Training Surgical Residents to Communicate with Their Patients: A Scoping Review of the Literature

"Building bridges"-communication education for residents in radiology: a scoping review

BACKGROUND

Good communication is an important professional attribute for radiologists. However, explorations of communication education and their outcomes in radiology residents are sparse. This scoping review aims to evaluate the existing literature on communication education for radiology residents, identify gaps in current practices, and suggest directions for future studies.

METHODS

A scoping review following the six-step approach of Arksey and O'Malley was undertaken. We searched through PubMed, Embase, ERIC, and Web of Science databases, focusing on communication education in radiology residents.

RESULTS

Sixteen of the 3096 identified articles were included in the analysis. Most studies (13/16) originated from the United States. The studies varied in study design, including quantitative, qualitative and mixed-methods approaches. The sample sizes of most studies were small to moderate, with more than half of the studies had fewer than 30 participants. The identified studies predominantly focused on communication with patients and healthcare professionals. The need for communication education, the efficacy of specific communication education programs, and the capability of some assessment tools for evaluating residents' communication skills were investigated.

CONCLUSIONS

This scoping review reveals the gap between the need for communication education and the lack of comprehensive education programs in radiology residents globally. Future studies should develop tailored interventions and use reliable assessment tools, engaging more participants with extended follow-up periods, and expand the scope of communication training to include all relevant stakeholders.

Physicians' attention to patients' communication cues can improve patient satisfaction with care and perception of physicians' empathy

BACKGROUND

The pathway that links good communication skills and better health outcomes is still unclear. However, it is known that the way that physicians and patients communicate with each other has direct consequences on more "proximal outcomes", such as perceptions of physician empathy and patient satisfaction. However, which specific communication skills lead to those patient outcomes is still unknown. In this study, the authors aimed to analyze which specific patient and physician communication skills are correlated to patients' satisfaction with care and patient-perceived physician empathy.

METHODS

The authors classified and quantified verbal and nonverbal communication of second-year internal medicine residents and their patients through video recordings of their consultations. Patients also rated their satisfaction with care and the physician's empathy for them.

RESULTS

Using a linear regression model, the authors identified that patients' and physicians' expressions of disapproval, physicians' disruptions, and patients' use of content questions negatively correlated to patients' satisfaction and patient-perceived physician empathy. Conversely, patient affective behaviors and the physician's provision of advice/suggestion were positively correlated to at least one of the patient-measured outcomes.

CONCLUSION

Our findings point to the importance of physicians' attentiveness to patients' communication cues. Training physicians to interpret those cues could help develop more satisfactory and empathic therapeutic relationships.

Attitudes toward communication skills with learner needs assessment within radiology residency programs in China: a cross-sectional survey

BACKGROUND

Communication skills (CS) represent a core competency in radiology residency training. However, no structured curriculum exists to train radiology residents in CS in China. The aim of this study was to evaluate the status and prevalence of doctor-patient communication training among radiology residents in nine Chinese accredited radiology residency training programs and to determine whether there is a perceived need for a formalized curriculum in this field.

METHODS

We administered a cross-sectional online survey to radiology residents involved in CS training at nine standard residency training programs in China. The questionnaire developed for this study included CS training status, residents' demographics, attitudes toward CS training, communication needs, and barriers. Residents' attitudes toward CS training were measured with the Communication Skills Attitude Scale (CSAS) and its subscales, a positive attitude scale (PAS) and negative attitude scale (NAS).

RESULTS

A total of 133 (48.36%) residents participated in the survey. The mean total scores on the two dimensions of the CSAS were 47.61 ± 9.35 in the PAS and 36.34 ± 7.75 in the NAS. Factors found to be significantly associated with the PAS included receiving previous training in CS, medical ethics, or humanities and the doctor's attire. We found that first-year residents and poor personal CS were the most influential factors on the NAS. Only 58.65% of participants reported having previously received CS training during medical school, and 72.93% of respondents reported failure in at least one difficult communication during their residency rotation. Most of those surveyed agreed that CS can be learned through courses and were interested in CS training. Some of the most common barriers to implementing formal CS training were a lack of time, no standardized curriculum, and a lack of materials and faculty expertise.

