Difficult Conversations Research Articles

A Surgeon’s Review for Difficult Conversations

The goal of this review is to synthesize a strategy for difficult conversations using evidence from the literature and our experience in surgical and palliative care practice. Several published and established resources can inform surgeons’ communication skills. Vital Talk and the Serious Illness Care Program are formal training programs of four days and a half-day in length, respectively, for improving providers’ communication skills. The Best Case/Worst Case tool is a decision aid developed by surgeons for surgeons guiding patients through difficult choices. Published frameworks such as SPIKES and ABCDE outline key steps to navigate challenging conversations and break bad news. Numerous factors contribute to quality of communication, including setting, positioning of participants, open-ended questions, clear and concise language, responding to emotion, and engaging in shared decision-making. We describe a strategy for difficult conversations that is tailored for use by surgeons and modeled on surgical principles.

Professionalism and Ethics: A Standardized Patient Observed Standardized Clinical Examination to Assess ACGME Pediatric Professionalism Milestones.

The ethical skills fundamental to medical practice encompass a large portion of the Accreditation Council for Graduate Medical Education (ACGME) professionalism milestones. Yet many ethical practices are difficult to reduce to milestone frameworks given the variety of traditions of moral reasoning that clinician-trainees and their colleagues might properly employ. We developed an observed standardized clinical examination (OSCE) simulation with standardized patients to assess the ethical skills captured in professionalism milestones in pediatrics. The OSCE included four vignettes based on actual cases that presented problems without a correct answer. Residents discussed ethically challenging issues with standardized patients and were evaluated on specific ethical tenets contained in the professionalism milestones. Our assessment guide for preceptors offered content for debriefing and assessment. We piloted this OSCE with seven preceptors and 17 pediatric residents in two different medical settings. Residents all agreed that the four cases were realistic. All but two residents agreed that OSCEs like this one are an appropriate or objective way of assessing the ACGME professionalism milestones. All preceptors reported that they strongly agreed the assessment improved their ability to assess the professionalism milestones. This OSCE offers a structured method to assess professionalism milestones and a forum to discuss ethical problem solving. It can also be used solely as a training exercise in ethical decision making and having difficult conversations.

The “DEAL” Seminar: Developing Excellence in Academic Leadership

This article describes a program of study for developing excellence in academic leadership in mathematics departments. It is organized as a seminar that features a wide selection of readings and case studies. The seminar can be pursued through self-study or with a group of interested faculty, providing opportunities for current and future leaders. Among the topics of the readings are planning department meetings, knowing one's strengths and weaknesses, guiding difficult conversations, and working with external constituents.

Difficult Conversations—An Academic Intervention to Enhance Physician Communication (QI608)

Difficult Conversations—An Academic Intervention to Enhance Physician Communication (QI608)

Educators Forum: ‘Getting Better All the Time’—Giving Faculty Tools for Effective Feedback and Quality Improvement (P13)

•Understand and describe the role of effective feedback and communication when working with learners in a variety of settings.•Identify and practice unique skills for communicating with learners and educators, rather than patients and families, when having difficult conversations.•Explain the role and growing importance of quality improvement in medicine, including the scholarly work done by learners and faculty.•Learn and apply strategies for successfully facilitating quality improvement with learners. Hospice and Palliative Care (HAPC) educators are constantly striving to improve their efforts for learners of diverse backgrounds and stages of education. This session will focus on two of the most pressing and quickly developing topics in education: feedback and quality improvement (QI). The session will be facilitated by five recognized educators and experts in these fields. Effective feedback is desired by all, but rarely thought to be delivered. This is true even in HAPC, a field with a great emphasis on communication. The rising generation of learners identify feedback as a key to learning. The session will first focus on helping educators recognize the role of effective feedback and the way that the learner, expectations, and setting help determine what is truly effective. Drs. Beck and Yang will discuss the areas of overlap and divergence in communicating with learners compared with communicating during our clinical work. Through practice in small groups, educators will gain perspective on their own style and challenges. They will then assess their needs and the methods to improve feedback in their own learning environment. QI has become a driving force of change in healthcare and a rigorous field of academic work. It has been instrumental in navigating the challenges and broad possibilities faced in HAPC. As a new generation of learners progress, many educators may find themselves asked to mentor or directly participate in quality improvement projects. Many educators feel unprepared for such work. Dr. Kamal and Lakin will give educators tools for navigating QI learning opportunities. The presenters will use their experience and published work to comment on common pitfalls and keys to success when implementing QI in an educational environment. Participants will join small breakout groups to brainstorm ways to take these lessons into their own work.

