Teaching residents how to break bad news: piloting a resident-led curriculum and feedback task force as a proof-of-concept study

Education for communication: much already known, so much more to understand

Because of numerous criticisms of the content and structure of residency training, redesigning graduate medical education (GME) has become a high priority for the internal medicine community. From 2005 to 2007, the leadership of the internal medicine community, working under the auspices of the Alliance for Academic Internal Medicine Education Redesign Task Force, developed six recommendations it will pursue to improve residency education: (1) focus education around a "core" of internal medicine, which provides the framework for both the structure and content of residents' educational experiences, (2) fully adopt competency-based evaluation and advancement, which will enhance training by focusing on individual learners' needs, (3) allow for increased, resident-centered education beyond the internal medicine core, because different types of practice require customized knowledge and skills, (4) improve ambulatory training by providing patient-centered longitudinal care that addresses the conflict between inpatient and outpatient responsibilities, (5) use new faculty models that emphasize the creation of a core faculty, and (6) align institutional and programmatic resources with the goals of redesign, balancing the clinical mission of the institution with the educational goals of residency training. Adoption of these recommendations will require significant efforts, including pilot projects, faculty development, changes in accreditation requirements, and modifications of GME funding systems. Opportunities are ample for individual programs to develop creative approaches based on the framework for educational redesign outlined in this article, and for these educational and clinical redesign initiatives to work hand-in-hand for the benefit of patients, faculty, trainees, and institutions.

Communication skills

This article reports on the initial development and evaluation of a group skill-training program for couples. The program, entitled the Communication Skills Workshop (CSW), aims at improving communication and problem-solving skills within the context of relationships. The orientation of the CSW is preventive and educational in that it (a) serves couples prior to the onset of serious relationship discord, and (b) focuses on the learning of general communication skills and problem-solving strategies rather than the amelioration of specific relationship conflicts.

Weill Cornell Medical College of Cornell University

Research on patient-clinician relationships: celebrating success and identifying the next scope of work.

BackgroundThe MSKUS has shown higher sensitivity in detecting synovitis than clinical examination in RA patients. However this imaging modality is considered as examiner – dependent.Since 2004 OMERACT ultrasound task force...

Few studies have assessed the efficacy of communication skills training for postgraduate physician trainees at the level of behaviors. We designed a residential communication skills workshop (Oncotalk) for medical oncology fellows. The intervention design built on existing successful models by teaching specific communication tasks linked to the patient's trajectory of illness. This study evaluated the efficacy of Oncotalk in changing observable communication behaviors. Oncotalk was a 4-day residential workshop emphasizing skills practice in small groups. This preintervention and postintervention cohort study involved 115 medical oncology fellows from 62 different institutions during a 3-year study. The primary outcomes were observable participant communication skills measured during standardized patient encounters before and after the workshop in giving bad news and discussing transitions to palliative care. The standardized patient encounters were audiorecorded and assessed by blinded coders using a validated coding system. Before-after comparisons were made using each participant as his or her own control. Compared with preworkshop standardized patient encounters, postworkshop encounters showed that participants acquired a mean of 5.4 bad news skills (P<.001) and a mean of 4.4 transitions skills (P<.001). Most changes in individual skills were substantial; for example, in the bad news encounter, 16% of participants used the word "cancer" when giving bad news before the workshop, and 54% used it after the workshop (P<.001). Also in the bad news encounter, blinded coders were able to identify whether a standardized patient encounter occurred before or after the workshop in 91% of the audiorecordings. Oncotalk represents a successful teaching model for improving communication skills for postgraduate medical trainees.

Patient anxiety about the dental procedures is one of the most common problems in this profession. Most people avoid going to a dentist because of their fear and anxiety. The aim of this study was to examine the effects of communication skills training concerning satisfaction and anxiety level of dental students and their patients. The Ethics Committee of Mashhad University of Medical Sciences in Iran (no 86379) approved this study. In this controlled experimental clinical study, fifty-one last year dental students of Mashhad University and one hundred fifty-three patients were participated. Through use of an Anxiety standard questionnaire and school average of scores, data were collected about the level of satisfaction and anxiety and scientific and practical skills. Students of the experimental group took part in the communication skills workshop. The questionnaires were collected and because of ethic principles, participants were identified with numeric codes. Data were analyzed with t-test and Pearson correlation coefficient. There was a significant difference between satisfaction of interventional and control group. The communication skills workshop increased satisfaction of dental students (p=0/024). There was a negative correlation between anxiety and satisfaction (p-value=0.030, r=0.305). There was no significant difference between patients’ satisfaction, patients’ anxiety students’ anxiety in the experimental and control group. Communication skills workshop increased the satisfaction of students but there was no effect on patients’ satisfaction. There was a significant negative correlation between anxiety and satisfaction in both dental students and their patients. Communication skills increased the students’ satisfaction, had an indirect effect on their anxiety level, and decreased it. Communication skills workshop is useful for dental students and their patient and would have good effects on doctor-patient correlation.