CONCLUSIONS

Most residents had a very positive attitude toward CS training and would value further training, despite the limited formal CS training for radiology residents in China. Future efforts should be made to establish and promote a standard and targeted CS curriculum for Chinese radiology residents.

Patients' Emotional Talk During Surveillance Cystoscopy for Non-muscle Invasive Bladder Cancer: Opportunities for Improving Communication

OBJECTIVE

To examine the emotional communication that takes place between patients and health care providers during surveillance cystoscopy for non-muscle invasive bladder cancer (NMIBC).

METHODS

Participants were 57 patients with a diagnosis of NMIBC attending for surveillance cystoscopy and 10 health care professionals (HCPs). Cystoscopy procedures were audio-recorded and transcribed verbatim. Two approaches to analysis of transcriptions were undertaken: (1) a template analysis and (2) Verona Coding Definitions of Emotional Sequences.

RESULTS

Communication during cystoscopy generally comprised of "social/small talk," "results of the cystoscopy," and "providing instructions to the patient." Emotional talk was present in 41/57 consultations, with 129 emotional cues and concerns expressed by patients. Typically patients used hints to their emotions rather than stating explicit concerns. The majority (86%) of HCPs responses to the patient did not explicitly mention the patient's emotional concern or cue. Urology trainees were less likely than other HCPs to provide space for patients to explore their emotional concerns (t = -1.78, P <.05).

CONCLUSION

Emotional communication was expressed by the majority of patients during cystoscopy. While all HCPs responded to patients' emotional communication, there were a number of missed opportunities to "pick-up" on patients' emotional cues and improve communication. Urologists need to be aware of the nuances of patients' emotional communication. Learning to identify and respond appropriately to emotional cues may improve communication with patients.

Training and competence perception differences in otolaryngology and head and neck surgery training program - an anonymous electronic national survey

BACKGROUND

Otorhinolaryngology / Head and Neck Surgery consists of different sub-specialties, each comprising unique characteristics and challenges. Herein, we investigate the use of a uniform national electronic questionnaire for curriculum planning.

MAIN OUTCOME MEASURES

(1) Analyze the residents' perception of the different sub-specialties training programs and their competence capabilities. (2) Identify sub-specialties requiring attention. (3) Investigate the characteristics associated with competence perception.

METHODS

This is a national cross sectional study. An anonymous electronic questionnaire was emailed to all registered Otorhinolaryngology / Head and Neck Surgery residents.

RESULTS

63.5% registered residents responded to the questionnaire. Two sub-specialties, Rhinology and Laryngology, are located in the extremities of the residents' perceptions of competence and training (p < 0.0001), despite similar complexity perception (means 6.10 and 6.01, respectively). Rhinology is perceived as the most well-trained sub-specialty, both surgically and clinically (means 7.08 and 7.66, respectively), whereas Laryngology is bottom scaled (means 5.16 and 6.14, respectively). The same is true for perceived competence, surgical and clinical, in Rhinology (means 6.80 and 8.02, respectively) compared to Laryngology (means 5.04 and 6.75, respectively). Significant positive correlations were found between training, competence perception and workload ("golden training triangle").

CONCLUSIONS

Each ORL-HNS sub-specialty comprises different characteristics and a different learning curve, necessitating a tailored training program. Recognizing its sub-specialties distinctive features may assist in establishment of better-adapted learning curves in residency programs. Herein, we examine the use of anonymous electronic national survey. Laryngology, bottom ranked, is a prototype of a relatively new surgical discipline. Rhinology, ranked top by the residents, is an exemplar of a sub-specialty with an optimal 'educational environment'. Moreover, we have established golden training triangle, implicating, highlights the essential role of institutional and senior staff for proper residency teaching. We demonstrate and advocate the benefit of using an anonymous electronic questionnaire.

