Evaluation of a Mastery Learning Intervention on Hospitalists' Code Status Discussion Skills

Sharma, Rashmi; Szmuilowicz, Eytan; Ogunseitan, Adeboye; Jones, Sasha; Montalvo, Jessica; O’Leary, Kevin J.; Wayne, Diane B.

doi:10.1016/j.jpainsymman.2016.12.341

Cited by 39 publications

(32 citation statements)

References 13 publications

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“…Although participants may "pass" individual items on the UCC at a rate of 60% at baseline, we estimate a baseline performance of 3% of residents meeting the MPS on the pre-test. This estimate was based on prior SBML studies in communication with pass-rates all less than 10% [29,33]. We expect waitlist subjects to have only a slight improvement in meeting MPS at T2 resulting in a 10% pass rate.…”

Section: Sample Size Calculationmentioning

confidence: 99%

“…There is a large and growing body of evidence supporting the use of SBML as an educational modality for acquiring technical and procedural skills [27][28][29][30][31][32]. However, SBML has less frequently been used for acquisition of communication and interpersonal skills [33,34]. SBML is time and resource intensive, as one of the main means by which trainees acquire mastery is through repeated deliberate practice.…”

Section: Introductionmentioning

confidence: 99%

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Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial

et al. 2020

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Background: Diagnostic uncertainty occurs frequently in emergency medical care, with more than one-third of patients leaving the emergency department (ED) without a clear diagnosis. Despite this frequency, ED providers are not adequately trained on how to discuss diagnostic uncertainty with these patients, who often leave the ED confused and concerned. To address this training need, we developed the Uncertainty Communication Education Module (UCEM) to teach physicians how to discuss diagnostic uncertainty. The purpose of the study is to evaluate the effectiveness of the UCEM in improving physician communications. Methods: The trial is a multicenter, two-arm randomized controlled trial designed to teach communication skills using simulation-based mastery learning (SBML). Resident emergency physicians from two training programs will be randomly assigned to immediate or delayed receipt of the two-part UCEM intervention after completing a baseline standardized patient encounter. The two UCEM components are: 1) a web-based interactive module, and 2) a smart-phone-based game. Both formats teach and reinforce communication skills for patient cases involving diagnostic uncertainty. Following baseline testing, participants in the immediate intervention arm will complete a remote deliberate practice session via a video platform and subsequently return for a second study visit to assess if they have achieved mastery. Participants in the delayed intervention arm will receive access to UCEM and remote deliberate practice after the second study visit. The primary outcome of interest is the proportion of residents in the immediate intervention arm who achieve mastery at the second study visit. Discussion: Patients' understanding of the care they received has implications for care quality, safety, and patient satisfaction, especially when they are discharged without a definitive diagnosis. Developing a patient-centered diagnostic uncertainty communication strategy will improve safety of acute care discharges. Although use of SBML is a resource intensive educational approach, this trial has been deliberately designed to have a low-resource, scalable intervention that would allow for widespread dissemination and uptake. Trial registration: The trial was registered at clinicaltrials.gov (NCT04021771). Registration date: July 16, 2019.

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Section: Sample Size Calculationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial

et al. 2020

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“…18 Making a recommendation is a communication skill that can be learned with practice. 4,42 If you feel uncomfortable making recommendations, we suggest learning how via a graded approach. Thus, practice in clinical situations that lend themselves easier to a recommendation.…”

Section: What If I Feel Uncomfortable Making a Recommendation?mentioning

confidence: 99%

“…In fact, many clinicians do not conceptualize making a recommendation as a component of shared decision making 3 and do not routinely offer recommendations to patients and families. 4,5 Clinicians worry that giving a recommendation may be too paternalistic and thus infringe on patient autonomy 5 and bias decision making. 6 Clinicians also are uncertain whether recommendations fit into a shared decisionmaking framework.…”

Section: Introductionmentioning

confidence: 99%

“I'd Recommend …” How to Incorporate Your Recommendation Into Shared Decision Making for Patients With Serious Illness

Jacobsen

Blinderman

Cole

et al. 2018

Journal of Pain and Symptom Management

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Patients and families facing serious illness often want and need their clinicians to help guide medical decision making by offering a recommendation. Yet clinicians worry that recommendations are not compatible with shared decision making and feel reluctant to offer them. We describe an expert approach to formulating a recommendation using a shared decision-making framework. We offer three steps to formulating a recommendation: 1) evaluate the prognosis and treatment options; 2) understand the range of priorities that are important to your patient given the prognosis; and 3) base your recommendation on the patient's priorities most compatible with the likely prognosis and available treatment options.

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“…10,11 Recently, medical educators have begun applying these methods to communication skills training, with promising results. 12,13 Gardner and colleagues made important strides in their study by developing a checklist of key skills and a method of assessment. Mastery learning offers an opportunity to build on this foundation.…”

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confidence: 99%

Moving Toward Entrustment of Difficult Conversations

Vermylen

Wood

2018

Journal of Graduate Medical Education

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Evaluation of a Mastery Learning Intervention on Hospitalists' Code Status Discussion Skills

Abstract: Few hospitalists demonstrated mastery of CSD skills at baseline; SBML was an effective way to improve these skills.

Cited by 39 publications

References 13 publications

Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial

Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial

“I'd Recommend …” How to Incorporate Your Recommendation Into Shared Decision Making for Patients With Serious Illness

Moving Toward Entrustment of Difficult Conversations

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