You Should Probably Write This Down: Effective Documentation in Communication Skills Training (FR482C)

Abstract

•Describe the ASCEND pathway of communication.•Explain how documentation is an essential final step of effective communication.•Compose documentation that effectively communicates patient's goals, values, and next steps. Critical conversations on serious diagnoses, goals of care, and end of life planning rely on effective communication. Communication skills training programs emphasize interpersonal communication, though studies repeatedly indicate that patients retain very little of what is said in medical encounters. Provide formal teaching on how to effectively document critical conversations. Target audience are resident and fellowship level learners. These skills were taught using a combination of teaching modalities including several interactive didactic sessions describing the ASCEND pathway and a pocket guide that was created for clinicians. Primary outcomes were competency in running family meetings, documentation, and learner's satisfaction with the training. 18 learners from Memorial Sloan Kettering Cancer Center were taught how to use the ASCEND pathway. By the end of the academic year all learners demonstrated proficiency in documenting family meetings. Clinicians are rarely, if ever, provided formal guidance on how to effectively document critical conversations. In an era of increasing patient access to electronic documentation and increased use of visual communication and culturally aligned educational materials, skillful use of documentation methods cannot be excluded as a communication skill. The ASCEND pathway builds on recommendations and research in advance care planning, breaking bad news, and other clinical communication. The pathway is unique in its inclusion of documentation as a vital step in effective communication. Next steps would be obtaining buy in from established clinicians who may not necessarily see the benefit of improving their documentation skills.