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Tan XH, Foo MA, Lim SLH, Lim MBXY, Chin AMC, Zhou J, Chiam M, Krishna LKR. Teaching and assessing communication skills in the postgraduate medical setting: a systematic scoping review. BMC MEDICAL EDUCATION 2021; 21:483. [PMID: 34503497 PMCID: PMC8431930 DOI: 10.1186/s12909-021-02892-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 08/17/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Poor communication skills can potentially compromise patient care. However, as communication skills training (CST) programs are not seen as a priority to many clinical departments, there is a discernible absence of a standardised, recommended framework for these programs to be built upon. This systematic scoping review (SSR) aims to gather prevailing data on existing CSTs to identify key factors in teaching and assessing communication skills in the postgraduate medical setting. METHODS Independent searches across seven bibliographic databases (PubMed, PsycINFO, EMBASE, ERIC, CINAHL, Scopus and Google Scholar) were carried out. Krishna's Systematic Evidence-Based Approach (SEBA) was used to guide concurrent thematic and content analysis of the data. The themes and categories identified were compared and combined where possible in keeping with this approach and then compared with the tabulated summaries of the included articles. RESULTS Twenty-five thousand eight hundred ninety-four abstracts were identified, and 151 articles were included and analysed. The Split Approach revealed similar categories and themes: curriculum design, teaching methods, curriculum content, assessment methods, integration into curriculum, and facilitators and barriers to CST. Amidst a wide variety of curricula designs, efforts to develop the requisite knowledge, skills and attitudes set out by the ACGME current teaching and assessment methods in CST maybe categorised into didactic and interactive methods and assessed along Kirkpatrick's Four Levels of Learning Evaluation. CONCLUSIONS A major flaw in existing CSTs is a lack of curriculum structure, focus and standardisation. Based upon the findings and current design principles identified in this SSR in SEBA, we forward a stepwise approach to designing CST programs. These involve 1) defining goals and learning objectives, 2) identifying target population and ideal characteristics, 3) determining curriculum structure, 4) ensuring adequate resources and mitigating barriers, 5) determining curriculum content, and 6) assessing learners and adopting quality improvement processes.
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Affiliation(s)
- Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Malia Alexandra Foo
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Shaun Li He Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Marie Bernadette Xin Yi Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Block MD 6, 14 Medical Drive, #05-01, Singapore, 117599, Singapore
| | - Jamie Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Lien Centre of Palliative Care, Duke-NUS Graduate Medical School, 8College Road, Singapore, 169857, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Centre of Biomedical Ethics, National University of Singapore, Block MD 11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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Jeffers JM, Bord S, Hooper JE, Fleishman C, Cayea D, Garibaldi B. End-of-Life Care: A Multimodal and Comprehensive Curriculum for Graduating Medical Students Utilizing Experiential Learning Opportunities. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11149. [PMID: 33928187 PMCID: PMC8076371 DOI: 10.15766/mep_2374-8265.11149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION End-of-life (EOL) care is an essential skill for most physicians and health care providers, yet there continues to be an educational gap in medical education literature for these skills. The Johns Hopkins School of Medicine developed the Transition to Residency, Internship, and Preparation for Life Events (TRIPLE) curriculum with the primary goal of preparing graduating medical students for life after medical school. METHODS The EOL module was one of many within the TRIPLE curriculum and consisted of two half-day sessions that targeted EOL care, death, dying, and communication skills. The first half-day session focused on a standardized patient encounter where learners initiated and completed an EOL care goals conversation around a living will. The second half-day session focused on death and dying. It included didactic sessions on organ donation, autopsy/death certificates, a simulation-based learning session on ending a resuscitation, and a standardized patient encounter where learners disclosed the death of a loved one. End-of-day and end-of-course evaluations were collected via anonymous online surveys. RESULTS In 2019, 120 students and 26 instructors participated in TRIPLE. Students rated the EOL module overall as 4.6 of 5 (SD = 0.6) and rated instructors overall as 4.6 of 5 (SD = 0.6). DISCUSSION By implementing a thorough and diverse curriculum with a variety of modalities and targeted skills, learners may be better prepared to care for patients dealing with EOL care issues. Further, the generalization of these skills may assist learners in a variety of other aspects of patient and family care.
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Affiliation(s)
- Justin M. Jeffers
- Assistant Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine
| | - Sharon Bord
- Assistant Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine; Co-Director, Transition to Residency, Internship, and Preparation for Life Events (TRIPLE)
| | - Jody E. Hooper
- Associate Professor and Director of Autopsy, Department of Pathology and Oncology, Johns Hopkins University School of Medicine
| | - Carol Fleishman
- Senior Simulation Educator, Johns Hopkins Medical Simulation; Standardized Patient Lead, TRIPLE
| | - Danelle Cayea
- Associate Professor, Department of Medicine, Johns Hopkins University School of Medicine
| | - Brian Garibaldi
- Associate Professor, Department of Medicine and Physiology, Pulmonary and Critical Care, Johns Hopkins University School of Medicine; Co-Director, TRIPLE
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Ko JJ, Ballard MS, Shenkier T, Simon J, Roze des Ordons A, Fyles G, Lefresne S, Hawley P, Chen C, McKenzie M, Ghement I, Sanders JJ, Bernacki R, Jones S. Serious Illness Conversation-Evaluation Exercise: A Novel Assessment Tool for Residents Leading Serious Illness Conversations. Palliat Med Rep 2020; 1:280-290. [PMID: 34223487 PMCID: PMC8241377 DOI: 10.1089/pmr.2020.0086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 11/28/2022] Open
Abstract
Background/Objectives: The serious illness conversation (SIC) is an evidence-based framework for conversations with patients about a serious illness diagnosis. The objective of our study was to develop and validate a novel tool, the SIC-evaluation exercise (SIC-Ex), to facilitate assessment of resident-led conversations with oncology patients. Design: We developed the SIC-Ex based on SIC and on the Royal College of Canada Medical Oncology milestones. Seven resident trainees and 10 evaluators were recruited. Each trainee conducted an SIC with a patient, which was videotaped. The evaluators watched the videos and evaluated each trainee by using the novel SIC-Ex and the reference Calgary-Cambridge guide (CCG) at months zero and three. We used Kane's validity framework to assess validity. Results: Intra-class correlation using average SIC-Ex scores showed a moderate level of inter-evaluator agreement (range 0.523–0.822). Most evaluators rated a particular resident similar to the group average, except for one to two evaluator outliers in each domain. Test–retest reliability showed a moderate level of consistency among SIC-Ex scores at months zero and three. Global rating at zero and three months showed fair to good/very good inter-evaluator correlation. Pearson correlation coefficients comparing total SIC-Ex and CCG scores were high for most evaluators. Self-scores by trainees did not correlate well with scores by evaluators. Conclusions: SIC-Ex is the first assessment tool that provides evidence for incorporating the SIG guide framework for evaluation of resident competence. SIC-Ex is conceptually related to, but more specific than, CCG in evaluating serious illness conversation skills.
