Perspectives of internal medicine residents on approaching serious illness conversations

Abstract

Background Navigating serious illness conversations is a critical competency for clinical trainees in any discipline, yet many feel underprepared to engage in such conversations. This study explored the challenges and emotions experienced by residents (junior doctors) when approaching serious illness conversations and how their perceptions might inform the development of effective communication skills curricula. Methods Using qualitative methodology, we explored the prior experience of Internal Medicine residents who attended communication skills workshops at Brigham and Women's Hospital between January and May 2020. Using an open‐ended questionnaire, we solicited participants' reflections on conducting serious illness conversations. Narratives were de‐identified and analysed for key themes. The Mass General Brigham Institutional Review Board approved the study. Findings Fifty‐one out of 70 eligible residents (72.8%) completed the questionnaire. Qualitative analysis identified five key themes: (a) finding the time to do it right, (b) fear of using the wrong words, (c) managing the patient's response and emotion, (d) not knowing how much they can say and (e) finding meaning and fulfilment. Residents also proposed several practical strategies to enhance their communication training. Discussion and conclusion Though serious illness conversations were reported as stressful, study participants emphasised that the experiences enabled them to forge meaningful therapeutic relationships and led to a sense of fulfilment. The strategies recommended by our residents offer valuable insights to improve communication training, including through increased simulated and real‐time skills practice. Cocreation of curricula by trainees and faculty could potentially address trainees' challenges, promote essential skills, and foster professional identity formation.

An innovative approach to comprehensive communication skills training for residents: A resident-led communication curriculum

“…Some mentioned the curriculum led to “a gradual switch in how we dialogue with our peers” and to “a change in our program’s cultural norm.” Faculty and residents hypothesize one reason for the high acceptability was the unique approach of having the sessions led by residents, trusted colleagues who are “in the trenches” with them. A qualitative study of residents’ experiences when approaching serious illness conversations concluded that “cocreation of curricula by trainees and faculty could potentially address trainee’s challenges, promote essential skills, and foster professional identity formation.” 39 Another study showed that interns reported a preference for senior residents as teachers and increased comfort in asking questions in senior resident-led compared to attending-led didactics. 31 Four years after the pilot curriculum, we continue to implement a resident-led communication curriculum.…”

“…35 In order to foster these initiatives, curricular innovations are needed to enhance training in the competency of interpersonal and communication skills which is essential to engaging patients. 13,21,28,39…”

“…35 In order to foster these initiatives, curricular innovations are needed to enhance training in the competency of interpersonal and communication skills which is essential to engaging patients. 13,21,28,39 Comprehensive communication curriculums for residents are sparse and the effect of a resident-led strategy is not well established with little current literature providing any insight. This study aims to fill that gap.…”

Serious illness conversations in South Africa

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Dear EditorResearch conducted by Lawton et al 1 sheds light on the perspectives of internal medicine residents in having serious illness conversations. Primarily, our lived experiences as a medical doctor, scholar of medical education (LG) and internal medicine registrar (PS) corroborates the findings of Lawton et al 1 However, as we practice in South Africa, we note that our setting has presented unique communication challenges, which we outline below.

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Dear EditorResearch conducted by Lawton et al 1 sheds light on the perspectives of internal medicine residents in having serious illness conversations. Primarily, our lived experiences as a medical doctor, scholar of medical education (LG) and internal medicine registrar (PS) corroborates the findings of Lawton et al 1 However, as we practice in South Africa, we note that our setting has presented unique communication challenges, which we outline below. As our diverse and resource-constrained setting mimics many others internationally, we present this letter to your global readership for consideration.In a heterogeneous and diverse South African setting, language barriers are a significant challenge in serious illness conversations; the

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