From Simulation to Bedside: A Pilot Study to Measure Impact of Communication Skills Training Program (QI630)

Abstract

•Describe an approach to evaluating residents' performance in serious illness communication and reinforcing their skills over time.•Describe ways to engage patients and families to provide constructive feedback to residents on their communication skills. There is a growing national mandate to train all clinicians in primary palliative care skills including serious illness communication. As a result, there has been extraordinary growth of programs to teach complex communication, but few studies to evaluate retention of skills acquired in training. At University of Massachusetts, internal medicine (IM) residents have a mandatory training in serious illness communication using simulation and patient actors. We designed a pilot to compare residents' performance in simulation versus real-life bedside encounters with hospitalized patients. To evaluate the impact of simulation training on residents' performance in real-life conversations about serious illness with hospitalized patients and families. IM residents identified a hospitalized patient in need of a serious illness conversation during their inpatient medicine rotations and arranged for a family meeting. Faculty from simulation training observed and evaluated the resident using a mini-clinical evaluation exercise (mini-CEX) tool which mirrored the evaluation tool used in simulation. Patients and families were offered a brief survey to provide feedback for the resident at the end of encounter. All the bedside evaluations occurred 3–12 months after the simulation training. Between 2017–2019, 53 residents completed simulation training and mini-CEX evaluation. Analysis of mini-CEX scores revealed the majority of residents' communication skills were the “same or improved” at the bedside, with significant improvement in ensuring patients' comfort, using silence, displaying empathy, and recognizing and responding to emotion. However, residents were more likely to discuss prognosis during simulation versus real-life encounters. Many patients and families completed a postsurvey and reported feeling heard and satisfied with their conversation with the resident. Our pilot program demonstrated a trend towards retention and improvement of residents' communication skills in real-life patient encounters after simulation training. Our findings contribute to the gap in understanding the downstream impact of training programs on the communication skills and patient satisfaction.