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Affiliation(s)
- Jenny J Ko
- Department of Medical Oncology, University of British Columbia, BC Cancer-Abbotsford, Abbotsford, British Columbia, Canada
| | - Mark S Ballard
- Department of Internal Medicine, Chilliwack General Hospital, Chilliwack, British Columbia, Canada
| | - Tamara Shenkier
- Department of Medical Oncology, BC Cancer-Vancouver, Vancouver, British Columbia, Canada
| | - Jessica Simon
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | | | - Gillian Fyles
- BC Centre for Palliative Care, Vancouver, British Columbia, Canada
| | - Shilo Lefresne
- Department of Radiation Oncology, BC Cancer-Vancouver, Vancouver, British Columbia, Canada
| | - Philippa Hawley
- Pain and Symptom Management/Palliative Care Program, BC Cancer-Vancouver, Vancouver, British Columbia, Canada
| | - Charlie Chen
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Michael McKenzie
- Department of Radiation Oncology, BC Cancer-Vancouver, Vancouver, British Columbia, Canada
| | | | - Justin J Sanders
- Ariadne Labs, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Rachelle Bernacki
- Ariadne Labs, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Scott Jones
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Paulsen K, Wu DS, Mehta AK. Primary Palliative Care Education for Trainees in U.S. Medical Residencies and Fellowships: A Scoping Review. J Palliat Med 2020; 24:354-375. [PMID: 32640863 DOI: 10.1089/jpm.2020.0293] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: The medical profession increasingly recognizes the growing need to educate nonpalliative physicians in palliative care. Objective: This study aims to provide a scoping review of the primary palliative care (PPC) education currently available to graduate medical trainees in primary and specialty tracks. Design: Studies of PPC interventions in U.S. residency or fellowship programs of all subspecialties published in English and listed on MEDLINE, CINAHL, and EMBASE through January 2020 were included. To meet admission criteria, studies had to describe the content, delivery methods, and evaluation instruments of a PPC educational intervention. Results: Of 233 eligible full texts, 85 studies were included for assessment, of which 66 were novel PPC educational interventions and 19 were standard education. Total number of publications evaluating PPC education increased from 8 (2000-2004) to 36 (2015-2019), across 11 residency and 10 fellowship specialties. Residency specialties representing the majority of publications were emergency medicine, general surgery, internal medicine, and pediatric/medicine-pediatrics. PPC content domains most taught in residencies were communication and symptom management; the primary delivery method was didactics, and the outcome assessed was attitudes. Fellowship specialties representing the majority of publications were pediatric subspecialties, nephrology, and oncology. The PPC content domain most taught in fellowships was communication; the primary delivery method was didactics and the outcome evaluated was attitudes. Conclusions: While PPC education has increased, it remains varied in content, delivery method, and intervention evaluations. Future studies should include more widespread evaluation of behavioral outcomes, longitudinal persistence of use, and clinical impact.
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Affiliation(s)
- Kate Paulsen
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - David S Wu
- Palliative Care Program, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ambereen K Mehta
- Palliative Care Program, Department of Medicine, University of California, Los Angeles Medical Center, Santa Monica, California, USA
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5
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Mortaz Hejri S, Jalili M, Masoomi R, Shirazi M, Nedjat S, Norcini J. The utility of mini-Clinical Evaluation Exercise in undergraduate and postgraduate medical education: A BEME review: BEME Guide No. 59. MEDICAL TEACHER 2020; 42:125-142. [PMID: 31524016 DOI: 10.1080/0142159x.2019.1652732] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: This BEME review aims at exploring, analyzing, and synthesizing the evidence considering the utility of the mini-CEX for assessing undergraduate and postgraduate medical trainees, specifically as it relates to reliability, validity, educational impact, acceptability, and cost.Methods: This registered BEME review applied a systematic search strategy in seven databases to identify studies on validity, reliability, educational impact, acceptability, or cost of the mini-CEX. Data extraction and quality assessment were carried out by two authors. Discrepancies were resolved by a third reviewer. Descriptive synthesis was mainly used to address the review questions. A meta-analysis was performed for Cronbach's alpha.Results: Fifty-eight papers were included. Only two studies evaluated all five utility criteria. Forty-seven (81%) of the included studies met seven or more of the quality criteria. Cronbach's alpha ranged from 0.58 to 0.97 (weighted mean = 0.90). Reported G coefficients, Standard error of measurement, and confidence interval were diverse and varied based on the number of encounters and the nested or crossed design of the study. The calculated number of encounters needed for a desirable G coefficient also varied greatly. Content coverage was reported satisfactory in several studies. Mini-CEX discriminated between various levels of competency. Factor analyses revealed a single dimension. The six competencies showed high levels of correlation with statistical significance with the overall competence. Moderate to high correlations between mini-CEX scores and other clinical exams were reported. The mini-CEX improved students' performance in other examinations. By providing a framework for structured observation and feedback, the mini-CEX exerts a favorable educational impact. Included studies revealed that feedback was provided in most encounters but its quality was questionable. The completion rates were generally above 50%. Feasibility and high satisfaction were reported.Conclusion: The mini-CEX has reasonable validity, reliability, and educational impact. Acceptability and feasibility should be interpreted given the required number of encounters.
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Affiliation(s)
- Sara Mortaz Hejri
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Jalili
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Rasoul Masoomi
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mandana Shirazi
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Department of Clinical Science and Education at SOS Hospital, Karolina Institute, Stockholm, Sweden
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - John Norcini
- Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, PA, USA
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Edmonds KP, Ajayi TA. Do We Know What We Mean? An Examination of the Use of the Phrase “Goals of Care” in the Literature. J Palliat Med 2019; 22:1546-1552. [DOI: 10.1089/jpm.2019.0059] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Kyle P. Edmonds
- Doris A. Howell Palliative Care, UC San Diego Health, San Diego, California
| | - Toluwalase A. Ajayi
- Scripps Research, San Diego, California
- Scripps Health, San Diego, California
- Department of Pediatrics, UC San Diego Health, San Diego, California
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Ajayi TA, Shaw D, Edmonds KP. Feasibility and Effectiveness of a Mnemonic Approach to Teach Residents How to Assess Goals of Care. J Palliat Med 2019; 22:696-701. [PMID: 30702367 DOI: 10.1089/jpm.2018.0509] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Shared decision making is a collaborative process that allows patients, or their surrogates, and clinicians to make health care decisions together. There is an imperative to teach young physicians early in their training the importance of engaging in a shared decision-making process to define overall goals of care (GOC). The PERSON mnemonic proposes a structured format that allows providers to evaluate GOC across the spectrum of serious illnesses, outside of breaking bad news or end-of-life planning. Objectives: This study evaluated the utility of the PERSON mnemonic in training residents to have GOC with their patients, and investigated if these skills translated to the bedside with real patient encounters. Methods: First-year residents were divided into groups to participate in an in-depth education session. A pre-/postbaseline survey was administered immediately after the education intervention and approximately seven months later to assess retention and utility. Results: Thirty first-year residents were eligible for this study; 30 attended the educational sessions and completed the immediate baseline pre-/postsurvey and the seven-month follow-up survey, resulting in 100% retention rate throughout study. Residents found sustained utility in the mnemonic. It was significantly successful in increasing the knowledge and confidence level in exploring GOC. Patient-centered outcomes could not be analyzed due to low response rates and limited granularity of hospital-level data. Conclusion: The PERSON mnemonic is a feasible and useful format for teaching residents how to have a GOC discussion.
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Affiliation(s)
- Toluwalase A Ajayi
- 1 Scripps Translational Science Institute, La Jolla, California.,2 Scripps Health, San Diego, California.,3 Department of Pediatrics, UC San Diego Health, La Jolla, California
| | | | - Kyle P Edmonds
- 4 Doris A. Howell Palliative Teams, UC San Diego Health, La Jolla, California.,5 UC San Diego Health Sciences, Skaggs School of Medicine, Pharmacy and Pharmaceutical Sciences, La Jolla, California
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Rajdev K, Loghmanieh N, Farberov MA, Demissie S, Maniatis T. Are Health-Care Providers Well Prepared in Providing Optimal End-of-Life Care to Critically Ill Patients? A Cross-Sectional Study at a Tertiary Care Hospital in the United States. J Intensive Care Med 2018; 35:1080-1094. [PMID: 30501452 DOI: 10.1177/0885066618811794] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is important for health-care providers to be comfortable in providing end-of-life (EOL) care to critically ill patients and realizing when continuing aggressive measures would be futile. Therefore, there is a need to understand health-care providers' self-perceived skills and barriers to providing optimum EOL care. A total of 660 health-care providers from medicine and surgery departments were asked via e-mail to complete an anonymous survey assessing their self-reported EOL care competencies, of which 238 responses were received. Our study identified several deficiencies in the self-reported EOL care competencies among health-care providers. Around 34% of the participants either disagreed (strongly disagree or disagree) or were neutral when asked whether they feel well prepared for delivering EOL care. Around 30% of the participants did not agree (agree and strongly agree) that they were well prepared to determine when to refer patients to hospice. 51% of the participants, did not agree (agree and strongly agree) that clear and accurate information is delivered by team members to patients/family. The most common barrier to providing EOL care in the intensive care unit was family not accepting the patient's poor prognosis. Nursing staff (registered nurse) had higher knowledge and attitudes mean competency scores than the medical staff. Attending physicians reported stronger knowledge competencies when compared to residents and fellows. More than half of the participants denied having received any previous training in EOL care. 82% of the participants agreed that training should be mandatory in this field. Most of the participants reported that the palliative care team is involved in EOL care when the patient is believed to be terminally ill. Apart from a need for a stronger training in the field of EOL care for health-care providers, the overall policies surrounding EOL and palliative care delivery require further evaluation and improvement to promote better outcomes in caring patients at the EOL.
