Critical Care Communication Skills Training for Internal Medicine Residents

Rock, Laura; Gadmer, Nina; Arnold, Robert M.; Roberts, David; Anandaiah, Asha; Pogach, Melanie; Clardy, Peter; Schwartzstein, Richard M.; Sullivan, Amy

doi:10.15766/mep_2374-8265.10212

Cited by 3 publications

(4 citation statements)

References 13 publications

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“…Examples of specific skills include the following: sharing complex information clearly, making a connection, or identifying and responding to emotion to provide empathy and understand values. 7, 13,18,[25][26][27] Notably, teaching should be limited to just 1 or 2 key strategies or skills to avoid overwhelming the learner.…”

Section: Years Of Research On Productive Conversations In the Organiz...mentioning

confidence: 99%

Communication as a High-Stakes Clinical Skill: “Just-in-Time” Simulation and Vicarious Observational Learning to Promote Patient- and Family-Centered Care and to Improve Trainee Skill

Rock

2021

Academic Medicine

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Patient–provider communication is a hallmark of high-quality care and patient safety; however, the pace and increasingly complex challenges that face overextended teams strain even the most dedicated clinicians. The COVID-19 pandemic has further disrupted communication between clinicians and their patients and families. The dependence on phone communication and the physical barriers of protective gear limit nonverbal communication and diminish clinicians’ ability to recognize and respond to emotion. Developing new approaches to teach communication skills to trainees who are often responsible for communicating with patients and their families is challenging, especially during a pandemic or other crisis. “Just-in-time” simulation—simulation-based training immediately before an intervention—provides the scaffolding and support trainees need for conducting difficult conversations, and it enhances patients’ and families’ experiences. Using a realistic scenario, the author illustrates key steps for effectively using just-in-time simulation-based communication training: assessing the learner’s understanding of the situation; determining what aspects of the encounter may prove most challenging; providing a script as a cognitive aid; refreshing or teaching a specific skill; preparing learners emotionally through reflection and mental rehearsal; coaching on the approach, pace, and tone for a delivery that conveys empathy and meaning; and providing specific, honest, and curious feedback to close a performance gap. Additionally, the author acknowledges that clinical conditions sometimes require learning by observing rather than doing and has thus provided guidance for making the most of vicarious observational learning: identify potential challenges in the encounter and explicitly connect them to trainee learning goals, explain why a more advanced member of the team is conducting the conversation, ask the trainee to observe and prepare feedback, choose the location carefully, identify everyone’s role at the beginning of the conversation, debrief, share reactions, and thank the trainee for their feedback and observations.

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Section: Years Of Research On Productive Conversations In the Organiz...mentioning

confidence: 99%

Communication as a High-Stakes Clinical Skill: “Just-in-Time” Simulation and Vicarious Observational Learning to Promote Patient- and Family-Centered Care and to Improve Trainee Skill

Rock

2021

Academic Medicine

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“…In a review of the literature and similar topic areas in MedEdPORTAL , we found examples of effective curricula promoting humanism and professionalism in residents 16 , 17 and fellows, 18 as well as a creative simulation-based curriculum promoting empathy in anesthesiology residents. 19 Indeed, there is a strong need for curricula that promote empathy, kindness, and compassionate care, as residents indicate they often do not have opportunity to discuss empathy or receive formal communication skills training following the first two years of medical school.…”

Section: Introductionmentioning

confidence: 99%

“…Also, the studies reviewed here utilize educational methods such as written case-based learning, 17 simulation, 18 and reflective writing, 22 but none provide opportunities to work with patients directly. One curriculum involves training residents to lead family goals of care discussions, 16 while another, developed by Kesselheim and colleagues, uses case vignettes to highlight challenges in humanism and professionalism and promote discussion among residents 17 and fellows. 18 In a simulation-based curriculum, anesthesiology residents role-play being a patient requiring an emergent C-section in order to build skills in empathy.…”

Section: Introductionmentioning

confidence: 99%

The Kind Care Bundle: A Curriculum to Teach Medical Students the Behaviors of Kind, Compassionate Care

Cooper

Gheihman

2021

MedEdPORTAL

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Introduction Patients’ hospital experiences can be adversely affected by clinicians’ negative behaviors. Simple positive behaviors, however, can have a dramatic impact on patient-clinician relationships. Medical students starting clinical training are ideal educational targets for learning good behavioral habits that promote kind, compassionate care. Methods We developed the Kind Care Bundle, a collection of concrete verbal and nonverbal behaviors for showing compassion in patient interactions. The curriculum was taught in 3-hour small-group interactive sessions to first-year students. Students reflected on personal experiences of compassionate care and role-played the use of the Kind Care Bundle. In pairs, students interviewed patients about their experiences of kind, compassionate care while practicing the Kind Care Bundle. Students completed a postsession evaluation with Likert scales and free-text responses. Results Thirty-seven of 40 students (92%) completed postsession evaluation forms. Session organization was considered excellent (27 of 37 students, 73%) or very good (nine of 37, 27%). Session relevance was rated as excellent by 30 of 37 students (81%) and very good by six of 37 students (16%). Students believed the bundle filled an educational gap. Qualitative themes included appreciation of concrete behaviors in the bundle, importance of empathy, and opportunity to reflect on one's own experience of compassion. Discussion Students appreciated learning about specific behaviors for improving patient interactions. Targeting preclinical medical students has the potential to promote kinder and more compassionate patient interactions during subsequent clinical training. The long-term impact on students’ behavior and on their personal and professional development requires further study.

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“…During tele-health visits, responding with empathy can be difficult because most of the physical and nonverbal clues are easily missed. Especially when communicating with older adults the encounter can be challenging and need extra attention on the patient's perceptual capabilities such as hearing, vision, cognitive, motor and technological skills (5).…”

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confidence: 99%