Challenging Communication Scenarios Research Articles

Interdisciplinary and interprofessional communication intervention: How psychological safety fosters communication and increases patient safety.

Effective teamwork and communication are imperative for patient safety and quality care. Communication errors and human failures are considered the main source of patient harm. Thus, team trainings focusing on communication and creating psychologically safe environments are required. This can facilitate challenging communication and teamwork scenarios, prevent patient safety risks, and increase team performance perception. The sparse research concerning communication interventions calls for an understanding of psychological mechanisms. Therefore, this study investigated mechanisms of an interpersonal team intervention targeting communication and the relation of psychological safety to patient safety and team performance perception based on the applied input-process-output model of team effectiveness. Before and after a 4-h communication intervention for multidisciplinary teams, a paper-pencil survey with N = 137 healthcare workers from obstetric units of two university hospitals was conducted. Changes after the intervention in perceived communication, patient safety risks, and team performance perception were analyzed via t-tests. To examine psychological mechanisms regarding psychological safety and communication behavior, mediation analyses were conducted. On average, perceived patient safety risks were lower after the intervention than before the intervention (MT1 = 3.220, SDT1 = 0.735; MT2 = 2.887, SDT2 = 0.902). This change was statistically significant (t (67) = 2.760, p =.007). However, no such effect was found for interpersonal communication and team performance perception. The results illustrate the mediating role of interpersonal communication between psychological safety and safety performances operationalized as perceived patient safety risks ( = -0.163, 95% CI [-0.310, -0.046]) and team performance perception ( = 0.189, 95% CI [0.044, 0.370]). This study demonstrates the psychological mechanisms of communication team training to foster safety performances and psychological safety as an important predecessor for interpersonal communication. Our results highlight the importance of teamwork for patient safety. Interpersonal and interprofessional team training represents a novel approach as it empirically brings together interpersonal communication and collaboration in the context of patient safety. Future research should work on follow-up measures in randomized-controlled trials to broaden an understanding of changes over time.

𝖧𝗒𝖣𝖱𝖤𝖠: Utilizing Hyperdimensional Computing for a More Robust and Efficient Machine Learning System

Today’s systems rely on sending all the data to the cloud and then using complex algorithms, such as Deep Neural Networks, which require billions of parameters and many hours to train a model. In contrast, the human brain can do much of this learning effortlessly. Hyperdimensional (HD) Computing aims to mimic the behavior of the human brain by utilizing high-dimensional representations. This leads to various desirable properties that other Machine Learning (ML) algorithms lack, such as robustness to noise in the system and simple, highly parallel operations. In this article, we propose 𝖧𝗒𝖣𝖱𝖤𝖠, a HyperDimensional Computing system that is Robust, Efficient, and Accurate. We propose a Processing-in-Memory (PIM) architecture that works in a federated learning environment with challenging communication scenarios that cause errors in the transmitted data. 𝖧𝗒𝖣𝖱𝖤𝖠 adaptively changes the bitwidth of the model based on the signal-to-noise ratio (SNR) of the incoming sample to maintain the accuracy of the HD model while achieving significant speedup and energy efficiency. Our PIM architecture is able to achieve a speedup of 28× and 255× better energy efficiency compared to the baseline PIM architecture for Classification and achieves 32 × speed up and 289 × higher energy efficiency than the baseline architecture for Clustering. 𝖧𝗒𝖣𝖱𝖤𝖠 is able to achieve this by relaxing hardware parameters to gain energy efficiency and speedup while introducing computational errors. We show experimentally, HD Computing is able to handle the errors without a significant drop in accuracy due to its unique robustness property. For wireless noise, we found that 𝖧𝗒𝖣𝖱𝖤𝖠 is 48 × more robust to noise than other comparable ML algorithms. Our results indicate that our proposed system loses less than 1% Classification accuracy, even in scenarios with an SNR of 6.64. We additionally test the robustness of using HD Computing for Clustering applications and found that our proposed system also looses less than 1% in the mutual information score, even in scenarios with an SNR under 7 dB, which is 57 × more robust to noise than K-means.