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Affiliation(s)
- Kartikeya Rajdev
- Department of Medicine, Northwell Health Staten Island University Hospital, Staten Island, NY, USA
| | - Nina Loghmanieh
- Department of Palliative Medicine, Northwell Health Staten Island University Hospital, Staten Island, NY, USA
| | - Maria A Farberov
- Department of Medicine, Northwell Health Staten Island University Hospital, Staten Island, NY, USA
| | - Seleshi Demissie
- Department of Biostatistics, Northwell Health Staten Island University Hospital, Staten Island, NY, USA
| | - Theodore Maniatis
- Department of Pulmonary and Critical Care Medicine, Northwell Health Staten Island University Hospital, Staten Island, NY, USA
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Berns SH, Camargo M, Meier DE, Yuen JK. Goals of Care Ambulatory Resident Education: Training Residents in Advance Care Planning Conversations in the Outpatient Setting. J Palliat Med 2017; 20:1345-1351. [PMID: 28661787 DOI: 10.1089/jpm.2016.0273] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Advance care planning (ACP) discussions often occur in the inpatient setting when patients are too ill to participate in decision making. Although the outpatient setting is the preferred time to begin these discussions, few physicians do so in practice. Many internal medicine (IM) residents report inadequate training as a barrier to having outpatient ACP discussions. OBJECTIVE To assess whether a novel curriculum entitled Goals of Care Ambulatory Resident Education (GOCARE) improved resident physicians' understanding of and preparedness for conducting ACP discussions in the outpatient setting. DESIGN The curriculum was delivered over four weekly three-hour small group sessions to IM residents. Each session included didactics, a demonstration of skills, and a simulated patient communication laboratory that emphasized deliberate practice. SETTING/SUBJECTS IM residents from an urban, academic ambulatory care practice. MEASUREMENTS Impact of the intervention was evaluated using a retrospective pre-post design. Residents completed surveys immediately after the course and six months later. RESULTS Forty-two residents participated in the curriculum and 95% completed the postcourse survey. Residents' self-rated level of preparedness increased for ACP discussions overall (4.0 pre vs. 5.2 post on 7-point Likert scale) and for communication steps involved in ACP (p < 0.001). Fifty-nine percent of participants completed the six-month follow-up survey. Residents' self-rated preparedness to engage in outpatient ACP discussions remained high (4.5 pre vs. 5.5 post at six months p < 0.001). Residents also reported increased use of ACP communication skills (p < 0.001) six months later. CONCLUSIONS The GOCARE curriculum provides an alternative model of communication training that can be integrated into residency training and improve residents' skills in outpatient ACP discussions.
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Affiliation(s)
- Stephen H Berns
- 1 Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,2 Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Marianne Camargo
- 2 Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Diane E Meier
- 1 Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Jacqueline K Yuen
- 1 Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,2 Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
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10
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Bond WF, Gonzalez HC, Funk AM, Fehr LS, McGarvey JS, Svendsen JD, Sawicki R. Deliberate Practice with Standardized Patient Actors and the Development of Formative Feedback for Advance Care Planning Facilitators. J Palliat Med 2017; 20:631-637. [PMID: 28085541 DOI: 10.1089/jpm.2016.0431] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Multimodal curricular assessment after adding standardized patient (SP) actor-based simulation to an advance care planning (ACP) facilitator training course and development of a formative feedback tool. BACKGROUND ACP represents a highly valued service requiring more and better trained facilitators. METHODS Participants were primarily nurses and social workers in a large multisite health system. The course included a precourse video demonstration of ACP, traditional lectures, and four 30-minute simulations with SPs. Knowledge was tested with a multiple choice question (MCQ) test. In addition to standard postcourse/postsimulation evaluations, learners were surveyed pre/post/30-90 days delayed for self-perceived confidence. A linear mixed-effects model was used to analyze changes over time. Trained faculty rated performance in simulations with an observational mini-clinical examination (mini-CEX)-type rating form with a checklist, global competency, and global communication rating. Inter-rater reliability (IRR) was calculated on randomly selected paired ratings. RESULTS Sixty-seven individuals consented to participate. MCQ scores improved from 83% ± 10% to 92% ± 8% (p < 0.001). Paired learner surveys of self-confidence across six domains were available for 65 pre, 65 post, and 40 delayed with a mean positive change on a 0 to 10 point scale from pre-post (2.32 ± 1.65; p < 0.001) and predelayed (2.34 ± 1.96; p < 0.001) time frames. For the faculty observation ratings of simulation performance, the average raw agreement for critical actions was 82% and IRR was 0.71. CONCLUSIONS Learner feedback and self-assessment suggest that actor-based simulation contributed to improved confidence in conducting ACP. The mini-CEX observation form is adequate for formative feedback, with further testing needed to make judgments of competence.
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Affiliation(s)
- William F Bond
- 1 OSF HealthCare , Peoria, Illinois.,2 Jump Simulation , Peoria, Illinois.,3 University of Illinois College of Medicine at Peoria , Peoria, Illinois
| | - Hanna C Gonzalez
- 3 University of Illinois College of Medicine at Peoria , Peoria, Illinois
| | - Amy M Funk
- 4 Illinois Wesleyan University , Bloomington, Illinois
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11
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Min AA, Spear-Ellinwood K, Berman M, Nisson P, Rhodes SM. Social worker assessment of bad news delivery by emergency medicine residents: a novel direct-observation milestone assessment. Intern Emerg Med 2016; 11:843-52. [PMID: 26892405 DOI: 10.1007/s11739-016-1405-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/04/2016] [Indexed: 11/24/2022]
Abstract
The skill of delivering bad news is difficult to teach and evaluate. Residents may practice in simulated settings; however, this may not translate to confidence or competence during real experiences. We investigated the acceptability and feasibility of social workers as evaluators of residents' delivery of bad news during patient encounters, and assessed the attitudes of both groups regarding this process. From August 2013 to June 2014, emergency medicine residents completed self-assessments after delivering bad news. Social workers completed evaluations after observing these conversations. The Assessment tools were designed by modifying the global Breaking Bad News Assessment Scale. Residents and social workers completed post-study surveys. 37 evaluations were received, 20 completed by social workers and 17 resident self-evaluations. Social workers reported discussing plans with residents prior to conversations 90 % of the time (18/20, 95 % CI 64.5, 97.8). Social workers who had previously observed the resident delivering bad news reported that the resident was more skilled on subsequent encounters 90 % of the time (95 % CI 42.2, 99). Both social workers and residents felt that prior training or experience was important. First-year residents valued advice from social workers less than advice from attending physicians, whereas more experienced residents perceived advice from social workers to be equivalent with that of attending physicians (40 versus 2.9 %, p = 0.002). Social worker assessment of residents' abilities to deliver bad news is feasible and acceptable to both groups. This formalized self-assessment and evaluation process highlights the importance of social workers' involvement in delivery of bad news, and the teaching of this skill. This method may also be used as direct-observation for resident milestone assessment.
