Assessing Physician-Patient Communication and Shared Decision-making Skills in IBD Patient Care: ACG/AstraZeneca Fellow Award: Presidential Poster

Abstract

Purpose: A paradigm of shared decision-making (SDM) is increasingly recognized as an effective strategy for information exchange, but is not formally evaluated in gastroenterology fellowship training. Given its management complexities, the field of inflammatory bowel disease (IBD) represents fertile ground for the evaluation of an SDM strategy to patient care. We assessed this clinical skillset in gastroenterology (GI) fellows through the use of novel objective structured clinical examinations (OSCEs). Methods: Twelve second-year GI fellows from five GI fellowship programs participated in a four-station OSCE. Previously validated OSCE checklists were used to assess the GI fellows' performance in IBD-specific cases, two of which will be discussed here. In the first case (“New Diagnosis” or “ND case”), the goal of the GI fellow was to educate a patient on her recent diagnosis of ulcerative colitis and to navigate a complex conversation about her risk of colon cancer. In the second case (“SDM case”), the objective was to evaluate a patient with Crohn's disease who would benefit from combination therapy with infliximab and azathioprine. Each station was videotaped and observed live by faculty gastroenterologists. Checklists were scored independently by the physician-observer and the standardized patient (SP), who both provided feedback to the fellow immediately following each case. Post-OSCE, fellows attended a debriefing session on patient communication, and were surveyed to assess their perspective on the exam's educational value. Results: For the ND case, the majority of fellows received high ratings for patient interaction (11/12, 91.7%), appropriate non-verbal behavior (8/12, 66.7%), and providing clear explanations and information (11/12, 91.7%). However, 10/12 (83.3%) did not assess the SP's comprehension of the concept of endoscopic surveillance of dysplasia, and only 4/12 (33.3%) educated the patient on alarm symptoms that would require urgent consultation. In the SDM case, 8/12 (66.6%) did not completely elicit the SP's preferences regarding treatment, although 9/12 (75%) shared the treatment decision with the SP. The vast majority recognized patient factors that are considered high-risk for complications (11/12, 91.7%) and discussed mucosal healing as an endpoint (9/12, 75%). The fellows rated the OSCE experience highly, regarding its educational value, and noted improvement in their IBD-specific knowledge after the exercise. Conclusion: To our knowledge, this is the first OSCE designed specifically for assessing SDM in IBD patient care. OSCEs are a particularly valuable educational tool for the evaluation of interpersonal and communicative competency in the field of IBD.