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BACKGROUND: Despite the ever-expanding role that the patient experience plays in healthcare, effective strategies proven to increase patient satisfaction ratings remain scarce. At the University of Pittsburgh Medical Center, we identified patient-doctor and patient-nurse communication as an area for intervention to improve suboptimal patient satisfaction among medicine inpatients. We posited that the likely reasons for underperformance in this area were a lack of adequate training in bedside communication skills. DESIGN: We developed and evaluated a curriculum for medicine residents and nurses focused on clear communication at the bedside. A total of 76 internal medicine residents and 85 medical service nurses participated in 2016. The curriculum utilized didactics, video demonstrations, and role play, and was evaluated using pre-and post-surveys of participants' health literacy knowledge, attitudes, and confidence. Communication skills were evaluated using pre-and post-direct observation at the bedside with a communication skills checklist. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores were compared 3 months before and after the curriculum to assess changes in patient satisfaction. KEY RESULTS: Knowledge and attitudes improved significantly for both residents and nurses. Residents' and nurses' observed clinical communication skills improved significantly in most domains, and there was moderate increase in communication-specific HCAHPS scores. CONCLUSION: A small investment of curricular time devoted to clear communication skills improved residents' and medical nurses' knowledge, attitudes, skills, and communication-specific HCAHPS scores. This curriculum, focused on improving bedside communication skills, could be implemented in a variety of settings to improve patient satisfaction and patient experience. Among many barriers to communication, one particular barrier is health literacy. Only 12% of adults have proficient health literacy 7 and it is known that patients with limited health literacy have trouble understanding written medical information, communicating with healthcare providers, and implementing self-care instructions. 1,8 Additionally, both communication skills and an understanding of poor health literacy are required milestones for resident education 9 and communication skills are tested on the national nursing exam. 10 Though recent studies have shown that system-wide communication skills training for faculty physicians can combat poor health literacy and improve patient satisfaction scores, 11,12 these outcomes have not been studied in the resident and nurse populations. As part of a division-wide effort to improve the patient experience, we noted that the general medicine service HCAHPS scores for both our doctors' and nurses' communication had room for improvement, particularly on the item, BDuring this hospital stay, how often did doctors (nurses) explain things in a way you could understand?^Based on

SDM is teachable, and this skill-based curricular intervention resulted in improvement in senior medicine residents' knowledge of, attitudes toward, and demonstration of SDM skills.

Experienced clinician-educators improved their communication knowledge, attitudes, and skills in managing patients with CNMP after implementation of this curriculum. The improvements in attitudes were sustained at six months. A Web-based curriculum such as COPE-REMS® may be useful for other programs seeking improvement in faculty communication with patients who have CNMP.

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This curriculum pilot demonstrated an improvement in IM residents' knowledge of and confidence in providing care to LGBT patients. Our results suggest that curricular materials can be developed by experts in LGBT health and utilized effectively by nonexpert faculty to increase residents' knowledge and confidence regarding LGBT healthcare.

Introduction: Significant gaps remain in the training of health professionals regarding the care of individuals who identify as lesbian, gay, bisexual, and transgender (LGBT). Although curricula have been developed at the undergraduate medical education level, few materials address the education of graduate medical trainees. The purpose of this curriculum was to develop case-based modules targeting internal medicine residents to address LGBT primary health care. Methods: We designed and implemented a four-module, case-based, interactive curriculum at one university's internal medicine residency program. The modules contained facilitator and learner guides and addressed four main content areas: understanding gender and sexuality; performing a sensitive history and physical examination; health promotion and disease prevention; and mental health, violence, and reproductive health. Knowledge, perceived importance, and confidence were assessed before and after each module to assess curricular effectiveness and acceptability. General medicine faculty delivered these modules. Results: Perceived importance of LGBT topics was high at baseline and remained high after the curricular intervention. Confidence significantly increased in many areas, including being able to provide resources to patients and to institute gender-affirming practices (p < .05). Knowledge improved significantly on almost all topics (p < .0001). Faculty felt the materials gave enough preparation to teach, and residents perceived that the faculty were knowledgeable. Discussion: This resource provides an effective curriculum for training internal medicine residents to better understand and feel confident addressing LGBT primary health care needs. Despite limitations, this is an easily transferable curriculum that can be adapted in a variety of curricular settings.