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Affiliation(s)
- Alice Ann Min
- Department of Emergency Medicine, College of Medicine, The University of Arizona, P.O. Box 245057, Tucson, AZ, 85724-5057, USA.
| | - Karen Spear-Ellinwood
- Department of Obstetrics and Gynecology, College of Medicine, The University of Arizona, Tucson, AZ, USA
- Faculty Instructional Development, Office of Medical Student Education, College of Medicine, The University of Arizona, Tucson, AZ, USA
| | - Melissa Berman
- Department of Clinical Resource Management, University of Arizona Medical Center, Tucson, AZ, USA
| | - Peyton Nisson
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
| | - Suzanne Michelle Rhodes
- Department of Emergency Medicine, College of Medicine, The University of Arizona, P.O. Box 245057, Tucson, AZ, 85724-5057, USA
- Division of Geriatrics, General Medicine, and Palliative Medicine, College of Medicine, The University of Arizona, Tucson, AZ, USA
- Arizona Center on Aging, The University of Arizona, Tucson, AZ, USA
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12
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Sanchez-Reilly SE, Wittenberg-Lyles EM, Villagran MM. Using a Pilot Curriculum in Geriatric Palliative Care to Improve Communication Skills Among Medical Students. Am J Hosp Palliat Care 2016; 24:131-6. [PMID: 17502438 DOI: 10.1177/1049909106297071] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to assess the impact of an elective geriatric palliative care course on medical students' attitudes, knowledge, and behaviors regarding communication with terminally ill patients. Surveys were administered at the beginning and end of the elective. Despite a significant increase in knowledge about geriatric and palliative medicine ( F = 24.80; P < .001), there were no significant changes in students' self-reported behaviors when applying curriculum-based communication strategies. However, the qualitative analysis of open-ended questions showed that the curriculum intervention did result in an improvement in empowering message strategies for breaking bad news. The evaluation of the end-of-life curriculum needs to exceed the measurement of attitudes and knowledge and include behavioral assessment of end-of-life communication skills.
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Affiliation(s)
- Sandra E Sanchez-Reilly
- Division of Geriatrics and Gerontology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA.
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13
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Hendricks-Ferguson VL, Kane JR, Pradhan KR, Shih CS, Gauvain KM, Baker JN, Haase JE. Evaluation of Physician and Nurse Dyad Training Procedures to Deliver a Palliative and End-of-Life Communication Intervention to Parents of Children with a Brain Tumor. J Pediatr Oncol Nurs 2015; 32:337-47. [PMID: 25623029 PMCID: PMC5918283 DOI: 10.1177/1043454214563410] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
When a child's prognosis is poor, physicians and nurses (MDs/RNs) often struggle with initiating discussions about palliative and end-of-life care (PC/EOL) early in the course of illness trajectory. We describe evaluation of training procedures used to prepare MD/RN dyads to deliver an intervention entitled: Communication Plan: Early Through End of Life (COMPLETE) intervention. Our training was delivered to 5 pediatric neuro-oncologists and 8 pediatric nurses by a team of expert consultants (i.e., in medical ethics, communication, and PC/EOL) and parent advisors. Although half of the group received training in a 1-day program and half in a 2-day program, content for all participants included 4 modules: family assessment, goal-directed treatment planning, anticipatory guidance, and staff communication and follow-up. Evaluations included dichotomous ratings and qualitative comments on content, reflection, and skills practice for each module. Positive aspects of our training included parent advisers' insights, emphasis on hope and non-abandonment messages, written materials to facilitate PC/EOL communication, and an MD/RN dyad approach. Lessons learned and challenges related to our training procedures will be described. Overall, the MDs and RNs reported that our PC/EOL communication-training procedures were helpful and useful. Future investigators should carefully plan training procedures for PC/EOL communication interventions.
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Affiliation(s)
| | | | | | - Chie-Schin Shih
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Joan E Haase
- Indiana University School of Nursing, Indianapolis, IN, USA
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14
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Markin A, Cabrera-Fernandez DF, Bajoka RM, Noll SM, Drake SM, Awdish RL, Buick DS, Kokas MS, Chasteen KA, Mendez MP. Impact of a Simulation-Based Communication Workshop on Resident Preparedness for End-of-Life Communication in the Intensive Care Unit. Crit Care Res Pract 2015; 2015:534879. [PMID: 26199755 PMCID: PMC4496471 DOI: 10.1155/2015/534879] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/02/2015] [Accepted: 06/10/2015] [Indexed: 12/30/2022] Open
Abstract
Introduction. Although residents frequently lead end-of-life (EOL) discussions in the intensive care unit (ICU), training in EOL care during residency has been required only recently, and few educational interventions target EOL communication in the ICU. This study evaluated a simulation-based intervention designed to improve resident EOL communication skills with families in the ICU. Methods. Thirty-four second-year internal medicine residents at a large urban teaching hospital participated in small group sessions with faculty trained in the "VitalTalk" method. A Likert-type scale questionnaire measured self-assessed preparedness before, immediately following, and approximately 9 months after intervention. Data were analyzed using Wilcoxon rank-sum analysis. Results. Self-assessed preparedness significantly improved for all categories surveyed (preintervention mean; postintervention mean; p value), including discussing bad news (3.3; 4.2; p < 0.01), conducting a family conference (3.1; 4.1; p < 0.01), discussing treatment options (3.2; 3.9; p < 0.01), discussing discontinuing ICU treatments (2.9; 3.5; p < 0.01), and expressing empathy (3.9; 4.5; p < 0.01). Improvement persisted at follow-up for all items except "expressing empathy." Residents rated the educational quality highly. Conclusion. This study provides evidence that brief simulation-based interventions can produce lasting improvements in residents' confidence to discuss EOL care with family members of patients in the ICU.
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Affiliation(s)
- Abraham Markin
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | | | - Rebecca M. Bajoka
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Samantha M. Noll
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Sean M. Drake
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Rana L. Awdish
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Dana S. Buick
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Maria S. Kokas
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Kristen A. Chasteen
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Michael P. Mendez
- Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
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15
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Gelfman LP, Lindenberger E, Fernandez H, Goldberg GR, Lim BB, Litrivis E, O'Neill L, Smith CB, Kelley AS. The effectiveness of the Geritalk communication skills course: a real-time assessment of skill acquisition and deliberate practice. J Pain Symptom Manage 2014; 48:738-44.e1-6. [PMID: 24681183 PMCID: PMC4177519 DOI: 10.1016/j.jpainsymman.2013.12.231] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 11/22/2013] [Accepted: 12/12/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Communication skills are critical in Geriatrics and Palliative Medicine because these patients confront complex clinical scenarios. We evaluated the effectiveness of the Geritalk communication skills course by comparing pre- and post-course real-time assessment of the participants leading family meetings. We also evaluated the participants' sustained skills practice. MEASURES We compare the participants' skill acquisition before and after Geritalk using a direct observation Family Meeting Communication Assessment Tool and assess their deliberate practice at follow-up. INTERVENTION First-year Geriatrics or Palliative Medicine fellows at Mount Sinai Medical Center and the James J. Peters Bronx VA Medical Center participated in Geritalk. OUTCOMES Pre- and post-course family meeting assessments were compared. An average net gain of 6.8 skills represented a greater than 20% improvement in use of applicable skills. At two month follow-up, most participants reported deliberate practice of fundamental and advanced skills. CONCLUSIONS/LESSONS LEARNED This intensive training and family meeting assessment offers evidence-based communication skills training.
