Expert communication is essential to high quality care for older patients with serious illness. While the importance of communication skills is widely recognized, formal curricula for teaching communication skills to geriatrics and palliative medicine fellows is often inadequate or unavailable. We drew upon the educational principles and format of an evidence-based, interactive teaching method, to develop an intensive communication skills training course designed specifically to address the common communication challenges faced by geriatrics and palliative medicine fellows. The 2-day retreat, held away from the hospital environment, included large-group overview presentations, small-group communication skills practice, and development of future skills practice commitment. Faculty received in-depth training in small-group facilitation techniques prior to the course. Geriatrics and palliative medicine fellows were recruited to participate in the course and 100% (n=18) enrolled. Overall satisfaction with the course was very high (mean 4.8 on 5-point scale). Compared to before the course, fellows reported an increase in self-assessed preparedness for specific communication challenges (mean increase 1.4 on 5-point scale, p<0.01). Two months after the course, fellows reported a high level of sustained skills practice (mean 4.3 on 5-point scale). In sum, the intensive communication skills program, tailored to the specific needs of geriatrics and palliative medicine fellows, improved fellows’ self-assessed preparedness for challenging communication tasks and provided a model for ongoing deliberate practice of communication skills.
Although professional knowledge and attitudes about pain and nursing pain assessment rates have been shown to be improvable, no systematic, hospital-wide intervention has yet to be associated with improvement in pain severity. Future research on the development of new interventions, perhaps targeted specifically at physicians, is urgently needed.
Background
Communication skills are critical in Geriatrics and Palliative Medicine because these patients confront complex clinical scenarios. We evaluated effectiveness of the Geritalk communication skills course by comparing pre- and post-course real-time assessment of participants leading family meetings. We also evaluated the participants’ sustained skills practice.
Measures
We compare participants’ skill acquisition before and after Geritalk using a direct observation Family Meeting Communication Assessment Tool, and assessed their deliberate practice at follow-up.
Intervention
First-year Geriatrics or Palliative Medicine fellows at Mount Sinai Medical Center and the James J. Peters Bronx VA Medical Center participated in Geritalk.
Outcomes
Pre- and post-course family meeting assessments were compared. An average net gain of 6.8 skills represented a greater than 20% improvement in use of applicable skills. At two-month follow-up, most participants reported deliberate practice of fundamental and advanced skills.
Conclusions
This intensive training and family meeting assessment offers evidence-based communication skills training.
Among patients who died in the hospital, transfer to a PCU is associated with significant cost savings as compared with patients on hospital wards who are seen by a PCCS.
Graduating medical students who had a 1-week clinical rotation in palliative medicine had higher self-assessed skills in pain management and communication than students who received no clinical exposure. A brief clinical experience in palliative care should be considered for integration into the curriculum at all medical schools.
Introduction
Given the growing population of older adults, it is of utmost importance for all future physicians to be trained in the core skills of conducting geriatric assessment.
Methods
We designed an interactive, skills-based session introducing core competencies for geriatric assessment for second-year medical students (MS2s). We organized our curriculum for early learners based on the 4Ms framework: mind/memory, medications, mobility, and matters most. The session consisted of brief didactics with integration of real-time skills-based practice. Students completed pre- and postsession surveys to assess their confidence in their knowledge and skills. All students completed a geriatric assessment during a clinical skills encounter as part of a multistation, end-of-course, summative clinical skills examination (CSE). The session was conducted virtually over 2 academic years, and the CSE was conducted virtually in 2020 and in person in 2021.
Results
One hundred ninety-nine MS2s participated in the session (100 in 2020, 99 in 2021). All students surveyed (33%) reported improved confidence in geriatric knowledge and skills by the end of the session (
p
s < .001). Students were more likely to use a cognitive screening tool, ask about advance care planning, and assess medication adherence on the CSE in 2021 compared to 2020 (
p
s < .001).
Discussion
We provide an interactive curriculum for MS2s to develop geriatric assessment skills. The curriculum and assessment tools are versatile, can be easily integrated into any medical school curriculum, and can be effectively delivered in person or on a virtual platform.
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