Education Considerations: Communication Curricula, Simulated Resuscitation, and Duty Hour Restrictions.

Abstract

In routine practice, an intensivist must convey intricate and often devastating information to patients and surrogates, guiding them through complex decisions with life-and-death implications. Although the Accreditation Council for Graduate Medical Education (ACGME) and the American Thoracic Society have called for pulmonary and critical care medicine (PCCM) trainees to receive formal communication skills training, few curricula have been developed, implemented, and published. Focusing on the family meeting as a prototypical intensive care unit (ICU) encounter, McCallister and colleagues (1) developed a year-long communication skills educational program. Beginning with a 3-hour didactic workshop incorporating role plays, the program was interwoven into the first year of PCCM fellowship. The authors created a checklist-based assessment derived from available literature on ICU communication, the Family Meeting Behavioral Skills Checklist, to facilitate feedback and monitor evolution of fellows’ skills. This tool was used for self-evaluation, to provide structured feedback from palliative medicine faculty observing fellows conducting family meetings, and by two blinded psychologists who scored digital recordings of simulated family meetings performed before and after the intervention. In a pre–post analysis, trainees demonstrated a significant increase in total observed Family Meeting Behavioral Skills Checklist skills from 51 to 65% (P, 0.01; Cohen’s D effect size, 1.13) and improved self-confidence (from 77 to 89%, P, 0.01; effect size, 0.87). In the same issue of AnnalsATS, Hope and colleagues (2) describe a communication skills program implemented in their medical ICU. This 1-month curriculum incorporated didactic sessions focused on palliative care, ethics, and end-of-life care, as well as several family conference simulations. Key communication concepts were emphasized through repetition and reinforcement. In unblinded pre–post faculty evaluations fellows demonstrated a statistically significant improvement in three skills: setting an agenda (64% vs. 41%; chi-square, 5.27; P = 0.02); summarizing the care the patient would receive (64% vs. 39%; chi-square, 6.21; P = 0.01); and outlining the follow-up plan (60% vs. 37%; chi-square, 5.2; P = 0.02). Both fellowships created a didactic series, an original checklist evaluation, and used both self-assessments and simulations to judge trainees’ progress. Whereas one was interwoven throughout the year, the other occurred in a single medical ICU rotation. These studies demonstrate the feasibility of embedding communication training in PCCM fellowship, thereby improving trainees’ observable skills and self-confidence. Further study is required to validate these novel assessment tools and measure impact of the educational interventions on patient-centered outcomes, including attention to emotion and to assess optimal structure and duration of curriculum. n