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Affiliation(s)
- Laura P Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Hematology/Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Elizabeth Lindenberger
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Hematology/Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Helen Fernandez
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Hematology/Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gabrielle R Goldberg
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Hematology/Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Betty B Lim
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Hematology/Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Evgenia Litrivis
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Hematology/Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lynn O'Neill
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cardinale B Smith
- Division of Hematology/Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy S Kelley
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Hematology/Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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16
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Kottewar SA, Bearelly D, Bearelly S, Johnson ED, Fleming DA. Residents' End-of-Life Training Experience: A Literature Review of Interventions. J Palliat Med 2014; 17:725-32. [DOI: 10.1089/jpm.2013.0353] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Saket A. Kottewar
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri
| | - Dilip Bearelly
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri
| | - Smith Bearelly
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri
| | - E. Diane Johnson
- Information Services and Resources, J. Otto Lottes Health Sciences Library, University of Missouri School of Medicine, Columbia, Missouri
| | - David A. Fleming
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri
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17
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Unpacking resident-led code status discussions: results from a mixed methods study. J Gen Intern Med 2014; 29:750-7. [PMID: 24526542 PMCID: PMC4000342 DOI: 10.1007/s11606-014-2791-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 12/03/2013] [Accepted: 01/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The quality of code status discussions (CSDs) is suboptimal as physicians often fail to discuss patients' goals of care and resuscitation outcomes. We previously demonstrated that internal medicine residents randomized to a communication skills intervention scored higher than controls on a CSD checklist using a standardized patient. However, the impact of this training on CSD content is unknown. OBJECTIVE Compare CSD content between intervention and control residents. DESIGN We conducted qualitative analysis of simulated CSDs. Augmenting a priori codes with constant comparative analysis, we identified key themes associated with resident determination of code status. We dichotomized each theme as present or absent. We used chi-square tests to evaluate the association between training and presence of each theme. PARTICIPANTS Fifty-six residents rotating on the internal medicine service in July 2010 were randomized to intervention (n = 25) or control (n = 31). INTERVENTION Intervention residents completed CSD skills training (lectures, deliberate practice, and self-study). Six months later, all 56 residents completed a simulated CSD. MAIN MEASURE Comparison of key themes identified in CSDs among intervention and controls. KEY RESULTS Fifty-one transcripts were recorded and reviewed. Themes identified included: exploration of patient values/goals, framing code status as a patient decision, discussion of resuscitation outcomes and quality of life, and making a recommendation regarding code status. Intervention residents were more likely than controls to explore patient values/goals (p = 0.002) and make a recommendation (p < 0.001); and less likely to frame the decision as one solely to be made by the patient (p = 0.01). Less than one-third of residents discussed resuscitation outcomes or quality of life. CONCLUSION Training positively influenced CSD content in key domains, including exploration of patient values/goals, making a recommendation regarding code status, and not framing code status as solely a patient decision. However, despite the intervention, residents infrequently discussed resuscitation outcomes and quality of life.
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Abstract
The announcement about the handicap of a child is communicated to parents by gynecologists or ultrasonographists, in the prenatal period. Often, these professionals are not prepared to communicate this news to the parents, and they have some limitations that lead them to act inappropriately. Therefore, the aims of this research were to identify and to describe the feelings of professionals facing this situation, and to examine their behaviors when they have to inform a couple about the child's anomaly. Ten gynecologists and ultrasonographists were interviewed: five were consultants in Public Health Services and five were private clinicians. Interviews were carried out with a semi-structured script. The results showed that, according to the participants, there is no specific moment, nor a standard behavior, that is most appropriate for making such an announcement. Yet the data show that all the participants feel hurt or frustrated when they must announce this phenomenon, becoming involved with the case. In conclusion, no graduate course has prepared them to deal with this deficiency. Suggestions are made concerning the graduate curriculum in order to improve the preparation of future doctors. A mental health professional is even necessary among the multidisciplinary team formed to deal with the pain produced in the moment of the announcement.
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19
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Kumar SP, D'souza M, Sisodia V. Interpersonal communication skills and palliative care: "finding the story behind the story". Indian J Palliat Care 2014; 20:62-4. [PMID: 24600187 PMCID: PMC3931247 DOI: 10.4103/0973-1075.125571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Senthil P Kumar
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation (Maharishi Markandeshwar University), Mullana-Ambala, Haryana, India
| | - Mariella D'souza
- Department of Psychiatry, Kasturba Medical College, Manipal University, Mangalore, India
| | - Vaishali Sisodia
- Department of Psychiatry, Srinivas College of Physiotherapy and Research Centre, Pandeshwar, Mangalore, India
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Abstract
Pediatric palliative care and pediatric hospice care (PPC-PHC) are often essential aspects of medical care for patients who have life-threatening conditions or need end-of-life care. PPC-PHC aims to relieve suffering, improve quality of life, facilitate informed decision-making, and assist in care coordination between clinicians and across sites of care. Core commitments of PPC-PHC include being patient centered and family engaged; respecting and partnering with patients and families; pursuing care that is high quality, readily accessible, and equitable; providing care across the age spectrum and life span, integrated into the continuum of care; ensuring that all clinicians can provide basic palliative care and consult PPC-PHC specialists in a timely manner; and improving care through research and quality improvement efforts. PPC-PHC guidelines and recommendations include ensuring that all large health care organizations serving children with life-threatening conditions have dedicated interdisciplinary PPC-PHC teams, which should develop collaborative relationships between hospital- and community-based teams; that PPC-PHC be provided as integrated multimodal care and practiced as a cornerstone of patient safety and quality for patients with life-threatening conditions; that PPC-PHC teams should facilitate clear, compassionate, and forthright discussions about medical issues and the goals of care and support families, siblings, and health care staff; that PPC-PHC be part of all pediatric education and training curricula, be an active area of research and quality improvement, and exemplify the highest ethical standards; and that PPC-PHC services be supported by financial and regulatory arrangements to ensure access to high-quality PPC-PHC by all patients with life-threatening and life-shortening diseases.
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21
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Friedrichsen M, Heedman PA, Åstradsson E, Jakobsson M, Milberg A. Does a Half-Day Course about Palliative Care Matter? A Quantitative and Qualitative Evaluation among Health Care Practitioners. J Palliat Med 2013; 16:496-501. [DOI: 10.1089/jpm.2012.0489] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Maria Friedrichsen
- Palliative Education and Research Center in the County of Östergötland, Vrinnevi Hospital, Norrköping, Sweden
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden
| | - Per-Anders Heedman
- Palliative Education and Research Center in the County of Östergötland, Vrinnevi Hospital, Norrköping, Sweden
| | - Eva Åstradsson
- Palliative Education and Research Center in the County of Östergötland, Vrinnevi Hospital, Norrköping, Sweden
| | - Maria Jakobsson
- Palliative Education and Research Center in the County of Östergötland, Vrinnevi Hospital, Norrköping, Sweden
| | - Anna Milberg
- Palliative Education and Research Center in the County of Östergötland, Vrinnevi Hospital, Norrköping, Sweden
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden
- LAH/Unit of Palliative Care, University Hospital in Linköping, Linköping, Sweden
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22
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Yuen JK, Mehta SS, Roberts JE, Cooke JT, Reid MC. A brief educational intervention to teach residents shared decision making in the intensive care unit. J Palliat Med 2013; 16:531-6. [PMID: 23621707 DOI: 10.1089/jpm.2012.0356] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Effective communication is essential for shared decision making with families of critically ill patients in the intensive care unit (ICU), yet there is limited evidence on effective strategies to teach these skills. OBJECTIVE The study's objective was to pilot test an educational intervention to teach internal medicine interns skills in discussing goals of care and treatment decisions with families of critically ill patients using the shared decision making framework. DESIGN The intervention consisted of a PowerPoint online module followed by a four-hour workshop implemented at a retreat for medicine interns training at an urban, academic medical center. MEASUREMENTS Participants (N=33) completed post-intervention questionnaires that included self-assessed skills learned, an open-ended question on the most important learning points from the workshop, and retrospective pre- and post-workshop comfort level with ICU communication skills. Participants rated their satisfaction with the workshop. RESULTS Twenty-nine interns (88%) completed the questionnaires. Important self-assessed communication skills learned reflect key components of shared decision making, which include assessing the family's understanding of the patient's condition (endorsed by 100%) and obtaining an understanding of the patient/family's perspectives, values, and goals (100%). Interns reported significant improvement in their comfort level with ICU communication skills (pre 3.26, post 3.73 on a five-point scale, p=0.004). Overall satisfaction with the intervention was high (mean 4.45 on a five-point scale). CONCLUSIONS The findings suggest that a brief intervention designed to teach residents communication skills in conducting goals of care and treatment discussions in the ICU is feasible and can improve their comfort level with these conversations.
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Affiliation(s)
- Jacqueline K Yuen
- Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA.