Inventing Codes for Channels With Active Feedback via Deep Learning

Designing reliable codes for channels with feedback, which has significant theoretical and practical importance, is one of the long-standing open problems in coding theory. While there are numerous prior works on analytical codes for channels with feedback, the majority of them focus on channels with noiseless output feedback, where the optimal coding scheme is still unknown. For channels with noisy feedback, deriving analytical codes becomes even more challenging, and much less is known. Recently, it has been shown that deep learning can, in part, address these challenges and lead to the discovery of new codes for channels with noisy output feedback. Despite the success, there are three important open problems: (a) deep learning-based codes mainly focus on the passive feedback setup, which is shown to be worse than the active feedback setup; (b) deep learning-based codes are hard to interpret or analyze; and (c) they have not been successfully demonstrated in the over-the-air channels with feedback. We address these three challenges. First, we present a learning-based framework for designing codes for channels with active feedback. Second, we analyze the latent features of the learned codes to devise an analytical coding scheme. We show that the approximated analytical code is a non-trivial variation of the state-of-the-art codes, demonstrating that deep learning is a powerful tool for deriving a new analytical communication scheme for challenging communication scenarios. Finally, we demonstrate the over-the-air performance of our neural codes by building a wireless testbed that consists of two separate N200 USRPs operating as the transmitter and the receiver. To the best of our knowledge, this is the first over-the-air hardware implementation of neural codes for interactive channels.

Academic video lectures over named data networking

PurposeInformation-centric networking (ICN) is an innovative paradigm for the future internet architecture. This paper aims to provide a view on how academic video lectures can exploit the ICN paradigm. It discusses the design of academic video lectures over named data networking (NDN) (an ICN architecture) and speculates their future development. To the best of author’s knowledge, a similar study has not been presented.Design/methodology/approachThe paper is a visionary essay that introduces the background, elaborates the basic concepts and presents the author’s views and insights into academic video lectures that exploit the latest development of NDN approach and its applications.FindingsThe ICN paradigm is closely related to the levels of automation and large-scale uptake of multimedia applications that provide video lectures. Academic video lectures over NDN have: improved efficiency, better scalability with respect to information/bandwidth demand and better robustness in challenging communication scenarios. A framework of academic video lectures over NDN must take into account various key issues such as naming (name resolution), optimized routing, resource control, congestion control, security and privacy. The size of the network in which academic video lectures are distributed, the content location dynamics and the popularity of the stored video lectures will determine which routing scheme must be selected. If semantic information is included into academic video lectures, the network dynamically may assist video (streaming) lecture service by permitting the network to locate the proper version of the requested video lecture that can be better delivered to e-learners and/or select the appropriate network paths.Practical implicationsThe paper helps researchers already working on video lectures in finding a direction for designing and deploying platforms that will provide content-centric academic video lectures.Originality/valueThe paper pioneers the investigation of academic video lecture distribution in ICN and presents an in-depth view to its potentials and research trends.

The Quest for Information-Centric Networking

The articles in this special section focus on the topic of information centric networking (ICN), an approach that shifts the Internet infrastructure from a host-centric paradigm, based on perpetual connectivity and the end-to-end principle, to a new paradigm where named data becomes independent from location, application, storage, and means of transportation, enabling in-network storage and replication. The expected benefits include improved effi ciency, better scalability with respect to information/bandwidth demand, and better robustness in challenging communication scenarios. As the most promising clean-slate approach for future Internet, ICN has attracted much attention in the past few years, and created a trajectory that is to replace the current IP-based Internet. There have been many prototypes of ICN, but more research is still ongoing, which includes naming, forwarding/routing, and caching policy, deployment strategy, security policy, and so on.