Interprofessional Education Between Midwifery Students and Obstetrics and Gynecology Residents: An American College of Nurse-Midwives and American College of Obstetricians and Gynecologists Collaboration.

Despite areas of excellence, US perinatal care outcomes lag behind most developed countries. In addition, a shortage and maldistribution of health care providers exists. The American College of Nurse‐Midwives and the American College of Obstetricians and Gynecologists (ACOG) partnered to obtain funding to develop interprofessional education modules and other learning activities for midwifery students and obstetrics and gynecology residents in 4 demonstration sites. The multidisciplinary 2016 ACOG document Collaboration in Practice: Implementing Team‐Based Care was adopted as a framework. Core competencies of values and ethics, roles and responsibilities, interprofessional communication, and teams and teamwork developed by the Interprofessional Education Collaborative were used to guide the work. Seven modules have been developed including guiding principles, patient‐centered care, role clarification, collaborative practice, history and culture, care transition, and difficult conversations. Learners participate in laboratory and simulation activities and work together in clinical care settings. Stakeholder experiences as well as barriers to implementation are discussed. Learning materials and activity descriptions are open resourced and shared on a project website for use by programs interested in implementing an interprofessional curriculum. Ongoing formal evaluation including pilot testing of a program evaluation method is described.

How to Handle Difficult Conversations

How to Handle Difficult Conversations

Congregational Discernment: One Church Case Study

This case study reflects the congregational practices of members and staff within a congregation in the southwest of the United States which self-identifies as a congregation within the Christian tradition. The congregation has completed processes and procedures that resulted in the congregation self-identifying as a welcoming and affirming congregation to all people. A Master of Social Work intern was embedded for an academic year, as her field internship experience, in the congregation as part of the ministerial staff. The intern examined congregational and denominational processes that included difficult conversations, daily practices, and decisions with specific reference to LGBTQI+ issues as part of a national research study of Christian congregations determining inclusivity in their membership, governance, and leadership functions. The case study included participant-observation by the intern of the lived experiences of church leadership and members as a result of these conversations and decisions specific to the practices of a congregation with membership of approximately 700 people. Findings included a decision for affirmation and inclusion that resulted in the congregation being discharged from the denomination. There was significant impact on the ministry including the loss of membership and finances. Additionally, ministries of inclusion are enhanced as formerly marginalized populations are now central to the congregation.

Don’t forget the parents: preparing trainee teachers for family–school partnership

ABSTRACTThe value of strong collaborative relationships between schools and the families of their pupils has been consistently highlighted through research and has been found to benefit all parties involved. Trainee teachers in England however have continued to report feeling unprepared to ‘communicate with parents/carers’, a sentiment that has been supported by the findings of wider-ranging research. This study therefore aimed to determine which elements of family–school partnership (FSP) should be considered as core content when covering the subject in ITE. The findings suggest that home-school communication is the most valued element of FSP for inclusion in the taught content of ITE, specifically the preparation for and running of home-school meetings, dealing with difficult conversations and communicating effectively. Whilst the significance of communication is widely understood, this research argues that setting out a rationale for the importance of FSP and challenging trainees to reflect on their attitudes towards parents foregrounds the development of effective communication skills.

Avoiding Difficult Conversations in the Australian Health Sector.

BackgroundHealth professionals avoiding difficult conversations with each other can lead to serious negative consequences for patients. Clinical supervisors are in the unique position of interacting both with students as well as colleagues and peers. This study explores the avoidance of difficult conversations from the perspective of clinical supervisors in order to better understand why health professionals avoid difficult conversations.ObjectiveThis study aimed to identify the reasons why difficult conversations are avoided between health-care professionals and to gain deeper insight into the phenomenon of avoiding difficult conversations in general.MethodsConvergent interviewing was used with 20 clinical supervisors to explore the following question: Why do you think that people in your workplace avoid difficult conversations?ResultsMajor reasons for avoiding difficult conversations included the fear of negative consequences, a general distaste for confrontation, and a lack of confidence in their skills to have such conversations. Additional factors included individual qualities such as personality type and communication style, available time, size of the workplace, and a range of perceived cultural barriers standing in the way of having difficult conversations.ConclusionThere is a need to encourage clinical supervisors and other health professionals to embrace difficult conversations to reduce adverse events and enhance patient outcomes. This requires additional training and educational opportunities to enhance knowledge, skills, and confidence to plan and engage in difficult conversations. Some types of difficult conversations require more skills than others.