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Case AA, Orrange SM, Weissman DE. Palliative medicine physician education in the United States: a historical review. J Palliat Med 2013; 16:230-6. [PMID: 23346870 DOI: 10.1089/jpm.2012.0436] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
In this review we discuss the history of Hospice and Palliative Medicine (HPM) physician education in the United States over the last 20 years, as there has been dramatic growth in our specialty during this time. A Medline literature search was completed and we surveyed leaders in the field of HPM education regarding their experiences in promoting palliative medicine education. Educators were selected based on their peer reviewed publications on key educational initiatives since 1990. A survey tool was designed and emailed to 18 educators across the country and follow-up phone interviews were done to further explore specific questions. The survey and interviews sought information about major palliative care education milestones, instrumental projects, and barriers to further development of palliative medicine education.
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Affiliation(s)
- Amy A Case
- Palliative Medicine, VA Western New York Healthcare System, Buffalo, New York 14215, USA.
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24
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Do DT, Ogrinc G. Assessing Third Year Medical Students' Understanding of Code Status. J Palliat Med 2011; 14:1254-8. [DOI: 10.1089/jpm.2011.0173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Duc T. Do
- Section of Hospital Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Dartmouth Medical School, Lebanon, New Hampshire
| | - Greg Ogrinc
- Dartmouth Medical School, Lebanon, New Hampshire
- Quality Scholars Program, White River Junction VA Medical Center, White River Junction, Vermont
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Geraci SA, Thigpen SC. The fundamental need for relative value metrics in educational innovation. Am J Med 2011; 124:1086-9. [PMID: 22017786 DOI: 10.1016/j.amjmed.2011.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 05/21/2011] [Accepted: 07/18/2011] [Indexed: 11/24/2022]
Affiliation(s)
- Stephen A Geraci
- Department of Internal Medicine, University of Mississippi School of Medicine, Jackson, MS, USA.
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26
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Hospital do-not-resuscitate orders: why they have failed and how to fix them. J Gen Intern Med 2011; 26:791-7. [PMID: 21286839 PMCID: PMC3138592 DOI: 10.1007/s11606-011-1632-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 12/16/2010] [Accepted: 12/27/2010] [Indexed: 12/11/2022]
Abstract
Do-not-resuscitate (DNR) orders have been in use in hospitals nationwide for over 20 years. Nonetheless, as currently implemented, they fail to adequately fulfill their two intended purposes--to support patient autonomy and to prevent non-beneficial interventions. These failures lead to serious consequences. Patients are deprived of the opportunity to make informed decisions regarding resuscitation, and CPR is performed on patients who would have wanted it withheld or are harmed by the procedure. This article highlights the persistent problems with today's use of inpatient DNR orders, i.e., DNR discussions do not occur frequently enough and occur too late in the course of patients' illnesses to allow their participation in resuscitation decisions. Furthermore, many physicians fail to provide adequate information to allow patients or surrogates to make informed decisions and inappropriately extrapolate DNR orders to limit other treatments. Because these failings are primarily due to systemic factors that result in deficient physician behaviors, we propose strategies to target these factors including changing the hospital culture, reforming hospital policies on DNR discussions, mandating provider communication skills training, and using financial incentives. These strategies could help overcome existing barriers to proper DNR discussions and align the use of DNR orders closer to their intended purposes of supporting patient self-determination and avoiding non-beneficial interventions at the end of life.
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Pelgrim EAM, Kramer AWM, Mokkink HGA, van den Elsen L, Grol RPTM, van der Vleuten CPM. In-training assessment using direct observation of single-patient encounters: a literature review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2011; 16:131-42. [PMID: 20559868 PMCID: PMC3074070 DOI: 10.1007/s10459-010-9235-6] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 05/12/2010] [Indexed: 05/17/2023]
Abstract
We reviewed the literature on instruments for work-based assessment in single clinical encounters, such as the mini-clinical evaluation exercise (mini-CEX), and examined differences between these instruments in characteristics and feasibility, reliability, validity and educational effect. A PubMed search of the literature published before 8 January 2009 yielded 39 articles dealing with 18 different assessment instruments. One researcher extracted data on the characteristics of the instruments and two researchers extracted data on feasibility, reliability, validity and educational effect. Instruments are predominantly formative. Feasibility is generally deemed good and assessor training occurs sparsely but is considered crucial for successful implementation. Acceptable reliability can be achieved with 10 encounters. The validity of many instruments is not investigated, but the validity of the mini-CEX and the 'clinical evaluation exercise' is supported by strong and significant correlations with other valid assessment instruments. The evidence from the few studies on educational effects is not very convincing. The reports on clinical assessment instruments for single work-based encounters are generally positive, but supporting evidence is sparse. Feasibility of instruments seems to be good and reliability requires a minimum of 10 encounters, but no clear conclusions emerge on other aspects. Studies on assessor and learner training and studies examining effects beyond 'happiness data' are badly needed.
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Affiliation(s)
- E A M Pelgrim
- Department of Primary Care and Community Care, Radboud University Nijmegen Medical Centre, Postbus 9101, Huispostnummer, 6500 HB, Nijmegen, The Netherlands.
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28
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Hauer KE, Holmboe ES, Kogan JR. Twelve tips for implementing tools for direct observation of medical trainees' clinical skills during patient encounters. MEDICAL TEACHER 2011; 33:27-33. [PMID: 20874011 DOI: 10.3109/0142159x.2010.507710] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Direct observation of medical trainees by their supervisors with actual patients is essential for trainees to develop clinical skills competence. Despite the many available tools for direct observation of trainees by supervisors, it is unclear how educators should identify an appropriate tool for a particular clinical setting and implement the tool to maximize educational benefits for trainees in a manner that is feasible for faculty. AIMS AND METHODS Based on our previous systematic review of the literature, we provide 12 tips for selecting and incorporating a tool for direct observation into a medical training program. We focus specifically on direct observation that occurs in clinical settings with actual patients. RESULTS Educators should focus on the existing tools for direct observation that have evidence of validity. Tool implementation must be a component of an educational program that includes faculty development about rating performance, providing meaningful feedback, and developing action plans collaboratively with learners. CONCLUSIONS Educators can enhance clinical skills education with strategic incorporation of tools for direct observation into medical training programs. Identification of a psychometrically sound instrument and attention to faculty development and the feedback process are critical to the success of a program of direct observation.
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Affiliation(s)
- Karen E Hauer
- Department of Medicine, University of California, San Francisco, CA 94143-0120, USA.
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Williams DM, Fisicaro T, Veloski JJ, Berg D. Development and evaluation of a program to strengthen first year residents' proficiency in leading end-of-life discussions. Am J Hosp Palliat Care 2010; 28:328-34. [PMID: 21156658 DOI: 10.1177/1049909110391646] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Multiple interventions have been developed to teach and improve internal medicine residents' end-of-life communication skills, but have not been easily adaptable to other institutions. The purpose of this study was to develop and evaluate a program to enhance physicians' end-of-life communication with families of dying patients using a format that could be incorporated into an existing curriculum for first-year internal medicine residents. METHODS An end-of-life educational program was developed and evaluated in the context of educating first-year residents at an urban academic medical center during the 2008-2009 academic year. The program consisted of three sessions including an interactive workshop flanked by pre- and post-workshop evaluations in simulated encounter and clinical vignette formats. Simulated encounters were recorded on video and residents' performances were rated by two independent observers using a 23 point checklist. RESULTS Complete data were available for 24 (73%) of 33 residents who participated in the program. The residents' checklist scores increased significantly from a mean of 48.1 at baseline to 73.9 at follow-up. The increase in the scores on the clinical vignettes was also statistically significant, but of lesser magnitude. CONCLUSIONS A short, focused intervention can have significant impact on residents' communication skills in the setting of an end-of-life objective structured clinical examination (OSCE).