Confidence with and Barriers to Serious Illness Communication: A National Survey of Hospitalists.

To describe the concerns, confidence, and barriers of practicing hospitalists around serious illness communication. Hospitalist physicians are optimally positioned to provide primary palliative care, yet their experiences in serious illness communication are not well described. Web-based survey, conducted in May 2016. The survey link was distributed via email to 4000 members of the Society of Hospital Medicine. The 39-item survey assessed frequency of concerns about serious illness communication, confidence for common tasks, and barriers using Likert-type scales. It was developed by the authors based on prior work, a focus group, and feedback from pilot respondents. We received 332 completed surveys. On most or every shift, many participants reported having concerns about a patient's or family's understanding of prognosis (53%) or the patient's code status (63%). Most participants were either confident or very confident in discussing goals of care (93%) and prognosis (87%). Fewer were confident or very confident in responding to patients or families who had not accepted the seriousness of an illness (59%) or in managing conflict (50%). Other frequently cited barriers were lack of time, lack of prior discussions in the outpatient setting, unrealistic prognostic expectations from other physicians, limited institutional support, and difficulty finding records of previous discussions. Our results suggest opportunities to improve hospitalists' ability to lead serious illness communication by increasing the time hospitalists have for discussions, improving documentation systems and communication between inpatient and outpatient clinicians, and targeted training on challenging communication scenarios.

From Communication Skills to Skillful Communication: A Longitudinal Integrated Curriculum for Critical Care Medicine Fellows.

Communication with patients and families in critical care medicine (CCM) can be complex and challenging. A longitudinal curricular model integrating multiple techniques within classroom and clinical milieus may facilitate skillful communication across diverse settings. In 2014-2015, the authors developed and implemented a curriculum for CCM fellows at the Cumming School of Medicine, University of Calgary, to promote the longitudinal development of skillful communication. A departmental needs assessment informed curriculum development. Five 4-hour classroom sessions were developed: basic communication principles, family meetings about goals and transitions of care, discussing patient safety incidents, addressing conflict, and offering organ donation. Teaching methods-including instructor-led presentations incorporating a consistent framework for approaching challenging conversations, simulation and clinical practice, and feedback from peers, trained facilitators, family members, and clinicians-supported integration of skills into the clinical setting and longitudinal development of skillful communication. Seven fellows participated during the first year of the curriculum. CCM fellows engaged enthusiastically in the program, commented that the framework provided was helpful, and highly valued the opportunity to practice challenging communication scenarios, learn from observing their peers, and receive immediate feedback. More detailed accounts of fellows', patients', and family members' experiences will be obtained to guide curricular development. The curriculum will be expanded to involve other members of the multidisciplinary intensive care unit team, and faculty education initiatives will be offered to enhance the quality of the feedback provided. The impact of the curriculum on initial skill development, retention, and progression will be assessed.

Critical conversations in gynecologic oncology: Pilot study of communication skills training for fellows and advanced practice providers.

29 Background: Good communication is crucial to good patient care. Gynecologic oncology providers often face challenging communication scenarios, including giving serious news and discussing goals of care. Communication skills training (CST) has been shown to improve skill acquisition among providers of multiple specialties, but it has not been described in providers from gynecologic oncology or any surgical oncology specialty. Methods: We conducted a two-day CST workshop, based on the VitalTalk© model, with four faculty members (2 gynecologic oncologists and 2 palliative care physicians) and 10 gynecologic oncology provider participants (5 fellows and 5 advanced practice providers). Using didactics, demonstrations and practice sessions with simulated patients we focused on giving serious news and discussing goals of care. Pre and immediate post-workshop surveys evaluated acceptability of the workshop, perceived impact of preparedness to address challenging communication scenarios and anticipated impact on clinical practice. We compared pre and post-workshop prevalence of score of 4 or 5 out of 5 on a Likert scale for preparedness to handle 14 challenging communication scenarios. Results: Participants reported statistically significant increase in preparedness to handle 13 out of 14 challenging communication scenarios. Among those 13 topics, magnitude of improvement in proportion of participants rating preparedness 4 or 5 out of 5 ranged from 40-100% (all p < 0.05). All participants would recommend the course to others and all strongly agreed that this training should be required of all gynecologic oncology clinicians. Conclusions: Participants felt strongly that the workshop provided high quality education relevant to their practice. As a result of the workshop, participants reported statistically significantly increased preparedness to handle challenging communication scenarios. CST is feasible and has high perceived effectiveness for clinicians in the primarily surgical oncologic specialty of gynecologic oncology.