The Difficult, Uncomfortable, and Imperative Conversations Needed in Game Music and Sound Studies

Canons—of music, video games, or people—can provide a shared pool of resources for scholars, practitioners, and fans; but the formation of canons can also lead to an obscuring or devaluing of materials and people outside of a canon. The four authors in this colloquy interrogate issues of canons relating to video game music and sound from a variety of perspectives. Each author considers an aspect of canonization and argues for a wider purview. In “Rewritable Memory: Concerts, Canons, and Game Music History,” William Gibbons examines the ways in which concerts of video game music may create canons and reinforce particular historical narratives. In “On Canons as Music and Muse,” Julianne Grasso views the music originally presented in a video game as itself a type of canon and argues that official and fan arrangements of original game music may provide windows into lived experiences of play. In “The Difficult, Uncomfortable, and Imperative Conversations Needed in Game Music and Sound Studies,” Hyeonjin Park highlights issues of diversity and representation in the field of video game music and sound studies, with respect to the people and music that make up the subjects of the field, the people who produce scholarship in the field, and the people who engage with game music and sound. In “Canon Anxiety?” Karen Cook pulls together various issues of academic canons to question the scope, focus, and diversity of the growing field in which the Journal of Sound and Music in Games exists.

Experiences of radiography students upon their early interactions with patients – A study in difficult conversations

Experiences of radiography students upon their early interactions with patients – A study in difficult conversations

Dubious Data and Difficult Conversations: Review of <em>No BS (Bad Stats): Black People Need People Who Believe in Black People Enough Not to Believe Every Bad Thing They Hear about Black People</em>, by Ivory A. Toldson.

Dubious Data and Difficult Conversations: Review of <em>No BS (Bad Stats): Black People Need People Who Believe in Black People Enough Not to Believe Every Bad Thing They Hear about Black People</em>, by Ivory A. Toldson.

Rewritable Memory: Concerts, Canons, and Game Music History

Canons—of music, video games, or people—can provide a shared pool of resources for scholars, practitioners, and fans; but the formation of canons can also lead to an obscuring or devaluing of materials and people outside of a canon. The four authors in this colloquy interrogate issues of canons relating to video game music and sound from a variety of perspectives. Each author considers an aspect of canonization and argues for a wider purview. In “Rewritable Memory: Concerts, Canons, and Game Music History,” William Gibbons examines the ways in which concerts of video game music may create canons and reinforce particular historical narratives. In “On Canons as Music and Muse,” Julianne Grasso views the music originally presented in a video game as itself a type of canon and argues that official and fan arrangements of original game music may provide windows into lived experiences of play. In “The Difficult, Uncomfortable, and Imperative Conversations Needed in Game Music and Sound Studies,” Hyeonjin Park highlights issues of diversity and representation in the field of video game music and sound studies, with respect to the people and music that make up the subjects of the field, the people who produce scholarship in the field, and the people who engage with game music and sound. In “Canon Anxiety?” Karen Cook pulls together various issues of academic canons to question the scope, focus, and diversity of the growing field in which the Journal of Sound and Music in Games exists.

Using GoFundMe to Obtain Medical Care

Abstract Advancements in surgical interventions, specifically the newer biventricular valve replacement, for babies born with hypoplastic left heart syndrome have increased the survival rate of this otherwise fatal congenital deformity. For those interested in surgical intervention, patients are lucky to have this option, although not all babies are candidates for this surgery. Survival rates must remain only a part of the conversation, as there are significant lifelong medical needs/risks for these babies, including neurologic and developmental disabilities. Medical factors are only part of the story. The out-of-pocket costs for this new procedure are very very high and can financially devastate families, who are frequently turning to crowdsourcing to cover their medical bills. Crowdsourcing to purchase medical procedures invites a host of ethical concerns to be discussed here. Finally, the inclusion of a pediatric palliative care team during these discussions will help parents and providers navigate these difficult and complicated conversations and decisions.

Preserving the Painful: Lessons on Agency, Preservation, and Dialogue in Acknowledging Canada's Indian Residential School Sites

For nearly 150 years, Canada's Residential School Program sought to forcibly place Indigenous youth in boarding schools that would strip them of their Indigenous cultural knowledge and assimilate them into settler society. The trauma induced by these acts of cultural violence is now being acknowledged by the final report of the Truth and Reconciliation Commission, which contains Calls to Action for how these and other atrocities committed against Indigenous Peoples might be brought to light. Among these calls to action is the mandate to work with Indigenous Peoples to acknowledge the sites of the Residential School Program. However, there are few precedents for commemorating sites of trauma associated with forced social reform. Drawing on lessons from sites of state-sanctioned social reform forcibly carried out against marginalized communities at the Sean McDermott Laundry in Dublin, Ireland, and the Holy Cross Laundry in Brisbane, Bennett House in Perth, and the Kinchela Aboriginal Boys Home in Kinchela, Australia, this paper demonstrates how attention can be paid to the agency and sovereignty of Indigenous Peoples in the best cases by acknowledging the diversity of survivor experiences. These projects point to the potential for preservation processes to be used as important avenues for difficult but necessary conversations regarding reconciliation and demonstrate instances where the process fell short of the objectives the TRC sets for the preservation of the Residential School sites.