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Affiliation(s)
- Donna M Williams
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
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Hawkins RE, Margolis MJ, Durning SJ, Norcini JJ. Constructing a validity argument for the mini-Clinical Evaluation Exercise: a review of the research. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2010; 85:1453-1461. [PMID: 20736673 DOI: 10.1097/acm.0b013e3181eac3e6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE The mini-Clinical Evaluation Exercise (mCEX) is increasingly being used to assess the clinical skills of medical trainees. Existing mCEX research has typically focused on isolated aspects of the instrument's reliability and validity. A more thorough validity analysis is necessary to inform use of the mCEX, particularly in light of increased interest in high-stakes applications of the methodology. METHOD Kane's (2006) validity framework, in which a structured argument is developed to support the intended interpretation(s) of assessment results, was used to evaluate mCEX research published from 1995 to 2009. In this framework, evidence to support the argument is divided into four components (scoring, generalization, extrapolation, and interpretation/decision), each of which relates to different features of the assessment or resulting scores. The strength and limitations of the reviewed research were identified in relation to these components, and the findings were synthesized to highlight overall strengths and weaknesses of existing mCEX research. RESULTS The scoring component yielded the most concerns relating to the validity of mCEX score interpretations. More research is needed to determine whether scoring-related issues, such as leniency error and high interitem correlations, limit the utility of the mCEX for providing feedback to trainees. Evidence within the generalization and extrapolation components is generally supportive of the validity of mCEX score interpretations. CONCLUSIONS Careful evaluation of the circumstances of mCEX assessment will help to improve the quality of the resulting information. Future research should address issues of rater selection, training, and monitoring which can impact rating accuracy.
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Affiliation(s)
- Richard E Hawkins
- American Board of Medical Specialties, Chicago, Illinois 60601, USA.
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31
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Shaw EA, Marshall D, Howard M, Taniguchi A, Winemaker S, Burns S. A Systematic Review of Postgraduate Palliative Care Curricula. J Palliat Med 2010; 13:1091-108. [DOI: 10.1089/jpm.2010.0034] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Elizabeth Ann Shaw
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Denise Marshall
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Palliative Care, McMaster University, Hamilton, Ontario, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alan Taniguchi
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Palliative Care, McMaster University, Hamilton, Ontario, Canada
| | - Samantha Winemaker
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Palliative Care, McMaster University, Hamilton, Ontario, Canada
| | - Sheri Burns
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Parker MG. Nephrology Training in the 21st Century: Toward Outcomes-Based Education. Am J Kidney Dis 2010; 56:132-42. [DOI: 10.1053/j.ajkd.2009.11.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 11/10/2009] [Indexed: 11/11/2022]
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Geller G, Rushton CH, Francomano C, Kolodner K, Bernhardt BA. Genetics professionals' experiences with grief and loss: implications for support and training. Clin Genet 2010; 77:421-9. [DOI: 10.1111/j.1399-0004.2010.01409.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
AbstractObjective:Health care professionals report a lack of skills in the psychosocial and spiritual aspects of caring for dying people and high levels of moral distress, grief, and burnout. To address these concerns, the “Being with Dying: Professional Training Program in Contemplative End-of-Life Care” (BWD) was created. The premise of BWD, which is based on the development of mindfulness and receptive attention through contemplative practice, is that cultivating stability of mind and emotions enables clinicians to respond to others and themselves with compassion. This article describes the impact of BWD on the participants.Methods:Ninety-five BWD participants completed an anonymous online survey; 40 completed a confidential open-ended telephone interview.Results:Four main themes—the power of presence, cultivating balanced compassion, recognizing grief, and the importance of self-care—emerged in the interviews and were supported in the survey data. The interviewees considered BWD's contemplative and reflective practices meaningful, useful, and valuable and reported that BWD provided skills, attitudes, behaviors, and tools to change how they worked with the dying and bereaved.Significance of results:The quality of presence has the potential to transform the care of dying people and the caregivers themselves. Cultivating this quality within themselves and others allows clinicians to explore alternatives to exclusively intellectual, procedural, and task-oriented approaches when caring for dying people. BWD provides a rare opportunity to engage in practices and methods that cultivate the stability of mind and emotions that may facilitate compassionate care of dying patients, families, and caregivers.
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Wittenberg-Lyles EM, Goldsmith J, Ragan SL, Sanchez-Reilly S. Medical Students’ Views and Ideas About Palliative Care Communicatio Training. Am J Hosp Palliat Care 2009; 27:38-49. [DOI: 10.1177/1049909109347327] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study focused on the undergraduate medical student to identify views and ideas held toward palliative care communication training, pedagogical approaches to this training, and its perceived effectiveness and use in the medical field. Two focus groups consisting of fourth-year medical students were conducted, and their responses were analyzed using grounded theory categorization. Results indicated that students: (a) prefer to learn nonverbal communication techniques, (b) believe that natural ability and experience outweigh communication curriculum, (c) view the skill of breaking bad news as largely dependent on knowledge and expertise, and (d) prefer curriculum on palliative care and hospice to consist of information (eg, advance directives) rather than communication skills. Implications for these interpretive themes are discussed as well as future research and practice.
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Affiliation(s)
| | - Joy Goldsmith
- Department of Communication Studies Young Harris College, Young Harris, Georgia
| | - Sandra L. Ragan
- Department of Communication, The University of Oklahoma, Norman, Oklahoma
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Boss RD, Hutton N, Donohue PK, Arnold RM. Neonatologist training to guide family decision making for critically ill infants. ACTA ACUST UNITED AC 2009; 163:783-8. [PMID: 19736330 DOI: 10.1001/archpediatrics.2009.155] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To assess neonatology fellow training in guiding family decision making for high-risk newborns and in several critical communication skills for physicians in these scenarios. DESIGN A Web-based national survey. SETTING Neonatal-perinatal training programs in the United States. PARTICIPANTS Graduating fellows in their final month of fellowship. MAIN OUTCOME MEASURES Fellows' perceived training and preparedness to communicate with families about decision making. RESULTS The response rate was 72%, representing 83% of accredited training programs. Fellows had a great deal of training in the medical management of extremely premature and dying infants. However, they reported much less training to communicate and make collaborative decisions with the families of these infants. More than 40% of fellows reported no communication training in the form of didactic sessions, role play, or simulated patient scenarios and no clinical communication skills training in the form of supervision and feedback of fellow-led family meetings. Fellows felt least trained to discuss palliative care, families' religious and spiritual needs, and managing conflicts of opinion between families and staff or among staff. Fellows perceived communication skills training to be of a higher priority to them than to faculty, and 93% of fellows feel that training in this area should be improved. CONCLUSIONS Graduating neonatology fellows are highly trained in the technical skills necessary to care for critically ill and dying neonates but are inadequately trained in the communication skills that families identify as critically important when facing end-of-life decisions.
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Affiliation(s)
- Renee D Boss
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD 21287, USA.
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Park ER, Chun MBJ, Betancourt JR, Green AR, Weissman JS. Measuring residents' perceived preparedness and skillfulness to deliver cross-cultural care. J Gen Intern Med 2009; 24:1053-6. [PMID: 19557481 PMCID: PMC2726883 DOI: 10.1007/s11606-009-1046-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 03/24/2009] [Accepted: 05/27/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND As patient populations become increasingly diverse, we need to be able to measure residents' preparedness and skillfulness to provide cross-cultural care. OBJECTIVE To develop a measure that assesses residents' perceived readiness and abilities to provide cross-cultural care. DESIGN Survey items were developed based on an extensive literature review, interviews with experts, and seven focus groups and ten individual interviews, as part of a larger national mailed survey effort of graduating residents in seven specialties. Reliability and weighted principal components analyses were performed with items that assessed perceived preparedness and skillfulness to provide cross-cultural care. Construct validity was assessed. PARTICIPANTS A total of 2,047 of 3,435 eligible residents participated (response rate = 60%). MEASUREMENTS AND MAIN RESULTS The final scale consisted of 18 items and 3 components (general cross-cultural preparedness, general cross-cultural skillfulness, and cross-cultural language preparedness and skillfulness), and yielded a Cronbach's alpha = 0.92. Construct validity was supported; the scale total was inversely correlated with a measure of helplessness when providing care to patients of a different culture (p < 0.001). CONCLUSIONS We developed a three-component cross-cultural preparedness and skillfulness scale that was internally consistent and demonstrated construct validity. This measure can be used to evaluate residents' perceived effectiveness of cross-cultural medical training programs and could be used in future work to validate residents' self assessments with objective assessments.
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Affiliation(s)
- Elyse R Park
- Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA.