Information-centric networking for the internet of things: challenges and opportunities

In view of evolving the Internet infrastructure, ICN is promoting a communication model that is fundamentally different from the traditional IP address-centric model. The ICN approach consists of the retrieval of content by (unique) names, regardless of origin server location (i.e., IP address), application, and distribution channel, thus enabling in-network caching/replication and content-based security. The expected benefits in terms of improved data dissemination efficiency and robustness in challenging communication scenarios indicate the high potential of ICN as an innovative networking paradigm in the IoT domain. IoT is a challenging environment, mainly due to the high number of heterogeneous and potentially constrained networked devices, and unique and heavy traffic patterns. The application of ICN principles in such a context opens new opportunities, while requiring careful design choices. This article critically discusses potential ways toward this goal by surveying the current literature after presenting several possible motivations for the introduction of ICN in the context of IoT. Major challenges and opportunities are also highlighted, serving as guidelines for progress beyond the state of the art in this timely and increasingly relevant topic.

On the economic sustainability of supplying bandwidth policies in multi-layer wireless cognitive networks

Nowadays, advanced inventory management policies guarantee cost reductions and higher service levels, making them very attractive for modern and challenging communication scenarios such as those related to Multi-layer Wireless Cognitive Networks (MWCNs). In these systems, the radio resources can be considered extremely perishable “commodities” with a short-term lifetime. After describing the latest state of the art on this topic, the novelty of the paper is in being the first to adapt the NewsVendor model from Logistics in order to guarantee a cost-effective bandwidth provisioning in MWCNs. Then, we study the economic sustainability of the proposed approach compared to the one based on the adaptive period inventory management policy, already presented in the literature. Numerical results show that the NewsVendor model outperforms the adaptive period inventory management policy in all the cases under investigation. It provides decision makers with more stable supply solutions by taking into consideration both the randomness of the bandwidth requirements and its short-term lifetime. In addition, it also improves both the total profit and user satisfaction levels.

The Challenge of Communication

“Mend your speech a little, Lest you may mar your fortunes.” — William Shakespeare, King Lear, 1608 As educators in physical therapy, we take seriously the goal of developing effective communication skills in our students. Sometimes this simply takes the form of correcting students’ overuse of the word “like” as they speak with their patients. Sometimes our teaching helps students with the complex task of listening for true understanding as they take a patient’s history. This issue of the Journal of Physical Therapy Education (JOPTE) includes 2 papers that address professional communication in challenging situations. Cambier presents a perspective paper that recommends instructional methods for educating students in addressing inappropriate patient sexual behavior in the clinical environment. The Ingram and colleagues study indicates that one-third of physical therapist students report occasions in which their clinical instructors have “badmouthed” a professional colleague in their presence. Inappropriate patient sexual behavior is experienced by a significant number of physical therapists, and it is likely a topic of discussion of many clinicians. Similarly, it is likely that many physical therapist educators are aware of instances of badmouthing. Both of these topics describe very challenging communication scenarios, and ones in which practitioners may rely primarily on their lived experiences as PTs or PTAs to guide their actions with students. The editors invited 2 members of the Editorial Board of JOPTE to write commentaries for the 2 aforementioned papers to extend the discussion of communication in difficult situations. We hope that all physical therapy educators take up the challenge of enhancing their teaching of professional communication in these complex situations. Both of these papers, and the commentaries, will provide a context for important discussions between educators and students. Speaking of communication, we are pleased to have received a letter to the editor about a previously published article, which has allowed the letter writers and the author to clarify information. We hope this inspires more of you to send us letters of clarification, discussion, and further exploration of the ideas presented by our authors. This issue presents a wide range of topics: classroom teaching, clinical teaching, PTA education, international perspectives—demonstrating the breath of physical therapy education. We hope that you find this issue valuable to you in your role as an educator.