On Canons as Music and Muse

Canons—of music, video games, or people—can provide a shared pool of resources for scholars, practitioners, and fans; but the formation of canons can also lead to an obscuring or devaluing of materials and people outside of a canon. The four authors in this colloquy interrogate issues of canons relating to video game music and sound from a variety of perspectives. Each author considers an aspect of canonization and argues for a wider purview. In “Rewritable Memory: Concerts, Canons, and Game Music History,” William Gibbons examines the ways in which concerts of video game music may create canons and reinforce particular historical narratives. In “On Canons as Music and Muse,” Julianne Grasso views the music originally presented in a video game as itself a type of canon and argues that official and fan arrangements of original game music may provide windows into lived experiences of play. In “The Difficult, Uncomfortable, and Imperative Conversations Needed in Game Music and Sound Studies,” Hyeonjin Park highlights issues of diversity and representation in the field of video game music and sound studies, with respect to the people and music that make up the subjects of the field, the people who produce scholarship in the field, and the people who engage with game music and sound. In “Canon Anxiety?” Karen Cook pulls together various issues of academic canons to question the scope, focus, and diversity of the growing field in which the Journal of Sound and Music in Games exists.

Time to get real- difficult and unexpected conversations and first year therapeutic radiography students

Time to get real- difficult and unexpected conversations and first year therapeutic radiography students

Medical Students’ Experience in a Trauma Chaplain Shadowing Program: A Mixed Method Analysis

ABSTRACT Despite the importance of spirituality to health and patient care, there remains a lack of educational opportunities for medical students to learn about and engage the spiritual needs of patients. Shadowing of hospital chaplains has been employed as a means of providing instruction in spirituality, but published experiences of this pedagogy are limited. This study therefore analyzed an elective, first-year medical student, eight-hour, trauma chaplain shadowing experience, the objectives of which are to increase students’ knowledge and understanding of (i) the role of chaplains/pastoral care in patient care; (ii) strategies for engaging patients and/or families in difficult situations; and (iii) approaches for discussing issues of spirituality with patients and families. A questionnaire was sent to participants after the experience assessing the value of the experience. Two focus groups provided additional qualitative data. Of the 148 participants over 6 years, 100 completed the questionnaire (68%). Participants on average engaged 1.78 trauma patients or their families and experienced 3.63 overall patient/family interactions during their shadowing. Over 90% of respondents agreed or strongly agreed that the experience provided agreater understanding of the role of the chaplain, and was educationally, professionally, and personally useful. Over 60% of respondents agreed or strongly agreed that the experience improved their understanding of discussing difficult or spiritual topics with patients and families. Nearly all respondents (98%) would recommend asimilar shadowing experience to fellow medical students. Qualitative remarks echoed these findings, revealing themes surrounding the educational benefits, surprise, and awe experienced by participants, and indicating appreciation for the interprofessional aspect of the experience. These data demonstrate that trauma chaplain shadowing may be effective for introducing first-year medical students to healthcare chaplaincy, educating them about the challenges of navigating difficult spiritual conversations with patients and families, and exposing them to interprofessional collaboration.

Canon Anxiety?

Canons—of music, video games, or people—can provide a shared pool of resources for scholars, practitioners, and fans; but the formation of canons can also lead to an obscuring or devaluing of materials and people outside of a canon. The four authors in this colloquy interrogate issues of canons relating to video game music and sound from a variety of perspectives. Each author considers an aspect of canonization and argues for a wider purview. In “Rewritable Memory: Concerts, Canons, and Game Music History,” William Gibbons examines the ways in which concerts of video game music may create canons and reinforce particular historical narratives. In “On Canons as Music and Muse,” Julianne Grasso views the music originally presented in a video game as itself a type of canon and argues that official and fan arrangements of original game music may provide windows into lived experiences of play. In “The Difficult, Uncomfortable, and Imperative Conversations Needed in Game Music and Sound Studies,” Hyeonjin Park highlights issues of diversity and representation in the field of video game music and sound studies, with respect to the people and music that make up the subjects of the field, the people who produce scholarship in the field, and the people who engage with game music and sound. In “Canon Anxiety?” Karen Cook pulls together various issues of academic canons to question the scope, focus, and diversity of the growing field in which the Journal of Sound and Music in Games exists.