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Professionalism and communication in the intensive care unit: reliability and validity of a simulated family conference. Simul Healthc 2009; 3:224-38. [PMID: 19088667 DOI: 10.1097/sih.0b013e31817e6149] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE An Objective Structured Clinical Exam was designed to assess physician's ability to discuss end-of-life (EOL) and disclose iatrogenic complications (DOC) with family members of intensive care unit patients. The study explores reliability and validity based on scores from contrasting rater groups (clinicians, SPs, and examinees). METHODS Two 20-minute stations were administered to 17 surgical residents and 2 critical fellows at a university-based training program. The exam was conducted, videotaped, and scored in a standardized setting by 8 clinical raters (MD and RN) and 8 standardized families using separate rating tools (EOL and DOC). Examinees assessed themselves using the same tools. We analyzed the internal consistency, inter-rater agreement, and discriminant validity of both cases using data from each rater group. Cross-rater group comparisons were also made. RESULTS The internal consistency reliability correlations were above 0.90 regardless of case or rater group. Within rater groups, raters were within 1 point of agreement (5-pt and 6-pt scales) on 81% of the DOC and between 74% and 79% of the EOL items. Family raters were more favorable than clinical raters in scoring DOC, but not EOL cases. Large raw differences in performance by training level favored more experienced trainees (3rd year residents and fellows). These differences were statistically significant when based on residents own self-ratings, but not when they were based on clinical or family ratings. DISCUSSION The Family Conference Objective Structured Clinical Exam is a reliable exam with high content validity. It seems unique in the literature for assessing surgical trainees' ability to discuss "bad news" with family members in intensive care.
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Agren Bolmsjo I. Review Article: End-of-Life Care for Old People: A Review of the Literature. Am J Hosp Palliat Care 2008; 25:328-38. [DOI: 10.1177/1049909108315910] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to make an inventory of various aspects of end-of-life care of the old people. An additional aim was to illuminate gaps in existing knowledge. A systematic literature review focusing on intervention studies was carried out. Three concepts were of special interest: end-of-life care, palliative care, and terminal care. The result encompassed 29 studies, and the articles were grouped together under 4 headings: education and support for close relatives, education and support for staff, education and support for patients, and articles dealing with care planning. The result highlights the need for further research regarding end-of-life care in geographical and cultural settings that differ from those in the USA, needs of old people (ie, 80+), preferences concerning end-of-life care, and the effect of adjusted and generalizable palliative care models.
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Affiliation(s)
- Ingrid Agren Bolmsjo
- Faculty of Health and Society, School of Health and Society, Malmo University, Sweden,
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Forbes T, Goeman E, Stark Z, Hynson J, Forrester M. Discussing withdrawing and withholding of life-sustaining medical treatment in a tertiary paediatric hospital: a survey of clinician attitudes and practices. J Paediatr Child Health 2008; 44:392-8. [PMID: 18638330 DOI: 10.1111/j.1440-1754.2008.01351.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To better understand current attitudes and practices relating to discussions concerning the withholding and withdrawing of life-sustaining medical treatment (WWLSMT) among medical staff in the paediatric setting. METHODS An anonymous online survey of paediatricians (senior medical staff - SMS) and paediatric trainees (junior medical staff - JMS) likely to be involved in the care of children with life limiting illness. RESULTS A total of 162 responses were obtained (response rate 42%). SMS indicated feeling more comfortable with their abilities to discuss WWLSMT than JMS. Barriers to discussing WWLSMT were numerous and included clinician concerns about family readiness for the discussion, prognostic uncertainty, family disagreement with the treating team regarding the child's prognosis/diagnosis and concerns about how to manage family requests for treatments that are not perceived to be in the child's best interests. Fifty-eight per cent of JMS and 35.8% of SMS reported receiving no specific communication training regarding WWLSMT. Most learned through experience and by observing more senior colleagues. There was a high level of support for additional training in this area and for the provision of resources such as discussion guidelines and a structured form for documenting the outcomes WWLSMT discussions. CONCLUSION The majority of JMS feel less comfortable with their abilities to facilitate these discussions than their senior colleagues. The results of this study suggest that although confidence correlates with experience, junior and senior clinicians are eager to improve their skills through ongoing professional development and the provision of resources. The education needs of JMS and SMS appear to be different.
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Affiliation(s)
- Tom Forbes
- Royal Children's Hospital, Melbourne, Victoria, Australia
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Runkle C, Wu E, Wang EC, Gordon GH, Frankel R. Clinician Confidence About Conversations at the End of Life Is Strengthened Using the Four Habits Approach. J Psychosoc Oncol 2008; 26:81-95. [DOI: 10.1080/07347330802118040] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Weissman DE, Ambuel B, von Gunten CF, Block S, Warm E, Hallenbeck J, Milch R, Brasel K, Mullan PB. Outcomes from a national multispecialty palliative care curriculum development project. J Palliat Med 2007; 10:408-19. [PMID: 17472513 DOI: 10.1089/jpm.2006.0183] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 1998 we completed a successful regional pilot project in palliative care curriculum development among 32 internal medicine residency programs recruited from the mid-western United States. Between 1999 and 2004 this project was expanded to include 358 U.S. programs, from four specialties, based on new training requirements in internal medicine, family medicine, neurology, and general surgery. OBJECTIVE To assess the 1-year outcomes from residency programs participating in a national multispecialty palliative care curriculum development project. MEASUREMENT Outcome data obtained from residency programs' responses to a structured progress report 12 months after enrolling in the project and from published residency project reports. RESULTS Three hundred fifty-eight residency programs, representing 27% of all eligible training programs in the four specialties, participated in the project. Outcome data was available from 224 residencies (63%). Most programs started new teaching in pain, non-pain symptom management, and communication skills. More than 50% of programs integrated palliative care topics within established institutional grand rounds, morbidity/mortality conferences or morning report. More than 70% of internal medicine and family practice programs began new direct patient care training opportunities utilizing hospital-based palliative care or hospice programs. New faculty development initiatives and use of quality improvement projects to drive curriculum change were reported in less than 50% of programs. CONCLUSIONS Focused short-term instruction in palliative care curriculum development, in a diverse group of residency programs, is feasible and associated with significant curriculum change.
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Chipman JG, Beilman GJ, Schmitz CC, Seatter SC. Development and pilot testing of an OSCE for difficult conversations in surgical intensive care. JOURNAL OF SURGICAL EDUCATION 2007; 64:79-87. [PMID: 17462207 DOI: 10.1016/j.jsurg.2006.11.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Accepted: 11/05/2006] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To describe the development and results of an Objective Structured Clinical Exam (OSCE) for leading family conferences in the surgical intensive care unit (SICU). DESIGN Pilot demonstration and reliability assessment. SETTING General surgery residency program at a major academic teaching hospital. PARTICIPANTS PGY-2 and PGY-4 categorical general surgery residents (n=8). RESULTS The SICU Family Conference OSCE consists of two 20-minute stations, one requiring residents to lead an end-of-life discussion and the other to disclose an iatrogenic complication. Actual case scenarios and trained actors were used; the examinations were videotaped in a standardized setting. Two professional raters as well as the participating actors assessed each resident performance using rating tools developed for each station and based on guiding principles gleaned from the literature. Resident debriefings and evaluation surveys were also conducted. Resident perception of the OSCE overall was positive. Analysis of the videotapes revealed the need for greater standardization of the actors' roles. The rating tools showed strong internal consistency (0.77-0.85), but inter-rater agreement of scores was generally low (<0.70) within rater groups. Family actors consistently gave residents higher global assessment scores than did the professional raters. Second- and fourth-year residents scored equally well on the examination. CONCLUSIONS This pilot provided residents with a positive learning experience and valid formative feedback. Case materials developed for each station served their function well. More work in actor and rater training is needed before the examination scores can be reliably used in summative evaluation.
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Affiliation(s)
- Jeffrey G Chipman
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota 55455-0321, USA
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Solomon MZ, Browning D. Pediatric Palliative Care: Relationships Matter and So Does Pain Control. J Clin Oncol 2005; 23:9055-7. [PMID: 16314610 DOI: 10.1200/jco.2005.04.4677] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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