Communication Skills Training Curriculum for Pulmonary and Critical Care Fellows

McCallister, Jennifer W.; Gustin, Jillian; Gregorio, Sharla Wells-Di; Way, David P.; Mastronarde, John G.

doi:10.1513/annalsats.201501-039oc

Cited by 56 publications

(75 citation statements)

References 24 publications

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“…Multiple studies have shown that pediatric intensivists often lack the appropriate skills to conduct these conversations sensitively and adeptly (1, 6, 14, 15). Pediatric critical care physicians (faculty as well as trainees) themselves often feel unprepared to have these difficult and emotion-laden conversations (16, 17). …”

Section: Discussionmentioning

confidence: 99%

An Intensive, Simulation-Based Communication Course for Pediatric Critical Care Medicine Fellows

Johnson

Hamilton

Watson

et al. 2017

Pediatric Critical Care Medicine

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Objective Effective communication among providers, families, and patients is essential in critical care, but is often inadequate in the pediatric ICU. To address the lack of communication education PCCM fellows receive, the Children’s Hospital of Pittsburgh PICU developed a simulation-based communication course, Pediatric Critical Care Communication Course (PC3). PCCM trainees have limited prior training in communication and will have increased confidence in their communication skills after participating in the PC3 course. Design PC3 is a 3-day course taken once during fellowship featuring simulation with actors portraying family members. Prior to and after the course, fellows complete an anonymous survey asking about 1) prior instruction in communication 2) preparedness for difficult conversations, 3) attitudes about end-of-life care, and 4) course satisfaction. We compared pre- and post-course surveys using paired student’s t-test. Main Results Most of the 38 fellows who participated over 4 years had no prior communication training in conducting a care conference (70%), providing bad news (57%), or discussing end of life options (75%). Across all four iterations of the course, fellows after the course reported increased confidence across many topics of communication, including giving bad news, conducting a family conference, eliciting both a family’s emotional reaction to their child’s illness and their concerns at the end of a child’s life, discussing a child’s code status, and discussing religious issues. Specifically, fellows in 2014 reported significant increases in self-perceived preparedness to provide empathic communication to families regarding many aspects of discussing critical care, end of life care and religious issues with patients’ families (p<0.05). The majority (90%) of fellows recommended that the course be required in PCCM fellowship. Conclusions The PC3 course increased fellow confidence in having difficult discussions common in the PICU. Fellows highly recommend it as part of PICU education. Further work should focus on the course’s impact on family satisfaction with fellow communication.

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Section: Discussionmentioning

confidence: 99%

An Intensive, Simulation-Based Communication Course for Pediatric Critical Care Medicine Fellows

Johnson

Hamilton

Watson

et al. 2017

Pediatric Critical Care Medicine

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“…Programs like IMPACT-ICU could complement training developed for other ICU clinicians. [41][42][43] Some of our sites have expanded the IMPACT-ICU program to include participants from other disciplines. We hope that training of ICU clinicians, in conjunction with integration of palliative care processes into routine practice, 44 will influence aspects of palliative care that did not improve with our program, such as identification of uncontrolled symptoms.…”

Section: Discussionmentioning

confidence: 99%

Palliative Care Professional Development for Critical Care Nurses: A Multicenter Program

