Introduction. Although residents frequently lead end-of-life (EOL) discussions in the intensive care unit (ICU), training in EOL care during residency has been required only recently, and few educational interventions target EOL communication in the ICU. This study evaluated a simulation-based intervention designed to improve resident EOL communication skills with families in the ICU. Methods. Thirty-four second-year internal medicine residents at a large urban teaching hospital participated in small group sessions with faculty trained in the “VitalTalk” method. A Likert-type scale questionnaire measured self-assessed preparedness before, immediately following, and approximately 9 months after intervention. Data were analyzed using Wilcoxon rank-sum analysis. Results. Self-assessed preparedness significantly improved for all categories surveyed (preintervention mean; postintervention mean; p value), including discussing bad news (3.3; 4.2; p < 0.01), conducting a family conference (3.1; 4.1; p < 0.01), discussing treatment options (3.2; 3.9; p < 0.01), discussing discontinuing ICU treatments (2.9; 3.5; p < 0.01), and expressing empathy (3.9; 4.5; p < 0.01). Improvement persisted at follow-up for all items except “expressing empathy.” Residents rated the educational quality highly. Conclusion. This study provides evidence that brief simulation-based interventions can produce lasting improvements in residents' confidence to discuss EOL care with family members of patients in the ICU.
Use of the communications bundle proved feasible in the MICU and suggests association with improved patient satisfaction and trainee self-perception of communication preparedness.
Traditional interviews for residency and fellowship training programs are an important component in the selection process, but can be of variable value due to a nonstandardized approach. We redesigned the candidate interview process for our large pulmonary and critical care medicine fellowship program in the United States using a behavioral-based interview (BBI) structure. The primary goal of this approach was to standardize the assessment of candidates within noncognitive domains with the goal of selecting those with the best fit for our institution's fellowship program. Eight faculty members attended two BBI workshops. The first workshop identified our program's "best fit" criteria using the framework of the Accreditation Council for Graduate Medical Education's six core competencies and additional behaviors that fit within our programs. BBI questions were then selected from a national database and refined based on the attributes deemed most important by our faculty. In the second workshop, faculty practiced the BBI format in mock interviews with third-year fellows. The interview process was further refined based on feedback from the interviewees, and then applied with fellowship candidates for the 2014 recruitment season. The 1-year pilot of behavioral-based interviewing allowed us to achieve consensus on the traits sought for our incoming fellows and to standardize the interview process for our program using the framework of the Accreditation Council for Graduate Medical Education core competencies. Although the effects of this change on the clinical performance of our fellows have not yet been assessed, this description of our development and implementation processes may be helpful for programs seeking to redesign their applicant interviews.
Background Little is known about residents' performance on the milestones at the institutional level. Our institution formed a work group to explore this using an institutional-level curriculum and residents' evaluation of the milestones.
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