When theory meets reality- a mismatch in communication: a qualitative study of clinical transition from communication skills training to the surgical ward

BACKGROUND

Communication skills training in patient centered communication is an integral part of the medical undergraduate education and has been shown to improve various components of communication. While the effects of different educational interventions have been investigated, little is known about the transfer from theoretical settings to clinical practice in the context of communication skills courses not integrated in the clinical curriculum. Most studies focus on single factors affecting transfer without considering the comprehensive perspective of the students themselves. The aim of this study is to explore how the students experience the transition to clinical practice and what they perceive as challenges in using patient centered communication.

METHODS

Fifteen 4th year medical students were interviewed 3 weeks after the transition from an advanced communication skills course to surgical internship using semi-structured interviews. Qualitative content analysis was used to analyze the interviews.

RESULTS

The analysis resulted in a theme 'When theory meets reality- a mismatch in communication'. It was comprised of four categories that encompassed the transfer process, from theoretical education, practical communication training and surgical internship to students' wishes and perceived needs.

CONCLUSIONS

We concluded that preparing the students through theoretical and practical training should reflect the reality they will face when entering clinical practice. When educating medical students as a group, their proclivity for perfectionism, high performance environment and achievement-related stress should be taken into consideration. The role of tutors being role models, offering guidance, giving feedback and providing support plays a major part in facilitating transfer of communication skills. To enable transfer to a larger extent, the environment needs to promote patient centeredness and students need more opportunities to practice communication with their patients.

Measuring Impact of Simulation-Based Informed Consent Training on Surgical Intern's Long-Term Confidence

OBJECTIVE

Our objective was to evaluate the outcome of a training program on long-term confidence of interns and attending physicians.

DESIGN

In this prospective cohort study, general surgery interns underwent a training program on informed consent that involved didactics, standardized patient encounters, and supplemental procedure specific guides at the start of the academic year. At the end of the academic year, we surveyed interns from the classes of 2020 (trained) and 2019 (untrained) about their experience and confidence in obtaining an informed consent. Further, we queried attending physicians on their experience and confidence in the interns at the end of each academic year.

SETTING

Single academic general surgery residency program based at 2 urban tertiary hospitals.

PARTICIPANTS

General surgery interns including unmatched preliminary residents and categorical interns from general surgery, interventional radiology, and urology.

RESULTS

Twenty-four incoming interns participated in the training program. Intern confidence discussing operation benefits improved from a median score of 4 to 5 (p = 0.03), and total confidence improved from a median score of 15 to 17.5 (p = 0.08). There was no difference in median total confidence scores (15 vs. 17.5; p = 0.21) between classes. Attending physicians had similar median total confidence scores following intervention (10 vs. 11; p = 0.87). Intern satisfaction was 80% with the didactic session, and 90% with standardized patient encounters. Twenty percent of learners used the supplemental procedure specific guides.

CONCLUSIONS

Implementation of an intern targeted program on informed consent that incorporated didactics and standardized patient encounters was viewed as useful and may contribute to long-term improvements in confidence.

How Do We Learn About Error? A Cross-Sectional Study of Urology Trainees

OBJECTIVE

This qualitative descriptive study aims to explore trainees' experiences of error disclosure (ED) during their surgical postgraduate training and the factors influencing the intention-behavior gap for ED.

DESIGN

This study employs an interpretivist methodology and a qualitative descriptive research strategy. Data were collected using focus group interviews. Data coding was performed by the principal investigator using Braun and Clarke's reflexive thematic analysis. Themes were developed from the data in a deductive manner. Analysis was carried out using NVivo 12.6.1.

SETTING

All participants were at various stages of an 8-year specialist program under the auspices of the Royal College of Surgeons in Ireland. The training program involves clinical work in a teaching hospital under the supervision of senior doctors in their specialist field. Trainees attend mandatory communication skills training days throughout the program.

PARTICIPANTS

Study participants were recruited using purposive sampling from a sampling frame of 25 urology trainees on a national training scheme. Eleven trainees participated in the study.

RESULTS

Participants' stage of training ranged from first to final year. Seven key themes emerged from the data relating to the trainees' experiences of error disclosure and the intention-behavior gap for ED. These themes include observed positive and negative practice in the workplace, impact of stage of training, importance of interpersonal interactions, perceived blame/responsibility for multifactorial error or recognized complication, lack of formal training in ED, cultural aspects of the training environment and medicolegal issues around ED.