Anderson¹,

Puntillo²,

Cimino³

et al. 2017

Am J Crit Care

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Background Integrating palliative care into intensive care units (ICUs) requires involvement of bedside nurses, who report inadequate education in palliative care. Objective To implement and evaluate a palliative care professional development program for ICU bedside nurses. Methods From May 2013 to January 2015, palliative care advanced practice nurses and nurse educators in 5 academic medical centers completed a 3-day train-the-trainer program followed by 2 years of mentoring to implement the initiative. The program consisted of 8-hour communication workshops for bedside nurses and structured rounds in ICUs, where nurse leaders coached bedside nurses in identifying and addressing palliative care needs. Primary outcomes were nurses' ratings of their palliative care communication skills in surveys, and nurses' identification of palliative care needs during coaching rounds. Results Each center held at least 6 workshops, training 428 bedside nurses. Nurses rated their skill level higher after the workshop for 15 tasks (eg, responding to family distress, ensuring families understand information in family meetings, all P < .01 vs preworkshop). Coaching rounds in each ICU took a mean of 3 hours per month. For 82% of 1110 patients discussed in rounds, bedside nurses identified palliative care needs and created plans to address them. Conclusions Communication skills training workshops increased nurses' ratings of their palliative care communication skills. Coaching rounds supported nurses in identifying and addressing palliative care needs. (American Journal of Critical Care. 2017; 26:361-371) by AACN on May 12, 2018 http://ajcc.aacnjournals.org/ Downloaded from P alliative care is a specialty and focus of care that aims to improve quality of care for patients who have serious and complex illnesses and their families. [1][2][3] Patients in intensive care units (ICUs) and their families have palliative care needs, including emotional support, management of pain and symptoms, and clinician-family communication to ensure that patients receive treatments that are consistent with their goals. [3][4][5][6][7][8][9][10][11][12][13] AJCC AMERICAN JOURNAL OF CRITICAL CARE, September 2017, Volume 26, No. 5 www.ajcconline.orgIn the ICU, palliative care is provided along with life-sustaining therapies and may be delivered by the ICU team (primary palliative care), a palliative care consult service (specialty palliative care), or both. 2,3,14 A number of barriers to integrating palliative care into the ICU have been identified, including inadequate training of clinicians and misperceptions that such treatment is the same as hospice, comfortfocused care, or end-of-life care. 3 Families, physicians, and nurses identify involvement of bedside nurses as a key factor in the quality of ICU palliative care. [15][16][17][18][19][20] Nurses' training and constancy at the bedside position them to identify palliative care needs, coordinate communication among families and an array of clinicians, and support and educate families. 15,16,19...

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“…In this month's issue of AnnalsATS, there appear two important reports of programs designed to teach critical care fellows to conduct effective and supportive ICU family conferences (10,11). Both reports describe the development and implementation of a formal program for teaching this important skill set, although they apply somewhat different approaches.…”

mentioning

confidence: 99%

“…Both reports describe the development and implementation of a formal program for teaching this important skill set, although they apply somewhat different approaches. Both of these programs also showed improved communication ratings, as assessed by a third-party rater: either a faculty member teaching the course, who could not be blinded to whether fellows had received the training (10), or independent clinical psychologists who were blinded to pre-versus posttraining (11). 520-525) uses a formal family conference checklist as a teaching guide to provide formative feedback to fellows about their performance during actual family conferences in the ICU (11).…”

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The Intensive Care Unit Family Conference. Teaching a Critical Intensive Care Unit Procedure

Hurd

Curtis

2015

Annals ATS

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The intensive care unit (ICU) is a setting in which clinicians care for many of the sickest, most critically ill patients in our healthcare system. Unfortunately, many of our patients die in the ICU. Indeed, approximately 20% of Americans die in, or shortly after, a stay in the ICU, making the ICU a common location for end-of-life care (1). The majority of deaths that occur in ICUs in the United States are preceded by a decision to withhold or withdraw life-sustaining therapy (2), which means ICU clinicians are often making difficult decisions with patients or, more commonly, as patients often cannot participate, with the patients' family members.Many of these decisions are made in the setting of an ICU family conference, and studies have used the ICU family conference as an important quality metric for patients at significant risk for death or prolonged ICU stay (3). Importantly, even if patients ultimately survive the ICU, their family members often have intense communication needs and are also at risk for consequences of stress and poor communication, including anxiety, depression, and posttraumatic stress disorder (4). In fact, family members of patients who survive the ICU rate ICU clinician communication more poorly than family members of patients who die in the ICU, attesting to the importance of communication for family members of all ICU patients (5).The consequences of poor communication with family members in the ICU are significant. A randomized trial showed that a relatively simple intervention designed to improve communication during family conferences and provide a bereavement packet to family members

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Communication Skills Training Curriculum for Pulmonary and Critical Care Fellows

Abstract: A structured curriculum that includes abundant opportunities for fellows to practice and receive feedback using a behavioral checklist during their ICU rotations helps to develop physicians with advanced communication skills.

Cited by 56 publications

References 24 publications

An Intensive, Simulation-Based Communication Course for Pediatric Critical Care Medicine Fellows

An Intensive, Simulation-Based Communication Course for Pediatric Critical Care Medicine Fellows

Palliative Care Professional Development for Critical Care Nurses: A Multicenter Program

The Intensive Care Unit Family Conference. Teaching a Critical Intensive Care Unit Procedure

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