214TF Advancing Communication Excellence at Stanford in Emergency Medicine Residency: A Curriculum for Interns

Abstract

Effective communication is essential for patient safety and enhancing the patient experience in the Emergency Department. Effective communication also promotes efficiency in practice and a culture of wellness needed to attain professional fulfillment. Patient-centered care may conflict with physicians creating boundaries and their attempt to advocate for self-care and self-valuation in their roles as healers. With a strategic focus of developing a relationship-centered culture, the EM residency leadership, EM interns and the Physician Partnership Team in Patient Experience designed an innovative pilot using formative and summative evaluation to identify how best to deliver knowledge, and practice 3 relationship-centered communication (RCC) skills. A series of 4 workshops and individualized coaching observations were part of the design. We proposed a curriculum for EM interns focusing on relationship-centered care using the Advancing Communication Excellence at Stanford (ACES) initially designed for Stanford faculty. By teaching evidenced-based strategies on managing challenging interactions in the health care arena, we hope to provide our EM interns a curriculum to develop skills that will enhance the physician-patient relationship, while also addressing physician wellbeing. The primary objective was to learn how best to engage EM interns to learn and adopt the 3 foundational RCC ACES skills. The second objective was to design a reproducible EM RCC curriculum within the residency program based on time constraints and entry-level cognitive demands. Curricular Design: We developed a curriculum for EM interns, supplemented by individualized coaching and asynchronous learning using the flipped-classroom model. We used intern-driven scenarios and role-playing techniques to demonstrate and emphasize key communication skills. We used online surveys and text-messages check-ins to assess the effectiveness and further iterate this learner-centered curriculum. The first 3 sessions included a reflection, a check-in, demonstration of a skillset and small group practice with an ACES coach. Bedside clinical EM coaching was scheduled with each intern between sessions 3 and 4. Session 4 integrated all 3 skills with a standardized patient. This session was video-recorded and coded in addition to the immediate feedback and debrief after each encounter. This will be used in the final individual coaching session. The ACES in EM Residency Curriculum is an effective way to teach communication skills that promote relationship-centered care. We have successfully integrated the RCC into the EM intern curriculum over 3 in-person, 60-90-minute workshop sessions and individualized clinical coaching. The impact will be assessed through a learner self-assessment and coaching assessment. We plan to scale this to the entire EM residency.