CONCLUSIONS

While trainees recognize the importance of ED, personal psychological factors, negative environmental culture, and medicolegal concerns are significant barriers to the practice of ED. A training environment that focuses on role-modelling and experiential learning with adequate time for reflection and debriefing is paramount. Areas for further research include broadening the scope of this study of ED across different medical and surgical subspecialties.

Is Plastic Surgery Training Equitable? An Analysis of Health Equity across US Plastic Surgery Residency Programs

Achieving health equity includes training surgeons in environments exemplifying access, treatment, and outcomes across the racial, ethnic, and socioeconomic spectrum. Increased attention on health equity has generated metrics comparing hospitals. To establish the quality of health equity in plastic and reconstructive surgery (PRS) residency training, we determined the mean equity score (MES) across training hospitals of US PRS residencies.

Methods

The 2021 Lown Institute Hospital Index database was merged with affiliated training hospitals of US integrated PRS residency programs. The Lown equity category is composed of three domains (community benefit, inclusivity, pay equity) generating a health equity grade. MES (standard deviation) was calculated and reported for residency programs (higher MES represented greater health equity). Linear regression modeled the effects of a program's number of training hospitals, safety net hospitals, and geographical region on MES.

Results

The MES was 2.64 (0.62). An estimated 5.9% of programs had an MES between 1-2. In total, 56.5% of programs had an MES between 2 and 3, and 37.7% had an MES of 3 or more. The southern region was associated with a higher MES compared with the reference group (Northeast) (P = 0.03). The number of safety net hospitals per program was associated with higher MES (P = 0.02).

Conclusions

Two out of three programs train residents in facilities failing to demonstrate high equity healthcare. Programs should promote health equity by diversifying care delivery through affiliated hospitals. This will aid in the creation of a PRS workforce trained to provide care for a socioeconomically, racially, and ethnically diverse population.

State of Communication Training During the Breast Imaging Fellowship Year

OBJECTIVE

The purpose of this study was to survey breast imaging fellowship programs nationally on the state of communication skills training during fellowship training.

METHODS

In this IRB-exempt study, fellowship program director members of the Society of Breast Imaging (SBI) were anonymously surveyed on current provision and types of communication skills training in their fellowship curricula.

RESULTS

A six-question survey was sent to all 95 SBI member fellowship program directors with a response rate of 56% (53/95). Although direct fellow patient-centered communication interactions are practiced across all respondent training programs, formal communication skills training was offered in a minority of programs with 32% (17/53) providing formal communication in the form of a didactic lecture and 17% (9/53) engaging fellows in a simulation communication skills workshop. Of the 53 programs, 12 (22%) reported no formal communication skills training of any kind, while a majority (44/53, 83%) of programs provide regular feedback based on observed fellow-patient communication interactions.

CONCLUSION

Despite nearly uniform practice of engaging breast imaging fellows in direct patient-centered interaction at the onset of the fellowship training year, the majority of fellowship programs do not provide any formal communication skills training curricula at any point during fellowship training. To equip future breast radiologists with the skills to provide value in an increasingly patient-centered field, dedicated formal communication curricula ought to be incorporated consistently into breast imaging fellowship training programs.

Annual Structured Communication Skills Training for Surgery Residents

INTRODUCTION

There is no formalized communication curriculum for surgical training. The aim of this study is to determine the benefit of annual communication skill-building workshops for surgical residents over several years.

METHODS

The general surgery and the integrated cardiothoracic surgery residents in a tertiary care, urban academic center participated in a 2-hour communication skill-building workshop each year from July 2017 to June 2021. Each participant was administered an anonymous pre-session and post-session survey with a 5-point Likert scale to assess their self-reported preparedness and their evaluation of the workshop. Survey responses were divided into three groups based on their experience in this workshop; no experience (Experience 0), 1 y of experience (Experience 1), and two or more years of experience (Experience 2+). They were compared among groups.