A 2G/3G Cellular Analog Baseband Based on a Filtering ADC

A current-driven low-pass filter embedded in a sigma-delta analog-to-digital converter is presented. The implementation of a class-B feedback digital-to-analog converter, together with in-band noise reduction and passive filtering, gives the possibility to handle challenging wireless communication scenarios with low power consumption. The architecture is a suitable candidate to implement the entire baseband analog section of a Global System for Mobile Communications-Universal Mobile Telecommunications System (GSM-UMTS) reconfigurable receiver.

Combining Interdisciplinary and International Medical Graduate Perspectives to Teach Clinical and Ethical Communication Using Multimedia

In Australia, international medical graduates (IMGs) play a crucial role in addressing workforce shortages in healthcare. Their ability to deliver safe and effective healthcare in an unfamiliar cultural setting is intrinsically tied to effective communication. Hospital-based medical clinical educators, who play an important role in providing communication training to IMGs, would benefit from practical resources and an understanding of the relevant pedagogies to address these issues in their teaching. This paper examines the nature of an interdisciplinary collaboration to develop multimedia resources for teaching clinical and ethical communication to IMGs. We describe the processes and dynamics of the collaboration, and outline the methodologies from applied linguistics, medical education, and health ethics that we drew upon. The multimedia consist of three video clips of challenging communication scenarios as well as experienced IMGs talking about communication and ethics. The multimedia are supported by teaching guidelines that address relevant disciplinary concerns of the three areas of collaboration. In the paper's discussion we point out the pre-conditions that facilitated the interdisciplinary collaboration. We propose that such collaborative approaches between the disciplines and participants can provide new perspectives to address the multifaceted challenges of clinical teaching and practice.

Words That Work: Patient-Centered Strategies for Difficult Conversations (P19)

1.List common patient and family frameworks that create challenging communication scenarios for palliative care clinicians.2.Describe communication strategies that effectively reframe difficult conversations into collaborative patient-centered, goal-directed care planning discussions.3.Cite model dialogue that can enhance communication in specific challenging clinical scenarios. Effective communication is a core skill requirement for quality palliative care. Skillful palliative care clinicians achieve successful communication by serving as interpreters bridging the world of medicine that focuses on communicating facts about diagnosis prognosis treatment plans to the world of patients and families who worry about their illness in terms of values purpose and meaning and how to make trade-offs given current and future quality of life. Effective strategies include creating safe environments that invite patients, families, and clinicians to express their opinions frankly and using meta-communication techniques of simultaneously listening to each person's narrative and monitoring one's own words to match others as a way to find common ground and demonstrate that all the participants have been heard. This workshop is responding to the request to expand our 1-hour presentation from the 2010 AAHPM meeting to include more time to review and analyze successful communication strategies and conduct as well as to debrief and discuss role play demonstrations in small groups. For the role playing, we will break into small groups and invite participants to pose their own communication challenges from topics such as eliciting goals of care, discussing miracles, managing uncertainty, dealing with denial, and responding to clinician and family requests to “stop the torture” or “get the DNR.” We will enact the same conversation 2–3 times using different communication strategies to show how the process changes when any one of the four components (ie, words, attitude, body language, and timing) shifts. Our work is based on ethnographic research observing expert clinicians, conducting consults, and our experience translating this research into practical education strategies for medical students and residents. This session is designed for less-experienced practitioners who want to improve their skills as well as educators seeking effective teaching strategies. Psychological and Psychiatric Aspects of Care; Social Aspects of Care; Spiritual, Religious and Existential Aspects of Care; Cultural Aspects of Care

An Evaluation of Hybrid Simulations to Support Medical Students Learning Clinical Procedures - A Focus on Patient Safety and Communication.

