Abstract
It has been a challenge to assess communication and professional values Milestones in emergency medicine (EM) residents using standardized methods, as mandated by the Accreditation Council for Graduate Medical Education (ACGME). This paper outlines an innovative method of assessing these Milestones using an established instructional method. EM faculty mapped the communication and professional values Milestones to an existing communication and interpersonal skills scale. We identified six communication-focused scenarios: death notification; informed consent; medical non-compliance; medical error; treatment refusal; and advanced directives. In a pilot, 18 EM residents completed these six standardized patient (SP) encounters. Our experience suggests SP encounters can support standardized direct observation of residents’ achievement of ACGME Milestones. Further effort can be made to create a tailored, behaviorally-anchored tool that uses the Milestones as the conceptual framework.
Highlights
This study was included under the Clinical Performance Center Institutional Review Board approval. As this was intended as a pilot of an innovative Milestone assessment method, the sample size was small and collected data was limited
In the individual survey 94% of residents agreed that verbal feedback from the standardized patient (SP) was helpful and 100% of residents felt the cases allowed them to demonstrate their communication and professionalism skills
This paper demonstrates the utilization of an established OSCE method for Milestone assessment that could provide useful, quantitative performance data to a residency Competency Committee (CCC)
Summary
Effective communication with patients is an integral part of the role of all physicians and has gained the spotlight over the last decade, there is no established standard on how it should be taught and assessed during traditional medical training.[1,2,3,4,5,6] The urgency to address this gap is evident, as the literature indicates that deficiencies in communication skills can lead to higher malpractice rates, patient dissatisfaction, and adverse patient outcomes.[7,8,9] The Accreditation Council for Graduate Medical Education (ACGME) endorsed “Interpersonal and Communication Skills” and “Professionalism” as two of the six core competencies These competencies, and newly mandated ACGME Milestones, are challenging to assess in the clinical setting due to varying faculty frames of reference and the influence of factors external to resident performance.[10] Faculty may use themselves, other doctors, or patient outcomes as frames of reference when assessing residents. Faculty report that they often use “gut feeling” or “gestalt” to translate their observations to numerical assessment scores.[10]
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