RESULTS

Seventy-one surgical residents participated in the workshop generating 124 survey results (Experience 0, 71 [57.3%], Experience 1, 41 [33.1%], and Experience 2+, 12 [9.7%]). Self-reported preparedness scores improved for the overall group as well as for each experience group. While scores decreased significantly in the following years, they improved after each workshop. Scores were significantly better with more experience (4, interquartile range [IQR] 3-4 in Experience 0, 4, IQR 3-5 in Experience 1, 4, IQR 4-5 in Experience 2+, P < 0.001 between Experience 0 and Experience 1, P = 0.041 between Experience 1 and Experience 2+). All residents reported an overwhelmingly positive review of the curriculum.

CONCLUSIONS

Yearly 2-hour communication skills practice increased surgical residents' self-reported preparedness, and the repetition helped the improvement. Annual workshops are important for residents to be more prepared for serious illness communication.

The Patient's Voice in Assessing Resident Communication Skills

OBJECTIVE

To generate validity evidence for using patient-reported satisfaction ratings of residents' communication skills to determine progress along the Interpersonal and Communication Skills (ICS) Milestones.

DESIGN

A single-institution, retrospective study analyzed a CAHPS Clinician and Group Survey (CG-CAHPS) database which collects inpatients' ratings of residents' communication skills using 6 questions on a scale of 1 (very poor) to 5 (very good). CG-CAHPS results for each resident were averaged for each question as well as across the 6 questions. The averaged ratings were compared between low and high performer groups.

SETTING

A large, academic, mid-western General Surgery residency program.

PARTICIPANTS

General Surgery residents with 3 or more survey responses from July 2020 to June 2021 were included. Residents were dichotomized into low or high performer groups based on their end-of-year ICS1 sub-competency milestone within their post-graduate year (PGY) cohort.

RESULTS

543 CG-CAHPS responses across 44 residents were analyzed with a median of 9 (Interquartile range 6, 17) responses per resident. When residents were compared based on PGY, ratings for the question "resident's knowledge about your medical care of condition" demonstrated statistically significant differences with PGY5s receiving the lowest score (p = 0.05). PGY5s received the lowest averaged ratings across all questions (p = 0.08, η² = 0.10). When residents were dichotomized into low (n = 21) and high performer groups (n = 23) based on ICS1 milestones, statistically significant differences were noted in ratings for the questions "concern the resident showed for your questions or worries" (4.81 vs. 5, p = 0.047) and "courtesy and respect of the resident" (4.75 vs. 5, p = 0.046).

CONCLUSIONS

Analysis of patient ratings of surgery residents' communication skills demonstrated concordant findings between ICS1 milestone and 2 domains of CG-CAHPS responses. When low and high performer groups were compared, CG-CAHPS responses demonstrated a similar pattern. These findings provide validity evidence for CG-CAHPS data as a source of information for ICS1 sub-competency assessment.

Framing Concerns about Body Image during Pre- and Post-Surgical Consultations for Head and Neck Cancer: A Qualitative Study of Patient–Physician Interactions

Patients with head and neck cancer report high unmet psychosocial needs as they undergo lifesaving treatments that can significantly alter their appearance and cause functional impairments. This qualitative analysis of recordings of 88 pre- and post-surgical consultations involving 20 patients respond to the need for empirical studies of patient–provider conversations about body image concerns. It indicates that the emphasis on concerns about survival, cure, and physical recovery during clinical consultations may leave concerns about the impacts of surgery on appearance and function unexplored and even silenced. The interviews with patients and medical team members that complement the analysis of the recordings suggest that an emphasis on survival, cure, and physical recovery can respond to the need for reassurance in the context of serious illness. However, it can also be problematic as it contributes to the silencing of patients’ concerns and to a potential lack of preparedness for the consequences of surgery. The results of this study can contribute to raising surgeons’ awareness of the interactional dynamics during clinical consultations. Moreover, the results highlight the unique role that surgeons can play in validating patients’ psychosocial concerns to support patients’ rehabilitation in both physical and psychosocial domains.