BACKGROUND: Internal review highlighted teaching patient safety and communication skills associated with clinical procedures. Both topics feature in the General Medical Council’s document on graduate outcomes. Challenges included developing an educational intervention within a limited budget, large student cohorts (∼380) and an already full curriculum. We aimed to provide opportunities for students to: · Reflect on progress towards meeting the GMC’s expectations · Observe and discuss ways to manage challenging patient safety and communication scenarios RESEARCH QUESTION: To what extent does the session raise students’ awareness of their responsibilities in patient safety and communication and provide practical strategies to manage relevant clinical scenarios? METHODS: The 3-hour session consisted of readings, reviews, observations and discussions, grounded in students’ experiences of clinical procedures. All activities focused on patient safety and communication. Using three hybrid simulations (where an actor is ‘seamlessly connected’ to simulation kit), students rated the degree to which they met learning objectives and the usefulness of educational methods. RESULTS: Eight sessions with group sizes of 25 to 47 students, 4 tutors and 3 actors were run. The response rate was 64%. Table 1 shows mean ratings of the degree to which students met learning objectives. The simulation activities had the highest mean rating of educational methods (5.2, SD 1.1). Recommendations from students included better alignment of the session with timing of clinical attachments, making explicit links with other curriculum activities, highlighting professionalism, providing scenarios that deal with managing patients whose language is different to their own, who are experiencing strong emotions and scenarios that demonstrate interactions with clinicians from other cultures.Table 1: Students’ ratings of the degree to which they met learning objectives (n=196) (6-point scale from 1=not at all to 6=completely met)CONCLUSIONS: The session was highly valued and raised awareness of students’ responsibilities for patient safety and communication. Hybrid simulations were engaging because of their drama, relevance and trigger for discussion.

Views of new internal medicine faculty of their preparedness and competence in physician-patient communication

BackgroundWe sought to assess self-rated importance of the medical interview to clinical practice and competence in physician-patient communication among new internal medicine faculty at an academic medical center.MethodsSince 2001, new internal medicine faculty at the Mayo Clinic College of Medicine (Rochester, Minnesota) have completed a survey on physician-patient communication. The survey asks the new faculty to rate their overall competence in medical interviewing, the importance of the medical interview to their practice, their confidence and adequacy of previous training in handling eight frequently encountered challenging communication scenarios, and whether they would benefit from additional communication training.ResultsBetween 2001 and 2004, 75 general internists and internal medicine subspecialists were appointed to the faculty, and of these, 58 (77%) completed the survey. The faculty rated (on a 10-point scale) the importance of the medical interview higher than their competence in interviewing; this difference was significant (average ± SD, 9.4 ± 1.0 vs 7.7 ± 1.2, P < .001). Similar results were obtained by sex, age, specialty, years since residency or fellowship training, and perceived benefit of training. Experienced faculty rated their competence in medical interviewing and the importance of the medical interview higher than recent graduates (ie, less than one year since training). For each challenging communication scenario, the new faculty rated the adequacy of their previous training in handling the scenario relatively low. A majority (57%) said they would benefit from additional communication training.ConclusionAlthough new internal medicine faculty rate high the importance of the medical interview, they rate their competence and adequacy of previous training in medical interviewing relatively low, and many indicate that they would benefit from additional communication training. These results should encourage academic medical centers to make curricula in physician-patient communication available to their faculty members because many of them not only care for patients, but also teach clinical skills, including communication skills, to trainees.