IntroductionDifficult patient encounters (DPEs) are common and can lead to frustration and dissatisfaction among healthcare providers. Pediatric resident physician experiences with DPEs and curricula for enhancing necessary communication skills have not been well described.Materials and methodsWe used a cross-sectional survey research design for our needs assessment on resident experiences with DPEs. Thirty-three pediatric residents completed this anonymous survey. The survey assessed residents’ experiences with and self-efficacy regarding DPEs. Descriptive statistics were used to analyze the quantitative data. Additionally, two authors independently coded free response data to include in the narrative description of the survey results.ResultsThese survey results include the views of 92% of the residents in the program (33/36). Residents reported a greater frequency of difficult encounters in the inpatient setting than the outpatient setting. The majority of residents rated their communication skills during DPEs as “fair” or “good” (70%, 23/33). Residents tended to have lower confidence when discussing chronic pain, managing parental insistence on a plan, and breaking bad news. They generally reported higher levels of anxiety for scenarios involving angry patients and families, families insisting on a plan, and when breaking bad news. Residents cited many challenges, including working with angry and demanding families. Additionally, residents described difficulty with managing discordant opinions between the family and the healthcare team regarding the care plan. Residents expressed a preference for learning how to manage challenging patient encounters using clinical experiences. Simulation, discussion, and observation of role models also rated highly as educational methods for increasing skills, while most residents rated lectures as the least important means of training skills for these difficult encounters.DiscussionWe found that pediatric residents experience difficult encounters frequently, especially in the inpatient setting. Individual residents vary in their confidence and anxiety levels with different types of difficult encounters and may benefit from not only general communication skills training, but also from targeted training to equip them for the particular contexts they find most challenging. Residents value interactive structured learning activities, including discussion and simulation. Residents most consistently value the opportunity to lead challenging conversations in the clinical setting, especially when followed by effective debriefing and feedback by trained faculty preceptors.ConclusionsNext steps include creating a “Difficult Encounters” communication skills curriculum informed by this needs assessment, which aim to enhance patient care as well as increase resident self-efficacy. In addition to the curriculum development for residents, it may be helpful to initiate faculty development on how to supervise resident-led difficult conversations and provide effective debriefing and feedback to...
The German-Polish border region, located along the European Union's eastern boundary, is characterized by sharp disparities in living standards and development. It also is a zone of contact between two very different political traditions and cultures that often have confronted each other in conf lict. Since 1990, cooperation attempts on the German-Polish border have been actively encouraged by EU and German government agencies and supported through the creation of Euroregions, intergovernmental advisory boards, and other international bodies. Transboundary regionalism is seen as a means of promoting integrated development and socioeconomic cohesion within the context of European expansion and integration.However, evaluations of German-Polish cooperation indicate that the creation of new institutions of cross-border planning is not enough; in order to be effective, German-Polish transboundary regionalism must not only prevail against policy discontinuities caused by administrative mismatches but also transcend traditional interagency rivalries within national contexts. Furthermore, it must engage both communities and senior governments on both sides of the border as partners in a regional development dialogue. This would require combining available resources at various levels, including a synergistic utilization of transboundary links of public and private agencies at various levels. Nevertheless, a vital question remains as to the proper mix of formal institutions and informal networks required in order to achieve this.Here, experiences from other international border regions, such as the U.S.-Mexican borderlands, could provide important comparative insights.
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