Education Research: Communication skills for neurology residents

Abstract

Objective: Despite the importance of communication skills for neurologists, specific training in this area at the residency level is often lacking. This study aimed to enhance learning of these skills and to encourage reflective practice around communication skills. Methods:A group of 12 neurology residents participated in a series of six case-based communication skills workshops. Each workshop focused on a particular clinical scenario, including breaking bad news, discussing do-not-resuscitate orders, communicating with "difficult" patients, disclosing medical errors, obtaining informed consent for neurologic tests and procedures, and discussing life-and-death decisions with families of critically ill patients. Residents also kept reflective portfolios in which real examples of these interactions were recorded. Results:The program was well accepted, and residents rated the workshops as effective and relevant to their practice. Analysis of residents' portfolios revealed three themes relevant to patient-physician communication: 1) communication is more successful when adequate time is allowed, 2) the ability to empathize with patients and their families is essential to successful interactions, and 3) the development of specific approaches to challenging scenarios can facilitate effective interactions. The portfolios also demonstrated that residents would engage in reflective practice. Time and experience alone often fail to produce improvements in physicians' communication skills, 6-8 but there is compelling evidence for a positive effect of communication skills training. 9 Residency programs should therefore develop specific educational interventions that address communication skills. ConclusionsThe practicing neurologist must be able to rely on a repertoire of communication skills to facilitate effective, patient-centered care. To date, the area of communication skills training has been largely neglected in the neurologic literature. 10 The objectives of this pilot project were to develop a communication skills training program specifically for neurology residents, directed at some of the most challenging clinical scenarios that they will face in practice, and to foster reflective practice as a tool for enhancement of communication skills. Educational intervention. Residents participated in a series of six 2-hour workshops over the course of a single academic year. Each workshop focused on a specific clinical scenario of particular relevance to neurologic practice. Workshop topics were as follows: 1) breaking bad news, 2) discussing do-not-resuscitate orders, 3) communicating with "difficult" patients or family members, 4) obtaining informed consent for neurologic tests, procedures, or therapies, 5) communicating with families around life-and-death decision making for patients with critical illness, and 6) disclosing medical errors. All workshops followed a four-part format. Part 1 was a video clip chosen to trigger discussion on the workshop topic. Part 2 was a facilitated discussion among the reside...

Assessing Interpersonal and Communication Skills in Emergency Medicine

“…31,32 Use of portfolios was evaluated in psychiatry education 33 and in neurology. 34 Other Countries For the purposes of this overview, we will concentrate mainly on the other English-speaking countries that have similar training systems; namely Canada, Australia, and the United Kingdom. Canadian and Australian systems use the conceptual framework called Can-MEDS, 35 while the Scottish Doctor Collaboration is utilized in the United Kingdom.…”

Residency Training: Teaching communication

“…Not only do patients deserve such skills in their physicians, but residents actually want these skills and desire to participate in educational experiences that teach how to communicate effectively. 1 It is known that a connection exists between healing and human relationships. 2 People who enter the study of medicine often have preexisting qualities of humanism and intelligence.…”

“…This may not be true, as previous reports have suggested that time and experience alone may not produce adequate improvements in physician communication. 1 The Accreditation Council for Graduate Medical Education requires competency of communication and professionalism. Unfortunately, these competencies are often learned informally, without formal instruction.…”

“…4 Finally, a pilot study for neurology residents used a series of 6 cased-based communication skill workshops (e.g., breaking bad news, discussing donot-resuscitate orders, communicating with "difficult" patients, disclosing medical errors, obtaining informed consent, and end-of-life decisions), and found that the experience was viewed favorably by the participating residents and felt to be relevant to their practice. 1 Providing lectures on communication skills, interviewing simulated patients, and role-playing seem to be effective strategies to teach communication. It is not clear how well these interventions work when residents and physicians interact with real patients.…”

A new method for the assessment of patient safety competencies during a medical school clerkship using an objective structured clinical examination

“…The objective structured clinical examination,21 which uses standardized patients, is a powerful tool for the evaluation of patient safety competencies. There are several positive aspects of this tool, including professional development in a low-risk environment and the incorporation of skills and attitudes for handling medical error recognition and disclosure, patient-centered care, communication, and interpersonal skills and humanism issues 4,6,7,10,22. In addition, the objective structured clinical examination provides valuable feedback to both examinees and educators4,6,7,23 and offers reinforcement that is critical for promoting lasting changes in physician behavior 4,6,7,23.…”