Purpose:Effective communication lies at the heart of a patient--doctor relationship. Communication skills (CS) teaching and assessment is not a part of the postgraduate (PG) curriculum. Lack of effective CS in current PG students’ results in patient distrust and dissatisfaction, conflicts, and compromised healthcare. The regulatory authorities of medical education have recognized the need to inculcate soft skills among medical graduates, one of which is CS. The purpose of this study was to assess the need for teaching CS to ophthalmology PG students and develop and introduce a module for the same.Methods:In this prospective, interventional study done at the ophthalmology department of a tertiary hospital, a validated 8 day CS workshop was conducted for 60 PG students through interactive lectures, observations, video sessions, and role plays. Feedbacks were obtained through narratives, validated Google survey, reflections and verbal method and analyzed.Results:In the needs assessment done on 27 departmental faculties, 20 faculties found poor communication to be a major reason for patient complaints. All faculties agreed that CS should be taught to medical students. Statistically significant improvement in CS awareness was noted among students after the workshop. Lack of CS training, work burden, and language were identified as main barriers to effective communication. All the students were satisfied with the workshop and wanted it to be conducted regularly.Conclusion:This study establishes that CS training is essential to improve patient satisfaction and patient-doctor relationships. Barriers to effective CS could be identified, for which possible solutions could be found.

Effective communication skills of hospital personnel can lead to increased quality of healthcare services. Communication skills are defined as the most important feature of healthcare providers. Given the importance of communication in medical settings, the present study was conducted to examine the effects of communication skills training for treatment personnel on patients’ satisfaction. The present quasi-experimental study was conducted on 508 employees and patients in Hamadan Fatemieh Hospital, 2016. Each group of participants was divided into two groups of experimental and controls. The required data were collected through a questionnaire covering demographic characteristics, the Communication Skills Inventory and the Patient Satisfaction Questionnaire. The CSI and the PSQ were completed twice. Hospital personnel in the experimental group received 4 sessions of communication skills training. Using the SPSS-21 software, the collected data were analyzed through descriptive statistics and parametric and nonparametric statistical tests. According to the results, the average age of medical employees in the experimental group was 31.89±6.96 years and in the control group were 28.81±5.19 years. Medical personnel in the control group received lower scores in all aspects of communication skills before and after the intervention. Before the intervention, there were significant differences between the two groups in terms of age, work experience, job category, feedback and overall communication skills (p<0.05). Using Analysis of Covariance and adjustment of age, work experience and job category, no significant difference was observed in communication skills domains of feedback and overall communication skills between the two groups after the intervention. After the intervention, patients in the experimental group were more satisfied with the performance of treatment personnel than patients in the control group. Due to the lack of communication skills, many of hospital personnel cannot communicate effectively with patients and colleagues. Accordingly, providing these employees with communication skills workshops and in-service training programs can be helpful.

Practice Advisory for the Perioperative Management of Patients with Cardiac Rhythm Management Devices: Pacemakers and Implantable Cardioverter–Defibrillators

Delivering Bad News: Improving Communication Skills Training of Medical Students and Residents Through the Use of Second Life Technology (755)

Purpose: Delivering bad news is a task that occurs in most medical practices, rendering communication skills essential to competent patient care. The purpose of this study was to identify factors that are associated with scores on an assessment of medical students' communication skills in delivering bad news to help develop more effective curricula to enhance these essential skills. Methods: One hundred fifty-four fourth-year medical students at Pusan National University were included. Skills for delivering bad news were assessed using the SPIKES protocol in the CPX. The students were categorized into three main groups according to total scores: ‘Exceeds expectations(E)’, ‘Meets expectations(M)’, and ‘Needs development(N)’. Personal experiences with misfortune and attitudes toward breaking bad news were surveyed, and school records were collected. The differences between the E and N groups were analyzed based on performance test and survey. Results: Compared with students in the N group, E group students acquired significantlyhigher scores on the items of Perception, Invitation, a division of Knowledge, Empathy and Strategy, and Summary but not on Setting and a part of Knowledge. E group students had better records in classes and clerkships. There were no differences in personal experiences and attitudes toward breaking bad news between the groups. Conclusion: Personal experience with delivering bad news does not guarantee better communication, and attitudes toward this task do not influence student performance. We expect that deliberate educational programs will have a positive impact on improving communication skills for delivering bad news.

175TF Design and Integration of an Emergency Medicine Focused Interpersonal Skills Simulation Curriculum