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
- Division of Geriatric Medicine, Rochester Regional Health System, Rochester, New York, USA
| | - Mitsuya Katayama
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Tomofumi Hayashi
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Takuhiro Hashiyama
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Toshinori Iyanagi
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Saki Une
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Miwako Honda
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| |
Collapse
|
4
|
Jin J, Son YJ, Tate JA, Choi J. Challenges and Learning Needs of Nurse-Patients' Family Communication: Focus Group Interviews With Intensive Care Unit Nurses in South Korea. Eval Health Prof 2022; 45:411-419. [PMID: 35337208 PMCID: PMC9630962 DOI: 10.1177/01632787221076911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Intensive care unit (ICU) nurses are expected to facilitate effective day-to-day communication with patients and family members at the bedside. To date, communication training for ICU health care professionals has targeted mainly intensivists-in-training, but there is limited data on communication experience and needs to be evaluated among ICU nurses. This qualitative study used focus group interviews to explore daily communication experiences with patients' families and communication training needs and preferences among ICU nurses in South Korea. Five focus group interviews were conducted with 27 ICU nurses (4-6 nurses per group). The results of inductive qualitative content analysis highlighted four main categories: "Perceived difficulties during communication," "burden from working conditions," "endeavors to promote communication skills," and "strategies for cultivating effective communication." Regarding suggestions for future communication training, nurses preferred interactive learning with peer-support over traditional methods (e.g., lectures). Nurses also suggested that communication training for ICU nurses should include learning skills appropriate for difficult situations (e.g., angry family members). Findings from this study can serve as a framework for stakeholders in ICU care and healthcare education (e.g., hospital and nursing administrators, nurse educators) when designing communication training to support ICU nurses with their practical knowledge and communication skills.
Collapse
Affiliation(s)
- Juhye Jin
- Department of Nursing, College of
Health and Life Science, Korea National University of
Transportation, Jeungpyeong, South Korea
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
| | - Judith A. Tate
- The Ohio State University, College of
Nursing, Columbus, OH, USA
| | - JiYeon Choi
- Mo-Im Kim Nursing Research
Institute, Yonsei University College of
Nursing, Seoul, South Korea,JiYeon Choi, Yonsei University College of
Nursing, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
| |
Collapse
|